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Sihan Song1, Hyun Jo Youn2, So-Youn Jung3, Eunsook Lee3, Zisun Kim4, Jihyoung Cho5, Young Bum Yoo6, Hyeong-Gon Moon7, 8, Dong-Young Noh7, 8, Jung Eun Lee9
Abstract
Objectives
We aimed to examine levels of physical activity, anthropometric features, and health-related quality of life (HRQoL) among Korean breast cancer survivors who reported changes in their diet after diagnosis.
Methods
A total of 380 women who had been diagnosed with stage I to III breast cancer and had breast cancer surgery at least six months before the interview were included. Participants provided information on dietary change after diagnosis, post-diagnostic diet, physical activity, anthropometric measures, and HRQoL through face-to-face interview. We assessed HRQoL levels of breast cancer survivors using a validated Korean version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Breast Cancer Module (BR23). We used the logistic regression and generalized linear models to identify the associations of dietary changes in relation with physical activity, anthropometry, and HRQoL.
Results
The majority of participants (72.6%) reported that they have changed their diet to a healthier diet after diagnosis. Breast cancer survivors who reported to have change to a healthy diet had higher intakes of vegetables and fruits and lower intakes of red and processed meats, and refined grains than those who did not. Also, survivors with a healthy change in their diet were more likely to engage in physical activity (top vs. bottom tertile: odds ratio [OR], 1.85; 95% confidence interval [95% CI], 1.02-3.36) and have lower body mass index (BMI) (OR, 0.90; 95% CI, 0.82-0.98 for one kg/m2 increment in BMI) compared to those who did not. We found that a healthy change in diet was associated with higher scores of physical functioning (p=0.02) and lower scores of constipation (p=0.04) and diarrhea (p=0.006) compared to those who did not.
Figures and Tables
Table 1
Demographic, clinical and lifestyle characteristics of study participants according to change to a healthy diet after diagnosis of breast cancer
1) Log transformed t-test was used for continuous variables and chi-square test was used for categorical variables.
2) SD: standard deviation
3) Number of participants did not equal to 380 because some participants did not provide the relevent information.
4) AJCC: American Joint Committee on Cancer
5) BMI: body mass index
6) NA: Not available
7) Fisher exact test was used.
Table 2
Adherence score of American Cancer Society (ACS) or World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines and intake of food groups at interview according to change to a healthy diet after diagnosis of breast cancer (n=380)
Table 3
Odds ratio (OR) and 95% confidence interval (CI) for change to a healthy diet by physical activity and anthropometric measures (n=380)
1) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current).
2) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current). For physical activity, BMI at diagnosis (<23, 23-<25, ≥25 kg/m2) was additionally adjusted. For BMI or weight change, physical activity (MET hours/week, tertile) was additionally adjusted.
3) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current), physical activity (MET hours/week, tertile), and BMI at diagnosis (<23, 23-<25, ≥25 kg/m2).
4) MET: metabolic equivalent task.
5) P for trend was calculated by assigning median or ordinal value as continuous variable.
6) Number of participants did not equal to 380 because some participants did not provide the relevant information.
7) BMI: body mass index
8) SD: standard deviation
Table 4
Health-related quality of life (HRQoL) scores according to change to a healthy diet after diagnosis of breast cancer (n=204)
1) LS means: least-squares means
2) 95% CI: 95% confidence interval
3) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index at diagnosis (<23, 23-<25, ≥25 kg/m2), marital status (married or cohabitation, unmarried or divorced or widowed), current menopausal status (premenopausal, postmenopausal), education level (middle school or below, high school, and college or above), stage of breast cancer (I, II, III), time from breast cancer surgery (6 month-<1 year, 1 year-<5 years, ≥5 years), and alcohol intake (never, former, current).
4) EORTC QLQ-30: EUROPEAN Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30
5) BR23: breast cancer module
Acknowledgments
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2014R1A2A2A01007794).
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