Diet quality of Australian breast cancer survivors: a cross-sectional analysis from the Australian Longitudinal Study on Women's Health

Alcohol and Breast Cancer: Results From the Women's Wellness After Cancer Program Randomized Controlled Trial

BACKGROUND

There is evidence that drinking alcohol increases the risk of recurrent breast cancer. It is unclear whether Australian women with breast cancer are aware of this evidence or modify their alcohol intake accordingly.

OBJECTIVE

This article reports a secondary analysis of data from the Women's Wellness after Cancer Program (WWACP) randomized controlled trial (N = 351). The WWACP aimed to enhance quality of life and reduce chronic disease risk in women previously treated for cancer through lifestyle modification. Here we provide the alcohol-related data from the study's breast cancer participants (n = 269). We analyzed baseline alcohol consumption, the variables associated with alcohol intake, and intervention effect on intake at weeks 12 (end of intervention) and 24 (to determine sustainability).

INTERVENTIONS/METHODS

Measures included the Dietary Questionnaire for Epidemiological Studies, Short Form-36, International Physical Activity Questionnaire, Green Climacteric Scale, Pittsburgh Sleep Quality Index, and Center for Epidemiologic Studies Depression Scale.

RESULTS

Most participants practiced safe alcohol consumption. Among drinkers, drinking caffeine, smoking, emotional and physical role limitations, and greater discomfort with vasomotor symptoms were associated with increased intake. Relative to baseline, alcohol consumption decreased from 5.22 g/d to 4.18 g/d in the intervention group, whereas consumption increased among control subjects at 12 weeks. No difference between groups was observed at week 24.

CONCLUSION

The intervention was associated with less alcohol intake at week 12 among drinkers, but this reduction was not sustained at the 24-week follow-up.

IMPLICATIONS FOR PRACTICE

Future iterations of the WWACP will emphasize stronger messaging and supports regarding alcohol consumption after breast cancer treatment.

Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal

Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.

Determinants of bone health in adults Polish women: The influence of physical activity, nutrition, sun exposure and biological factors

Purpose

The aim of this study was to assess the determinants of bone health in the group of women over 40 years old. Lifestyle factors such as past and present physical activity, past and present sun exposure, current dietary intake of calcium and vitamin D, nutritional status as measured by BMI, family history of osteoporosis and current hormonal status were analysed.

Methods

The study involved 500 women over 40 years old. All examined women was the same ethnicity- European origin. Methods used: densitometry method (DXA), bioelectrical impedance analysis, International Physical Activity Questionnaire, nutrition questionnaire, past and present sun exposure questionnaire. Past and present physical activity, past and present sun exposure and sufficient level of calcium in the diet proved to be the most important factors determining mineralization of bone tissue of women. In order to indicate an independent association of the correct bone tissue mineralization with individual factors, multivariate analysis was used—logistic regression.

Results

The norm BMD in the distal part of the forearm was strongly influenced: recommended dietary calcium intake (OR = 5.95; p = 0.003), moderately (OR = 1.88; p = 0.053) and high (OR = 14.0; p<0.001) past physical activity, sufficient (OR = 4.97; p<0.001) and high (OR = 18.9; p = 0.004) level of present physical activity, sufficient past (OR = 5.15; p<0.001) and sufficient present sun exposure (OR = 10.0; p<0.001).

The chance for the BMD prox norm was also increased several times: high past physical activity (OR = 68.4; p<0.0001) and sufficient past sun exposure (OR = 10.6; p<0.001), moderate past activity (OR = 4.20; p<0.001), sufficient (OR = 6.13; p<0.001) and high (OR = 10.0; p<0.001) present physical activity, sufficient present sun exposure (OR = 9.09; p<0.0001), recommended intake of calcium (OR = 9.57; p<0.001) and vitamin D (OR = 2.68; p = 0.052). Whereas e significantly lower likelihood for the BMD prox norm was found in women with the oldest hormonal status (postmenopausal period) (OR = 0.18; p<0.001), with osteoporosis in the family (OR = 0.37; p<0.001) and living in an agglomeration (OR = 0.68; p = 0.03).

Conclusion

Interventions to increase physical activity, especially outdoors, may help reduce risk of osteoporosis, fractures and subsequent healthcare costs.

Diet Quality among Cancer Survivors and Participants without Cancer: A Population-Based, Cross-Sectional Study in the Atlantic Partnership for Tomorrow's Health Project

Cancer survivors are encouraged to have a healthy lifestyle to reduce health risks and improve survival. An understanding of health behaviors, such as diet, is also important for informing post-diagnosis support. We investigated the diet quality of cancer survivors relative to participants without cancer, overall and by cancer site and time from diagnosis. A cross-sectional study design within the Atlantic PATH study was used which included 19,973 participants aged 35 to 69 years from Atlantic Canada, of whom 1,930 were cancer survivors. A diet quality score was derived from a food frequency questionnaire. Comparisons of diet quality between cancer survivors and non-cancer controls, cancer site and years since diagnosis were examined in multivariable multi-level models. Cancer survivors had a mean diet quality of 39.1 out of 60 (SD: 8.82) and a higher diet quality than participants without cancer (mean difference: 0.45, 95% CI: 0.07, 0.84) after adjustment for confounders. Odds of high diet quality was greater in breast cancer survivors than participants without cancer (OR = 1.42, 95% CI: 1.06, 1.90), and higher among survivors diagnosed ≤2 years versus >10 years (OR = 1.71, 95% CI: 1.05, 2.80). No other differences by cancer site and years since diagnosis were observed. The difference in diet quality, although statistically significant, is unlikely to be meaningful, suggesting that cancer survivors have similar diet quality as participants without cancer. There was considerable room for dietary improvement regardless of cancer status, highlighting the need for dietary interventions, especially among cancer survivors, who are at higher risk for secondary health problems.

Modifications in dietary and alcohol intakes between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort

Postdiagnosis diet and alcohol consumption may be associated with cancer prognosis, recurrence and mortality. Our aim was to investigate food, nutrient and alcohol intake variations between before and after cancer diagnosis and their determinants in a prospective cohort. Subjects (n = 696) were incident cancer cases diagnosed in the NutriNet-Santé cohort between 2009 and 2016. Food, nutrient and alcohol intakes were prospectively collected using repeated nonconsecutive 24-hr dietary records since subjects' inclusion (i.e. an average of 2 y before diagnosis). Mean number of dietary records per subject was 5.9 before and 8.1 after diagnosis. All dietary data before and after diagnosis were compared by mixed models. Factors associated with the main dietary changes observed were also investigated using multivariable logistic regressions. We observed a decrease in intakes of vegetables (mean decrease in intake in patients who decreased their intake=-102.4 ± 79.8 g/d), dairy products (-93.9 ± 82.8 g/d), meat/offal (-35.5 ± 27.8/d), soy products (-85.8 ± 104.1 g/d), sweetened soft drinks (-77.9 ± 95.4 g/d), and alcoholic drinks (-92.9 ± 119.9 g/d), and an increase in broths (42.1 ± 34.9 g/d) and fats/sauces (18.0 ± 13.4 g/d). We observed a decrease in energy intake (-377.2 ± 243.5 kcal/d) and in intakes of alcohol (-7.6 ± 9.4 g/d) proteins (-17.4 ± 12.5 g/d), and several vitamins (p < 0.05) and micronutrients (p < 0.05). Conversely, lipid (19.4 ± 14.6 g/d), SFA (9.3 ± 7.0 g/d), MUFA (8.3 ± 6.3 g/d) and vitamin E (3.9 ± 3.3 mg/d) intakes increased after diagnosis. This large prospective study suggests that cancer diagnosis is a key period for nutritional changes. It highlights some healthy behaviors such as a decrease in alcohol and sweetened drink consumption, but also less favorable trends, such as a decrease in vegetable consumption and in many vitamin and mineral intakes. These results provide insights to identify and target recommendations to put forward for better nutritional care of cancer survivors.

Exploring Diet Quality between Urban and Rural Dwelling Women of Reproductive Age

Health disparities, including weight gain and obesity exist between urban and rural dwelling women. The primary aim was to compare diet quality in urban and rural women of reproductive age, and secondary analyses of the difference in macronutrient and micronutrient intake in urban and rural women, and the predictors of diet quality. Diet quality was assessed in urban (n = 149) and rural (n = 394) women by a modified version of the Dietary Guideline Index (DGI) energy, macronutrient and micronutrient intake from a food frequency questionnaire (FFQ) and predictors of diet quality. Diet quality did not significantly differ between urban and rural women (mean ± standard deviation (SD), 84.8 ± 15.9 vs. 83.9 ± 16.5, p = 0.264). Rural women reported a significantly higher intake of protein, fat, saturated fat, monounsaturated fat, cholesterol and iron and a higher score in the meat and meat alternatives component of the diet quality tool in comparison to urban women. In all women, a higher diet quality was associated with higher annual household income (>$Australian dollar (AUD) 80,000 vs. <$AUD80,000 p = 0.013) and working status (working fulltime/part-time vs. unemployed p = 0.043). Total diet quality did not differ in urban and rural women; however, a higher macronutrient consumption pattern was potentially related to a higher lean meat intake in rural women. Women who are unemployed and on a lower income are an important target group for future dietary interventions aiming to improve diet quality.

Autoantibodies are not Predictive Markers for the Development of Depressive Symptoms in a Population-Based Cohort of Older Adults

Background

Autoantibodies have been implicated in the etiologic pathway of depressive disorders. Here, we determine the association between the presence of a panel of autoantibodies at baseline and change in depression symptom score over 5-year follow-up in a cohort of healthy elderly Australians.

Methods

Serum samples from 2049 randomly selected subjects enrolled in the Hunter Community Study (HCS) aged 55–85 years were assayed for a range of autoimmune markers (anti-nuclear autoantibodies, extractable nuclear antigen autoantibodies, anti-neutrophil cytoplasmic autoantibodies, thyroid peroxidase autoantibodies, tissue transglutaminase autoantibodies, anti-cardiolipin autoantibodies, rheumatoid factor and cyclic citrullinated peptide autoantibodies) at baseline. Depression symptom score was assessed using the Centre for Epidemiological Study (CES-D) scale at baseline and 5 years later.

Results

Autoantibody prevalence varied amongst our sample with ANA being the most prevalent; positive in 16% and borderline in 36% of study population. No evidence for a relationship was found between change in CES-D score over time and any autoimmune marker. Statins and high cholesterol were significantly associated with change in CES-D score over time in univariate analysis; however, these were probably confounded since they failed to remain significant following multivariable analysis.

Conclusions

Autoantibodies were not associated with change in CES-D score over time. These findings point to an absence of autoimmune mechanisms in the general population or in moderate cases of depression.