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dc.contributor.authorCastro-Espin, Carlota
dc.contributor.authorBonet, Catalina
dc.contributor.authorCrous-Bou, Marta
dc.contributor.authorNadal-Zaragoza, Núria
dc.contributor.authorTjønneland, Anne
dc.contributor.authorMellemkjær, Lene
dc.contributor.authorHajji-Louati, Mariem
dc.contributor.authorTruong, Thérèse
dc.contributor.authorKatzke, Verena
dc.contributor.authorLe Cornet, Charlotte
dc.contributor.authorSchulze, Matthias B.
dc.contributor.authorJannasch, Franziska
dc.contributor.authorMasala, Giovanna
dc.contributor.authorSieri, Sabina
dc.contributor.authorPanico, Salvatore
dc.contributor.authorDi Girolamo, Chiara
dc.contributor.authorSkeie, Guri
dc.contributor.authorBorch, Kristin Benjaminsen
dc.contributor.authorOlsen, Karina Standahl
dc.contributor.authorSánchez, Maria-Jose
dc.contributor.authorAmiano, Pilar
dc.contributor.authorChirlaque, María-Dolores
dc.contributor.authorGuevara, Marcela
dc.contributor.authorSund, Malin
dc.contributor.authorBodén, Stina
dc.contributor.authorGunter, Marc J.
dc.contributor.authorGonzalez-Gil, Esther M.
dc.contributor.authorWeiderpass, Elisabete
dc.contributor.authorAguilera-Buenosvinos, Inmaculada
dc.contributor.authorTsilidis, Kostas K.
dc.contributor.authorHeath, Alicia K.
dc.contributor.authorAune, Dagfinn
dc.contributor.authorDossus, Laure
dc.contributor.authorAgudo, Antonio
dc.date.accessioned2023-09-06T12:22:18Z
dc.date.available2023-09-06T12:22:18Z
dc.date.issued2023-06-26
dc.description.abstractBackground - The Mediterranean diet has been associated with lower risk of breast cancer (BC) but evidence from prospective studies on the role of Mediterranean diet on BC survival remains sparse and conflicting. We aimed to investigate whether adherence to Mediterranean diet prior to diagnosis is associated with overall and BC-specific mortality.<p> <p>Methods - A total of 13,270 incident breast cancer cases were identified from an initial sample of 318,686 women in 9 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Adherence to Mediterranean diet was estimated through the adapted relative Mediterranean diet (arMED), a 16-point score that includes 8 key components of the Mediterranean diet and excludes alcohol. The degree of adherence to arMED was classified as low (score 0–5), medium (score 6–8), and high (score 9–16). Multivariable Cox proportional hazards models were used to analyze the association between the arMED score and overall mortality, and Fine-Gray competing risks models were applied for BC-specific mortality.<p> <p>Results - After a mean follow-up of 8.6 years from diagnosis, 2340 women died, including 1475 from breast cancer. Among all BC survivors, low compared to medium adherence to arMED score was associated with a 13% higher risk of all-cause mortality (HR 1.13, 95%CI 1.01–1.26). High compared to medium adherence to arMED showed a non-statistically significant association (HR 0.94; 95% CI 0.84–1.05). With no statistically significant departures from linearity, on a continuous scale, a 3-unit increase in the arMED score was associated with an 8% reduced risk of overall mortality (HR3-unit 0.92, 95% CI: 0.87–0.97). This result sustained when restricted to postmenopausal women and was stronger among metastatic BC cases (HR3-unit 0.81, 95% CI: 0.72–0.91).<p> <p>Conclusions - Consuming a Mediterranean diet before BC diagnosis may improve long-term prognosis, particularly after menopause and in cases of metastatic breast cancer. Well-designed dietary interventions are needed to confirm these findings and define specific dietary recommendations.en_US
dc.identifier.citationCastro-Espin, Bonet, Crous-Bou, Nadal-Zaragoza, Tjønneland, Mellemkjær, Hajji-Louati, Truong, Katzke, Le Cornet, Schulze, Jannasch, Masala, Sieri, Panico, Di Girolamo, Skeie, Borch, Olsen, Sánchez, Amiano, Chirlaque, Guevara, Sund, Bodén, Gunter, Gonzalez-Gil, Weiderpass, Aguilera-Buenosvinos, Tsilidis, Heath, Aune, Dossus, Agudo. Association of Mediterranean diet with survival after breast cancer diagnosis in women from nine European countries: results from the EPIC cohort study. BMC Medicine. 2023;21(1)en_US
dc.identifier.cristinIDFRIDAID 2169631
dc.identifier.doi10.1186/s12916-023-02934-3
dc.identifier.issn1741-7015
dc.identifier.urihttps://hdl.handle.net/10037/30755
dc.language.isoengen_US
dc.publisherSpringer Natureen_US
dc.relation.journalBMC Medicine
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2023 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0en_US
dc.rightsAttribution 4.0 International (CC BY 4.0)en_US
dc.titleAssociation of Mediterranean diet with survival after breast cancer diagnosis in women from nine European countries: results from the EPIC cohort studyen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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