Fassier Philippine, Zelek Laurent, Lécuyer Lucie, Bachmann Patrick, Touillaud Marina, Druesne-Pecollo Nathalie, Galan Pilar, Cohen Patrice, Hoarau Hélène, Latino-Martel Paule, Kesse-Guyot Emmanuelle, Baudry Julia, Hercberg Serge, Deschasaux Mélanie, Touvier Mathilde
Sorbonne Paris Cité Epidemiology and Statistics Research Center, Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Bobigny, F-93017, France.
Oncology Department, Avicenne Hospital, Bobigny, F-93017, France.
Int J Cancer. 2017 Aug 1;141(3):457-470. doi: 10.1002/ijc.30704. Epub 2017 May 15.
Postdiagnosis diet and alcohol consumption may be associated with cancer prognosis, recurrence and mortality. Our aim was to investigate food, nutrient and alcohol intake variations between before and after cancer diagnosis and their determinants in a prospective cohort. Subjects (n = 696) were incident cancer cases diagnosed in the NutriNet-Santé cohort between 2009 and 2016. Food, nutrient and alcohol intakes were prospectively collected using repeated nonconsecutive 24-hr dietary records since subjects' inclusion (i.e. an average of 2 y before diagnosis). Mean number of dietary records per subject was 5.9 before and 8.1 after diagnosis. All dietary data before and after diagnosis were compared by mixed models. Factors associated with the main dietary changes observed were also investigated using multivariable logistic regressions. We observed a decrease in intakes of vegetables (mean decrease in intake in patients who decreased their intake=-102.4 ± 79.8 g/d), dairy products (-93.9 ± 82.8 g/d), meat/offal (-35.5 ± 27.8/d), soy products (-85.8 ± 104.1 g/d), sweetened soft drinks (-77.9 ± 95.4 g/d), and alcoholic drinks (-92.9 ± 119.9 g/d), and an increase in broths (42.1 ± 34.9 g/d) and fats/sauces (18.0 ± 13.4 g/d). We observed a decrease in energy intake (-377.2 ± 243.5 kcal/d) and in intakes of alcohol (-7.6 ± 9.4 g/d) proteins (-17.4 ± 12.5 g/d), and several vitamins (p < 0.05) and micronutrients (p < 0.05). Conversely, lipid (19.4 ± 14.6 g/d), SFA (9.3 ± 7.0 g/d), MUFA (8.3 ± 6.3 g/d) and vitamin E (3.9 ± 3.3 mg/d) intakes increased after diagnosis. This large prospective study suggests that cancer diagnosis is a key period for nutritional changes. It highlights some healthy behaviors such as a decrease in alcohol and sweetened drink consumption, but also less favorable trends, such as a decrease in vegetable consumption and in many vitamin and mineral intakes. These results provide insights to identify and target recommendations to put forward for better nutritional care of cancer survivors.
癌症诊断后的饮食和酒精摄入可能与癌症预后、复发及死亡率相关。我们的目的是在一个前瞻性队列中，研究癌症诊断前后食物、营养素及酒精摄入量的变化及其决定因素。研究对象（n = 696）为2009年至2016年在NutriNet-Santé队列中确诊的新发癌症病例。自研究对象入组（即诊断前平均2年）起，通过重复非连续的24小时饮食记录前瞻性收集食物、营养素及酒精摄入量。每位研究对象诊断前饮食记录的平均数量为5.9次，诊断后为8.1次。采用混合模型比较诊断前后的所有饮食数据。还使用多变量逻辑回归研究与观察到的主要饮食变化相关的因素。我们观察到蔬菜摄入量减少（摄入量减少的患者平均减少量=-102.4±79.8克/天）、乳制品（-93.9±82.8克/天）、肉类/内脏（-35.5±27.8/天）、豆制品（-85.8±104.1克/天）、甜味软饮料（-77.9±95.4克/天）及酒精饮料（-92.9±119.9克/天），而肉汤（42.1±34.9克/天）和脂肪/调味汁（18.0±13.4克/天）摄入量增加。我们还观察到能量摄入量减少（-377.2±243.5千卡/天）、酒精摄入量（-7.6±9.4克/天）、蛋白质摄入量（-17.4±12.5克/天）以及多种维生素（p<0.05）和微量营养素（p<0.05）摄入量减少。相反，诊断后脂质（19.4±14.6克/天）、饱和脂肪酸（9.3±7.0克/天）、单不饱和脂肪酸（8.3±6.3克/天）及维生素E摄入量（3.9±3.3毫克/天）增加。这项大型前瞻性研究表明，癌症诊断是营养变化的关键时期。它突出了一些健康行为，如酒精和甜味饮料消费减少，但也存在一些不太有利的趋势，如蔬菜消费减少以及多种维生素和矿物质摄入量减少。这些结果为确定并针对性地提出建议以改善癌症幸存者的营养护理提供了见解。
