Skip to main content
British Journal of Cancer logoLink to British Journal of Cancer
. 1994 Sep;70(3):537–541. doi: 10.1038/bjc.1994.341

The association of fat and other macronutrients with breast cancer: a case-control study from Greece.

K Katsouyanni 1, A Trichopoulou 1, S Stuver 1, Y Garas 1, A Kritselis 1, G Kyriakou 1, M Stoïkidou 1, P Boyle 1, D Trichopoulos 1
PMCID: PMC2033363  PMID: 8080743

Abstract

The Greek diet is characterized by a high total fat but low saturated fat intake. In a hospital-based case-control study of female breast cancer conducted in Athens (1989-91), 820 patients with confirmed cancer of the breast were compared with 795 orthopaedic patient controls and 753 hospital visitor controls, matched to the cases by age and interviewer. Diet was ascertained through a semiquantitative food frequency questionnaire; macronutrient intakes were estimated from the nutrient content of a selected typical portion size for each specified food item, summed for all items. Logistic regression was used to analyse the data, controlling for demographic and reproductive risk factors for breast cancer as well as for total energy intake and mutual confounding influences among nutrients. There was no significant or suggestive association of total protein, total fat, categories of fat or total carbohydrates with breast cancer risk. Thus, the mutually adjusted relative risk per quintile and (in parenthesis) 95% confidence interval were: for protein, 1.06 (0.94-1.20); saturated fat, 0.99 (0.89-1.11); monounsaturated fat, 0.97 (0.88-1.07), polyunsaturated fat, 1.05 (0.97-1.13); and total carbohydrates, 1.03 (0.94-1.12). In alternative analytical approaches only total protein appeared to be positively associated to the occurrence of breast cancer with some consistency, but the results were far from statistically significant. These findings do not support a role for fat or other energy-generating nutrients in the aetiology of breast cancer.

Full text

PDF
537

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adlercreutz H. Western diet and Western diseases: some hormonal and biochemical mechanisms and associations. Scand J Clin Lab Invest Suppl. 1990;201:3–23. [PubMed] [Google Scholar]
  2. Albanes D., Winick M. Are cell number and cell proliferation risk factors for cancer? J Natl Cancer Inst. 1988 Jul 20;80(10):772–774. doi: 10.1093/jnci/80.10.772. [DOI] [PubMed] [Google Scholar]
  3. Armstrong B., Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer. 1975 Apr 15;15(4):617–631. doi: 10.1002/ijc.2910150411. [DOI] [PubMed] [Google Scholar]
  4. Bennett F. C., Ingram D. M. Diet and female sex hormone concentrations: an intervention study for the type of fat consumed. Am J Clin Nutr. 1990 Nov;52(5):808–812. doi: 10.1093/ajcn/52.5.808. [DOI] [PubMed] [Google Scholar]
  5. Birt D. F. Dietary fat and experimental carcinogenesis: a summary of recent in vivo studies. Adv Exp Med Biol. 1986;206:69–83. doi: 10.1007/978-1-4613-1835-4_8. [DOI] [PubMed] [Google Scholar]
  6. Boyar A. P., Rose D. P., Loughridge J. R., Engle A., Palgi A., Laakso K., Kinne D., Wynder E. L. Response to a diet low in total fat in women with postmenopausal breast cancer: a pilot study. Nutr Cancer. 1988;11(2):93–99. doi: 10.1080/01635588809513975. [DOI] [PubMed] [Google Scholar]
  7. Boyd N. F., Martin L. J., Noffel M., Lockwood G. A., Trichler D. L. A meta-analysis of studies of dietary fat and breast cancer risk. Br J Cancer. 1993 Sep;68(3):627–636. doi: 10.1038/bjc.1993.398. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cole P., MacMahon B. Oestrogen fractions during early reproductive life in the aetiology of breast cancer. Lancet. 1969 Mar 22;1(7595):604–606. doi: 10.1016/s0140-6736(69)91537-2. [DOI] [PubMed] [Google Scholar]
  9. Ewertz M., Gill C. Dietary factors and breast-cancer risk in Denmark. Int J Cancer. 1990 Nov 15;46(5):779–784. doi: 10.1002/ijc.2910460505. [DOI] [PubMed] [Google Scholar]
  10. Freedman L. S., Clifford C., Messina M. Analysis of dietary fat, calories, body weight, and the development of mammary tumors in rats and mice: a review. Cancer Res. 1990 Sep 15;50(18):5710–5719. [PubMed] [Google Scholar]
  11. Giovannucci E., Stampfer M. J., Colditz G. A., Manson J. E., Rosner B. A., Longnecker M., Speizer F. E., Willett W. C. A comparison of prospective and retrospective assessments of diet in the study of breast cancer. Am J Epidemiol. 1993 Mar 1;137(5):502–511. doi: 10.1093/oxfordjournals.aje.a116703. [DOI] [PubMed] [Google Scholar]
  12. Goldin B. R., Adlercreutz H., Gorbach S. L., Woods M. N., Dwyer J. T., Conlon T., Bohn E., Gershoff S. N. The relationship between estrogen levels and diets of Caucasian American and Oriental immigrant women. Am J Clin Nutr. 1986 Dec;44(6):945–953. doi: 10.1093/ajcn/44.6.945. [DOI] [PubMed] [Google Scholar]
  13. Graham S., Dayal H., Swanson M., Mittelman A., Wilkinson G. Diet in the epidemiology of cancer of the colon and rectum. J Natl Cancer Inst. 1978 Sep;61(3):709–714. [PubMed] [Google Scholar]
  14. Howe G. R., Friedenreich C. M., Jain M., Miller A. B. A cohort study of fat intake and risk of breast cancer. J Natl Cancer Inst. 1991 Mar 6;83(5):336–340. doi: 10.1093/jnci/83.5.336. [DOI] [PubMed] [Google Scholar]
  15. Howe G. R., Hirohata T., Hislop T. G., Iscovich J. M., Yuan J. M., Katsouyanni K., Lubin F., Marubini E., Modan B., Rohan T. Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies. J Natl Cancer Inst. 1990 Apr 4;82(7):561–569. doi: 10.1093/jnci/82.7.561. [DOI] [PubMed] [Google Scholar]
  16. Hsieh C. C., Maisonneuve P., Boyle P., Macfarlane G. J., Roberston C. Analysis of quantitative data by quantiles in epidemiologic studies: classification according to cases, noncases, or all subjects? Epidemiology. 1991 Mar;2(2):137–140. doi: 10.1097/00001648-199103000-00008. [DOI] [PubMed] [Google Scholar]
  17. Hsieh C. C., Trichopoulos D., Katsouyanni K., Yuasa S. Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case-control study. Int J Cancer. 1990 Nov 15;46(5):796–800. doi: 10.1002/ijc.2910460508. [DOI] [PubMed] [Google Scholar]
  18. Hunter D. J., Willett W. C. Diet, body size, and breast cancer. Epidemiol Rev. 1993;15(1):110–132. doi: 10.1093/oxfordjournals.epirev.a036096. [DOI] [PubMed] [Google Scholar]
  19. Katsouyanni K., Skalkidis Y., Petridou E., Polychronopoulou-Trichopoulou A., Willett W., Trichopoulos D. Diet and peripheral arterial occlusive disease: the role of poly-, mono-, and saturated fatty acids. Am J Epidemiol. 1991 Jan;133(1):24–31. doi: 10.1093/oxfordjournals.aje.a115798. [DOI] [PubMed] [Google Scholar]
  20. Katsouyanni K., Trichopoulos D., Boyle P., Xirouchaki E., Trichopoulou A., Lisseos B., Vasilaros S., MacMahon B. Diet and breast cancer: a case-control study in Greece. Int J Cancer. 1986 Dec 15;38(6):815–820. doi: 10.1002/ijc.2910380606. [DOI] [PubMed] [Google Scholar]
  21. Katsouyanni K., Willett W., Trichopoulos D., Boyle P., Trichopoulou A., Vasilaros S., Papadiamantis J., MacMahon B. Risk of breast cancer among Greek women in relation to nutrient intake. Cancer. 1988 Jan 1;61(1):181–185. doi: 10.1002/1097-0142(19880101)61:1<181::aid-cncr2820610130>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  22. Knekt P., Albanes D., Seppänen R., Aromaa A., Järvinen R., Hyvönen L., Teppo L., Pukkala E. Dietary fat and risk of breast cancer. Am J Clin Nutr. 1990 Nov;52(5):903–908. doi: 10.1093/ajcn/52.5.903. [DOI] [PubMed] [Google Scholar]
  23. La Vecchia C., Decarli A., Franceschi S., Gentile A., Negri E., Parazzini F. Dietary factors and the risk of breast cancer. Nutr Cancer. 1987;10(4):205–214. doi: 10.1080/01635588709513958. [DOI] [PubMed] [Google Scholar]
  24. Manousos O., Day N. E., Trichopoulos D., Gerovassilis F., Tzonou A., Polychronopoulou A. Diet and colorectal cancer: a case-control study in Greece. Int J Cancer. 1983 Jul 15;32(1):1–5. doi: 10.1002/ijc.2910320102. [DOI] [PubMed] [Google Scholar]
  25. Prentice R. L., Kakar F., Hursting S., Sheppard L., Klein R., Kushi L. H. Aspects of the rationale for the Women's Health Trial. J Natl Cancer Inst. 1988 Aug 3;80(11):802–814. doi: 10.1093/jnci/80.11.802. [DOI] [PubMed] [Google Scholar]
  26. Prentice R. L., Sheppard L. Dietary fat and cancer: consistency of the epidemiologic data, and disease prevention that may follow from a practical reduction in fat consumption. Cancer Causes Control. 1990 Jul;1(1):81–109. doi: 10.1007/BF00053187. [DOI] [PubMed] [Google Scholar]
  27. Prentice R., Thompson D., Clifford C., Gorbach S., Goldin B., Byar D. Dietary fat reduction and plasma estradiol concentration in healthy postmenopausal women. The Women's Health Trial Study Group. J Natl Cancer Inst. 1990 Jan 17;82(2):129–134. doi: 10.1093/jnci/82.2.129. [DOI] [PubMed] [Google Scholar]
  28. Rose D. P., Boyar A. P., Cohen C., Strong L. E. Effect of a low-fat diet on hormone levels in women with cystic breast disease. I. Serum steroids and gonadotropins. J Natl Cancer Inst. 1987 Apr;78(4):623–626. [PubMed] [Google Scholar]
  29. Seidman H., Stellman S. D., Mushinski M. H. A different perspective on breast cancer risk factors: some implications of the nonattributable risk. CA Cancer J Clin. 1982 Sep-Oct;32(5):301–313. doi: 10.3322/canjclin.32.5.301. [DOI] [PubMed] [Google Scholar]
  30. Sun M. Debate rages over breast cancer study. Science. 1988 Jan 1;239(4835):17–18. doi: 10.1126/science.3336770. [DOI] [PubMed] [Google Scholar]
  31. Toniolo P., Riboli E., Protta F., Charrel M., Cappa A. P. Calorie-providing nutrients and risk of breast cancer. J Natl Cancer Inst. 1989 Feb 15;81(4):278–286. doi: 10.1093/jnci/81.4.278. [DOI] [PubMed] [Google Scholar]
  32. Trichopoulos D., Tzonou A., Katsouyanni K., Trichopoulou A. Diet and cancer: the role of case-control studies. Ann Nutr Metab. 1991;35 (Suppl 1):89–92. doi: 10.1159/000177686. [DOI] [PubMed] [Google Scholar]
  33. Trichopoulou A., Toupadaki N., Tzonou A., Katsouyanni K., Manousos O., Kada E., Trichopoulos D. The macronutrient composition of the Greek diet: estimates derived from six case-control studies. Eur J Clin Nutr. 1993 Aug;47(8):549–558. [PubMed] [Google Scholar]
  34. Trichopoulou A., Tzonou A., Hsieh C. C., Toupadaki N., Manousos O., Trichopoulos D. High protein, saturated fat and cholesterol diet, and low levels of serum lipids in colorectal cancer. Int J Cancer. 1992 May 28;51(3):386–389. doi: 10.1002/ijc.2910510309. [DOI] [PubMed] [Google Scholar]
  35. Tzonou A., Kalandidi A., Trichopoulou A., Hsieh C. C., Toupadaki N., Willett W., Trichopoulos D. Diet and coronary heart disease: a case-control study in Athens, Greece. Epidemiology. 1993 Nov;4(6):511–516. [PubMed] [Google Scholar]
  36. Tzonou A., Kaldor J., Smith P. G., Day N. E., Trichopoulos D. Misclassification in case-control studies with two dichotomous risk factors. Rev Epidemiol Sante Publique. 1986;34(1):10–17. [PubMed] [Google Scholar]
  37. Willett W. C., Hunter D. J., Stampfer M. J., Colditz G., Manson J. E., Spiegelman D., Rosner B., Hennekens C. H., Speizer F. E. Dietary fat and fiber in relation to risk of breast cancer. An 8-year follow-up. JAMA. 1992 Oct 21;268(15):2037–2044. [PubMed] [Google Scholar]
  38. Willett W., Stampfer M. J. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986 Jul;124(1):17–27. doi: 10.1093/oxfordjournals.aje.a114366. [DOI] [PubMed] [Google Scholar]
  39. Willett W. The search for the causes of breast and colon cancer. Nature. 1989 Mar 30;338(6214):389–394. doi: 10.1038/338389a0. [DOI] [PubMed] [Google Scholar]
  40. de Waard F., Trichopoulos D. A unifying concept of the aetiology of breast cancer. Int J Cancer. 1988 May 15;41(5):666–669. doi: 10.1002/ijc.2910410505. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES