title: Spanish Mediterranean diet and other dietary patterns and breast cancer risk: case-control EpiGEICAM study.
abstract: BACKGROUND
  Although there are solid findings regarding the detrimental effect of alcohol consumption, the existing evidence on the effect of other dietary factors on breast cancer (BC) risk is inconclusive. This study aimed to evaluate the association between dietary patterns and risk of BC in Spanish women, stratifying by menopausal status and tumour subtype, and to compare the results with those of Alternate Healthy Index (AHEI) and Alternate Mediterranean Diet Score (aMED).
  
  
  METHODS
  We recruited 1017 incident BC cases and 1017 matched healthy controls of similar age (±5 years) without a history of BC. The association between 'a priori' and 'a posteriori' developed dietary patterns and BC in general and according to menopausal status and intrinsic tumour subtypes (ER+/PR+ and HER2-; HER2+; and ER-/PR- and HER2-) was evaluated using logistic and multinomial regression models.
  
  
  RESULTS
  Adherence to the Western dietary pattern was related to higher risk of BC (OR for the top vs the bottom quartile 1.46 (95% CI 1.06-2.01)), especially in premenopausal women (OR=1.75; 95% CI 1.14-2.67). In contrast, the Mediterranean pattern was related to a lower risk (OR for the top quartile vs the bottom quartile 0.56 (95% CI 0.40-0.79)). Although the deleterious effect of the Western pattern was similarly observed in all tumour subtypes, the protective effect of our Mediterranean pattern was stronger for triple-negative tumours (OR=0.32; 95% CI 0.15-0.66 and Pheterogeneity=0.04). No association was found between adherence to the Prudent pattern and BC risk. The associations between 'a priori' indices and BC risk were less marked (OR for the top vs the bottom quartile of AHEI=0.69; 95% CI 0.51-0.94 and aMED=0.74; 95% CI 0.46-1.18)).
  
  
  CONCLUSIONS
  Our results confirm the harmful effect of a Western diet on BC risk, and add new evidence on the benefits of a diet rich in fruits, vegetables, legumes, oily fish and vegetable oils for preventing all BC subtypes, and particularly triple-negative tumours.
authors.affiliation: 1] Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [2] Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [3] Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Castelló
authors.affiliation: 1] Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [2] Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029 Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pollán
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Buijsse
authors.affiliation: Medical Oncology Unit, Instituto Valenciano de Oncología, C/Profesor Beltrán Baguena 19, 46009 Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ruiz
authors.affiliation: Medical Oncology Unit, Hospital Virgen del Rocío, Avenida Maneul Siurot S/N, 41013 Sevilla, Spain.
authors.forename: A M
authors.initials: AM
authors.lastname: Casas
authors.affiliation: Medical Oncology Unit, Hospital Puerta del Mar, Avenida Ana De Viya 21, 11009 Cádiz, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Baena-Cañada
authors.affiliation: 1] Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [2] Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029 Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Lope
authors.affiliation: Medical Oncology Unit, Complejo Hospitalario Universitario, Calle Xubias De Arriba, 84, 15006 A Coruña, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Antolín
authors.affiliation: Medical Oncology Unit, Centro Oncológico de Galicia, Avenida Monsterrat S/N, 15009 A Coruña, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ramos
authors.affiliation: Medical Oncology Unit, Hospital Clinic I Provincial de Barcelona, Calle Villaroel 170, 08036 Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Muñoz
authors.affiliation: Hematology-Oncology Department, Hospital Clínico Universitario de Valencia / INCLIVA, Universidad de Valencia, Avenida Blasco Ibáñez, 17, 46010 Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Lluch
authors.affiliation: Medical Oncology Unit, Hospital Marqués de Valdecilla, Avenida De Valdecilla S/N, 39008 Santander, Spain.
authors.forename: A
authors.initials: A
authors.lastname: de Juan-Ferré
authors.affiliation: Medical Oncology Unit, Fundación Hospitalaria de Alcorcón, Calle Budapest 1, 28922 Alcorcón, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Jara
authors.affiliation: Spanish Breast Cancer Research Group (GEICAM) Headquarters, Avenida De los Pirineos 7, 28703 San Sebastián de los Reyes, Madrid, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Jimeno
authors.affiliation: Medical Oncology Unit, Hospital Puerta del Mar, Avenida Ana De Viya 21, 11009 Cádiz, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Rosado
authors.affiliation: Medical Oncology Unit, Hospital Virgen del Rocío, Avenida Maneul Siurot S/N, 41013 Sevilla, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Díaz
authors.affiliation: Medical Oncology Unit, Instituto Valenciano de Oncología, C/Profesor Beltrán Baguena 19, 46009 Valencia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Guillem
authors.affiliation: Spanish Breast Cancer Research Group (GEICAM) Headquarters, Avenida De los Pirineos 7, 28703 San Sebastián de los Reyes, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Carrasco
authors.affiliation: 1] Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [2] Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029 Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Pérez-Gómez
authors.affiliation: 1] Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029 Madrid, Spain [2] Department of Public Health, Universidad Miguel Hernandez, Ctra. Alicante-Valencia, Km. 87, 03550 Sant Joan D'Alacant, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Vioque
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Boeing
authors.affiliation: 1] Medical Oncology Unit, Hospital Clínico Universitario San Carlos, Calle Profesor Martín Lagos, S/N, 28040 Madrid, Spain [2] Health Research Institute Gregorio Marañón, Universidad Complutense, Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Martín
mesh_terms: D016022:Case-Control Studies; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D015994:Incidence; D012306:Risk; D013030:Spain; D064726:Triple Negative Breast Neoplasms / Q000453:epidemiology / Q000209:etiology*
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