The Independent and Joint Associations of Whole Grain and Refined Grain with Total Mortality among Breast Cancer Survivors: A Prospective Cohort Study
Highlights
- Whole grain intake is associated with a marginally increased risk of total mortality among breast cancer survivors.
- Among breast cancer survivors with high intakes of refined grains, higher intakes of whole grains were linked to an increased risk of mortality compared to lower intakes of whole grains.
- Whole grains are widely recognized as healthy carbohydrates in dietary guidelines. However, the optimal number of whole grains for consumption may vary depending on individual characteristics, a consideration that current dietary guidelines might not fully address.
- High intakes of whole grains could be challenging for people with weakened digestive systems, such as breast cancer survivors, potentially leading to discomfort or other adverse effects. More mechanistic studies are needed to confirm these findings.
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Assessment of Total Dietary Intakes, Whole Grain, and Refined Grain Intakes
2.3. Assessment of Mortality
2.4. Assessment of Demographic Factors, Lifestyle Habits, and Treatment Regimens
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Independent Associations of Whole Grain and Refined Grain with Mortality
3.3. Joint Associations of Whole Grain and Refined Grain with Total Mortality
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Overall | Mortality Status | p-Value | ||
---|---|---|---|---|
No (n = 2767) | Yes (n = 314) | |||
Age at diagnosis (years) | 50.7 ± 8.85 | 50.66 ± 8.7 | 51.45 ± 10.08 | 0.13 |
Age at randomization (years) | 52.7 ± 8.97 | 52.63 ± 8.81 | 53.20 ± 10.29 | 0.30 |
BMI (kg/m2) | 27.25 ± 6.07 | 27.16 ± 6.01 | 28.06 ± 6.52 | 0.01 |
Physical activity (Mets) | 839.04 ± 878.83 | 857.30 ± 891.21 | 678.16 ± 743.15 | 0.0007 |
Total calorie intake (kcal) | 1717.64 ± 407.59 | 1719.39 ± 403.81 | 1702.22 ± 439.87 | 0.48 |
Randomization group (N, %) | 0.59 | |||
Intervention | 1534 (49.79) | 1379 (49.84) | 155 (49.36) | |
Comparison | 1547 (50.21) | 1388 (50.16) | 159 (50.64) | |
Chemotherapy (N, %) | 0.02 | |||
Yes | 2154 (69.91) | 1909 (68.99) | 245 (78.03) | |
No | 925 (30.02) | 856 (30.94) | 69 (21.97) | |
Radiation therapy (N, %) | 0.72 | |||
Yes | 1894 (61.47) | 1701 (61.47) | 193 (61.46) | |
No | 1183 (38.40) | 1062 (38.38) | 121 (38.54) | |
Hormone status (N, %) | 0.0005 | |||
ER+/PR+ | 1905 (61.83) | 1742 (62.96) | 163 (51.91) | |
ER+/PR- | 493 (16.00) | 432 (15.61) | 61 (19.43) | |
ER-/PR+ | 618 (20.06) | 532 (19.23) | 86 (27.39) | |
ER-/PR- | 65 (2.11) | 61 (2.20) | 4 (1.27) | |
Ethnicity (N, %) | 0.32 | |||
White | 2627 (85.3) | 2368 (85.58) | 259 (82.48) | |
Non-white | 454 (14.7) | 399 (14.42) | 55 (17.52) | |
Education (N, %) | 0.0197 | |||
High school or less | 377 (12.24) | 329 (11.89) | 48 (15.29) | |
Post high school to college | 1912 (62.06) | 1715 (61.98) | 197 (62.74) | |
Post college | 792 (25.71) | 723 (26.13) | 69 (21.97) | |
Employment status (N, %) | 0.20 | |||
Employed | 2210 (71.73) | 2003 (72.39) | 105 (33.44) | |
Unemployed | 853 (27.69) | 748 (27.03) | 207 (65.92) | |
Marital status (N, %) | 0.0417 | |||
Single | 338 (10.97) | 299 (10.81) | 39 (12.42) | |
Married | 2154 (69.91) | 1945 (70.29) | 209 (66.56) | |
Other | 589 (19.12) | 523 (18.90) | 66 (21.02) |
Whole Grains (Servings/Day) | |||||
---|---|---|---|---|---|
Quartile 1 | Quartile 2 | Quartile 3 | Quartile 4 | p-Value | |
Refined Grains (servings/day) | 2.13 ± 1.08 | 2.05 ± 1.04 | 1.80 ± 1.19 | 1.7 ± 1.02 | <0.0001 |
Age at diagnosis (years) | 50 ± 8.59 | 50 ± 8.87 | 51 ± 9.05 | 50 ± 8.89 | 0.31 |
BMI | 26.62 ± 6.45 | 25.95 ± 6.06 | 26.07 ± 5.69 | 24.97 ± 6.01 | 0.0002 |
Physical activity (METs) | 450 ± 876.08 | 555 ± 880.49 | 600 ± 803.98 | 750 ± 940.95 | <0.0001 |
Total calorie intake (kcal) | 1597 ± 424.69 | 1631 ± 380.67 | 1687 ± 382.54 | 1816 ± 403.72 | <0.0001 |
Smoking status (N, %) | 0.0013 | ||||
Never | 421 (25.66) | 409 (24.92) | 427 (26.02) | 384 (23.40) | |
Former | 329 (25.84) | 299 (23.49) | 315 (24.74) | 330 (25.92) | |
Current | 52 (37.96) | 41 (29.93) | 27 (19.71) | 17 (12.41) | |
Chemotherapy (N, %) | 0.14 | ||||
No | 223 (24.11) | 233 (25.19) | 236 (25.51) | 233(25.19) | |
Yes | 586 (27.21) | 524 (24.33) | 544 (25.26) | 500 (23.21) | |
Cancer stage (N, %) | 0.46 | ||||
Stage I | 309 (26.01) | 299 (25.17) | 294 (24.75) | 286 (24.07) | |
Stage II | 467 (26.85) | 423 (24.32) | 449 (25.82) | 400 (23.00) | |
Stage III | 33 (21.43) | 37 (24.03) | 37 (24.03) | 47 (30.52) | |
Hormone status (N, %) | 0.78 | ||||
ER+/PR+ | 497 (26.09) | 472 (24.78) | 472 (24.78) | 464 (24.36) | |
ER+/PR− | 132 (26.77) | 111 (22.52) | 125 (25.35) | 125 (25.35) | |
ER−/PR+ | 163 (26.38) | 158 (25.57) | 168 (27.18) | 129 (20.87) | |
ER−/PR− | 17 (26.15) | 18 (27.69) | 15 (23.08) | 15 (23.08) |
Total Mortality | Breast-Cancer-Specific Mortality | ||||
---|---|---|---|---|---|
Event | HR (95% CI) | Event | HR (95% CI) | ||
Whole Grains (servings/day) | Range | ||||
Quartile 1 | ≤0.5 | 142 | Ref | 102 | Ref |
Quartile 2 | 0.6–0.98 | 140 | 1.06 (0.74, 1.58) | 110 | 0.99 (0.93, 1.06) |
Quartile 3 | 0.99–1.56 | 146 | 1.30 (0.91, 1.86) | 119 | 1.03 (0.96, 1.10) |
Quartile 4 | ≥1.57 | 130 | 1.36 (0.94, 1.97) | 105 | 1.02 (0.95, 1.09) |
P for trend | 0.07 | 0.55 | |||
Refined Grains (servings/day) | Range | ||||
Quartile 1 | ≤0.91 | 98 | Ref | 70 | Ref |
Quartile 2 | 0.92–1.53 | 141 | 1.18 (0.81, 1.71) | 113 | 1.07 (1.00, 1.15) |
Quartile 3 | 1.54–2.31 | 142 | 1.40 (0.95, 2.06) | 107 | 1.16 (1.08, 1.25) |
Quartile 4 | ≥2.32 | 177 | 1.74 (1.17, 2.59) | 146 | 1.16 (1.08, 1.26) |
P for trend | 0.0047 | <0.0001 |
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Ernest, D.K.; Lemus, H.; Hsu, F.-C.; Pierce, J.P.; Wu, T. The Independent and Joint Associations of Whole Grain and Refined Grain with Total Mortality among Breast Cancer Survivors: A Prospective Cohort Study. Nutrients 2022, 14, 3333. https://doi.org/10.3390/nu14163333
Ernest DK, Lemus H, Hsu F-C, Pierce JP, Wu T. The Independent and Joint Associations of Whole Grain and Refined Grain with Total Mortality among Breast Cancer Survivors: A Prospective Cohort Study. Nutrients. 2022; 14(16):3333. https://doi.org/10.3390/nu14163333
Chicago/Turabian StyleErnest, Deepali Karina, Hector Lemus, Fang-Chi Hsu, John P. Pierce, and Tianying Wu. 2022. "The Independent and Joint Associations of Whole Grain and Refined Grain with Total Mortality among Breast Cancer Survivors: A Prospective Cohort Study" Nutrients 14, no. 16: 3333. https://doi.org/10.3390/nu14163333