Changes in Overall Diet Quality in Relation to Survival in Postmenopausal Women with Breast Cancer: Results from the Women’s Health Initiative - 31/07/18

Doi : 10.1016/j.jand.2018.03.017

Yangbo Sun, MD, PhD, Wei Bao, MD, PhD, Buyun Liu, MD, PhD, Bette J. Caan, DrPH, Dorothy S. Lane, MD, MPH, Amy E. Millen, PhD, Michael S. Simon, MD, MPH, Cynthia A. Thomson, PhD, RD, Lesley F. Tinker, PhD, RD, Linda V. Van Horn, PhD, RD, Mara Z. Vitolins, DrPH, Linda G. Snetselaar, PhD, RDN, LD ^⁎

^∗Address correspondence to: Linda G. Snetselaar, PhD, RDN, LD, Department of Epidemiology, College of Public Health, University of Iowa, 145 N Riverside Dr, Room S425 CPHB, Iowa City, IA 52242.Department of EpidemiologyCollege of Public HealthUniversity of Iowa145 N Riverside Dr, Room S425 CPHBIowa CityIA52242

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 31 July 2018

Abstract

Background

Lifestyle factors are important for cancer survival. However, empirical evidence regarding the effects of dietary changes on mortality in breast cancer survivors is sparse.

Objective

The objective was to examine the associations of changes in overall diet quality, indicated by the Healthy Eating Index (HEI)-2010 score, with mortality in breast cancer survivors.

Design

This was a prospective cohort study from September 1993 through September 30, 2015.

Participants/setting

This study included 2,295 postmenopausal women who were diagnosed with invasive breast cancer and completed a food frequency questionnaire both before and after the diagnosis of breast cancer in the Women’s Health Initiative.

Main outcome measures

The HEI-2010 score (maximum score of 100) was calculated based on consumption of 12 dietary components. The outcomes were mortality from all causes, breast cancer, and causes other than breast cancer.

Statistical analyses performed

Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios of mortality from all causes, breast cancer, and other causes.

Results

Over 12 years of follow-up, 763 deaths occurred. Compared with women with relatively stable diet quality (±14.9% change in HEI-2010 score), women who decreased diet quality (≥15% decrease in HEI-2010 score) had a higher risk of death from breast cancer (adjusted hazard ratio 1.66, 95% CI 1.09 to 2.52). Increased diet quality (≥15% increase in HEI-2010 score) was not significantly associated with lower risk of death. These associations persisted after additional adjustment for change in body mass index.

Conclusions

Among women with breast cancer, decreased diet quality after breast cancer diagnosis was associated with higher risk of death from breast cancer.

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Keywords : Diet quality change, Before and after diagnosis, Breast cancer survival, Women, Prospective cohort study

Plan

Materials and Methods

Study Population

Dietary Assessment

Other Covariate Assessments

Ascertainment of Breast Cancer Outcomes

Ascertainment of Death

	Supplementary materials: Table 4, Table 5, Table 6, Table 7, Table 8, and Table 9 are available at www.jandonline.org
	STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
	FUNDING/SUPPORT The WHI programs is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services, through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.