Hartman Terryl J, Gapstur Susan M, Gaudet Mia M, Shah Roma, Flanders W Dana, Wang Ying, McCullough Marjorie L
Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA; and
Epidemiology Research Program, American Cancer Society, Atlanta, GA.
J Nutr. 2016 Oct;146(10):2045-2050. doi: 10.3945/jn.116.234344. Epub 2016 Sep 14.
Dietary energy density (ED) is a measure of diet quality that estimates the amount of energy per unit of food (kilocalories per gram) consumed. Low-ED diets are generally high in fiber and fruits and vegetables and low in fat. Dietary ED has been positively associated with body mass index (BMI) and other risk factors for postmenopausal breast cancer.
We evaluated the associations of total dietary ED and energy-dense (high-ED) foods with postmenopausal breast cancer incidence.
Analyses included 56,795 postmenopausal women from the Cancer Prevention Study II Nutrition Cohort with no previous history of breast or other cancers and who provided information on diet, lifestyle, and medical history in 1999. Multivariable-adjusted breast cancer incidence rate ratios (RRs and 95% CIs) were estimated for quintiles of total dietary ED and for the consumption of high-ED foods in Cox proportional hazards regression models.
During a median follow-up of 11.7 y, 2509 invasive breast cancer cases were identified, including 1857 estrogen receptor-positive and 277 estrogen receptor-negative tumors. Median dietary ED was 1.5 kcal/g (IQR: 1.3-1.7 kcal/g). After adjusting for age, race, education, reproductive characteristics, and family history, high compared with low dietary ED was associated with a statistically significantly higher risk of breast cancer (RR for fifth quintile compared with first quintile: 1.20; 95% CI: 1.05, 1.36; P-trend = 0.03). The association between the amount of high-ED foods consumed and breast cancer risk was not statistically significant. We observed no differences by estrogen receptor status or effect modification by BMI, age, or physical activity.
These results suggest a modest positive association between total dietary ED and risk of postmenopausal breast cancer.
膳食能量密度（ED）是衡量饮食质量的一个指标，用于估算所摄入食物每单位（每克千卡）的能量含量。低能量密度饮食通常富含纤维、水果和蔬菜，脂肪含量较低。膳食能量密度与体重指数（BMI）及绝经后乳腺癌的其他风险因素呈正相关。
我们评估了总膳食能量密度及高能量密度食物与绝经后乳腺癌发病率之间的关联。
分析纳入了来自癌症预防研究II营养队列的56795名绝经后女性，这些女性既往无乳腺癌或其他癌症病史，并于1999年提供了饮食、生活方式及病史信息。在Cox比例风险回归模型中，针对总膳食能量密度的五分位数及高能量密度食物的摄入量，估算多变量调整后的乳腺癌发病率比值比（RRs及95%CI）。
在中位随访11.7年期间，共确诊2509例浸润性乳腺癌病例，其中包括1857例雌激素受体阳性肿瘤和277例雌激素受体阴性肿瘤。膳食能量密度中位数为1.5千卡/克（四分位间距：1.3 - 1.7千卡/克）。在调整年龄、种族、教育程度、生殖特征及家族史后，与低膳食能量密度相比，高膳食能量密度与乳腺癌风险在统计学上显著升高相关（第五五分位数与第一五分位数相比的RR：1.20；95%CI：1.05，1.36；P趋势 = 0.03）。高能量密度食物的摄入量与乳腺癌风险之间的关联无统计学意义。我们未观察到雌激素受体状态、BMI、年龄或体力活动的效应修饰存在差异。
这些结果表明，总膳食能量密度与绝经后乳腺癌风险之间存在适度的正相关。
