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Epidemiology

Adherence to plant-based dietary pattern and risk of breast cancer among Iranian women

European Journal of Clinical Nutrition volume 75, pages 1578–1587 (2021)Cite this article

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Abstract

Objectives

Previous studies assessed the link between plant based diet and breast cancer risk rather than healthy and unhealthy plant based diet. This study examined the relation between plant-based dietary pattern and risk of breast cancer among Iranian women.

Methods

This hospital-based case–control study was conducted among 412 women with pathologically confirmed breast cancer within the past year and 456 apparently healthy controls. Dietary data were collected using a validated and reliable 168-item FFQ. We created three patterns including overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). The risk of breast cancer was compared across quartiles of PDI, hPDI, and uPDI.

Results

we did not find significant association between adherence to PDI and uPDI score and odds of breast cancer among women. However, a greater score of hPDI was inversely associated to the risk of breast cancer (OR: 0.63; 95% CI: 0.43–0.93, P = 0.01), in the crude model. After adjustment for age and energy, we saw stronger association between breast cancer risk and higher hPDI score (OR: 0.55; 95% CI: 0.37–0.82, P = 0.002). After stratified by menopausal status, we did not find significant association between PDI and uPDI score and risk of breast cancer. However, pre- and postmenopausal women in the highest quartile of hPDI score had lower risk of breast cancer than those in the lowest quartile.

Conclusions

we found an inverse significant association between hPDI and odds of breast cancer in the whole population of study. After stratifying by menopausal status, this correlation was also seen both in pre and postmenopausal women.

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References

  1. Albeshan SM, Mackey MG, Hossain SZ, Alfuraih AA, Brennan PC. Breast cancer epidemiology in gulf cooperation council countries: a regional and international comparison. Clin Breast Cancer 2018;18:e381–e92.

    Article  Google Scholar 

  2. Cancer IAfRo. GLOBOCAN: World Health Organization International Agency for Research on Cancer; 2018. https://gco.iarc.fr/today/online-analysis-multi-bars?v=2018&mode=cancer&mode_population=countries&population. Accessed 17 Jul 2018.

  3. Cancer IAfRo. GLOBOCAN: World Health Organization/International Agency for Research on Cancer; 2018. https://gco.iarc.fr/today/online-analysis-map. Accessed 6 Feb 2019.

  4. Iyengar NM, Arthur R, Manson JE, Chlebowski RT, Kroenke CH, Peterson L, et al. Association of body fat and risk of breast cancer in postmenopausal women with normal body mass index: a secondary analysis of a randomized clinical trial and observational study. JAMA Oncol. 2018;5:155–163.

    Article  Google Scholar 

  5. LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and cancer: a statement of the American Society of Clinical Oncology. J Clin Oncol. 2018;36:83–93.

    Article  CAS  Google Scholar 

  6. Steiner E, Klubert D, Knutson D. Assessing breast cancer risk in women. Am Fam Physician. 2008;78:1361–6.

    PubMed  Google Scholar 

  7. Brinton LA, Brogan DR, Coates RJ, Swanson CA, Potischman N, Stanford JL. Breast cancer risk among women under 55 years of age by joint effects of usage of oral contraceptives and hormone replacement therapy. Menopause. 2018;25:1195–200.

    Article  Google Scholar 

  8. Gram IT, Park S-Y, Maskarinec G, Wilkens LR, Haiman CA, Le Marchand L. Smoking and breast cancer risk by race/ethnicity and oestrogen and progesterone receptor status: the Multiethnic Cohort (MEC) study. Int J Epidemiol. 2019.

  9. Xiao Y, Ke Y, Wu S, Huang S, Li S, Lv Z, et al. Association between whole grain intake and breast cancer risk: a systematic review and meta-analysis of observational studies. Nutr J. 2018;17:87.

    Article  Google Scholar 

  10. Farvid MS, Chen WY, Michels KB, Cho E, Willett WC, Eliassen AH. Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study. BMJ. 2016;353:i2343.

    Article  Google Scholar 

  11. Sangaramoorthy M, Koo J, John EM. Intake of bean fiber, beans, and grains and reduced risk of hormone receptor‐negative breast cancer: the San Francisco Bay Area Breast Cancer Study. Cancer Med. 2018;7:2131–44.

    Article  CAS  Google Scholar 

  12. Farvid MS, Stern MC, Norat T, Sasazuki S, Vineis P, Weijenberg MP, et al. Consumption of red and processed meat and breast cancer incidence: A systematic review and meta‐analysis of prospective studies. Int J Cancer. 2018;143:2787–99.

    Article  CAS  Google Scholar 

  13. Romanos-Nanclares A, Toledo E, Gardeazabal I, Jiménez-Moleón J, Martínez-González M, Gea A. Sugar-sweetened beverage consumption and incidence of breast cancer: the Seguimiento Universidad de Navarra (SUN) Project. Eur J Nutr. 2018;58:1–12.

    Google Scholar 

  14. Xiao Y, Xia J, Li L, Ke Y, Cheng J, Xie Y, et al. Associations between dietary patterns and the risk of breast cancer: a systematic review and meta-analysis of observational studies. Breast Cancer Res. 2019;21:16.

    Article  Google Scholar 

  15. Turati F, Carioli G, Bravi F, Ferraroni M, Serraino D, Montella M, et al. Mediterranean diet and breast cancer risk. Nutrients. 2018;10:326.

    Article  Google Scholar 

  16. Penniecook-Sawyers JA, Jaceldo-Siegl K, Fan J, Beeson L, Knutsen S, Herring P, et al. Vegetarian dietary patterns and the risk of breast cancer in a low-risk population. Br J Nutr. 2016;115:1790–7.

    Article  CAS  Google Scholar 

  17. Chang Y-J, Hou Y-C, Chen L-J, Wu J-H, Wu C-C, Chang Y-J, et al. Is vegetarian diet associated with a lower risk of breast cancer in Taiwanese women? BMC Public Health. 2017;17:800.

    Article  Google Scholar 

  18. Gilsing A, Weijenberg M, Goldbohm R, Dagnelie P, Van Den Brandt P, Schouten L. Vegetarianism, low meat consumption and the risk of lung, postmenopausal breast and prostate cancer in a population-based cohort study. Eur J Clin Nutr.2016;70:723

    Article  CAS  Google Scholar 

  19. Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Crit Rev food Sci Nutr. 2017;57:3640–9.

    Article  Google Scholar 

  20. Chatenoud L, La Vecchia C, Franceschi S, Tavani A, Jacobs DR Jr, Parpinel MT, et al. Refined-cereal intake and risk of selected cancers in Italy. Am J Clin Nutr. 1999;70:1107–10.

    Article  CAS  Google Scholar 

  21. Tajaddini A, Pourzand A, Sanaat Z, Pirouzpanah S. Dietary resistant starch contained foods and breast cancer risk: a case-control study in northwest of Iran. Asian Pac J Cancer Prev. 2015;16:4185–92.

    Article  Google Scholar 

  22. Sieri S, Krogh V, Ferrari P, Berrino F, Pala V, Thiébaut AC, et al. Dietary fat and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2008;88:1304–12.

    CAS  PubMed  Google Scholar 

  23. Esmaillzadeh A, Azadbakht L. Food intake patterns may explain the high prevalence of cardiovascular risk factors among Iranian women. J Nutr. 2008;138:1469–75.

    Article  CAS  Google Scholar 

  24. Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F. Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr. 2010;13:654–62.

    Article  Google Scholar 

  25. Asghari G, Rezazadeh A, Hosseini-Esfahani F, Mehrabi Y, Mirmiran P, Azizi F. Reliability, comparative validity and stability of dietary patterns derived from an FFQ in the Tehran Lipid and Glucose Study. Br J Nutr. 2012;108:1109–17.

    Article  CAS  Google Scholar 

  26. Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol. 2010;20:150–8.

    Article  Google Scholar 

  27. Esmaillzadeh A, Mirmiran P, Azizi F. Whole-grain intake and the prevalence of hypertriglyceridemic waist phenotype in Tehranian adults. Am J Clin Nutr. 2005;81:55–63.

    Article  CAS  Google Scholar 

  28. Madigan M. The role of plant-based nutrition in preventing heart disease. Univ Toronto Med J. 2017;94:17–24.

    Google Scholar 

  29. Liu Y, Colditz GA, Cotterchio M, Boucher BA, Kreiger N. Adolescent dietary fiber, vegetable fat, vegetable protein, and nut intakes and breast cancer risk. Breast Cancer Res Treat. 2014;145:461–70.

    Article  CAS  Google Scholar 

  30. Shridhar K, Singh G, Dey S, Singh Dhatt S, Paul Singh Gill J, Goodman M, et al. Dietary patterns and breast cancer risk: a multi-centre case control study among north Indian women. Int J Environ Res Public Health. 2018;15:1946.

    Article  Google Scholar 

  31. Gathani T, Barnes I, Ali R, Arumugham R, Chacko R, Digumarti R, et al. Lifelong vegetarianism and breast cancer risk: a large multicentre case control study in India. BMC Women’s Health 2017;17:6.

    Article  Google Scholar 

  32. Godos J, Bella F, Sciacca S, Galvano F, Grosso G. Vegetarianism and breast, colorectal and prostate cancer risk: an overview and meta‐analysis of cohort studies. J Hum Nutr Dietetics. 2017;30:349–59.

    Article  CAS  Google Scholar 

  33. Kojima R, Okada E, Ukawa S, Mori M, Wakai K, Date C, et al. Dietary patterns and breast cancer risk in a prospective Japanese study. Breast Cancer. 2017;24:152–60.

    Article  Google Scholar 

  34. Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J, Fraser G. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Prev Biomarkers. 2013;22:286–94.

    Article  Google Scholar 

  35. Catsburg C, Kim RS, Kirsh VA, Soskolne CL, Kreiger N, Rohan TE. Dietary patterns and breast cancer risk: a study in 2 cohorts. Am J Clin Nutr. 2015;101:817–23.

    Article  CAS  Google Scholar 

  36. O’Keefe SJ. Plant-based foods and the microbiome in the preservation of health and prevention of disease. American J Clin Nutr. 2019;110:265–266.

    Article  Google Scholar 

  37. Mattisson I, Wirfält E, Johansson U, Gullberg B, Olsson H, Berglund G. Intakes of plant foods, fibre and fat and risk of breast cancer—a prospective study in the Malmö Diet and Cancer cohort. Br J Cancer. 2004;90:122.

    Article  CAS  Google Scholar 

  38. Forman MR. Changes in dietary fat and fiber and serum hormone concentrations: nutritional strategies for breast cancer prevention over the life course. J Nutr. 2007;137:S170S–S4.

    Article  Google Scholar 

  39. Kerver JM, Gardiner JC, Dorgan JF, Rosen CJ, Velie EM. Dietary predictors of the insulin-like growth factor system in adolescent females: results from the Dietary Intervention Study in Children (DISC). Am J Clin Nutr. 2010;91:643–50.

    Article  CAS  Google Scholar 

  40. Rowlands MA, Gunnell D, Harris R, Vatten LJ, Holly JM, Martin RM. Circulating insulin‐like growth factor peptides and prostate cancer risk: a systematic review and meta‐analysis. Int J Cancer. 2009;124:2416–29.

    Article  CAS  Google Scholar 

  41. Nagel G, Linseisen J, Van Gils C, Peeters P, Boutron-Ruault M, Clavel-Chapelon F, et al. Dietary β-carotene, vitamin C and E intake and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Breast Cancer Res Treat. 2010;119:753–65.

    Article  CAS  Google Scholar 

  42. Hodge AM, Bassett JK, Milne RL, English DR, Giles GG. Consumption of sugar-sweetened and artificially sweetened soft drinks and risk of obesity-related cancers. Public health Nutr. 2018;21:1618–26.

    Article  Google Scholar 

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Acknowledgements

We would like to express our special thanks to the participants and healthcare executives in public health centers, without whom the study would not have been possible.

Funding

This study was financially supported by Cancer Research Center in Tehran University of Medical Science (no. 27113).

Author information

Authors and Affiliations

  1. Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Bahareh Sasanfar

  2. Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I.R., Iran

    Fatemeh Toorang, Zahra Booyani, Fatemeh Vassalami & Kazem Zendehdel

  3. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

    Fatemeh Toorang & Leila Azadbakht

  4. Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran

    Elham Mohebbi

  5. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Leila Azadbakht

  6. Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

    Leila Azadbakht

  7. Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I.R., Iran

    Kazem Zendehdel

  8. Breast Diseases Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I.R., Iran

    Kazem Zendehdel

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Contributions

BS and FT participated in the study design, analysis, and drafting the initial version. FT helped in data analysis. BS implemented comments and suggestions of the co-authors. ZB and FV contributed as questioner of FFQ. KZ and LA contributed in conception, design, and data analysis. All authors reviewed the final version of the manuscript. KZ and LA supervised the study.

Corresponding authors

Correspondence to Leila Azadbakht or Kazem Zendehdel.

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Conflict of interest

The authors declare no competing interests.

Ethical standards disclosure

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the Tehran University of Medical Science. Written informed consent was obtained from all subjects/patients.

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Sasanfar, B., Toorang, F., Booyani, Z. et al. Adherence to plant-based dietary pattern and risk of breast cancer among Iranian women. Eur J Clin Nutr 75, 1578–1587 (2021). https://doi.org/10.1038/s41430-021-00869-7

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