Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: Breast cancer is the leading cause of female cancer burden, and its incidence has increased by more than 20% worldwide since 2008. Some observational studies have suggested that the Mediterranean diet may reduce the risk of breast cancer. OBJECTIVE: To evaluate the effect of 2 interventions with Mediterranean diet vs the advice to follow a low-fat diet (control) on breast cancer incidence. DESIGN, SETTING, AND PARTICIPANTS: The PREDIMED study is a 1:1:1 randomized, single-blind, controlled field trial conducted at primary health care centers in Spain. From 2003 to 2009, 4282 women aged 60 to 80 years and at high cardiovascular disease risk were recruited after invitation by their primary care physicians. INTERVENTIONS: Participants were randomly allocated to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). MAIN OUTCOMES AND MEASURES: Breast cancer incidence was a prespecified secondary outcome of the trial for women without a prior history of breast cancer (n = 4152). RESULTS: After a median follow-up of 4.8 years, we identified 35 confirmed incident cases of breast cancer. Observed rates (per 1000 person-years) were 1.1 for the Mediterranean diet with extra-virgin olive oil group, 1.8 for the Mediterranean diet with nuts group, and 2.9 for the control group. The multivariable-adjusted hazard ratios vs the control group were 0.32 (95% CI, 0.13-0.79) for the Mediterranean diet with extra-virgin olive oil group and 0.59 (95% CI, 0.26-1.35) for the Mediterranean diet with nuts group. In analyses with yearly cumulative updated dietary exposures, the hazard ratio for each additional 5% of calories from extra-virgin olive oil was 0.72 (95% CI, 0.57-0.90). CONCLUSIONS AND RELEVANCE: This is the first randomized trial finding an effect of a long-term dietary intervention on breast cancer incidence. Our results suggest a beneficial effect of a Mediterranean diet supplemented with extra-virgin olive oil in the primary prevention of breast cancer. These results come from a secondary analysis of a previous trial and are based on few incident cases and, therefore, need to be confirmed in longer-term and larger studies. TRIAL REGISTRATION: ISRCTN.org Identifier: ISRCTN35739639.
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In the PREDIMED study, after a mean follow-up of 4.8 years, breast cancer rates were lower in the intervention groups with EVOO or nuts than in the control group with a low-fat diet; after multivariate adjustment, the EVOO group had a significantly lower risk of developing breast cancer, with a 28% lower risk for every 5% additional calories from EVOO.
“Data from the PREDIMED study showed that after a mean follow-up of 4.8 years, the observed rates of breast cancer were lower in the intervention groups with EVOO or with nuts than in the control group with a low-fat diet. After multivariate adjustment, the group supplementing MD with EVOO had a significantly lower risk of developing breast cancer than the control group; for every 5% additional”
From Mediterranean Diet and Obesity-related Disorders: What is the Evidence? (2022) · cites this paper as [148]
In substudies using the PRIDIMED database, the incidence of type 2 diabetes, peripheral artery disease, atrial fibrillation, and breast cancer, but not the incidence of heart failure, was significantly reduced in individuals randomized to the Mediterranean diet.
“The incidence of type 2 diabetes, peripheral artery disease, atrial fibrillation, breast cancer, but not the incidence of heart failure, was significantly reduced in individuals randomized to the Mediterranean diet (25–27).”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [26]
In the PREDIMED trial, after a median follow-up of 4.8 years in 4282 postmenopausal women, breast cancer incidence rates per 1000 person-years were 1.1 for the EVOO-enriched MedDiet group, 1.8 for the nuts-enriched MedDiet group, and 2.9 for the control group.
“After a median follow-up of 4.8 years, on 4282 postmenopausal women, 35 incident cases of breast cancer were identified. The observed incidence rates (per 1000 person-years) of breast cancer were 1.1 for the EVOO-enriched MedDiet group, 1.8 for the nuts-enriched MedDiet group, and 2.9 for the control group [159].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [159]
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“However, stronger evidence for primary chemoprevention of breast malignancies with frequent consumption of EVOO is provided by a prespecified outcome of the PREvención con DIeta MEDiterránea (PREDIMED) trial [159].”
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- Authors
- Toledo, E., Salas-Salvadó, J., Donat-Vargas, C., Buil-Cosiales, P., Estruch, R., Ros, E., Corella, D., Fitó, M., Hu, F. B., Arós, F., Gómez-Gracia, E., Romaguera, D., Ortega-Calvo, M., Serra-Majem, L., Pintó, X., Schröder, H., Basora, J., Sorlí, J. V., Bulló, M., Serra-Mir, M., & Martínez-González, M. A.
- Affiliations
- Instituto de Salud Carlos III (ES)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra–School of Medicine, Pamplona, Navarra, Spain
- Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain
- Universitat de València (ES)
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2015-11-01
- Volume
- 175
- Issue
- 11
- Pages
- 1752
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2155215362
- Cited by
- 528
- References
- 39
- Citations by year
- 2026: 31 · 2025: 35 · 2024: 42 · 2023: 53 · 2022: 53 · 2021: 74 · 2020: 56 · 2019: 44 · 2018: 60 · 2017: 43 · 2016: 31 · 2015: 6
- FWCI
- 49.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Hispana (submittedVersion, cc-by-nc-nd)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, public-domain)
- Acceda (Universidad de Las Palmas de Gran Canaria) (submittedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion)
- Docusalut (Conselleria de Salut i Consum del Govern de les Illes Balears) (submittedVersion, cc-by-nc-nd)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- Loma Linda University
- Generalitat Valenciana (ACOMP/2013/159, ACOMP/2013/165)
- National Institutes of Health (RTIC RD 06/0045, PI10/02658, RTIC G03/140, PI10/01407, PI0105/2007, PI07/0240)
- Instituto de Salud Carlos III (PI040233, AGL2010-22319-C03, PI1002658, RTIC G03/140, PI11/00049, 06/0045, RD06/0045, PI11/, PI07/0240, AGL2010‐22319‐C03‐03, PI050976, 1R01HL118264-01, RTIC RD06/0045, G03/140, PI1001407, PI0105/2007, PI11/02505)
- European Regional Development Fund (06/0045, PI10/01407, PI07/0240, PI11/02505, RTIC G03/140, (RD 06/0045, AGL2010-22319-C03-03, PI10/02658, G03/140, PI11/00049)
- National Heart, Lung, and Blood Institute (R01HL118264)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Nursing › Nutrition and Dietetics › Nuts composition and effects
- Keywords
- Mediterranean diet, breast cancer incidence, extra virgin olive oil, mixed nuts, dietary fat reduction, cardiovascular risk, PREDIMED trial, older women, dietary intervention, secondary prevention of cardiovascular disease
- MeSH terms
- Olive Oil, Aged, Breast Neoplasms, Cardiovascular Diseases, Dietary Fats, Female, Follow-Up Studies, Humans, Middle Aged, Nuts, Primary Prevention, Time, Incidence, Treatment Outcome, Diet, Mediterranean, Risk Reduction Behavior
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