Skip to main content

Advertisement

SpringerLink
Log in

Fruit and vegetable consumptions in relation to frequent mental distress in breast cancer survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Evidence suggests that fruit and vegetable consumptions may improve mental health among general population. However, their associations among breast cancer survivors are unclear. We planned to investigate this association via a nationwide survey in the USA.

Methods

We identified 7988 breast cancer survivors from 2009 Behavioral Risk Factor Surveillance System (BRFSS). Fruit juice, fruit, and vegetable consumptions were categorized as ordinal variables to approximate tertiles. Survivors who were mentally unhealthy for at least 14 days in the past 30 days were defined as having frequent mental distress (FMD). Multivariable logistic regression treating FMD as the outcome was used to calculate adjusted odd ratios (aORs) and 95% confidence intervals (CIs) for exposures. Quadratic model was used to depict the dose-response pattern in primary analysis. Subgroup analyses by adverse lifestyle behaviors were conducted; Wald tests were used to examine if there were interactions between these factors and exposures in relation to FMD.

Results

Overall, 825 (10.3%) survivors had FMD. Mean age was 67.2 years, and 89.7% of survivors were white. Juice showed non-significant associations with FMD. Moderate (aOR = 0.81, 95% CI = 0.68–0.98) and high (aOR = 0.79, 95% CI = 0.63–0.98) fruit consumptions, as well as moderate vegetable consumption (aOR = 0.78, 95% CI = 0.64–0.94), were significantly and inversely associated with FMD. The dose-response curves were consistent with results in primary analysis. No interaction was identified for adverse lifestyle behaviors.

Conclusion

Fruit and vegetable, but not fruit juice, show potential preventive effects against FMD among breast cancer survivors. The conclusion should be verified by studies with clear temporality in future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tao Z, Shi A, Lu C, Song T, Zhang Z, Zhao J (2015) Breast cancer: epidemiology and etiology. Cell Biochem Biophys 72(2):333–338

    Article  CAS  Google Scholar 

  2. Alteri R, Andrews K, Barnes C, Bluethmann S, Brooks D, Cahn Z, Chang E, Cowal S, Daniels K (2019) American Cancer Society Cancer Facts & Figures. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf.

  3. Cancer Stat Facts: Female Breast Cancer https://seer.cancer.gov/statfacts/html/breast.html [Last accessed Oct 20th 2019]

  4. Zainal NZ, Booth S, Huppert FA (2013) The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psychooncology 22(7):1457–1465

    Article  Google Scholar 

  5. Epping-Jordan JE, Compas BE, Osowiecki DM, Oppedisano G, Gerhardt C, Primo K, Krag DN (1999) Psychological adjustment in breast cancer: processes of emotional distress. Health Psychol 18(4):315–326

    Article  CAS  Google Scholar 

  6. Lueboonthavatchai P (2007) Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. J Med Assoc Thail 90(10):2164–2174

    Google Scholar 

  7. Hegel MT, Moore CP, Collins ED, Kearing S, Gillock KL, Riggs RL, Clay KF, Ahles TA (2006) Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer. Cancer 107(12):2924–2931

    Article  Google Scholar 

  8. Chen X, Zheng Y, Zheng W, Gu K, Chen Z, Lu W, Shu XO (2009) Prevalence of depression and its related factors among Chinese women with breast cancer. Acta Oncol 48(8):1128–1136

    Article  Google Scholar 

  9. Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, Spiegel D (2011) Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol 29(4):413–420

    Article  Google Scholar 

  10. Andrykowski MA, Lykins E, Floyd A (2008) Psychological health in cancer survivors. Semin Oncol Nurs 24(3):193–201

    Article  Google Scholar 

  11. Pekmezi DW, Demark-Wahnefried W (2011) Updated evidence in support of diet and exercise interventions in cancer survivors. Acta Oncol 50(2):167–178

    Article  Google Scholar 

  12. McMartin SE, Jacka FN, Colman I (2013) The association between fruit and vegetable consumption and mental health disorders: evidence from five waves of a national survey of Canadians. Prev Med 56(3–4):225–230

    Article  Google Scholar 

  13. Nguyen B, Ding D, Mihrshahi S (2017) Fruit and vegetable consumption and psychological distress: cross-sectional and longitudinal analyses based on a large Australian sample. BMJ Open 7(3):e014201

    Article  Google Scholar 

  14. Khushalani JS, Qin J, Cyrus J, Buchanan Lunsford N, Rim SH, Han X, Yabroff KR, Ekwueme DU (2018) Systematic review of healthcare costs related to mental health conditions among cancer survivors. Expert Rev Pharmacoecon Outcomes Res 18(5):505–517

    Article  Google Scholar 

  15. McDonald BC, Conroy SK, Ahles TA, West JD, Saykin AJ (2010) Gray matter reduction associated with systemic chemotherapy for breast cancer: a prospective MRI study. Breast Cancer Res Treat 123(3):819–828

    Article  CAS  Google Scholar 

  16. CDC: Centers for Disease Control and Prevention (CDC) (2018) Behavioral Risk Factor Surveillance System Survey Questionnaire. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia

  17. CDC: Centers for Disease Control and Prevention (CDC) (2018) Behavioral Risk Factor Surveillance System Survey Data. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia

  18. Khan NF, Rose PW, Evans J (2012) Defining cancer survivorship: a more transparent approach is needed. J Cancer Surviv 6(1):33–36

    Article  Google Scholar 

  19. Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Mokdad AH (2017) Self-reported general health, physical distress, mental distress, and activity limitation by US county, 1995-2012. Popul Health Metrics 15(1):16

    Article  Google Scholar 

  20. Abell JE, Hootman JM, Zack MM, Moriarty D, Helmick CG (2005) Physical activity and health related quality of life among people with arthritis. J Epidemiol Community Health 59(5):380–385

    Article  Google Scholar 

  21. Zahran HS, Kobau R, Moriarty DG, Zack MM, Holt J, Donehoo R (2005) Centers for disease C, prevention: health-related quality of life surveillance--United States, 1993-2002. MMWR Surveill Summ 54(4):1–35

    PubMed  Google Scholar 

  22. Zhang D, Zhang C, Sun X, Zhao Y, Tan Q, Zhou J, Huang H (2019) BMI, physical inactivity, and pap test use in Asian women in the U.S. Am J Prev Med 56(3):e85–e94

    Article  Google Scholar 

  23. Brinker J, Cheruvu VK (2017) Social and emotional support as a protective factor against current depression among individuals with adverse childhood experiences. Prev Med Rep 5:127–133

    Article  Google Scholar 

  24. Greenland S (1995) Dose-response and trend analysis in epidemiology: alternatives to categorical analysis. Epidemiology 6(4):356–365

    Article  CAS  Google Scholar 

  25. Engen PA, Green SJ, Voigt RM, Forsyth CB, Keshavarzian A (2015) The gastrointestinal microbiome: alcohol effects on the composition of intestinal microbiota. Alcohol Res 37(2):223–236

    PubMed  PubMed Central  Google Scholar 

  26. Lee SH, Yun Y, Kim SJ, Lee EJ, Chang Y, Ryu S, Shin H, Kim HL, Kim HN, Lee JH (2018) Association between cigarette smoking status and composition of gut microbiota: population-based cross-sectional study. J Clin Med 7(9):282

  27. Monda V, Villano I, Messina A, Valenzano A, Esposito T, Moscatelli F, Viggiano A, Cibelli G, Chieffi S, Monda M et al (2017) Exercise modifies the gut microbiota with positive health effects. Oxidative Med Cell Longev 2017:3831972

    Article  Google Scholar 

  28. Mayer EA, Knight R, Mazmanian SK, Cryan JF, Tillisch K (2014) Gut microbes and the brain: paradigm shift in neuroscience. J Neurosci 34(46):15490–15496

    Article  Google Scholar 

  29. Foster JA, Rinaman L, Cryan JF (2017) Stress & the gut-brain axis: regulation by the microbiome. Neurobiol Stress 7:124–136

    Article  Google Scholar 

  30. Makki K, Deehan EC, Walter J, Backhed F (2018) The impact of dietary Fiber on gut microbiota in host health and disease. Cell Host Microbe 23(6):705–715

    Article  CAS  Google Scholar 

  31. Dickerson F, Severance E, Yolken R (2017) The microbiome, immunity, and schizophrenia and bipolar disorder. Brain Behav Immun 62:46–52

    Article  CAS  Google Scholar 

  32. Salim S (2014) Oxidative stress and psychological disorders. Curr Neuropharmacol 12(2):140–147

    Article  CAS  Google Scholar 

  33. Ng F, Berk M, Dean O, Bush AI (2008) Oxidative stress in psychiatric disorders: evidence base and therapeutic implications. Int J Neuropsychopharmacol 11(6):851–876

    Article  CAS  Google Scholar 

  34. Zhang D, Ferguson K, Troester M, Bensen JT, Cai J, Milne GL, Sandler DP, Nichols HB (2019) Tea consumption and oxidative stress: a crosssectional analysis of 889 premenopausal women from the sister study. Br J Nutr 121(5):582–590

  35. Zafir A, Ara A, Banu N (2009) Invivo antioxidant status: a putative target of antidepressant action. Prog Neuro-Psychopharmacol Biol Psychiatry 33(2):220–228

    Article  CAS  Google Scholar 

  36. Gautam M, Agrawal M, Gautam M, Sharma P, Gautam AS, Gautam S (2012) Role of antioxidants in generalised anxiety disorder and depression. Indian J Psychiatry 54(3):244–247

    Article  Google Scholar 

  37. Serpen JY (2012) Comparison of sugar content in bottled 100% fruit juice versus extracted juice of fresh fruit. Food Nutr Sci 3:1509–1513

    CAS  Google Scholar 

  38. Knuppel A, Shipley MJ, Llewellyn CH, Brunner EJ (2017) Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep 7(1):6287

    Article  Google Scholar 

  39. O'Keefe EB, Meltzer JP, Bethea TN (2015) Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000-2010. Front Public Health 3:51

    PubMed  PubMed Central  Google Scholar 

  40. Tao L, Gomez SL, Keegan TH, Kurian AW, Clarke CA (2015) Breast cancer mortality in African-American and non-Hispanic white women by molecular subtype and stage at diagnosis: a population-based study. Cancer Epidemiol Biomark Prev 24(7):1039–1045

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA

    Dongyu Zhang

  2. University of Michigan Medical School, Ann Arbor, MI, USA

    Yilin Feng

  3. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Nan Li

  4. Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA

    Xuezheng Sun

Authors
  1. Dongyu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yilin Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuezheng Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

D.Z. designed the study, analyzed data, and drafted the manuscript. D.Z., Y.F., N.L., and X.S. contributed to result interpretation and manuscript revision.

Corresponding author

Correspondence to Dongyu Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

IRB approval

We used publicly available de-identified data which does not require IRB approval.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 16 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, D., Feng, Y., Li, N. et al. Fruit and vegetable consumptions in relation to frequent mental distress in breast cancer survivors. Support Care Cancer 29, 193–201 (2021). https://doi.org/10.1007/s00520-020-05451-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05451-8

Keywords

Search

Navigation