Nutritional Training Increases Long-term Fruit and Vegetable Consumption in Women with Early Breast Cancer – A Randomized Controlled Trial
received 16 July 2014
accepted 30 October 2014
05 December 2014 (eFirst)
After primary treatment of early breast cancer many women want to change their dietary habits and this may influence disease recurrence. The aim of the study was to increase fruit and vegetable (FV) intake for at least 6 months in women with early breast cancer by a short modular nutritional training program and offering refresher sessions. Design: Single-centre randomized controlled study in women attending an in-hospital cancer rehabilitation program. Subjects in the intervention group (INT) participated in a 2-week structured nutritional training program and were invited to visit brief refresher courses after 3 and 6 months. Women in the control group (CON) were offered standard nutritional advice. All subjects completed 4-day food records before arrival (baseline), and 1, 3 and 6 months after the start of the study. Of 152 women included in the study complete follow-up was available for 118. Consumption of FV (mean±SD) was similar at baseline (INT 483±235, CON 460±177 g/d) but only increased in the intervention group and at all follow-up times (1 month: 743±287 vs. 526±177; 3 months: 673±246 vs. 485±169; 6 months: 631±222 vs. 505±172 g/d; p<0.001). There was no discernible effect of the refresher courses on FV intake. There was no relevant effect of intervention on energy and fat intake. A short modular nutritional training program increases FV intake in breast cancer survivors for at least 6 months. This program can be easily implemented and may be combined with other training programs to comprehensively modulate lifestyle.
- 1 American Cancer Society . Breast Cancer Facts & Figures 2009–2010. Atlanta, Georgia, USA: America Cancer Society, Inc; 2010
- 2 World Cancer Research Fund, American Instute for Cancer Research (ed.). Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. Washington, DC, USA: American Institute for Cancer Research; 2007
- 3 Goodwin PJ, Ennis M, Pritchard KI et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 2002; 20: 42-51
- 4 Patel AV, Callel EE, Bernstein L et al. Recreational physical activity and risk of postmenopausal breast cancer in a large cohort of US women. Cancer Causes Control 2003; 14: 519-529
- 5 Bernstein L, Patel AV, Ursin G et al. Lifetime recreational exercise activity and breast cancer risk among black women and white women. J Natl Cancer Inst 2005; 97: 1671-1679 DOI: 10.1093/jnci/dji374.
- 6 Holmes MD, Chen WY, Feskanich D et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293: 2479-2486 DOI: 10.1001/jama.293.20.2479.
- 7 Gold EB, Pierce JP, Natarajan L et al. Dietary pattern influences breast cancer prognosis in women without hot flashes: the women’s healthy eating and living trial. J Clin Oncol 2009; 27: 352-359 DOI: 10.1200/JCO.2008.16.1067.
- 8 Smith-Warner SA, Spiegelman D, Yaun SS et al. Intake of fruits and vegetables and risk of breast cancer: a pooled analysis of cohort studies. JAMA 2001; 285: 769-776
- 9 Irwin ML, Duggan C, Wang C-Y et al. Fasting C-peptide levels and death resulting from all causes and breast cancer: the health, eating, activity, and lifestyle study. J Clin Oncol 2011; 29: 47-53 DOI: 10.1200/JCO.2010.28.4752.
- 10 Rock CL, Demark-Wahnefried W. Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 2002; 20: 3302-3316
- 11 Riboli E, Norat T. Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr 2003; 78: 559S-569S
- 12 Van Gils CH, Peeters PHM, Bueno-de-Mesquita HB et al. Consumption of vegetables and fruits and risk of breast cancer. JAMA 2005; 293: 183-193 DOI: 10.1001/jama.293.2.183.
- 13 Rock CL, Flatt SW, Natarajan L et al. Plasma carotenoids and recurrence-free survival in women with a history of breast cancer. J Clin Oncol 2005; 23: 6631-6638 DOI: 10.1200/JCO.2005.19.505.
- 14 Pierce JP, Stefanick ML, Flatt SW et al. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 2007; 25: 2345-2351 DOI: 10.1200/JCO.2006.08.6819.
- 15 Babio N, Bulló M, Salas-Salvadó J. Mediterranean diet and metabolic syndrome: the evidence. Public Health Nutr 2009; 12: 1607-1617 DOI: 10.1017/S1368980009990449.
- 16 Høstmark AT. The Oslo Health Study: a Dietary Index estimating high intake of soft drinks and low intake of fruits and vegetables was positively associated with components of the metabolic syndrome. Appl Physiol Nutr Metab 2010; 35: 816-825 DOI: 10.1139/h10-080.
- 17 Salminen E, Heikkilä S, Poussa T et al. Female patients tend to alter their diet following the diagnosis of rheumatoid arthritis and breast cancer. Prev Med 2002; 34: 529-535 DOI: 10.1006/pmed.2002.1015.
- 18 Demark-Wahnefried W, Peterson B, McBride C et al. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 2000; 88: 674-684
- 19 Reuss-Borst M, Kötter J, Hartmann U et al. Nutrition patterns in German breast cancer patients. Dtsch Med Wochenschr 2011; 136: 575-581 DOI: 10.1055/s-0031-1274541.
- 20 Deutsche Gesellschaft für Ernährung . Referenzwerte für die Nährstoffzufuhr. Frankfurt am Main: Umschau Buchverlag; 2000
- 21 Hu FB, Rimm E, Smith-Warner SA et al. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 1999; 69: 243-249
- 22 Chlebowski RT, Blackburn GL, Buzzard IM et al. Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. The Women’s Intervention Nutrition Study. J Clin Oncol 1993; 11: 2072-2080
- 23 Kluthe B, Kassel P. PRODI – Ernährungs- und Diätberatungssoftware. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 2001
- 24 SPSS . Statistical packages for social sciences. München; 2001
- 25 Arends J. Metabolism in cancer patients. Anticancer Res 2010; 30: 1863-1868
- 26 Pierce JP, Newman VA, Flatt SW et al. Telephone counseling intervention increases intakes of micronutrient- and phytochemical-rich vegetables, fruit and fiber in breast cancer survivors. J Nutr 2004; 134: 452-458
- 27 Prentice RL, Caan B, Chlebowski RT et al. Low-fat dietary pattern and risk of invasive breast cancer: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006; 295: 629-642 DOI: 10.1001/jama.295.6.629.
- 28 Pierce JP, Newman VA, Natarajan L et al. Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern. J Nutr 2007; 137: 2291-2296
- 29 Chlebowski RT, Blackburn GL, Thomson CA et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst 2006; 98: 1767-1776 DOI: 10.1093/jnci/djj494.
- 30 Panunzio MF, Caporizzi R, Antoniciello A et al. Randomized, controlled nutrition education trial promotes a Mediterranean diet and improves anthropometric, dietary, and metabolic parameters in adults. Ann Ig 2011; 23: 13-25
- 31 Simon MS, Heilbrun LK, Boomer A et al. A randomized trial of a low-fat dietary intervention in women at high risk for breast cancer. Nutr Cancer 1997; 27: 136-142
- 32 Holm LE, Nordevang E, Ikkala E et al. Dietary intervention as adjuvant therapy in breast cancer patients – a feasibility study. Breast Cancer Res Treat 1990; 16: 103-109
- 33 Boyd NF, Martin LJ, Beaton M et al. Long-term effects of participation in a randomized trial of a low-fat, high-carbohydrate diet. Cancer Epidemiol Biomarkers Prev 1996; 5: 217-222
- 34 Rock CL, Flatt SW, Wright FA et al. Responsiveness of carotenoids to a high vegetable diet intervention designed to prevent breast cancer recurrence. Cancer Epidemiol Biomarkers Prev 1997; 6: 617-623
- 35 McEligot AJ, Rock CL, Flatt SW et al. Plasma carotenoids are biomarkers of long-term high vegetable intake in women with breast cancer. J Nutr 1999; 129: 2258-2263
- 36 Le Marchand L, Hankin JH, Carter FS et al. A pilot study on the use of plasma carotenoids and ascorbic acid as markers of compliance to a high fruit and vegetable dietary intervention. Cancer Epidemiol Biomarkers Prev 1994; 3: 245-251
- 37 Pierce JP, Natarajan L, Sun S et al. Increases in plasma carotenoid concentrations in response to a major dietary change in the women’s healthy eating and living study. Cancer Epidemiol Biomarkers Prev 2006; 15: 1886-1892 DOI: 10.1158/1055-9965.EPI-05-0928.
- 38 Caan BJ, Flatt SW, Rock CL et al. Low-energy reporting in women at risk for breast cancer recurrence. Women’s Healthy Eating and Living Group. Cancer Epidemiol Biomarkers Prev 2000; 9: 1091-1097