Phenolic Acid Subclasses, Individual Compounds, and Breast Cancer Risk in a Mediterranean Cohort: The SUN Project

Published:January 22, 2020DOI:



      Biological and epidemiological evidence supports an inverse association of phenolic acids with obesity-related chronic diseases. However, no previous study has prospectively evaluated the relationship between subclasses and individual compounds of phenolic acids and the risk of postmenopausal breast cancer, one of the most important and prevalent obesity-related cancer sites.


      This study examined associations between subclasses of phenolic acids, including hydroxycinnamic and hydroxybenzoic acids intake, and risk of breast cancer.


      The Seguimiento Universidad de Navarra (SUN) Project is a dynamic, permanently open prospective cohort which started in 1999.


      Participants were 10,812 middle-aged women. All of them were university graduates.

      Main outcome measures

      Usual diet was assessed at baseline and after 10 years of follow-up with a 136-item food frequency questionnaire. Phenolic acid intake was calculated by matching food consumption with the Phenol-Explorer database on phenolic acids content of each reported food item.

      Statistical analysis performed

      Participants were classified according to tertiles of subclasses or individual compounds of phenolic acids. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios and 95% CIs for breast cancer incidence.


      Over an average of 11.8 years of follow-up, 101 incident cases of breast cancer were confirmed. After multivariable adjustment, an inverse association between hydroxycinnamic acids intake and breast cancer was observed (hazard ratio third tertile vs first tertile 0.37, 95% CI 0.16 to 0.85; P for trend=0.029) among postmenopausal women. Specifically, chlorogenic acids (3-, 4-, and 5- caffeoylquinic acids) showed the strongest inverse association (hazard ratio third tertile vs first tertile 0.33, 95% CI 0.14 to 0.78; P for trend=0.012).


      A higher intake of hydroxycinnamic acids, especially from chlorogenic acids—present in coffee, fruits, and vegetables—was associated with a lower incidence of breast cancer among postmenopausal women. Future observational studies are needed to corroborate these results.


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      A. Romanos-Nanclares is a registered dietitian and PhD student, Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Spain, and Navarra Institute for Health Research, Pamplona, Spain.


      C. Sánchez-Quesada is a PhD, Immunology Division, Department of Health Sciences, University of Jaén, Jaén, Spain.


      I. Gardeazábal is a Medical Doctor and PhD, Department of Preventive Medicine and Public Health, University of Navarra, Spain, and in the Department of Oncology, University of Navarra Clinic, Navarra, Spain.


      M. A. Martínez-González is chair, Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Navarra, Spain, Center for Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain, Navarra Institute for Health Research, Pamplona, Spain, and an adjunct professor, Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.


      A. Gea is assistant professor, Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Navarra, Spain, Center for Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain, and Navarra Institute for Health Research, Pamplona, Spain.


      E. Toledo is associate professor, Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Navarra, Spain, Center for Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain, and Navarra Institute for Health Research, Pamplona, Spain.