Abstract
Little information is available about the relationship between quality of life of women who have survived breast cancer (specifically, symptoms including those of menopause and depression) and the quality of their diet. In this cross-sectional study, 117 women with known primary breast cancer completed a self-administered food frequency questionnaire (FFQ) reflecting usual diet during the past year, a Survey of Feelings and Attitudes using the Center for Epidemiologic Studies Depression scale (CES-D) and a survey that includes menopausal symptoms among others common to women with a history of breast cancer. When women's responses to the FFQ were scored using the Healthy Eating Index (HEI), most often diets were evaluated as those that ‘need improvement’ with a mean total HEI score of 67.2. With regard to the CES-D scores, study women averaged 9.5, with 19 women being classified as clinically depressed. HEI and CES-D scores were inversely related (ρ = −0.22, p = 0.02). A negative correlation was also observed between energy-adjusted calcium intakes and CES-D scores (ρ = −0.19, p = 0.04). Clinical depressed women had not only lower HEI scores and calcium intakes, but also lower grain and variety scores. Comparisons to national data for disease-free women and that available for those with breast cancer suggest that our study women consumed diets low in energy and dietary variety. Diet quality may be an important factor influencing the manifestation of depressive symptoms in breast cancer survivors or conversely, poorer diet quality may be an outcome of depression.
References
Zhang S, Folsom AR, Sellers TA, Kushi LH, Potter JD: Better breast cancer survival for postmenopausal women who are less overweight and eat less fat: the Iowa Women's Health Study. Cancer 76: 275–283, 1995
Rohan TE, Hiller JE, McMichael AJ: Dietary factors and survival from breast cancer. Nutr Cancer 20: 167–177, 1993
Holm L-E, Nordvegang E, Hjalmar M-L, Lidbrin E, Callmer E, Nilsson B: Treatment failure and dietary habits in women with breast cancer. J Natl Cancer Inst 85: 32–36, 1993
Sasaki S, Horacsek M, Kesteloot H: An ecological study of the relationship between dietary fat intake and breast cancer mortality. Prev Med 22: 187–202, 1993
Gregorio DI, Emrich LJ, Graham S: Dietary fat consumption and survival among women with breast cancer. J Natl Cancer Inst 65: 37–41, 1985
Cohen LA, Rose DP, Wynder EL: A rationale for dietary intervention in postmenopausal breast cancer patients: an update. Nutr Cancer 19: 1–10, 1993
Nordevang E, Azavedo E, Svane G, Nilsson B, Holm L-E: Dietary habits and mammographic patterns in patients with breast cancer. Breast Cancer Res Treat 26: 207–215, 1993
Jain M, Miller B, To T: Premorbid diet and the prognosis of women with breast cancer. J Natl Cancer Inst 88: 1390–1397, 1994
Ingram D: Diet and subsequent survival in women with breast cancer. Br J Cancer 69: 592–595, 1994
Holm L-E, Callmer E, Hjalmer M-L, Lidbrink E, Nilsson B, Skoog L: Dietary habits and prognostic factors in breast cancer. J Natl Cancer Inst 81: 1218–1223, 1989
Saxe GA, Rock CL, Wicha MS, Schottenfeld D: Diet and risk for recurrence and survival. Breast Cancer Res Treat 53: 241–252, 1999
Kant AK, Schatzkin A, Graubard BI, Schairer C: A prospective study of dietary quality and mortality in women. JAMA 283: 2109–2115, 2000
Hebert JR, Hurley TG, Ma Y: The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat 51: 17–28, 1998
Ferrans CE: Quality of life through the eyes of survivors of breast cancer. Oncol Nurs Forum 21: 1645–1651, 1994
Duffy LS, Greenberg DB, Younger J, Ferraro MG: Iatrogenic acute estrogen deficiency and psychiatric syndromes in breast cancer patients. Psychosomatics 40: 304–308, 1999
Kensinger GJ, Murtaugh MA, Reichmann SK, Tangney CC: Psychological pathology is greater among weight cycling women with severe binge eating. J Am Diet Assoc 98: 863–868, 1998
Musante GJ, Costanzo PR, Friedman KE: The comorbidity of depression and eating dysregulation processes in a dietseeking obese population: a matter of gender specificity. Int J Eat Disord 23: 65–75, 1998
Pesa J: Psychosocial factors associated with dieting behaviors among female adolescents. J School Health 69: 196–201, 1999
Scott B, Larson T, Brunner R: Ecological and attidudinal influences on dietary quality in HIV infected adults. Int Conf AIDS 12: 843–844, 1998
Hebert J, Ebbeling CB, Olendzki BC, Hurley TG, Ma Y, Saal N, Ockene JK, Clemow L: Change in women's diet and body mass following intensive intervention for early stage breast cancer. J Am Diet Assoc 101: 421–428, 2001
Kristal AR, Patterson RE, Glanz K, Heimendinger J, Hebert JR, Feng Z, Probart C: Psychosocial correlates of healthful diets: baseline results from theWorking Well Study. Prev Med 24: 221–228, 1995
Dolecek TA, Milas NC, Van Horn LV, Ferrand ME, Gorder DD, Duchene AG, Dyer JR, Stone PA, Randall BL: A longterm intervention experience: lipid responses and dietary adherence patterns in the multiple risk factor intervention trial. J Am Diet Assoc 86: 752–758, 1986
Jeffery RW, French SA, Schmid TL: Attributions for dietary failures: problems reported by participants in the hypertension prevention trial. Health Psycho l9: 315–329, 1990
Boyd NF, Cousins M, Kriukov V: A randomized controlled trial of dietary fat reduction: retention of subjects and characteristics of dropouts. J Clin Epidemiol 45: 31–38, 1992
US Department of Agriculture, Center for Nutrition Policy and Promotion: The Healthy Eating Index 1994–1996. CNPP-5, 1998
Haines PS, Siega-Riz, AM, Popkin BM: The diet quality index revised: a measurement instrument for populations. J Am Diet Assoc 99: 697–704, 1999
Huijbregts PPCW, Feskens EJM, Rasanen L, Fidanza F, Nissinen A, Menotti A, Kromhout D: Dietary pattern and 20 year mortality of elderly men in Finland, Italy, and the Netherlands: longitudinal study. BMJ 315: 13–17, 1997
Kennedy ET, Ohls J, Carlson S, Fleming K: The healthy eating index: design and applications. J Am Diet Assoc. 95: 1103–1008, 1995
McCullough ML, Feskanich D, Stampfer MJ, Rosner BA, Hu FB, Hunter DJ, Variyam JN, Colditz GA, Willett WC: Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr 72: 1214–1222, 2000
Block G, Thompson FE, Hartman AM, Larkin FA, Guire KE: Comparison of two dietary questionnaires validated against multiple dietary records collected during a 1-year period. J Am Diet Assoc 92: 686–693, 1992
Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1: 385–401, 1977
Neugarten BL, Kraines RJ: ‘Menopausal symptoms’ in women of various ages. Psychosom Med 27: 266–273, 1965
Block G, Harrison G, Lee M, Gold E, Greendale G: Personal Communication, 1997
Bowman SA, Lino M, Gerrior SA, Basiotis PP: The Healthy Eating Index: 1994–1996. U.S. Department of Agriculture, Center for Nutrition Policy and Promotion, Washington, DC, CNPP-5, 1998
The American Cancer Society: Breast Cancer Treatment by Stage. Available at: http://www3.cancer.org/cancerinfo/ main_cont.asp?st =tr&ct=5. Accessed August 22, 1999
Harris JR, Hellman S: Natural history of breast cancer. In: Harris JR, Lippman ME, Morrow M, Hellman S (eds) Diseases of the Breast. Lippincott-Raven Publishers, Philadelphia, PA, pp. 375–391, 1996
Avis NE, Brambilla D, McKinaly SM, Vass K: A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women's Health Study. Ann Epidemiol 4: 214–220, 1994
Carpenter JS, Andrykowski MA: Menopausal symptoms in breast cancer survivors. Oncol Nurs Forum 26: 1311–1317, 1999
Couzi RJ, Helzlsouer KJ, Fetting JH: Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. J Clin Oncol 13: 2737–2744, 1995
Willett W, Stampfer MF: Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124: 17–29, 1986
Kushi LH, Potter JD, Bostick RM, Drinkard CR, Sellers TA, Gapstur SM, Cerhan JR, Folsom AR: Dietary fat and risk of breast cancer according to hormone receptor status. Cancer Epidemiol Biomark Prev 4: 11–19, 1995
Brown CC, Kipnis V, Freedman LS, Hartman AM, Schatzkin A, Wacholder S: Energy-adjustment methods for nutritional epidemiology: the effect of categorization. Am J Epidemiol 139: 323–338, 1994
US Department of Agriculture: Agricultural Research Service 1994–1996 Continuing Survey of Food Intakes by Individuals and 1994–1996 Diet and Health Knowledge Survey [CD_ROM]
Taioli E, Nicolosi A, Wynder EL: Dietary habits and breast cancer: a comparative study of United States and Italian data. Nutr Cancer 16: 259–265, 1991
Food and Nutrition Board: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academy Press, Washington DC, 2001
Food and Nutrition Board: Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride. National Academy Press, Washington DC, 1997
Food and Nutrition Board: Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. National Academy Press, Washington DC, 1998
Food and Nutrition Board: Dietary Reference Intakes for Vitamin E, Vitamin C, Selenium and Carotenoids. National Academy Press, Washington DC, 2000
Newman V, Rock CL, Faerber S, Flatt SW, Wright FA, Pierce JP: Dietary supplement use by women at risk for breast cancer recurrence. The Women's Healthy Eating and Living Study Group. J Am Diet Assoc 98: 285–292, 1998
Rock CL, Newman V, Flatt SW, Faerber S, Wright FA, Pierce JP, for the Women's Healthy Eating and Living Study Group: Nutrient intakes from foods and dietary supplements in women at risk for breast cancer recurrence. Nutr Cancer 29: 133–139, 1997
Alpert JE, Mischoulon D, Nierenberg AA, Fava M: Nutrition and depression: focus on folate. Nutrition 16: 544–581, 2000
Ghadirian AM, Anath J, Engelsmann F: Folic acid deficiency in depression. Psychomatics 21: 926–928, 1980
Godfrey PSA, Toone BK, Carney MWP, Flynn TG, Bottiglieri T, Laundy M, Chanarin I, Reynolds EH: Enhancement of recovery from psychiatric illness by methylfolate. Lancet 336: 392–393, 1990
Arasteh, K: A beneficial effect of calcium intake on mood. J Orthomol Med 9: 199–204, 1994
Burstein HJ, Gelber S, Guadagnoli E, Weeks JC: Use of alternative medicine by women with early-stage breast cancer. N Engl J Med 340: 1733–1739, 1999
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tangney, C., Young, J., Murtaugh, M. et al. Self-Reported Dietary Habits, Overall Dietary Quality and Symptomatology of Breast Cancer Survivors: a Cross-Sectional Examination. Breast Cancer Res Treat 71, 113–123 (2002). https://doi.org/10.1023/A:1013885508755
Issue Date:
DOI: https://doi.org/10.1023/A:1013885508755