Indices of Mediterranean diet adherence and breast cancer risk in a community-based cohort

Ioanna Yiannakou; Martha R Singer; Lynn L Moore

doi:10.3389/fnut.2023.1148075

Indices of Mediterranean diet adherence and breast cancer risk in a community-based cohort

Front Nutr. 2023 Mar 21:10:1148075. doi: 10.3389/fnut.2023.1148075. eCollection 2023.

Authors

Ioanna Yiannakou^{1

2}, Martha R Singer¹, Lynn L Moore¹

Affiliations

¹ Preventive Medicine and Epidemiology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
² Graduate Medical Sciences/Doctoral Program in Biomedical Sciences, Nutrition and Metabolism, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.

Abstract

Introduction: A Mediterranean-style dietary pattern is believed to have cancer-protective effects. We compared the prospective associations between adherence to four established Mediterranean diet indices and breast cancer risk (including total, postmenopausal, and hormone receptor positive cases) in women in the Framingham Offspring Study.

Methods: The four indices used two different approaches to measuring adherence to a Mediterranean diet: (a) scores based on the population-specific median intakes of Mediterranean diet-related foods in a given population (i.e., alternate Mediterranean Diet (aMED) index and Mediterranean Diet Score (MDS) index), and (b) scores based on compliance with recommended intakes of relevant foods from the Mediterranean diet pyramid [i.e., Mediterranean Diet (MeDiet) index and Mediterranean Style Dietary Pattern (MSDP) index]. Dietary data were derived from semiquantitative food frequency questionnaires collected in 1991-95. Participants included 1579 women aged ≤ 30 years who were free of prevalent cancer. Women were followed through 2014, and Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for various confounders.

Results: During a median follow-up of approximately 18 years, 87 breast cancer cases were documented. Women in the highest (vs. lowest) score category of the pyramid-based scores (i.e., MeDiet or MSDP) had approximately 45% statistically significantly lower breast cancer risks. These effects were even stronger for any hormone receptor positive cases using the MeDiet index (highest vs. lowest score categories: HR = 0.45, 95% CI: 0.22-0.90). Neither of the median intake-based scores (i.e., aMED, MDS) was associated with breast cancer risk.

Discussion: Our results suggest that the methodology and the composition of Mediterranean diet indices influence their ability to assess conformity to this specific diet pattern and predict breast cancer risk.

Keywords: Mediterranean diet; breast cancer; diet quality; dietary index; hormone receptor status; prospective cohort study.

Grants and funding

These data were originally collected with funding from the National Heart, Lung, and Blood Institute (Framingham Study Contract N01-HC-25195).