Charles Perkins Centre, The University of Sydney, Sydney, Australia.
Sydney Medical School, The University of Sydney, Sydney, Australia.
Eur J Nutr. 2024 Aug;63(5):1771-1781. doi: 10.1007/s00394-024-03379-x. Epub 2024 Apr 18.
PURPOSE: Recent evidence suggests that plant-based diets may reduce the risk of breast cancer (BC). However, the macronutrient composition of plant-based diets and its potential impact on BC risk has not been well explored. This analysis investigated the association of macronutrient composition with BC risk across a spectrum of plant-based diet indexes using a multidimensional approach. DESIGN: This study followed 64,655 participants from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) cohort from 1993 to 2014. Diets were evaluated using validated 208-item diet history questionnaires at baseline (1993) and follow-up (2005), to calculate adherence to the overall plant-based diet (PDI), healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). The association of macronutrient composition with BC risk was assessed via generalized additive time-dependent Cox models across different levels of these indexes. Response surfaces were generated to visualize compositional associations at the 25th, 50th, and 75th percentile of each index (low, moderate, and high). RESULTS: A total of 3,932 incident BC cases were identified during the 21-year follow-up. There was a significant association between macronutrient composition and BC risk for hPDI, uPDI, and PDI (all P < 0.001). Akaike information criterion favored the hPDI model for characterizing the association between macronutrients and BC. BC risk was highest for individuals with a lower hPDI score who also consumed a diet containing lower protein (10%), lower carbohydrate (35%), and higher fat (55%). The lowest risk of BC was observed in those with higher hPDI scores with the lowest intake of protein (10%). At higher PDI and uPDI, diets containing higher protein (30%) and fat (45%) had the highest BC risk. CONCLUSION: These results demonstrate a complex relationship between macronutrient composition, plant-based diet quality, and BC risk. Further research is needed to examine specific foods that may be driving these associations. REGISTRY: The protocol is registered at clinicaltrials.gov as NCT03285230.
目的：最近的证据表明，植物性饮食可能降低乳腺癌（BC）的风险。然而，植物性饮食的宏量营养素组成及其对 BC 风险的潜在影响尚未得到充分探索。本分析采用多维方法，通过一系列植物性饮食指数，研究了宏量营养素组成与 BC 风险之间的关联。
设计：本研究随访了 1993 年至 2014 年期间参加“法国教育女性群体的流行病学研究（E3N）”队列的 64655 名参与者。在基线（1993 年）和随访（2005 年）时使用经过验证的 208 项饮食历史问卷评估饮食，以计算对整体植物性饮食（PDI）、健康植物性饮食（hPDI）和不健康植物性饮食（uPDI）的依从性。通过广义加性时间依赖性 Cox 模型，在不同水平的这些指数下评估宏量营养素组成与 BC 风险的关联。为了可视化每个指数（低、中、高）的 25%、50%和 75%分位数处的组成关联，生成了响应面。
结果：在 21 年的随访期间，共发现 3932 例新的 BC 病例。hPDI、uPDI 和 PDI 均与宏量营养素组成和 BC 风险显著相关（均 P < 0.001）。赤池信息量准则支持 hPDI 模型来描述宏量营养素与 BC 之间的关联。hPDI 评分较低且饮食中蛋白质（10%）、碳水化合物（35%）较低而脂肪（55%）较高的个体，BC 风险最高。在 hPDI 评分较高且蛋白质摄入量最低（10%）的个体中，BC 风险最低。在更高的 PDI 和 uPDI 下，蛋白质（30%）和脂肪（45%）含量较高的饮食与最高的 BC 风险相关。
结论：这些结果表明，宏量营养素组成、植物性饮食质量与 BC 风险之间存在复杂关系。需要进一步研究来检查可能驱动这些关联的特定食物。
注册号：该方案在 clinicaltrials.gov 注册为 NCT03285230。
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