Dietary Fiber, Carbohydrates, Glycemic Index, and Glycemic Load in Relation to Breast Cancer Prognosis in the HEAL Cohort

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 03/2011; 20(5):890-9. DOI: 10.1158/1055-9965.EPI-10-1278
Source: PubMed


Dietary intake of fiber, carbohydrate, glycemic index (GI), and glycemic load (GL) may influence breast cancer survival, but consistent and convincing evidence is lacking.
We investigated associations of dietary fiber, carbohydrates, GI, and GL with breast cancer prognosis among n = 688 stage 0 to IIIA breast cancer survivors in the Health, Eating, Activity, and Lifestyle (HEAL) study. Premenopausal and postmenopausal women from Western Washington State, Los Angeles County, and New Mexico participated. Usual diet was assessed with a food frequency questionnaire. Total mortality, breast cancer mortality, nonfatal recurrence, and second occurrence data were obtained from SEER (Surveillance, Epidemiology, and End Results) registries and medical records. Cox proportional hazards regression estimated multivariate-adjusted hazard ratios and 95% confidence intervals (CI).
During a median of 6.7 years follow-up after diagnosis, n = 106 total deaths, n = 83 breast cancer-specific deaths, and n = 82 nonfatal recurrences were confirmed. We observed an inverse association between fiber intake and mortality. Multivariate-adjusted hazard rate ratios (HRR) comparing high to low intake were 0.53 (95% CI 0.23-1.23) and 0.75 (95% CI 0.43-1.31). A threshold effect was observed whereby no additional benefit was observed for intakes of 9 g/d or more. Fiber intake was suggestively inversely associated with breast cancer-specific mortality (HRR = 0.68, 95% CI 0.27-1.70) and risk of nonfatal recurrence or second occurrence (HRR = 0.68, 95% CI 0.27-1.70), but results were not statistically significant.
Dietary fiber was associated with a nonsignificant inverse association with breast cancer events and total mortality. Further studies to assess and confirm this relationship are needed in order to offer effective dietary strategies for breast cancer patients.
Increasing dietary fiber may an effective lifestyle modification strategy for breast cancer survivors.

8 Reads
  • Source
    • "Several studies have shown that pathological characteristics including tumor size, lymph-node status, and hormone receptor status are prognostic indicators that can be used in clinical practice (Osborne, 1998; Page et al., 1998; Cianfrocca and Goldstein, 2004). However, numerous studies have focused on the role of dietary factors in breast cancer, including dietary patterns, macronutrients, and micronutrients (Thomson and Thompson, 2009; Xu et al., 2009; Belle et al., 2011; Dong and Qin, 2011; Kroenke et al., 2013; Vrieling et al., 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Some studies have investigated the association between folate intake and breast cancer prognosis, but the results have been far from conclusive. Thus, a meta-analysis was carried out to explore this association. We performed a comprehensive search of the PubMed, Web of Knowledge, and Cochrane databases from inception to May 2013. The summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a random effects model. Prespecified stratified analyses, sensitivity analyses, and dose-response analysis were also carried out. Five studies, with a total of 7299 participants, were included in the meta-analysis. The pooled HR (95% CI) of the five studies on the association of dietary folate intake (highest vs. lowest) with all-cause mortality was 0.74 (0.60-0.92). Stratified analyses suggested that the inverse association of dietary folate and all-cause mortality was more easily detected in studies that focused on prediagnosis diets, included more patients (>1000), had longer follow-up periods (>7 years), used structured interviews, or had more categories of folate intake (>3). However, none of these differences was statistically significant. No significant association was found between total (dietary and supplementary) folate intake and all-cause mortality, or dietary folate intake and breast cancer-specific mortality, with pooled HRs (95% CI) of 0.93 (0.75-1.15) and 0.79 (0.61-1.01), respectively. Sensitivity analyses confirmed the robustness of the findings by excluding studies that poorly represented the cohort. Our findings suggest a significant inverse association between dietary folate intake and all-cause mortality, but not between total folate intake and all-cause mortality.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 04/2014; 24(2). DOI:10.1097/CEJ.0000000000000028 · 3.03 Impact Factor
  • Source
    • "Several recent observational studies focused on specific components in plant foods and breast cancer outcome, such as dietary fiber [27] and specific plant-based phytoestrogens. Buck et al. [28, 29••] recently investigated enterolactone, the main metabolite of lignans, the most important class of phytoestrogens in Western diets, and showed that high estimated prediagnostic and postdiagnostic serum levels were associated with increased overall survival in postmenopausal breast cancer patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: With the increase in the number of cancer patients worldwide in the coming years, the need for knowledge on the influence of lifestyle factors on cancer survival is increasing. In this paper, the current knowledge on diet, body mass index, and physical activity in relation to cancer outcome is summarized. Also, challenges are identified to be addressed to provide evidence-based recommendations for cancer patients. Studies in patients with breast, colorectal, or prostate cancer show that the influence of dietary factors on survival remains to be determined. Adiposity and a lack of physical activity, however, appear to influence cancer outcome negatively. Subsequent studies should focus on more detailed aspects of these lifestyle factors, such as body composition and dose of exercise, and on the timing with respect to diagnosis and treatment. Research should be directed toward investigating diet and physical activity simultaneously and on how changes in health behavior can be established.
    03/2012; 1(1). DOI:10.1007/s13668-011-0004-9
  • Source
    • "Second, relative to creating a microenvironment conducive to tumor growth, a repeated emergence of attention is noted in the metabolic re-programming that accompanies the development of cancer and recognition of the preference of many carcinomas for glucose or glutamine, which is actively taken up from the vascular system [40-44]. Hence, concern exists that diets rich in carbohydrates with a high glycemic load would stimulate tumor growth [45,46]. In the context of weight loss, no evidence was obtained to support either concern, as reflected by fasting glucose determined monthly over a period of 6 months; however, the differences between the slopes on diet averaged over weight were smaller (P = 0.06) than the differences between weight-loss groups averaged over diet (P = 0.21). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Healthy body weight is an important factor for prevention of breast cancer recurrence. Yet, weight loss and weight gain are not currently included in clinical-practice guidelines for posttreatment of breast cancer. The work reported addresses one of the questions that must be considered in recommending weight loss to patients: does it matter what diet plan is used, a question of particular importance because breast cancer treatment can increase risk for cardiovascular disease. Women who completed treatment for breast cancer were enrolled in a nonrandomized, controlled study investigating effects of weight loss achieved by using two dietary patterns at the extremes of macronutrient composition, although both diet arms were equivalent in protein: high fat, low carbohydrate versus low fat, high carbohydrate. A nonintervention group served as the control arm; women were assigned to intervention arms based on dietary preferences. During the 6-month weight-loss program, which was menu and recipe defined, participants had monthly clinical visits at which anthropometric data were collected and fasting blood was obtained for safety monitoring for plasma lipid profiles and fasting glucose. Results from 142 participants are reported. Adverse effects on fasting blood lipids or glucose were not observed in either dietary arm. A decrease in fasting glucose was observed with progressive weight loss and was greater in participants who lost more weight, but the effect was not statistically significant, even though it was observed across both diet groups (P = 0.21). Beneficial effects of weight loss on cholesterol (4.7%; P = 0.001), triglycerides (21.8%; P = 0.01), and low-density lipoprotein (LDL) cholesterol (5.8%; P = 0.06) were observed in both groups. For cholesterol (P = 0.07) and LDL cholesterol (P = 0.13), greater reduction trends were seen on the low-fat diet pattern; whereas, for triglycerides (P = 0.01) and high-density lipoprotein (HDL) cholesterol (P = 0.08), a decrease or increase, respectively, was greater on the low-carbohydrate diet pattern. Because an individual's dietary preferences can affect dietary adherence and weight-loss success, the lack of evidence of a negative effect of dietary pattern on biomarkers associated with cardiovascular risk is an important consideration in the development of breast cancer practice guidelines for physicians who recommend that their patients lose weight. Whether dietary pattern affects biomarkers that predict long-term survival is a primary question in this ongoing clinical trial.
    Breast cancer research: BCR 01/2012; 14(1):R1. DOI:10.1186/bcr3082 · 5.49 Impact Factor
Show more


8 Reads
Available from