Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer

Pierce, John P.; Natarajan, Loki; Caan, Bette J.; Parker, Barbara A.; Greenberg, E. Robert; Flatt, Shirley W.; Rock, Cheryl L.; Kealey, Sheila; Al-Delaimy, Wael K.; Bardwell, Wayne A.; Carlson, R. W.; Emond, Jennifer A.; Faerber, Susan; Gold, Ellen B.; Hajek, Richard A.; Hollenbach, Kathryn A.; Jones, Lovell A.; Karanja, Njeri; Madlensky, Lisa; Marshall, James R.; Newman, Vicky A.; Ritenbaugh, Cheryl; Thomson, Cynthia A.; Wasserman, Linda; Stefanick, Marcia L.

doi:10.1001/jama.298.3.289

Cited by 655 publications

(516 citation statements)

References 30 publications

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“…In the present study, the mean dietary intake of fruits and vegetables was approximately seven servings per day, well above the average U.S. intake (52). Yet, despite this relatively well-nourished study sample population (36), a range of plasma carotenoid concentrations was observed and linked with a protective effect for breast cancer recurrence.…”

Section: Discussioncontrasting

confidence: 53%

“…Further, a recent survival analysis from the Long Island Breast Cancer Study by Fink et al (35) suggested that a pattern of high fruit and vegetable intake among 1,235 women previously diagnosed with breast cancer did not significantly reduce all-cause mortality. Likewise, another recent analysis from the WHEL study population found no evidence that adoption of a diet high in fruit, vegetables, and fiber and low in fat compared with a 5-a-day fruit and vegetable diet prevents breast cancer recurrence or death among women with previously treated early-stage breast cancer (36). One noteworthy difference between the Fink study and the present study is that the dietary fruit and vegetable intake in the Long Island study subjects was assessed one year before diagnosis, whereas in the WHEL study population diet was assessed, on average, two years after breast cancer diagnosis and, as such, may have reflected change in intake after diagnosis (37).…”

Section: Discussionmentioning

confidence: 98%

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Plasma and Dietary Carotenoids Are Associated with Reduced Oxidative Stress in Women Previously Treated for Breast Cancer

Thomson

Stendell-Hollis

Rock³

et al. 2007

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Dietary carotenoids show numerous biological activities, including antioxidant activity, induction of apoptosis, and inhibition of mammary cell proliferation. Studies examining the role of carotenoid consumption in relation to breast cancer recurrence are limited and report mixed results. We tested the hypothesis that breast cancer survivors with high dietary and plasma carotenoids would show significantly lower levels of oxidative stress than breast cancer survivors with low dietary and plasma carotenoid levels. Two hundred seven postmenopausal breast cancer survivors from the Women's Healthy Eating and Living Study volunteered for this ancillary study. Dietary data were analyzed by the Arizona Food Frequency Questionnaire and plasma carotenoids A-carotene, B-carotene, lutein plus zeaxanthin, lycopene, and B-cryptoxanthin and quantified with high-performance liquid chromatography, and immunoaffinity chromatography-monoclonal antibodybased ELISAs were used to analyze the urine samples for 8-hydroxy-2 ¶-deoxyguanosine (8-OhdG) and 8-isoprostaglandin-F2A (8-iso-PGF2A). The correlations between dietary and plasma carotenoids were 0.34 for B-carotene, 0.46 for A-carotene, 0.39 for B-cryptoxanthin, 0.27 for lycopene, 0.30 for lutein plus zeaxanthin, and 0.30 for total carotenoids. The 8-OHdG oxidative stress biomarker was significantly reduced at the highest quartile of total plasma carotenoid concentrations (P = 0.001) and 8-iso-PGF2A was moderately reduced (P = 0.088). Dietary carotenoid levels were not significantly associated with oxidative, stress indicators, although dietary lycopene and lutein/zeaxanthin were modestly associated with 8-OHdG levels (P = 0.054 and 0.088, respectively). Key findings include a significant inverse association between total plasma carotenoid concentrations and oxidative stress as measured by urinary 8-OHdG and a moderately significant inverse association with 8-iso-PGF2A, a protective association that was not shown for dietary carotenoid intake. (Cancer Epidemiol Biomarkers Prev 2007;16(10):2008 -15)

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 98%

Plasma and Dietary Carotenoids Are Associated with Reduced Oxidative Stress in Women Previously Treated for Breast Cancer

Thomson

Stendell-Hollis

Rock³

et al. 2007

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…A limited number of FV intervention studies with clinical endpoints exist, and in these an increase in FV intake has been combined with another dietary or lifestyle change (48)(49)(50)(51)(52)(53) . For example, the Women's Health Initiative randomised controlled dietary modification trial tested the effect of a low-fat dietary pattern, rich in FV and high in wholegrains, on the risk of CVD in nearly 50 000 postmenopausal women (53) .…”

Section: Intervention Studies With Clinical Endpointsmentioning

confidence: 99%

Fruit and vegetable intake and risk of cardiovascular disease

2013

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A high intake of fruit and vegetables (FV) has been shown to be associated with reduced risk of a number of chronic diseases, including CVD. This review aims to provide an overview of the evidence that increased FV intake reduces risk of CVD, focusing on studies examining total FV intake. This evidence so far available is largely based on prospective cohort studies, with meta-analyses demonstrating an association between increased FV intake and reduced risk of both CHD and stroke. Controlled intervention trials examining either clinical or cardiovascular risk factor endpoints are scarce. However, such trials have shown that an increase in FV consumption can lower blood pressure and also improve microvascular function, both of which are commensurate with a reduced risk of CVD. The effects of increased FV consumption on plasma lipid levels, risk of diabetes and body weight have yet to be firmly established. In conclusion, evidence that FV consumption reduces the risk of CVD is so far largely confined to observational epidemiology, with further intervention studies required.

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“…But analyses from the Nurses' Health Study found that adherence to a prudent dietary pattern (characterized by a diet high in fruits, vegetables, whole grains, legumes, poultry and fish) was not associated with breast-cancer mortality but was negatively related to mortality from other causes [57]. The WHEL randomized trial confirmed that adherence to a diet very high in vegetables, fruit and fiber and low in fat does not reduce breast cancer recurrence or mortality [58]. In contrast, high consumption of b-carotene and vitamin C seems to influence survival [59].…”

Section: Other Dietary Macro-and Micronutrientsmentioning

confidence: 99%