Breast cancer prevention is of great importance to reduce high incidence in South Africa. This study aimed to investigate adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations and the association with breast cancer risk in black urban women from Soweto, South Africa. A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings was included. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to these recommendations, an 8-point adherence score was developed, using tertiles among controls for scoring each recommendation (0, 0.5 and 1) with zero indicating the lowest adherence to the recommendations. Odds ratios and 95% confidence intervals were estimated using multivariate logistic regression models to analyse associations between the WCRF/AICR score and breast cancer risk. Greater adherence (>4.5 vs <3.25) to the 2018 WCRF/AICR Cancer Prevention Recommendations was associated with a significant inverse association with breast cancer risk overall (OR=0.54, 95%CI:0.35-0.91) and specifically in postmenopausal women (OR=0.55, 95%CI:0.34-0.95), in cases with oestrogen positive (ER+) and progesterone positive (PR+) breast cancer subtypes (OR=0.54, 95%CI:0.39-0.89 and OR=0.68, 95%CI:0.43-0.89, respectively), and in obese women (OR=0.52, 95%CI:0.35-0.81). No significant association with breast cancer risk was observed in premenopausal women. Greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may reduce breast cancer risk in this black urban population of Soweto. Adherence thereof should be encouraged and form part of cost-effective breast cancer prevention guidelines.

Incidence rates of breast cancer (BC) are increasing in South Africa. The aim of this study was to investigate the association between dietary intake and BC risk in black South African women. The study population included 396 BC cases and 396 population-based controls matched on age and residence, participating in the South African Breast Cancer study. Diet was assessed using a validated quantified FFQ from which twelve energy-adjusted food groups were formed and analysed. OR were estimated using conditional logistic regressions, adjusted for confounding factors, comparing highestv.lowest median intake. Fresh fruit consumption showed an inverse association with BC risk (OR=0·3, 95 % CI 0·12, 0·80) in premenopausal women, whilst red and organ meat consumption showed an overall inverse association with BC risk (OR=0·6, 95 % CI 0·49, 0·94 and OR=0·6, 95 % CI 0·47, 0·91). Savoury food consumption (sauces, soups and snacks) were positively associated with BC risk in postmenopausal women (OR=2·1, 95 % CI 1·15, 4·07). Oestrogen receptor-positive stratification showed an inverse association with BC risk and consumption of nuts and seeds (OR=0·2, 95 % CI 0·58, 0·86). Based on these results, it is recommended that black South African women follow a diet with more fruit and vegetables together with a decreased consumption of less energy-dense, micronutrient-poor foods such as savoury foods. More research is necessary to investigate the association between BC risk and red and organ meat consumption. Affordable and practical methods regarding these recommendations should be implemented within health intervention strategies.

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A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings was included. Validated questionnaires were used to collect dietary and epidemiological data. Dietary patterns were derived using principal component analysis with a covariance matrix from 33 food groups. Odds ratios and 95% confidence intervals were estimated using conditional logistic regression. A traditional, a cereal-dairy breakfast and a processed food dietary pattern were identified, which together explained 40.3% of the total variance in the diet. After adjusting for potential confounders, the traditional dietary pattern and cereal-dairy breakfast dietary pattern were inversely associated with breast cancer risk (highest tertile versus lowest tertile) (OR = 0.72, 95%CI: 0.57–0.89, p-trend = 0.004 and OR = 0.73, 95%CI: 0.59–0.90, p-trend = 0.004, respectively). The processed food dietary pattern was not significantly associated with breast cancer risk. The results of this study show that a traditional dietary pattern and a cereal-dairy breakfast dietary pattern may reduce the risk of developing breast cancer in this population.

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In South Africa, child malnutrition is highly prevalent among children from in rural areas mostly at risk. In the Eastern Cape (EC) Province, maize is commonly used as complementary and weaning food. Previous studies conducted in parts of EC have indicated high levels of fumonisin B (FB) mycotoxins in home-grown maize, as well as the co-occurrence of other Fusarium mycotoxins, such as deoxynivalenol (DON) and zearalenone (ZEN). A cross-sectional study of children below 24 months was conducted in rural maize-subsistence farming areas in Centane, EC to determine mycotoxin exposure. Home-grown maize samples (n=171) were collected from households in the study area and analysed by LC-MS/MS for FB, DON and ZEN. Food intakes of 129 children were quantified using a validated quantitative food frequency questionnaire (QFFQ). Individual raw maize consumption was calculated using recipes from the QFFQ. Probable daily intakes (PDIs) for each mycotoxin were determined using a deterministic approach and were compared to the respective mycotoxins’ provisional maximum tolerable daily intake (PMTDI). The numerical means for total FB (sum of fumonisin B1, B2 and B3), DON and ZEN levels in home-grown maize were 1,035, 24.5 and 31.0 μg/kg, respectively. Mean daily maize intakes of children ranged from 2-321 g/day and increased with age. The mean PDIs for total FB, DON and ZEN were 8.4, 0.2 and 0.3 μg/kg body weight (bw)/day, respectively. Exposures stratified by age indicated persistent high mean PDIs for total FB, above the PMTDI of 2 μg/kg bw/day, ranging between 5.0-11.6 μg/kg bw/day. Mean exposure to DON and ZEN were below their relevant PMTDIs (1 and 0.5 μg/kg bw/day, respectively). Individually, 81 and 13% of children had exposures above the PMTDI for total FB and for ZEN, respectively. Results confirm the magnitude of FB exposure among vulnerable groups from rural maize subsistence farming areas in EC.

Abstract Objective: To examine the associations of dietary diversity with anaemia and iron status among primary school-aged children in South Africa. Design: An analysis was conducted with pooled individual data from the baseline surveys from three previously conducted independent intervention studies. Two different dietary diversity scores (DDS) were calculated based on data from 1-day (1-d) and 3-day (3-d) dietary recall periods, respectively. Logistic regression analysis was performed to examine the associations of dietary diversity with anaemia and iron status. Setting: KwaZulu-Natal and North West provinces, South Africa. Participants: Children (n 578) 5- to 12-year-old. Results: A DDS ≤ 4 was associated with higher odds of being anaemic (1-d P = 0·001; 3-d P = 0·006) and being iron deficient (ID) (3-d P < 0·001). For both recall periods, consumption of ‘vegetables and fruits other than vitamin A-rich’ and ‘animal-source foods (ASF)’ was associated with lower odds of being anaemic (both P = 0·002), and ‘organ meats’ with lower odds of being ID (1-d P = 0·045; 3-d P < 0·001). Consumption of ‘meat, chicken and fish’ was associated with lower odds of being anaemic (P = 0·045), and ‘vegetables and fruits other than vitamin A-rich’, ‘legumes, nuts and seeds’ and ‘ASF’ with lower odds of being ID for the 3-d recall period only (P = 0·038, P = 0·020 and P = 0·003, respectively). Conclusion: In order to improve anaemia and iron status among primary school-aged children, dietary diversification, with emphasis on consumption of vegetables, fruits and ASF (including organ meats), should be promoted.