Pierce John P, Natarajan Loki, Caan Bette J, Parker Barbara A, Greenberg E Robert, Flatt Shirley W, Rock Cheryl L, Kealey Sheila, Al-Delaimy Wael K, Bardwell Wayne A, Carlson Robert W, Emond Jennifer A, Faerber Susan, Gold Ellen B, Hajek Richard A, Hollenbach Kathryn, Jones Lovell A, Karanja Njeri, Madlensky Lisa, Marshall James, Newman Vicky A, Ritenbaugh Cheryl, Thomson Cynthia A, Wasserman Linda, Stefanick Marcia L
Moores UCSD Cancer Center, University of California, San Diego, La Jolla , CA 92093-0901, USA.
JAMA. 2007 Jul 18;298(3):289-98. doi: 10.1001/jama.298.3.289.
Evidence is lacking that a dietary pattern high in vegetables, fruit, and fiber and low in total fat can influence breast cancer recurrence or survival.
To assess whether a major increase in vegetable, fruit, and fiber intake and a decrease in dietary fat intake reduces the risk of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer.
DESIGN, SETTING, AND PARTICIPANTS: Multi-institutional randomized controlled trial of dietary change in 3088 women previously treated for early stage breast cancer who were 18 to 70 years old at diagnosis. Women were enrolled between 1995 and 2000 and followed up through June 1, 2006.
The intervention group (n = 1537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat. The comparison group (n = 1551) was provided with print materials describing the "5-A-Day" dietary guidelines.
Invasive breast cancer event (recurrence or new primary) or death from any cause.
From comparable dietary patterns at baseline, a conservative imputation analysis showed that the intervention group achieved and maintained the following statistically significant differences vs the comparison group through 4 years: servings of vegetables, +65%; fruit, +25%; fiber, +30%, and energy intake from fat, -13%. Plasma carotenoid concentrations validated changes in fruit and vegetable intake. Throughout the study, women in both groups received similar clinical care. Over the mean 7.3-year follow-up, 256 women in the intervention group (16.7%) vs 262 in the comparison group (16.9%) experienced an invasive breast cancer event (adjusted hazard ratio, 0.96; 95% confidence interval, 0.80-1.14; P = .63), and 155 intervention group women (10.1%) vs 160 comparison group women (10.3%) died (adjusted hazard ratio, 0.91; 95% confidence interval, 0.72-1.15; P = .43). No significant interactions were observed between diet group and baseline demographics, characteristics of the original tumor, baseline dietary pattern, or breast cancer treatment.
Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period.
clinicaltrials.gov Identifier: NCT00003787.
缺乏证据表明高蔬菜、水果和纤维且低总脂肪的饮食模式会影响乳腺癌复发或生存。
评估大幅增加蔬菜、水果和纤维摄入量以及减少膳食脂肪摄入量是否能降低既往接受过治疗的早期乳腺癌女性复发和新发原发性乳腺癌的风险以及全因死亡率。
设计、地点和参与者：对3088名既往接受过早期乳腺癌治疗、诊断时年龄在18至70岁之间的女性进行多机构饮食变化随机对照试验。这些女性于1995年至2000年入组，并随访至2006年6月1日。
干预组（n = 1537）被随机分配接受电话咨询项目，辅以烹饪课程和时事通讯，该项目促进每日目标为5份蔬菜加16盎司蔬菜汁；3份水果；30克纤维；以及15%至20%的能量摄入来自脂肪。对照组（n = 1551）被提供描述“每日五蔬果”饮食指南的印刷材料。
浸润性乳腺癌事件（复发或新发原发性）或任何原因导致的死亡。
从基线时可比的饮食模式来看，一项保守的归因分析表明，干预组在4年期间与对照组相比实现并维持了以下具有统计学意义的差异：蔬菜份数增加65%；水果份数增加25%；纤维增加30%，以及来自脂肪的能量摄入减少13%。血浆类胡萝卜素浓度验证了水果和蔬菜摄入量的变化。在整个研究过程中，两组女性接受了相似的临床护理。在平均7.3年的随访期内，干预组256名女性（16.7%）与对照组262名女性（16.9%）发生浸润性乳腺癌事件（调整后的风险比为0.96；95%置信区间为0.80 - 1.14；P = 0.63），干预组155名女性（10.1%）与对照组160名女性（10.3%）死亡（调整后的风险比为0.91；95%置信区间为0.72 - 1.15；P = 0.43）。在饮食组与基线人口统计学、原发肿瘤特征、基线饮食模式或乳腺癌治疗之间未观察到显著的相互作用。
在早期乳腺癌幸存者中，采用高蔬菜、水果和纤维且低脂肪的饮食在7.3年的随访期内并未降低额外的乳腺癌事件或死亡率。
clinicaltrials.gov标识符：NCT00003787。
