Dietary Patterns, Whole Plant Foods, Nutrients and Phytochemicals in Breast Cancer Prevention and Management

Abstract

Dietary choices including: (1) level of adherence to healthy vs Western dietary patterns; (2) high vs low dietary energy density intake; (3) type and level of dietary fat, fiber and protein consumed; (4) adequate vs inadequate intake of calcium, folate and α-tocopherol; (5) type and levels of non-starchy vegetables and fruits containing dietary carotenoids and flavonoids intake; (6) level of phytoestrogen containing legumes and seeds consumed; and (7) higher vs lower intake of alcohol or coffee are examples of dietary factors that may influence breast cancer (BC) risk, recurrence or mortality. Biological factors and mechanisms associated with diet and BC risk and survival include: body weight and central adiposity, tumor advancement, systemic and tissue lipid/fatty acid peroxidation and inflammation, epigenetic and transcriptional regulation, hormone levels (e.g., estrogen, insulin, leptin, adiponectin and growth factor cascades), insulin resistance, and various endometabolic and colonic microbiota processes, which can influence BC initiation and progression. Lifestyle indicators, which are associated with increased BC risk, recurrence or mortality, especially for postmenopausal women, may include having an overweight or obese BMI, weight gain by over 15 lbs over 4 years, and physical inactivity. Patients with BC are most often either overweight or obese at diagnosis and obesity increases mortality risk in both pre- and postmenopausal women with BC Meta-analyses reported that healthy dietary patterns reduced overall BC risk, whereas a high consumption of alcohol and a Western diet increased BC risk. Healthy dietary patterns, especially the Mediterranean diet, DASH diet and the vegan diet are effective in reducing BC risk and improving odds for survival. Highly colored non-starchy vegetables rich in carotenoids and flavonoids have been associated with reduced BC risk especially in estrogen receptor negative BC. Key adverse dietary components for BC risk and survival include high intake of red and processed meats, high energy dense and high glycemic foods and beverages and >1 alcoholic beverage/day. After BC diagnosis, soy foods (>10 mg isoflavones/day or > ½ cup of soy milk or 2 ounces of tofu/day) may help to reduce risk of BC recurrence or mortality in both Asian and Western women.

Appendices

Appendix A: Comparison of Western and Healthy Dietary Patterns per 2000 kcal (Approximated Values)

Components	Western Dietary Pattern (US)	USDA Base Pattern	DASH Diet Pattern	Healthy Mediterranean Pattern	Healthy Vegetarian Pattern (Lact-ovo based)	Vegan Pattern
Emphasizes	Refined grains, low fiber foods, red meats, sweets, and solid fats	Vegetables, fruits, whole-grains, and low-fat milk	Potassium rich vegetables, fruits, and low fat milk products	Whole grains, vegetables, fruits, dairy products, olive oil, and moderate wine	Vegetables, fruit, whole-grains, legumes, nuts, seeds, milk products, and soy foods	Plant foods: vegetables, fruits, whole grains, nuts, seeds, and soy foods
Includes	Processed meats, sugar sweetened beverages, and fast foods	Enriched grains, lean meat, fish, nuts, seeds, and vegetable oils	Whole-grains, poultry, fish, nuts, and seeds	Fish, nuts, seeds, and pulses	Eggs, non-dairy milk alternatives, and vegetable oils	Non-dairy milk alternatives
Limits	Fruits and vegetables, and whole-grains	Solid fats and added sugars	Red meats, sweets and sugar-sweetened beverages	Red meats, refined grains, and sweets	No red or white meats, or fish; limited sweets	No animal products
Estimated nutrients/components
Carbohydrates (% Total kcal)	51	51	55	50	54	57
Protein (% Total kcal)	16	17	18	16	14	13
Total fat (% Total kcal)	33	32	27	34	32	30
Saturated fat (% Total kcal)	11	8	6	8	8	7
Unsat. fat (% Total kcal)	22	25	21	24	26	25
Fiber (g)	16	31	29+	31	35+	40+
Potassium (mg)	2800	3350	4400	3350	3300	3650
Vegetable oils (g)	19	27	25	27	19–27	18–27
Sodium (mg)	3600	1790	1100	1690	1400	1225
Added sugar (g)	79 (20 tsp)	32 (8 tsp)	12 (3 tsp)	32 (8 tsp)	32 (8 tsp)	32 (8 tsp)
Plant food groups
Fruit (cup)	≤1.0	2.0	2.5	2.5	2.0	2.0
Vegetables (cup)	≤1.5	2.5	2.1	2.5	2.5	2.5
Whole-grains (oz.)	0.5	3.0	4.0	3.0	3.0	3.0
Legumes (oz.)	−	1.5	0.5	1.5	3.0	3.0+
Nuts/Seeds (oz.)	0.5	0.6	1.0	0.6	1.0	2.0
Soy products (oz.)	0.0	0.5	−	−	1.1	1.5

1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office. 2010; Table B2.4; http://www.choosemyplate.gov/ accessed 8.22.2015
2. U.S. Department of Agriculture, Agriculture Research Service, Nutrient Data Laboratory. 2014. USDA National Nutrient Database for Standard Reference, Release 27. http://www.ars.usda.gov/nutrientdata. Accessed 17 February 2015
3. Dietary Guidelines Advisory Committee. Scientific Report. Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. Appendix E-3.7: Developing vegetarian and Mediterranean-style food patterns.2015;1–9
4. Dietary Guidelines Advisory Committee. Scientific Report. Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. Part D. Chapter 1: Food and nutrient intakes, and health: current status and trends. 2015;1–78
5. Bhupathiraju SN, Tucker KL. Coronary heart disease prevention: nutrients, foods, and dietary patterns. Clinica Chimica Acta. 2011;412: 1493–1514

Appendix B: Estimated Range of Energy, Fiber, Nutrients and Phytochemicals Composition of Whole Plant Foods/100 g Edible Portion

Components	Whole-grains	Fresh fruit	Dried fruit	Vegetables	Legumes	Nuts/seeds
Nutrients/Phytochemicals	Wheat, oat, barley, rye, brown rice, whole grain bread, cereal, pasta, rolls and crackers	Apples, pears, bananas, grapes, oranges, blueberries, strawberries, and avocados	Dates, dried figs, apricots, cranberries, raisins and prunes	Potatoes, spinach, carrots, peppers, lettuce, green beans, cabbage, onions, cucumber, cauliflower, mushrooms, and broccoli	Lentils, chickpeas, split peas, black beans, pinto beans, and soy beans	Almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, walnuts, peanuts, sunflower seeds, and flaxseed
Energy (kcals)	110–350	30–170	240–310	10–115	85–170	520–700
Protein (g)	2.5–16	0.5–2.0	0.1–3.4	0.2–5.0	5.0–17	7.8–24
Available Carbohydrate (g)	23–77	1.0–25	64–82	0.2–25	10–27	12–33
Fiber (g)	3.5–18	2.0–7.0	5.7–10	1.2–9.5	5.0–11	3.0–27
Total fat (g)	0.9–6.5	0.0–15	0.4–1.4	0.2–1.5	0.2–9.0	46–76
SFAa (g)	0.2–1.0	0.0–2.1	0.0	0.0–0.1	0.1–1.3	4.0–12
MUFAa (g)	0.2–2.0	0.0–9.8	0.0–0.2	0.1–1.0	0.1–2.0	9.0–60
PUFAa (g)	0.3–2.5	0.0–1.8	0.0–0.7	0.0.0.4	0.1–5.0	1.5–47
Folate (ug)	4.0–44	<5.0–61	2–20	8.0–160	50–210	10–230
Tocopherols (mg)	0.1–3.0	0.1–1.0	0.1–4.5	0.0–1.7	0.0–1.0	1.0–35
Potassium (mg)	40–720	60–500	40–1160	100–680	200–520	360–1050
Calcium (mg)	7.0–50	3.0–25	10–160	5.0–200	20–100	20–265
Magnesium (mg)	40–160	3.0–30	5.0–70	3.0–80	40–90	120–400
Phytosterols (mg)	30–90	1.0–83	–	1.0–54	110–120	70–215
Polyphenols (mg)	70–100	50–800	–	24–1250	120–6500	130–1820
Carotenoids (ug)	–	25–6600	1.0–2160	10–20,000	50–600	1.0–1200

1. U.S. Department of Agriculture, Agriculture Research Service, Nutrient Data Laboratory. 2014. USDA National Nutrient Database for Standard Reference, Release 27. http://www.ars. usda.gov./nutrientdata. Accessed 17 February 2015
2. Ros E, Hu FB. Consumption of plant seeds and cardiovascular health epidemiological and clinical trial evidence. Circulation. 2013;128: 553–565
3. USDA. What we eat in America, NHANES 2011–2012, individuals 2 years and over (excluding breast-fed children). Available: www.ars.usda.gov/nea/bhnrc/fsrg
4. Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. 2012; 3:506–516
5. Rebello CJ, Greenway FL, Finley JW. A review of the nutritional value of legumes and their effects on obesity and its related co-morbidities. Obes Rev. 2014;15: 392–407
6. Gebhardt SE, Thomas RG. Nutritive Value of Foods. 2002; U.S. Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin 72
7. Holden JM, Eldridge AL, Beecher GR, et al. Carotenoid content of U.S. foods: An update of the database. J Food Comp An. 1999; 12:169–196
8. Lu Q-Y, Zhang Y, Wang Y, et al. California Hass avocado: profiling of carotenoids, tocopherol, fatty acid, and fat content during maturation and from different growing areas. J Agric Food Chem. 2009; 57(21):10408–10413
9. Wu X, Beecher GR, Holden JM, et al. Lipophilic and hydrophilic antioxidant capacities of common foods in the United States. J Agric Food Chem. 2004; 52: 4026–4037
10. Bhupathiraju SN, Tucker KL. Coronary heart disease prevention: nutrients, foods, and dietary patterns. Clinica Chimica Acta. 2011;412: 1493–1514
11. Dietary Guidelines Advisory Committee. Scientific Report. Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. Part D. Chapter 1: Food and nutrient intakes, and health: current status and trends. 2015;1–78
12. http://health.gov/dietaryguidelines/2015/guidelines/ accessed 1.26.2016
13. ^aSFA (saturated fat), MUFA (monounsaturated fat) and PUFA (polyunsaturated fat)