Advertisement

Nutritional Status of Breast Cancer Survivors 1 Year after Diagnosis: A Preliminary Analysis from the Malaysian Breast Cancer Survivorship Cohort Study

      Abstract

      Background

      Lifestyle factors, such as diet, body weight, and physical activity, are linked to better survival after breast cancer (BC) diagnosis. A high percentage of the Malaysian population is overweight or obese. In addition, studies have shown a disparity in survival among Malaysian women compared with other higher-income countries. The Malaysian Breast Cancer Survivorship Cohort (MyBCC) study aims to study lifestyle factors that affect survival in BC survivors. These are the preliminary findings on the nutritional status of Malaysian BC survivors.

      Objective

      Our aim was to evaluate the nutritional status of BC survivors at 1 year after diagnosis.

      Design

      This was a cross-sectional study of 194 participants from the MyBCC study, recruited within 1 year of their diagnosis. Participants completed a 3-day food diary.

      Participants

      Malaysian women (aged 18 years and older) who were newly diagnosed with primary BC, managed at the University Malaya Medical Center, and able to converse either in Malay, English, or Mandarin were included.

      Main outcome measures

      Dietary intake and prevalence of overweight or obesity among participants 1 year after diagnosis were measured.

      Statistical analyses performed

      Student’s t test and analysis of variance or its equivalent nonparametric test were used for association in continuous variables.

      Results

      About 66% (n=129) of participants were overweight or obese and >45% (n=86) had high body fat percentage 1 year after diagnosis. The participants’ diets were low in fiber (median=8.7 g/day; interquartile range=7.2 g/day) and calcium (median=458 mg/day; interquartile range=252 mg/day). Ethnicity and educational attainment contributed to the differences in dietary intake among participants. Higher saturated fat and lower fiber intake were observed among Malay participants compared with other ethnic groups.

      Conclusions

      Overweight and obesity were highly prevalent among BC survivors and suboptimal dietary intake was observed. Provision of an individualized medical nutrition therapy by a qualified dietitian is crucial as part of comprehensive BC survivorship care.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Youlden D.R.
        • Cramb S.M.
        • Yip C.H.
        • Baade P.D.
        Incidence and mortality of female breast cancer in the Asia-Pacific region.
        Cancer Biol Med. 2014; 11: 101-115
        • Zainal Arrifin O.
        • Nor Saleha I.T.
        National Cancer Registry Report 2007.
        Ministry of Health Malaysia, Kuala Lumpur, Malaysia2011
        • Abdullah N.A.
        • Mahiyuddin W.R.W.
        • Muhammad N.A.
        • et al.
        Survival rate of breast cancer patients in Malaysia: A population-based study.
        Asian Pac J Cancer Prev. 2013; 14: 4591-4594
        • Chan D.S.M.
        • Vieira A.R.
        • Aune D.
        • et al.
        Body mass index and survival in women with breast cancer—Systematic literature review and meta-analysis of 82 follow-up studies.
        Ann Oncol. 2014; 25: 1901-1914
        • Saquib N.
        • Flatt S.W.
        • Natarajan L.
        • et al.
        Weight gain and recovery of pre-cancer weight after breast cancer treatments: Evidence from the Women’s Healthy Eating and Living (WHEL) study.
        Breast Cancer Res Treat. 2007; 105: 177-186
        • Chen X.
        • Lu W.
        • Gu K.
        • et al.
        Weight change and its correlates among breast cancer survivors.
        Nutr Cancer. 2011; 63: 538-548
        • Yaw Y.H.
        • Shariff Z.M.
        • Kandiah M.
        • et al.
        Weight changes and lifestyle behaviors in women after breast cancer diagnosis: A cross-sectional study.
        BMC Public Health. 2011; 11: 309
        • Kim S.H.
        • Cho Y.U.
        • Kim S.J.
        Weight gain and its correlates among breast cancer survivors.
        Asian Nurs Res (Korean Soc Nurs Sci). 2013; 7: 161-167
        • Obi N.
        • Gornyk D.
        • Heinz J.
        • et al.
        Determinants of newly diagnosed comorbidities among breast cancer survivors.
        J Cancer Surviv. 2014; 8: 384-393
        • Kamineni A.
        • Anderson M.L.
        • White E.
        • et al.
        Body mass index, tumor characteristics, and prognosis following diagnosis of early stage breast cancer in a mammographically-screened population.
        Cancer Causes Control. 2013; 24: 305-312
        • Shaharudin S.H.
        • Sulaiman S.
        • Shahril M.R.
        • Emran N.A.
        • Akmal S.N.
        Dietary changes among breast cancer patients in Malaysia.
        Cancer Nurs. 2013; 36: 131-138
        • Lua P.L.
        • Salihah N.Z.
        • Mazlan N.
        Nutritional status and health-related quality of life of breast cancer patients on chemotherapy.
        Malays J Nutr. 2012; 18: 173-184
        • Islam T.
        • Bhoo-Pathy N.
        • Su T.T.
        • et al.
        The Malaysian Breast Cancer Survivorship Cohort (MyBCC): A study protocol.
        BMJ Open. 2015; 5: e008643
        • American Joint Committee on Cancer
        AJCC Cancer Staging Manual.
        7th ed. Springer, New York, NY2010
        • Gallagher D.
        • Heymsfield S.B.
        • Heo M.
        • Jebb S.A.
        • Murgatroyd P.R.
        • Sakamoto Y.
        Healthy percentage body fat ranges: An approach for developing guidelines based on body mass index.
        Am J Clin Nutr. 2000; 72: 694-701
        • World Health Organization
        The Asia-Pacific Perspective. Redefining Obesity and its Treatment.
        International Diabetes Institute, Sydney, Australia2000
        • Suzana S.
        • Noor Aini M.Y.
        • Nik Shanita S.
        • Rafidah G.
        • Roslina A.
        Atlas of Food Exchanges & Portion Sizes.
        2nd ed. MDC Publishers Sdn. Bhd, Kuala Lumpur, Malaysia2009
      1. Tee E.S. Ismail Noor M. Mohd Nasir A. Khatijah I. Nutrient Composition of Malaysian Foods. 4th ed. Institute for Medical Research, Kuala Lumpur, Malaysia1997
      2. Nutritionist Pro [computer program]. Version 5.4.0. Redmond, WA: Axxya System; 2016.

        • Li Y.
        • Hruby A.
        • Bernstein A.M.
        • et al.
        Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: A prospective cohort study.
        J Am Coll Cardiol. 2015; 66: 1538-1548
      3. SPSS [computer program]. Version 18. Chicago, IL: SPSS Inc; 2009.

        • World Cancer Research Fund/American Institute for Cancer Research
        Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective.
        American Institute for Cancer Research, Washington DC2007
        • National Coordinating Committee on Food and Nutrition
        Recommended Nutrient Intakes for Malaysia.
        Putrajaya, Malaysia YKL Print, 2005
      4. World Cancer Research Fund/American Institute for Cancer Research. Continuous update project report: Diet, nutrition, physical activity, and breast cancer survivors. www.wcrf.org/sites/default/files/Breast-Cancer-Survivors-2014-Report.pdf. Published 2014. Accessed March 1, 2017.

        • National Coordinating Committee on Food and Nutrition
        Malaysian Dietary Guidelines.
        Putrajaya, Malaysia Jaybees Print Industries Sdn. Bhd., 2010
        • Caan B.
        • Sternfeld B.
        • Gunderson E.
        • Coates A.
        • Quesenberry C.
        • Slattery M.L.
        Life after Cancer Epidemiology (LACE) Study: A cohort of early stage breast cancer survivors (United States).
        Cancer Causes Control. 2005; 16: 545-556
        • Cui X.
        • Dai Q.
        • Tseng M.
        • Shu X.O.
        • Gao Y.T.
        • Zheng W.
        Dietary patterns and breast cancer risk in the Shanghai Breast Cancer Study.
        Cancer Epidemiol Biomarkers Prev. 2007; 16: 1443-1448
        • Michaud L.B.
        Managing cancer treatment-induced bone loss and osteoporosis in patients with breast or prostate cancer.
        Am J Health Syst Pharm. 2010; 67: S20-S30
        • Lim P.S.
        • Ong F.B.
        • Adeeb N.
        • et al.
        Bone health in urban midlife Malaysian women: Risk factors and prevention.
        Osteoporos Int. 2005; 16: 2069-2079
        • Chee W.S.S.
        • Suriah A.R.
        • Zaitun Y.
        • Chan S.P.
        • Yap S.L.
        • Chan Y.M.
        Dietary calcium intake in postmenopausal Malaysian women: Comparison between the food frequency questionnaire and three-day food records.
        Asia Pac J Clin Nutr. 2002; 11: 142-146
        • Pon L.W.
        • Noor-Aini M.Y.
        • Ong F.B.
        • et al.
        Diet, nutritional knowledge and health status of urban middle-aged Malaysian women.
        Asia Pac J Clin Nutr. 2006; 15: 388-399
        • Abdul Majid H.
        • Ramli L.
        • Ying S.P.
        • Su T.T.
        • Jalaludin M.Y.
        • Abdul Mohsein N.A.-S.
        Dietary intake among adolescents in a Middle-Income Country: An outcome from the Malaysian Health and Adolescents Longitudinal Research Team Study (the MyHeARTs Study).
        PLoS One. 2016; 11: e0155447
        • McEligot A.J.
        • Largent J.
        • Ziogas A.
        • Peel D.
        • Anton-Culver H.
        Dietary fat, fiber, vegetable, and micronutrients are associated with overall survival in postmenopausal women diagnosed with breast cancer.
        Nutr Cancer. 2006; 55: 132-140
        • Pierce J.P.
        • Stefanick M.L.
        • Flatt S.W.
        • et al.
        Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity.
        J Clin Oncol. 2007; 25: 2345-2351
        • Saxe G.A.
        • Rock C.L.
        • Wicha M.S.
        • Schottenfeld D.
        Diet and risk for breast cancer recurrence and survival.
        Breast Cancer Res Treat. 1999; 53: 241-253
        • The Action Study Group
        Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: Results from a longitudinal study in eight countries.
        BMC Med. 2015; 13: 1-11

      Biography

      H. A. Majid is an associate professor, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, and a visiting fellow/scientist, Harvard T.H. Chan School of Public Health, Boston MA.

      Biography

      L. P. Keow is a dietitian, Hospital Taiping, Jalan Taming Sari, Taiping, Perak, Malaysia.

      Biography

      T. Islam is a senior lecturer, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

      Biography

      N. A. Taib is a professor, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

      Biography

      T. T. Su is an associate professor, Center for Population Health and Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

      Biography

      M. Cantwell is an associate professor, Nutrition and Metabolism Group, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, United Kingdom.