NUTRITIONAL EPIDEMIOLOGY

European Journal of Epidemiology

, Volume 27, Issue 7, pp 547-559

Open Access This content is freely available online to anyone, anywhere at any time.

Estimating the alcohol–breast cancer association: a comparison of diet diaries, FFQs and combined measurements

  • Ruth H. KeoghAffiliated withMRC Biostatistics Unit, Institute of Public Health, University Forvie SiteMRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge Email author 
  • , Jin Young ParkAffiliated withSection of Nutrition and Metabolism, International Agency for Research on Cancer
  • , Ian R. WhiteAffiliated withMRC Biostatistics Unit, Institute of Public Health, University Forvie Site
  • , Marleen A. H. LentjesAffiliated withMRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge
  • , Alison McTaggartAffiliated withMRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge
  • , Amit BhanianiAffiliated withMRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge
  • , Benjamin J. CairnsAffiliated withCancer Epidemiology Unit, University of Oxford
  • , Timothy J. KeyAffiliated withCancer Epidemiology Unit, University of Oxford
  • , Darren C. GreenwoodAffiliated withCentre for Epidemiology and Biostatistics, University of Leeds
    • , Victoria J. BurleyAffiliated withCentre for Epidemiology and Biostatistics, University of Leeds
    • , Janet E. CadeAffiliated withCentre for Epidemiology and Biostatistics, University of Leeds
    • , Christina C. DahmAffiliated withDepartment of Cardiology, Aarhus University HospitalDepartment of Epidemiology, School of Public Health Aarhus University
    • , Gerda K. PotAffiliated withMRC Human Nutrition Research, Elsie Widdowson Laboratory
    • , Alison M. StephenAffiliated withMRC Human Nutrition Research, Elsie Widdowson Laboratory
    • , Gabriel MassetAffiliated withDepartment of Epidemiology and Public Health, University College London
    • , Eric J. BrunnerAffiliated withDepartment of Epidemiology and Public Health, University College London
    • , Kay-Tee KhawAffiliated withMRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge

Abstract

The alcohol–breast cancer association has been established using alcohol intake measurements from Food Frequency Questionnaires (FFQ). For some nutrients diet diary measurements are more highly correlated with true intake compared with FFQ measurements, but it is unknown whether this is true for alcohol. A case–control study (656 breast cancer cases, 1905 matched controls) was sampled from four cohorts in the UK Dietary Cohort Consortium. Alcohol intake was measured prospectively using FFQs and 4- or 7-day diet diaries. Both relied on fixed portion sizes allocated to given beverage types, but those used to obtain FFQ measurements were lower. FFQ measurements were therefore on average lower and to enable fair comparison the FFQ was “calibrated” using diet diary portion sizes. Diet diaries gave more zero measurements, demonstrating the challenge of distinguishing never-from episodic-consumers using short term instruments. To use all information, two combined measurements were calculated. The first is an average of the two measurements with special treatment of zeros. The second is the expected true intake given both measurements, calculated using a measurement error model. After confounder adjustment the odds ratio (OR) per 10 g/day of alcohol intake was 1.05 (95 % CI 0.98, 1.13) using diet diaries, and 1.13 (1.02, 1.24) using FFQs. The calibrated FFQ measurement and combined measurements 1 and 2 gave ORs 1.10 (1.03, 1.18), 1.09 (1.01, 1.18), 1.09 (0.99,1.20), respectively. The association was modified by HRT use, being stronger among users versus non-users. In summary, using an alcohol measurement from a diet diary at one time point gave attenuated associations compared with FFQ.

Keywords

Breast cancer Alcohol Food frequency questionnaire Diet diary Case–control study Measurement error