Castelló A, Pollán M, Buijsse B, Ruiz A, Casas A M, Baena-Cañada J M, Lope V, Antolín S, Ramos M, Muñoz M, Lluch A, de Juan-Ferré A, Jara C, Jimeno M A, Rosado P, Díaz E, Guillem V, Carrasco E, Pérez-Gómez B, Vioque J, Boeing H, Martín M
1] Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [2] Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [3] Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
1] Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [2] Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029 Madrid, Spain.
Br J Cancer. 2014 Sep 23;111(7):1454-62. doi: 10.1038/bjc.2014.434. Epub 2014 Aug 7.
Although there are solid findings regarding the detrimental effect of alcohol consumption, the existing evidence on the effect of other dietary factors on breast cancer (BC) risk is inconclusive. This study aimed to evaluate the association between dietary patterns and risk of BC in Spanish women, stratifying by menopausal status and tumour subtype, and to compare the results with those of Alternate Healthy Index (AHEI) and Alternate Mediterranean Diet Score (aMED).
We recruited 1017 incident BC cases and 1017 matched healthy controls of similar age (±5 years) without a history of BC. The association between 'a priori' and 'a posteriori' developed dietary patterns and BC in general and according to menopausal status and intrinsic tumour subtypes (ER+/PR+ and HER2-; HER2+; and ER-/PR- and HER2-) was evaluated using logistic and multinomial regression models.
Adherence to the Western dietary pattern was related to higher risk of BC (OR for the top vs the bottom quartile 1.46 (95% CI 1.06-2.01)), especially in premenopausal women (OR=1.75; 95% CI 1.14-2.67). In contrast, the Mediterranean pattern was related to a lower risk (OR for the top quartile vs the bottom quartile 0.56 (95% CI 0.40-0.79)). Although the deleterious effect of the Western pattern was similarly observed in all tumour subtypes, the protective effect of our Mediterranean pattern was stronger for triple-negative tumours (OR=0.32; 95% CI 0.15-0.66 and Pheterogeneity=0.04). No association was found between adherence to the Prudent pattern and BC risk. The associations between 'a priori' indices and BC risk were less marked (OR for the top vs the bottom quartile of AHEI=0.69; 95% CI 0.51-0.94 and aMED=0.74; 95% CI 0.46-1.18)).
Our results confirm the harmful effect of a Western diet on BC risk, and add new evidence on the benefits of a diet rich in fruits, vegetables, legumes, oily fish and vegetable oils for preventing all BC subtypes, and particularly triple-negative tumours.
尽管关于饮酒的有害影响已有确凿的研究结果，但关于其他饮食因素对乳腺癌（BC）风险影响的现有证据尚无定论。本研究旨在评估西班牙女性的饮食模式与BC风险之间的关联，并按绝经状态和肿瘤亚型进行分层，同时将结果与替代健康指数（AHEI）和替代地中海饮食评分（aMED）的结果进行比较。
我们招募了1017例新发BC病例和1017名年龄相仿（±5岁）且无BC病史的匹配健康对照。使用逻辑回归和多项回归模型评估“先验”和“后验”制定的饮食模式与总体BC以及根据绝经状态和内在肿瘤亚型（雌激素受体阳性/孕激素受体阳性且人表皮生长因子受体2阴性；人表皮生长因子受体2阳性；以及雌激素受体阴性/孕激素受体阴性且人表皮生长因子受体2阴性）之间的关联。
坚持西方饮食模式与BC风险较高相关（最高四分位数与最低四分位数相比的比值比为1.46（95%置信区间1.06 - 2.01）），尤其是在绝经前女性中（比值比 = 1.75；95%置信区间1.14 - 2.67）。相比之下，地中海饮食模式与较低风险相关（最高四分位数与最低四分位数相比的比值比为0.56（95%置信区间0.40 - 0.79））。尽管在所有肿瘤亚型中均同样观察到西方饮食模式的有害影响，但我们的地中海饮食模式对三阴性肿瘤的保护作用更强（比值比 = 0.32；95%置信区间0.15 - 0.66，异质性P = 0.04）。未发现坚持谨慎饮食模式与BC风险之间存在关联。“先验”指数与BC风险之间的关联不太明显（AHEI最高四分位数与最低四分位数相比的比值比 = 0.69；95%置信区间0.51 - 0.94，aMED的比值比 = 0.74；95%置信区间0.46 - 1.18）。
我们的结果证实了西方饮食对BC风险的有害影响，并为富含水果、蔬菜、豆类、油性鱼类和植物油的饮食对预防所有BC亚型，尤其是三阴性肿瘤的益处提供了新的证据。
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