Our meta-analysis was aimed at providing a systematic review of the literature regarding the effect of energy restriction on spontaneous mammary tumors in mice and at providing a more precise pooled (summary) estimate of the risk of mammary tumors. A sensitivity analysis was conducted to obtain insight in potential heterogeneity between the animal studies. A literature search was conducted with the following terms to identify relevant articles: animal studies, mammary tumors, fat restricted, dietary carbohydrates, energy restriction and calorie restriction. A criteria list for the assessment of quality items (i.e., study characteristics) in animal experiments was developed that was intended to quantitatively assess potential factors that underlie heterogeneous results of different animal experiments. Incidence figures were used to calculate the risk difference. The pooled risk difference was calculated by random effects meta regression analysis. Fourteen animal experiments were included in this metaanalysis. Publication bias could not be identified. The pooled risk difference for the 14 studies was ؊0.55 with a narrow 95% confidence interval (؊0.69; ؊0.41), implying that the energy-restricted animal groups developed 55% less mammary tumors than the control groups. No heterogeneity could be detected between the studies based on study characteristics that included the age of mice at the start of intervention, duration of intervention, allocation of the mice, use of ad libitum control group, fertility of the mice and the type of energy-providing nutrient (fat, carbohydrate or protein). This meta-analysis confirms that energy restriction in itself consistently protects against the development of mammary tumor in mice, irrespective of the type of restricted nutrient or other study characteristics. © 2003 Wiley-Liss, Inc.
Key words: energy restriction; mammary tumors; mice; meta-analysisWorldwide, breast cancer is the most frequent cancer in women and is one of the main causes of death in women today. 1,2 It is important to understand more about the etiology and possibilities for prevention of breast cancer. The hypothesis that high fat intake will increase the risk of breast cancer has often been examined in human studies. Although epidemiological studies in humans suggested that diet (energy and fat) is related to the incidence of breast cancer, 3-5 the results are not consistent. A pooled analysis of the results of several cohort studies yielded no evidence of a positive association between total dietary fat intake and the risk of breast cancer. 6 To clarify the role of dietary factors in the etiology of breast cancer, much research has been conducted in rodents, especially regarding the effect of dietary fat-intake and energy (i.e., caloric) restriction on breast cancer risk. Energy restriction has been suggested to be a very effective way of reducing the incidence of mammary tumors in rodents. 7,8 The animal experimental data supports the hypothesis that, in mammary tumor development, there is a specific enhancin...