Carbohydrate quality index and breast cancer risk in a Mediterranean cohort: The SUN project

  • Andrea Romanos-Nanclares
    Affiliations
    University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain

    Navarra Institute for Health Research (IdisNA), Pamplona, Spain
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  • Alfredo Gea
    Correspondence
    Corresponding author. University of Navarra, Department of Preventive Medicine and Public Health, C/ Irunlarrea, 1, Pamplona, 31008, Spain.
    Affiliations
    University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain

    Navarra Institute for Health Research (IdisNA), Pamplona, Spain

    CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain
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  • Miguel Ángel Martínez-González
    Affiliations
    University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain

    Navarra Institute for Health Research (IdisNA), Pamplona, Spain

    CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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  • Itziar Zazpe
    Affiliations
    University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain

    Navarra Institute for Health Research (IdisNA), Pamplona, Spain

    CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain

    Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain
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  • Itziar Gardeazabal
    Affiliations
    Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander, Spain
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  • Cesar I. Fernandez-Lazaro
    Affiliations
    University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain

    Navarra Institute for Health Research (IdisNA), Pamplona, Spain
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  • Estefanía Toledo
    Affiliations
    University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain

    Navarra Institute for Health Research (IdisNA), Pamplona, Spain

    CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain
    Search for articles by this author

      Highlights

      • The previously defined CQI sums fiber, GI, whole-grain: total carbohydrates and solid: total carbohydrates.
      • A better score in the CQI showed a significant inverse association with BC incidence.
      • Better quality of carbohydrates among premenopausal women was associated with a lower risk of BC.
      • Cancer prevention guidelines should consider the type and quality of carbohydrate intake rather than just the quantity.
      • Replacing processed carbohydrates with unprocessed, high-fiber, whole-grain carbohydrates would benefit BC prevention.

      Summary

      Background & aims

      Beyond the quantity of carbohydrate intake, further research is needed on the relevance of carbohydrate quality. Thus, we evaluated the association between an a priori defined carbohydrate quality index (CQI) and the incidence of breast cancer (BC) in a Mediterranean cohort study.

      Methods

      We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 10,812 middle-aged women. We evaluated at baseline the CQI following 4 criteria: dietary fiber intake, glycemic index, whole-grain:total-grain carbohydrates ratio and the solid carbohydrate:total carbohydrate ratio. Subjects were classified into quartiles according to the final CQI score.

      Results

      During a median follow-up of 11.8 years, we confirmed 101 incident cases of BC. Our study suggests that a higher quality of carbohydrate intake, as measured by the baseline CQI, was associated with a lower risk of BC [HR Q4 vs. Q1 0.39 (95% CI 0.17, 0.87)]. Particularly, a higher whole-grain:total-grain carbohydrates ratio was associated with lower risk of BC [HR T3 vs. T1 0.56 (0.34, 0.90)]. When we stratified by menopausal status, we found an inverse association between CQI and BC in the comparison of extreme quartiles among premenopausal women.

      Conclusions

      In this Mediterranean cohort, a better quality of dietary carbohydrate intake showed a significant inverse association with the incidence of BC, which suggests that strategies for cancer prevention should highlight the quality of this macronutrient.

      Keywords

      Abbreviations:

      BMI (body mass index), CI (confidence interval), CQI (Carbohydrate Quality Index), FFQ (food frequency questionnaire), GI (Glycemic Index), HR (hazard ratio), MET (metabolic equivalent score), PREDIMED (Prevención con Dieta Mediterránea), SD (standard deviation), SUN (Seguimiento Universidad de Navarra – Follow-up University of Navarra)
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