Publications by authors named "Andrea Romanos-Nanclares"

19 Publications

  • Page 1 of 1

Association between parental attitudes towards their offspring's diet and children's actual dietary habits - The SENDO project.

Nutr Hosp 2021 Jul 26. Epub 2021 Jul 26.

Department of Food Sciences and Physiology. Facultad de Farmacia y Nutrición. Universidad de Navarra.

Introduction: the preschool stage is a critical period for teaching and modeling healthy habits to positively influence children's health and wellbeing throughout their lifetime.

Objectives: to evaluate the association between parental attitudes towards their offspring's dietary habits in Spanish children aged 4 to 7 years participating in the SEguimiento Del Niño para un Desarrollo Óptimo (SENDO) project.

Methods: we defined an index to measure information on parental attitudes towards their offspring's diet (0 to 8 points), and another one to measure children's actual dietary habits (0 to 19 points). A higher score meant healthier attitudes and healthier habits, respectively. Information was collected through an online questionnaire completed by parents. We calculated crude and multivariable-adjusted odds ratios (OR) and 95 % confidence intervals (CI) for children's healthy dietary habits associated with parental scores in the parental attitudes index. Generalized estimation equations (GEE) were used to account for intra-cluster correlation between siblings.

Results: a total of 423 preschoolers (52.3 % boys, mean age 5.3 years) were included in the analyses. Half of the children (51 %) reported unhealthy dietary habits, whereas 56 % of parents reported high adherence to the healthy eating index. Compared to those in the lowest category, the children whose parents were in the highest category in the parental attitudes index showed significantly higher odds of having healthy dietary habits (OR: 2.91; 95 % CI: 1.30-6.53, p for trend = 0.004).

Conclusions: our results support a direct association between parental attitudes and their offspring's dietary habits, suggesting that public health interventions aimed at improving children's dietary habits should shift from the individual- to a family-based approach.
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http://dx.doi.org/10.20960/nh.03649DOI Listing
July 2021

Healthful and Unhealthful Plant-Based Diets and Risk of Breast Cancer in U.S. Women: Results from the Nurses' Health Studies.

Cancer Epidemiol Biomarkers Prev 2021 Jul 21. Epub 2021 Jul 21.

Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts.

Background: Plant-based diets have been associated with lower risk of various diseases, including type 2 diabetes, cardiovascular disease, and other cardiometabolic risk factors. However, the association between plant-based diet quality and breast cancer remains unclear.

Methods: We prospectively followed 76,690 women from the Nurses' Health Study (NHS, 1984-2016) and 93,295 women from the NHSII (1991-2017). Adherence to an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI) was assessed using previously developed indices. Cox proportional hazards models were used to estimate HR and 95% confidence intervals (CI) for incident invasive breast cancer.

Results: Over 4,841,083 person-years of follow-up, we documented 12,482 incident invasive breast cancer cases. Women with greater adherence to PDI and hPDI were at modestly lower risk of breast cancer [(HR, 0.89; 95% CI, 0.84-0.95); (HR, 0.89; 95% CI, 0.83-0.94)]. We observed significant heterogeneity by estrogen receptor (ER) status, with the strongest inverse association between hPDI and breast cancer observed with ER-negative tumors [HR, 0.77; 95% CI, 0.65-0.90; < 0.01]. We also found an inverse association between extreme quintiles of healthy plant foods and ER-negative breast cancer [HR, 0.74; 95% CI, 0.61-0.88; < 0.01].

Conclusions: This study provides evidence that adherence to a healthful plant-based diet may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors.

Impact: This is the first prospective study investigating the relation between healthful and unhealthful plant-based dietary indices and risk of total and subtype-specific breast cancer.
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http://dx.doi.org/10.1158/1055-9965.EPI-21-0352DOI Listing
July 2021

Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Breast Cancer Risk: Results From 2 Prospective US Cohorts.

J Nutr 2021 Sep;151(9):2768-2779

Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Background: Whether consumption of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) is associated with the risk of breast cancer is of public health interest.

Objectives: We sought to evaluate associations between consumption of SSBs and ASBs and risks of total and subtype-specific breast cancer.

Methods: We followed 82,713 women from the Nurses' Health Study (1980 to 2016) and 93,085 women from the Nurses' Health Study II (1991 to 2017). Cumulatively averaged intakes of SSBs and ASBs from FFQs were tested for associations with incident breast cancer cases and subtypes using Cox regression models. We also evaluated the associations stratified by menopausal status, physical activity, BMI, and alcohol intake.

Results: We documented 11,379 breast cancer cases during 4,655,153 person-years of follow-up. Consumption of SSBs or ASBs was not associated with total breast cancer risk: pooled HRs comparing extreme categories (≥1/day compared with <1/month) were 1.03 (95% CI, 0.95-1.12) and 0.96 (95% CI, 0.91-1.02), respectively. We observed a suggestive interaction by BMI using pooled data (P-interaction = 0.08), where a modestly higher risk of breast cancer with each serving per day increment of SSBs was found in lean women (HR, 1.06; 95% CI, 1.01-1.11) but not among overweight or obese women (HR, 1.00; 95% CI, 0.95-1.06). Moreover, in the pooled, fully adjusted analysis, compared to infrequent consumers (<1/month), those who consumed ≥1 serving of ASBs per day had a lower risk of luminal A breast tumors (HR, 0.90; 95% CI, 0.80-1.01; P-trend = 0.02).

Conclusions: Although no significant associations were observed overall, consumption of SSBs was associated with a slightly higher risk of breast cancer among lean women. This finding could have occurred by chance and needs confirmation. Our findings also suggest no substantial increase in the risk of breast cancer with consumption of ASBs.
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http://dx.doi.org/10.1093/jn/nxab172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417930PMC
September 2021

Dietary calcium, vitamin D, and breast cancer risk in women: findings from the SUN cohort.

Eur J Nutr 2021 Oct 5;60(7):3783-3797. Epub 2021 Apr 5.

Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain.

Purpose: Epidemiological evidence concerning the relationship between calcium and vitamin D intake and breast cancer (BC) is inconclusive. Moreover, the association according to menopausal status remains unclear. We aimed to assess whether total intakes from dietary and supplemental sources of calcium and vitamin D were associated with the incidence of BC in a Mediterranean cohort.

Methods: We prospectively evaluated the association between intakes of calcium and vitamin D and BC risk among 10,812 women in the Seguimiento Universidad de Navarra (SUN) Project, a Spanish cohort of university graduates.

Results: During a mean follow-up of 10.7 years, 101 incident BC cases were confirmed. Evidence of a non-linear association between total calcium intake and BC risk was found (P = 0.011) with risk reductions associated with higher intake up to approximately 1400 mg/day. Moderate intake [Tertile 2 (T2)] of total calcium was associated with lower overall BC risk [HR for T2 vs. Tertile 1 (T1): 0.55; 95% CI 0.33-0.91] and also among postmenopausal women (HR = 0.38; 95% CI 0.16-0.92). Intake of vitamin D was not associated with BC risk.

Conclusions: Our findings suggest an L-shaped association between total calcium intake and BC incidence. Moderate calcium intake may be associated with lower BC risk among overall and postmenopausal women, but not among premenopausal women. No evidence for any association between vitamin D intake and BC was found. Adherence to current guidelines recommendations for calcium intake may help to reduce BC risk.
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http://dx.doi.org/10.1007/s00394-021-02549-5DOI Listing
October 2021

Dairy Consumption and Incidence of Breast Cancer in the 'Seguimiento Universidad de Navarra' (SUN) Project.

Nutrients 2021 Feb 21;13(2). Epub 2021 Feb 21.

Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain.

Dairy products might influence breast cancer (BC) risk. However, evidence is inconsistent. We sought to examine the association between dairy product consumption-and their subtypes-and incident BC in a Mediterranean cohort. The SUN ("Seguimiento Universidad de Navarra") Project is a Spanish dynamic ongoing cohort of university graduates. Dairy product consumption was estimated through a previously validated 136-item food frequency questionnaire (FFQ). Incident BC was reported in biennial follow-up questionnaires and confirmed with revision of medical records and consultation of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression models. Among 123,297 women-years of follow-up (10,930 women, median follow-up 12.1 years), we confirmed 119 incident BC cases. We found a nonlinear association between total dairy product consumption and BC incidence ( = 0.048) and a significant inverse association for women with moderate total dairy product consumption (HR = 0.49 (95% CI 0.28-0.84); HR = 0.49 (95% CI 0.29-0.84) = 0.623) and with moderate low-fat dairy product consumption (HR = 0.58 (95% CI 0.35-0.97); HR = 0.55 (95% CI 0.32-0.92), = 0.136). In stratified analyses, we found a significant inverse association between intermediate low-fat dairy product consumption and premenopausal BC and between medium total dairy product consumption and postmenopausal BC. Thus, dairy products, especially low-fat dairy products, may be considered within overall prudent dietary patterns.
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http://dx.doi.org/10.3390/nu13020687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924827PMC
February 2021

Dietary Antioxidant Vitamins and Minerals and Breast Cancer Risk: Prospective Results from the SUN Cohort.

Antioxidants (Basel) 2021 Feb 24;10(3). Epub 2021 Feb 24.

Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain.

There is growing interest in natural antioxidants and their potential effects on breast cancer (BC). Epidemiological evidence, however, is inconsistent. We prospectively evaluated the association between dietary intake of vitamins A, C, and E, selenium, and zinc and BC among 9983 female participants from the SUN Project, a Mediterranean cohort of university graduates. Participants completed a food frequency questionnaire at baseline, and biennial follow-up information about incident BC diagnosis was collected. Cases were ascertained through revision of medical charts and consultation of the National Death Index. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI). During an average follow-up of 11.3 years, 107 incident BC cases were confirmed. The multivariable HRs (95% CI) for BC comparing extreme tertiles of energy-adjusted dietary intakes were 1.07 (0.64-1.77; = 0.673) for vitamin A, 1.00 (0.58-1.71; = 0.846) for vitamin C, 0.92 (0.55-1.54; = 0.728) for vitamin E, 1.37 (0.85-2.20; = 0.135) for selenium, and 1.01 (0.61-1.69; = 0.939) for zinc. Stratified analyses showed an inverse association between vitamin E intake and postmenopausal BC (HR = 0.35; 95% CI, 0.14-0.86; = 0.027). Our results did not suggest significant protective associations between dietary vitamins A, C, and E, selenium, or zinc and BC risk.
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http://dx.doi.org/10.3390/antiox10030340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996327PMC
February 2021

Caesarean delivery is associated with an absolute increase in the prevalence of overweight in the offspring: The SENDO project.

J Paediatr Child Health 2021 06 11;57(6):819-825. Epub 2021 Jan 11.

IdiSNA (Instituto de Investigación Sanitaria de Navarra), Navarra Institute for Health Research, Pamplona, Spain.

Aim: The association between caesarean delivery and the risk of overweight/obesity in the offspring has been previously reported using conventional measures of association (relative risks or odds ratios). We aimed at refining the existing evidence by calculating the marginal effect of the exposure and estimating the unmeasured residual confounding.

Methods: In the 'SEguimiento del Niño para un Desarrollo Óptimo' Project, a dynamic multipurpose paediatric cohort study, we collected information from parents through self-administered online questionnaires. We estimated the offspring's risk of overweight/obesity at age 4-6 years, associated with the type of delivery through marginal effect of the exposure. Unmeasured residual confounding was assessed using the E-value.

Results: Among 407 participants (mean-age: 5.0 years (standard deviation: 0.9)), 86 (21.1%) were born by caesarean delivery. Children born by caesarean delivery had higher odds of overweight/obesity than those born vaginally. Subgroup analyses showed similar results. The multivariable adjusted marginal effect showed that caesarean delivery was associated with an 8.0% (95% confidence interval: 0.2-15.7) absolute increase in the prevalence of overweight/obesity. The estimated residual confounding showed an E-value of 4.03, higher than the OR obtained for all the confounding factors we accounted for.

Conclusions: Caesarean delivery was associated with an 8% absolute increase in the risk of overweight/obesity that is very unlikely explained by residual confounding.
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http://dx.doi.org/10.1111/jpc.15328DOI Listing
June 2021

Polyphenol intake and cognitive decline in the Seguimiento Universidad de Navarra (SUN) Project.

Br J Nutr 2021 Jul 8;126(1):43-52. Epub 2020 Oct 8.

Department of Preventive Medicine and Public Health, University of Navarra, 31008Pamplona, Navarra, Spain.

The global growing rates of cognitive decline and dementia, together with the absence of curative therapies for these conditions, support the interest in researching potential primary prevention interventions, with particular focus on dietary habits. The aim was to assess the association between polyphenol intake and 6-year change in cognitive function in the 'Seguimiento Universidad de Navarra' (SUN) Project, a Spanish prospective cohort study. Changes (final - initial) in cognitive function were evaluated in a subsample of 806 participants (mean age 66 (sd 5) years, 69·7 % male) of the SUN Project using the validated Spanish Telephone Interview for Cognitive Status-modified score. Polyphenol intake was derived from a validated semi-quantitative FFQ and matching food composition data from the Phenol-Explorer database. Multivariable linear regression models were used to evaluate the association between total polyphenol intake, polyphenol subclasses and cognitive changes. No significant association between total polyphenol intake and changes in cognitive function was found. However, a higher intake of lignans (βQuintile (Q) 5 v. Q1 0·81; 95 % CI 0·12, 1·51; Ptrend = 0·020) and stilbenes (βQ5 v. Q1 0·82; 95 % CI 0·15, 1·49; Ptrend = 0·028) was associated with more favourable changes in cognitive function over time, particularly with respect to immediate memory and language domains. Olive oil and nuts were the major sources of variability in lignan intake, and wine in stilbene intake. The results suggest that lignan and stilbene intake was associated with improvements in cognitive function.
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http://dx.doi.org/10.1017/S000711452000392XDOI Listing
July 2021

Healthful and unhealthful provegetarian food patterns and the incidence of breast cancer: Results from a Mediterranean cohort.

Nutrition 2020 Nov - Dec;79-80:110884. Epub 2020 Jun 3.

University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.

Objectives: Provegetarian diets, also known as predominantly plant-based (but not vegetarian or vegan) or plant-forward diets, have been associated with health benefits. However, a distinction is needed between high- and low-quality provegetarian dietary patterns (PVGs). We sought to examine potential associations between PVG indices and breast cancer (BC) incidence.

Methods: We assessed 10 812 women in the Seguimiento Universidad de Navarra cohort. We calculated an overall PVG pattern from a validated semi-quantitative food-frequency questionnaire as proposed by Martínez-Gonzalez et al, assigning positive scores (based on quintiles) to plant foods and reversing the quintile scores for animal foods. Participants were categorized according to tertiles of the overall score. We also calculated a healthful PVG (hPVG) and unhealthful PVG (uPVG) as proposed by Satija et al. RESULTS: After a median of 11.5 years of follow-up, 101 incident BC cases, confirmed by medical records, were observed. A significant inverse association with BC (comparing tertile 2 vs. tertile 1, HR= 0.55; 95% confidence interval, 0.32-0.95) was identified for a modest overall PVG, but not for hPVG and uPVG separately. Nevertheless, the highest tertile was not associated with BC.

Conclusions: In this large prospective cohort study, a moderate adherence to a PVG might decrease the risk of BC. Further studies should replicate and expand these results to other racial, ethnic, and socioeconomic groups.
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http://dx.doi.org/10.1016/j.nut.2020.110884DOI Listing
June 2021

Adherence to Mediterranean diet is inversely associated with the consumption of ultra-processed foods among Spanish children: the SENDO project.

Public Health Nutr 2021 Aug 23;24(11):3294-3303. Epub 2020 Jul 23.

Department of Preventive Medicine and Public Health, University of Navarra, School of Medicine, Pamplona, Spain.

Objective: To assess whether higher adherence to the traditional Mediterranean diet (MedDiet) was associated with lower consumption of ultra-processed foods (UPF) and lower free sugar intake.

Design: Cross-sectional analysis of baseline information among participants in the SENDO project, a Spanish paediatric cohort. Dietary information was collected through a semi-quantitative FFQ. Food items were classified according to the NOVA classification. Adherence to the MedDiet was evaluated through the KIDMED index.

Setting: Spain.

Participants: Three hundred eight-six children (52 % boys) with a mean age of 5·3 years old (sd 1·0) were included in the analysis.

Results: 74·4 % of the children had moderate adherence to the MedDiet (mean KIDMED score: 5·9 points; sd 1·7) and overall, 32·2 % of the total energy intake came from UPF. Each two additional points in the KIDMED score was associated with 3·1 % (95 % CI 2·1, 4·0) lower energy intake from UPF. Compared to those with low adherence to the MedDiet, children with medium and high adherence reported 5·0 % (95 % CI 2·2, 7·7) and 8·5 % (95 % CI 5·2, 11·9) lower energy intake from UPF, respectively. We also found that 71·6 % of the variability in free sugar intake was explained by the variability in UPF consumption.

Conclusions: Adherence to the traditional MedDiet was inversely associated with energy intake from UPF. Furthermore, most of the variability in free sugar intake was explained by the variability of UPF consumption. Public health strategies are needed to strengthen the adherence to the MedDiet in pre-schoolers while regulating the production, marketing and advertising of UPF.
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http://dx.doi.org/10.1017/S1368980020001524DOI Listing
August 2021

Validity and reproducibility of a semi-quantitative food frequency questionnaire in Spanish preschoolers - The SENDO project.

Nutr Hosp 2020 Aug;37(4):672-684

Universidad de Navarra.

Introduction: Introduction: currently, it is important to determine whether food frequency questionnaires (FFQ) are valid tools to collect information on usual diet in children. Objective: we evaluated the reproducibility and validity of the semi-quantitative FFQ used in a Spanish cohort of children aged 4-7 years. Methods: to explore its reproducibility, parents filled a 138-item FFQ at baseline (FFQ-0) and then one year later (FFQ-1). To explore its validity, the FFQ-1 was compared with four weighed 3-day dietary records (DRs) that were used as standard of reference. To estimate associations we calculated deattenuated Pearson's correlation coefficients to correct for season-to-season variability, and the Bland-Altman index. We also calculated the weighted kappa index and assessed participant's gross misclassification across quintiles. We analyzed data from 67 (for reproducibility) and 37 (for validity) children aged 4-7 years old, recruited by the pilot study of the SENDO project. Results: regarding reproducibility, we found mean Bland-Altman indexes of 0-10.45 % for nutrients and 1.49 %-10.45 % for foods. The adjusted r ranged between 0.29 and 0.71, and between 0.27 and 0.74 for nutrients and foods, respectively. Regarding validity, we found mean Bland-Altman indexes of 0 %-16.22 % and 0 %-10.81 % for nutrients and for food groups, respectively. The deattenuated r ranged between 0.38 and 0.81 for nutrients, and between 0.53 and 0.68 for foods. The weighted kappa index for agreement across quintiles ranged from 54.1 to 85.1 for nutrients, and from 55.4 to 78.4 for food groups. Conclusions: our results showed acceptable levels of both reproducibility and validity, and that the ad-hoc developed FFQ is a valid tool for assessing usual diet in Spanish preschoolers.
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http://dx.doi.org/10.20960/nh.03003DOI Listing
August 2020

Adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research Recommendations and Breast Cancer in the SUN Project.

Nutrients 2020 Jul 13;12(7). Epub 2020 Jul 13.

Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, 18016 Granada, Spain.

A proportion of breast cancer cases are attributable to combined modifiable risk factors. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) has recently updated the recommendations for cancer prevention and a standard scoring system has been published. The aim of this study was to evaluate the association between compliance with the 2018 WCRF/AICR cancer prevention recommendations (Third Expert Report) and the risk of breast cancer in the SUN ("Seguimiento Universidad de Navarra") prospective cohort. Spanish female university graduates, initially free of breast cancer, were included (n = 10,930). An 8-item score to measure compliance to the recommendations was built: body fat, physical activity, consumption of wholegrains/vegetables/fruit/beans, "fast foods", red/processed meat consumption, sugar-sweetened drinks consumption, alcohol intake, and breastfeeding. A stratified analysis was conducted according to menopausal status. A non-significant inverse association was observed for overall breast cancer. The inverse association became statistically significant for post-menopausal breast cancer after multivariable adjustment (hazard ratio for > 5 vs. ≤ 3 points = 0.27; 95% CI: 0.08-0.93). The results suggested that the possible inverse association with breast cancer was attributable to the combined effects of the different nutritional and lifestyle components.
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http://dx.doi.org/10.3390/nu12072076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400833PMC
July 2020

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

Clin Nutr 2021 01 4;40(1):137-145. Epub 2020 May 4.

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.

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 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 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.
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http://dx.doi.org/10.1016/j.clnu.2020.04.037DOI Listing
January 2021

Binge Drinking and Risk of Breast Cancer: Results from the SUN ('Seguimiento Universidad de Navarra') Project.

Nutrients 2020 Mar 10;12(3). Epub 2020 Mar 10.

Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain.

Alcohol intake is associated with the risk of breast cancer. Different patterns of alcohol-drinking may have different effects on breast cancer even when keeping constant the total amount of alcohol consumed. We aimed to assess the association between binge drinking and breast cancer risk. The SUN Project is a Spanish dynamic prospective cohort of university graduates initiated in 1999. In the 556-item lifestyle baseline questionnaire a validated food-frequency questionnaire was embedded. Participants completed biennial follow-up questionnaires. Cox regression models were used to estimate the hazard ratio (HR) for breast cancer associated with the exposure to binge drinking. A stratified analysis was performed according to menopausal status. We included 9577 women (mean age = 34 years, SD = 10 years), with a median follow-up of 11.8 years. Among 104,932 women-years of follow-up, we confirmed 88 incident cases of breast cancer. Women in the binge drinking group showed a higher risk of breast cancer (HR = 1.76; 95% CI: 1.03-2.99) compared to women in the non-binge drinking category. In the stratified analysis, a 2-fold higher risk for premenopausal breast cancer was associated with binge drinking habit (HR = 2.06; 95% CI: 1.11-3.82). This study adds new evidence on the association of binge drinking with breast cancer risk.
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http://dx.doi.org/10.3390/nu12030731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146187PMC
March 2020

Dietary Polyphenol Intake is Associated with HDL-Cholesterol and A Better Profile of other Components of the Metabolic Syndrome: A PREDIMED-Plus Sub-Study.

Nutrients 2020 Mar 4;12(3). Epub 2020 Mar 4.

Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain.

Dietary polyphenol intake is associated with improvement of metabolic disturbances. The aims of the present study are to describe dietary polyphenol intake in a population with metabolic syndrome (MetS) and to examine the association between polyphenol intake and the components of MetS. This cross-sectional analysis involved 6633 men and women included in the PREDIMED (PREvención con DIeta MEDiterranea-Plus) study. The polyphenol content of foods was estimated from the Phenol-Explorer 3.6 database. The mean of total polyphenol intake was 846 ± 318 mg/day. Except for stilbenes, women had higher polyphenol intake than men. Total polyphenol intake was higher in older participants (>70 years of age) compared to their younger counterparts. Participants with body mass index (BMI) >35 kg/m reported lower total polyphenol, flavonoid, and stilbene intake than those with lower BMI. Total polyphenol intake was not associated with a better profile concerning MetS components, except for high-density lipoprotein cholesterol (HDL-c), although stilbenes, lignans, and other polyphenols showed an inverse association with blood pressure, fasting plasma glucose, and triglycerides. A direct association with HDL-c was found for all subclasses except lignans and phenolic acids. To conclude, in participants with MetS, higher intake of several polyphenol subclasses was associated with a better profile of MetS components, especially HDL-c.
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http://dx.doi.org/10.3390/nu12030689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146338PMC
March 2020

Phenolic Acid Subclasses, Individual Compounds, and Breast Cancer Risk in a Mediterranean Cohort: The SUN Project.

J Acad Nutr Diet 2020 06 22;120(6):1002-1015.e5. Epub 2020 Jan 22.

Background: Biological and epidemiological evidence supports an inverse association of phenolic acids with obesity-related chronic diseases. However, no previous study has prospectively evaluated the relationship between subclasses and individual compounds of phenolic acids and the risk of postmenopausal breast cancer, one of the most important and prevalent obesity-related cancer sites.

Objective: This study examined associations between subclasses of phenolic acids, including hydroxycinnamic and hydroxybenzoic acids intake, and risk of breast cancer.

Design: The Seguimiento Universidad de Navarra (SUN) Project is a dynamic, permanently open prospective cohort which started in 1999.

Participants/setting: Participants were 10,812 middle-aged women. All of them were university graduates.

Main Outcome Measures: Usual diet was assessed at baseline and after 10 years of follow-up with a 136-item food frequency questionnaire. Phenolic acid intake was calculated by matching food consumption with the Phenol-Explorer database on phenolic acids content of each reported food item.

Statistical Analysis Performed: Participants were classified according to tertiles of subclasses or individual compounds of phenolic acids. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios and 95% CIs for breast cancer incidence.

Results: Over an average of 11.8 years of follow-up, 101 incident cases of breast cancer were confirmed. After multivariable adjustment, an inverse association between hydroxycinnamic acids intake and breast cancer was observed (hazard ratio third tertile vs first tertile 0.37, 95% CI 0.16 to 0.85; P for trend=0.029) among postmenopausal women. Specifically, chlorogenic acids (3-, 4-, and 5- caffeoylquinic acids) showed the strongest inverse association (hazard ratio third tertile vs first tertile 0.33, 95% CI 0.14 to 0.78; P for trend=0.012).

Conclusions: A higher intake of hydroxycinnamic acids, especially from chlorogenic acids-present in coffee, fruits, and vegetables-was associated with a lower incidence of breast cancer among postmenopausal women. Future observational studies are needed to corroborate these results.
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http://dx.doi.org/10.1016/j.jand.2019.11.007DOI Listing
June 2020

Coffee consumption and breast cancer risk in the SUN project.

Eur J Nutr 2020 Dec 18;59(8):3461-3471. Epub 2020 Jan 18.

Department of Preventive Medicine and Public Health, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain.

Introduction: Breast cancer prevalence is growing worldwide. Many factors, such as diet and lifestyle could be determinants of the incidence of breast cancer. Coffee has been extensively studied in relation to several chronic diseases because of its multiple effects in health maintenance and its elevated consumption. We studied the relationship between coffee intake and breast cancer risk in the SUN (Seguimiento Universidad de Navarra) prospective cohort.

Materials And Methods: We evaluated 10,812 middle-aged, Spanish female university graduates from the SUN Project, initially free of breast cancer. Coffee consumption was assessed with a 136-item validated food-frequency questionnaire (FFQ). Incident breast cancer cases were confirmed by a trained oncologist using medical records and by consultation of the National Death Index. We fitted Cox regression models to assess the relationship between baseline categories of coffee consumption and the incidence of breast cancer during follow-up. We stratified the analysis by menopausal status.

Results: During 115,802 person-years of follow-up, 101 new cases of breast cancer were confirmed. Among postmenopausal women, more than 1 cup of coffee per day was associated with a lower incidence of breast cancer (HR 0.44; 95% confidence interval: 0.21, 0.92) in the fully adjusted model, compared to women who consumed one cup of coffee or less per day. We observed no significant differences in regard to premenopausal women.

Conclusion: Even though the number of cases was low, slight indications of an inverse association between coffee consumption and breast cancer risk among postmenopausal women were observed. Further longitudinal studies are warranted to confirm this finding.
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http://dx.doi.org/10.1007/s00394-020-02180-wDOI Listing
December 2020

Total polyphenol intake and breast cancer risk in the Seguimiento Universidad de Navarra (SUN) cohort.

Br J Nutr 2019 09 12;122(5):542-551. Epub 2019 Feb 12.

Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain.

Polyphenols are a wide family of phytochemicals present in diverse foods. They might play a role in cancer development and progression. In vivo and in vitro studies have suggested beneficial properties and potential mechanisms. We aimed to evaluate the association between total and main classes of polyphenol intake and breast cancer (BC) risk in the Seguimiento Universidad de Navarra project - a prospective Mediterranean cohort study. We included 10 713 middle-aged, Spanish female university graduates. Polyphenol intake was derived from a semi-quantitative FFQ and matching food consumption data from the Phenol-Explorer database. Women with self-reported BC were asked to return a copy of their medical report for confirmation purposes; death certificates were used for fatal cases. Cox models were fitted to estimate multivariable-adjusted hazard ratios (HR) and 95 % CI for the association between tertiles (T) of polyphenol intake and BC. After 10·3 years of median follow-up, 168 probable incident BC cases were identified, out of which 100 were confirmed. We found no association between polyphenol intake and the overall BC risk. Nevertheless, we observed a significant inverse association between total polyphenol intake and BC risk for postmenopausal women, either for probable or only for confirmed cases (HRT3 v. T1 0·31 (95 % CI 0·13, 0·77; Ptrend=0·010)). Also, phenolic acid intake was inversely associated with postmenopausal BC. In summary, we observed no significant association between total polyphenol intake and BC risk. Despite a low number of incident BC cases in our cohort, higher total polyphenol intake was associated with a lower risk of postmenopausal BC.
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http://dx.doi.org/10.1017/S0007114518003811DOI Listing
September 2019

Influence of Parental Healthy-Eating Attitudes and Nutritional Knowledge on Nutritional Adequacy and Diet Quality among Preschoolers: The SENDO Project.

Nutrients 2018 Dec 3;10(12). Epub 2018 Dec 3.

Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain.

Parental nutrition knowledge and attitudes play a fundamental role in their children's food knowledge. However, little is known about their influence on their children's diet quality and micronutrient intake. Thus, we aimed to assess the association of parental nutrition knowledge and healthy-eating attitudes with their children's adherence to the Mediterranean dietary pattern and micronutrient adequacy. Parental healthy-eating attitudes and knowledge of the quality of their child's diet as well as anthropometric, lifestyle, and nutrient intake characteristics were recorded with a basal questionnaire that included a 140-item-food frequency-questionnaire. A total of 287 pre-school children were included in the analyses. Intake adequacy was defined using the Estimated Average Requirements (EAR) cut-off point method. We developed a parental nutrition knowledge and healthy-eating attitudes scores and evaluated whether they were independently associated with 1) children's inadequate intake (probability of failing to meet ≥3 EAR) of micronutrients, using logistic regression analyses, and 2) children's diet quality (adherence to the Mediterranean Diet according to a Mediterranean Diet Quality Index for children and adolescents, the KIDMED index), using multiple linear regression models. A higher score in the parental healthy-eating attitudes score was associated with lower risk of failing to meet ≥3 EAR compared with the reference category (odds ratio (OR): 0.3; 95% confidence interval (CI) 0.12⁻0.95; for trend: 0.037) and a higher adherence to the Mediterranean diet in the most adjusted model ( coefficient: 0.34; 95% CI 0.01⁻0.67; for trend: 0.045). Our results suggest a positive association of parental healthy-eating attitudes with nutritional adequacy and diet quality in a sample of Spanish preschoolers. Public health strategies should focus on encouraging parental healthy-eating attitudes rather than simply educating parents on what to feed their children, recognizing the important influence of parental behavior on children's practices.
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http://dx.doi.org/10.3390/nu10121875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316633PMC
December 2018
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