Association of Mediterranean diet with survival after breast cancer diagnosis in women from nine European countries: results from the EPIC cohort study

BMC Medicine

Research Article

Chiara Di Girolamo¹  Marcela Guevara²  Pilar Amiano³  Stina Bodén⁴  Kristin Benjaminsen Borch⁵  Karina Standahl Olsen⁵  Guri Skeie⁵  Alicia K. Heath⁶  Kostas K. Tsilidis⁷  Dagfinn Aune⁸  María-Dolores Chirlaque⁹  Franziska Jannasch^1,10  Matthias B. Schulze^1,11  Malin Sund^1,12  Salvatore Panico^1,13  Sabina Sieri^1,14  Maria-Jose Sánchez^1,15  Charlotte Le Cornet^1,16  Verena Katzke^1,16  Giovanna Masala^1,17  Esther M. Gonzalez-Gil^1,18  Elisabete Weiderpass^1,18  Laure Dossus^1,18  Marc J. Gunter^1,19  Inmaculada Aguilera-Buenosvinos^2,20  Lene Mellemkjær^2,21  Anne Tjønneland^2,22  Núria Nadal-Zaragoza^2,23  Carlota Castro-Espin^2,23  Catalina Bonet^2,23  Antonio Agudo^2,23  Marta Crous-Bou^2,24  Mariem Hajji-Louati^2,25  Thérèse Truong^2,25 

[1] Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano (TO), Italy;Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain;Instituto de Salud Pública y Laboral de Navarra, 31003, Pamplona, Spain;Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain;Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain;Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain;Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastian, Spain;Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden;Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK;Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK;Department of Nutrition, Oslo New University College, Oslo, Norway;Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway;Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain;CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain;Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany;Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany;Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany;Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden;Department of Surgery, University of Helsinki & Helsinki University Hospital, Helsinki, Finland;Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy;Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Via Venezian, 1. 20133, Milan, Italy;Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain;Instituto de Investigación Biosanitaria ibs.GRANADA, 18012, Granada, Spain;Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain;Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain;German Cancer Research Center (DKFZ), Heidelberg, Germany;Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy;International Agency for Research on Cancer, World Health Organization, Lyon, France;International Agency for Research on Cancer, World Health Organization, Lyon, France;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK;Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain;International Agency for Research on Cancer, World Health Organization, Lyon, France;Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain;The Danish Cancer Society Research Center, Copenhagen, Denmark;The Danish Cancer Society Research Center, Copenhagen, Denmark;Department of Public Health, The University of Copenhagen, Copenhagen, Denmark;Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L’Hospitalet de Llobregat, Barcelona, Spain;Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain;Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L’Hospitalet de Llobregat, Barcelona, Spain;Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Epidemiology, Harvard T.H. Chan School of Public Health, 02115, Boston, MA, USA;Université Paris-Saclay, UVSQ, Inserm “Exposome, Heredity, Cancer and Health” Team, CESP U1018, Gustave Roussy, Villejuif, France;

关键词: Mediterranean diet;    Breast cancer;    Cancer survivors;    Dietary patterns;    Prospective studies;   

DOI  :  10.1186/s12916-023-02934-3

 received in 2023-04-03, accepted in 2023-06-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe Mediterranean diet has been associated with lower risk of breast cancer (BC) but evidence from prospective studies on the role of Mediterranean diet on BC survival remains sparse and conflicting. We aimed to investigate whether adherence to Mediterranean diet prior to diagnosis is associated with overall and BC-specific mortality.MethodsA total of 13,270 incident breast cancer cases were identified from an initial sample of 318,686 women in 9 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Adherence to Mediterranean diet was estimated through the adapted relative Mediterranean diet (arMED), a 16-point score that includes 8 key components of the Mediterranean diet and excludes alcohol. The degree of adherence to arMED was classified as low (score 0–5), medium (score 6–8), and high (score 9–16). Multivariable Cox proportional hazards models were used to analyze the association between the arMED score and overall mortality, and Fine-Gray competing risks models were applied for BC-specific mortality.ResultsAfter a mean follow-up of 8.6 years from diagnosis, 2340 women died, including 1475 from breast cancer. Among all BC survivors, low compared to medium adherence to arMED score was associated with a 13% higher risk of all-cause mortality (HR 1.13, 95%CI 1.01–1.26). High compared to medium adherence to arMED showed a non-statistically significant association (HR 0.94; 95% CI 0.84–1.05). With no statistically significant departures from linearity, on a continuous scale, a 3-unit increase in the arMED score was associated with an 8% reduced risk of overall mortality (HR3-unit 0.92, 95% CI: 0.87–0.97). This result sustained when restricted to postmenopausal women and was stronger among metastatic BC cases (HR3-unit 0.81, 95% CI: 0.72–0.91).ConclusionsConsuming a Mediterranean diet before BC diagnosis may improve long-term prognosis, particularly after menopause and in cases of metastatic breast cancer. Well-designed dietary interventions are needed to confirm these findings and define specific dietary recommendations.

【 授权许可】

CC BY   
© The Author(s) 2023

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