Low-Carbohydrate Diets, Dietary Approaches to Stop Hypertension-Style Diets, and the Risk of Postmenopausal Breast Cancer

Department of Nutrition, Simmons College, 300 The Fenway, Boston, MA 02115, USA.
American journal of epidemiology (Impact Factor: 5.23). 08/2011; 174(6):652-60. DOI: 10.1093/aje/kwr148
Source: PubMed


The authors prospectively examined the association between the Dietary Approaches to Stop Hypertension diet score, overall, animal-based, and vegetable-based low-carbohydrate-diet scores, and major plant food groups and the risk of postmenopausal breast cancer in 86,621 women in the Nurses' Health Study. Diet scores were calculated by using data from up to 7 food frequency questionnaires, with follow-up from 1980 to 2006. The authors ascertained 5,522 incident cases of breast cancer, including 3,314 estrogen receptor-positive (ER+) cancers and 826 estrogen receptor-negative (ER-) cancers. After adjustment for potential confounders, the Dietary Approaches to Stop Hypertension diet score was associated with a lower risk of ER- cancer (relative risk comparing extreme quintiles = 0.80, 95% confidence interval: 0.64, 1.01; P trend = 0.02). However, this was largely explained by higher intakes of fruits and vegetables. The authors also observed an inverse association between risk of ER- cancer and the vegetable-based, low-carbohydrate-diet score (corresponding relative risk = 0.81, 95% confidence interval: 0.65, 1.01; P trend = 0.03). High total fruit and low-protein vegetable intakes were associated with a lower risk of ER- cancer (relative risk comparing extreme quintiles = 0.71, 95% confidence interval: 0.55, 0.90; P trend = 0.005). No association was found between ER+ tumors and fruit and vegetable intakes. A diet high in fruits and vegetables, such as one represented by the Dietary Approaches to Stop Hypertension diet score, was associated with a lower risk of ER- breast cancer. In addition, a diet high in plant protein and fat and moderate in carbohydrate content was associated with a lower risk of ER- cancer.

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    • "An increased risk of incident breast cancer has been observed for a dietary pattern characterized by a low intake of bread and fruit juice and a high intake of processed meat, fish, butter, other animal fats, and margarine [23]. In contrast, a plant-based, low-carbohydrate diet has been related to a reduced risk of estrogen-receptor-negative breast cancer [24]. "
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    ABSTRACT: Background Although carbohydrate reduction of varying degrees is a popular and controversial dietary trend, potential long-term effects for health, and cancer in specific, are largely unknown. Methods We studied a previously established low-carbohydrate, high-protein (LCHP) score in relation to the incidence of cancer and specific cancer types in a population-based cohort in northern Sweden. Participants were 62,582 men and women with up to 17.8 years of follow-up (median 9.7), including 3,059 prospective cancer cases. Cox regression analyses were performed for a LCHP score based on the sum of energy-adjusted deciles of carbohydrate (descending) and protein (ascending) intake labeled 1 to 10, with higher scores representing a diet lower in carbohydrates and higher in protein. Important potential confounders were accounted for, and the role of metabolic risk profile, macronutrient quality including saturated fat intake, and adequacy of energy intake reporting was explored. Results For the lowest to highest LCHP scores, 2 to 20, carbohydrate intakes ranged from median 60.9 to 38.9% of total energy intake. Both protein (primarily animal sources) and particularly fat (both saturated and unsaturated) intakes increased with increasing LCHP scores. LCHP score was not related to cancer risk, except for a non-dose-dependent, positive association for respiratory tract cancer that was statistically significant in men. The multivariate hazard ratio for medium (9–13) versus low (2–8) LCHP scores was 1.84 (95% confidence interval: 1.05-3.23; p-trend = 0.38). Other analyses were largely consistent with the main results, although LCHP score was associated with colorectal cancer risk inversely in women with high saturated fat intakes, and positively in men with higher LCHP scores based on vegetable protein. Conclusion These largely null results provide important information concerning the long-term safety of moderate carbohydrate reduction and consequent increases in protein and, in this cohort, especially fat intakes. In order to determine the effects of stricter carbohydrate restriction, further studies encompassing a wider range of macronutrient intakes are warranted.
    Nutrition Journal 05/2013; 12(1):58. DOI:10.1186/1475-2891-12-58 · 2.60 Impact Factor
  • Current opinion in lipidology 02/2012; 23(1):72-5. DOI:10.1097/MOL.0b013e32834f42d9 · 5.66 Impact Factor
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    ABSTRACT: Background Carotenoids, micronutrients in fruits and vegetables, may reduce breast cancer risk. Most, but not all, past studies of circulating carotenoids and breast cancer have found an inverse association with at least one carotenoid, although the specific carotenoid has varied across studies.Methods We conducted a pooled analysis of eight cohort studies comprising more than 80% of the world's published prospective data on plasma or serum carotenoids and breast cancer, including 3055 case subjects and 3956 matched control subjects. To account for laboratory differences and examine population differences across studies, we recalibrated participant carotenoid levels to a common standard by reassaying 20 plasma or serum samples from each cohort together at the same laboratory. Using conditional logistic regression, adjusting for several breast cancer risk factors, we calculated relative risks (RRs) and 95% confidence intervals (CIs) using quintiles defined among the control subjects from all studies. All P values are two-sided.ResultsStatistically significant inverse associations with breast cancer were observed for α-carotene (top vs bottom quintile RR = 0.87, 95% CI = 0.71 to 1.05, Ptrend = .04), β-carotene (RR = 0.83, 95% CI = 0.70 to 0.98, Ptrend = .02), lutein+zeaxanthin (RR = 0.84, 95% CI = 0.70 to 1.01, Ptrend = .05), lycopene (RR = 0.78, 95% CI = 0.62 to 0.99, Ptrend = .02), and total carotenoids (RR = 0.81, 95% CI = 0.68 to 0.96, Ptrend = .01). β-Cryptoxanthin was not statistically significantly associated with risk. Tests for heterogeneity across studies were not statistically significant. For several carotenoids, associations appeared stronger for estrogen receptor negative (ER(-)) than for ER(+) tumors (eg, β-carotene: ER(-): top vs bottom quintile RR = 0.52, 95% CI = 0.36 to 0.77, Ptrend = .001; ER(+): RR = 0.83, 95% CI = 0.66 to 1.04, Ptrend = .06; Pheterogeneity = .01).Conclusions This comprehensive prospective analysis suggests women with higher circulating levels of α-carotene, β-carotene, lutein+zeaxanthin, lycopene, and total carotenoids may be at reduced risk of breast cancer.
    Journal of the National Cancer Institute 12/2012; 104(24). DOI:10.1093/jnci/djs461 · 12.58 Impact Factor
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