title: Better postdiagnosis diet quality is associated with less cancer-related fatigue in breast cancer survivors.
abstract: OBJECTIVE
  A comprehensive understanding of the role of modifiable health behaviors in effective management of cancer-related fatigue is needed. Among breast cancer survivors, we examined how postdiagnosis diet quality, independently and jointly with physical activity, is related to fatigue, and the potential mediating role of inflammation.
  
  
  METHODS
  Seven hundred seventy women diagnosed with stage 0-IIIA breast cancer in the Health, Eating, Activity, and Lifestyle study completed food frequency and physical activity questionnaires 30 months postdiagnosis. We scored diet quality using the Healthy Eating Index 2010 (HEI-2010). Serum concentrations of C-reactive protein (CRP) were measured in fasting 30-ml blood samples. Multidimensional fatigue was measured 41 months postdiagnosis using the 22-item revised Piper Fatigue Scale. In multivariate linear models, we determined whether fatigue was associated HEI-2010 quartiles (Q1-Q4), and a variable jointly reflecting HEI quartiles and physical activity levels.
  
  
  RESULTS
  Survivors with better-quality diets (Q4 vs. Q1) had lower total fatigue (4.1 vs. 4.8, p-contrast = 0.003) and subscale scores (behavioral severity 3.4 vs. 4.2, p-contrast = 0.003; affective meaning 3.9 vs. 4.8, p-contrast = 0.007; sensory 4.4 vs. 5.2, p-contrast = 0.003; cognitive 4.6 vs. 5.0, p-contrast = 0.046). Least squares estimates of fatigue were similar in models including CRP. Compared to survivors with poor-quality diets and no physical activity, survivors with better-quality diets and meeting physical activity recommendations had significantly lower behavioral severity (3.2 vs. 4.7, p-contrast = 0.002) and sensory (3.8 vs. 4.8. p-contrast = 0.006) fatigue scores.
  
  
  CONCLUSIONS
  In this large breast cancer survivor cohort, postdiagnosis diet quality was inversely and independently associated with fatigue.
  
  
  CONCLUSIONS
  Future interventions designed to improve multiple energy balance behaviors can provide insight into their associations with fatigue.
authors.affiliation: Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9762, Bethesda, MD, 20892-9762, USA, stephanie.george@nih.gov.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: George
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Alfano
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Smith
authors.forename: Richard N
authors.initials: RN
authors.lastname: Baumgartner
authors.forename: Kathy B
authors.initials: KB
authors.lastname: Baumgartner
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
mesh_terms: D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology; D004032:Diet; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D011795:Surveys and Questionnaires; D017741:Survivors