Mariosa Daniela, Ponzano Marta, Grotta Alessandra, Lagerros Ylva Trolle, Hantikainen Essi, Adami Hans-Olov, Serafini Mauro, Bellocco Rino, Ye Weimin
International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France.
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
BMC Cancer. 2025 Aug 13;25(1):1310. doi: 10.1186/s12885-025-14658-z.
Total dietary antioxidant capacity has been associated with a lower risk of breast cancer, but the supporting evidence is limited. We investigated the association between dietary Non-Enzymatic Antioxidant Capacity (NEAC), measuring the total antioxidant potential of the diet, and the risk of breast cancer.
We followed 24,950 women recruited into the Swedish National March Cohort through record linkages to Swedish health registries from 1997 until 2016. Total NEAC was computed based on the baseline 96-item food frequency questionnaire. Three measures of dietary NEAC were assessed: total NEAC, NEAC from fruits and vegetables and NEAC from grains. We fitted multivariable Cox proportional hazards regression models to compute hazard ratios (HRs) and 95% confidence intervals (CIs) to quantify the association between dietary NEAC and risk of overall, as well as pre- and post-menopausal breast cancer.
During a median follow-up of 19.2 years, 1142/24,950 women were diagnosed with breast cancer (136/10,826 pre- and 975/21,152 post-menopausal). Findings indicated a trend in the association between total NEAC and the hazard of overall breast cancer (highest vs. lowest quartile: adjusted HR = 0.85, 95% CI 0.69-1.04; p-value for Wald test = 0.138, p-value for trend = 0.048). The association was more evident for post-menopausal breast cancer (HR = 0.76, 95% CI 0.60-0.96; p-value for trend = 0.010). However, when missing data were imputed, the magnitude of the association was found to be weaker in terms of hazard reduction and no statistically significant associations were observed but the direction of the associations remained consistent (overall: HR = 0.89 (0.74-1.08), p-value for trend = 0.091; post-menopausal: HR = 0.84 (0.69-1.03), p-value for trend = 0.057). When distinguishing NEAC based on food sources, breast cancer hazard was inversely associated with NEAC from fruits and vegetables (HR = 0.79, 95% CI 0.64-0.97; p-value for trend = 0.019), but not with NEAC from grains (HR = 1.05, 95% CI 0.86-1.29; p-value for trend = 0.630).
These results suggest an inverse association between dietary total antioxidant capacity and the risk of breast cancer, particularly in post-menopausal women, which seems to be driven by the consumption of fruits and vegetables. However, sensitivity analysis on imputed covariates did not fully confirm our findings, indicating the need for future confirmatory research.
膳食总抗氧化能力与较低的乳腺癌风险相关，但支持证据有限。我们调查了膳食非酶抗氧化能力（NEAC）（衡量饮食的总抗氧化潜力）与乳腺癌风险之间的关联。
我们通过与瑞典健康登记处的记录链接，对1997年至2016年招募到瑞典国家三月队列中的24950名女性进行了随访。基于基线96项食物频率问卷计算总NEAC。评估了膳食NEAC的三个指标：总NEAC、水果和蔬菜中的NEAC以及谷物中的NEAC。我们拟合了多变量Cox比例风险回归模型，以计算风险比（HR）和95%置信区间（CI），以量化膳食NEAC与总体以及绝经前和绝经后乳腺癌风险之间的关联。
在中位随访19.2年期间，24950名女性中有1142人被诊断患有乳腺癌（绝经前136/10826人，绝经后975/21152人）。结果表明，总NEAC与总体乳腺癌风险之间存在关联趋势（最高四分位数与最低四分位数相比：调整后HR = 0.85，95%CI 0.69 - 1.04；Wald检验p值 = 0.138，趋势p值 = 0.048）。这种关联在绝经后乳腺癌中更为明显（HR = 0.76，95%CI 0.60 - 0.96；趋势p值 = 0.010）。然而，当对缺失数据进行插补时，发现关联强度在降低风险方面较弱，未观察到统计学上显著的关联，但关联方向保持一致（总体：HR = 0.89（0.74 - 1.08），趋势p值 = 0.091；绝经后：HR = 0.84（0.69 - 1.03），趋势p值 = 0.057）。当根据食物来源区分NEAC时，乳腺癌风险与水果和蔬菜中的NEAC呈负相关（HR = 0.79，95%CI 0.64 - 0.97；趋势p值 = 0.019），但与谷物中的NEAC无关（HR = 1.05，95%CI 0.86 - 1.29；趋势p值 = 0.630）。
这些结果表明膳食总抗氧化能力与乳腺癌风险之间存在负相关，特别是在绝经后女性中，这似乎是由水果和蔬菜的消费驱动的。然而，对插补协变量的敏感性分析并未完全证实我们的发现，表明需要未来进行验证性研究。
