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Closely following a Mediterranean diet in everyday life may significantly reduce the risk for types of breast cancer that are associated with poorer prognoses in postmenopausal women, new research indicates.The traditional Mediterranean diet is characterized by a high intake of plant proteins, whole grains, fish, and monounsaturated fat, as well as moderate alcohol intake and low intake of refined grains, red meat, and sweets, say the study authors, led by Piet A. van den Brandt, PhD, an epidemiologist at the Maastricht University Medical Center in the Netherlands.This diet has been repeatedly shown to be associated with decreased risk for cardiovascular diseases, but the evidence in cancer, including breast cancer, is less established, say the authors.The new findings come from 62,573 Dutch women aged 55 to 69 years who provided information on dietary and lifestyle habits in 1986 and have since been followed for more than 20 years.
The study was published online March 5 in the International Journal of Cancer.It consisted of multivariate case–cohort analyses of 2321 incident breast cancer patients and 1665 women who were without breast cancer and for whom complete diet data were available.The investigators found that women who most closely adhered to a Mediterranean diet had a 40% reduced risk for estrogen receptor–negative (ER-) breast cancer compared to women who adhered to the diet the least (hazard ratio [HR], 0.60; ptrend = .032).They found a 39% reduced risk for progesterone receptor–negative (PR-)/ER- disease when comparing these same high- and low-adherence groups (HR, 0.61; ptrend = .047).Notably, in these results, the definition of the diet excluded alcohol intake, because the consumption of alcohol is a known risk factor for breast cancer. Alcohol was, however, one of many variables controlled for, along with other factors, such as age, body mass index, family history of breast cancer, use of hormone replacement therapy, and smoking status.The authors also report that there were no significant associations with the diet and the risk of ER+ disease or total breast cancer.It makes sense that the protective effect of the diet was not seen in women with ER+ disease, say the authors."Any potential influence of dietary factors may be difficult to detect in ER+ tumors given the strong influence of hormonal factors. In ER- tumors, other risk factors, including diet, may exert a relatively larger influence and be more easily detectable," they write.
Dr van den Brandt also explained that older women, who were the subjects of the new study, are more likely to derive benefit than younger women.
"Generally speaking, postmenopausal breast cancer seems somewhat more influenced by environmental factors, such as lifestyle and diet, than premenopausal breast cancer, where genetic factors seem to play a more prominent role," he told Medscape Medical News.
Hanna E. Bloomfield, MD, MPH, an internist at the University of Minnesota and the Minneapolis VA Healthcare System, currently recommends the Mediterranean diet to her female patients.
"I can't see any downside, and there is some evidence of benefit," she told Medscape Medical News.
Dr Bloomfield, who was not involved in the Dutch study, was the lead author a 2016 meta-analysis of studies of the diet and concluded that "limited evidence" indicates it "may" reduce the incidence of breast cancer.
The new study is "well-conducted," said Estefania Toledo, PhD, of the Department of Preventive Medicine and Public Health at the Universidad de Navarra in Spain, who was asked for comment.
It is also "important" because few prospective cohort studies have addressed an association between the Mediterranean diet and breast cancer, she said.
Dr Toledo was the senior author of the only large, randomized trial to date in which postmenopausal women were assigned to a dietary intervention to promote their adherence to the traditional Mediterranean diet (JAMA Intern Med. 2015;175:1752–60). The study found that women with a higher adherence to the diet (supplemented with extra-virgin olive oil) showed a substantial reduction of their risk for breast cancer compared to a control group, as reported by Medscape Medical News.
Dr Toledo highlighted the fact that the Dutch authors, in their new article, also conducted a meta-analysis of cohort studies that confirmed their own cohort study's finding.
Indeed, the Dutch authors report that, in the meta-analysis, summary hazard ratios for high vs low Mediterranean diet adherence were not significant for total postmenopausal breast cancer cases (0.94) and cases of ER+ disease (0.98) but were statistically significant for ER- (0.73) and ER-/PR- (0.77) breast cancer cases.
Other major cohort studies with similar findings to the Dutch study include the Nurses' Health Study and the European Prospective Investigation into Cancer (EPIC), say Dr van den Brandt and his coauthors.
The mechanisms of action behind the potential beneficial effects of the Mediterranean diet on cancer risk are uncertain, say the authors.
However, they say that the effects may be attributable to high amounts of fiber, antioxidants, and vitamins; they may be mediated through biological mechanisms, such as chronic inflammation and oxidative stress and through the regulation of body weight; and they may be associated DNA oxidative damage.
The study was funded by the Wereld Kanker Onderzoek Fonds Nederland as part of the World Cancer Research Fund International grant program. The authors, Dr Toledo, and Dr Bloomfield have disclosed no relevant financial relationships.
63 Highly Processed Foods May Raise Overall Cancer Risk 2018-02-16 Dr Rajesh Jain A diet that includes a lot of highly processed foods loaded with sugar, fat, and salt may do more than raise the risk for overweight, obesity, type 2 diabetes, and heart disease, researchers warn.Highly processed foods such as packaged baked goods, instant soups, reconstituted meats, frozen meals, and shelf-stable snacks also contain substances that may significantly increase overall risk for cancer and breast cancer, according to Mathilde Touvier, PhD, of the Sorbonne Paris Cité Epidemiology and Statistics Research Center in Paris, France, and colleagues.The team reports results from a prospective study of more than 100,000 participants from the NutriNet-Santé cohort, published online February 14 in the BMJ.They found that a 10% increase in the proportion of ultraprocessed foods in the diet was associated with an 11% increase in overall cancer risk [hazard ratio [HR], 1.12; P < .001). These foods included ultraprocessed fats and sauces (P = .002), as well as sugary products (P = .03) and drinks (P = .005).
"If confirmed in other populations and settings, these results suggest that the rapidly increasing consumption of ultra-processed foods may drive an increasing burden of cancer in the next decades," the authors warn.
The rapidly increasing consumption of ultra-processed foods may drive an increasing burden of cancer in the next decades.Dr Mathilde Touvier and colleagues
They also note that many people worldwide are eating highly processed foods. Previous surveys that assessed individual food intake in Europe, the United States, Canada, New Zealand, and Brazil indicate that up to 50% of the total daily energy intake of people living in developed countries comes from highly processed foods and food products.
Increased Risk for Breast Cancer
The study also found that consumption of ultraprocessed foods was associated with a 12% increase in the risk for breast cancer (HR, 1.11; P = .02). Such products include those that contain a lot of sugar (P = .006)group.No significant association was found between consumption of highly processed foods and an increased risk for prostate or colorectal cancer.There was also no significant association between less processed foods and risk for cancer. These included canned vegetables, cheeses, and fresh, unpackaged bread.Conversely, a diet consisting mostly of fresh or minimally processed foods, including fruits, vegetables, pulses, rice, pasta, eggs, meat, fish, and milk, was associated with a reduced risk for overall cancer and breast cancer, the study showed."These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis)," the study authors write.
Results Should Be Interpreted With Care
Because this is an observational study, no firm conclusions can be drawn about causality, Touvier told Medscape Medical News. "We need not be too alarmist. Caution is needed at this stage. These results need to be confirmed by other prospective cohorts, and deeper investigation [is needed] of the mechanisms involved."
In an accompanying editorial, Adriana Monge and Martin Lajous, MD, of the National Institute of Public Health in Mexico City and the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, called the results "interesting" but warned that they must be interpreted with care.
A lot more work is needed to provide the epidemiologic evidence that could shape public policy or lead to the development of actionable advice, the editorialists say.
"We are a long way from understanding the full implications of food processing for health and wellbeing," Monge and Lajous write. "The changing realities of the global food supply and the inherent limitations of epidemiologic studies call for more basic science, including data from animals, to inform further research on the effect of food processing on humans. Care should be taken to transmit the strengths and limitations of this latest analysis to the general public and to increase the public's understanding of the complexity associated with nutritional research in free living populations."
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