title: Fatigue, inflammation, and ω-3 and ω-6 fatty acid intake among breast cancer survivors.
abstract: OBJECTIVE
  Evidence suggests that inflammation may drive fatigue in cancer survivors. Research in healthy populations has shown reduced inflammation with higher dietary intake of ω-3 polyunsaturated fatty acids (PUFAs), which could potentially reduce fatigue. This study investigated fatigue, inflammation, and intake of ω-3 and ω-6 PUFAs among breast cancer survivors.
  
  
  METHODS
  Six hundred thirty-three survivors (mean age, 56 years; stage I to IIIA) participating in the Health, Eating, Activity, and Lifestyle Study completed a food frequency/dietary supplement questionnaire and provided a blood sample assayed for C-reactive protein (CRP) and serum amyloid A (30 months after diagnosis) and completed the Piper Fatigue Scale and Short Form-36 (SF-36) vitality scale (39 months after diagnosis). Analysis of covariance and logistic regression models tested relationships between inflammation and fatigue, inflammation and ω-3 and ω-6 PUFA intake, and PUFA intake and fatigue, controlling for three incremental levels of confounders. Fatigue was analyzed continuously (Piper scales) and dichotomously (SF-36 vitality ≤ 50).
  
  
  RESULTS
  Behavioral (P = .003) and sensory (P = .001) fatigue scale scores were higher by increasing CRP tertile; relationships were attenuated after adjustment for medication use and comorbidity. Survivors with high CRP had 1.8 times greater odds of fatigue after full adjustment (P < .05). Higher intake of ω-6 relative to ω-3 PUFAs was associated with greater CRP (P = .01 after full adjustment) and greater odds of fatigue (odds ratio, 2.6 for the highest v lowest intake; P < .05).
  
  
  CONCLUSIONS
  Results link higher intake of ω-3 PUFAs, decreased inflammation, and decreased physical aspects of fatigue. Future studies should test whether ω-3 supplementation may reduce fatigue among significantly fatigued breast cancer survivors.
authors.affiliation: Office of Cancer Survivorship, National Cancer Institute, 6116 Executive Blvd, Ste 404, Bethesda, MD 20892-8336, USA. alfanoc@mail.nih.gov
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Alfano
authors.forename: Ikuyo
authors.initials: I
authors.lastname: Imayama
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
authors.forename: Janice K
authors.initials: JK
authors.lastname: Kiecolt-Glaser
authors.forename: Ashley Wilder
authors.initials: AW
authors.lastname: Smith
authors.forename: Kathleen
authors.initials: K
authors.lastname: Meeske
authors.forename: Anne
authors.initials: A
authors.lastname: McTiernan
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
authors.forename: Kathy B
authors.initials: KB
authors.lastname: Baumgartner
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Ulrich
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D019587:Dietary Supplements; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000097:blood; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018836:Inflammation Mediators / Q000032:analysis; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D000685:Serum Amyloid A Protein / Q000378:metabolism; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D018836:Inflammation Mediators; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein