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    Adherence to the Western, Prudent and Mediterranean dietary patterns and breast cancer risk: MCC-Spain study

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    Objective To externally validate the previously identified effect on breast cancer risk of the Western, Prudent and Mediterranean dietary patterns. Study design MCC-Spain is a multicase-control study that collected epidemiological information on 1181 incident cases of female breast cancer and 1682 control cases from 10 Spanish provinces. Three dietary patterns derived in another Spanish case-control study were analysed in the MCC-Spain study. These patterns were termed Western (high intakes of fatty and sugary products and red and processed meat), Prudent (high intakes of low-fat dairy products, vegetables, fruits, whole grains and juices) and Mediterranean (high intake of fish, vegetables, legumes, boiled potatoes, fruits, olives, and vegetable oil, and a low intake of juices). Their association with breast cancer was assessed using logistic regression models with random province-specific intercepts considering an interaction with menopausal status. Risk according to tumour subtypes ? based on oestrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) receptors (ER+/PR+&HER2-; HER2+; ER-/PR-&HER2-) ? was evaluated with multinomial regression models. Main outcome measures Breast cancer and histological subtype. Results Our results confirm most of the associations found in the previous case-control study. A high adherence to the Western dietary pattern seems to increase breast cancer risk in both premenopausal women (OR4thvs.1stquartile(95%CI):1.68(1.02;2.79); OR1SD-increase(95%CI): 1.19(1.01;1.40)) and postmenopausal women (OR4thvs.1stquartile(95%CI):1.48(1.07;2.05); OR1SD-increase(95%CI): 1.14(1.01;1.28)). While high adherence to the Prudent pattern did not show any effect on breast cancer, the Mediterranean dietary pattern seemed to be protective, but only among postmenopausal women (OR4thvs.1stquartile (95%CI):0.72(95% CI 0.53;0.98); p-int = 0.075). There were no significant differences by tumour subtype. Conclusion Dietary recommendations based on a departure from the Western dietary pattern in favour of the Mediterranean diet could reduce breast cancer risk in the general population.The study was funded by Carlos III Institute of Health grants (PI12/00488, PI12/00265, PI12/00715, PI12/01270, PI09/00773 and PI08/1770), by the Spanish Ministry of Economy and Competitiveness (IJCI-2014-20900) and by Consejería de Salud de la Junta de Andalucía (PI-0571- 2009 and PI-0306-2011) competitive calls including peer review for scientific quality. Additional funding was provided by the Spanish Federation of Breast Cancer Patients (FECMA: EPY 1169- 10), the Association of Women with Breast Cancer from Elche (AMACMEC:EPY 1394/15), the Marqués de Valdecilla foundation (grant API 10/09), ) and by Acción Transversal del Cancer, approved by the Spanish Ministry Council on October 11, 2007. None of the funders played any role in conducting research or writing the paper
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