Adherence to the Mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study
Open accessAbstract
Epidemiological evidence suggests that the Mediterranean diet (MD) could reduce the risk of breast cancer (BC). As evidence from the prospective studies remains scarce and conflicting, we investigated the association between adherence to the MD and risk of BC among 335,062 women recruited from 1992 to 2000, in ten European countries, and followed for 11 years on average. Adherence to the MD was estimated through an adapted relative Mediterranean diet (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for BC risk factors. A total of 9,009 postmenopausal and 1,216 premenopausal first primary incident invasive BC were identified (5,862 estrogen or progesterone receptor positive [ER+/PR+] and 1,018 estrogen and progesterone receptor negative [ER-/PR-]). The arMED was inversely associated with the risk of BC overall and in postmenopausal women (high vs. low arMED score; hazard ratio [HR] = 0.94 [95% confidence interval [CI]: 0.88, 1.00] ptrend = 0.048, and HR = 0.93 [95% CI: 0.87, 0.99] ptrend = 0.037, respectively). The association was more pronounced in ER-/PR- tumors (HR = 0.80 [95% CI: 0.65, 0.99] ptrend = 0.043). The arMED score was not associated with BC in premenopausal women. Our findings show that adherence to a MD excluding alcohol was related to a modest reduced risk of BC in postmenopausal women, and this association was stronger in receptor-negative tumors. The results support the potential scope for BC prevention through dietary modification.
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Several population-based and prospective epidemiological studies have shown that adherence to the Mediterranean diet might have a protective effect against cardiovascular disease, stroke, obesity, diabetes, hypertension, several types of cancers, allergic diseases, and Alzheimer and Parkinson's disease.
“Several population-based and prospective epidemiological studies have shown that adherence to the Mediterranean diet might have a protective effect against cardiovascular disease, stroke, obesity, diabetes, hypertension, several type of cancers, allergic diseases and, most recently, Alzheimer and Parkinson’s disease (7–18).”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [15]
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- Authors
- Buckland, G., Travier, N., Cottet, V., González, C. A., Luján‐Barroso, L., Agudo, A., Trichopoulou, A., Lagiou, P., Trichopoulos, D., Peeters, P. H., May, A., Bueno‐de‐Mesquita, H. B., Bvan Duijnhoven, F. J., Key, T. J., Allen, N., Khaw, K. T., Wareham, N., Romieu, I., McCormack, V., Boutron‐Ruault, M., Clavel‐Chapelon, F., Panico, S., Agnoli, C., Palli, D., Tumino, R., Vineis, P., Amiano, P., Barricarte, A., Rodríguez, L., Sanchez, M. J., Chirlaque, M. D., Kaaks, R., Teucher, B., Boeing, H., Bergmann, M. M., Overvad, K., Dahm, C. C., Tjønneland, A., Olsen, A., Manjer, J., Wirfält, E., Hallmans, G., Johansson, I., Lund, E., Hjartåker, A., Skeie, G., Vergnaud, A. C., Norat, T., Romaguera, D., & Riboli, E.
- Affiliations
- Institut d'Investigació Biomédica de Bellvitge (ES)
- Université Paris-Sud (FR)
- National and Kapodistrian University of Athens (GR)
- Harvard University (US)
- University Medical Center Utrecht (NL)
- University of Oxford (GB)
- University of Cambridge (GB)
- Centre international de recherche sur le cancer (FR)
- Inserm (FR)
- Federico II University Hospital (IT)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Istituto per lo Studio e la Prevenzione Oncologica (IT)
- University of Ragusa (IT)
- Imperial College London (GB)
- Biogipuzkoa Health Research Institute (ES)
- Instituto de Salud Pública de Navarra (ES)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- German Cancer Research Center (DE)
- German Institute of Human Nutrition (DE)
- Aarhus University (DK)
- Danish Cancer Society (DK)
- Lund University (SE)
- Umeå University (SE)
- UiT The Arctic University of Norway (NO)
- University of Oslo (NO)
- Corresponding author
- Buckland, G.
- ORCID
- Buckland, G.
- Travier, N.
- Cottet, V.
- Luján‐Barroso, L.
- Agudo, A.
- Trichopoulou, A.
- Peeters, P.H.
- May, A.
- Khaw, K.T.
- Wareham, N.
- Romieu, I.
- McCormack, V.
- Boutron‐Ruault, M.
- Panico, S.
- Agnoli, C.
- Palli, D.
- Tumino, R.
- Vineis, P.
- Amiano, P.
- Barricarte, A.
- Rodríguez, L.
- Kaaks, R.
- Boeing, H.
- Bergmann, M.M.
- Overvad, K.
- Dahm, C.C.
- Tjønneland, A.
- Olsen, A.
- Manjer, J.
- Johansson, I.
- Lund, E.
- Hjartåker, A.
- Skeie, G.
- Romaguera, D.
- Venue
- International Journal of Cancer
- Publisher
- Wiley
- Published
- 2012-12-19
- Volume
- 132
- Issue
- 12
- Pages
- 2918-2927
- ISSN
- 0020-7136 (ISSN-L)
- 1097-0215
- OpenAlex
- W1981678892
- Cited by
- 238
- References
- 47
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 19 · 2023: 10 · 2022: 15 · 2021: 24 · 2020: 16 · 2019: 15 · 2018: 29 · 2017: 15 · 2016: 16 · 2015: 24 · 2014: 16 · 2013: 12 · 2012: 1
- FWCI
- 16.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Cancer (publishedVersion)
- PubMed (publishedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Cancer Research UK (14136)
- National Institute for Health and Care Research (NF-SI-0512-10114)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- Mediterranean diet, breast cancer risk, diet and cancer prevention, postmenopausal women, premenopausal women, hormone receptor-negative breast cancer, estrogen receptor, progesterone receptor, dietary change
- MeSH terms
- Breast Neoplasms, Europe, Female, Humans, Life Style, Menopause, Prospective Studies, Surveys and Questionnaires, Receptors, Estrogen, Receptors, Progesterone, Risk, Incidence, Diet, Mediterranean
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