Table 1.
Characteristics of the studies included in the systematic review and meta-analysis of dietary patterns and breast cancer risk
| Study | Location | Age of participants1 | Study design | Sample size (number of menopausal status) | Diet assessment method | Dietary patterns identified | Confounding factors adjusted for in the multivariable analysis |
|---|---|---|---|---|---|---|---|
| Mourouti et al., 2015 [70] | Greece | 56 ± 12 | Case-control | 250 cases (84 premenopausal women/166 postmenopausal women)/250 controls (91 premenopausal women/158 postmenopausal women) | FFQ (86 questions) | Unhealthy food pattern, healthy/prudent pattern, and olive oil and fish pattern | Years of education, family history of breast cancer, BMI, IPAQ score, smoking ever, and menopausal status, and place of living |
| Castello et al., 2014 [67] | Spain | No reported | Case-control | 973 cases (513 premenopausal women /460 postmenopausal women)/973 controls (551 premenopausal women/422 postmenopausal women) | FFQ (117 questions, past 5 years) | Western pattern, prudent pattern, Mediterranean pattern, Alternate Healthy Index, and Alternate Mediterranean Diet Score | Total calories, alcohol consumption, BMI, average physical activity in the past year, smoking, education, previous history of breast disease other than cancer, family history of breast cancer, age at menarche, age at first delivery, and menopausal status |
| Tumas et al., 2014 [69] | Argentina | 58 ± 12 | Case-control | 100 cases (22 premenopausal women/78 postmenopausal women) /294 controls (78 premenopausal women/216 postmenopausal women) | FFQ (127 questions, past 5 years) | Traditional, rural, prudent, and starchy | BMI, educational level, total energy intake, gynecological status, and physical activity |
| Karimi et al., 2013 | Iran | 30–65 | Case-control | 100 cases (63 premenopausal women/37 postmenopausal women) /174 controls (109 premenopausal women/65 postmenopausal women) | FFQ (168 questions, past 1-year) | Healthy dietary pattern, and unhealthy dietary pattern | Age and menopausal status, age at menarche, age at first full-term pregnancy, smoking status, oral contraceptive drug use, BMI, physical activity, family history of breast cancer, and relative accuracy of energy reporting |
| Bessaoud et al., 2012 [15] | France | 28–85 | Case-control | 437 cases (no reported) /922 controls (no reported) | FFQ (162 questions) | Mediterranean, Western, meat-eaters, and drinkers | Total energy intake, education, parity, breast-feeding age at first full-term pregnancy, duration of ovulatory activity, BMI, physical activity, and first-degree family history of breast cancer |
| Demetriou et al., 2012 [66] | Greece | 40–70 | Case-control | 935 cases/817 controls (all are postmenopausal women) | FFQ (32 questions) | Fruit/vegetables/fish | Age at interview, family history, age at first full term pregnancy, HRT use, exercise, age at menarche, height, BMI, and PCA derived patterns 1, 2 and 3 in post-menopausal women only |
| Buck et al., 2011 [64] | Germany | 50–74 | Case-control | 2884 cases/5509 controls (all are postmenopausal women) | FFQ (176 questions, past 1-year) | Healthy pattern and unhealthy pattern | Year of birth, study center, menopausal induction, BMI, education level, first-degree family history of breast cancer, history of benign breast disease, number of pregnancies, age at menarche, breastfeeding history, total number of mammograms, smoking habit, and total energy |
| Zhang et al., 2011 [65] | China | 25–70 | Case-control | 438 cases (306 premenopausal women/132 postmenopausal women)/438 controls (295 premenopausal women/143 postmenopausal women) | FFQ (81 questions, past 1-year) | Vegetable-fruit-soy-milk-poultry-fish, and refined grain-meat-pickle | Age at menarche, live births and age at first live birth, months of breast feeding, BMI, history of benign breast disease, mother/sister/daughter with breast cancer, physical activity, passive smoking, and total energy intake |
| Ronco et al., 2010 [20, 63] | Uruguay | 40–75 | Case-control | 111 cases (11 premenopausal women/100 postmenopausal women) /222 controls (24 premenopausal women/198 postmenopausal women) | FFQ (120 questions, past 5-year) | Low-fat, fried white meat, non-alcoholic beverages, Western, fatty cheese, and prudent | Age, education, physical activity, family history of breast cancer among first-degree relatives, BMI, smoking, drinking, age at menarche, parity, menopausal status, total energy intake, and scored patterns each for the others |
| Cho et al., 2011 | Korea | 25–77 | Case-control | 357 cases (216 premenopausal women/141 postmenopausal women)/357 controls (228 premenopausal women/129 postmenopausal women) | FFQ (103 questions, past 1-year) | Vegetables-seafood and meat starch | Age, BMI, family history of breast cancer, current use of dietary supplements, education, occupation, smoking, alcohol intake, physical activity, menopausal status (if applicable), age at menarche, parity, total energy intake, and postmenopausal hormone use for postmenopausal women |
| Wu et al., 2009 [12] | USA | 25–74 | Case-control | 1248 cases (no reported) /1148controls (no reported) | FFQ (174 questions, usual intake) | Western meat/starch; Ethnic meat/starch; and vegetable-soy | Age, Asian ethnicity, education, birthplace, years of residence in the USA, years of physical activity, marital status, parity, age at menarche, type of menopause, age at menopause, and recent BMI |
| De Stefani et al., 2009 [61] | Uruguay | Case-control | 461 cases (no reported)/2532 controls (no reported) | FFQ (64 questions, usual intake) | Prudent, drinker, traditional, and western | Age, residence, urban/rural status, education, BMI, smoking status, years since stopping smoking, number of cigarettes/d among current smokers, total energy intake, and main food groups for the individual dietary patterns | |
| Murtaugh et al., 2008 [11] | USA | 25–79 | Case-control | 757 cases (315 premenopausal women/442 postmenopausal women) /867 controls (312 premenopausal women/555 postmenopausal women) (Hispanic); 1524 cases (538 premenopausal women/986 postmenopausal women)/1598 controls (492 premenopausal women/1106 postmenopausal women) (non-Hispanic) | Diet-history Questionnaire (computerized–interviewer administered) | Western, prudent, Native Mexican, Mediterranean, and dieter | Age, center, education, family history of breast cancer, smoking, total activity, calories, dietary fiber, dietary calcium, height, parity, recent hormone exposure, BMI, interaction of recent hormone exposure and BMI |
| Edefonti et al., 2008 [60] | Italy | 17–79 | Case-control | 2569 cases (987 premenopausal women/1579 postmenopausal women)/3413 controls(1074 premenopausal women/2334 postmenopausal women) | FFQ (78; 2 years before diagnosis/hospital admission (controls) | Animal products, vitamins and fiber, unsaturated fats, and starch-rich | Age, education, parity, menopausal status, geographic area, BMI, history of female cancers, history of digestive cancers, and energy intake |
| Hirose et al., 2007 [59] | Japan | 40–79 | Case-control | 1885 cases (no reported)/22,333controls (10,577 premenopausal women/11756 postmenopausal women) | FFQ (13 diet factors, 17 food items; 1 year before diagnosis/interview (controls)) | Prudent, fatty, Japanese, and salty | Age, visit year, motivation, BMI, menopausal status, parity, age at first full-term pregnancy, age at menarche, smoking, drinking, family history of breast cancer, and exercise |
| Cui et al., 2007 [16] | China | 25–64 | Case-control | 1459 cases (952 premenopausal women/507 postmenopausal women)/1556 controls (990 premenopausal women/566 postmenopausal women) | FFQ (76; past 5 years) | Vegetable-soy and meat-sweet | Age, total energy, family history of breast cancer, history of fibroadenoma, age at menarche, live births, age at first live birth, menopausal status, age at menopause, physical activity during the past 10 y, waist-hip ratio, and education |
| Ronco et al., 2006 [58] | Uruguay | 30–89 | Case-control | 442 cases (84 premenopausal women /358 postmenopausal women)/442 controls (90 premenopausal women/352 postmenopausal women) | FFQ (64; usual intake) | Traditional, healthy, Western, stew, high-fat, and drinker | Age, residence, urban/rural status, education, family history of breast cancer among first-degree relatives, menopausal status, age at menarche, parity, and total energy intake |
| Nkondjock and Ghadirian, 2005 [57] | Canada | 35–79 | Case-control | 414 breast cancer cases (no reported)/429 controls (no reported) | FFQ (985; 2 years before diagnosis, corresponding time for controls) | Chocolate–cereal, pork-processed meat, and drinker | Total energy intake, family history of cancer, marital status, physical activity, smoking, BMI, age (at first full-term pregnancy for breast cancer), history of benign breast disease, full-term pregnancies |
| Shin et al., 2016 [78] | Japan | 57 ± 8 | Cohort (14·6) | 49,552 (718 cases: 185 premenopausal women/533 postmenopausal women) | FFQ (147; previous year) | Prudent, Westernized, and traditional | Age, public healthcare center area, log-transformed energy intake, BMI, smoking status, leisure-time physical activity, total physical activity, age at menarche, parity, age at first birth, menopause status, and use of exogenous female hormones |
| Harris et al., 2016 [17] | USA | 41.0 ± 4.5 | Cohort (22) | 45, 204 (1477 cases:863 premenopausal women/614 postmenopausal women) | FFQ (124 items; 1960 to 1980, for adolescent diet; 130 items in 1991, 1995, 1999, 2003, and 2007 for adult diet) | Prudent, Western, fast food, AHEI | Age, high-school total calories, height at age 18, age at menarche, BMI at age 18, physical activity in adolescence and family history of breast cancer. Age at first birth/parity, oral contraceptive use, physical activity in adulthood, alcohol consumption, weight change since age 18 and history of benign breast disease, menopausal status/age at menopause, and hormone use. |
| Kojima et al., 2016 | Japan | 55.5 ± 9.6 | Cohort (16.9) | 23,172 (119 cases: 48 premenopausal women/71 postmenopausal women) | FFQ (39 items) | Vegetable pattern, animal food pattern, and dairy product pattern | Age, area, tobacco smoking status, drinking status, family history of breast cancer, age at menarche, age at first birth, parity, energy intake, hormone therapy, daily walking, education, and BMI |
| Catsburg et al., 2015 [52] | Canada (CSDLH) | 49–72 | Cohort (13) | 39,532 (1496 cases: 591 premenopausal women/625 postmenopausal women) | FFQ (166 items, past 1-year) | Healthy, ethnic, meat and potatoes | BMI, calorie intake, physical activity, family history, and each dietary pattern |
| Canada (NBSS) | 40–59 | Cohort (23) | 49,410 (3659 cases: 1795 premenopausal women/1864 postmenopausal women) | FFQ (86-item, usual intake) | Healthy, ethnic, meat and potatoes | BMI, calorie intake, physical activity, family history, and each dietary pattern |
|
| Link et al., 2013 [13] | USA | 42–60 | Cohort (14.1) | 91,779 (4140 cases: 1780 premenopausal women/1821 postmenopausal women) | FFQ (103 items, 1-year before baseline) | Plant-based, high-protein, high-fat, high-carbohydrate, ethnic, salad and wine | Race-ethnicity/birthplace, family history of breast cancer, age at menarche, parity/age at first full-term pregnancy, average daily caloric intake, physical activity, socioeconomic status, history of a benign breast biopsy and its interaction with time-dependent age, BMI, height, menopausal status/hormone therapy use, and the other four dietary patterns |
| Baglietto et al., 2011 [77] | Australia | 27–76 | Cohort (14.1) | 20,967 (815 cases: 285 premenopausal women/530 postmenopausal women) | FFQ (121 items) | Vegetable, fruit and salad, traditional Australian, and meat | Country of birth, age at menarche, parity, duration of lactation, oral contraceptive use, HRT use, menopausal status at baseline, physical activity, alcohol, smoking, level of education, total energy intake, and BMI |
| Cottet et al., 2009 [10] | France | 53 ± 6 | Cohort (9.7) | 63,374 (2381 cases: all are postmenopausal women) | Diet history questionnaire (208 foods and beverages) | Alcohol/Western and healthy/Mediterranean | Age, education, region at baseline, BMI, height, family history of breast cancer, age at menarche, age at first full-term pregnancy, number of live births, menopausal hormone therapy, history of benign breast disease, lobular carcinoma in situ, oral contraceptive use, breastfeeding history, frequency of Papanicolaou testing, physical activity, smoking status, energy intake excluding alcohol intake, use of phytoestrogen supplement, and use of vitamin /mineral supplements |
| Agurs-Collins et al., 2009 [76] | USA | 38.5 ± 10.6 | Cohort (22) | 50,778 (1094 cases: 509 premenopausal women/442 postmenopausal women) | FFQ (68 items) | Western and prudent | Age, BMI, alcohol intake, education, age at menarche, parity, age at first birth, family history of breast cancer, strenuous physical activity, energy intake, menopausal status, smoking status, and female hormone use |
| Velie et al., 2005 [75] | USA | 62 ± 8 | Cohort (8) | 40,559 (1868 cases: no reported) | FFQ (61 items; past year) | Vegetable-fish/poultry-fruit, beef-pork starch, traditional Southern | Age, total energy intake, education, family history of breast cancer, BMI, height, parity, age at first live birth, age at menarche, menopausal hormone use, average weekday vigorous physical activity, smoking status, and alcohol intake |
| Adebamowo et al., 2005 [73] | USA | 26–46 | Cohort (8) | 90,638 (710 cases: all are premenopausal women) | FFQ [133 items (1991); 142 items (1995); past year] | Prudent and Western | Age at menarche, parity, age at first birth, family history of breast cancer, history of benign breast disease, oral contraceptive use, alcohol intake, energy intake, current BMI, height, smoking habit, physical activity, and multivitamin use |
| Fung et al., 2005 [74] | USA | 30–55 | Cohort (16) | 71,058 (3026 cases: all are postmenopausal women) | FFQ (116 items; past year) | Prudent and Western | Age, smoking status, BMI, multivitamin use, energy intake, physical activity, family history of breast cancer, history of benign breast disease, duration of and age at menopause, use of hormone replacement therapy, age at menarche, parity, age at first birth, BMI at 18 y of age, weight change since 18y of age, height, and alcohol intake |
| Mannisto et al., 2005 | Netherlands (NLCS) | 55–69 | Cohort (7) | 1598 (1127 cases: no reported) | FFQ (150 items; past year) | Vegetable; pork, processed meat, and potatoes | Age, BMI, height, education, smoking, family history of breast cancer, age at menarche, age at menopause, age at first birth, ever use of oral contraceptive, ever use of hormone replacement therapy, alcohol intake, and energy |
| Italy (ORDET) | 35–69 | Cohort (9) | 10,788 (212 cases: no reported) | FFQ (107 items; past year) | Vegetable; pork, processed meat, and potatoes | Age, BMI, height, education, smoking, family history of breast cancer, ever use of oral contraceptive, ever use of hormone replacement therapy, alcohol intake, and energy | |
| Sweden (SMC) | 40–74 | Cohort (13) | 66,651 (1932 cases: no reported) | FFQ (67 items; past half year) | Vegetable; pork, processed meat, and potatoes | Age, BMI, education, family history of breast cancer, age at first birth, parity, alcohol intake, and energy | |
| Sieri et al., 2004 [72] | Italy | 34–70 | Cohort (9.5) | 8984 (207 cases: no reported) | FFQ (107 items; past year) | Salad vegetable, Western, canteen, and prudent | Age, energy intake, education, parity, height, age at menarche, smoking, and menopausal status |
| Terry et al., 2001 [71] | Sweden | 40–76 | Cohort (9.6) | 61,463 (1328 cases: no reported) | FFQ (67 items; past half year) | Western, healthy, and drinker | Age, energy intake, BMI, education, family history, parity, and age at first birth |
AHEI, Alternative Healthy Eating Index; BMI, body mass index; CSDLH, Canadian Study of Diet, Lifestyle and Health; FFQ, food frequency questionnaire; HRT, hormone replacement therapy; IPAQ, International Physical Activity Questionnaire; NBSS, National Breast Screening Study; NLCS, Netherlands Cohort Study on Diet and Cancer; ORDET, Ormoni e Dieta nella Eziologia dei Tumori; PCA, principal component analysis; SMC, Swedish Mammography Cohort
1Values are mean ± SD or age range