• Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nan'an District, Chongqing, 400010, China. 1414054626@qq.com.
• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nan'an District, Chongqing, 400010, China.
• Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nan'an District, Chongqing, 400010, China. 300897@hospital.cqmu.edu.cn.
• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nan'an District, Chongqing, 400010, China. penglinglong_cqmu@cqmu.edu.cn.

BACKGROUND: There is little prospective evidence exists about whether adherence to a diabetes risk reduction diet (DRRD) is related to a significant reduction in renal cancer risk. We sought to clarify whether adherence to DRRD was associated with a reduced risk of renal cancer in a US population.

METHODS: A population-based cohort of 101,755 American adults was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. A DRRD score was calculated to assess adherence to this dietary pattern, where increased scores indicated greater adherence. The relationship between DRRD score and risk of renal cancer was assessed based on the hazard ratios (HRs) and 95% confidence intervals (CIs), which were both calculated using Cox regression. Non-linear association was determined through restricted cubic spline regression. Potential effect modifiers were identified through subgroup analyses.

RESULTS: Over a mean follow-up of 8.8 years, 446 renal cancers were detected. In this analysis, the fully adjusted model depicted a notable 29% reduction in the risk of renal cancer among individuals in the highest quartile of DRRD score in comparison with the lowest quartile individuals (HR_{Q4 vs. Q1}: 0.71; 95% CI = 0.54, 0.94; P_trend = 0.008). This association remained consistent across a series of sensitivity analyses. A non-linear inverse dose-response association between renal cancer risk with DRRD score was observed (P_nonlinearity = 0.026). Subgroup analyses showed that this favorable link was more prominent in participants with low Healthy Eating Index-2015 (P_interaction = 0.015). Regarding the individual components of DRRD, a decrease in the risk of renal cancer was linked to increased intake of cereal fiber and whole fruit, and lower sugar-sweetened beverage consumption (all P_trend < 0.05).

CONCLUSIONS: Our findings indicate that individuals adhering to DRRD are associated with a reduction in the risk of renal cancer.