Fat, Caloric Intake, and Obesity: Lifestyle Risk Factors for Breast Cancer

https://doi.org/10.1016/S0002-8223(97)00726-8Get rights and content

Abstract

Dietary fat is a likely important determinant of postmenopausal breast cancer as part of an intricate and inseparable interaction of lifestyle cancer risk factors that include dietary fat, type of fat, energy intake and expenditure, and obesity. These factors possibly build upon individual susceptibilities derived from a complex array of polygenetic risk determinants. Epidemiologic studies have not provided conclusive evidence for a dietary fat-breast cancer association, partly because studies that focus on a single nutrient cannot always evaluate readily the interactive effects of other lifestyle factors. Further, persons generally underestimate their usual dietary intake, measured by either food frequency questionnaires (FFQs) or diet records. A dietary measurement model that accounts for this underreporting demonstrated that FFQs and diet records may not be able to detect a dietary fat-breast cancer association because of measurement error biases. Although meta-analysis of epidemiologic data across individual studies suggests only a weak association between breast cancer and dietary fat, this result is compatible with the dietary measurement model and does not rule out a contributing role for dietary fat, either alone or with other causative factors. Research is needed that focuses on a comprehensive approach to dietary lifestyle choices and breast cancer risk and that emphasizes a fat-caloric intake-obesity linkage. The best hope for a definitive answer may rest with randomized, controlled clinical trials. Two such trials, the Women's Health Initiative and the Women's Intervention Nutrition Study, are under way. J Am Diet Assoc. 1997;97(suppl):S24-S30.

Section snippets

Epidemiologic Perspective

Historically, epidemiology, the study of the etiology, distribution, and control of disease in populations, has identified cause-and-effect determinants for many diseases, such as, for example, scurvy (4). Deficiency of vitamin C as the cause for scurvy was identified with relative ease, and conclusive associations were demonstrated. Research of this type made consumers become accustomed to science providing both the reason and the cure for many common maladies.

However, molecular biology has

Methods of Dietary Assessment

The strength of any epidemiologic dietary study is based, in part, on the assessment of dietary intake. Approaches to dietary assessment in international epidemiologic studies include semi-quantitative food frequency questionnaires (FFQ), diet/food records, and 24-hour dietary recalls. In many cases, these methods are based on less-than-complete data and cannot be validated in the true sense. The consistently poor agreement of dietary assessment methods with each other, even under the best of

Consumer Reaction

Americans have become increasingly interested in and often actively seek out news of clinical research that they believe will improve their health or extend the quality of their lives (66). A unique phenomenon of life in the late 20th century is that the results of recent epidemiologic research can become entwined with lifestyle within only months. The American public's eagerness for simple solutions to complex health concerns often results in inappropriate expectations and behavior. For

Conclusion

It is unlikely that any one epidemiologic study, regardless of its excellence, will provide the definitive evidence for a link between dietary lifestyle choices and breast cancer incidence. Each study contributes to the overall pattern of evidence that either supports or refutes a hypothesis (66). While this investigative process is being conducted, science, the media, and the public must acknowledge and accept certain responsibilities.

Primarily, science must provide sufficient and accurate

References (76)

  • P.F. Jacques et al.

    Comparison of micronutrient intake measured by a dietary questionnaire and biochemical indicators of micronutrient status

    Am J Clin Nutr.

    (1993)
  • D. Feskanich et al.

    Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire

    J Am Diet Assoc.

    (1993)
  • W. Mertz et al.

    What are people really eating? The relation between energy intake derived from estimated diet records and intake determined to maintain body weight

    Am J Clin Nutr.

    (1991)
  • A.E. Black et al.

    Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake

    J Am Diet Assoc.

    (1993)
  • E. Barrett-Connor

    Nutrition epidemiologyhow do we know what they ate?

    Am J Clin Nutr.

    (1991)
  • P. Knekt et al.

    Dietary fat and risk of breast cancer

    Am J Clin Nutr.

    (1990)
  • G.E. Gaull et al.

    Biotechnology and societywe scientists have responsibilities too

    J Nutr.

    (1996)
  • L.P. Finnegan

    The NIH Women's Health Initiativeits evolution and expected contributions to women's health

    Am J Prev Med.

    (1996)

  • The Surgeon General's Report on Nutrition, Health, NIH Publication No. 88-50210

    (1988)
  • V.T. Covello et al.

    Risk communication, risk statistics, and risk comparisonsa manual for plant managers

    Chem Manuf Assoc.

    (1988)
  • G. Taubes

    Epidemiology faces its limitsthe search for subtle links between diet, lifestyle, or environmental factors and disease is an unending source of fear - but often yields little certainty

    Science.

    (1995)
  • N. Pearce

    Traditional epidemiology, modern epidemiology, and public health

    Am J Public Health.

    (1996)
  • A. Schatzkin

    Dietary prevention of colorectal cancer. Prevention and Early Detection of Colorectal Cancer

  • D. Kritchevsky

    The effect of over- and undernutrition on cancer

    Eur J Cancer Prev.

    (1995)
  • B.J. Rolls

    Carbohydrates, fats, and satiety

    Am J Clin Nutr.

    (1995)
  • D.J. Hunter et al.

    Diet, body size, and breast cancer

    Epidemiol Rev.

    (1993)
  • L.H. Kuller

    The etiology of breast cancer - from epidemiology to prevention

    Public Health Rev.

    (1995)
  • M.M. Henderson

    Nutritional aspects of breast cancer

    Cancer.

    (1995)
  • N.F. Boyd

    Nutrition and breast cancer

    J Natl Cancer Inst.

    (1993)
  • D.P. Rose et al.

    Effect of a low-fat diet on hormone levels in women with cystic breast disease. 1. Serum steroids and gonadotropins

    J Natl Cancer Inst.

    (1987)
  • G.A. Colditz

    Fat, estrogens, and the time frame for prevention of breast cancer

    Epidemiology.

    (1995)
  • N. Potischman et al.

    Reversal of relation between body mass and endogenous estrogen concentrations with menopausal status

    J Natl Cancer Inst.

    (1996)
  • D. Barnes-Josiah et al.

    Early body size and subsequent weight gain as predictors of breast cancer incidence (Iowa, United States)

    Cancer Causes Control.

    (1995)
  • N.B. Kumar et al.

    Timing of weight gain and breast cancer risk

    Cancer.

    (1995)
  • D.V. Schapira et al.

    Visceral obesity and breast cancer risk

    Cancer.

    (1994)
  • K. Radimer et al.

    Relation between anthropometric indicators and risk of breast cancer among Australian women

    Am J Epidemiol.

    (1993)
  • C.P.J. Caygill et al.

    Fat, fish, fish oil and cancer

    Br J Cancer.

    (1996)
  • K.K. Carroll

    Nutrition and cancerfat. Nutrition, Toxicity and Cancer

    • Cited by (0)

    View full text
    Copyright © 1997 American Dietetic Association. Published by Elsevier Inc. All rights reserved.