DIETARY FIBER INTAKE IN YOUNG

ADULTS AND BREAST CANCER RISK

M A RYA M S . FA RV I D , P H D , . H E AT H E R E L I A S S E N , S C D , E U N YO U N G C H O , S C D ,
X I A O M E I L I A O , P H D , W E N D Y Y. C H E N , M D , M P H , W A LT E R C . W I L L E T T , M D , D R P

Cally Byrne
Oncology Rotation
Jennifer Davis, MS,
RD, LD

BACKGROUND
~1 in 8 U.S. women will develop invasive breast cancer
Previous studies No significant association b/t fiber &
breast cancer
No examination of diet during adolescence or early
adulthood

OBJECTIVE OF STUDY
Evaluate fiber intake during adolescence and early
adulthood in relation to breast cancer risk in the
Nurses Health Study II.
A diet high in fiber has been hypothesized to reduce
breast cancer incidence by inhibiting reabsorption of
estrogen, thus decreasing circulating levels.

DESIGN
Analysis of Nurses Health Study II
(NHSII), an ongoing prospective
cohort study.

PARTICIPANTS/SETTING
NHSII
1989: Enrollment of female RNs, 2542 y/o
n=116,430

1991: Diet was first measured w/

Food Frequency Questionnaire (FFQ)
After exclusions: n= 90,534

1997-1998: High School Food

Frequency Questionnaire (HS-FFQ)
After exclusions: n=44,263

EXCLUSION CRITERIA
Early Adulthood Fiber Intake Analysis
Implausible total energy intake (<600 or >3,500 kcal/day)
Postmenopausal in 1991
Cancer dx before 1991

Adolescent Fiber Intake Analysis

Implausible total energy intake (<600 or >5,000 kcal)
Cancer dx before 1998

DIETARY INTAKE
Validated
Semiquantitative FFQ
~130 items about usual dietary
intake and alcohol consumption
during the past year
1991 and every 4 years
thereafter
Early Adulthood Fiber Analysis

Validated
Semiquantitative HS-FFQ
124 items about foods typically
consumed b/t 1960-1980
Adolescent Fiber Intake
Analysis

DOCUMENTATION OF
BREAST CANCER
Bennial NHSII
questionnaires
Deaths:
Family members
USPS
Annual review of National
Death Index

Dx confirmation
Hospital records
Pathology reports

OTHER VARIABLES
BC Risk factors
BMI
Alcohol consumption
Menopausal status
Family hx of BC
Race
Age at menarche
Oral contraceptive use
Postmenopausal
hormone use

MAIN OUTCOME
MEASURES
Dietary Fiber
Intake
Adolescent
Early Adulthood

Breast Cancer
Premenopausal
Postmenopausal

STATISTICAL ANALYSES
PERFORMED
Quintiles based on dietary intake
Multivariable-adjusted Cox proportional hazards
regression
Adjusted for risk factors

Adjustment for alternate healthy eating index score,

red meat, animal fat, and beta-carotene
2-sided P-values

RESULTS

CONCLUSIONS
Consumption of foods high in fiber can reduce breast
cancer risk
10 g fiber = one apple and two slices of whole wheat
bread
Dietary fiber intake during adolescence and early
adulthood may be particularly important
American Cancer Society guidelines

IMPLICATIONS FOR
CLINICAL PRACTICE
Growing female
Veteran population
Ensure adequate
fiber intake in
women, particularly
those in early
adulthood

REFERENCES
Farvid MS, Eliassen H, Cho E, et al. Dietary Fiber intake
in young adults and breast cancer risk. Pediatrics.
2016; 137(3).
Breastcancer.org. U.S. Breast Cancer Statistics. http://
www.breastcancer.org/symptoms/understand_bc/statist
ics
. Accessed February 15, 2016. Breastcancer.org.
The Nurses Health Study. http
://www.channing.harvard.edu/nhs/?page_id=73.
Accessed February 15, 2016.

QUESTIONS?