title: Association of Mediterranean diet, dietary supplements and alcohol consumption with breast density among women in South Germany: a cross-sectional study.
abstract: BACKGROUND
  Effects of dietary factors, such as adherence to Mediterranean diet, multivitamin-multimineral supplements use and alcohol consumption on mammographic breast density, an important biomarker of breast cancer risk, are not sufficiently consistent to elaborate preventive recommendations. This study aims to investigate the association between current diet and mammographic density.
  
  
  METHODS
  We performed a cross-sectional study in 424 pre- and post-menopausal women aged 21 to 84 years. Current Mediterranean dietary pattern, multivitamin-multimineral supplements use, alcohol consumption and potential confounders were assessed with a self-administered questionnaire in the University Hospital Ulm (2007-2008). Radiologists evaluated mammographic density according to the American College of Radiology (ACR) classification, which was summarized in low = ACR1/2 and high = ACR3/4 mammographic density. Logistic regression models were used to assess the association between current diet and mammographic density.
  
  
  RESULTS
  Adherance to Mediterranean dietary pattern was inversely associated with mammographic density in the models adjusted for age and BMI (per 1 unit increase of score OR 0.95; 95%CI 0.90-0.997). Current use of multivitamin-multimineral supplements was also inversely associated with mammographic density (OR 0.53; 95%CI 0.34-0.83). Further adjustment revealed similar point estimates but the associations were no longer statistically significant. Compared to non-drinkers, excessive alcohol consumption (<10 g/d) was positively associated with mammographic density (OR 1.47; 95%CI 0.82-2.63).
  
  
  CONCLUSIONS
  Our results show that dietary factors are associated with mammographic density. Adherence to Mediterranean diet and current use of multivitamin-multimineral supplements could be inversely associated with mammographic density and may suggest a protective effect against breast cancer, whereas high alcohol consumption was associated with increased mammographic density.
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm 89081, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Voevodina
authors.forename: Christian
authors.initials: C
authors.lastname: Billich
authors.forename: Birke
authors.initials: B
authors.lastname: Arand
authors.forename: Gabriele
authors.initials: G
authors.lastname: Nagel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D000071060:Breast Density; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean; D019587:Dietary Supplements; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult