The association between plant-based dietary patterns and risk of breast cancer: a case-control study

Plant-based diet indices and their interaction with ambient air pollution on the ovarian cancer survival: A prospective cohort study

BACKGROUND

Ambient air pollution might serve as a prognostic factor for ovarian cancer (OC) survival, yet the relationships between plant-based diet indices (PDIs) and OC survival remain unclear. We aimed to investigate the associations of comprehensive air pollution and PDIs with OC survival and explored the effects of air pollution-diet interactions.

METHODS

The present study encompassed 658 patients diagnosed with OC. The overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) were evaluated by a self-reported validated food frequency questionnaire. In addition, an air pollution score (APS) was formulated by summing the concentrations of particulate matter with a diameter of 2.5 microns or less, ozone, and nitrogen dioxide. Cox proportional hazard models were applied to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs). The potential interactions of APS with PDIs in relation to overall survival (OS) were assessed on both multiplicative and additive scales.

RESULTS

Throughout a median follow-up of 37.60 (interquartile: 24.77-50.70) months, 123 deaths were confirmed. Comparing to the lowest tertiles, highest uPDI was associated with lower OS of OC (HR = 2.06, 95 % CI = 1.30, 3.28; P-trend < 0.01), whereas no significant associations were found between either overall PDI or hPDI and OC survival. Higher APS (HR for per interquartile range = 1.27, 95 % CI = 1.01, 1.60) was significantly associated with worse OC survival, and the association was exacerbated by adherence to uPDI. Notably, an additive interaction was identified between combined air pollution and uPDI (P < 0.005 for high APS and high uPDI). We also found that adherence to overall PDI aggravated associations of air pollution with OC survival (P-interaction = 0.006).

CONCLUSIONS

Joint exposure to various ambient air pollutants was significantly associated with lower survival among patients with OC, particularly for those who predominantly consumed unhealthy plant-based foods.

Macronutrient composition of plant-based diets and breast cancer risk: the E3N prospective cohort study

PURPOSE

Recent evidence suggests that plant-based diets may reduce the risk of breast cancer (BC). However, the macronutrient composition of plant-based diets and its potential impact on BC risk has not been well explored. This analysis investigated the association of macronutrient composition with BC risk across a spectrum of plant-based diet indexes using a multidimensional approach.

DESIGN

This study followed 64,655 participants from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) cohort from 1993 to 2014. Diets were evaluated using validated 208-item diet history questionnaires at baseline (1993) and follow-up (2005), to calculate adherence to the overall plant-based diet (PDI), healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). The association of macronutrient composition with BC risk was assessed via generalized additive time-dependent Cox models across different levels of these indexes. Response surfaces were generated to visualize compositional associations at the 25th, 50th, and 75th percentile of each index (low, moderate, and high).

RESULTS

A total of 3,932 incident BC cases were identified during the 21-year follow-up. There was a significant association between macronutrient composition and BC risk for hPDI, uPDI, and PDI (all P < 0.001). Akaike information criterion favored the hPDI model for characterizing the association between macronutrients and BC. BC risk was highest for individuals with a lower hPDI score who also consumed a diet containing lower protein (10%), lower carbohydrate (35%), and higher fat (55%). The lowest risk of BC was observed in those with higher hPDI scores with the lowest intake of protein (10%). At higher PDI and uPDI, diets containing higher protein (30%) and fat (45%) had the highest BC risk.

CONCLUSION

These results demonstrate a complex relationship between macronutrient composition, plant-based diet quality, and BC risk. Further research is needed to examine specific foods that may be driving these associations.

REGISTRY

The protocol is registered at clinicaltrials.gov as NCT03285230.

Advances in Diet and Physical Activity in Breast Cancer Prevention and Treatment

There is currently a growing interest in diets and physical activity patterns that may be beneficial in preventing and treating breast cancer (BC). Mounting evidence indicates that indeed, the so-called Mediterranean diet (MedDiet) and regular physical activity likely both help reduce the risk of developing BC. For those who have already received a BC diagnosis, these interventions may decrease the risk of tumor recurrence after treatment and improve quality of life. Studies also show the potential of other dietary interventions, including fasting or modified fasting, calorie restriction, ketogenic diets, and vegan or plant-based diets, to enhance the efficacy of BC therapies. In this review article, we discuss the biological rationale for utilizing these dietary interventions and physical activity in BC prevention and treatment. We highlight published and ongoing clinical studies that have applied these lifestyle interventions to BC patients. This review offers valuable insights into the potential application of these dietary interventions and physical activity as complimentary therapies in BC management.

Pro-vegetarian dietary pattern and risk of breast cancer: a case-control study

BACKGROUND

There are a few conflicting results from studies assessing the association between plant-based diets, particularly pro-vegetarian dietary pattern (PDP), and breast cancer (BC) incidence. Therefore, this study aimed to investigate the association between PDP and BC odds in the Iranian population.

METHODS

This case-control study was conducted on 134 women with BC and 265 without cancer (control). Participants were selected from two referral hospitals in Tehran, Iran. Also, a validated food frequency questionnaire was used to collect food information. Logistic regression was used to assess the association between PDP and BC and the association between PDP and BC by menopausal status.

RESULTS

It was observed that in two models of logistic regression, the chance of BC was lower in the second and last tertile (T) than in the first tertile of PDP (model 1-T2: odds ratio (OR) = 0.39; 95% confidence interval (CI): 0.23-0.67; P = 0.001, and T3: OR = 0.43; 95% CI: 0.26-0.73; P = 0.002-model 2: T2: OR = 0.42; 95% CI: 0.24-0.74; P = 0.003, and T3: OR = 0.49; 95% CI: 0.27-0.88; P = 0.017). Also, according to menopausal status, the odds of developing BC in post-menopausal women in the second and last tertile of PDP was significantly lower than the first tertile in both logistic regression models.

CONCLUSIONS

The findings revealed that Iranian women who followed PDP had a lower chance of developing BC. Also, we found that a diet high in plant-based foods and low in animal products is beneficial for reducing BC odds, particularly for post-menopausal women.

Dietary Patterns Associated with Breast Cancer in the Middle East: A Scoping Review

Breast cancer (BC) is the most predominant malignancy in Arab women in the Middle East, and yearly increases in occurrence by 37.5 and mortality rates by 15.2 for every 100,000 in 2019. This review explores the gap in research investigating the role of dietary patterns and BC in Middle Eastern countries. Furthermore, we analyze the evidence connecting these patterns to BC prevalence in the region, discussing implications for public health and preventive strategies. PubMed, ProQuest, and Cochrane databases were searched up to November 2023. Articles published in English from 2000 to 2023 were identified. Our search included dietary patterns (DP), their association with BC and specific to Middle Eastern Regions. The majority of existing research is concentrated in Iran, with limited illustration from Saudi Arabia, Turkey, and Jordan, and a notable absence of studies from other Middle Eastern countries. We found that dietary intervention is closely related to the occurrence, development, and prognosis of BC. Most DPs such as the Dietary Approaches to Stop Hypertension, Mediterranean, Plant-based and Paleolithic diets are identified to decrease the probability of BC by being rich sources of fiber, healthy fats, and vitamins and minerals. However, there are few DPs that increase the risk of BC, because of the existence of foods such as unhealthy fats, low fiber, sugars, and fried foods in those patterns which contribute to increasing the risk factors associated with BC. This review highlights the intricate connection between DPs and the risk of BC in the Middle East, revealing potential protective effects and heightened risks linked to specific dietary elements.

High-protein diet scores, macronutrient substitution, and breast cancer risk: insights from substitution analysis

BACKGROUND

Evidence from recent studies suggested that variation in the quantity and quality of macronutrients in the diet may potentially play a role in predicting the risk of breast cancer (BC). In the current study, we aimed to assess the association of different high-protein diet scores and replacing fats and carbohydrate (CHO) with protein in the diet with the BC risk among Iranian women.

METHODS

The current hospital-based case-control study was conducted on 401 participants, aged ≥ 30 years old, including 134 women in the case group who had been diagnosed with histologically confirmed BC and 267 women in the control group. Dietary intake data was collected using a validated food frequency questionnaire, and high protein diet scores were determined. Logistic regression models were used to determine the odds ratios (OR) and 95% confidence interval (CI) of BC across tertiles of high protein diet scores. Also, we assessed how substituting protein with other macronutrients affected BC odds while adjusting for the various confounding variables.

RESULTS

Participants' mean ± SD of age and body mass index were 47.9 ± 10.3 years and 29.4 ± 5.5 kg/m2, respectively. The scores of high-protein-low-CHO and fat diet, high-protein and CHO-low-fat diet, and high-protein and fat-low-CHO diet in participants were 16.5 ± 3.8, 16.5 ± 6.7, and 16.4 ± 5.9, respectively. In the multivariable model, individuals in the highest tertile of high-protein-low-CHO and fat diet score (OR:0.71;95%CI:0.56-0.90) and high-protein and CHO-low-fat diet (OR:0.76;95%CI:0.60-0.97) had lower odds of BC compared to those in the lowest tertile (P < 0.05). However, no significant association was found between high-protein and fat-low-CHO diet and BC risk. Our results showed that replacing fat by protein (ORdifferences:-0.40;95%CI:-0.73,-0.07) and also replacing refined-CHO by plant protein (ORdifferences:-0.66;95%CI:-1.26,-0.07) in the diet are associated inversely with risk of BC(P < 0.05).

CONCLUSIONS

The results of our study suggested that higher adherence to a high-protein-low-CHO and fat diet, characterized by a higher intake of plant proteins and a lower intake of refined grains and saturated fat can play a protective role against the odds of BC.

Association of plant-based dietary patterns with the risk of type 2 diabetes mellitus using cross-sectional results from RaNCD cohort

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in middle- and low-income countries, and this disease is a burden on public health systems. Notably, dietary components are crucial regulatory factors in T2DM. Plant-based dietary patterns and certain food groups, such as whole grains, legumes, nuts, vegetables, and fruits, are inversely correlated with diabetes incidence. We conducted the present study to determine the association between adherence to a plant-based diet and the risk of diabetes among adults. We conducted a cross-sectional, population-based RaNCD cohort study involving 3401 men and 3699 women. The plant-based diet index (PDI) was developed using a 118-item food frequency questionnaire (FFQ). Logistic regression models were used to evaluate the association between the PDI score and the risk of T2DM. A total of 7100 participants with a mean age of 45.96 ± 7.78 years were analysed. The mean PDI scores in the first, second, and third tertiles (T) were 47.13 ± 3.41, 54.44 ± 1.69, and 61.57 ± 3.24, respectively. A lower PDI was significantly correlated with a greater incidence of T2DM (T1 = 7.50%, T2 = 4.85%, T3 = 4.63%; P value < 0.001). Higher PDI scores were associated with significantly increased intakes of fibre, vegetables, fruits, olives, olive oil, legumes, soy products, tea/coffee, whole grains, nuts, vitamin E, vitamin C, and omega-6 fatty acids (P value < 0.001). After adjusting for confounding variables, the odds of having T2DM were significantly lower (by 30%) at T3 of the PDI than at T1 (OR = 0.70; 95% CI = 0.51, 0.96; P value < 0.001). Our data suggest that adhering to plant-based diets comprising whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee can be recommended today to reduce the risk of T2DM.

Plant-Based Dietary Indices in Relation to Nutrient and Food Group Intakes in Preschool-Aged Children

Dietary guidance promotes plant-based foods, yet minimal research has examined intake in children. This study examined plant-based food intake in preschool-aged children using plant-based dietary index (PDI) metrics and related these metrics to nutrient and food group intakes. Dietary data were collected from preschool-aged children (n = 283, 3.45 ± 1.22 years) from the Guelph Family Health Study at baseline using the Automated Self-Administered 24-Hour Dietary Assessment Tool. Food intake servings were assigned to 16 food groups for calculation of overall PDI (oPDI), healthful PDI (hPDI), and less healthful (lhPDI) scores and summarized into tertiles for energy-adjusted comparisons. For oPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to encourage (e.g., dietary fiber, fruits) as well as lower intakes of nutrients to encourage (e.g., calcium, vitamin D). For hPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to encourage and lower intakes of those to limit (e.g., saturated fat, sweets and desserts). For lhPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to limit and lower intakes of those to encourage. These results can inform dietetic practice for dietary guidance that promotes plant-based foods in children.

The Impact of Modern Dietary Practices on Cancer Risk and Progression: A Systematic Review

Cancer is a leading cause of mortality around the world, despite continued advancements in the management of cancer. Recent research efforts have shifted to evaluating the role that modifiable risk factors play in cancer risk and development, as diet and nutrition have been found to play a significant role in the onset and progression of cancer. As a result, there has been an increasing focus on the impact of dietary modifications on preventing the onset, progression, and reoccurrence of cancer. In this systematic review, data were collected on three common diets, the Mediterranean diet (MD), ketogenic diet (KD), and plant-based diet, to gain insight into the application of these three dietary modification approaches for risk prevention and limitation of cancer burden. Initially, 4,397 articles were identified from three databases (Ovid, Web of Science, and CINHAL). After removing studies based on the exclusion criteria, only 23 studies were eligible to be included in the systematic review of which 15 evaluated the MD, four assessed the ketogenic diet, and four evaluated the plant-based diet. Each article was considered for its methods, procedures, and findings. The findings indicate that dietary interventions may effectively reduce the odds of cancer development and the advancement of diagnosed cancers. With the introduction of the MD, KD, and plant-based diets, significant improvements in lowering cancer development, recurrence-free status, and limiting tumor growth were noted across numerous cancer types. Currently, the MD has been extensively studied in the literature, and amongst the widest variety of cancer types. Additional information and evaluation are required on the ketogenic and plant-based diets to fully understand their impact on the cancer burden across a wider subset of cancers. Clinicians should evaluate and recommend nutritional adaptations to their patients to limit the development of specific cancers and as an adjunctive therapy to traditional pharmacological treatment options for patients with diagnosed cancers.

Healthy and Unhealthy Plant-Based Diets and Glioma in the Chinese Population

Plant-based diets have been suggested to help prevent various chronic diseases, including cancer. However, there are few reports on central nervous system tumors, and data on dose-response relationships are lacking. This individual-matched case-control study included 506 cases and 506 controls. The overall plant-based diet index (PDI), the healthy plant-based diet index (hPDI), and the unhealthy plant-based diet index (uPDI) were calculated using dietary information collected through a food frequency questionnaire, with higher scores indicating better adherence. We analyzed the relationship of plant-based diets with glioma. After adequate adjustment for confounders, PDI was associated with a reduced glioma risk (OR = 0.42, 95% CI: 0.24-0.72). Conversely, uPDI was associated with an elevated glioma risk (OR = 8.04, 95% CI: 4.15-15.60). However, hPDI was not significantly associated with glioma risk (OR = 0.83, 95% CI: 0.48-1.45). For subgroups, PDI was not significant in analyzing young age, BMI, or any pathological subtypes. The restricted cubic spline function showed a significant dose-response relationship between PDI (p-nonlinearity< 0.0001) and uPDI (p-nonlinearity= 0.0711) and glioma. Further analysis found that refined grains had the greatest effect on gliomas in the less healthy plant-based food group. Therefore, following a plant-based diet was linked to a lower risk of glioma, especially when consuming fewer unhealthy plant-based foods.

Scoping review of the association of plant-based diet quality with health outcomes

Introduction

The association of plant-based dietary patterns with health outcomes has traditionally been assessed without considering nutritional value. The plant-based dietary index (PDI), first published in 2016, overcomes this limitation with both a healthful PDI (hPDI) and an unhealthful PDI (uPDI), based on the quality of plant foods consumed plus the frequency of animal foods. We sought to summarize the breadth of research using the hPDI and uPDI to gain insight into how the quality of plant-based dietary patterns might be associated with health outcomes.

Methods

Scoping review of studies that used the PDI, hPDI, or uPDI to report associations with health outcomes. Multiple databases were searched from 2010 through April 2023 with 2 authors independently assessing eligibility and extracting data. In addition to assessing the association of the indices to health outcomes, we determined the frequency of concordant or discordant findings for hPDI versus PDI and for hPDI versus uPDI.

Results

We included 95 articles (54% longitudinal, 37% cross-sectional, and 9% case-control) with a median sample size of 3,646. Higher hPDI levels were associated with favorable health outcomes in 36% of comparisons (most often for obesity, mortality, diabetes, cardiovascular disease, and psychiatric disorders), compared to 25% for the PDI and only 2% for the uPDI. Conversely, higher levels of the uPDI were associated with unfavorable health outcomes in 33% of comparisons, in contrast to under 1% for the hPDI and 2% for the PDI. When the hPDI association to an outcome was discordant with the uPDI or PDI, the significance and directionality always favored the hPDI over the uPDI, and nearly always favored the hPDI over the PDI.

Discussion

Dietary indices that account for the quality of plant foods can show health benefits that might be missed by a generic plant-based index. A greater focus on the quality of plant foods could improve nutrition guidelines, raise awareness about the benefits of adding unrefined plant foods to the diet, and empower consumers to make incremental additions of such foods to displace unhealthy foods. We anticipate increasing use of indices that address food quality in future research.

The association of plant-based dietary pattern with general and abdominal obesity: a large cross-sectional study

Purpose

Only a few studies have studied the association between plant-based dietary index (PDI) and the prevalence of obesity. The purpose of this study was to investigate the association between PDI and the prevalence of general and abdominal obesity in a large sample of Iranian adults.

Methods

The current cross-sectional study was performed from 2010 to 2012 in Isfahan, Iran. This study comprised 6,724 adults between the ages of 18 and 55. We analyzed data from 6,724 participants who were classified as having general obesity and 5,203 individuals who were classified as having abdominal obesity. Dietary intake was assessed using a validated food frequency questionnaire. We determined the PDI by assigning plant foods positive scores and animal foods negative values using the method of Satija et al. General obesity was defined as having a body mass index (BMI) greater than 30 kg/m2, whereas abdominal obesity was classified as having a waist circumference (WC) greater than 88 cm for women and 102 cm for men. Data was examined using Chi-squared test and the analysis of variance (ANOVA and ANCOVA). Multivariable binary logistic regression analyses were performed to evaluate the association between PDI and risk of general as well as abdominal obesity.

Results

The mean age of the study participants was 36.8 ± 8.08 years, and 57% of them were female. General obesity prevalence was 9.6%, while abdominal obesity was 26.8%. In all the unadjusted and multivariable adjusted models of the total population, there was no significant association between highest vs. lowest adherence to the PDI and general obesity or abdominal obesity. No significant association was found when men and women were analyzed separately as well.

Conclusion

In the present study, no association was observed between PDI and general and abdominal obesity in the Iranian adult population.

Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study

Menopause is one the most crucial stages in a female's life. Identifying the education gaps regarding menopause is important, thus this study aims to explain the health-related needs of females during menopause. Scopus, PubMed, Scientific Information Database, and Web of Science databases were searched for the available observational (cohort, case-control, and cross-sectional), systematic review, meta-analysis, and clinical trial studies (2007-2021) using keywords, such as 'Educational Needs Assessment,' 'Assessment of Healthcare Needs,' 'menopause,' 'climacteric,' 'premenopause,' and 'postmenopause.' A total of 180 out of 5,705 papers were evaluated after considering the inclusion and exclusion criteria. The educational needs of females during menopause in the reviewed studies include osteoporosis, oral and dental problems, metabolic disorders, cardiovascular diseases, hypertension, lung diseases, infectious diseases, musculoskeletal problems, urinary problems, breast cancer, defecation problems, genital disorders, special diseases such as eye diseases and hypothyroidism and hormone therapy, mental disorders, cognitive function, sleep disorders, sexual disorders, physical activity, supplement consumption, public health issues, health education, fall, and nutrition. The study results reveal that females during postmenopause require training, counseling, and support in all aspects to get through this challenging time, and providing these services, infrastructure, appropriate policy, and the use and support of the medical team's capacity are all required.

Long-term adherence to healthful and unhealthful plant-based diets and breast cancer risk overall and by hormone receptor and histologic subtypes among postmenopausal females

BACKGROUND

Epidemiological studies assessing the influence of vegetarian diets on breast cancer (BC) risk have produced inconsistent results. Few studies have assessed how the incremental decrease in animal foods and the quality of plant foods are linked with BC.

OBJECTIVES

Disentangle the influence of plant-based diet quality on BC risk between postmenopausal females.

METHODS

Total of 65,574 participants from the E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale) cohort were followed from 1993-2014. Incident BC cases were confirmed through pathological reports and classified into subtypes. Cumulative average scores for healthful (hPDI) and unhealthful (uPDI) plant-based diet indices were developed using self-reported dietary intakes at baseline (1993) and follow-up (2005) and divided into quintiles. Cox proportional hazards models were used to estimate adjusted HR and 95% CI.

RESULTS

During a mean follow-up of 21 y, 3968 incident postmenopausal BC cases were identified. There was a nonlinear association between adherence to hPDI and BC risk (Pnonlinear < 0.01). Compared to participants with low adherence to hPDI, those with high adherence had a lower BC risk [HRQ3 compared withQ1 (95% CI): 0.79 (0.71, 0.87) and HRQ4 compared with Q1 (95% CI): 0.78 (0.70, 0.86)]. In contrast, higher adherence to unhealthful was associated with a linear increase in BC risk [Pnonlinear = 0.18; HRQ5 compared with Q1 (95% CI): 1.20 (1.08, 1.33); Ptrend < 0.01]. Associations were similar according to BC subtypes (Pheterogeneity > 0.05 for all).

CONCLUSIONS

Long-term adherence to healthful plant foods with some intake of unhealthy plant and animal foods may reduce BC risk with an optimal risk reduction in the moderate intake range. Adherence to an unhealthful plant-based diet may increase BC risk. These results emphasize the importance of the quality of plant foods for cancer prevention. This trial was registered at clinicaltrials.gov (NCT03285230).

Plant-based diets and the risk of pancreatic cancer: a large prospective multicenter study

BACKGROUND

Plant-based diets have been recommended for improving health outcomes, including cancer. However, previous studies on plant-based diets and the risk of pancreatic cancer are scarce and fail to consider plant food quality.

OBJECTIVES

We sought to examine the potential associations of 3 plant-based diet indices (PDIs) with the risk of pancreatic cancer in a US population.

METHODS

A population-based cohort of 101,748 US adults was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The overall PDI, healthful PDI (hPDI), and unhealthful PDI (uPDI) were constructed to qualify adherence to overall, healthy, and less healthy plant-based diets, respectively, with higher scores indicating better adherence. Multivariable Cox regression was used to compute hazard ratios (HRs) for pancreatic cancer incidence. Subgroup analysis was conducted to identify the potential effect modifiers.

RESULTS

Over a mean follow-up of 8.86 years, 421 pancreatic cancer cases occurred. Participants in the highest compared with the lowest quartiles of overall PDI had a lower risk of pancreatic cancer [HR_{quartile 4 versus 1}: 0.74; 95% confidence interval (CI): 0.57, 0.96; P_trend = 0.023]. A stronger inverse association was observed for hPDI (HR_{quartile 4 versus 1}: 0.56; 95% CI: 0.42, 0.75; P_trend < 0.001). Conversely, uPDI was positively associated with the risk of pancreatic cancer (HR_{quartile 4 versus 1}: 1.38; 95% CI: 1.02, 1.85; P_trend = 0.012). Subgroup analyses revealed a stronger positive association for uPDI in participants with BMI <25 (HR_{quartile 4 versus 1}: 3.22; 95% CI: 1.56, 6.65) than in those with BMI ≥25 (HR_{quartile 4 versus 1}: 1.08; 95% CI: 0.78, 1.51) (P_interaction = 0.001).

CONCLUSIONS

In this US population, adherence to a healthy plant-based diet confers a lower risk of pancreatic cancer, whereas adherence to a less healthy plant-based diet confers a higher risk. These findings highlight the importance of considering plant food quality in preventing pancreatic cancer.

Sentiment Analysis to Understand the Perception and Requirements of a Plant-Based Food App for Cancer Patients

Understanding human perception and requirements on food for cancer prevention and condition management is important so that food applications can be catered to cancer patients. In this paper, web scraping was conducted to understand the public’s perception, attitude, and requirements related to a plant-based diet as a recommended diet for cancer prevention and condition management. Text and sentiment analyses were carried out on results gathered from 82 social sites to determine whether noncancer and cancer patients use plant-based diets, how they have been consumed, their benefits in the prevention and condition management of cancers, the existing myths/fake news about cancer, and what do cancer patients need in a food app. The results of the text analysis highlighted gaps in existing apps, including a lack of credibility as there were a lot of fake news and myths about cancer and endorsement by professionals. Future food apps should provide personalized diets to include both plant-based diets as well as meat, symptom management, good user experience, credibility, and emotional and mental health support.

Dietary patterns and breast cancer risk, prognosis, and quality of life: A systematic review

Background

Statistics indicate that the morbidity of breast cancer is increasing globally, and its (overall figures) incidence has now surpassed that of lung cancer for the first time. The relation between a whole dietary pattern, rather than of a single food or nutrient, and breast cancer (BC) should be examined for findings to capture the complexities of diet and the potential for synergism between dietary components. Hence, the effects of dietary patterns on breast cancer have recently attracted increasing attention.

Objective

To systematically review the effects of dietary patterns on breast cancer risk, prognosis, and quality of life in survivors.

Methods

This systematic review was conducted following PRISMA guidelines and was registered in PROSPERO. Data from Ovid, China Biomedical Literature Database, Wanfang Data Knowledge Service Platform, CNKI, PubMed, Weipu, The Cochrane Library, Duxiu Data, ProQuest, Embase, Web of Science, and Scopus Database were retrieved and evaluated.

Results

A total of 47 studies that investigated the association between eating patterns and breast cancer were identified. Ten studies evaluated the effect of the model on treatment outcome and prognosis of breast cancer and two cross-sectional studies examined the influence of dietary patterns on quality of life. The resulting favorable dietary patterns were shown to regulate metabolic biomarkers, antioxidants, anti-inflammatory agents, and protective genes, and inhibit cell proliferation and invasion.

Conclusion

Numerous studies have examined the effects of healthy eating, plant-based, anti-inflammation, low-fat, and other favorable dietary patterns in relation to breast cancer. However, few studies reported significant associations and the studies had limitations, suggesting that the current findings should be interpreted with caution.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, CRD4202 2350171.

Three food pattern-based indices diagnose lactating women's nutritional inadequacies in Argentina: A clinimetric approach using diet quality indicators and breast milk biomarkers

Diet is a health foundation that supports breastfeeding and enables lactating women's recovery. This study aimed to develop 3 valid diet adherence indices by clinimetric contrast with different parameters. We hypothesize that the 3 diet adherence-based indices are positively correlated with diet quality and milk biomarkers and directly related to calcium, fiber, and energy intake. A cross-sectional study recorded food frequency, anthropometric and dietary measures, and milk analysis to estimate correlations, sensitivity, and specificity (n = 284). Three reliable indices agreed by >75% with food frequency: macronutritional (MDI), phytochemical (PDI), and energetic (EDI), which correlated positively to the Fat Quality Index and Minimum Dietary Diversity for Women. MDI and EDI correlated negatively to the Healthy Plant-Based Diet Index (H-PBDI), whereas PDI correlated positively. MDI correlated positively to the protein-to-carbohydrate ratio, whereas EDI correlated negatively. Inadequate intakes of calcium, fiber, and energy were indicated by MDI <19, PDI <19, and EDI ≥19, respectively, in a sensitive and specific manner. Body fat was therefore positively associated with EDI. MDI was associated with increased protein and superoxide anion in milk, depending on its high protein-to-carbohydrate ratio and low H-PBDI. These indices allowed us to assess diet to diagnose maternal malnutrition promptly. Index validity was supported by significant dietary correlations and biological responsiveness. MDI and EDI promoted breast bioactivity and body adiposity, respectively, whereas PDI represented a healthier option.

Association of plant-based dietary patterns with the risk of colorectal cancer: a large-scale case-control study

Plant-based diets are associated with a lower risk of colorectal cancer, but the risk might differ by the quality of plant-based diets. This study aimed to investigate the association between different types of plant-based dietary patterns and colorectal cancer risk in the Chinese population. We conducted a case-control study with 2799 eligible colorectal cancer cases and 2799 sex- and age-matched controls in Guangzhou, China. A validated food frequency questionnaire was used to collect dietary data, from which we derived plant-based diet indices, including the plant-based diet index (PDI), the healthy PDI (hPDI), and the unhealthy PDI (uPDI). The PDI, hPDI, and uPDI assess the adherence to overall, healthy, and unhealthy plant-based dietary patterns, respectively. The odds ratios (ORs) and 95% confidence intervals (CIs) for colorectal cancer risk were estimated using unconditional logistic regression models. Higher adherence to the PDI, particularly the hPDI, was associated with a lower risk of colorectal cancer, whereas greater adherence to the uPDI was associated with a higher risk of colorectal cancer. Compared with the lowest quintile, the adjusted ORs in the highest quintile were 0.79 (95% CI: 0.66-0.95) for the PDI, 0.45 (95% CI: 0.38-0.55) for the hPDI, and 1.45 (95% CI: 1.18-1.78) for the hPDI, respectively. In stratified analysis, the inverse association between the PDI and colorectal cancer risk was not observed in women, and the positive association between the uPDI and colorectal cancer risk was not observed in men. In conclusion, these results support recommendations that shifting to a healthy plant-based dietary pattern is important for the prevention of colorectal cancer, particularly in the Chinese population that habitually consumes plant foods.

Anti-breast cancer effects of phytochemicals: primary, secondary, and tertiary care

Breast cancer incidence is actually the highest one among all cancers. Overall breast cancer management is associated with challenges considering risk assessment and predictive diagnostics, targeted prevention of metastatic disease, appropriate treatment options, and cost-effectiveness of approaches applied. Accumulated research evidence indicates promising anti-cancer effects of phytochemicals protecting cells against malignant transformation, inhibiting carcinogenesis and metastatic spread, supporting immune system and increasing effectiveness of conventional anti-cancer therapies, among others. Molecular and sub-/cellular mechanisms are highly complex affecting several pathways considered potent targets for advanced diagnostics and cost-effective treatments. Demonstrated anti-cancer affects, therefore, are clinically relevant for improving individual outcomes and might be applicable to the primary (protection against initial cancer development), secondary (protection against potential metastatic disease development), and tertiary (towards cascading complications) care. However, a detailed data analysis is essential to adapt treatment algorithms to individuals’ and patients’ needs. Consequently, advanced concepts of patient stratification, predictive diagnostics, targeted prevention, and treatments tailored to the individualized patient profile are instrumental for the cost-effective application of natural anti-cancer substances to improve overall breast cancer management benefiting affected individuals and the society at large.

Consumption of “Diabetes Risk Reduction Diet” and Odds of Breast Cancer Among Women in a Middle Eastern Country

Background:

Given the role of insulin resistance in several cancers, we hypothesized that consumption of a diet that reduces insulin resistance might lower the risk of breast cancer.

Objective

The present study was designed to assess the association between consumption of “diabetes risk reduction diet” (DRRD) and odds of breast cancer among a large group of women in a Middle Eastern country.

Methods

This population-based case-control study enrolled 350 newly diagnosed cases of stage I-IV breast cancer and 700 age-matched apparently healthy individuals as controls. We collected dietary data via a validated 106-item Willett-format semi-quantitative dish-based food frequency questionnaire. A DRRD score was included based on 9 dietary factors (cereal fiber, coffee, nuts, whole fruits, ratio of polyunsaturated to saturated, trans fat, sugar-sweetened beverages, red and processed meat, and lower glycemic index). For food and nutrient items with a protective association with diabetes in earlier studies, participants were given the score as the quintile of that food item, but for food groups with unfavorable association with diabetes, we did vice versa. Total DRRD score ranged from 5 to 45.

Results

Mean age of cases and controls was 65.28 and 61.04 years. Mean BMI of patients with breast cancer and controls was 25.5 and 21.0. We found that individuals with the greatest adherence to the DRRD were 0.41 times less likely to have breast cancer than those with the lowest adherence (OR: 0.59; 95% CI: 0.38, 0.90, and P-trend = 0.002). Stratified analysis by menopausal status indicated a significant inverse relationship in postmenopausal women (OR: 0.57; 95% CI: 0.36–0.90), but not in premenopausal women (OR: 0.76; 95% CI: 0.19–2.96). Moreover, by BMI status, we found statistically significant inverse association between adherence to the DRRD and odds of breast cancer among normal-weight women (OR: 0.59; 95% CI: 0.36, 0.98) but not in overweight women (OR: 0.66; 95% CI: 0.31, 1.40). Conclusions: Significant inverse associations were found between adherence to DRRD and breast cancer, especially among postmenopausal and normal-weight women.

Plant-Based Diets and Cancer Risk: What is the Evidence?

PURPOSE OF REVIEW

The purpose of this review is to summarize the recent (past 5 years) available evidence regarding the association between plant-based diets on cancer risk from clinical trials and observational studies. Biological mechanisms and gaps in the current literature will also be discussed.

RECENT FINDINGS

There is a lack of intervention studies but there are abundant observational studies assessing the association between plant-based diets and cancer risk, including multiple longitudinal cohort studies and similar data from case-control studies that demonstrate a decreased overall cancer risk with plant-based diets. Case-control studies support a decreased risk of colorectal and breast cancers with plant-based diets, but results for specific cancers remain inconsistent in cohort studies. Current evidence from observational studies indicates an inverse association between plant-based diets and overall cancer risk. Future research should include intervention studies, address inconsistencies in dietary assessment methods and provide greater detail on underrepresented groups.

Dietary acid load and the risk of cancer: a systematic review and dose-response meta-analysis of observational studies

AIMS

Recent evidence suggests the link between adherence to an acidogenic diet and the risk of some types of cancers, such as colorectal and breast cancers. This systematic review and meta-analysis aimed to clarify the association between dietary acid load and cancer risk.

DATA SEARCH AND SYNTHESIS

Online databases (PubMed, Scopus, EMBASE, Scholar Google and ISI web of sciences) were searched between January 1990 and May 2021. The risk ratio (RR) was extracted from eligible studies and random-effects meta-analysis was performed to calculate pooled RR of studies. Nine studies (three cohorts, six case-control) were included. Higher dietary acid load scores [including potential renal acid load (PRAL) and net endogenous acid production (NEAP)] were associated with the increased risk of cancer [RRPRAL, 1.77; 95% confidence interval (CI), 1.27-2.46; n = 8; RRNEAP, 1.58, 95% CI: 1.20-2.09, n = 7). Dose-response analysis suggested that a 20-score increase in dietary PRAL and NEAP was associated with 27 and 8% higher risk of cancer, respectively (RRPRAL, 1.27; 95% CI, 1.02-1.60; nonlinearity P = 0.12; RRNEAP, 1.08; 95% CI, 1.02-1.13, nonlinearity P = 0.06). A significant positive relationship between dietary PRAL and risk of cancer was only observed in the subgroup of women. Associations were significant in both men and women for dietary NEAP. Subgroup analyses based on cancer type were only possible for breast cancer. There was no significant association between dietary acid load (PRAL and NEAP) and breast cancer risk.

CONCLUSION

Our analysis showed that high adherence to an acidogenic diet is associated with an increased risk of cancer. The protocol for this meta-analysis was registered in PROSPERO registration no. CRD42019146460.

Adherence to plant-based dietary patterns in relation to glioma: a case-control study

Available evidence suggests a favorable association between adherence to a plant-based diet and disease prevention, but data on the link between such dietary intakes and cancer are scarce. We examined the association between the overall plant-based diet (PDI), healthy plant-based diet (hPDI), and unhealthy plant-based diet (uPDI) and risk of glioma. This case–control study was conducted on 128 newly diagnosed glioma patients, and 256 hospital-based controls. Cases were diagnosed by pathological test and controls were selected from hospitalized people in orthopedic and surgical wards. Dietary intakes were assessed using a validated Block-format 123-items food frequency questionnaire. Scores of plant-based dietary patterns were calculated using the method suggested by Satija et al. After controlling for potential confounders, individuals with higher scores of PDI (OR: 0.54, 95% CI: 0.32–0.91, P-trend < 0.001) and hPDI (OR: 0.32, 95% CI: 0.18–0.57, P-trend < 0.001) had significantly lower odds of glioma compared with those with the lowest scores. This association did not change in the fully adjusted model; such that subjects in the highest tertile of PDI and hPDI were 69% and 71% less likely to have glioma compared with those in the lowest tertile. In contrast, higher scores of uPDI was significantly associated with a greater odds of glioma (OR: 2.85, 95% CI: 1.26–6.47, P-trend = 0.02). Adherence to PDI and hPDI was associated with a lower odds of glioma, while greater adherence to uPDI was directly associated with the likelihood of glioma. Further prospective cohort studies are needed to examine our findings.

The relationship between dairy products intake and breast cancer incidence: a meta-analysis of observational studies

BACKGROUND

The effect of dairy products intake on breast cancer (BC) is highly controversial. This study aims to investigate the relationship between dairy intake and BC incidence.

METHODS

A search was carried out in PubMed, EBSCO, Web of Science, and Cochrane Library databases before January 2021. The primary objective was the risk of BC and intake of dairy products were exposure variables.

RESULTS

The meta-analysis comprised 36 articles with 1,019,232 participants. Total dairy products have a protective effect on female population (hazard ratio (HR) =0.95, 95% confidence interval (CI) =0.91-0.99, p = 0.019), especially for estrogen receptor-positive (ER+) (HR = 0.79, p = 0.002) and progesterone receptor-positive (PR+) BC (HR = 0.75, p = 0.027). For ER+/PR+ BC, there is a trend of protection, but it has not reached statistical significance (HR = 0.92, p = 0.075). Fermented dairy products can reduce BC risk in postmenopausal population (HR = 0.96, 95%CI = 0.93-0.99, p = 0.021), but have no protective effect on premenopausal population (HR = 0.98, 95%CI = 0.94-1.03, p = 0.52). Non-fermented dairy products have no significant effect on BC occurrence (p > 0.05). High-fat dairy products are harmful to women, without statistical difference (HR = 1.06, 95%CI = 1.00-1.13, p = 0.066). On the contrary, low-fat dairy products can protect the premenopausal population (HR = 0.94, 95%CI = 0.89-1.00, p = 0.048).

CONCLUSION

The intake of dairy products can overall reduce BC risk in the female population, but different dairy products have varying effects on different BC subtypes and menopausal status.

Plant-Based Dietary Patterns and Breast Cancer Recurrence and Survival in the Pathways Study

Plant-based diets are recommended for cancer survivors, but their relationship with breast cancer outcomes has not been examined. We evaluated whether long-term concordance with plant-based diets reduced the risk of recurrence and mortality among a prospective cohort of 3646 women diagnosed with breast cancer from 2005 to 2013. Participants completed food frequency questionnaires at diagnosis and 6-, 25-, and 72-month follow-up, from which we derived plant-based diet indices, including overall (PDI), healthful (hPDI), and unhealthful (uPDI). We observed 461 recurrences and 653 deaths over a median follow-up of 9.51 years. Using multivariable-adjusted Cox proportional hazards models, we estimated hazard ratios (HR) and 95% confidence intervals for breast cancer recurrence and all-cause, breast-cancer-specific, and non-breast-cancer mortality. Increased concordance with hPDI was associated with a reduced hazard of all-cause (HR 0.93, 95% CI: 0.83–1.05) and non-breast-cancer mortality (HR 0.83, 95% CI: 0.71–0.98), whereas increased concordance with uPDI was associated with increased hazards (HR 1.07, 95% CI: 0.96–1.2 and HR 1.20, 95% CI: 1.02–1.41, respectively). No associations with recurrence or breast-cancer-specific mortality were observed. In conclusion, healthful vs. unhealthful plant-based dietary patterns had differing associations with mortality. To enhance overall survival, dietary recommendations for breast cancer patients should emphasize healthful plant foods.

Lupin-Derived Bioactive Peptides: Intestinal Transport, Bioavailability and Health Benefits

There is a renewed interest on the reliance of food-based bioactive compounds as sources of nutritive factors and health-beneficial chemical compounds. Among these food components, several proteins from foods have been shown to promote health and wellness as seen in proteins such as α/γ-conglutins from the seeds of Lupinus species (Lupin), a genus of leguminous plant that are widely used in traditional medicine for treating chronic diseases. Lupin-derived peptides (LDPs) are increasingly being explored and they have been shown to possess multifunctional health improving properties. This paper discusses the intestinal transport, bioavailability and biological activities of LDPs, focusing on molecular mechanisms of action as reported in in vitro, cell culture, animal and human studies. The potentials of several LDPs to demonstrate multitarget mechanism of regulation of glucose and lipid metabolism, chemo- and osteoprotective properties, and antioxidant and anti-inflammatory activities position LDPs as good candidates for nutraceutical development for the prevention and management of medical conditions whose etiology are multifactorial.

Differential effects of phenolic extracts from red-fleshed apple peels and flesh induced G1 cell cycle arrest and apoptosis in human breast cancer MDA-MB-231 cells

Red-fleshedapples are preferredbecause of their high content of phenolics and antioxidants in peel and pulp. Herein, we evaluated the mechanisms of apple peel polyphenolic extracts (APP) and apple flesh polyphenolic extracts (AFP) from the new red-fleshed apple in inhibiting cell proliferation and inducing apoptosis on human breast cancer MDA-MB-231 cells. The antiproliferative activities were determined by the CCK8 assay. The expression of proteins was determined using Western blot. We found that the content of polyphenols and flavonoids in APP was significantly higher than that in AFP, and 14 main phenolic compounds in APP and AFP were quantified using UPLC-MS/MS techniques. Besides, the significant inhibition effects of APP and AFP were achieved through Akt pathway by inducing apoptosis (significantly upregulating reactive oxygen species [ROS] levels, and downregulating expression of pAkt, pBad, Bcl-2, promoting Cytochrome c release, activating Cle-Caspase 9, and inducing expressions of Cle-Caspase 3 and Cle-PARP), and inducing G0/G1 cell cycle arrest (increased expressions of p-p53 and p21 and decreased expressions of PCNA and Cyclin D1). And the inhibition effect of APP was stronger than that of AFP. These results suggest that AFP and APP may be excellent sources of natural chemicals for treating triple-negative breast cancer MDA-MB-231 cells. PRACTICAL APPLICATION: The effects of antiproliferation of phenolic extracts from red-fleshed apple peels and flesh on human breast cancer MDA-MB-231 cells were evaluated. The data may clarify the functional parts of red-fleshed apple and provide some basis for scientific researchers and consumers to recognize and exploit red-fleshed apple.

The Association between Dietary Calcium Intake and Breast Cancer Risk among Iranian Women

No information is available from Middle Eastern countries linking dietary calcium intake and odds of breast cancer.

OBJECTIVE

This study was conducted to investigate the association between dietary calcium intake and odds of having breast cancer among Iranian women.

In this population-based case-control study, 350 newly diagnosed breast cancer cases were recruited and 700 age-matched subjects were enrolled as controls. Dietary intakes were examined by the use of a 106-item validated FFQ. Total dietary calcium intake of each participant was computed by summing up calcium intake from all foods and dishes. The quartile cutoff points of energy-adjusted calcium intake was obtained in the control group. These cutoff points were used to classify all study participants into quartiles in terms of dietary calcium intake.

After adjustment for age and energy intake, we found that individuals in second quartile of calcium intake were 43% less likely to have breast cancer compared with those in the bottom quartile (OR: 0.57; 95% CI: 0.38-0.86). This significant association disappeared after further controlling for other potential confounders including dietary factors and BMI (OR: 0.91; 95% CI: 0.57-1.45). When the analyses were done by menopausal status, premenopausal women with the greatest calcium intake were 60% less likely to have breast malignancy than those with the lowest intake (OR: 0.40; 95% CI: 0.16-0.99). Adjustment for potential confounders did not substantially influence this finding (OR: 0.32; 95% CI: 0.11-0.95). The association remained significant even after additional controlling for dietary covariates (OR: 021; 95% CI: 0.06-0.72) and BMI (OR: 0.21; 95% CI: 0.04-0.93). No significant association was found between dietary calcium intakes and odds of breast cancer in postmenopausal women.

Dietary calcium intake was protectively associated with odds of breast cancer in premenopausal women, but not in postmenopausal women. Further prospective investigations are needed to confirm these findings.

Association between dietary phytochemical index and breast cancer: a case-control study

BACKGROUND

Dietary intake of isoflavones has been positively associated with risk of breast cancer (BC) in some earlier studies. In addition, most studies on diet-disease associations came from western countries and limited data are available in the Middle-East.

METHODS

This case-control study was performed on 350 women with BC aged over 30 years who were recruited from hospitals or private clinics in Isfahan, Iran. All patients were diagnosed with BC during the maximum of the last 6 months using physical examination and mammography findings. Using cluster method sampling, 700 apparently healthy age- and socioeconomic status-matched controls were randomly selected from healthy women who had no relationship with BC patients and had no familial history of BC. Data on dietary intakes were collected using a validated food-frequency questionnaire. The DPI was calculated based on dietary energy derived from foods rich in phytochemicals (kcal) divided by total daily energy intake (kcal) of each participant.

RESULTS

Mean ± SD age and BMI in the study participants were 62.4 ± 10.8 years and 24.3 ± 5.2 kg/m², respectively. In the crude model, participants in the highest quartile of DPI had 63% lower odds of breast cancer compared to those in the lowest quartile (95% CI 0.26, 0.54; P-trend < 0.001). After adjustment for potential confounders, this inverse association became strengthened (95% CI 0.22, 0.49; P-trend < 0.001). Further adjustment for BMI did not change the association (OR for the highest quartile vs. the lowest quartile = 0.40, 95% CI 0.26, 0.60; P-trend < 0.001).

CONCLUSION

In conclusion, a protective association was observed between DPI and BC in this case-control study. Therefore, high consumption of foods rich in phytochemicals such as fruits, vegetables, and whole grains might help reducing the odds of BC among women.