Distinct trajectories of fruits and vegetables, dietary fat, and alcohol intake following a breast cancer diagnosis: the Pathways Study

  • Zaixing ShiEmail author
  • Andrew Rundle
  • Jeanine M. Genkinger
  • Ying Kuen Cheung
  • Isaac J. Ergas
  • Janise M. Roh
  • Lawrence H. Kushi
  • Marilyn L. Kwan
  • Heather Greenlee



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.


Diet 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.

Supplementary material

10549_2019_5457_MOESM1_ESM.docx (41 kb)
Supplementary material 1 (DOCX 41 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Zaixing Shi
    • 1
    Email author
  • Andrew Rundle
    • 2
    • 3
  • Jeanine M. Genkinger
    • 2
    • 3
  • Ying Kuen Cheung
    • 2
    • 3
  • Isaac J. Ergas
    • 4
  • Janise M. Roh
    • 4
  • Lawrence H. Kushi
    • 4
  • Marilyn L. Kwan
    • 4
  • Heather Greenlee
    • 1
    • 2
    • 5
    • 6
  1. 1.Fred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Columbia University Mailman School of Public HealthNew YorkUSA
  3. 3.Herbert Irving Comprehensive Cancer CenterNew YorkUSA
  4. 4.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  5. 5.University of WashingtonSeattleUSA
  6. 6.Seattle Cancer Care AllianceSeattleUSA

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