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Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data

Published:December 09, 2017DOI:https://doi.org/10.1016/j.jand.2017.09.024

      Abstract

      Background

      Modifiable lifestyle factors, such as diet quality, could reduce inflammation and improve quality of life (QOL) in breast cancer survivors, but data are inconclusive.

      Objective

      To determine whether diet quality, as measured by Healthy Eating Index-2010 (HEI-2010) score, is associated with inflammation, health status, or functional outcomes affecting QOL in survivors of early-stage breast cancer.

      Design

      This is a cross-sectional, secondary analysis of baseline data collected from breast cancer survivors after completion of primary therapy and before random assignment to a pilot nutritional intervention aimed at reducing side effects of aromatase inhibitor treatment.

      Participants/setting

      Participants were 44 postmenopausal women with stage I to III endocrine receptor–positive breast cancer receiving outpatient care at a midwestern cancer center between November 2011 and October 2013.

      Main outcome measures

      Primary outcomes were serum proinflammatory cytokines (interleukin-6 [IL-6], IL-17, and tumor necrosis factor-α receptor 2 [TNFR-2]). Secondary outcomes included QOL measured by the Stanford Health and Disability Questionnaire and the Functional Assessment of Cancer Therapy–Breast with Endocrine Subscale.

      Statistical analyses performed

      Pearson correlation coefficients (r) and linear regression models were used to evaluate the relationship of dietary variables with inflammatory cytokines and QOL measures.

      Results

      A higher overall HEI-2010 score (healthier diet) was associated with lower IL-6 (r=−0.46; P=0.002) and TNFR-2 (r=−0.41; P=0.006); however, associations were attenuated by body mass index (BMI) (IL=6 [r=−0.26; P=0.10]; TNFR-2 [r=−0.30; P=0.06]). In women with prior chemotherapy, a higher HEI-2010 score was strongly associated with lower IL-6 (r=−0.67; P=0.009) and TNFR-2 (r=−0.59; P=0.03) after BMI adjustment. There were no significant correlations between HEI-2010 score and QOL measures after adjustment for BMI.

      Conclusions

      These data suggest the need for more rigorous investigation into the relationship of diet quality, BMI, and inflammation in breast cancer survivors.

      Keywords

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      References

        • American Cancer Society
        Breast Cancer Facts & Figures 2015-2016.
        American Cancer Society, Inc, Atlanta, GA2015
        • Ganz P.A.
        • Desmond K.A.
        • Leedham B.
        • Rowland J.H.
        • Meyerowitz B.E.
        • Belin T.R.
        Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study.
        J Natl Cancer Inst. 2002; 94: 39-49
        • Alfano C.M.
        • Imayama I.
        • Neuhouser M.L.
        • et al.
        Fatigue, inflammation, and omega-3 and omega-6 fatty acid intake among breast cancer survivors.
        J Clin Oncol. 2012; 30: 1280-1287
        • Imayama I.
        • Alfano C.M.
        • Neuhouser M.L.
        • et al.
        Weight, inflammation, cancer-related symptoms and health related quality of life among breast cancer survivors.
        Breast Cancer Res Treat. 2013; 140: 159-176
        • Henry N.L.
        • Pchejetski D.
        • A'Hern R.
        • et al.
        Inflammatory cytokines and aromatase inhibitor-associated musculoskeletal syndrome: A case–control study.
        Br J Cancer. 2010; 103: 291-296
        • Cheung Y.T.
        • Ng T.
        • Shwe M.
        • et al.
        Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: A multi-centered, prospective, cohort study.
        Ann Oncol. 2015; 26: 1446-1451
        • Villaseñor A.
        • Flatt S.W.
        • Marinac C.
        • Natarajan L.
        • Pierce J.P.
        • Patterson R.E.
        Postdiagnosis C-reactive protein and breast cancer survivorship: Findings from the WHEL Study.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 189-199
        • Pierce B.L.
        • Ballard-Barbash R.
        • Bernstein L.
        • et al.
        Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients.
        J Clin Oncol. 2009; 27: 3437-3444
        • Hanahan D.
        • Weinberg Robert A.
        Hallmarks of cancer: The next generation.
        Cell. 2011; 144: 646-674
        • Corley J.
        • Kyle J.A.
        • Starr J.M.
        • McNeill G.
        • Deary I.J.
        Dietary factors and biomarkers of systemic inflammation in older people: The Lothian Birth Cohort 1936.
        Br J Nutr. 2015; 114: 1088-1098
        • Dias J.A.
        • Wirfalt E.
        • Drake I.
        • et al.
        A high quality diet is associated with reduced systemic inflammation in middle-aged individuals.
        Atherosclerosis. 2015; 238: 38-44
        • Barbaresko J.
        • Koch M.
        • Schulze M.B.
        • Nothlings U.
        Dietary pattern analysis and biomarkers of low-grade inflammation: A systematic literature review.
        Nutr Rev. 2013; 71: 511-527
        • Arthur A.E.
        • Peterson K.E.
        • Shen J.
        • et al.
        Diet and proinflammatory cytokine levels in head and neck squamous cell carcinoma.
        Cancer. 2014; 120: 2704-2712
        • George S.M.
        • Neuhouser M.L.
        • Mayne S.T.
        • et al.
        Postdiagnosis diet quality is inversely related to a biomarker of inflammation among breast cancer survivors.
        Cancer Epidemiol Biomarkers Prev. 2010; 19: 2220-2228
        • Wayne S.J.
        • Baumgartner K.
        • Baumgartner R.N.
        • Bernstein L.
        • Bowen D.J.
        • Ballard-Barbash R.
        Diet quality is directly associated with quality of life in breast cancer survivors.
        Breast Cancer Research Treat. 2006; 96: 227-232
        • Kassianos A.P.
        • Raats M.M.
        • Gage H.
        • Peacock M.
        Quality of life and dietary changes among cancer patients: A systematic review.
        Qual Life Res. 2015; 24: 705-719
        • Henry N.L.
        • Giles J.T.
        • Ang D.
        • et al.
        Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors.
        Breast Cancer Res Treat. 2008; 111: 365-372
        • Patterson R.E.
        • Kristal A.R.
        • Tinker L.F.
        • Carter R.A.
        • Bolton M.P.
        • Agurs-Collins T.
        Measurement characteristics of the Women's Health Initiative food frequency questionnaire.
        Ann Epidemiol. 1999; 9: 178-187
      1. Nutrition Data Systems for Research. Version 2013. Minneapolis, MN: University of Minnesota Nutrition Coordinating Center; 2013.

        • Bowman S.F.J.
        • Moshfegh A.
        MyPyramid Equivalents Database, 2.0 for USDA Survey Foods, 2003-2004 [Online].
        2008 ed. US Department of Agriculture, ARS, Beltsville, MD2008
        • US Department of Agriculture and U.S. Department of Health and Human Services
        Dietary Guidelines for Americans, 2010.
        7th ed. U.S.Government Printing Office, Washington, DC2010
        • Guenther P.M.
        • Casavale K.O.
        • Reedy J.
        • et al.
        Update of the Healthy Eating Index: HEI-2010.
        J Acad Nutr Diet. 2013; 113: 569-580
        • Sheibanie A.F.
        • Khayrullina T.
        • Safadi F.F.
        • Ganea D.
        Prostaglandin E2 exacerbates collagen-induced arthritis in mice through the inflammatory interleukin-23/interleukin-17 axis.
        Arthritis Rheum. 2007; 56: 2608-2619
        • Zainal Z.
        • Longman A.J.
        • Hurst S.
        • et al.
        Relative efficacies of omega-3 polyunsaturated fatty acids in reducing expression of key proteins in a model system for studying osteoarthritis.
        Osteoarthritis Cartilage. 2009; 17: 896-905
        • Ingle J.N.
        • Schaid D.J.
        • Goss P.E.
        • et al.
        Genome-wide associations and functional genomic studies of musculoskeletal adverse events in women receiving aromatase inhibitors.
        J Clin Oncol. 2010; 28: 4674-4682
        • Paulissen S.M.
        • van Hamburg J.P.
        • Davelaar N.
        • Asmawidjaja P.S.
        • Hazes J.M.
        • Lubberts E.
        Synovial fibroblasts directly induce Th17 pathogenicity via the cyclooxygenase/prostaglandin E2 pathway, independent of IL-23.
        J Immunol. 2013; 191: 1364-1372
        • Multhoff G.
        • Molls M.
        • Radons J.
        Chronic inflammation in cancer Development.
        Front Immunol. 2012; 2: 98
        • Aderka D.
        • Engelmann H.
        • Shemer-Avni Y.
        • et al.
        Variation in serum levels of the soluble TNF receptors among healthy individuals.
        Lymphokine Cytokine Res. 1992; 11: 157-159
        • Ing S.W.
        • Orchard T.S.
        • Lu B.
        • et al.
        TNF receptors predict hip fracture risk in the WHI study and fatty acid intake does not modify this association.
        J Clin Endocrinol Metab. 2015; 100: 3380-3387
        • Hershman D.L.
        • Unger J.M.
        • Crew K.D.
        • et al.
        Randomized multicenter placebo-controlled trial of omega-3 fatty acids for the control of aromatase inhibitor-induced musculoskeletal pain: SWOG S0927.
        J Clin Oncol. 2015; 33: 1910-1917
        • Fallowfield L.J.
        • Leaity S.K.
        • Howell A.
        • Benson S.
        • Cella D.
        Assessment of quality of life in women undergoing hormonal therapy for breast cancer: Validation of an endocrine symptom subscale for the FACT-B.
        Breast Cancer Res Treat. 1999; 55: 189-199
        • Bruce B.
        • Fries J.F.
        The Stanford Health Assessment Questionnaire: Dimensions and practical applications.
        Health Qual Life Outcomes. 2003; 1: 20
        • Bruce B.
        • Fries J.F.
        The Stanford Health Assessment Questionnaire: A review of its history, issues, progress, and documentation.
        J Rheumatol. 2003; 30: 167-178
        • Janelsins M.C.
        • Mustian K.M.
        • Palesh O.G.
        • et al.
        Differential expression of cytokines in breast cancer patients receiving different chemotherapies: Implications for cognitive impairment research.
        Support Care Cancer. 2012; 20: 831-839
      2. SAS Software [computer program]. Version 9.4. Cary, NC: SAS Institute Inc; 2013.

        • George S.M.
        • Ballard-Barbash R.
        • Shikany J.M.
        • et al.
        Better postdiagnosis diet quality is associated with reduced risk of death among postmenopausal women with invasive breast cancer in the women's health initiative.
        Cancer epidemiology, biomarkers & prevention: A publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2014; 23: 575-583
        • Cavicchia P.P.
        • Steck S.E.
        • Hurley T.G.
        • et al.
        A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein.
        J Nutr. 2009; 139: 2365-2372
        • Coventry B.J.
        • Ashdown M.L.
        • Quinn M.A.
        • Markovic S.N.
        • Yatomi-Clarke S.L.
        • Robinson A.P.
        CRP identifies homeostatic immune oscillations in cancer patients: a potential treatment targeting tool?.
        J Transl Med. 2009; 7: 102
        • Walsh D.
        • Mahmoud F.
        • Barna B.
        Assessment of nutritional status and prognosis in advanced cancer: Interleukin-6, C-reactive protein, and the prognostic and inflammatory nutritional index.
        Support Care Cancer. 2003; 11: 60-62
        • Guo R.M.
        • Xu W.M.
        • Lin J.C.
        • et al.
        Activation of the p38 MAPK/NF-kappaB pathway contributes to doxorubicin-induced inflammation and cytotoxicity in H9c2 cardiac cells.
        Mol Med Rep. 2013; 8: 603-608
        • Sharma A.
        • Binita G.
        • Nikhil G.
        • Baidarbhi C.
        The utility of pro-inflammatory cytokines-TNF alpha and CRP as indicators of response to chemotherapy in patients with breast carcinoma.
        J Mol Biomark Diagn. 2014; 5: 1-5
        • Guest D.D.
        • Evans E.M.
        • Rogers L.Q.
        Diet components associated with perceived fatigue in breast cancer survivors.
        Eur J Cancer Care. 2013; 22: 51-59
        • George S.M.
        • Ballard-Barbash R.
        • Manson J.E.
        • et al.
        Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observational Study: Evidence to inform national dietary guidance.
        AmJ Epidemiol. 2014; 180: 616-625

      Biography

      T. S. Orchard is an assistant professor, Department of Human Sciences, The Ohio State University, Columbus.

      Biography

      R. R. Andridge is an associate professor, College of Public Health, The Ohio State University, Columbus.

      Biography

      L. D. Yee is an associate clinical professor, College of Medicine, Comprehensive Cancer Center, Ohio State University Wexner Medical Center, Columbus.

      Biography

      M. B. Lustberg is an assistant professor, College of Medicine, Comprehensive Cancer Center, Ohio State University Wexner Medical Center, Columbus.