Intakes of Energy and Nutrients and Risk of Breast Cancer - Case-Control Study in Daegu.Gyeongbuk Area, Korea -

영양소 섭취 수준과 유방암 위험 - 대구.경북지역 환자-대조군 연구 -

  • Lee, Eun-Ju (Department of Food Science and Nutrition, Center for Beautiful Aging, Kyungpook National University) ;
  • Lee, Won-Kee (Health Promotion Research Center, Kyungpook National University Hospital) ;
  • Suh, Su-Won (Korea Nutrition Team, Kyungpook National University Hospital) ;
  • Suh, Bo-Hyun (Department of Food Science and Nutrition, Center for Beautiful Aging, Kyungpook National University) ;
  • Lee, Hye-Sung (Department of Food Science and Nutrition, Center for Beautiful Aging, Kyungpook National University)
  • 이은주 (경북대학교 식품영양학과, 경북대학교 장수생활과학연구소) ;
  • 이원기 (경북대학교병원 건강증진연구소) ;
  • 서수원 (경북대학교병원 영양팀) ;
  • 서보현 (경북대학교 식품영양학과, 경북대학교 장수생활과학연구소) ;
  • 이혜성 (경북대학교 식품영양학과, 경북대학교 장수생활과학연구소)
  • Published : 2008.12.31

Abstract

This study was performed to evaluate the effect of nutrient intake levels on the relative risk of breast cancer in the Daegu and Gyeongbuk area. The case subjects were 103 patients newly diagnosed as breast cancer at Kyungpook National University Hospital. The control subjects were 159 healthy women without breast cancer-related disease in the same community selected by frequency matching of age and menopausal status. The survey was administered by individual interviews by trained dietitians using semiquantitative food frequency questionnaires. The odds ratios were determined by using unconditional logistic regression after adjusting for the confounding factors found in the analysis of general characteristics of the subjects. In overall, it has been found that high consumptions of energy and carbohydrates significantly raised the relative risk of breast cancer, and that high intakes of total fat, plant fat, dietary fiber, all kinds of fatty acids, vitamin E and calcium significantly lowered the risk of breast cancer. The results of the study suggest that the possible protective factors to the breast cancer risk include a higher intakes of total fat, especially plant fat, dietary fiber, and micronutrients such as vitamin E, folic acid, calcium, phosphorus and potassium. On the other hand, high intakes of energy and carbohydrate appeared to be the risk factors.

본 연구는 대구 경북지역의 유방암 환자와 대조군을 대상으로 열량 및 영양소 섭취수준에 따른 유방암 발생의 상대 위험도를 분석하였다. 조사 대상자는 경북대학교 병원에서 유방암 진단을 처음 받고 입원한 103명의 유방암 환자와 유방암과 관련된 질환 및 전신 질환이 없으면서 연령(5세 내의 차이) 및 폐경 상태가 동일한 사람들을 대상으로 빈도 짝짓기를 통하여 선정한 159명의 지역사회 대조군이었다. 이들의 반정량적 식품섭취 빈도조사 결과를 분석하여 영양 섭취량을 산출하였고, 일반 특성에 대한 분석 결과에서 환자군과 대조군간 유의한 차이를 보인 요인들을 혼란변수로 통제한 후 열량 및 영양섭취 수준에 따른 상대 위험도를 분석하였다. 전체적으로 높은 BMI와 열량과 당질의 높은 섭취 수준은 유방암 발생의 상대적 위험을 유의하게 높이는 것으로 나타났고, 총 지방, 식이섬유, 포화지방산, 단일불포화지방산, 다불포화지방산, n-3 지방산, n-6 지방산, 비타민 E, 칼슘은 섭취수준이 높을수록 위험도가 유의하게 낮아지는 것으로 나타났다. 폐경 전 여성에서는 당질의 섭취 수준이 높을 때 유방암 위험이 유의하게 높고, 총지방, 식이섬유, 포화지방산, 단일불포화지방산, 다불포화지방산, n-6 지방산, 비타민 E, 엽산, 칼슘, 인, 칼륨의 섭취 수준이 높을 때 위험도가 유의하게 낮은 것으로 나타났다. 폐경 후 여성에서는 총지방, 콜레스테롤, 다불포화지방산, n-6 지방산의 섭취 수준이 높을 때 유방암 위험도가 유의하게 낮은 것으로 나타났다. 특히 지방의 경우 식물성 급원의 섭취 수준이 높을 때 유방암의 위험이 유의하게 감소되는 것으로 나타났다. 이상의 결과에서 대구 경북지역에서 유방암 발생 위험을 높일 가능성이 있는 영양섭취상태는 열량과 당질의 높은 섭취이며, 한편 유방암의 위험을 낮출 가능성이 있는 영양섭취 상태는 높은 지방의 섭취로 나타났다. 특히 지방의 경우 식물성 급원의 섭취가 높을 때 위험이 낮아지는 것으로 나타났다. 이는 지방 섭취량과 유방암 위험도 사이에 정의 상관성을 보고한 일부 국외의 연구 결과와는 상반되는 결과이며 그 원인으로는 한국인의 경우 식물성 지방 섭취의 비율이 서구인에 비해 상대적으로 높기 때문인 것으로 추정된다. 유방암의 위험을 낮출 가능성이 있는 미량 영양소로는 비타민 중에는 E와 엽산, 무기질로서는 칼슘, 인 그리고 칼륨으로 나타났다. 본 연구결과의 제한점으로서 조사 사례수가 적다는점을 들 수 있으므로 선행연구들의 결과와 상반된 결과를 보인 지방섭취와 유방암 위험과의 관련성에 대해서는 향후보다 많은 사례를 대상으로 한 조사 연구를 통해 재확인할 필요가 있다고 보며, 본 연구의 결과는 지역민의 유방암 예방을 위한 영양교육 자료의 일부로서 활용될 수 있다고 본다.

Keywords

References

  1. Ministry of Health & Welfare, Cancer Incidence in Korea (2003- 2005), Republic of Korea; 2008
  2. Kelsey JL, Gammon MD, John EM. Reproductive factors and breast cancer. Epidemiol Rev 1993; 15: 36-47 https://doi.org/10.1093/oxfordjournals.epirev.a036115
  3. Longnecker MP. Alcohol beverage consumption in relation to risk of breast cancer, meta-analysis and review. Cancer Causes & Control 1994; 5: 73-82 https://doi.org/10.1007/BF01830729
  4. Rohan TE, Jain M, Howe GR, Miller AB. Alcohol consumption and risk of breast cancer: A cohort study. Cancer Causes & Control 2000; 11: 239-247 https://doi.org/10.1023/A:1008933824645
  5. Do MH, Lee SS, Jung PJ, Lee MH. Relation of breast cancer risk with alcohol consumption and physical activity: A case-control study. Korean J Nutr 2003; 36(1): 40-48
  6. Lee IM, Cook NR, Rexrode KM, Buring JE. Lifetime physical activity and risk of breast cancer. Br J Cancer 2001; 85: 962-965 https://doi.org/10.1054/bjoc.2001.2003
  7. Mordi T, Adami HO, Ekbom A, Wedren S, Terry P. Physical activity and risk for breast cancer, a prospective cohort study among Swedish twins. Int J Cancer 2002; 100: 76-81 https://doi.org/10.1002/ijc.10447
  8. Deslypere JP. Obesity and cancer. Metabolism: Clin & Exp 1995; 44(suppl 3): 24-27
  9. Gori GB. Dietary and nutritional implications in the multifactorial etiology of certain prevalent human cancers. Cancer 1979; 43 (suppl 5): 2151-2161 https://doi.org/10.1002/1097-0142(197905)43:5+<2151::AID-CNCR2820430726>3.0.CO;2-4
  10. Stoll BA. Macronutrient supplements may reduce breast cancer risk: how, when, which? Eur J Clin Nutr 1997; 51(9): 573-577 https://doi.org/10.1038/sj.ejcn.1600441
  11. Kaaks R. Nutrition, hormone, and breast cancer: Is insulin the missing link? Cancer Causes & Control 1996; 7: 605-625 https://doi.org/10.1007/BF00051703
  12. Toniolo P, Riboli E, Shore RE, Pasternack BS. Consumption of meat, animal products, protein and fat and risk of breast cancer - A Prospective cohort study in New York. Epidemiol 1994; 5: 391-397 https://doi.org/10.1097/00001648-199407000-00003
  13. Jarvinen R, Knekt P, Seppanen R, Teppo L. Diet and breast cancer risk in a cohort of Finnish women. Cancer Let 1997; 114: 251-253 https://doi.org/10.1016/S0304-3835(97)04675-2
  14. Missmer SA, Smith-Warner SA, Spiegelman D, Yaun SS, Adami HO, Beeson WL, van den Brandt PA, Fraser GE, Freudenheim JL, Goldbohm RA, Graham S, Kushi LH, Miller AB, Potter JD, Rohan TE, Speizer FE, Toniolo P, Willett WC, Wolk A, Zeleniuch- Jacquotte A, Hunter DJ. Meat and dairy food consumption and breast cancer: a pooled analysis of cohort studies. Int J Epidemiol 2002; 31: 78-85 https://doi.org/10.1093/ije/31.1.78
  15. Franceschi S, Favero A, Decarli A, Negri E, La Vecchia C, Ferraroni M, Russo A, Salvini S, Amadori D, Conti E, et al. Intake of macronutrients and risk of breast cancer. Lancet 1996; 347: 1351- 1356 https://doi.org/10.1016/S0140-6736(96)91008-9
  16. Favero A, Parpinel M, Montella M. Energy sources and risk of cancer of the breast and colon-rectum in Italy. Adv Exp Med Biol 1999; 472: 51-55
  17. Hunter DJ, Spiegelman D, Adami HO, Beeson L, van den Brandt PA, Folsom AR, Fraser GE, Goldbohm RA, Graham S, Howe GR, et al.(1996). Cohort studies of fat intake and the risk of breast cancer-a pooled analysis. N Engl J Med 1996; 334: 356-361 https://doi.org/10.1056/NEJM199602083340603
  18. Martin-Moreno JM, Willett WC, Gorgojo L, Banegas JR, Rodriguez- Artalejo F, Fernandez-Rodriguez JC, Maisonneuve P, Boyle P. Dietary fat, olive oil intake and breast cancer risk. Int J Cancer 1994; 58: 774-780 https://doi.org/10.1002/ijc.2910580604
  19. Wynder EL, Cohen LA, Rose DP, Stellman SD. Dietary fat and breast cancer: Where do we stand on the evidence? J Clin Epidemiol 1994; 47: 217-222 https://doi.org/10.1016/0895-4356(94)90001-9
  20. Wolk A, Bergstrom R, Hunter D, Willett W, Ljung H, Holmberg L, Bergkvist L, Bruce A, Adami HO. A prospective study of association of monounsaturated fat other types of fat with risk of breast cancer. Arch Intern Med 1998; 158: 41-45 https://doi.org/10.1001/archinte.158.1.41
  21. Smith-Warner SA, Spiegelman D, Adami HO, Beeson WL, van den Brandt PA, Folsom AR, Fraser GE, Freudenheim JL, Goldbohm RA, Graham S Kushi LH, Miller AB, Roham TE, Speizer FE, Toniolo P, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Hunter DJ. Types of dietary fat and breast cancer: a pooled analysis of cohort studies. Int J Cancer 2001; 92: 767-774 https://doi.org/10.1002/1097-0215(20010601)92:5<767::AID-IJC1247>3.0.CO;2-0
  22. London SJ, Sacks FM, Stampfer MJ, Henderson IC, Maclure M, Tomita A, et al. Fatty acid composition of subcutaneous adipose tissue and risk of proliferative benign breast disease and breast cancer. J Natl Cancer Inst 1993; 56: 785-793
  23. Kohlmeier L, Mendez M (1997). Controversies surrounding diet and breast cancer. Proc Nutr Soc 1997; 56: 369-382 https://doi.org/10.1079/PNS19970039
  24. Steinmetz KA, Potter JD (1996). Vegetables, fruit, and cancer prevention: A review. J Am Diet Assoc 1996; 96: 1027-1039 https://doi.org/10.1016/S0002-8223(96)00273-8
  25. Do MH, Lee SS, Jung PJ, Lee MH. Food intake and breast cancer risk: A case-control study. Korean J Nutr 2001; 34(2): 165-175
  26. Mannisto S, Pietinen P, Virtanen M, Kataja V, Uusitupa M. Diet and the risk of breast cancer in a case-control. J Clin Epidemiol 1999; 52: 429-439 https://doi.org/10.1016/S0895-4356(99)00010-4
  27. Do MH, Kim HJ, Lee SS, Jung PJ, Lee MH. Breast cancer risk and dietary factor; A case-control study. J Kor Surg Soc 2000; 59 (2): 163-174
  28. Lee EJ, Suh SW, Lee WK, Lee HS. Reproductive factor and food intake pattern influencing on the breast cancer risk in Daegu. Gyungbuk area, Korea. Korean J Nutr 2007; 40(5): 334-346
  29. Kim WY, Yang EJ. A study on development and validation of food frequency questionnare for Koreans. Korean J Nutr 1998; 21(2): 220-230
  30. Paik HY, Ryu JY, Choi JS, Ahn YJ, Moon HK, Park YS, Lee HK. Development and validation of food frequency questionnaire for dietary assessment of Korean adults in rural area. Korean J Nutr 1995; 28(9): 914-922
  31. Kerlinger FN. Foundations of Behavioral Research. 3th edition. Holt, Rinehart and Winston Inc.: New York.; 1986
  32. Nishimune T, Sumimoto T, Yakusiji T, Kunita N. Determination of total dietary fiber in Japanes foods. J Assoc Off Anal Chem 1991; 74(2): 350-359
  33. Baek JW, Koo BK, Kim KJ, Lee YK, Lee SK, Lee HS. Nutritional status of the long-lived elderly people in Kyungpook Sang-Ju. Korean J Nutr 2000; 33(4): 438-453
  34. Huang Z, Hankinson SE, Colditz GA, Stampfer MJ, Hunter DJ, Manson JE, Hennekens CH, Rosner B, Speizer FE, Willett WC. Dual effect of weight and weight gain on breast cancer risk. J Am Med Assoc 1997; 278(17): 1407-1411 https://doi.org/10.1001/jama.278.17.1407
  35. Zeigler RG, Hoover RN, Nomura AMY, West DW, Wu AH, Pike MC, Lake AJ, Horn-Ross PL, Kolonel LN, Siiteri PK, Fraumeni JF. Relative weight, weight change, height, and breast cancer risk in Asian-American women. J Natl Cancer Inst 1996; 88(10): 650-660 https://doi.org/10.1093/jnci/88.10.650
  36. Stoll BA. Timing of weight gain in relation to breast cancer risk. Ann Oncol 1995; 6(3): 245-248 https://doi.org/10.1093/oxfordjournals.annonc.a059153
  37. Kuller LH (1995). The etiology of breast cancer from epidemiology to prevention. Public Health Rev 1995; 23(2): 157-213
  38. Ahn SH, Kim MK, Kim SI. Relation between Body size and body mass index and breast cancer by menopausal status in Korea. J Korean Cancer Assoc 1999; 31(1): 72-81
  39. Yoo KY, Park SK, Sung JH, Kang DH, Kim YC, Kang HS, Suh JS, Kim JS, Yun IJ, Han SH, Noh DY, Choe KJ. High risk group for female breast cancer in Korea. J Korean Cancer Assoc 1998; 30(3): 435-449
  40. Moon SW, Choi SY, Lee TY, Chung YC. Studies on Risk Factors in Cancers of the Breast, Uterine Cervix and Ovary. Korean J Epidemiol 1997; 19(2): 161-179
  41. Kim WY, Ryu YS, Yang EJ. A study on dietary factors related to the incidence of breast and cervical cancer in Korean women. Korean J Nutr 1994; 27(10): 1058-1069
  42. Yuan JM, Wang QS, Ross RK, Henderson BE, Yu MC. Diet and breast cancer in Shanghai and Tianjin, China. Br J Cancer 1995 71: 1353-1358 https://doi.org/10.1038/bjc.1995.263
  43. Van't Veer P, van Leer EM, Rietdijk A, Kok FJ, Schouten EG, Hermus RJ, Sturmans F. Combination of dietary factors in relation to breast-cancer occurrence. Int J Cancer 1991; 47: 649-653 https://doi.org/10.1002/ijc.2910470503
  44. Adlercreutz H, Mousavi Y. Diet and breast cancer. Acta Oncologica 1992; 31: 175-181 https://doi.org/10.3109/02841869209088899
  45. Shin MH. Food, nutrient, and the risk of breast cancer. Korean J Epidemiol 2002; 24(2): 164-170
  46. Kimmick GG, Bell RA, Bostick RM. Vitamin E and breast cancer: A review. Nutr Cancer 1997; 27: 109-117 https://doi.org/10.1080/01635589709514511
  47. Sellers TA, Kushi LH, Cerhan JR, Vierkant RA, Gapstur SM, Vachon CM, Olson JE, Therneau TM, Folsom AR. Dietary folate intake, alcohol, and risk of breast cancer in a prospective study of postmenpausal women. Epidemiol 2001; 12: 420-428 https://doi.org/10.1097/00001648-200107000-00012
  48. Freudenheim JL, Marshall JR, Vena JE, Laughlin R, Brasure JR, Swanson MK, Nemoto T, Graham S. Premenopausal breast cancer risk and intake of vegetable, fruits, and related nutrients. J Natl Cancer Inst 1996; 91: 547-556
  49. Wu K, Helzlsouer KJ, Comstock GW, Hoffman SC, Nadeau MR, Selhub J. A prospective study on folate, B12, and pyridoxal -5'- phosphate (B6) and breast cancer. Cancer Epidem Biomar 1996; 8: 209-217
  50. Graham S, Hellmann R, Marshall J, Freudenheim J, Vena J, Swanson M, Zielezny M, Nemoto T, Stubbe N, Raimondo T. Nutritional epidemiology of postmenopausal breast cancer in western New York. Am J Epidemiol 1991; 134: 552-566 https://doi.org/10.1093/oxfordjournals.aje.a116129
  51. Howe GR, Hirohata T, Hislop TG, Iscovich JM, Yuan JM, Katsouyanni K, Lubin F, Marubini E, Modan B, Rohan T, et al. Dietary factors and risk of breast cancer:combined analysis of 12 case-control studies. JNCL 1990; 82: 561-569
  52. Clark LC. The epidemiology of selenium and cancer. Fed Proc 1985; 44: 2584-2589
  53. Willett WC. Diet and breast cancer. J Inter Med 2001; 249: 395-411 https://doi.org/10.1046/j.1365-2796.2001.00822.x