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OBJECTIVES: Beyond the quantity of carbohydrate intake, further research is needed on the relevance of carbohydrate quality and chronic conditions. No previous longitudinal study has assessed the association between an integrated multi-dimensional index for carbohydrate intake quality and the risk of breast cancer (BC). Thus, we evaluated the association between an a priori defined carbohydrate quality index (CQI) and the incidence of BC in a Mediterranean cohort study. METHODS: We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) to evaluate the CQI at baseline, as previously described (PMID: 31,868,210), based on 4 criteria: dietary fiber intake, glycemic index, whole grain/total grain ratio, and solid carbohydrate/total carbohydrate ratio), in 10,812 middle-aged women. RESULTS: During a median follow-up of 11.8 years, we confirmed 101 incident cases of BC. A higher CQI (fourth quartile) was associated with a lower risk of BC [HR (Q4 vs. Q1) 0.39 (95% CI 0.17, 0.87) p for trend: 0.049]. When we additionally included probable incident cases (n = 190) this association between CQI and BC persisted with a relative risk reduction of 48% for the overall sample of women [HR (Q4 vs. Q1) 0.52, 95% CI 0.31, 0.89; p for trend: 0.034]. Furthermore, when we stratified by menopausal status, we found a significant inverse association between the CQI and premenopausal BC for both confirmed (HR (T3 vs. T1) 0.32, 95% CI 0.10, 1.00) and probable (HR (T3 vs. T1) 0.46, 95% CI 0.22, 0.96) cases. CONCLUSIONS: In this Mediterranean cohort, a better quality of dietary carbohydrate intake showed a significant inverse association with the incidence of BC, particularly among premenopausal women, which suggests that strategies for cancer prevention should focus, in relation to diet, on the quality of this macronutrient. FUNDING SOURCES: The SUN Project has been supported by the Institute of Health Carlos III, the European Regional Development Fund, the Navarra Regional Government, and the University of Navarra.

OBJECTIVES: Dietary patterns may have a greater influence on human health than individual foods or nutrients and they are also being widely studied in the field of breast cancer prevention. Beyond the adequate balance of macronutrients, evidence shows that the quality of fat sources may play an important role in health outcomes. Our aim was to assess the relationship between healthful and less healthful low-fat dietary patterns in relation to breast cancer in a Mediterranean cohort (the SUN project). METHODS: The SUN Project is a Mediterranean dynamic prospective follow-up cohort study assessing participants every 2 years. We evaluated 10,930 middle-aged women initially free of breast cancer during a median of follow-up of 12.1 years. Dietary variables were evaluated through a previously validated 136-item FFQ. We calculated an overall, an unhealthful, and a healthful low-fat-diet score (rang: 0–30 points) based on the percentage of energy from total and subtypes of carbohydrate, fat, and protein. Participants were then categorized into tertiles. Incident breast cancer was de primary outcome. We fitted Cox regression models adjusted for potential confounders to investigate the relationship between baseline categories of low-fat-diet scores and the incidence of breast cancer- overall and stratified by menopausal status-. RESULTS: During 123,297 person-years of follow-up, 119 cases of incident breast cancer were confirmed. Among postmenopausal women, a significant direct association with postmenopausal breast cancer (comparing tertile 2 vs. tertile 1, HR = 2.60; 95% CI 1.24–5.45, P value = 0.012) was found. None of the other associations was statistically significant. CONCLUSIONS: In this Mediterranean prospective cohort study, a moderate adherence to an unhealthy low-fat-diet-score might increase the risk of postmenopausal breast cancer. These results must be further confirmed in future studies. FUNDING SOURCES: The SUN project received funding from the Spanish Government-Instituto de Salud Carlos III, and the ...

Objective: The aim of this study was to assess body shape trajectories in childhood and midlife in relation to subsequent risk of breast cancer (BC) in a Mediterranean cohort. Design: The "Seguimiento Universidad de Navarra" (SUN) Project is a dynamic prospective cohort study of university graduates initiated in 1999. With a group-based modelling approach, we assessed body shape trajectories from age 5 to 40 years. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for BC after the age of 40 years according to the body shape trajectory. Setting: City of Pamplona, in the North of Spain. Participants: 6498 women with a mean age of 40 years (sd 9). Results: We identified four distinct body shape trajectories ("childhood lean-midlife increase" (19·9 %), "childhood medium-midlife stable" (53 %), "childhood heavy-midlife stable" (21 %) and "childhood heavy-midlife increase" (6·1 %)). Among 54 978 women-years of follow-up, we confirmed eighty-two incident cases of BC. Women in the "childhood lean-midlife increase" group showed a higher risk of BC (HR = 1·84, 95 % CI 1·11, 3·04) compared with women in the "childhood medium-midlife stable" category. This association was stronger for postmenopausal BC (HR = 2·42, 95 % CI 1·07, 5·48). Conclusions: Our results suggest a role for lifetime adiposity in breast carcinogenesis. ; Financial support: The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045, CIBER-OBN, grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, PI17/01795 and G03/140), the Navarra Regional Government (45/2011, 122/2014 and 41/2016) and the University of Navarra.

A moderately high-fat Mediterranean diet does not promote weight gain. This study aimed to investigate the association between dietary intake of specific types of fat and obesity and body weight. A prospective cohort study was performed using data of 6942 participants in the PREDIMED trial, with yearly repeated validated food-frequency questionnaires, and anthropometric outcomes (median follow-up: 4.8 years). The effects of replacing dietary fat subtypes for one another, proteins or carbohydrates were estimated using generalized estimating equations substitution models. Replacement of 5% energy from saturated fatty acids (SFA) with monounsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA) resulted in weight changes of -0.38 kg (95% Confidece Iinterval (CI): -0.69, -0.07), and -0.51 kg (95% CI: -0.81, -0.20), respectively. Replacing proteins with MUFA or PUFA decreased the odds of becoming obese. Estimates for the daily substitution of one portion of red meat with white meat, oily fish or white fish showed weight changes up to -0.87 kg. Increasing the intake of unsaturated fatty acids at the expense of SFA, proteins, and carbohydrates showed beneficial effects on body weight and obesity. It may therefore be desirable to encourage high-quality fat diets like the Mediterranean diet instead of restricting total fat intake. ; The PREDIMED trial (www.predimed.es) was supported by the Instituto de Salud Carlos III (ISCIII), Spanish Ministry of Health, through grants provided to research networks specifically developed for the trial, namely, RTIC G03/140 (Coordinator: R. Estruch, M.D., Ph.D., during 2003-2005) and RTIC RD 06/0045 (Coordinator: M.A. Martínez-González, M.D., Ph.D., during 2006-2013). We also acknowledge CIBERobn (an Initiative of ISCIII), the grants from Centro Nacional de Investigaciones Cardiovasculares CNIC 06/2007, Fondo de Investigación Sanitaria—Fondo Europeo de Desarrollo Regional (PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505), Ministerio de Ciencia e Innovación (AGL-2009-13906-C02, AGL2010-22319-C03), Fundación Mapfre 2010, Consejería de Salud de la Junta de Andalucía (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (ACOMP06109, GVACOMP2010-181, GVACOMP2011-151, CS2010-AP-111, CS2011-AP-042, and PROMETEO17/2017), and Regional Government of Navarra (P27/2011).