Dietary Patterns, Whole Plant Foods, Nutrients and Phytochemicals in Breast Cancer Prevention and Management

Abstract

Dietary choices including: (1) level of adherence to healthy vs Western dietary patterns; (2) high vs low dietary energy density intake; (3) type and level of dietary fat, fiber and protein consumed; (4) adequate vs inadequate intake of calcium, folate and α-tocopherol; (5) type and levels of non-starchy vegetables and fruits containing dietary carotenoids and flavonoids intake; (6) level of phytoestrogen containing legumes and seeds consumed; and (7) higher vs lower intake of alcohol or coffee are examples of dietary factors that may influence breast cancer (BC) risk, recurrence or mortality. Biological factors and mechanisms associated with diet and BC risk and survival include: body weight and central adiposity, tumor advancement, systemic and tissue lipid/fatty acid peroxidation and inflammation, epigenetic and transcriptional regulation, hormone levels (e.g., estrogen, insulin, leptin, adiponectin and growth factor cascades), insulin resistance, and various endometabolic and colonic microbiota processes, which can influence BC initiation and progression. Lifestyle indicators, which are associated with increased BC risk, recurrence or mortality, especially for postmenopausal women, may include having an overweight or obese BMI, weight gain by over 15 lbs over 4 years, and physical inactivity. Patients with BC are most often either overweight or obese at diagnosis and obesity increases mortality risk in both pre- and postmenopausal women with BC Meta-analyses reported that healthy dietary patterns reduced overall BC risk, whereas a high consumption of alcohol and a Western diet increased BC risk. Healthy dietary patterns, especially the Mediterranean diet, DASH diet and the vegan diet are effective in reducing BC risk and improving odds for survival. Highly colored non-starchy vegetables rich in carotenoids and flavonoids have been associated with reduced BC risk especially in estrogen receptor negative BC. Key adverse dietary components for BC risk and survival include high intake of red and processed meats, high energy dense and high glycemic foods and beverages and >1 alcoholic beverage/day. After BC diagnosis, soy foods (>10 mg isoflavones/day or > ½ cup of soy milk or 2 ounces of tofu/day) may help to reduce risk of BC recurrence or mortality in both Asian and Western women.