title: Diet quality and related factors among Spanish female participants in breast cancer screening programs.
abstract: OBJECTIVE
  A healthy diet is particularly important during menopause, a period in which the risk of a number of health problems increases. This study analyzed diet quality as measured by two indices, namely, the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet (aMED) index, which measures adherence to a Mediterranean diet, and examined the factors associated with lower diet quality.
  
  
  METHODS
  This was a cross-sectional study covering 3,564 women aged 45 to 68 years who underwent breast cancer screening at 7 centers (Corunna, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia, and Zaragoza). Data on diet were collected using a food frequency questionnaire validated for the Spanish population. We calculated the AHEI out of a total of 80 points and the aMED out of a total of 9 points. Ordinal logistic regression models were fitted, taking diet quality (tertiles of the AHEI and the aMED) as dependent variables. The following were included in the final multivariate models as explanatory variables: sociodemographic characteristics, chronic diseases, and lifestyles that were associated with diet quality, with a P value <0.100 in an initial simple model (adjusted solely for calorie intake and screening center). Interaction between menopause status and the other explanatory variables was checked.
  
  
  RESULTS
  The median score for AHEI was 40 of a maximum of 80 points. Lower diet quality was registered by the youngest women (P for trend < 0.001), premenopausal and perimenopausal women (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; and OR, 1.48; CI, 1.20-1.83, respectively), obese women (OR, 1.18; CI, 0.99-1.41), those with a diagnosis of diabetes (OR, 1.35; CI, 1.01-1.79), smokers (OR, 1.41; CI, 1.21-1.66), and women reporting lower daily physical activity (OR, 1.31; CI, 1.12-1.53). Better diet quality was shown by women with higher education (OR, 0.74; CI, 0.62-0.88) and ex-smokers (OR, 0.82; CI, 0.69-0.98). Nulliparity was associated with higher AHEI scores, but only among premenopausal women (OR, 0.50; CI, 0.32-0.78). aMED index varied between 0 and 9 (median 5). Lower scores were associated with younger age (P for trend < 0.001), low socioeconomic level (OR, 1.13; CI, 0.96-1.33), lower educational level (P for trend = 0.008), and low level of daily physical activity (OR, 1.27, CI, 1.08-1.50).
  
  
  CONCLUSIONS
  The youngest women, the most sedentary women, and those who had a lower educational level and socioeconomic status registered worse diet quality. Ex-smokers and postmenopausal women obtained better scores, probably reflecting a keener concern about leading a healthy life.
authors: Unidad de Medicina Preventiva, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Spain.
authors: Nicolás
authors: N
authors: García-Arenzana
authors: Eva María
authors: EM
authors: Navarrete-Muñoz
authors: Mercé
authors: M
authors: Peris
authors: Dolores
authors: D
authors: Salas
authors: Nieves
authors: N
authors: Ascunce
authors: Isabel
authors: I
authors: Gonzalez
authors: Carmen
authors: C
authors: Sánchez-Contador
authors: Carmen
authors: C
authors: Santamariña
authors: Pilar
authors: P
authors: Moreo
authors: María Pilar
authors: MP
authors: Moreno
authors: Jose Antonio Vazquez
authors: JA
authors: Carrete
authors: Francisca
authors: F
authors: Collado-García
authors: Carmen
authors: C
authors: Pedraz-Pingarrón
authors: María
authors: M
authors: Ederra
authors: Josefa
authors: J
authors: Miranda-García
authors: Carmen
authors: C
authors: Vidal
authors: Nuria
authors: N
authors: Aragonés
authors: Beatriz
authors: B
authors: Pérez-Gómez
authors: Jesús
authors: J
authors: Vioque
authors: Marina
authors: M
authors: Pollán
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D004032:Diet / Q000592:standards*; D004034:Diet Surveys; D055088:Early Detection of Cancer; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008019:Life Style; D008593:Menopause; D008875:Middle Aged; D012923:Social Class; D013030:Spain; D011795:Surveys and Questionnaires; D016387:Women's Health