title: Are diet quality scores after breast cancer diagnosis associated with improved breast cancer survival?
abstract: Previous studies have found that diets rich in fruits and vegetables are associated with reduced breast cancer mortality. However, these eating patterns do not necessarily reflect overall diet quality. The association of breast cancer mortality with a priori defined dietary scores, which are based on recommended dietary guidelines and reflect diet quality, has not been evaluated. We hypothesized that diet quality indices based on recommended guidelines are associated with decreased risk of breast cancer and nonbreast cancer mortality in breast cancer survivors. We examined the association between the Dietary Approaches to Stop Hypertension (DASH) score, and the Alternative Healthy Eating Index (AHEI)-2010, and the risk of breast cancer mortality and total mortality among women from the Nurses' Health Study diagnosed with breast cancer. Adherence to DASH-style and AHEI-2010 diets were associated with reduced risk of nonbreast cancer mortality (comparing the fifth quintile with the first quintile, relative risk (RR) = 0.72, 95% confidence interval (CI): 0.53-0.99, P trend = 0.03 for DASH, and RR = 0.57, 95% CI: 0.42-0.77, P trend <0.0001 for AHEI-2010). Diet scores were not significantly associated with breast cancer mortality. Our findings suggest that adherence to a higher quality diet after breast cancer diagnosis does not considerably change the risk of breast cancer death and recurrence. However, healthy dietary choices after breast cancer were associated with reduced risk of nonbreast cancer mortality in women with breast cancer.
authors.affiliation: The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Monika A
authors.initials: MA
authors.lastname: Izano
authors.forename: Teresa T
authors.initials: TT
authors.lastname: Fung
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Chiuve
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000178:diet therapy* / Q000401:mortality*; D004032:Diet; D023381:Endpoint Determination; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D008875:Middle Aged; D015596:Nutrition Assessment; D018673:Nutrition Policy; D010349:Patient Compliance; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014481:United States; D014675:Vegetables
references.citation: J Nutr. 2012 Jun;142(6):1009-18
references.pmid: 22513989
references.citation: J Clin Oncol. 2003 Jul 1;21(13):2500-7
references.pmid: 12829669
references.citation: Breast Cancer Res Treat. 1998 Sep;51(1):17-28
references.pmid: 9877026
references.citation: J Clin Oncol. 2009 Feb 20;27(6):919-26
references.pmid: 19114692
references.citation: Am J Epidemiol. 1984 May;119(5):837-9
references.pmid: 6720679
references.citation: Nutr Cancer. 2011;63(3):381-8
references.pmid: 21462090
references.citation: J Clin Oncol. 2005 Mar 1;23(7):1370-8
references.pmid: 15684320
references.citation: J Vet Med B Infect Dis Vet Public Health. 2006 Sep;53(7):326-32
references.pmid: 16930277
references.citation: J Nutr. 2007 Nov;137(11):2443-50
references.pmid: 17951483
references.citation: Am J Clin Nutr. 2010 Dec;92(6):1429-35
references.pmid: 21097651
references.citation: Biometrics. 1979 Mar;35(1):25-39
references.pmid: 497336
references.citation: JAMA. 2007 Jul 18;298(3):289-98
references.pmid: 17635889
references.citation: Breast Cancer Res Treat. 1991 May;18 Suppl 1:S135-41
references.pmid: 1873551
references.citation: Breast Cancer Res Treat. 1999 Feb;53(3):241-53
references.pmid: 10369070
references.citation: Arch Intern Med. 2008 Apr 14;168(7):713-20
references.pmid: 18413553
references.citation: J Clin Oncol. 2005 Dec 20;23(36):9295-303
references.pmid: 16361628
references.citation: JAMA. 1999 Mar 10;281(10):914-20
references.pmid: 10078488
references.citation: J Nutr. 2006 Feb;136(2):466-72
references.pmid: 16424129
references.citation: Am J Clin Nutr. 2008 Feb;87(2):339-46
references.pmid: 18258623
references.citation: Nutr Cancer. 2002;44(2):139-44
references.pmid: 12734059
references.citation: Am J Epidemiol. 2011 Sep 15;174(6):652-60
references.pmid: 21832271
references.citation: JAMA. 2005 May 25;293(20):2479-86
references.pmid: 15914748
references.citation: Br J Cancer. 1994 Mar;69(3):592-5
references.pmid: 8123493
references.citation: Am J Clin Nutr. 2007 Sep;86(3):s878-81
references.pmid: 18265482
references.citation: Am J Epidemiol. 1999 Mar 15;149(6):531-40
references.pmid: 10084242
references.citation: Breast Cancer Res Treat. 2009 Mar;114(1):1-6
references.pmid: 18373274
references.citation: Int J Cancer. 2007 Jun 15;120(12):2672-7
references.pmid: 17278091
references.citation: J Natl Cancer Inst. 1993 Jan 6;85(1):32-6
references.pmid: 8416253
references.citation: J Natl Cancer Inst. 1994 Sep 21;86(18):1390-7
references.pmid: 8072032
references.citation: J Natl Cancer Inst. 2006 Dec 20;98(24):1767-76
references.pmid: 17179478