Dietary patterns and breast cancer risk among women in northern Tanzania: a case-control study

Dietary patterns, cooking methods and breast cancer risk in Mexico: An exploratory case-control study

Background: Nutrition has an important influence on the risk of developing breast cancer (BC). Dietary patterns can capture the complex interplay of nutrients and cooking methods can contribute to the presence of heterocyclic amines, which are potent mammary carcinogens. Research on dietary patterns, cooking methods, and their association with BC in Mexican women is scarce. Aim: To evaluate the association of dietary patterns and cooking methods with BC risk among women from the Northwest region of Mexico. Methods: This case-control study included 120 women. Eligible cases (n = 60) were diagnosed and biopsy-confirmed in the past 2 years. Control subjects (n = 60) were hospital and population-based. Dietary intake and cooking methods were respectively assessed through a food frequency questionnaire (FFQ) and the National Cancer Institute survey. We obtained dietary patterns from a K-means cluster analysis (CA), and multivariate logistic regression tested the association of dietary patterns and cooking methods with BC risk. Results: Prudent and caloric dietary patterns were identified. The caloric pattern was associated with BC risk (Model 1: ORadj: 5.07, 95%CI:1.44-17.84, p = 0.011; Model 2: ORadj: 4.99 (95%CI:1.39-17.92, p = 0.014). Intense frying, meat grilling and poultry resulted in a significant BC risk (Model 1: ORadj: 5.54,95%CI: 2.13-14.41), p < 0.001; Model 2: ORadj: 5.12, 95%CI: 1.83-14.31, p = 0.002). At Oestrogen exposure of <32 years, there was an association between dietary patterns and BC risk (ORadj: 4.69, 95%CI: 1.01-21.92, p = 0.049). The relationship between BC risk and cooking intensity was found in both strata of exposure to oestrogens: <32 years (ORadj: 3.72, 95%CI:1.04-13.33, p = 0.044), and ≥32 years (ORadj: 6.06, 95%CI:1.34-27.42, p = 0.019). Conclusions: A caloric dietary pattern rich in refined carbohydrates and saturated fat, and intense meat product cooking may increase the risk of BC in Mexican women.

High adherence to Western dietary pattern increases breast cancer risk (an EPIC-Spain study)

OBJECTIVE

To explore the association between three previously identified and validated dietary patterns (Western, Prudent and Mediterranean) and breast cancer risk by tumour subtype and menopausal status.

METHODS

Data from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study provided epidemiological information (including diet and cancer incidence) from 24,892 women (639 breast cancer cases) recruited between 1992 and 1996. The associations between adherence to the three dietary patterns and breast cancer risk (overall and by tumour subtype) were explored by fitting multivariate Cox proportional hazards regression models stratified by region, among other variables. A possible interaction with menopausal status (changing over time) was explored.

RESULTS

No clear association of the Prudent and Mediterranean dietary patterns with breast cancer risk was found. When compared with women with a level of adherence to the Western diet in the first quartile, women with a level of adherence in the third (hazard ratio (95 % confidence interval) (HR(95%CI)):1.37 (1.07;1.77)) and fourth quartiles (1.37 (1.03;1.83)); p for curvature of splines = 0.016) showed a non-linear increased risk, especially postmenopausal women (HR (95 % CI) 1.30 (0.98;1.72) in the third and 1.42 (1.04;1.94) in the fourth quartiles; p for curvature of splines = 0.081) and for estrogen or progesterone receptor positive with human epidermal growth factor receptor 2 negative tumours (HR (95 % CI) 1.62 (1.10;2.38) and 1.71 (1.11;2.63) for the third and fourth quartiles respectively; p for curvature of splines = 0.013).

CONCLUSIONS

Intake of foods such as high-fat dairy products, red and processed meats, refined grains, sweets, caloric drinks, convenience food and sauces might be associated with a higher risk of breast cancer.

In silico targeting breast cancer biomarkers by applying rambutan (Nephelium lappaceum) phytocompounds

Worldwide, breast cancer is the leading type of cancer among women. Overexpression of various prognostic indicators, including nuclear receptors, is linked to breast cancer features. To date, no effective drug has been discovered to block the proliferation of breast cancer cells. This study has been designed to discover target-based small molecular-like natural drug candidates that have anti-cancer potential without causing any serious side effects. A comprehensive substrate-based drug design was carried out to discover the potential plant compounds against the target breast cancer biomarkers including phytochemicals screening, active site identification, molecular docking, pharmacokinetic (PK) properties prediction, toxicity prediction, and molecular dynamics (MD) simulation approaches. Twenty plant compounds extracted from the rambutan (Nephelium lappaceum) were obtained from PubChem Database; and screened against the breast cancer biomarkers including estrogen receptor (ER), progesterone receptor (PR), and androgen receptor (AR). The best docking interaction was chosen based on the higher binding affinity. Analyzing the pharmacokinetic properties and toxicity prediction results indicated that the fifteen selected plant compounds have good potency without toxicity and are safe for humans. Four phytochemicals with a higher binding affinity were chosen for each breast cancer biomarker to study their stability in interaction with the target proteins using MD simulation. Among the above compounds, Ellagic acid showed the high binding affinity against all three breast cancer biomarkers.Communicated by Ramaswamy H. Sarma.

Dietary Iron Intake and HIV-Related Outcomes Among Adults Initiating Antiretroviral Therapy in Tanzania

OBJECTIVE

Anemia is highly prevalent among people living with HIV (PLWHIV) and is often due to iron deficiency. This study evaluated the relationship of dietary iron intake levels and sources with mortality and clinical outcomes among adults initiating HAART.

DESIGN

We conducted a secondary analysis of a multivitamin supplementation trial among 2293 PLWHIV initiating HAART in Dar es Salaam, Tanzania.

METHODS

Dietary iron intake was assessed with a food frequency questionnaire at HAART initiation, and participants followed until death or censoring. Total, animal-, and plant-sourced iron were categorized into quartiles. Intake of food groups was categorized into 0-1, 2-3, and ≥4 servings/wk. Cox proportional hazards models estimated hazard ratios for mortality and incident clinical outcomes.

RESULTS

There were 175 deaths (8%). Red meat intake was associated with a lower risk of all-cause mortality (HR: 0.54; 95% CI: 0.35 to 0.83), AIDS-related mortality (HR: 0.49; 95% CI: 0.28 to 0.85), and severe anemia (HR: 0.57; 95% CI: 0.35 to 0.91), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Legume intake was a lower risk of associated with all-cause mortality (HR: 0.49; 95% CI: 0.31 to 0.77) and AIDS-related mortality (HR: 0.37; 95% CI: 0.23 to 0.61), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Although total dietary iron and overall plant-sourced iron intake were not associated with the risk of mortality or HIV-related outcomes, the highest quartile of animal-sourced iron intake was associated with a lower risk of all-cause mortality (HR: 0.56; 95% CI: 0.35 to 0.90) and a lower risk of AIDS-related mortality (HR: 0.50; 95% CI: 0.30 to 0.90), compared with the lowest quartile.

CONCLUSION

Intake of iron-rich food groups may be associated with a lower risk of mortality and critical HIV-related outcomes among adults initiating HAART.

TRIAL REGISTRATION

The parent trial was registered at Clinicaltrials.gov . Identifier: NCT00383669.

A Socio-Ecological Framework for Cancer Prevention in Low and Middle-Income Countries

Cancer incidence and mortality rates continue to rise globally, a trend mostly driven by preventable cancers occurring in low-and middle-income countries (LMICs). There is growing concern that many LMICs are ill-equipped to cope with markedly increased burden of cancer due to lack of comprehensive cancer control programs that incorporate primary, secondary, and tertiary prevention strategies. Notably, few countries have allocated budgets to implement such programs. In this review, we utilize a socio-ecological framework to summarize primary (risk reduction), secondary (early detection), and tertiary (treatment and survivorship) strategies to reduce the cancer burden in these countries across the individual, organizational, community, and policy levels. We highlight strategies that center on promoting health behaviors and reducing cancer risk, including diet, tobacco, alcohol, and vaccine uptake, approaches to promote routine cancer screenings, and policies to support comprehensive cancer treatment. Consistent with goals promulgated by the United Nations General Assembly on Noncommunicable Disease Prevention and Control, our review supports the development and implementation of sustainable national comprehensive cancer control plans in partnership with local communities to enhance cultural relevance and adoption, incorporating strategies across the socio-ecological framework. Such a concerted commitment will be necessary to curtail the rising cancer and chronic disease burden in LMICs.

The African Female Breast Cancer Epidemiology Study Protocol

Breast cancer is now the commonest cancer in most sub-Saharan African countries. Few studies of the epidemiology and genomics of breast cancer and its molecular subtypes in these countries have been done. The African Female Breast Cancer Epidemiology (AFBRECANE) study, a part of the Human Heredity and Health in Africa (H3Africa) initiative, is designed to study the genomics and epidemiology of breast cancer and its molecular subtypes in Nigerian women. We link recruitment of breast cancer cases at study sites with population-based cancer registries activities to enable ascertainment of the incidence of breast cancer and its molecular subtypes. We use centralized laboratory processing to characterize the histopathological and molecular diagnosis of breast cancer and its subtypes using multiple technologies. By combining genome-wide association study (GWAS) data from this study with that generated from 12,000 women participating in our prospective cohort study of cervical cancer, we conduct GWAS of breast cancer in an entirely indigenous African population. We test associations between dietary intakes and breast cancer and focus on vitamin D which we measure using dietary intakes, serum vitamin D, and Mendelian randomization. This paper describes the AFBRECANE project, its design, objectives and anticipated contributions to knowledge and understanding of breast cancer.

Dietary Intake and Cancer in Sub-Saharan Africa: A Critical Review of Epidemiological Studies

Cancer incidence is rising rapidly in Sub-Saharan Africa (SSA). Dietary intake is an established risk factor for certain cancers but only a few epidemiological studies have been conducted in SSA. This study systematically reviewed and summarized the published literature on this issue and identified gaps that can be addressed in future research. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and literature searched was conducted until 11/2/2021. Out of the 5,457 potential references, we reviewed 19 eligible studies: 17 case-controls, two cross-sectionals and no cohort study. South Africa and Kenya conducted the majorities of the studies. The commonest studied cancers were esophageal (9/19), colorectal (4/19) and breast (4/19). Only four studies utilized a validated Food Frequency Questionnaire (FFQ). Although most studies (16/19) reported associations between dietary intake and cancer risks, they were lacking important confounders including total energy intake, multivitamin intake, body fat measures, physical-activity, smoking, and alcohol. Despite rapidly expanding cases of cancer associated with diet, the existent evidence on diet-cancer relationship is too scarce to deduce solid conclusions. There is a need for large cohorts with comprehensive datasets, validated dietary instruments while using advanced statistical analyses that can provide further insights into the imperative links between African diet and cancer risk.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2022.2032217 .

Design and validation of a food frequency questionnaire to assess the dietary intake for adults in pastoral settings in Northern Tanzania

OBJECTIVE

Food frequency questionnaires are widely used as a dietary assessment tool in nutritional epidemiology to determine the relationship between diet and diseases. In Tanzania, there are several cultural variations in food intake which makes it necessary to design and validate a culture-specific food frequency questionnaire (CFFQ). Therefore, we designed a 27-items CFFQ and examine its validity in pastoral communities. Validity of CFFQ was assessed by comparing nutrient intake estimated from the CFFQ against the average from two 24-h diet recall (2R24). Spearman's correlation coefficients, cross classification and Bland-Altman's methods were used to assess the validity of CFFQ.

RESULTS

A total of 130 adults aged 18 years and above completed both CFFQ and 2R24. Correlation coefficients between CFFQ and 2R24 ranged from low (r = - 0.07) to moderate (r = 0.37). The correlation coefficients were moderately significant for kilocalories (r = 0.31, p < 0.001), carbohydrate (r = 0.33, p < 0.001), magnesium (r = 0.37, p < 0.001), and iron (r = 0.34, p < 0.001). On average, about 69% of participants were correctly classified into the same or adjacent quartile of energy and nutrient intake, while 9% were misclassified by the CFFQ. Bland-Altman's plot demonstrated that the CFFQ had acceptable agreement with the 2R24.

Health, lifestyle and sociodemographic characteristics are associated with Brazilian dietary patterns: Brazilian National Health Survey

This study aimed to identify Brazilian dietary patterns and their associations with health, lifestyle and sociodemographic characteristics. Data from the Brazilian National Health Survey conducted in 2013 were used. A questionnaire was applied containing 22 items related to dietary consumption. Dietary patterns were determined through factor analysis (FA). Poisson regression models, with robust variance, were used to identify associations between dietary patterns and independents variables. Statistical significance was defined as p-value<0.05. Data were analysed for 60,202 adults (estimated population size: 146,308,458). FA identified three dietary patterns: healthy, protein, and western. The younger age group (18-24 years) had a lower adherence to the healthy pattern (PR:0.53; 95%CI:0.49-0.58) and greater adherence to the protein (PR:1.52; 95%CI:1.42-1.62) and western (PR:1.80; 95%CI:1.68-1.93) patterns compared to the elderly (≥60 years). Women had a greater association with the healthy pattern (PR:1.32; 95%CI:1.28-1.38) and lower association with the protein pattern (PR:0.80; 95%CI:0.77-0.82) compared to men. Illiterate participants showed lower adherence to the healthy (PR:0.58; 95%CI:0.53-0.63) and western (PR:0.54; 95%CI:0.48-0.62) patterns compared to those with higher educational levels. Smokers had lower adherence to the healthy (PR:0.76; 95%CI:0.71-0.81) and higher adherence to the protein (PR:1.14; 95%CI:1.11-1.19) patterns compared to non-smokers. Participants with poor/very poor self-rated health status had a lower adherence to the healthy (PR:0.79; 95%CI:0.73-0.86) and western (PR:0.81; 95%CI:0.73-0.89) patterns compared to those in a very good/good self-rated health status. Multimorbidity was positively associated with the healthy pattern (PR:1.18; 95%CI:1.11-1.26) and inversely associated with the protein pattern (PR:0.88; 95%CI:0.80-0.96) compared to participants without comorbidities. We suggest that strategies to promote healthy eating should consider health, lifestyle and sociodemographic characteristics in the Brazilian population.

A culture-sensitive semi-quantitative FFQ for use among the adult population in Nairobi, Kenya: development, validity and reproducibility

OBJECTIVE

To develop a semi-quantitative FFQ and to evaluate its validity and reproducibility for the assessment of total dietary intake of Kenyan urban adult population, given its non-existence in Kenya.

DESIGN

The current study adopted a cross-sectional design. A culture-sensitive semi-quantitative FFQ was developed and its validity was tested relative to three non-consecutive 24-h recalls (24hR). Reproducibility was tested by the test-retest method, with a 3-week interval. Spearman's correlation coefficients and intra-class correlation coefficients were calculated for several macro- and micronutrients. Cross-classification into quartiles and Bland and Altman plots were analysed.

SETTING

Nairobi county (Dagoreti South and Starehe constituencies).

PARTICIPANTS

A convenient sample was recruited in three different clusters in Nairobi.

RESULTS

A culture-sensitive 123-food-item semi-quantitative FFQ showed higher nutrient intakes compared with the 24hR (total energy median 12543·632 v. 8501·888 kJ, P < 0·001). Energy-adjusted and deattenuated Spearman's correlations for macronutrients ranged between 0·21 (total fat) and 0·47 (protein). The agreement in the same quartile varied from 28 % (protein) to 41 % (carbohydrates). Including adjacent quartiles, the range increased: 76 % (protein and fat) to 81 % (carbohydrates). The extreme disagreement was low. The first FFQ application resulted in higher mean values for all nutrients compared with the second FFQ (total energy median 12459·952 v. 10485·104 kJ, P < 0·001). Energy-adjusted correlations for macronutrients ranged from 0·28 (carbohydrates) to 0·61 (protein). Intra-class correlation coefficients for macronutrients were moderate, between 0·6 and 0·7.

CONCLUSIONS

The developed semi-quantitative FFQ was shown to be a valid and reproducible tool for ranking urban adult Kenyans according to their dietary intake.

Cross-country comparison of dietary patterns and overweight and obesity among adult women in urban Sub-Saharan Africa

OBJECTIVE

To derive dietary patterns (DP) among women of reproductive age (WRA) and older women in urban Sub-Saharan Africa (SSA), and to examine their association with body mass index (BMI), overweight and obesity.

DESIGN

We used principal component analysis to derive DP. Their association with BMI, overweight and obesity was assessed using linear and multinomial logistic regression models controlling for age, marital status, education and wealth.

SETTING

Cross-sectional data from prospective studies in Accra, Ghana (2008-2009), Dar es Salaam, Tanzania (2014) and Lilongwe and Kasungu, Malawi (2017-2018) were used.

PARTICIPANTS

We compared WRA in Ghana (18-54 years, n 1762) and Malawi (19-48 years, n 137), and older women in Ghana (≥55 years, n 514) and Tanzania (≥50 years, n 134).

RESULTS

Among WRA, protein and healthy DP were identified in both Ghana and Malawi. In Ghana, the protein DP was associated with higher odds of overweight or obesity (adjusted OR 1·82, 95 % CI 1·27, 2·60 for quintile 2). Among older women, three DP were identified in Ghana (cereal, protein and healthy) and two DP in Tanzania (protein and healthy). The protein DP was associated with higher BMI in Ghana (adjusted mean difference 2·83, 95 % CI 0·95, 4·71 for quartile 3).

CONCLUSIONS

Higher quintiles of the protein DP were associated with higher BMI and odds of overweight or obesity among women in urban Ghana, but not in Malawi or Tanzania. Further research is needed to understand how DP influence overweight and obesity among adult women in urban SSA.

Epidemiological characteristics of and risk factors for breast cancer in the world

AIM

Breast cancer is the most common cancer among women and one of the most important causes of death among them. This review aimed to investigate the incidence and mortality rates of breast cancer and to identify the risk factors for breast cancer in the world.

MATERIALS AND METHODS

A search was performed in PubMed, Web of Science, and Scopus databases without any time restrictions. The search keywords included the following terms: breast cancer, risk factors, incidence, and mortality and a combination of these terms. Studies published in English that referred to various aspects of breast cancer including epidemiology and risk factors were included in the study. Overall, 142 articles published in English were included in the study.

RESULTS

Based on the published studies, the incidence rate of breast cancer varies greatly with race and ethnicity and is higher in developed countries. Results of this study show that mortality rate of breast cancer is higher in less developed regions. The findings of this study demonstrated that various risk factors including demographic, reproductive, hormonal, hereditary, breast related, and lifestyle contribute to the incidence of breast cancer.

CONCLUSION

The results of this study indicated that incidence and mortality rates of breast cancer is rising, so design and implementation of screening programs and the control of risk factors seem essential.

Associations between dietary patterns and the risk of breast cancer: a systematic review and meta-analysis of observational studies

BACKGROUND

Epidemiologic evidence suggests that certain dietary patterns were associated with breast cancer risk, but the results have been inconclusive. We assessed the associations between different dietary patterns and the risk of breast cancer by conducting a meta-analysis of observational studies.

METHODS

Relevant articles were searched in PubMed, Embase, and Cochrane library databases through September 2017. Multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) comparing the highest and lowest categories of Western and prudent dietary patterns were combined by using the random-effects meta-analyses.

RESULTS

We identified 32 eligible articles including 14 cohort and 18 case-control studies (34 Western and 35 prudent studies). The pooled analyses found that a Western dietary pattern was associated with a 14% increased risk (RR 1.14, 95% CI 1.02, 1.28), whereas a prudent dietary pattern was associated with an 18% reduced risk of breast cancer (RR 0.82, 95% CI 0.75, 0.89). In addition, sub-group analyses showed that the positive association between a Western dietary pattern and breast cancer risk was significant among postmenopausal (RR 1.20, 95% CI 1.06, 1.35), but not premenopausal women (RR 1.18, 95% CI 0.99, 1.40), and significant for hormone receptor-positive tumors (RR 1.18, 95% CI 1.04, 1.33), but not receptor-negative tumors (RR 0.97, 95% CI 0.83, 1.12). In contrast, the inverse association between a prudent dietary pattern and breast cancer was significant in premenopausal (RR 0.77, 95% CI 0.61, 0.98), but not postmenopausal women (RR 0.88, 95% CI 0.74, 1.03), and significant for both hormone receptor-positive and receptor-negative tumors.

CONCLUSIONS

The results of the current meta-analysis suggest a possible increased risk of breast cancer associated with a Western dietary pattern and a reduced risk with a prudent dietary pattern. Large-scale cohort studies with a high quality need to be conducted to further confirm the findings of the current meta-analysis. As dietary patterns are modifiable, these findings may provide viable strategies for breast cancer prevention through changes in dietary intake.

Diet Quality Scores Inversely Associated with Postmenopausal Breast Cancer Risk Are Not Associated with Premenopausal Breast Cancer Risk in the California Teachers Study

Background

Evidence for the association between diet and breast cancer risk is inconsistent Thus, research that compares indexes of overall diet quality may provide new insight.

Objective

We examined the association between diet quality indexes and pre- and postmenopausal breast cancer risk in a large prospective cohort.

Methods

This was a prospective analysis of 96,959 women, aged 22-104 y, in the California Teachers Study cohort (1995-2011). Diet quality was characterized by 4 different indexes. Specifically, we examined Alternate Mediterranean Diet (aMED), Alternative Healthy Eating Index-2010 (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH), and Paleolithic index (PALEO) scores with the risk of developing breast cancer. We used multivariable Cox proportional hazards regression models to derive HRs and 95% CIs for breast cancer risk.

Results

In the analysis of 42,517 women at risk of premenopausal breast cancer, there was no association between any of the indexes and incident breast cancer (346 cases). In the analysis of 54,442 women at risk of postmenopausal breast cancer at baseline, higher AHEI-2010, aMED, and DASH scores were inversely associated with incident breast cancer (3523 incident cases). Respectively, HRs (95% CIs) comparing quintile 5 to quintile 1 (reference) for AHEI-2010, aMED, and DASH indexes were 0.87 (0.78, 0.97; P-trend = 0.004), 0.91 (0.82, 1.02; P-trend = 0.03), and 0.89 (0.80, 1.00; P-trend = 0.03). The PALEO score was not associated with postmenopausal breast cancer (HR for quintile 5 compared with quintile 1: 1.05; 95% CI: 0.94, 1.17).

Conclusions

Diet quality indexes that emphasize intake of whole grains, vegetables, fruits, legumes, and nuts and seeds and de-emphasize red and processed meats and sugar-sweetened beverages were modestly associated with a lower risk of incident postmenopausal breast cancer risk. However, they were not associated with premenopausal breast cancer, and the PALEO score was not associated with cancer risk regardless of menopausal status.

Validity of an FFQ to measure nutrient and food intakes in Tanzania

OBJECTIVE

FFQ are often used to estimate food and nutrient intakes to rank individuals by their level of intake. We evaluated the relative validity of a semi-quantitative FFQ created for use in Tanzania by comparing it with two 24 h diet recalls.

DESIGN

We measured relative validity of the FFQ with deattenuated energy-adjusted rank correlations for nutrients, deattenuated rank correlations for food groups, and performed a cross-classification analysis of energy-adjusted nutrient quartiles using percentage of agreement and Bland-Altman analysis.

SETTING

Interviews were conducted in 2014 in participants' homes in Ukonga, Dar es Salaam, Tanzania.

SUBJECTS

We surveyed 317 adults aged 40 years or older from the general public.

RESULTS

Deattenuated energy-adjusted rank correlation coefficients of nutrients ranged from -0·03 for riboflavin to 0·41 for percentage of energy from carbohydrates, with a median correlation of 0·21. Coefficients for food groups ranged from 0·00 for root vegetables to 0·51 for alcohol, with a median of 0·35. Relative to the average of the two 24 h diet recalls, the FFQ overestimated energy intake and intakes of all nutrients and food groups, other than tea, with ratios among nutrients ranging from 1·34 for SFA to 7·08 for vitamin A; and among food groups from 0·92 for tea to 9·00 for fruit. The percentage of participants classified into the same nutrient intake quartile ranged from 23 % for SFA to 32 % for both niacin and pantothenic acid, with a median of 28 %.

CONCLUSIONS

The FFQ performed moderately well in urban Tanzanian adults.

Possible role of diet in cancer: systematic review and multiple meta-analyses of dietary patterns, lifestyle factors, and cancer risk

Context

Evidence of an association between dietary patterns derived a posteriori and risk of cancer has not been reviewed comprehensively.

Objective

The aim of this review was to investigate the relation between a posteriori-derived dietary patterns, grouped as healthy or unhealthy, and cancer risk. The relation between cancer risk and background characteristics associated with adherence to dietary patterns was also examined.

Data Sources

PubMed and Embase electronic databases were searched.

Study Selection

A total of 93 studies including over 85 000 cases, 100 000 controls, and 2 000 000 exposed individuals were selected.

Data Extraction

Data were extracted from each identified study using a standardized form by two independent authors.

Results

The most convincing evidence (significant results from prospective cohort studies) supported an association between healthy dietary patterns and decreased risk of colon and breast cancer, especially in postmenopausal, hormone receptor-negative women, and an association between unhealthy dietary patterns and increased risk of colon cancer. Limited evidence of a relation between an unhealthy dietary pattern and risk of upper aerodigestive tract, pancreatic, ovarian, endometrial, and prostatic cancers relied only on case-control studies. Unhealthy dietary patterns were associated with higher body mass index and energy intake, while healthy patterns were associated with higher education, physical activity, and less smoking. Potential differences across geographical regions require further evaluation.

Conclusions

The results suggest a potential role of diet in certain cancers, but the evidence is not conclusive and may be driven or mediated by lifestyle factors.

Consumption of processed food dietary patterns in four African populations

OBJECTIVE

To identify predominant dietary patterns in four African populations and examine their association with obesity.

DESIGN

Cross-sectional study.Setting/SubjectsWe used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men.

RESULTS

We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern's lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity.

CONCLUSIONS

We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.

Urban and rural dietary patterns are associated with anthropometric and biochemical indicators of nutritional status of adolescent Mozambican girls

OBJECTIVE

The objective of the present study was to explore whether dietary patterns (DP) are associated with nutritional status indicators among adolescent Mozambican girls. Design/Setting/Subjects In this population-based cross-sectional study we used the FFQ data of 547 girls aged 14-19 years from Central Mozambique to derive dietary patterns by means of principal component analysis. We used two-level linear regression models to examine the associations between the DP and anthropometric and biochemical indicators of nutritional status.

RESULTS

We identified three DP: 'Urban bread and fats', 'Rural meat and vegetables' and 'Rural cassava and coconut'. The 'Urban bread and fats' DP was positively associated with BMI-for-age Z-score (BMIZ), mid-upper arm circumference (MUAC), triceps skinfold (P for all<0·001) and blood Hb (P=0·025). A negative association was observed between the 'Urban bread and fats' DP and serum folate (P<0·001). The 'Rural meat and vegetables' DP and the 'Rural cassava and coconut' DP were associated negatively with BMIZ, MUAC and triceps skinfold (P for all<0·05), but the 'Rural meat and vegetables' DP was associated positively with serum ferritin (P=0·007).

CONCLUSIONS

Urban and rural DP were associated with nutritional status indicators. In a low-resource setting, urban diets may promote body fat storage and blood Hb concentrations but compromise serum folate concentration. It is important to continue valuing the traditional, rural foods that are high in folate.

Dietary pattern and other lifestyle factors as potential contributors to hypertension prevalence in Arusha City, Tanzania: a population-based descriptive study

BACKGROUND

High blood pressure is increasing worldwide, disproportionately so in developing countries. Inadequate health care systems and adoption of unhealthy lifestyles have been linked to this emergent pattern. To better understand this trend, it is imperative we measure prevalence of hypertension, and examine specific risk factors, at a local level. This study provides a cross-sectional view of urban residents of Arusha City to determine prevalence and associated risk factors.

METHODS

Blood pressure was measured using a digital sphygmomanometer. Interviews were conducted using the WHO STEPwise survey questionnaire to assess lifestyle factors. Dietary intake information was collected by a standardized Food Frequency Questionnaire (FFQ). Descriptive statistics were used to analyze demographic characteristics. Means and standard deviations were calculated for continuous variables and percentages for categorical variables. Pearson's Chi Square (χ 2) tests were used to determine significant risk factors for hypertension, and multivariate log binomial regression was used to reveal potential predictors of hypertension. Dietary patterns were analyzed by principal component analysis.

RESULTS

Approximately 45% of the study population was found to be hypertensive. The mean arterial blood pressure (MABP) of the sample was 102.3 mmHg (SD = 18.3). Mean systolic and diastolic blood pressure were 136.3 (SD = 30.5) and 85.3 (SD = 16.1) mmHg, respectively. Through multivariate analysis, age and body mass index were found to be independently, positively, associated with hypertension. Adherence to 'healthy' dietary pattern was negatively independently associated with hypertension.

CONCLUSIONS

With nearly half of participants being hypertensive, this study suggests that hypertension is a significant health risk in Arusha, Tanzania. Obesity, healthy diet, and age were found to be positively associated with hypertension risk. This study did not establish any significant association between increased blood pressure and Western-dietary pattern, cigarette smoking, alcohol intake, and physical activities.

How dietary intake has been assessed in African countries? A systematic review

BACKGROUND

Dietary patterns are often considered as one of the main causes of non-communicable diseases worldwide. It is of utmost importance to study dietary habits in developing countries since this work is scarce.

OBJECTIVE

To summarize the most recent research conducted in this field in African countries, namely the most used methodologies and tools.

METHODS

A systematic review was conducted on MEDLINE®/PubMed, aiming to identify scientific publications focused on studies of dietary intake of different African populations, in a ten-year period. Papers not written in English/Portuguese/Spanish, studies developed among African people but not developed in African countries, studies aiming to assess a particular nutrient/specific food/food toxin and studies that assessed dietary intake among children were excluded.

FINDINGS

Out of 99 included studies, the 24-hour recall and the food-frequency questionnaire were the most used dietary intake assessment tools, used to assess diet at an individual level. It was also observed that often country-unspecific food composition databases are used, and the methodologies employed are poorly validated and standardized.

CONCLUSIONS

There is an emergent need to improve the existing food databases by updating food data and to develop suitable country-specific databases for those that do not have their own food composition table.

Design, Response Rates, and Population Characteristics of a Cross-Sectional Study in Zanzibar, Tanzania

Background

Data on nutritional status and correlates of noncommunicable diseases are scarce for resource-poor settings in sub-Saharan countries. With the scope of a project, “Access to Food and Nutrition Status of the Zanzibari Population,” data for investigating public health questions were collected using proven measurement and laboratory standards.

Objective

The present study aims at providing a descriptive overview of recruitment approaches, standardization, quality control measures, and data collection, with special attention to the design, responses, and participant characteristics of the overall project.

Methods

A cross-sectional study across 80 randomly selected Shehias (wards) was conducted in 2013 in Unguja Island, Zanzibar. Examinations included all members living in 1 household, face-to-face interviews and anthropometric measurements (weight, height, mid-upper arm circumference, waist and hip circumference, and body composition) were assessed for all household members, blood pressure was taken from participants older than 2 years, and biosamples (urine and blood) from eligible household members were collected. Data collected from the core sample included sociodemographic data, nutritional status, and medical history (hypertension). Physical activity data was collected from a subsample of children between 3 and 16 years of age.

Results

A total of 1314 participants (mean age 23.6 ± 18.9 years, 54.54% female) completed all anthropometric measurements and were included in the analysis. Out of which, 98.40% (1293/1314) completed the household member’s questionnaire, 93.32% (1229/1314) participants older than 2 years completed blood pressure measurements, and 64.31% (845/1314) blood samples were collected from participants older than 5 years. Underweight prevalence for the total study population was 36.53% (480/1314) with the highest prevalence in children under 14 years. Overweight and obesity was highest among females with the prevalence of 7.61% (100/1314) and 6.62% (87/1314), respectively; obesity was rare among male participants.

Conclusions

The study provides valuable data to investigate the interplay of socioeconomic, demographic, environmental, physiological, and behavioral factors in the development of diet-related disorders in a representative sample of the Zanzibari population.

Meta-Analysis of Saturated Fatty Acid Intake and Breast Cancer Risk

The associations between saturated fatty acid (SFA) consumption and risk of breast cancer (BC) remains inconclusive. Therefore, we conducted this meta-analysis to determine the quantitative relations between dietary SFA intake and incidence of BC.Literatures published up to April 2015 were systematically screened through Pubmed and Web of Science. Relevant publication quality was evaluated by conducting the Newcastle-Ottawa scale. We used fixed effects models or random effect models to calculate the summary relative risks (RRs) and odds ratios (ORs), and conducted sensitivity analyses and evaluated the publication bias.We identified a total of 52 studies (24 cohort studies and 28 case-control studies), with over 50,000 females diagnosed with BC. The associations between dietary SFA intake and risk of BC were 1.18 for case-control studies (high vs low intake, 95% confidence interval [CI] = 1.03-1.34) and 1.04 for cohort studies (95% CI = 0.97-1.11). When restricted analyses to population-based studies, positive associations were observed for both cohort (RR [95% CI] = 1.11 [1.01-1.21]) and case-control studies (OR [95% CI] = 1.26 [1.03-1.53]). Additionally, for case-control studies, significant positive associations between higher SFA intake and BC risk were observed for Asian (OR [95% CI] = 1.17 [1.02-1.34]) and Caucasian (OR [95% CI] = 1.19 [1.00-1.41]), as well as for postmenopausal women (OR = 1.33, 95% CI: 1.02-1.73). In contrast, higher dietary SFA intake was not associated with risk of BC among premenopausal women, in cohort studies or hospital-based studies.A positive association between higher dietary SFA intake and postmenopausal BC risk was observed in case-control but not in cohort studies. More studies are warranted to confirm these findings.

Risk of female breast cancer and serum concentrations of organochlorine pesticides and polychlorinated biphenyls: a case-control study in Tunisia

The aim of this study was to investigate the association between serum concentrations of a group of organochlorine pesticides/polychlorinated biphenyls with xenoestrogenic potential and the risk of breast cancer in a female population from Tunisia. The relationship between serum levels of the pollutants and the risk of cancer was assessed using logistic regression analyses. In the unadjusted models, β-hexachlorocyclohexane (β-HCH), hexachlorobenzene, heptachlor, polychlorinated biphenyl congeners 138, 153, and 180, and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) were positively associated with breast cancer risk. However, when the models were further adjusted for the selected covariates, only β-HCH and p,p'-DDE remained statistically significant, and heptachlor was borderline significant. In addition, analyses using POP concentration tertiles corroborated a positive dose-response relationship that was significant for p,p'-DDE (p-trend=0.020) and borderline significant for heptachlor (p-trend=0.078). A similar trend was also confirmed for β-HCH, in which concentrations≥limit of detection were positively associated with breast cancer risk (vs. concentrations<limit of detection, OR=3.44, p<0.05). Finally, the relative influence of each chemical in the presence of the others was assessed by entering the three chemicals in a single model with all covariates, and only β-HCH remained positively associated with the risk of cancer (OR:1.18, 95%CI: 1.05-1.34). Our findings suggest a potential association between exposure to at least one organochlorine pesticide and breast cancer risk. However, our results should be interpreted with caution, and further research is warranted to confirm these findings.

Breast cancer in Sub-Saharan Africa: opportunities for prevention

Although breast cancer is a growing health problem in sub-Saharan Africa, reasons for its increased occurrence remain unclear. We reviewed the published literature to determine the magnitude of the increase in breast cancer, associated risk factors (including for breast cancer subtypes), and ways to reduce incidence and mortality. Some of the increased breast cancer occurrence likely reflects that women are living longer and adopting lifestyles that favor higher incidence rates. However, a greater proportion of breast cancers occur among premenopausal women as compared to elsewhere, which may reflect unique risk factors. Breast cancers diagnosed among African women reportedly include a disproportionate number of poor prognosis tumors, including hormone receptor negative, triple negative, and core basal phenotype tumors. However, it is unclear how lack of standardized methods for tissue collection, fixation, and classification contribute to these rates. Given appropriate classifications, it will be of interest to compare rates with other populations and to identify risk factors that relate to specific tumor subtypes. This includes not only risk factors that have been recognized in other populations but also some that may play unique roles among African women, such as genetic factors, microbiomata, xenoestrogens, hair relaxers, and skin lighteners. With limited opportunities for effective treatment, a focus is needed on identifying etiologic factors that may be amenable to intervention. It will also be essential to understand reasons why women delay seeking care after the onset of symptoms and for there to be educational campaigns about the importance of early detection.

Breast cancer and dietary patterns: a systematic review

This systematic review collates research on the topic of dietary patterns and breast cancer risks. The literature search targeted epidemiological studies published up to December 2012 and was conducted using the Medline (U.S. National Library of Medicine, Bethesda MD, USA) and Lilacs (Latin American and Caribbean Health Sciences, São Paulo, Brazil) databases. The following search terms were used: breast cancer, breast neoplasm, breast carcinoma, diet, food, eating habits, dietary patterns, factor analysis, and principal component analysis. Only studies that used factor analysis techniques and/or principal component analysis were eligible, and a total of 26 studies were included. The findings of these studies suggest the Mediterranean dietary pattern and diets composed largely of vegetables, fruit, fish, and soy are associated with a decreased risk of breast cancer. There was no evidence of an association between traditional dietary patterns and risk of breast cancer, and only one study showed a significant increase in risk associated with the Western dietary pattern. Diets that include alcoholic beverages may be associated with increased risk.

Dietary patterns and breast cancer risk in the California Teachers Study cohort

BACKGROUND

Evidence that diet is associated with breast cancer risk is inconsistent. Most studies have examined risks associated with specific foods and nutrients, rather than measures of overall diet.

OBJECTIVE

This study aimed to evaluate dietary patterns and their relation to breast cancer risk in a large cohort of women.

DESIGN

Data from 91,779 women in the California Teachers Study cohort were analyzed, including data from 4140 women with a diagnosis of invasive breast cancer made between 1995 and 2009. Five predominant dietary patterns were identified by using principal components factor analysis: a plant-based diet, high in fruit and vegetables; a high-protein, high-fat diet, high in meats, eggs, fried foods, and high-fat condiments; a high-carbohydrate diet, high in convenience foods, pasta, and bread products; an ethnic diet, high in legumes, soy-based foods, rice, and dark-green leafy vegetables; and a salad and wine diet, high in lettuce, fish, wine, low-fat salad dressing, and coffee and tea.

RESULTS

The plant-based pattern was associated with a reduction in breast cancer risk (RR: 0.85; 95% CI: 0.76, 0.95 for the highest compared with the lowest consumption quintile; P-trend = 0.003); risk reduction was greater for estrogen receptor-negative progesterone receptor-negative (ER-PR-) tumors (RR: 0.66; 95% CI: 0.48, 0.91; P-trend = 0.03). The salad and wine pattern was associated with an increased risk of estrogen receptor-positive progesterone receptor-positive tumors (RR: 1.29; 95% CI: 1.12, 1.49); this effect was only slightly attenuated after adjustment for alcohol consumption.

CONCLUSION

The finding that greater consumption of a plant-based dietary pattern is associated with a reduced breast cancer risk, particularly for ER-PR- tumors, offers a potential avenue for prevention.

Prevalence of asthenopia and its risk factors in Chinese college students

AIM

To determine the prevalence of asthenopia and identify any associated risk factors in the college students in Xi'an, China.

METHODS

From April to September 2012, 1 500 students from five universities in Xi'an were selected according to a multi-stage stratified cluster sampling method. Data on demographic features, lifestyle or dietary habits, health status, living environment conditions, sleep and mental status, and asthenopia symptoms were collected through a self-administered validated questionnaire. Univariate logistic regression and multivariate logistic regression analysis modified by the factor analysis were performed to evaluate risk factors for asthenopia.

RESULTS

Fifty-seven percent of the college students complained of asthenopia. Statistically significant risk factors for asthenopia in the univariate analysis included 13 variables. Multivariate analysis revealed a significant relationship between the use of computer and asthenopia (OR 1.21, 95%CI: 1.09 to 1.35). Good sleep and mental status (OR 0.86, 95%CI: 0.76 to 0.97), good living environment conditions (OR 0.67, 95%CI: 0.60 to 0.76), and high intake of green leafy vegetables (OR 0.89, 95%CI: 0.80 to 0.98) were found to be strong predictors of decreasing the occurrence of asthenopia complaints.

CONCLUSION

Asthenopia symptom appears to be common among college students; and it is strongly associated with computer use, psychosocial state, environment conditions and dietary habits, suggesting that additional studies are warranted to verify these risk factors and establish prevention guidelines, especially for college students.

Is Usual Dietary Pattern Related to the Risk of Developing Breast Cancer?

Dietary patterns capture total diet providing a more comprehensive understanding of the effect of diet on chronic disease risk. Dietary patterns have been associated with several chronic diseases, including cardiovascular disease and selected cancers; however, the association with breast cancer remains unclear. The objective of this review was to examine critically the most recent literature on dietary patterns and breast cancer and report on current results, new developments, and future directions. Seven case-control and cohort studies from multiple countries have been published during the previous year (2011-2012). Many have analyzed a posteriori dietary patterns via factor and principal component analysis. Whereas results remain mixed, the majority of studies indicate healthier patterns decrease breast cancer risk, although patterns higher in meat and alcohol increase risk. Future studies that examine the associations between diet and tumor subtypes and collect dietary data at younger ages and, if possible, longitudinally would be beneficial.