Overeating, caloric restriction and breast cancer risk by pathologic subtype: the EPIGEICAM study

Virginia Lope ,Adela Castelló ,Antonio Antón ,M A Jimeno ,Amparo Ruı́z ,Susana Bezares ,Àngels Arcusa ,Carlos Jara ,Jesús Vioque ,José Manuel Baena-Cañada ,Ana Lluch ,José Ignacio Chacón ,Miguel Martín ,Montserrat Muñoz ,José Ángel García-Sáenz ,Beatriz Pérez‐Gómez ,Ana Casas ,Eva Carrasco ,Manuel Ramos-Vázquez ,Ana De Juan-Ferré ,Silvia Antolín ,Pedro Sánchez‐Rovira ,Marina Pollán

doi:10.1038/s41598-019-39346-4

Abstract

This study analyzes the association of excessive energy intake and caloric restriction with breast cancer (BC) risk taking into account the individual energy needs of Spanish women. We conducted a multicenter matched case-control study where 973 pairs completed lifestyle and food frequency questionnaires. Expected caloric intake was predicted from a linear regression model in controls, including calories consumed as dependent variable, basal metabolic rate as an offset and physical activity as explanatory. Overeating and caloric restriction were defined taking into account the 99% confidence interval of the predicted value. The association with BC risk, overall and by pathologic subtype, was evaluated using conditional and multinomial logistic regression models. While premenopausal women that consumed few calories (>20% below predicted) had lower BC risk (OR = 0.36; 95% CI = 0.21–0.63), postmenopausal women with an excessive intake (≥40% above predicted) showed an increased risk (OR = 2.81; 95% CI = 1.65–4.79). For every 20% increase in relative (observed/predicted) caloric intake the risk of hormone receptor positive (p-trend < 0.001) and HER2+ (p-trend = 0.015) tumours increased 13%, being this figure 7% for triple negative tumours. While high energy intake increases BC risk, caloric restriction could be protective. Moderate caloric restriction, in combination with regular physical activity, could be a good strategy for BC prevention.

Highlights

Breast cancer is the most common malignant tumour in women worldwide
The present study analyzes the association between breast cancer risk and women’s relative caloric intake according to participants’ physical activity and basal metabolic rate
Our results suggest that restricted caloric intake offers a protective effect against breast cancer, especially in premenopausal women, whereas excessive caloric consumption increases breast cancer risk

Summary

Introduction

Breast cancer is the most common malignant tumour in women worldwide. Compared to European levels, rates in Spain in 2015 are somewhere in the middle, with an age-standardised rate of 88.3 cases[1] and 15.7 deaths[2] per 100,000 women-years (based on the European standard). Basal metabolic rate is defined as the energy required for maintaining the body’s vital functions under resting conditions, and represents 45 to 70 percent of daily total energy expenditure. This rate is determined by the individual’s age, gender, body size, and body composition[19]. The main aim of this study is to investigate the association between relative caloric intake, as a function of daily total energetic expenditure and body size, and the risk of breast cancer in Spanish women. Secondary aims include evaluating whether this association differs by menopausal status, specific risk profile, and/or tumour pathologic subtype

Objectives

Methods

Results

Conclusion