Distinct trajectories of fruits and vegetables, dietary fat, and alcohol intake following a breast cancer diagnosis: the Pathways Study
To identify distinct diet trajectories after breast cancer (BC) diagnosis, and to examine the characteristics associated with diet trajectories.
We analyzed 2865 Pathways Study participants who completed ≥ 2 food frequency questionnaires at the time of BC diagnosis (baseline), and at 6 and 24 months after baseline. Trajectory groups of fruit and vegetable (F/V) intake, % calories from dietary fat, and alcohol intake over 24 months were identified using group-based trajectory modeling. Associations between diet trajectories and sociodemographic, psychosocial, and clinical factors were analyzed using multinomial logistic regression.
Analyses identified 3 F/V trajectory groups, 4 dietary fat groups, and 3 alcohol groups. All 3 F/V trajectory groups reported slightly increased F/V intake post-diagnosis (mean increase = 0.2–0.5 serving/day), while 2 groups (48% of participants) persistently consumed < 4 servings/day of F/V. Dietary fat intake did not change post-diagnosis, with 45% of survivors maintaining a high-fat diet (> 40% of calories from fat). While most survivors consumed < 1 drink/day of alcohol at all times, 21% of survivors had 1.4-3.0 drinks/day at baseline and temporarily decreased to 0.1–0.5 drinks/day at 6 months. In multivariable analysis, diet trajectory groups were significantly associated with education (ORs: 1.93–2.49), income (ORs: 1.32–2.57), optimism (ORs: 1.93–2.49), social support (OR = 1.82), and changes in physical well-being (ORs: 0.58–0.61) and neuropathy symptoms after diagnosis (ORs: 1.29–1.66).
Pathways Study participants reported slightly increasing F/V and decreasing alcohol intake after BC diagnosis. Nearly half of survivors consumed insufficient F/V and excessive dietary fat. It is important to prioritize nutrition counseling and education in BC survivors.
KeywordsDiet Cancer survivors Breast cancer Trajectory analysis Group-based trajectory modeling
Supported by National Institute of Health/National Cancer Institute R01CA105274 (to LHK), U01CA195565 (to LHK), and China Scholarship Council predoctoral training award No. 201208000008 (to ZS).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD (2011) Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 13(3):R64. https://doi.org/10.1186/bcr2901 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL (2015) Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: a Systematic Review for the Community Preventive Services Task Force. Ann Intern Med 163(6):437–451. https://doi.org/10.7326/M15-0452 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Kwan ML, Lo JC, Tang L, Laurent CA, Roh JM, Chandra M, Hahn TE, Hong CC, Sucheston-Campbell L, Hershman DL, Quesenberry CP Jr, Ambrosone CB, Kushi LH, Yao S (2014) Bone health history in breast cancer patients on aromatase inhibitors. PLoS ONE 9(10):e111477. https://doi.org/10.1371/journal.pone.0111477 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):243–274. https://doi.org/10.3322/caac.21142 CrossRefGoogle Scholar
- 5.World Cancer Research Fund/American Institute for Cancer Research (2018) Diet, nutrition, physical activity and cancer: a global perspective. Continuous update project expert report. American Institute for Cancer Research, Washington, DCGoogle Scholar
- 6.Blanchard CM, Courneya KS, Stein K, American Cancer Society’s SCS, II (2008) Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 26(13):2198–2204. https://doi.org/10.1200/jco.2007.14.6217 CrossRefPubMedGoogle Scholar
- 7.Milliron BJ, Vitolins MZ, Tooze JA (2014) Usual dietary intake among female breast cancer survivors is not significantly different from women with no cancer history: results of the National Health and Nutrition Examination Survey, 2003-2006. J Acad Nutr Diet 114(6):932–937. https://doi.org/10.1016/j.jand.2013.08.015 CrossRefPubMedGoogle Scholar
- 14.Fassier P, Zelek L, Lecuyer L, Bachmann P, Touillaud M, Druesne-Pecollo N, Galan P, Cohen P, Hoarau H, Latino-Martel P, Kesse-Guyot E, Baudry J, Hercberg S, Deschasaux M, Touvier M (2017) Modifications in dietary and alcohol intakes between before and after cancer diagnosis: results from the prospective population-based NutriNet-Sante cohort. Int J Cancer 141(3):457–470. https://doi.org/10.1002/ijc.30704 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Affret A, His M, Severi G, Mancini FR, Arveux P, Clavel-Chapelon F, Boutron-Ruault MC, Fagherazzi G (2018) Influence of a cancer diagnosis on changes in fruit and vegetable consumption according to cancer site, stage at diagnosis and socioeconomic factors: results from the large E3 N-EPIC study. Int J Cancer. https://doi.org/10.1002/ijc.31572 CrossRefPubMedGoogle Scholar
- 16.Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, Blackwell K, Rimer BK (2001) Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19(9):2381–2389. https://doi.org/10.1200/JCO.2001.19.9.2381 CrossRefPubMedGoogle Scholar
- 18.Bell RJ, Lijovic M, Fradkin P, Schwarz M, Davis SR (2012) Changes in patterns of use of cigarettes and alcohol in women after a first diagnosis of invasive breast cancer: a cohort study of women from Victoria, Australia. Support Care Cancer 20(4):783–789. https://doi.org/10.1007/s00520-011-1150-8 CrossRefPubMedGoogle Scholar
- 19.Bidstrup PE, Dalton SO, Christensen J, Tjonneland A, Larsen SB, Karlsen R, Brewster A, Bondy M, Johansen C (2013) Changes in body mass index and alcohol and tobacco consumption among breast cancer survivors and cancer-free women: a prospective study in the Danish Diet. Cancer and Health Cohort. Acta Oncol 52(2):327–335. https://doi.org/10.3109/0284186X.2012.746466 CrossRefPubMedGoogle Scholar
- 20.Tinker LF, Rosal MC, Young AF, Perri MG, Patterson RE, Van Horn L, Assaf AR, Bowen DJ, Ockene J, Hays J, Wu L (2007) Predictors of dietary change and maintenance in the Women’s Health Initiative Dietary Modification Trial. J Am Diet Assoc 107(7):1155–1166. https://doi.org/10.1016/j.jada.2007.04.010 CrossRefPubMedGoogle Scholar
- 22.Kwan ML, Ambrosone CB, Lee MM, Barlow J, Krathwohl SE, Ergas IJ, Ashley CH, Bittner JR, Darbinian J, Stronach K, Caan BJ, Davis W, Kutner SE, Quesenberry CP, Somkin CP, Sternfeld B, Wiencke JK, Zheng S, Kushi LH (2008) The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California. Cancer Causes Control 19(10):1065–1076. https://doi.org/10.1007/s10552-008-9170-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Willet W (1999) Nutritional epidemiology, 2nd edn. Oxford University Press, New YorkGoogle Scholar
- 34.Richardson AS, Meyer KA, Howard AG, Boone-Heinonen J, Popkin BM, Evenson KR, Kiefe CI, Lewis CE, Gordon-Larsen P (2014) Neighborhood socioeconomic status and food environment: a 20-year longitudinal latent class analysis among CARDIA participants. Health Place 30:145–153. https://doi.org/10.1016/j.healthplace.2014.08.011 CrossRefPubMedGoogle Scholar
- 37.Mongiovi JM, Zirpoli GR, Cannioto R, Sucheston-Campbell LE, Hershman DL, Unger JM, Moore HCF, Stewart JA, Isaacs C, Hobday TJ, Salim M, Hortobagyi GN, Gralow JR, Thomas Budd G, Albain KS, Ambrosone CB, McCann SE (2018) Associations between self-reported diet during treatment and chemotherapy-induced peripheral neuropathy in a cooperative group trial (S0221). Breast Cancer Res 20(1):146. https://doi.org/10.1186/s13058-018-1077-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495. https://doi.org/10.1016/S1470-2045(10)70218-7 CrossRefPubMedGoogle Scholar
- 42.Schatzkin A, Kipnis V, Carroll RJ, Midthune D, Subar AF, Bingham S, Schoeller DA, Troiano RP, Freedman LS (2003) A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study. Int J Epidemiol 32(6):1054–1062CrossRefGoogle Scholar
- 43.Kristal AR, Vizenor NC, Patterson RE, Neuhouser ML, Shattuck AL, McLerran D (2000) Precision and bias of food frequency-based measures of fruit and vegetable intakes. Cancer Epidemiol Biomark Prev 9(9):939–944Google Scholar
- 45.George SM, Ballard-Barbash R, Shikany JM, Caan BJ, Freudenheim JL, Kroenke CH, Vitolins MZ, Beresford SA, Neuhouser ML (2014) Better postdiagnosis diet quality is associated with reduced risk of death among postmenopausal women with invasive breast cancer in the women’s health initiative. Cancer Epidemiol Biomark Prev 23(4):575–583. https://doi.org/10.1158/1055-9965.EPI-13-1162 CrossRefGoogle Scholar
- 46.George SM, Irwin ML, Smith AW, Neuhouser ML, Reedy J, McTiernan A, Alfano CM, Bernstein L, Ulrich CM, Baumgartner KB, Moore SC, Albanes D, Mayne ST, Gail MH, Ballard-Barbash R (2011) Postdiagnosis diet quality, the combination of diet quality and recreational physical activity, and prognosis after early-stage breast cancer. Cancer Causes Control 22(4):589–598. https://doi.org/10.1007/s10552-011-9732-9 CrossRefPubMedPubMedCentralGoogle Scholar