"Exposome and Heredity" Team, Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, Villejuif, France.
International Agency for Research on Cancer (IARC/WHO), Lyon, France.
Am J Clin Nutr. 2023 Mar;117(3):467-476. doi: 10.1016/j.ajcnut.2022.11.019.
Epidemiological studies assessing the influence of vegetarian diets on breast cancer (BC) risk have produced inconsistent results. Few studies have assessed how the incremental decrease in animal foods and the quality of plant foods are linked with BC.
Disentangle the influence of plant-based diet quality on BC risk between postmenopausal females.
Total of 65,574 participants from the E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale) cohort were followed from 1993-2014. Incident BC cases were confirmed through pathological reports and classified into subtypes. Cumulative average scores for healthful (hPDI) and unhealthful (uPDI) plant-based diet indices were developed using self-reported dietary intakes at baseline (1993) and follow-up (2005) and divided into quintiles. Cox proportional hazards models were used to estimate adjusted HR and 95% CI.
During a mean follow-up of 21 y, 3968 incident postmenopausal BC cases were identified. There was a nonlinear association between adherence to hPDI and BC risk (P < 0.01). Compared to participants with low adherence to hPDI, those with high adherence had a lower BC risk [HR (95% CI): 0.79 (0.71, 0.87) and HR (95% CI): 0.78 (0.70, 0.86)]. In contrast, higher adherence to unhealthful was associated with a linear increase in BC risk [P = 0.18; HR (95% CI): 1.20 (1.08, 1.33); P < 0.01]. Associations were similar according to BC subtypes (P > 0.05 for all).
Long-term adherence to healthful plant foods with some intake of unhealthy plant and animal foods may reduce BC risk with an optimal risk reduction in the moderate intake range. Adherence to an unhealthful plant-based diet may increase BC risk. These results emphasize the importance of the quality of plant foods for cancer prevention. This trial was registered at clinicaltrials.gov (NCT03285230).
评估素食饮食对乳腺癌（BC）风险影响的流行病学研究结果并不一致。很少有研究评估动物食品摄入量的逐渐减少和植物食品质量与 BC 之间的关系。
阐明植物性饮食质量对绝经后女性 BC 风险的影响。
共纳入 E3N（法国女性教育互助会队列研究）队列中的 65574 名参与者，随访时间为 1993 年至 2014 年。通过病理报告确认新发病例 BC，并对其进行亚型分类。使用基线（1993 年）和随访（2005 年）时的自我报告饮食摄入量，计算健康植物性饮食指数（hPDI）和不健康植物性饮食指数（uPDI）的累积平均得分，并将其分为五分位数。采用 Cox 比例风险模型估计调整后的 HR 和 95%CI。
在平均 21 年的随访期间，共确诊 3968 例绝经后 BC 病例。hPDI 依从性与 BC 风险之间呈非线性关联（P<0.01）。与低 hPDI 依从性的参与者相比，高 hPDI 依从性者 BC 风险较低[HR（95%CI）：0.79（0.71，0.87）和 HR（95%CI）：0.78（0.70，0.86）]。相反，较高的不健康饮食依从性与 BC 风险的线性增加相关[P=0.18；HR（95%CI）：1.20（1.08，1.33）；P<0.01]。根据 BC 亚型，相关性相似（所有 P 值均>0.05）。
长期坚持健康植物性食物，同时摄入一些不健康的植物性和动物性食物，可能会降低 BC 风险，在适度摄入范围内可获得最佳风险降低效果。坚持不健康的植物性饮食可能会增加 BC 风险。这些结果强调了植物性食物质量在癌症预防中的重要性。该试验在 clinicaltrials.gov 注册（NCT03285230）。
