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Types of carbohydrate intake and breast cancer survival

European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Objective

To investigate the associations of different types of carbohydrate intake after breast cancer diagnosis with breast cancer-specific and all-cause mortality.

Methods

We prospectively assessed post-diagnostic intake of total sugar, added sugar, and natural sugar as well as carbohydrate from different sources, among 8932 women with stage I–III breast cancer that were identified in the Nurses’ Health Study from 1980 to 2010 and Nurses’ Health Study II from 1991 to 2011. Participants completed a validated food frequency questionnaire every four years after diagnosis and were followed up for death.

Results

We prospectively documented 1071 deaths due to breast cancer and 2532 all-cause deaths, over a mean of 11.5 years of follow-up. After adjustment for confounding variables, greater post-diagnostic total sugar intake was suggestively associated with greater risk of breast cancer-specific mortality [hazard ratio (HR)Q5vsQ1 = 1.16, 95% confidence interval (CI ) = 0.95–1.41; Ptrend = 0.02] and significantly associated with greater risk of all-cause mortality (HRQ5vsQ1 = 1.23, 95% CI = 1.08–1.41; Ptrend = 0.0001). Greater post-diagnostic added sugar intake was significantly associated with greater risk of all-cause mortality (HRQ5vsQ1 = 1.20, 95% CI = 1.06–1.36; Ptrend = 0.001). Post-diagnostic natural sugar (occurring in foods and not added as an ingredient) intake was not associated with mortality risk. Greater post-diagnostic fructose intake was significantly associated with greater risk of breast cancer-specific mortality (HRQ5vsQ1 = 1.34, 95% CI = 1.10–1.64; Ptrend = 0.005) and all-cause mortality (HRQ5vsQ1 = 1.16, 95% CI = 1.02–1.32; Ptrend = 0.01). High post-diagnostic intake of sucrose was associated with higher risk of breast cancer-specific and all-cause mortality. Increased post-diagnostic intake of carbohydrate from fruit juice was significantly associated with higher risk of breast cancer-specific and all-cause mortality and carbohydrate from vegetables was significantly associated with lower risk of all-cause mortality. High post-diagnostic intake of carbohydrate from potatoes was suggestively associated with higher risk of breast cancer-specific mortality and carbohydrate from refined grains was suggestively associated with higher risk of all-cause mortality.

Conclusions

We found that higher total sugar intake, especially added sugar, sucrose, and fructose, as well as carbohydrate from fruit juice after a breast cancer diagnosis were associated with poorer prognosis. High post-diagnostic intake of carbohydrate from vegetables was associated with reduced risk of mortality.

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Acknowledgements

We would like to thank the participants and staff of the NHS and NHSII for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY.

Funding

The study was supported by the National Institutes of Health (grants U01 CA176726, UM1 CA186107) and the American Institute for Cancer Research (to MSF). The study sponsors were not involved in the study design and collection, analysis and interpretation of data, or the writing of the article or the decision to submit it for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors were independent from study sponsors.

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Authors

Contributions

The authors’ responsibility was as follows: MSF and MDH: designed the research; MSF:  statistical analysis, interpretation of data, funding acquisition, writing–original draft, critical revision of the article for important intellectual content, and approval of the final version for submission; JBB, NDS, BAR, and MDH: interpretation of data, critical revision of the article for important intellectual content, and approval of the final version for submission. The authors assume full responsibility for analyses and interpretation of these data.

Corresponding author

Correspondence to Maryam S. Farvid.

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Conflict interest

Michelle D. Holmes reported a grant from FHI Solutions, non-financial support from Bayer AG (Bayer supplies aspirin and placebo for the Aspirin after Breast Cancer trial) and personal fees from Arla Foods (participated in a systematic review of dietary intake in Nigerian children for this company) outside the submitted work. The other authors made no disclosures.

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Farvid, M.S., Barnett, J.B., Spence, N.D. et al. Types of carbohydrate intake and breast cancer survival. Eur J Nutr 60, 4565–4577 (2021). https://doi.org/10.1007/s00394-021-02517-z

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  • DOI: https://doi.org/10.1007/s00394-021-02517-z

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