Abstract
Background
Lifestyle factors are important for cancer survival. However, empirical evidence regarding
the effects of dietary changes on mortality in breast cancer survivors is sparse.
Objective
The objective was to examine the associations of changes in overall diet quality,
indicated by the Healthy Eating Index (HEI)-2010 score, with mortality in breast cancer
survivors.
Design
This was a prospective cohort study from September 1993 through September 30, 2015.
Participants/setting
This study included 2,295 postmenopausal women who were diagnosed with invasive breast
cancer and completed a food frequency questionnaire both before and after the diagnosis
of breast cancer in the Women’s Health Initiative.
Main outcome measures
The HEI-2010 score (maximum score of 100) was calculated based on consumption of 12
dietary components. The outcomes were mortality from all causes, breast cancer, and
causes other than breast cancer.
Statistical analyses performed
Multivariable Cox proportional hazards models were used to estimate adjusted hazard
ratios of mortality from all causes, breast cancer, and other causes.
Results
Over 12 years of follow-up, 763 deaths occurred. Compared with women with relatively
stable diet quality (±14.9% change in HEI-2010 score), women who decreased diet quality
(≥15% decrease in HEI-2010 score) had a higher risk of death from breast cancer (adjusted
hazard ratio 1.66, 95% CI 1.09 to 2.52). Increased diet quality (≥15% increase in
HEI-2010 score) was not significantly associated with lower risk of death. These associations
persisted after additional adjustment for change in body mass index.
Conclusions
Among women with breast cancer, decreased diet quality after breast cancer diagnosis
was associated with higher risk of death from breast cancer.
Keywords
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Biography
Y. Sun is a postdoctoral research scholar, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
Biography
B. Liu is a postdoctoral research scholar, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
Biography
L. G. Snetselaar is a professor and chair, Preventive Nutrition Education, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
Biography
W. Bao is an assistant professor, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, and a member, Obesity Research and Education Initiative and the Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City.
Biography
B. J. Caan is a senior research scientist and director of the early stage scientist program, Division of Research, Kaiser Permanente Northern California, Oakland.
Biography
D. S. Lane is vice chair and a professor, Department of Family, Population and Preventive Medicine; division head, Preventive Medicine and Population Health; and division head, Graduate Medical Education, School of Medicine, Stony Brook University, Stony Brook, NY.
Biography
A. E. Millen is an associate professor, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo.
Biography
M. S. Simon is an oncologist and professor, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI.
Biography
C. A. Thomson is a professor, Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson.
Biography
L. F. Tinker is a nutrition scientist, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
Biography
L. V. Van Horn is a professor, associate dean, and chief of nutrition, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Biography
M. Z. Vitolins is vice chair and a professor, Department of Epidemiology and Prevention, Wake Forest School of Medicine and Comprehensive Cancer Center at Wake Forest Baptist Health, Winston-Salem, NC.
Article info
Publication history
Published online: May 30, 2018
Accepted:
March 22,
2018
Received:
December 28,
2017
Footnotes
Supplementary materials: Tables 4, 5, 6, 7, 8, and 9 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT The WHI programs is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services, through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
