Shah Sanam, Laouali Nasser, Mahamat-Saleh Yahya, Biessy Carine, Nicolas Geneviève, Rinaldi Sabina, Zamora-Ros Raul, Papadimitriou Nikos, Morales-Berstein Fernanda, Dahm Christina C, Christensen Anne Kristine Lundgård, Mellemkjaer Lene, Nielsen Anne Marie Overgaard, Mancini Francesca Romana, Ren Xuan, Marques Chloé, Katzke Verena, Le Cornet Charlotte, El-Khoury Christine, Schulze Matthias B, Agnoli Claudia, Simeon Vittorio, Tumino Rosario, Milani Lorenzo, Castro-Espin Carlota, Sánchez Maria-Jose, Aizpurua Amaia, Colorado-Yohar Sandra M, Guevara Marcela, Heath Alicia, Aune Dagfinn, Freisling Heinz, Huybrechts Inge, Dossus Laure
Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, (IARC-WHO), 25 Avenue Tony Garnier, Lyon CEDEX 07, 69366, France.
Institute of Biological Sciences (ISSB), UM6P Faculty of Medical Sciences, Mohammed VI Polytechnic University, Ben Guerir, Morocco.
Eur J Epidemiol. 2025 Jul 14. doi: 10.1007/s10654-025-01277-y.
While previous literature suggests that plant-based diets may be associated with a lower risk of breast cancer, evidence remains inconsistent. In this study, we investigated the association between adherence to plant-based diets and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Overall plant-based diet index (PDI), healthful (hPDI), and unhealthful PDI (uPDI) were calculated, and multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of breast cancer for the three indices. Mediation analysis was performed to assess the role of body mass index (BMI) and waist circumference (WC) in the association between hPDI and postmenopausal breast cancer risk. Over a median follow-up of 14.9 years, 10,805 incident invasive breast cancer cases were identified among 258,343 women. In the multivariable model, not adjusted for BMI, higher adherence to hPDI was inversely associated with breast cancer risk, with HR per 1-SD increase [95% (CI)] of 0.97 (0.94, 0.99). The corresponding HRs (95% CI) per 1-SD increase for overall PDI and uPDI were 0.98 (0.96, 1.00) and 1.01 (0.99, 1.03), respectively. The associations between hPDI and postmenopausal breast cancer were partly explained by BMI and WC, which mediated 30% and 52% of this association, respectively. Higher adherence to hPDI was associated with a slightly lower total breast cancer risk. For postmenopausal breast cancer, this association was partly explained by lower BMI or WC. These findings suggest that promoting healthful plant-based diets could support breast cancer risk reduction.
虽然先前的文献表明，以植物为基础的饮食可能与较低的乳腺癌风险相关，但证据仍然不一致。在本研究中，我们在欧洲癌症与营养前瞻性调查（EPIC）研究中调查了坚持以植物为基础的饮食与乳腺癌风险之间的关联。计算了总体植物性饮食指数（PDI）、健康（hPDI）和不健康PDI（uPDI），并使用多变量Cox模型估计这三个指数的乳腺癌风险比（HR）和95%置信区间（CI）。进行中介分析以评估体重指数（BMI）和腰围（WC）在hPDI与绝经后乳腺癌风险之间关联中的作用。在中位随访14.9年期间，在258,343名女性中确定了10,805例浸润性乳腺癌病例。在未根据BMI进行调整的多变量模型中，更高的hPDI依从性与乳腺癌风险呈负相关，每增加1个标准差的HR[95%（CI）]为0.97（0.94，0.99）。总体PDI和uPDI每增加1个标准差的相应HR（95%CI）分别为0.98（0.96，1.00）和1.01（0.99，1.03）。hPDI与绝经后乳腺癌之间的关联部分由BMI和WC解释，它们分别介导了这种关联的30%和52%。更高的hPDI依从性与略低的总体乳腺癌风险相关。对于绝经后乳腺癌，这种关联部分由较低的BMI或WC解释。这些发现表明，推广健康的以植物为基础的饮食可能有助于降低乳腺癌风险。
