Adherence to Dietary Recommendations among Long-Term Breast Cancer Survivors and Cancer Outcome Associations
- 1 February 2020
- journal article
- research article
- Published by American Association for Cancer Research (AACR) in Cancer Epidemiology, Biomarkers & Prevention
- Vol. 29 (2), 386-395
- https://doi.org/10.1158/1055-9965.epi-19-0872
Abstract
Background: Adherence to dietary recommendations has been shown to be associated with reduced mortality in healthy populations. Little is known about the possible benefits of adherence to dietary recommendations among breast cancer survivors. Methods: Dietary information was collected using food frequency questionnaires at the 5-year postdiagnosis survey in 3,450 5-year breast cancer survivors from the Shanghai Breast Cancer Survival Study. Adherence scores to Chinese Food Pagoda (CHFP)-2007, CHFP-2016, modified Dietary Approaches to Stop Hypertension (DASH) and Healthy Eating Index 2015 (HEI-2015) were created. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for total mortality and breast cancer specific events according to adherence scores. Results: Participants in the highest quartiles of CHFP-2007, CHFP-2016 and DASH had 25-34% lower risk of total mortality (HR=0.66, 95%CI: 0.48 to 0.89 for CHFP-2007; HR=0.75, 95%CI: 0.55 to 1.01 for CHFP-2016; HR=0.66, 95%CI: 0.49 to 0.91 for DASH), and 36-40% lower risk of breast cancer specific events (HR=0.64, 95%CI: 0.44 to 0.93 for CHFP-2007; HR=0.67, 95%CI: 0.45 to 0.99 for CHFP-2016; HR=0.60, 95%CI: 0.40 to 0.90 for DASH) comparing to the lowest quartiles. Associations did not vary by known prognostic factors. HEI-2015 scores were not significantly associated with breast cancer outcomes. Conclusion: Higher adherence to CHFP and DASH dietary guidelines post-cancer diagnosis was associated with reduced risk of both overall death, and breast cancer specific recurrence or death among long-term breast cancer survivors. Impact: Our study highlights the importance of overall dietary quality among long-term breast cancer survivors.Funding Information
- China Scholarship Council (201806225032)
- U.S. Department of Defense (DAMD 17-02-1-0607)
- National Cancer Institute (R01 CA118229)
- National Natural Science Foundation of China (81402734)
This publication has 33 references indexed in Scilit:
- Adherence to the WCRF/AICR Guidelines for Cancer Prevention Is Associated with Lower Mortality among Older Female Cancer SurvivorsCancer Epidemiology, Biomarkers & Prevention, 2013
- Postdiagnosis diet quality, the combination of diet quality and recreational physical activity, and prognosis after early-stage breast cancerCancer Causes & Control, 2011
- Post-diagnosis dietary factors and survival after invasive breast cancerBreast Cancer Research and Treatment, 2011
- Postdiagnosis Diet Quality Is Inversely Related to a Biomarker of Inflammation among Breast Cancer SurvivorsCancer Epidemiology, Biomarkers & Prevention, 2010
- Soy Food Intake and Breast Cancer SurvivalJAMA, 2009
- Dietary Patterns and Breast Cancer Recurrence and Survival Among Women With Early-Stage Breast CancerJournal of Clinical Oncology, 2009
- Development of the Healthy Eating Index-2005Journal of the American Dietetic Association, 2008
- Evaluation of the Healthy Eating Index-2005Journal of the American Dietetic Association, 2008
- Association of Physical Activity with Hormone Receptor Status: The Shanghai Breast Cancer StudyCancer Epidemiology, Biomarkers & Prevention, 2006
- Dietary Patterns and Survival After Breast Cancer DiagnosisJournal of Clinical Oncology, 2005