The Effect of Diet Intervention in Breast Cancer: A Meta-analysis

Bok Yae Chung; Eun Hee Oh

doi:10.5388/aon.2017.17.1.1

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Chung and Oh: The Effect of Diet Intervention in Breast Cancer: A Meta-analysis

Review Article

Asian Oncology Nursing 2017; 17(1): 1-11.

Published online: 31 March 2017

DOI: https://doi.org/10.5388/aon.2017.17.1.1

The Effect of Diet Intervention in Breast Cancer: A Meta-analysis

Bok Yae Chung¹, Eun Hee Oh²

¹College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea.

²Department of Nursing, Kyungpook National University Hospital, Daegu, Korea.

Address reprint requests to: Oh, Eun Hee. Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-5170, Fax: +82-53-200-5171, misum1999@naver.com

Received 10 January 2017 Revised 18 March 2017 Accepted 24 March 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the effect of diet intervention in breast cancer patients through meta-analysis.

Methods

For the study purpose, 18 studies were selected using PubMed, ScienceDirect, ProQuest and CINAHL. Meta-analysis was performed using a random effects model, and the effect size on outcome variables in breast cancer were calculated.

Results

The effect size for body mass index, body weight, energy intake from fat (%), and energy intake of diet intervention was −0.75 (95% CI:−1.22~−0.27), −0.93 (95% CI:−1.58~−0.28), −0.82 (95% CI:−1.11~−0.52), and −1.10 (95% CI:−1.85~−0.34). For heterogeneity, moderator analysis was performed using intervention type and intervention duration. As a result of the moderator analysis, BMI, body weight, energy intake from fat (%), and energy intake were not statistically significant on intervention type and intervention duration. But, only BMI had a significant difference on intervention duration (p=.013).

Conclusion

Further research is needed to determine whether exercise intervention will be included in nutritional intervention for breast cancer patients. Also, even if the duration of the intervention is less than six months, a strategy for sustaining long-term intervention effects will be needed.

Keywords: Breast Neoplasms, Diet, Meta-Analysis

Figures and Tables

Fig. 1

Flow chart of study selection process.

Fig. 2

Effect Size of Outcome Variables.

Table 1

General Characteristics of Studies Included in Meta-analysis

Reference	Study design	Staging	Subject	Sample size			Intervention type	Intervention duration	Measurement
Reference	Study design	Staging	Subject	Exp.	Cont.	T	Intervention type	Intervention duration	Measurement
Christy et al. (2011)	RCT	Early stage	PC, BC	236	253	489	Diet	10 months	Diet quality index, Total % calories from fat, Total % calories from saturated fat, No. of daily servings of F/V, BMI
Denmark-Wahnefried et al. (2006)	RCT	-	BC, PC	77	83	160	Exercise+Diet	6 months	Exercise frequency, self-efficacy, readiness to exercise, energy intake from fat (%), fruit and vegetable intake, BMI, depression
Denmark-Wahnefried et al. (2007)	RCT	Early stage	BC, PC	253	266	519	Exercise+Diet	10 months	BMI, dietary consumption, physical activity, psychosocial/behavioral indices
Denmark-Wahnefried et al. (2008)	RCT	I-IIIA	BC	CA+EX 26 CA+EX+FVLF29	CA 27	82	Exercise+Diet	6 months	Physical activity, dietary intake, body composition, anthropometric, quality of life
Denmark-Wahnefried et al. (2014)	RCT	0~III	Overweight BC & Daughters	Individual 23 Team 23	17	63	Exercise+Diet	1 year	BMI, BW, SBP, physical activity, diet quality index, self-efficacy, physical quality of life, mental quality of life
Djuric et al. (2002)	RCT	-	BC	WW 6 IC 9 Combination 8	11	34	Diet	1 year	Weight loss, numbers of women achieving 10% weight loss, Reported dietary intakes from 3-day food records
Goodwin et al. (2014)	RCT	I-III	BC	120	124	244	Exercise+Diet	2 years	BW, PA, Diet, QoL
Greenlee et al. (2015)	RCT	0~III	BC	30	31	61	Diet	3 months	Daily total caloric intake, daily fruit and vegetable intake, daily intake of targeted fruit and vegetable, daily fat intake, waist & hip circumference, BMI, BW
Harrigan et al. (2016)	RCT	0~III	BC	In-person counseling 33 Telephone counseling 34	usual care 33	100	Exercise+Diet	6 months	Body composition, physical activity, diet, and serum biomarkers.
Hebert et al. (2001)	RCT	I~II	BC	Nutrition education 50 Stress reduction 51	Usual care 56	157	Diet	4 months	Dietary fat, complex carbohydrates, fiber, body mass
Hoy et al. (2009)	RCT	Early stage	BC	380	648	1,028	Diet	5 years	Energy intake from fat (%)
Mefferd et al. (2007)		I~IIIA	overweight BC	47	29	76	Exercise+Diet	4 months	Waist & hip circumference, waisto-hip ratio, BMI
Pakiz et al. (2011)	RCT	I~IIIA	overweight or obese BC	44	24	68	Exercise+Diet	4 months	BMI, BW, waist circumference, % body fat, PA
Schiavon et al. (2015)	NRCT	Early stage	BC	18	75	93	Diet	1 year	Daily dietary intake, biomarkers, BW, BMI
Shaw et al. (2007)a	RCT	-	BC	Weight reduction 19 Low fat 17	15	51	Diet	6 months	Arm volume, anthropometric measures, dietary intake
Shaw et al. (2007)b	RCT	-	BC	11	10	21	Diet	3 months	Arm volume, anthropometric measures, dietary intake
Thompson et al. (2015)	NRCT	-	BC	Low carbohydrate diet 66 Low fat diet 73	53	192	Diet	6 months	BW, BMI, body fat, body mass index, waist & hip circumference, lean weight
Winters et al. (2004)	RCT	Early stage	BC	50	113	163	Diet	1 year	Energy, dietary variables

Exp.= Experimental group; Cont.= Control group; T= Total; RCT= Randomized Controlled Trial; NRCT= Non-Randomized Controlled Trial; BC= Breast cance; PC= Prostatic cancer; BMI= Body mass index; TG= Plasma triglycerides; Chol= Plasma cholesterol; HDL= HDL cholesterol; LDL= LDL cholesterol; QOL= Quality of life; PA= Physical activity; CA= Calcium-rich diet; EX= Exercise; FVLF= High fruit and vegetable and low-fat diet; WW= Weight Watchers; IC= Individualized counseling.

Table 2

Risk of Bias for RCT and NRCT

Categories	Domain	Risk of Bias
Categories	Domain	Unclear	Low	High
Randomized controlled trial studies	Random sequence generation	5	7	3
	Allocation concealment	9	6	-
	Blinding of participants and personnel	9	6	-
	Blinding of outcome assessment	7	8	-
	Incomplete outcome data	-	15	-
	Selective reporting	-	15	-
	Other bias	-	15	-
Non randomized controlled trial studies	Selection of participants	-	3	-
	Confounding variables	3	-	-
	Measurement of exposure	-	3	-
	Blinding of the outcome assessments	3	-	-
	Incomplete outcome data	-	3	-
	Selective outcome reporting (reporting bias)	-	3	-

RCT= Randomized controlled trial; NRCT= Non-randomized controlled trial.

Table 3

Subgroup Analysis by Intervention Type and Intervention Duration

Variables	Categories	Subgroup	k	Hedges'g	95%CI		I² (%)	Q_b (p)
Variables	Categories	Subgroup	k	Hedges'g	Lower	Upper	I² (%)	Q_b (p)
Intervention type	Body mass index	Diet	6	−1.04	−1.83	−0.24	97.0	0.95 (.331)
	Body mass index	Diet with exercise	6	−0.48	−1.26	0.29	83.5	0.95 (.331)
	Body weight	Diet	4	−1.28	−2.15	−0.41	91.6	1.10 (.294)
	Body weight	Diet with exercise	5	−0.66	−1.42	0.09	89.7	1.10 (.294)
	Energy intake from fat (%)	Diet	7	−1.03	−1.41	−0.64	91.0	2.92 (.087)
	Energy intake from fat (%)	Diet with exercise	4	−0.49	−0.97	−0.01	78.6	2.92 (.087)
	Energy intake	Diet	7	-1.40	−2.32	−0.47	94.7	1.48 (.224)
	Energy intake	Diet with exercise	2	−0.21	−1.88	1.47	27.0	1.48 (.224)
Intervention duration	Body mass index	>6 months	4	0.01	−0.73	0.75	0.0	6.19 (.013)
	Body mass index	≤6 months	8	−1.16	−1.70	−0.61	95.0	6.19 (.013)
	Body weight	>6 months	2	−0.16	−1.46	1.14	0.0	1.72 (.189)
	Body weight	≤6 months	7	−1.16	−1.87	−0.44	92.1	1.72 (.189)
	Energy intake from fat (%)	>6 months	5	−0.88	−1.33	−0.44	94.3	0.14 (.705)
	Energy intake from fat (%)	≤6 months	6	−0.77	−1.19	−0.34	82.8	0.14 (.705)
	Energy intake	>6 months	4	−0.71	−1.96	0.53	38.0	0.79 (.374)
	Energy intake	≤6 months	5	−1.48	−2.61	−0.34	96.4	0.79 (.374)

Notes

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. 2015R1D1A1A01061493).

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