乳腺癌幸存者的饮食质量与心脏代谢健康：路径研究
Diet quality and cardiometabolic health in breast cancer survivors: the Pathways Study.
作者信息
Ergas Isaac J, Cheng Richard K, Roh Janise M, Kresovich Jacob K, Iribarren Carlos, Nguyen-Huynh Mai, Rana Jamal S, Rillamas-Sun Eileen, Laurent Cecile A, Lee Valerie S, Quesenberry Charles P, Bhatt Ankeet, Yao Song, Kushi Lawrence H, Greenlee Heather, Kwan Marilyn L
机构信息
Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, CA, 94558, USA.
University of Washington School of Medicine, Seattle, WA, USA.
出版信息
Breast Cancer Res Treat. 2025 May;211(1):139-150. doi: 10.1007/s10549-025-07629-2. Epub 2025 Feb 1.
PURPOSE
Breast cancer (BC) survivors experience higher rates of cardiometabolic conditions, partly due to treatment. While healthy eating decreases the risk of these conditions in the general population, its association in BC survivors is unclear.
METHODS
We included 3415 participants from the Pathways Study, a prospective cohort of women diagnosed with invasive BC between 2005 and 2013 and followed through 2021. Concordance of food intakes from food frequency questionnaires was estimated for five healthy eating patterns at BC diagnosis: Dietary Approaches to Stop Hypertension (DASH), healthy Plant-based Dietary Index (hPDI), 2020 Healthy Eating Index (HEI), American Cancer Society nutrition guidelines (ACS), and the alternate Mediterranean Diet Index (aMED). Incident hypertension, diabetes, and dyslipidemia were identified through electronic health records. Cumulative incidence rates (CIRs) were estimated accounting for the competing risk of death. Covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Fine and Gray regression models, stratified by BC treatment status.
RESULTS
Over an average 11.5 years (range = 0.3-16.3) of follow-up, 554 (16.2%) participants developed hypertension, 362 (10.6%) developed diabetes, and 652 (19.1%) developed dyslipidemia. CIRs for any cardiometabolic condition 15 years after BC diagnosis were 39.2% for women in the highest HEI quartile compared to 49.3% in the lowest. After adjustment, women in the highest HEI quartile had lower risks of any cardiometabolic condition (HR = 0.70, 95% CI 0.54-0.91, P = 0.006), including hypertension (HR = 0.71, 95% CI 0.54-0.94, P = 0.007), diabetes (HR = 0.57, 95% CI 0.41-0.79, P < 0.001), and dyslipidemia (HR = 0.77, 95% CI 0.59-0.99, P = 0.04). Similar associations were observed for DASH, hPDI, and ACS with diabetes incidence.
CONCLUSION
Healthier diets at BC diagnosis, particularly those aligned with the HEI, were associated with lower cardiometabolic risks.
目的
乳腺癌（BC）幸存者患心脏代谢疾病的几率更高，部分原因是治疗。虽然健康饮食可降低普通人群患这些疾病的风险，但其与BC幸存者的关联尚不清楚。
方法
我们纳入了来自路径研究的3415名参与者，这是一个对2005年至2013年间被诊断为浸润性BC的女性进行的前瞻性队列研究，并随访至2021年。通过食物频率问卷评估了BC诊断时五种健康饮食模式的食物摄入量一致性：终止高血压饮食方法（DASH）、健康植物性饮食指数（hPDI）、2020健康饮食指数（HEI）、美国癌症协会营养指南（ACS）和替代地中海饮食指数（aMED）。通过电子健康记录确定新发高血压、糖尿病和血脂异常。估计累积发病率（CIRs）时考虑了死亡的竞争风险。使用Fine和Gray回归模型计算协变量调整后的风险比（HRs）和95%置信区间（CIs），并按BC治疗状态分层。
结果
在平均11.5年（范围=0.3 - 16.3年）的随访中，554名（16.2%）参与者患高血压，362名（10.6%）患糖尿病，652名（19.1%）患血脂异常。BC诊断后15年，HEI四分位数最高的女性患任何心脏代谢疾病的CIRs为39.2%，而最低四分位数的女性为49.3%。调整后，HEI四分位数最高的女性患任何心脏代谢疾病的风险较低（HR = 0.70，95% CI 0.54 - 0.91，P = 0.006），包括高血压（HR = 0.71，95% CI 0.54 - 0.94，P = 0.007）、糖尿病（HR = 0.57，95% CI 0.41 - 0.79，P < 0.001）和血脂异常（HR = 0.77，95% CI 0.59 - 0.99，P = 0.04）。在DASH、hPDI和ACS与糖尿病发病率之间也观察到类似的关联。
结论
BC诊断时更健康的饮食，尤其是与HEI一致的饮食，与较低的心脏代谢风险相关。
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