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.

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    • "The evidence on the association of GI and GL with breast cancer is inconsistent. For instance, the association between these indices and mortality from breast cancer was evaluated in a group of American women, without significant results for both GI and GL (Belle et al., 2011). "
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    ABSTRACT: The objective of this study was to evaluate the prospective associations between dietary glycemic index (GI) and glycemic load (GL) and the risk for invasive breast cancer incidence in postmenopausal women at high cardiovascular disease (CVD) risk. This study was conducted within the framework of the PREvención con DIeta MEDiterránea (PREDIMED) study, a nutritional intervention trial for primary cardiovascular prevention. We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease. Dietary information was collected using a validated 137-item food frequency questionnaire. We assigned GI values using the International Tables of GI and GL values. Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index. Only cases confirmed by results from cytology tests or histological evaluation were included. We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models. We repeated our analyses using yearly repeated measures of GI/GL intakes. No associations were found between baseline dietary GI/GL and invasive breast cancer incidence. The multivariable hazard ratio and 95% confidence interval (CI) for the top tertile of dietary GI was 1.02 (95% CI: 0.42-2.46) and for dietary GL was 1.00 (95% CI: 0.44-2.30) when compared with the bottom tertile. Repeated-measures analyses yielded similar results. In sensitivity analyses, no significant associations were observed for women with obesity or diabetes. Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk.
    Full-text · Article · Dec 2015 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
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    • "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). "
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    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.
    Full-text · Article · Apr 2014 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
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    • "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. "
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    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.
    Full-text · Article · Mar 2012
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