Table 4.
Characteristics of Studies on the Association Between Diet and BD.
| Author, Year | Study Design | Study Population (n) | Diet/BD Assessment Age | Food Species of Interest | Dietary Assessment | Outcome | Significant Results | Adjustments |
|---|---|---|---|---|---|---|---|---|
| Bérubé et al,72 2005 | CSS | ● Postmenopausal women: n = 783 ● Premenopausal women: n = 777 (Canada) |
● Postmenopausal women: 61.8 years ● Premenopausal women: 46.7 years |
Dietary and supplemental VD and Ca | Food questionnaire (661 items) | PMD (computer-assisted approach | ● Premenopausal: 8.5% BD decreases with 1000 mg and 400 IU intake of Ca and VD (P ≤ .004) Postmenopausal women: null |
Smoking status, alcohol, PA, OC use, age, age at menarche, BMI, education, age at first full-term and number of full-term births, ethnicity, FH of BC (first-degree relatives), previous breast biopsies |
| Masala et al,73 2006 | CSS | Mediterranean women–EPIC Florence section; n = 1668 (Italy) | Premenopausal, perimenopausal, and postmenopausal women | Ca and VD; cheese; vegetables | Food frequency questionnaire (FFQ; 160 items) | Wolfe’s method (P2 + DY vs N1 + P1) | BD inversely associated with vegetables, cheese, VD, and Ca; P < .05 | BMI, age, education, total energy, menopausal status, Ca, and VD |
| Vachon et al,74 2000 | CSS | MBCFSC; n = 1508 (United States, NH-White) | 61.4 years | Polyunsaturated fat, vitamins E and C, saturated fat, total diary intake | FFQ (153 items) | PMD (visual assessment) | Null association for polyunsaturated fat, vitamins E and C; P < .05 for saturated fat, total diary intake | Smoking status, OC use, alcohol, energy, age, age at menarche, BMI, age at first full-term birth and number of full-term births, FH of BC, HRT. |
| Nordevang et al,75 1993 | CSS | BC patients; n = 238 (Sweden) | 57.5 years | Ca | Interview of dietary history with 4 months of BC diagnosis | Wolfe’s method (P2 + DY vs N1 + P1) | Mammographic pattern: low Ca intake is associated with P2 and Dy patterns | ER status, BMI, age |
| Diorio et al,77 2006 | CSS | Premenopausal women; n = 771 (Canada) | <46 years If smoker and <48 years if nonsmoker | Dietary and supplemental Ca and VD | Food questionnaire | PMD (computer-assisted method) | PMD (food and supplement) ● VD: β = −1.4 ● Ca: β = −1.9 PMD (food only) ● VD: β = −1.8 ● Ca: β = −1.8 ● (P = .002) |
Age, age at menarche, age at first full-term birth, number of full-term births, alcohol, total energy, BMI, FH of BC (first- degree relative), breast biopsies, past use of HRT and OC, PA, education |
| Bérubé et al,76 2004 | CSS | Premenopausal and postmenopausal women with extreme densities; n = 543 (United States) | ● PMD ≤30%: 51 years ● PMD ≥70%: 46 years |
Dietary Ca and VD | Food questionnaire (232 items) | PMD (visual assessment) | BD (ORQ4 vs Q1) ● VD: P = .0005 Ca: P = .0006 |
Smoking status, alcohol, PA, OC use age, age at menarche, BMI, education, age at first full-term gestation, number of full-term gestations combined, FH of BC, menopausal status, and use of HRT |
| Bertone-Johnson et al,78 2010 | CSS | MDAS: WHI; n = 808 postmenopausal (United States NH-White, Black, other races) | 50-79 years | Dietary and supplemental Ca and VD | Supplement inventory + food questionnaire (122 items) | PMD (computer-assisted approach) | Null | Smoking, alcohol, PA, OC use and duration of use, previous HRT use and duration, MV use, parity, age at menarche, BMI, age, ethnicity, Gail risk |
| Knight et al,79 2006 | CSS | MBCFSC; n = 487 (United States, NH-White) | 56.4 years | Dietary Ca and VD—25(OH)D | FFQ | TDA, PMD (Cumulus) | Null | Age, BMI, PA, parity, age at first birth |
| Brisson et al,26 1989 | CCS | NBSS ● Cases: n = 290 ● Controls: n = 645 (Canada) |
40-62 years | Dietary fats; vegetables (carotenoid) | FFQ (114 items) | Wolfe’s method (P2 + DY vs N1 + P1) and visual assessment | ● Increased BD with dietary fat (P > .05) Lower BD with carotenoid intake (P < .05) |
Education, age, parity, body weight, energy |
| Tseng et al,84 2007 | CSS | Women with FH of BC and ovarian cancer; n = 157 (United States, NH-White) | 50 years | Ca and VD | FFQ (126 items) | PMD (visual assessment) | PMD; VD intakeT3 vs T1: OR = 0.5; 95% CI = 0.2-1.1 | Age, age at menarche, menopausal status, HRT Hx, FH of category, calorie intake, BMI |
| Sala et al,82 2000 | CCS | EPIC-Norfolk ● Cases: n = 203 Controls: n = 203 |
59 years | Dietary fats, carbohydrates and proteins | Seven-day record | Wolfe’s method (P2 + DY vs N1 + P1) | Null for dietary fats; high BD for carbohydrates and proteins intake (P = .04) | Parity, BMI, menopausal status, HRT |
| Nagata et al,80 2005 | CSS | Japanese women; n = 601 (Japan) | ● Premenopausal women: 42.6 years ● Postmenopausal women: 57.8 years |
Dietary fats; carbohydrates | FFQ (169 items) | PMD (fully automated method) | ● Dietary fats Postmenopausal: positively associated; P > .05 ● Premenopausal: null Carbohydrates: inversely associated with BD; P = .03 |
● Premenopausal: BMI, age, smoking status, number of births, breastfeeding Hx Postmenopausal: education, age, BMI, age at menopause, total energy |
| Qureshi et al,81 2011 | CSS | NBCSP; n = 2252 (Norway) | 58 years | Protein, carbohydrates, dietary fiber, total fat, saturated fat | FFQ (180 items) | AD and PMD; computer-assisted approach | Null for protein, carbohydrates, dietary fiber; high BD with total fat intake (P = .10) and saturated fat (P = .06) | Age at menarche, age at mammography, age at full-term birth, number of pregnancies, BMI, HRT, education, total energy |
| Knight et al,83 1999 | RCT | ● Entry: premenopausal ● Follow-up: postmenopausal n = 78 (Canada) |
● Intervention: 49.5 years ● Controls: 49.2 years |
Low-fat, high CHO interventions vs control (2 years) | 3 Food records | PMD, ADT (automated approach) | ● Mean decrease in DA: −11.0 vs −4.5 cm2; P = .004 Decrease in percentage density: −11.0% vs −5.2%; P = .025 |
Age, FH, age at menarche, parity, age at first birth, OC use, PA, breastfeeding, total energy, weight change |
| Bertone-Johnson et al,85 2012 | RCT | WHI ca + D trial; n = 330 postmenopausal women (United States) | ● Intervention: 61.8 years ● Controls: 62.0 years |
Daily supplementation of 400 IU of VD and 1000 mg of Ca (1 year) | FFQ (122 items) | PMD (computer-assisted approach) | Null | Total VD, age, ethnicity, HT treatment, BMI, residence region, Gail risk score, baseline BD |
| Martin et al,29 2009 | RCT | Women with PMD ≥ 50%; n = 461 (Canada) | ● Intervention: 48.7 years ● Controls: 48.6 years |
Low-fat, high CHO interventions | Food records | PMD, DA, TBA NDA (computer assisted) | Null | FH of BC, HRT use, OC use, dietary fats, and postmenopausal status |
| Boyd et al,25 1997 | RCT | PMD ≥ 50%; n = 817 (Canada) | ● Intervention: 46.5 years ● Controls: 45.9 years |
Low-fat, high CHO diet interventions (2 years) | Food records (3 days) | PMD (automated approach) | Intervention 6.1% vs control (2.1%); P = .01 | Menopausal status, weight, age, grouping |
| Maskarinec et al,88 2003 | RCT | Isoflavone trials; n = 30 (Hawaii) | 35-46 years | 100 mg Of isoflavone mixture/d for 12 months | Tablet counts and urinary isoflavone excretion | PMD (computer-assisted approach) | Null | Race, weight, BD ≥40% |
| Maskarinec et al,31 2004 | RCT | n = 220 (Caucasians, Asians and others) Hawaii | ● Intervention: = 43.2 ± 3.1 years ● Control: 42.8 ± 2.9 years |
2 Daily servings of soy for 2 years | Validated soy questionnaire, urinary isoflavone excretions | PMD (computer-assisted approach | BD reduction of 3.14%/year at least 1 serving/wk (insignificant BD change) | Ethnicity, age, group status, place of birth, number of children, %BD at baseline |
| Atkinson et al,86 2004 | RCT | NHSBSP; n = 205 (United Kingdom) | 49–65 years | Red clover–derived isoflavone tablet/d for 12 months | Urinary isoflavone excretions | PMD (Wolfe classification, visual assessment) | Null | Menopausal status, age at baseline, BMI, genotype |
| Verheus et al,89 2008 | RCT | DPBCSP; n = 202 (Netherlands) | 60-75 years | 99 mg isoflavone/d for 1year | Intake of 36.5 g of soy powder/d | PMD (computer assisted) | Null | Equol status, %BD at baseline |
| Maskarinec et al,87 2009 | RCT | OPUS; n = 406 (United States, Greece) | 40-60 years | 80 Or 120 mg/d of isoflavone for 2 years | FFQ, pill counts, blood isoflavone measurement | PMD (computer-assisted method) | Null | Age, BMI |
| Tseng et al,91 2013 | LS | Chinese immigrants; n = 436 (United States) | 36-58 years | 25 to 30 mg/d of isoflavone for 3 days | 48-Hour dietary recall, urinary isoflavone excretions | PMD (computer-assisted method) | Null; PMD for Equol vs non–equol producers: 31.8 vs 35.3, respectively | Sociodemographic characteristics, dietary intake, equol status, equol dose |
| Jones et al,28 2015 | CSS | DISC; n = 172 (United States) | 25-29 years | Dietary energy density | 24-Hour dietary recalls | %DBV, ADBV (MRI) | 25.9% (95% CI = 6.2% to 56.8%) increase in %DBV (P < .01) | Race, smoking status, education, parity, duration of sex hormone use, whole body percentage fat, childhood BMI, and energy from beverage, fat, and alcohol |
| Masala et al,90 2013 | CSS | EPIC-Florence; n = 1668 (Italy) | Not specified | Carbohydrate intake | Self-administered FFQ | PMD (Wolfe classification, visual assessment) | ● BD increase: OR = 1.73, 95% CI = 1.13-2.67 ● Simple sugar: OR = 1.71; 95% CI = 1.13-2.59 |
Age, education, BMI, menopause, number of children, breastfeeding, physical activity, non–alcohol energy, fibers, saturated fat, and alcohol |
| Voevodina et al,92 2013 | CSS | n = 424 (Germany) | 21-84 years; Premenopausal and postmenopausal | Mediterranean diet and M-M supplements | Self-administered FFQ | PMD (BI-RADS) | OR for lower BD ● Mediterranean diet: 0.95; P < .05 ● M-M supplements: ● Premenopausal: 0.53; P > .05 Postmenopausal: 0.51; P < .05 |
Age, age at menarche, age at first birth, number of live births, PA, alcohol, smoking status, menopausal status, education, HRT, OCs, Hx of BC, breastfeeding |
| Bérubé et al,24 2008 | CSS | Premenopausal and postmenopausal women; n = 1560 (Canada) | ● Mean age Postmenopausal = 61.8 years Premenopausal = 46.7 years |
Diet and multivitamin multimineral, and individual vitamin and mineral supplement use | Self-administered FFQ | PMD, Cumulus | BD ● Increase in premenopausal (P for trend = .04) ● Postmenopausal: null (P for trend = .40) |
Smoking status, alcohol, PA, OC use, age, age at menarche, BMI, education, age at first full-term birth and number of full-term births, ethnicity, FH of BC (first-degree relatives), previous breast biopsies |
| Vachon et al,93 2005 | CSS | MBCFSC; n = 1575 (NH-white, United States) | <18 years/60.4 years | Alcohol | Follow-up questionnaire | PMD (Cumulus) | Null | Age, age at menarche, age at first birth, number of live births, HRT, BMI, smoking status, education, oral OC use, menopausal status, alcohol |
| Sellers at al,64 2007 | MBCFSC; n = 1552(NH-white, United States) | 12-13 years/60.4 years | Chicken and fish, vegetables, fruits, high-fat meats, animal fat, dairy, high-fat foods, high-fat snacks and desserts | Questionnaire (retrospective recall) | PMD (Cumulus) | Null | Age at menarche, parity, age at first birth, smoking history, education, OC use, HRT use, menopausal status, alcohol intake | |
| Mishra et al,94 2008 | PCS | MRC NSHD; n = 979 (Britain) | 4/51.5 years | Dietary VD and Ca | Maternal recall of child’s diet within 1-24 hours | ADT, ANDT, PMD (Cumulus) | Null | BMI, age at menarche, parity, energy, smoking status, adult SES |
| Tseng et al,68 2011 | CSS | Chinese-American immigrant; n = 201 (United States, Asian) | 12-17/53.1 years | Green vegetables, fruits, tofu, beef, pork | Questionnaire (Retrospective recall) | BI-RADS | OR 95% CI for high BD ● Red meat: 3.0%; P = .003 ● Tofu and fruits: 1.6%; P = .39 Vegetables: null |
Age, BMI, level of acculturation, age at first live birth, number of live births, adult dietary intake |
| Mishra et al,95 2011 | PCS | MRC NSHD; n = 792 (Britain) |
4 years/51.5 years | Dietary patterns at age 4: (a) Fried potatoes and fish (b) Breads and fats (c) Milk, biscuits, and fruits |
Maternal recall of child’s diet within 1-24 hours | ADT, ANDT, PMD (Cumulus | Null | BMI at 53 years, age at menarche, parity, energy, age at mammogram, HRT, mammographic view, smoking status, adult SES, PA, social class, dietary pattern |
| Dorgan et al,27 2010 | CSS (RCT follow-up) | DISC; premenopausal women; n = 182 (United States, NH-White | 25-29 years | Low-fat diet long-term effect assessment | 3-24 Hour dietary recalls | VDT and PMD (MRI) | Null | Age at randomization, race, education, BMI-Z score, percentage body fat, age at visit, smoking status, clinic, number of full-term gestations, hormonal contraceptives, PA at age 14-17 years and during the past year |
| Haars et al,96 2010 | CSS | DOM-project; n = 356 (Holland) | 10-18/53 years | Short-term energy restriction | Exposure to hunger, cold, and weight loss (retrospective recalls of 1944-1945 Dutch famine) | PMD, NDT, DT, BS (visual mammographic assessment) | Null | Menopausal status, parity, BMI, and age at mammography |
Abbreviations: BD, breast density; CSS, cross-sectional study; VD, vitamin D; PMD, percentage mammographic density; PA, physical activity; OC, oral contraceptive; BMI, body mass index; FH, family history; BC, breast cancer; EPIC, European Prospective Investigation Into Cancer; MBCFSC, Minnesota Breast Cancer Family Study cohort; NH-Whites, Non-Hispanic Whites; HRT, hormone replacement therapy; ER, estrogen receptor; MDAS WHI, Mammogram Density Ancillary Study of the Women’s Health Initiative; MV, multivitamins; TDA, total dense area; NBSS, National Breast Screening Study; RCT, randomized controlled trial; TBA, total breast area; AD, absolute density; Hx, history; ADT, area of dense tissue; NDA, nondense area; NHSBSP, National Health Service Breast Screening Programme; DPBCSP, Dutch Population-Based Breast Cancer Screening Programme; OPUS, osteoporosis prevention using soy; LS, longitudinal study; MRI, magnetic resonance imaging; M-M, multivitamin-multimineral; BI-RADS, Breast Imaging Reporting and Data System; PCS, prospective cohort study; SES, socioeconomic status; CHO, carbohydrates; NBCSP, Norwegian Breast Cancer Screening Program DISC, dietary intervention study in children; DBV, dense breast volume; ADBV, absolute dense breast volume; MRC NSHD; Medical Research Council National Survey of Health and Development; ADT, area of dense tissue; ANDT, area of non-dense tissue; VDT, volume of dense tissue NDT, non-dense tissue; DT, dense tissue; BS, breast size.