TABLE 4.

Direct and indirect effect of the chain mediation model with mediator of erythrocyte n – 3 PUFAs in association between dietary ALA intake and breast cancer risk^a.

	Effect	95% CI	SE
Direct effect
Dietary ALA → breast cancer	–0.556	-1.018, -0.093	0.236
Indirect effect
(1) Dietary ALA → RALA → breast cancer	0.014	–0.024, 0.057	0.020
(2) Dietary ALA → REPA → breast cancer	–0.029	–0.082, 0.003	0.022
(3) Dietary ALA → RDPA → breast cancer	0.008	–0.031, 0.047	0.019
(4) Dietary ALA → RDHA → breast cancer	–0.013	–0.062, 0.030	0.023
(5) Dietary ALA → RALA → REPA → breast cancer	0.002	–0.004, 0.011	0.004
(6) Dietary ALA → RALA → RDPA → breast cancer	0.001	–0.002, 0.005	0.002
(7) Dietary ALA → RALA → RDHA → breast cancer	0.0002	–0.001, 0.002	0.001
(8) Dietary ALA → REPA → RDPA → breast cancer	–0.014	–0.033, –0.002	0.008
(9) Dietary ALA → REPA → RDHA → breast cancer	–0.012	–0.026, –0.003	0.006
(10) Dietary ALA → RDPA → RDHA → breast cancer	0.001	–0.002, 0.007	0.002
(11) Dietary ALA → RALA → REPA → RDPA → breast cancer	0.001	–0.002, 0.005	0.002
(12) Dietary ALA → RALA → REPA → RDHA → breast cancer	0.001	–0.002, 0.004	0.001
(13) Dietary ALA → RALA → RDPA → RDHA → breast cancer	0.0001	–0.0002, 0.0005	0.0002
(14) Dietary ALA → REPA → RDPA → RDHA → breast cancer	–0.001	–0.004, –0.0002	0.001
(15) Dietary ALA → RALA → REPA → RDPA → RDHA → breast cancer	0.0001	–0.0002, 0.0005	0.0002
Total indirect effect
Dietary ALA → breast cancer	–0.042	-0.144, 0.049	0.049

RALA, erythrocyte α-linolenic acid; CI, confidence interval; RDHA, erythrocyte docosahexaenoic acid; RDPA, erythrocyte docosapentaenoic acid; REPA, erythrocyte eicosapentaenoic acid; PUFA, polyunsaturated fatty acid; SE, standard error.

^aAdjusted for age, BMI, MET-h/week, education, passive smoking, regular drinking, first-degree relatives with cancer and energy intake.