Breast cancer and dietary patterns: a systematic review

A novel role of IGFBP5 in the migration, invasion and spheroids formation induced by IGF-I and insulin in MCF-7 breast cancer cells

PURPOSE

The insulin-like growth factor (IGF) system includes IGF-I, IGF-II insulin and their membrane receptors. IGF system also includes a family of proteins namely insulin-like growth factor-binding proteins (IGFBPs) composed for six major members (IGFBP-1 to IGFBP6), which capture, transport and prolonging half-life of IGFs. However, it has been described that IGFBPs can also have other functions.

METHODS

IGFBP5 expression was inhibited by shRNAs, migration was analyzed by scratch-wound assays, invasion assays were performed by the Boyden chamber method, spheroids formation assays were performed on ultra-low attachment surfaces, expression and phosphorylation of proteins were analyzed by Western blot.

RESULTS

IGFBP5 is a repressor of IGF-IR expression, but it is not a repressor of IR in MCF-7 breast cancer cells. In addition, IGFBP5 is a suppressor of migration and MMP-9 secretion induced by IGF-I and insulin, but it does not regulate invasion in MCF-7 cells. IGFBP5 also is a repressor of MCF-7 spheroids formation. However treatment with 340 nM rescues the inhibitory effect of IGFBP in the MCF-7 spheroids formation.

CONCLUSION

IGFBP5 regulates IGF-IR expression, migration and MMP-9 secretion induced by IGF-I and/or insulin, and the spheroids formation in MCF-7 breast cancer cells.

Causes and Risk Factors of Breast Cancer, What Do We Know for Sure? An Evidence Synthesis of Systematic Reviews and Meta-Analyses

Breast cancer affected more than 2.3 million women in 2022 and is the most diagnosed cancer among women worldwide. The incidence rates are greater in developed regions and are significantly higher among women with higher education and socioeconomic status. Therefore, it is reasonable to assume that the way women live their lives may impact their risk of being diagnosed with breast cancer. This systematic review aimed to identify what is known about the causes and risk factors of breast cancer, excluding genetic causes. A comprehensive systematic search identified 2387 systematic reviews, 122 were included and six overall themes identified. In our "top list" with the 36 most important findings, a study of breast density had the highest effect size for increasing the risk of breast cancer, and a high sex-hormone-binding globulin level was the most protective factor. Many of the included studies investigating the same topics had conflicting results. The conclusion from this evidence synthesis reveals a lack of consensus of factors associated with the causes and risk of breast cancer. These findings suggest that recommendations about lifestyle and breast cancer should be made with caution.

Individualizing Breast Cancer Risk Assessment in Clinical Practice

Multiple tools exist to assess a patient's breast cancer risk. The choice of risk model depends on the patient's risk factors and how the calculation will impact care. High-risk patients-those with a lifetime breast cancer risk of ≥20%-are, for instance, eligible for supplemental screening with breast magnetic resonance imaging. Those with an elevated short-term breast cancer risk (frequently defined as a 5-year risk ≥1.66%) should be offered endocrine prophylaxis. High-risk patients should also receive guidance on modification of lifestyle factors that affect breast cancer risk.

Estrogens and the risk of breast cancer: A narrative review of literature

In female mammals, the development and regulation of the reproductive system and non-reproductive system are significantly influenced by estrogens (oestrogens). In addition, lipid metabolism is another physiological role of estrogens. Estrogens act through different types of receptors to introduce signals to the target cell by affecting many estrogen response elements. Breast cancer is considered mostly a hormone-dependent disease. Approximately 70% of breast cancers express progesterone receptors and/or estrogen receptors, and they are a good marker for cancer prognosis. This review will discuss estrogen metabolism and the interaction of estrogen metabolites with breast cancer. The carcinogenic role of estrogen is discussed in light of both conventional and atypical cancers susceptible to hormones, such as prostate, endometrial, and lung cancer, as we examine how estrogen contributes to the formation and activation of breast cancer. In addition, this review will discuss other factors that can be associated with estrogen-driven breast cancer.

Associations between an obesity-related dietary pattern and incidence of overall and site-specific cancers: a prospective cohort study

BACKGROUND

A dietary pattern (DP) may impact on cancer incidence more strongly than individual foods, but this association remains uncertain. Here, we aimed to broadly explore the associations of an obesity-related DP with overall and 19 site-specific cancers.

METHODS

This study included 114,289 cancer-free participants with at least two dietary assessments. A total of 210 food items were classified into 47 food groups, and the mean amount of each food group was used in reduced-rank regression to derive the obesity-related DP. Cox regressions were conducted to explore the associations of the obesity-related DP with overall and 19 site-specific cancers. The parallel mediation model was constructed to quantify the mediating roles of potential mediators.

RESULTS

During a median follow-up period of 9.4 years, 10,145 (8.9%) incident cancer cases were documented. The derived-DP was characterized by a higher intake of beer and cider, processed meat, high sugar beverages, red meat, and artificial sweetener, and a lower intake of fresh vegetables, olive oil, tea, and high fiber breakfast cereals. Observational analysis showed that a higher obesity-related DP Z-score was linearly associated with an increased risk of overall cancer (adjusted hazard ratio (HR) = 1.02, 95% CI: 1.01, 1.04 per 1-SD increase, corrected P < 0.001). For site-specific cancer, positive linear associations for six cancer sites (oral, colorectal, liver, lung, endometrium, and thyroid) and nonlinear associations for six cancer sites (esophagus, malignant melanoma, prostate, kidney, bladder, and multiple myeloma) were observed. The paralleled mediation analysis suggested that the association between the obesity-related DP and overall cancer is mediated by the body mass index (BMI), the waist-to-hip ratio (WHR), C-reactive protein, high-density lipoproteins (HDLs), and triglycerides.

CONCLUSIONS

The developed obesity-related DP is strongly associated with overall and multiple cancer sites. Our findings highlight the complicated and diverse associations between an obesity-related DP and cancers and provide clues for future research directions.

Mediterranean diet and risk of breast cancer: An umbrella review

BACKGROUND

The Mediterranean Diet (MedDiet) is a healthy dietary pattern which has been related to a lower risk of certain chronic diseases, such as some cancers. However, its role in breast cancer development remains unclear. This umbrella review aims to summarize the highest available evidence on MedDiet and breast cancer risk.

METHODS

Pubmed, Web of Science, and Scopus electronic platforms were searched for relevant systematic reviews and meta-analyses. The selection criteria included systematic reviews with or without meta-analysis including women aged 18 years or older which evaluated the adherence to a MedDiet as the exposure and incidence of breast cancer as the outcome variable. Overlapping and quality of the reviews using AMSTAR-2 tool were independently assessed by two authors.

RESULTS

Five systematic reviews and six systematic reviews with meta-analysis were included. Overall, 4 systematic reviews - two with and two without meta-analysis - were rated as of high quality. An inverse association was found in 5 of the 9 reviews which evaluated the role of MedDiet on the risk of total breast cancer. The meta-analyses showed moderate-high heterogeneity. The risk reduction seemed to be more consistent among postmenopausal women. No association was found for MedDiet among premenopausal women.

CONCLUSIONS

The results of this umbrella review suggest that adherence to a MedDiet pattern had a protective effect on the risk of breast cancer, especially for postmenopausal breast cancer. The stratification of breast cancer cases and conducting high-quality reviews are aspects needed to overcome the current results' heterogeneity and to improve knowledge in this field.

Bovine holo-lactoferrin inhibits migration and invasion in MDA-MB-231 breast cancer cells

PURPOSE

Breast cancer is the most common malignancy in developed countries and the main cause of deaths in women worldwide. Lactoferrin (Lf) is an iron-binding protein constituted for a single polypeptide chain that is folded into two symmetrical lobes that bind Fe²⁺ or Fe³⁺. Lf has the ability to reversibly bind Fe³⁺ and is found free of Fe³⁺ (Apo-Lf) or associated with Fe³⁺ (Holo-Lf) with a different three-dimensional conformation. However, the role of bovine Apo-Lf (Apo-BLf) and bovine Holo-Lf (Holo-BLf) in the migration and invasion induced by linoleic acid (LA) and fetal bovine serum (FBS), as well as in the expression of mesenchymal and epithelial proteins in breast cancer cells has not been studied.

METHODS AND RESULTS

Scratch wound assays demonstrated that Holo-BLf and Apo-BLf do not induce migration, however they differentially inhibit the migration induced by FBS and LA in breast cancer cells MDA-MB-231. Western blot, invasion, zymography and immunofluorescence confocal microscopy assays demonstrated that Holo-BLf partly inhibit the invasion, FAK phosphorylation at tyrosine (Tyr)-397 and MMP-9 secretion, whereas it increased the number and size of focal adhesions induced by FBS in MDA-MB-231 cells. Moreover, Holo-BLf induced a slight increase of E-cadherin expression in MCF-7 cells, and inhibited vimentin expression in MCF-7 and MDA-MB-231 breast cancer cells.

CONCLUSION

Holo-BLf inhibits cellular processes that mediate the invasion process in breast cancer cells.

Preventive Nutrition: Heart Disease and Cancer

Two of the leading chronic diseases are cardiovascular disease (CVD) and cancer. A cornerstone of prevention for CVD and cancer is a healthy dietary pattern throughout the lifespan. Dietary patterns represent the totality of the diet and reflect habitual consumption of combinations and quantities of foods and nutrients that cumulatively affect health and disease. This article summarizes recent evidence on the relationship of diet quality as measured by adherence to healthy dietary patterns and CVD and cancer risk reduction. Optimal adherence to a healthy dietary pattern decreases CVD and cancer risk; even small changes in diet quality are beneficial.

Obesity, the other pandemic: linking diet and carcinogenesis by epigenetic mechanisms

Both obesity and cancer are complex medical conditions that are considered public health problems. The influence of obesity on the predisposition to develop various types of cancer has been observed in a wide variety of studies. Due to their importance as public health problems, and the close relationship between both conditions, it is important to be able to understand and associate them mechanistically. In this review article, we intend to go a little further, by finding relationships between lifestyle, which can lead a person to develop obesity, and how it influences at the cellular and molecular level, affecting gene expression to favor signaling pathways or transcriptional programs involved in cancer. We describe how products of metabolism and intermediate metabolism can affect chromatin structure, participating in the regulation (or dysregulation) of gene expression, and we show an analysis of genes that are responsive to diets high in sugar and fat, and how their epigenetic landscape is altered.

Influence of Olive Oil and Its Components on Breast Cancer: Molecular Mechanisms

Breast cancer is the most frequent malignant neoplasia and a leading cause of mortality in women worldwide. The Mediterranean diet has been proposed as a healthy dietary pattern with protective effects in several chronic diseases, including breast cancer. This diet is characterized by the consumption of abundant plant foods and olive oil as the principal source of fat, which is considered one of the main components with potential antioxidant, anti-inflammatory and anticancer effects. Extra-virgin olive oil (EVOO) has several bioactive compounds, mainly including monounsaturated fatty acids, triterpenes and polyphenols, such as phenolic alcohols (e.g., hydroxytyrosol), secoiridoids (e.g., oleuropein and oleocanthal), lignans (e.g., pinoresinol) or flavonoids (e.g., luteolin). While epidemiological evidence is still limited, experimental in vivo and in vitro data have shown a protective effect of this oil and its compounds on mammary carcinogenesis. Such effects account through complex and multiple mechanisms, including changes in epigenetics, transcriptome and protein expression that modulate several signaling pathways. Molecular targets of EVOO compounds have a role in the acquisition of cancer hallmarks. Although further research is needed to elucidate their beneficial effects on human prevention and progression of the disease, evidence points to EVOO in the context of the Mediterranean diet as a heathy choice, while EVOO components may be promising adjuvants in anticancer strategies.

Association Between Dietary Patterns and Plasma Lipid Biomarker and Female Breast Cancer Risk: Comparison of Latent Class Analysis (LCA) and Factor Analysis (FA)

Background: Diet research focuses on the characteristics of "dietary patterns" regardless of the statistical methods used to derive them. However, the solutions to these methods are both conceptually and statistically different. Methods: We compared factor analysis (FA) and latent class analysis (LCA) methods to identify the dietary patterns of participants in the Chinese Wuxi Exposure and Breast Cancer Study, a population-based case-control study that included 818 patients and 935 healthy controls. We examined the association between dietary patterns and plasma lipid markers and the breast cancer risk. Results: Factor analysis grouped correlated food items into five factors, while LCA classified the subjects into four mutually exclusive classes. For FA, we found that the Prudent-factor was associated with a lower risk of breast cancer [4th vs. 1st quartile: odds ratio (OR) for 0.70, 95% CI = 0.52, 0.95], whereas the Picky-factor was associated with a higher risk (4th vs. 1st quartile: OR for 1.35, 95% CI = 1.00, 1.81). For LCA, using the Prudent-class as the reference, the Picky-class has a positive association with the risk of breast cancer (OR for 1.42, 95% CI = 1.06, 1.90). The multivariate-adjusted model containing all of the factors was better than that containing all of the classes in predicting HDL cholesterol (p = 0.04), triacylglycerols (p = 0.03), blood glucose (p = 0.04), apolipoprotein A1 (p = 0.02), and high-sensitivity C-reactive protein (p = 0.02), but was weaker than that in predicting the breast cancer risk (p = 0.03). Conclusion: Factor analysis is useful for understanding which foods are consumed in combination and for studying the associations with biomarkers, while LCA is useful for classifying individuals into mutually exclusive subgroups and compares the disease risk between the groups.

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08854-w.

Association between dietary patterns and risk of breast cancer in Chinese female population: a latent class analysis

OBJECTIVE

To determine if specific dietary patterns are associated with breast cancer (BC) risk in Chinese women.

DESIGN

Latent class analysis (LCA) was performed to identify generic dietary patterns based on daily food-frequency data.

SETTING

The Chinese Wuxi Exposure and Breast Cancer Study (2013-2014).

PARTICIPANTS

A population-based case-control study (695 cases, 804 controls).

RESULTS

Four dietary patterns were identified, Prudent, Chinese traditional, Western and Picky; the proportion in the controls and cases was 0·30/0·32/0·16/0·23 and 0·29/0·26/0·11/0·33, respectively. Women in Picky class were characterised by higher extreme probabilities of non-consumption of specific foods, the highest probabilities of consumption of pickled foods and the lowest probabilities of consumption of cereals, soya foods and nuts. Compared with Prudent class, Picky class was associated with a higher risk (OR = 1·42, 95 % CI 1·06, 1·90), while the relevant association was only in post- (OR = 1·44, 95 % CI 1·01, 2·05) but not in premenopausal women. The Western class characterised by high-protein, high-fat and high-sugar foods, and the Chinese traditional class characterised by typical consumption of soya foods and white meat over red meat, both of them showed no difference in BC risk compared with Prudent class did.

CONCLUSIONS

LCA captures the heterogeneity of individuals embedded in the population and could be a useful approach in the study of dietary pattern and disease. Our results indicated that the Picky class might have a positive association with the risk of BC.

Dietary changes and food habits: social and clinical determinants in a cohort of women diagnosed with breast cancer in Barcelona (DAMA cohort)

OBJECTIVE

The aim of this study was to analyze the influence of social determinants on changes in dietary habits before and after diagnosis of breast cancer in women (Barcelona, 2003-2013).

METHODS

We performed a cohort study with 2,235 women diagnosed with breast cancer. The information was obtained from an ad hoc questionnaire based on recommendations from the Spanish Society of Community Nutrition. We conducted a descriptive bivariate analysis and fit logistic regression models. The dependent variable was the change in dietary habits (food groups) and the independent variables were a selection of social and clinical variables (age, social class, cohabitation, years since diagnosis, history of replaces, and treatment with chemotherapy).

RESULTS

While 5.8% of women followed a healthy diet (consumption of vegetables, fruits, farinaceous, lean meat, and seafood) before diagnosis, 9.5% did so after diagnosis. We observed statistically significant changes in consumption of all food groups (p < 0.001) after diagnosis. The greatest change in consumption patterns was observed in women aged < 50 years and those from non-manual classes (high classes) [e.g., legume consumption: OR_{<50 years/>65 years} = 2.9 (95% CI 1.78-4.81); OR_{non-manual/manual} = 2.5 (95% CI 1.38-4.36)]. The occurrence of relapses and chemotherapy was associated with greater changes in dietary habits.

CONCLUSION

Women with breast cancer change their eating habits after diagnosis, and these changes are conditioned by social and clinical determinants.

Dietary inflammatory index and odds of breast cancer: A case-control study

Breast cancer (BrCA) is one of the most commonly diagnosed cancers and is the leading cause of cancer deaths in women worldwide. This study aimed to examine the association between the dietary inflammatory index (DII®) and BrCA among Jordanian women. A total of 400 adult women were enrolled into this case-control study. Cases were 200 women recently diagnosed with BrCA selected from the two hospitals that provide cancer therapy in Jordan. They were matched on age, income, and marital status with 200 BrCA-free controls. DII scores were calculated from dietary data that were collected in a face-to-face interview conducted between October 2016 and September 2017 using a validated food frequency questionnaire. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% CIs. The study results revealed no significant associations between DII scores in relation to the odds of developing BrCA after multivariable adjustment including age, education, total energy, BMI, number of pregnancy, contraceptive use, lactation, smoking, and family history of BrCA. Stratified analyses by obesity status showed that overweight/obese participants in the highest DII tertile had a >75% increased BrCA risk (OR of 1.77 [95% CI, 1.01-3.12]) compared with participants in the lowest tertile, after adjusting for age. The results from this study showed no significant relationship between the proinflammatory potential of the diet and BrCA risk in the overall study population. However, results stratified by weight category indicated an effect of diet-associated inflammation on BrCA risk in the overweight/obese group. Results of the study are consistent with a recommendation aimed at maintaining higher diet quality, that is, adopting healthy diets characterized by low DII scores in order to reduce the risk for BrCA.

Plasmalogen Deficiency and Overactive Fatty Acid Elongation Biomarkers in Serum of Breast Cancer Patients Pre- and Post-Surgery-New Insights on Diagnosis, Risk Assessment, and Disease Mechanisms

Simple Summary

Breast cancer (BC) is the most commonly diagnosed cancer in women. Mammography and ultrasonography are commonly used for BC screening; however, they are associated with problems such as inconvenience, radiation exposure, and dependence on the skill level of operators. To overcome this problem, we performed a comprehensive lipid metabolomic analysis of serum using high-resolution accurate mass spectrometry from two case-control studies that included non-BC, BC subjects pre-surgery and BC subjects one-month post-surgery to determine if the metabolic signatures of over-active fatty acid elongation and other lipid changes could be detected in BC vs. non-BC subjects. The ratios of the linoleic acid to the oleic acid which were evaluated in multiple lipid pools were lower in pre-surgery BC subjects, however, these ratios increased at post-surgery and were no longer different from non-BC subjects. On the other hand, the ethanolamine plasmalogen levels were lower in pre-surgery BC subjects and were not recovered by surgical removal. These do not appear to be caused by BC tumor activity and may be pre-existent and a possible risk factor for BC. In this study, we have identified several lipid metabolic systems that detect both BC risk and BC activity.

Abstract

The polyunsaturated fatty acid (PUFA) elongase, ELOVL5, is upregulated in breast cancer (BC) vs. adjacent normal tissue. We performed a comprehensive lipid metabolomic analysis of serum using high-resolution accurate mass spectrometry from two case-control studies that included non-BC, BC subjects pre-surgery, and BC subjects one-month post-surgery to determine if the metabolic signatures of over-active fatty acid elongation and other lipid changes could be detected in BC vs. non-BC subjects: study 1 (n = 48: non-BC, n = 69: pre-surgery BC); study 2 (blinded validation: n = 121: non-BC, n = 62: pre-surgery BC, n = 31: one month post-surgery). The ratio of the ELOVL5 precursor, linoleic acid (18:2) to a non-ELOVL5 precursor, oleic acid (18:1) was evaluated in multiple lipid pools (phosphatidylethanolamine (PtdEtn), phosphatidylcholine (PtdCho), lyso-PtdCho, and free fatty acids). This ratio was lower in pre-surgery BC subjects in all pools in both studies (p < 0.001). At one-month post-surgery, the 18:2/18:1 ratios increased vs. pre-surgery and were no longer different from non-BC subjects (p > 0.05 expect for lyso-PtdCho). In contrast to the elongation biomarkers, docosahexaenoic acid (22:6n-3) containing ethanolamine plasmalogen (EtnPls) species were observed to be further decreased in BC subjects one-month post-surgery vs. pre-surgery levels (p < 0.001). These results are consistent with the hypothesis that ELOVL5 is upregulated in BC tissue, which would result in the selective depletion of 18:2 vs. 18:1 containing lipid species. Surgical removal of the tumor removes the overactive ELOVL5 effect on serum lipids. In contrast, the low EtnPls levels do not appear to be caused by BC tumor activity and may be pre-existent and a possible risk factor for BC. These results indicate that it may be possible to screen for both breast cancer risk and breast cancer activity using a simple blood test.

Mortality due to breast cancer in a region of high socioeconomic vulnerability in Brazil: Analysis of the effect of age-period and cohort

INTRODUCTION

Breast cancer is an important public health problem worldwide, with important disparities in incidence, mortality, and survival rates between developed and developing countries due to inequalities regarding access to measures for the prevention and treatment of the disease. In Brazil, there are higher rates of incidence and a downward trend in mortality in regions of greater socioeconomic development.

OBJECTIVE

To evaluate the effect of age, period, and birth cohort on breast cancer mortality in women aged 20 years and older in the states of the Northeast Region of Brazil, an area of high socioeconomic vulnerability, from 1980 to 2019.

METHODS

The death records were extracted from the DATASUS Mortality Information System website (Department of National Health Informatics) from the Ministry of Health of Brazil. Estimable functions were used to estimate the age-period and cohort models (APC) using the Epi library from the R statistical software version 6.4.1.

RESULTS

The average breast cancer mortality rate for the period was 20.45 deaths per 100,000 women. The highest coefficients per 100,000 women were observed in the states of Pernambuco (21.09 deaths) and Ceará (20.85 deaths), and the lowest in Maranhão (13.58 deaths) and Piauí (15.43 deaths). In all of the locations, there was a progressive increase in mortality rates in individuals over 40 years of age, with higher rates in the last five-year period (2015-2019). There was an increase in the risk of death for the five-year period of the 2000s in relation to the reference period (1995-1999) in the Northeast region and in the states of Alagoas, Bahia, Maranhão, Paraíba, and Piauí. In addition, there was an increased risk of death for women born after the 1950s in all locations.

CONCLUSION

The highest mortality rates in all five-year periods analyzed were observed in states with greater socioeconomic development, with an increase in mortality rates in the 2000s, and a higher risk of death in the younger cohorts.

Factors influencing the nutritional behavior of Syrian migrants in Germany - results of a qualitative study

Background

Syrian migrants represent the third-largest group of foreigners in Germany and are therefore potential users of health promotion initiatives, including nutrition programs. It is little known how (healthy) nutrition is understood and implemented by this group and which factors influence their experiences related to food and eating in the host country. Thus, this study aimed to explore the importance of (healthy) nutrition, facilitators, and barriers of a preferred diet; nutritional changes in relation to the country of origin; and how nutrition may change with increasing length of stay.

Methods

Thirty semi-structured qualitative interviews with Syrian migrants (male = 16, female = 14, 18–35 years, length of stay 10–68 months) were conducted in 2018. Seventeen migrants could be followed-up after 12 months and were interviewed in 2019 again and were asked for changes in their nutritional behavior. Interviews were conducted in German, English, or Arabic, transcribed and translated into English if necessary. For analysis, an abbreviated version of the Grounded Theory was used.

Results

We identified six overarching themes that described influencing factors on a favored diet in Germany over the course of stay: (1) managing everyday life; (2) intercultural contact with local residents; (3) social context of cooking and eating; (4) ambiguity toward Arabic food; (5) mistrust toward certain types of food; and (6) influence of postmigration stressors. In general, the importance of nutrition is high among Syrian migrants. However, daily stressors, the lack of practical knowledge of how to cook favored dishes, and food insecurity in the new food environment make it difficult to obtain a preferred diet. With increasing stay, many developed a higher awareness of healthy eating, mainly due to a new independence or influences from the social environment in Germany.

Conclusion

Results highlight the need for health promotion interventions to be more responsive to the specific needs of Syrian migrants, including nutrition. Syrian migrants differ in their capabilities, needs, and aims, and they should be addressed differently by health professionals, social services or migrant specific services. Future research should continue to focus on the living conditions of Syrian migrants and its influence on nutrition.

Examining the associations between a posteriori dietary patterns and obesity indexes: Systematic review of observational studies

BACKGROUND

Few reports on the association of population-derived dietary patterns with excess body weight, using the approach of a systematic review currently exist.

AIM

The aim of the present systematic review was to identify dietary patterns associated with body mass index (BMI), body weight (BW)/BMI change, weight status and weight loss maintenance status.

METHODS

Using MEDLINE (via PubMed) and EBSCO Host databases, we systematically reviewed studies from 1980 to 2020, which included men and women, aged ≥18 years. Primary outcome was BMI or the longitudinal change of individuals' BW or BMI, or weight status (normal weight/overweight/obesity) or weight loss maintenance status. We included observational studies, with or without a prospective design. Studies which met the inclusion criteria were evaluated based on the Newcastle-Ottawa Scale; only a posteriori dietary patterns were evaluated.

RESULTS

Twenty-six studies were eligible for inclusion in the current analysis. The results indicate a relationship between adherence to a lacto-vegetarian dietary pattern, characterized by high intake of fruits, vegetables, whole grains, unprocessed cereals, dairy and low intake of high-fat foods and sweets, and longitudinal change of individuals' BW or BMI, or the risk of overweight/obesity.

CONCLUSIONS

Promotion of this healthy dietary pattern, as an alternative to focusing on specific nutrients or foods, may be a promising approach to be included in future long-term weight maintenance interventions.

The relationship between dietary patterns, dietary quality index, and dietary inflammatory index with the risk of all types of cancer: Golestan cohort study

Background: Dietary patterns and diet quality index (DQI) are widely discussed in relation with different health conditions and have recently been taken into consideration for all cancer types. Since chronic inflammation has been recognized as an important biologic risk factor for cancer occurrence, especially in epithelial tissues, proinflammatory or anti-inflammatory characteristics of diet has become the center of attention. In the present study, we aimed to identify whether a specific dietary pattern, Mediterranean dietary score (MDs), and dietary inflammatory index (DII) were associated with overall cancer risk in Iranian population.

Methods: This study was performed in the context of the Golestan cohort study. Participants with extreme daily energy intake or those who did not answer more than 30 question of the Food Frequency questionnaire (FFQ) were excluded. Dietary patterns, MDs, and DII were measured from FFQ. Age, sex, total energy, place of residence, smoking, wealth score, ethnicity, opiate use, BMI, education, marital status, and physical activity score were considered as confounding variables. Using Cox proportional hazards regression models, hazard ratios (HRs) and 95% confidence interval of cancer were estimated.

Results: HRs (95% CIs) of all cancers by quartiles of Western dietary pattern, DII, and MDs showed that the forth quartile of the Western dietary pattern is attributed to 23% higher cancer risk (HRs: 1.23, CI: 1.09-1.40, P< 0.001, adjusted for age and sex) compared to the first quartile. It also remained significant after further adjustments (HRs = 1.20, CI: 1.06-1.36, P< 0.001). There was a higher cancer risk in the fourth quartile of DII in comparison with the first quartile (HRs = 1.16, CI: 1.01-1.32, P trend < 0.001, adjusted for age and sex). The lower adherence to the Mediterranean dietary pattern also largely contributes to 27% higher cancer risk (HRs: 1.27, CI: 1.12-1.44), P trend < 0.001, adjusted for age and sex), which also remained remarkable after further adjustments ((HRs =1.19, CI: 1.05-1.35, P trend < 0.001).

Conclusion: Cancer is highly correlated to dietary intake and dietary patterns, such as the Western dietary pattern, while the Mediterranean diet score was inversely associated with cancer risk. Further investigations are required to get a broader insight into cancer determinants in population.

Assessment of Human Papillomavirus Infection and Risk Factors in Egyptian Women With Breast Cancer

Numerous risk factors for breast cancer (BC) have been identified. High-risk human papilloma virus (HR-HPV) is the etiological agent of cervical cancer and in some cases of head and neck cancer, specifically oropharyngeal cancer, but the role of HR-HPV in evoking neoplasia in BC is still unclear. In this study, all women above the age of 18 visiting the oncology clinic at Al-Azhar university hospital and Ain Shams specialized hospital between the period of February 2017 and March 2018 were invited to participate. We determined the prevalence of HR-HPV genotypes 16, 18, and 31 in breast tissue samples from 72 women with treatment-naïve BC and 15 women with benign breast lesions (BBL) by quantitative real-time PCR (qRT-PCR) and primer sets targeting the E6 and E7 regions. High-risk human papilloma virus DNA was detected in 16 of 72 (22.2%) BC cases (viral load range = 0.3-237.8 copies/uL) and 0 of 15 women with BBL. High-risk human papilloma virus was detected in 14 of 16 (87.5%), 2 of 16 (12.5%), and 0 of 16 (0%) for genotypes 16, 18, and 31, respectively. Forty-three age-matched healthy Egyptian women were enrolled as controls for assessment of local risk factors that can be used to initiate a strategy of BC prevention in Egypt. Assessment of the risk factors demonstrated that low education level, passive smoking, lack of physical activity, family history of cancer, and use of oral contraception were significant risk factors for BC. In conclusion, our results lead us to postulate that HR-HPV infection may be implicated in the development of some types of BC in Egyptian women. In addition, identification of local risk factors can support practical prevention strategies for BC in Egypt.

Premenopausal breast cancer is a health challenge: nutritional habits show potential to prevent this disease

Background:

The incidence of breast cancer had increased around the world. More premenopausal women suffer from this condition with great economic and social impact. The objective of this study is to establish possible associations between lifestyle and the presence of breast cancer in premenopausal women.

Methods:

The study population was composed of 330 premenopausal patients younger than 55 years with breast disease, cared between 2013 and 2017 at the University Hospital Mayor Méderi. Two comparison groups were formed. Patients with a tumor diagnosed as malignant considering cases and control group of patients with a tumor diagnosed as benign. With factors associated significantly in the bivariate analysis (P < .10), the hierarchically organized multiple regression model controlled by the confounding variables was constructed. The logistic regression model was adjusted by the age variable, to avoid residual confounder.

Results:

The population included 330 premenopausal women with benign and malignant breast disease: 134 cases and 196 controls. From the multivariate analysis, it was identified that the whole-grain consumption was inversely associated with presence of breast cancer (odds ratio [OR] = 0.579; 95% confidence interval [CI]: 0.339, 0.991; P = .046). On the other hand, consumption of fish was associated with the presence of breast malignancy (OR = 2.560; 95% CI: 1.200, 5.460; P = .015).

Conclusions:

Considering the epigenetic and multiomics individual profiles in the development of premenopausal breast cancer and its social and economic impact can be useful in development of modern clinical strategies with crucial interventions at the primary, secondary, and tertiary prevention levels for this disease.

Dietary patterns and breast cancer in Colombia: an ecological study

Background

The role that diet plays in the development of breast cancer is unclear and breast cancer continues to increase in Colombia and worldwide. The objective of this study was to assess the association between patterns of dietary consumption and the incidence of breast cancer.

Methods

An ecological study was conducted in 24 geodemographic units in which 95% of the women of Colombia live. The association between breast cancer rate (dependent variable) and three dietary patterns established with factor analysis (traditional/starch, fiber/dairy and snack) was investigated using simple and multiple linear regression. The use of variables related to socioeconomic context and the duration of breastfeeding allowed for the control of possible confounding. All information was derived from concurrent national surveys or was obtained directly over a period of time close to the period during which the study was conducted.

Results

There is an inverse relationship between breast cancer rate and illiteracy rate (β=−2808.3), duration of breastfeeding (β=−3354.1), adherence to traditional/fiber dietary patterns (β=−30467) and adherence to the snack dietary pattern (β=−43612). The goodness of fit for the model was R²=84%.

Conclusions

Increasing the duration of breastfeeding, ensuring education to promote health and following traditional food consumption patterns, regardless of what foods are consumed, can protect against the development of breast cancer.

Breast Cancer Primary Prevention and Diet: An Umbrella Review

Introduction: Many studies have been published, but none have pooled the useful evidence available in the literature to produce guidelines and health policies promoting healthy eating styles to prevent breast cancer (BC). The present study aimed to summarize the evidence produced to date, taking a judicious, critical approach to the quality of the studies analyzed. Methods: An umbrella review method was adopted, which is a systematic review of second-level studies, meta-analyses and literature reviews. Results: In all, 48 studies were considered: 32 meta-analyses, 4 pooled analyses, 5 systematic reviews, and 7 qualitative reviews. A higher intake of total meat, or red or processed meats, or foods with a high glycemic index, or eggs would seem to be associated with a higher risk of BC. Some foods, such as vegetables, would seem instead to have an inverse association with BC risk. One meta-analysis revealed an inverse association between citrus fruit and mushroom consumption and BC. Some nutrients, such as calcium, folate, vitamin D, lignans and carotenoids, also seem to be inversely associated with BC risk. The evidence is still conflicting as concerns exposure to other dietary elements (e.g., polyunsaturated fatty acids, dairy foods). Conclusion: Nutrition is one of the most modifiable aspects of people’s lifestyles and dietary choices can affect health and the risk of cancer. Overall, adhering to a healthy eating style may be associated with a significant reduction in the risk of BC.

Legume and Nuts Consumption in Relation to Odds of Breast Cancer: A Case-Control Study

Previous studies on the association between legume and nuts intake and risk of breast cancer have mainly been focused on individual components of legume or nuts, rather than consumption of the whole food group. This study aimed to investigate the relation between legume and nuts intake in relation to breast cancer in Iranian women. In this population-based case-control study, we enrolled 350 pathologically confirmed new cases of breast cancer and 700 controls which were matched with cases in terms of age and socioeconomic status. Dietary intakes were assessed using a validated block-format 168-item semi-quantitative food frequency questionnaire. Legume intake was computed by summing up the consumption of lentils, peas, chickpeas, and different kinds of beans, including red beans and pinto beans. To calculate nuts consumption, we summed up intake of mixed nuts, almond, peanut, walnut and hazelnut. Data on potential confounding variables were also collected using pre-tested questionnaires. Mean consumption of legume and nuts among cases and controls were 14.7 ± 15.0 and 2.3 ± 5.6, respectively. A significant inverse association was found between legume intake and breast cancer (OR: 0.41, 95% CI: 0.30-0.57); such that after adjusting for confounders, participants in the top tertile of legume intake had 46% lower odds of breast cancer compared with those in the bottom tertile (OR: 0.54, 95% CI: 0.36-0.88). Such inverse association was seen among postmenopausal women (OR: 0.51, 95% CI: 0.31-0.85) and also among normal-weight participants (OR: 0.49, 95% CI: 0.29-0.82). In terms of nuts intake, it was inversely associated with odds of breast cancer (OR: 0.16, 95% CI: 0.11-0.23). This association remained significant even after taking potential confounders into account (OR: 0.15, 95% CI: 0.09-0.26). The same association was also seen in premenopausal women (OR: 0.21, 95% CI: 0.14-0.31), postmenopausal women (OR: 0.23, 95% CI: 0.13-0.42), normal-weight (OR: 0.15, 95% CI: 0.08-0.28), and overweight or obese people (OR: 0.27, 95% CI: 0.10-0.71). Our findings on the inverse association of legume and nuts intake with odds of breast cancer support the current recommendations on these foods. Prospective studies are needed to further examine this link.

Dietary Patterns and Risk of Invasive Ductal and Lobular Breast Carcinomas: A Systematic Review and Meta-analysis

The histopathologic subtypes of breast cancer, including invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC), differ in terms of risk factors, progression, and response to treatment. The PubMed/Medline, Web of Science, and Scopus databases were searched up to February 2020 for published studies on the association between dietary patterns (Western diet [WD] or Mediterranean diet [WD]) and the risk of IDC/ILC of breast. Multivariable adjusted relative risk (RR) and 95% confidence intervals (CIs) comparing the highest and lowest categories of WD and MD patterns were combined by using the random-effects meta-analyses. After searching the databases, 10 eligible studies on the association of diet and IDC (7 articles) and ILC (3 articles) were included in the analysis. A statistically significant adverse association was observed between MD and IDC in case-control studies (RR = 0.47; 95% CI, 0.39-0.55; I² = 85.1%; P < .001). However, the association was nonsignificant in cohort studies (RR = 0.98; 95% CI, 0.92-1.05; I² = 88.8%; P = .003). The pooled analysis also suggested a significant and direct association between the WD and the risk of IDC (RR = 1.36; 95% CI, 1.18-1.53; I² = 63.7%; P = .017). The risk of ILC for the highest compared to the lowest category of MD was highly protective (RR = 0.76; 95% CI, 0.64-0.87; I² = 89.2%; P < .001), and a marginally significant association was found between the WD and risk of ILC (RR = 1.45; 95% CI, 1.04-1.86), with no heterogeneity (I² = 0; P = .52). This meta-analysis provides supporting evidence for the association between MD decreased risk of IDC and ILC of the breast and the association between WD and increased risk of IDC and ILC. Further investigations are needed to better understand the reasons behind the etiologic mechanisms of how dietary patterns affect patients differently by common breast cancer subtypes, including IDC and ILC.

Dietary patterns and cancer risk

Over the past decade, the search for dietary factors on which to base cancer prevention guidelines has led to the rapid expansion of the field of dietary patterns and cancer. Multiple systematic reviews and meta-analyses have reported epidemiological associations between specific cancer types and both data-driven dietary patterns determined by empirical analyses and investigator-defined dietary indexes based on a predetermined set of dietary components. New developments, such as the use of metabolomics to identify objective biomarkers of dietary patterns and novel statistical techniques, could provide further insights into the links between diet and cancer risk. Although animal models of dietary patterns are limited, progress in this area could identify the potential mechanisms underlying the disease-specific associations observed in epidemiological studies. In this Review, we summarize the current state of the field, provide a critical appraisal of new developments and identify priority areas for future research. An underlying theme that emerges is that the effectiveness of different dietary pattern recommendations in reducing risk could depend on the type of cancer or on other risk factors such as family history, sex, age and other lifestyle factors or comorbidities as well as on metabolomic signatures or gut microbiota profiles.

Dietary Research on Coffee: Improving Adjustment for Confounding

Meta-analyses have reported higher levels of coffee consumption to be associated with lower mortality. In contrast, some systematic reviews have linked coffee consumption to increased risks for lung cancer and hypertension. Given these inconsistencies, this narrative review critically evaluated the methods and analyses of cohort studies investigating coffee and mortality. A specific focus was adjustment for confounding related to smoking, healthy and unhealthy foods, and alcohol. Assessment of 36 cohort samples showed that many did not adequately adjust for smoking. Consuming 1-5 cups of coffee per day was related to lower mortality among never smokers, in studies that adjusted for pack-years of smoking, and in studies adjusting for healthy and unhealthy foods. Possible reduced health benefits for coffee with added sugar have not been adequately investigated. Research on coffee and health should report separate analyses for never smokers, adjust for consumption of healthy and unhealthy foods, and for sugar added to coffee.

Adherence to a snacking dietary pattern is decreasing in Colombia among the youngest and the wealthiest: results of two representative national surveys

Background

A common recommendation is to reduce the consumption of snack food and replace this consumption with nutrient-dense foods. The objective was to assess whether in Colombian children and adults there were changes in the consumption of the snack dietary pattern (SP) in the 5 years 2010–2015. In addition, this study aimed to establish the relationship between the SP and some biological, socioeconomic, and geographic variables in Colombia, South America.

Methods

Based on a Food Frequency Questionnaire (FFQ) applied both in 2010 and 2015 in the national nutritional situation surveys, the adherence to the snack consumption pattern was established through factor analysis. The change in the adherence of consumption to the SP was established for the five-year period [2015 minus 2010], using multiple linear regression models. Crude and adjusted differences were estimated by the following covariables: sex, age, marital status, food security, wealth index, ethnicity, education of the head of the household, area and region. In total, 37,981 subjects were analyzed. In 2010, 10,150 children (5 to 17 years old) and 5145 adults (18 to 64 years old) were included, and in 2015, 13,243 children and 9443 adults.

Results

In children, the adjusted difference in the adherence to SP was − 0.37 (95% CI: − 0.42, − 0.32). In adults, the adjusted difference in the adherence to SP was − 0.27 (95% CI: − 0.31, − 0.24). In all categories of covariables, consumption decreased, for all p < 0.0001. In children, the decrease in consumption was inversely associated with height-age. The decrease was smaller at the extremes of the BMI distribution, Z < -2 and Z > 2. The decrease in consumption was directly associated with the level of food security in the home and the wealth index. In adults, the decrease in consumption was inversely related to age and was directly related to the level of food security of the household, wealth index, and education level. The BMI decrease was greater in subjects with 18.5–24.9. In subjects with 30+, it was lower than in subjects with 25.0–29.9.

Conclusions

In the 5 years 2010–2015, snack consumption is decreasing. The region, the richest subjects, those with adequate BMI, and in households with more educated heads of household, achieved a greater decrease in SP.

Definition of the Traditional Mexican Diet and Its Role in Health: A Systematic Review

Promoting traditional diets could potentially reduce the current high rates of non-communicable diseases (NCDs) globally. While the traditional Mexican diet (TMexD) could be specifically promoted in Mexico, a concise definition of the TMexD and evidence of its association with NCDs are needed before its promotion. To evaluate what constitutes this diet pattern, we aimed to systematically review, for the first time, how the TMexD has been described in the literature to date. A secondary aim was to examine whether the TMexD, as described by available definitions, is associated with NCD outcomes. We searched for records describing a whole TMexD up to July 2019 in 12 electronic databases, reference lists, a relevant journal, and by contacting experts on the topic. We reported the results using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included 61 records for the definition of the diet and six for the association with NCD outcomes. The food groups characterising the TMexD that were consistently mentioned in all the study subgroups were grains and tubers, legumes, and vegetables; specific foods included maize, beans, chile, squash, tomato, and onion. Other groups also mentioned, although with lesser frequency, were maize products, fruits, beverages, fish and seafood, meats, sweets and sweeteners, and herbs and condiments. Only a few studies reported on the frequency of consumption or the amounts in which these foods were consumed in the TMexD. It was not possible to reach strong conclusions for the association between adherence to the TMexD and NCD outcomes. The TMexD was weakly associated with developing breast cancer, not associated with triglyceride levels, and inconsistently associated with obesity and diabetes outcomes. However, results were limited by the small number of studies (n = 6), of which most were of observational nature and evaluated diets using different TMexD definitions. These findings provide systematically identified evidence of the characteristics of the TMexD. More studies are needed to ascertain the exact quantities by which foods were consumed in the TMexD in order to establish whether this dietary pattern is associated with health and should be promoted within the Mexican population.

Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction

Noncommunicable disease now contributes to the World Health Organization top 10 causes of death in low-, middle- and high-income countries. Particular examples include stroke, coronary heart disease, dementia and certain cancers. Research linking clinical and lifestyle risk factors to increased risk of noncommunicable disease is now well established with examples of confirmed risk factors, including smoking, physical inactivity, obesity and hypertension. However, despite a need to target our resources to achieve risk reduction, relatively little work has examined the overlap between the risk factors for these main noncommunicable diseases. Our high-level review draws together the evidence in this area. Using a systematic overview of reviews, we demonstrate the likely commonality of established risk factors having an impact on multiple noncommunicable disease outcomes. For example, systematic reviews of the evidence on physical inactivity and poor diet found each to be associated with increased risk of cancers, coronary heart disease, stroke, diabetes mellitus and dementia. We highlight the potential for targeted risk reduction to simultaneously impact multiple noncommunicable disease areas. These relationships now need to be further quantified to allow the most effective development of public health interventions in this area.

Corporate Social Responsibility and Financial Performance: A Quantile Regression Approach

A prominent claim within the literature is that corporate social responsibility-disclosured firms are fundamentally more resilient to financial shocks, relative to firms that take no corporate social responsibility action. To test this, we examine the impact of corporate social responsibility (CSR) information disclosure on financial constraints (FC). Our sample is composed of A-share publicly listed firms from Shanghai and Shenzhen in China during 2013–2017. We find that CSR disclosure influences negatively financial constraints. The quantile regression results also indicate that the influences would more obvious when a company faces stronger financial constraints. Further, CSR disclosure influences negatively financial constraints in financially opaque firms, and the effect of financial opaque on the relationship strengthens when the company faces great financial constraints. After considering the problems of missing variables and endogenous, changing the level of CSR and FC measurement, using 2SLS and two-step GMM methods, the conclusion is still robust. However, the results should not be generalized, since the sample was based on 434 A-share publicly listed firms for 2013–2017. From the perspective of FC, this study contributes to the literature in the field of CSR and expands the empirical research on the economic consequences of CSR. It also can encourage enterprises to voluntarily disclose social responsibility information and it is of great significance to promote the stable development of the capital market and society.

Healthy dietary patterns and risk and survival of breast cancer: a meta-analysis of cohort studies

PURPOSES

Dietary patterns have been found to be associated with the overall cancer risk and survival. However, the associations of healthy dietary patterns and breast cancer remain unclear. We aimed to conduct a meta-analysis of prospective cohort studies to estimate the pooled results of the association of healthy dietary patterns with breast cancer risk and survival.

METHODS

PubMed, EMBASE, and Web of Science were searched for literature published until June 24th, 2018 that examined the associations between healthy dietary patterns and breast cancer risk and survival. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated by using a random-effects model for meta-analysis.

RESULTS

There were 32 articles retrieved for the meta-analysis, with 27 for breast cancer risk and five for breast cancer survival. There was a statistically significant lower risk of breast cancer associated with healthy dietary patterns (RR = 0.93, 95% CI: 0.88, 0.98). Subgroup analysis results suggested that there was an inverse association between breast cancer risk and posterori-derived healthy patterns, but no statistically significant associations were found in other stratified subgroups (a priori-derived diet, study region, menopausal status, or breast cancer subtypes). Healthy dietary patterns were associated inversely with all-cause mortality (RR = 0.76, 95% CI: 0.63, 0.92); however, no association was found for breast cancer-specific mortality.

CONCLUSIONS

The results suggested that healthy dietary patterns might be associated with a reduced risk of breast cancer and all-cause mortality among breast cancer patients. It could be clinically relevant to promote healthy dietary patterns for breast cancer prevention and improve survival among breast cancer patients.

The antigenic link between thyroid autoimmunity and breast cancer

The association between breast cancer and benign thyroid disorders, in particular thyroid autoimmunity, has been debated for decades. Autoantibodies to thyroid peroxidase, the hallmark of thyroid autoimmunity, have a higher prevalence among patients with breast cancer compared with the general population. Furthermore a correlation between their positivity and a better prognosis of breast cancer was found in several independent small-scale studies, even if such observation was not confirmed in a subsequent retrospective study conducted on the largest patient cohort to date. The thyroid and mammary glands present several biological similarities, therefore the hypothesis of an immune response to shared thyroid/breast antigens could in part explain the association between thyroid autoimmunity and breast cancer. The sodium iodide symporter is expressed in both glands, however it seems unlikely to be the key common antigen, considering that autoantibodies targeting it are rare. Instead thyroid peroxidase, one of the major thyroid autoantigens, is also expressed in breast tissue and therefore represents the main antigenic link between thyroid autoimmunity and breast cancer. Furthermore lactoperoxidase, an enzyme of the same family that shares structural similarities with thyroid peroxidase, is expressed in neoplastic breast cells and is responsible for the cross-reactivity with some autoantibodies to thyroid peroxidase. Novel strategies for the diagnosis and treatment of breast cancer might take advantage of the antigenic link between thyroid and breast tissues.

Shikimic acid promotes estrogen receptor(ER)-positive breast cancer cells proliferation via activation of NF-κB signaling

Shikimic acid (SA), a widely-known hydroaromatic compound enriched in Bracken fern and Illicium verum (also known as Chinese star anise), increases the risk of gastric and esophageal carcinoma, nevertheless, the influence of SA on breast cancer remains indistinct. Herein we found that, with models in vitro, SA significantly promoted estrogen receptor(ER) positive cells proliferation and NF-κB activation was involved in it. Moreover, our data showed that IκBα, a critically endogenous inhibitor of NF-κB, was repressed. Subsequently, we found increase of miR-300 by SA treatment sand miR-300 could target IκBα mRNA. Additionally, inhibition of miR-300 abrogated the repression of IκBα by SA. As a result, miR-300 was also involved in NF-κB activation and breast cancer cells proliferation promotion due to SA exposure. Taken together, with ER-positive breast cancer cell models in vitro, MCF-7 and T47D, our results implied that SA promoted breast cancer cells proliferation via a miR-300-induced NF-κB dependent pathway controlling cell cycle proteins.

Long Non-Coding RNA TFAP2A-AS1 Inhibits Cell Proliferation and Invasion in Breast Cancer via miR-933/SMAD2

BACKGROUND It is well documented that long non-coding RNAs (lncRNAs) are involved in the progression of multiple human tumors by sponging microRNAs (miRNAs). However, whether lncRNA TFAP2A-AS1 plays a role in the tumorigenesis of breast cancer (BC) remains undetermined. MATERIAL AND METHODS Real-time PCR (qRT-PCR) assay was performed to detect the relative mRNA expression of TFAP2A-AS1 and miR-933. Flow cytometry analysis, CCK-8 assay, and Transwell assay were applied to detect the effects of TFAP2A-AS1 overexpression on cell cycle, apoptosis, viability, and invasion of BC cells. In vivo proliferation assay was performed to evaluate the effects of TFAP2A-AS1 overexpression on tumor growth. Bioinformatics methods, dual-luciferase reporter, RNA immunoprecipitation (RIP), and RNA pull-down assays were used to predict and validate the interaction between TFAP2A-AS1 and miR-933, as well as SMAD2 and miR-933. Western blot assay was performed to examine the protein expression of SMAD2 in treated BC cells. RESULTS TFAP2A-AS1 expression was significantly lower in BC tissues and cell lines, and patients with high TFAP2A-AS1 expression exhibited a better prognosis than those with low TFAP2A-AS1 expression. Overexpression of TFAP2A-AS1 in BC cells caused cell cycle arrest, promoted cell apoptosis, suppressed cell ability, and attenuated cell invasion in vitro, and inhibited tumor growth in vivo. TFAP2A-AS1 was revealed to act as a miRNA sponge for miR-933 and then regulated the expression of Smad2. CONCLUSIONS Results from the present study suggest that TFAP2A-AS1 acts as a tumor suppressor in BC via the miR-933/SMAD2 axis.

The Vitamins Involved in One-Carbon Metabolisms are Associated with Reduced Risk of Breast Cancer in Overall and Subtypes

Background: Some micronutrients like folate, vitamin B12, B6, and B2 are the source of coenzymes, which participate in one-carbon metabolism. Any disruption in this metabolism can interfere with DNA replication, repair and regulation of gene expression and ultimately promote the likelihood of carcinogenesis. This study aimed at investigating the relationship between the intakes of micronutrients involved in one-carbon metabolism with breast cancer (BrCa) and its subtype's odds. Methods: Nutrients' intake from diet and supplements were collected through interviewing 151 cases and 154 controls by a 168-item semiquantitative food frequency questionnaire. Logistic regression was used to determine the relationship between dietary and/or total intake of studied nutrients and odds of BrCa and its subtypes. Results: After adjusting the effects of confounding variables in the models, the odds of BrCa was significantly lower in the highest intake quartile compared with the lowest quartile for total intake of vitamin B2 (OR = 0.17, 95% CI, 0.07-0.39; P_trend < 0.001), vitamin B6 (OR = 0.11, 95% CI, 0.05-0.27; P_trend < 0.001), vitamin B12 (OR = 0.20, 95% CI, 0.09-0.43; P_trend < 0.001) and folate (OR = 0.09, 95% CI, 0.04-0.21; P_trend < 0.001). Also, those with the highest quartile of vitamin B6, B12, B2 and folate intake compared with the lowest quartile were less likely to develop estrogen receptor (ER)+ and progesterone receptor (PR)+ subtypes, ER- status, PR- and human epidermal growth factor receptor 2 (HER2)+ subtypes and HER2- status. Conclusion: High intakes of vitamins B2, B6 and folate are associated with reduced odds of BrCa in overall and all ER, PR and HER2 subtypes. Also, high intakes of vitamin B12 reduced the odds of all subtypes of BrCa except ER- subtype.

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.

Dietary inflammatory index and incidence of breast cancer in the SUN project

BACKGROUND & AIMS

Breast cancer (BC) is the most commonly diagnosed cancer, and diet is suspected to play a role in its development. Dietary factors may mediate this process through modulation of inflammation, though findings from previous studies have not been consistent. We aimed to longitudinally assess the association between the dietary inflammatory index (DII^®), a frequently used method to assess the inflammatory potential of the diet, and incident BC.

METHODS

We included 10,713 middle-aged, Spanish female university graduates from the SUN cohort. DII^® scores were derived from a validated 136-item food-frequency questionnaire, and it was based on scientific evidence on the relationship between diet and inflammatory biomarkers. Diagnosis of BC was reported by the participant or, if deceased, by the next of kin or identified from death certificates. Self-reports of BC were confirmed by revision of medical reports by an experienced oncologist. Cox proportional hazard models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between quartiles of DII^® and incident BC.

RESULTS

After 10.3 years of median follow-up, we identified 100 confirmed and 168 probable incident BC cases. The multivariable-adjusted HR for participants in the 4th quartile to the 1st quartile was 1.44 (95% CI 0.76-2.72; p-trend: 0.339) when confirmed cases were analyzed, and 1.20 (95% CI 0.72-1.99; p-trend: 0.757) for the probable cases. We neither observed statistically significant differences in regard to menopausal status.

CONCLUSIONS

The apparent increase in risk between DII^® scores and BC in our cohort was not statistically significant, which could be partly explained by the small number of observed cases.

Dietary Inflammatory Index and Odds of Breast Cancer in a Case-Control Study from Iran

Chronic inflammation is implicated in breast cancer (BrCa) development; however, studies on the association of the inflammatory potential of diet and breast cancer have produced conflicting results. With this as background, we investigated the association between dietary inflammatory index (DII^®) scores and BrCa risk in an Iranian case-control study. In this study, 136 newly diagnosed breast cancer patients and 272 hospitalized controls were recruited using convenience sampling. DII scores were computed from dietary intake data collected through a validated food frequency questionnaire (FFQ). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between the DII and BrCa risk were estimated by logistic regression. After controlling for multiple potential confounders, a significantly increased BrCa odds was observed in the highest quartile of DII score compared to the lowest quartile (OR_{quartile 4 vs. 1} = 2.64, 95% CI: 1.12-6.25; P_trend = 0.01). In subanalysis based on menopausal status, a positive association was observed between the DII and BrCa risk among premenopausal women (OR_{quartile 4 vs. 1} = 5.51, 95% CI: 1.45-20.93; P_trend = 0.005); however, no association was detected in postmenopausal women. Our findings suggest that more proinflammatory diets, indicated by higher DII scores, may increase the odds of BrCa, especially among premenopausal women.

A Comparison Study: The Risk Factors in the Lifestyles of Thyroid Cancer Patients and Healthy Adults of South Korea

BACKGROUND

In South Korea, there has been a rapid increase in thyroid cancer diagnoses, and the thyroid cancer incidence rate is the highest in the world. This study explored possible risk factors that may influence the development of thyroid cancer by comparing life habits of thyroid cancer patients and healthy adults.

OBJECTIVE

The aims of this study were to identify lifestyle and habit differences in thyroid cancer patients and healthy adults and to investigate risk factors that influence the development of thyroid cancer.

METHODS

The study was designed as a retrospective comparison survey study of thyroid cancer patient group and healthy adult group. One hundred two thyroid cancer patients in a university hospital and 115 healthy adults were recruited for this study. Data were analyzed using descriptive statistics, χ test/t test, and logistic regression with SPSS program.

RESULTS

Previous smoking history, lower physical activity level, higher stress, and unhealthy eating habits (consumption of instant food products) were shown to be risk factors in the development of thyroid cancer.

CONCLUSION

Based on the results of this study comparing thyroid cancer patients and healthy adults, it is recommended to encourage an increase in physical activity, minimize both direct and indirect exposure to smoking, develop healthy eating habits of consuming more vegetables, and effectively manage stress levels.

IMPLICATIONS FOR PRACTICE

Lifestyle preferences and habits may influence the development of thyroid cancer. It is imperative to identify and modify the risk factors in order to prevent thyroid cancer development.

Association between Dietary Inflammatory Index (DII) and Risk of Breast Cancer: a Case-Control Study

Background:

Breast cancer (BrCa) is the most common cancer among women worldwide and is the second leading cause of cancer-related death in women, in developed countries. This cancer is among the top five most common cancers in Iran. Studies have shown that dietary components are implicated in the etiology of BrCa. The existence of molecular connections between inflammation and BrCa has been demonstrated via different bimolecular events.

Methods:

We examined the ability of the dietary inflammatory index (DIITM) to predict the risk of BrCa. This included 145 cases and 148 controls, who attended the specialized centers. DII scores were computed based on dietary intake assessed using a 168-item FFQ. Logistic regression models were used to estimate multivariable ORs.

Results:

Modeling DII as a continuous variable in relation to risk of BrCa showed a positive association after adjustment for age and energy (OR=1.76; 95% CI=1.43-2.18); and were nearly identical in the multivariable analyses (OR=1.80; 95% CI=1.42-2.28). DII as tertiles, and adjusting for age and energy, subjects in tertile 3 had an OR of 6.94 (95% CI= 3.26-14.79; P-trend ≤0.0001) in comparison to subjects in tertile 1. After multivariable adjustment, results were essentially identical as in the model adjusting for age and energy (OR tertile 3vs1=7.24; 95% CI=3.14-16.68; P-trend ≤0.001). Sub group analyses revealed similar positive associations with HER 2 receptor +ve, progesterone receptor +ve, estrogen receptor +ve and lymph node invasive cases.

Conclusion:

Subjects who consumed a more pro-inflammatory diet were at increased risk of BrCa compared to those who consumed a more anti-inflammatory diet.

Glucosinolate and isothiocyanate intakes are inversely associated with breast cancer risk: a case–control study in China

Although previous studies have investigated the association of cruciferous vegetable consumption with breast cancer risk, few studies focused on the association between bioactive components in cruciferous vegetables, glucosinolates (GSL) and isothiocyanates (ITC), and breast cancer risk. This study aimed to examine the association between consumption of cruciferous vegetables and breast cancer risk according to GSL and ITC contents in a Chinese population. A total of 1485 cases and 1506 controls were recruited into this case–control study from June 2007 to March 2017. Consumption of cruciferous vegetables was assessed using a validated FFQ. Dietary GSL and ITC were computed by using two food composition databases linking GSL and ITC contents in cruciferous vegetables with responses to the FFQ. The OR and 95 % CI were assessed by unconditional logistic regression after adjusting for the potential confounders. Significant inverse associations were found between consumption of cruciferous vegetables, GSL and ITC and breast cancer risk. The adjusted OR comparing the highest with the lowest quartile were 0·51 (95 % CI 0·41, 0·63) for cruciferous vegetables, 0·54 (95 % CI 0·44, 0·67) for GSL and 0·62 (95 % CI 0·50, 0·76) for ITC, respectively. These inverse associations were also observed in both premenopausal and postmenopausal women. Subgroup analysis by hormone receptor status found inverse associations between cruciferous vegetables, GSL and ITC and both hormone-receptor-positive or hormone-receptor-negative breast cancer. This study indicated that consumption of cruciferous vegetables, GSL and ITC was inversely associated with breast cancer risk among Chinese women.

Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center

Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P ≤ 0.05). Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.