Plain English summary
Introduction
Methods
Patients
Data collection at each assessment
Dietary intake and dietary pattern assessment
QoL assessment using EORTC QLQ-C30
Statistical analysis
Results
Two major dietary patterns
Foods/food groups | Factor 1 Grain and animal food pattern | Factor 2 Vegetable and fruit pattern |
---|---|---|
Refined grain | 0.722 | |
Red meat | 0.478 | |
Fish and seafood | 0.411 | |
Oil | 0.408 | |
Cakes and snacks | 0.302 | |
Processed meat | 0.266 | |
Eggs | 0.262 | |
Leaf vegetables | 0.932 | |
Other vegetables | 0.489 | |
Fruits | 0.390 | |
Potato | 0.314 | |
Legumes | 0.281 | |
Variance explained (%) | 26.228 | 12.154 |
Patients’ characteristics according to the tertiles of factor score in each dietary pattern at 18-month follow-up
Grain and animal food pattern | Vegetables and fruits pattern | |||||||
---|---|---|---|---|---|---|---|---|
Tertile 1 | Tertile 2 | Tertile 3 | P | Tertile 1 | Tertile 2 | Tertile 3 | P | |
Number of patients | 408 | 410 | 408 | 409 | 409 | 408 | ||
Factor score, median (range) | − 0.9 (-3.4 to -0.5) | − 0.1 (-0.5 to 0.3) | 0.9 (0.3 to 5.1) | − 0.9 (-2.1 to − 0.5) | − 0.2 (− 0.5 to 0.3) | 0.8 (0.3 to 5.3) | ||
Follow-up time since diagnosis, months, mean (SD) | 19.1 (3.6) | 19.2 (3.4) | 19.5 (3.9) | 0.219 | 19.3 (3.5) | 19.1 (3.4) | 19.6 (3.9) | 0.135 |
Age at follow-up, years, mean (SD) | 55.0 (9.2) | 54.1 (8.8) | 52.4 (8.9) | < 0.0001 | 54.4 (9.3) | 53.5 (9.3) | 53.6 (8.5) | 0.260 |
Education level, % | 0.269 | 0.018 | ||||||
High school or below | 83.6 | 87.6 | 85.5 | 88.3 | 86.8 | 81.6 | ||
Collage or above | 16.4 | 12.4 | 14.5 | 11.7 | 13.2 | 18.4 | ||
Marital status, % | 0.020 | 0.040 | ||||||
Married or cohabitation | 67.9 | 75.9 | 68.7 | 66.7 | 74.8 | 70.6 | ||
Unmarried or divorced | 32.1 | 24.1 | 32.3 | 33.3 | 25.5 | 29.4 | ||
Household income (HKD/month), % | 0.900 | 0.008 | ||||||
< 15,000 | 48.0 | 47.8 | 45.1 | 49.6 | 41.3 | 50.0 | ||
15,000–30,000 | 30.4 | 31.5 | 33.1 | 32.8 | 31.8 | 30.4 | ||
≥ 30,000 | 21.6 | 20.7 | 21.8 | 12.6 | 26.9 | 19.6 | ||
BMI at follow-up, kg/m2, % | 0.450 | 0.007 | ||||||
Underweight (< 18.5) | 6.1 | 4.6 | 4.9 | 4.4 | 8.3 | 2.9 | ||
Normal (18.5–22.9) | 48.0 | 44.9 | 43.9 | 44.7 | 41.6 | 50.5 | ||
Overweight (23–24.9) | 20.3 | 22.4 | 19.4 | 20.5 | 20.5 | 21.1 | ||
Obese (≥ 25) | 23.5 | 28.0 | 31.9 | 30.3 | 29.6 | 25.5 | ||
Number of comorbidities, % | 0.056 | 0.094 | ||||||
None | 57.8 | 60.5 | 64.7 | 57.9 | 62.3 | 62.7 | ||
1 | 25.5 | 26.8 | 25.5 | 25.9 | 24.4 | 27.5 | ||
≥ 2 | 16.7 | 12.7 | 9.8 | 16.1 | 13.3 | 9.8 | ||
Parity, % | 0.916 | 0.212 | ||||||
0 | 22.1 | 20.7 | 24.3 | 22.2 | 19.5 | 25.2 | ||
1 | 22.8 | 22.7 | 23.0 | 22.0 | 25.2 | 21.3 | ||
2 | 36.8 | 39.0 | 35.8 | 35.8 | 37.2 | 38.8 | ||
≥ 3 | 18.4 | 17.6 | 16.9 | 20.0 | 18.1 | 14.7 | ||
Menopause status at follow-up, % | 0.016 | 0.609 | ||||||
Pre-menopausal | 18.4 | 16.6 | 24.3 | 79.5 | 79.5 | 81.9 | ||
Post-menopausal | 81.6 | 83.4 | 75.7 | 20.5 | 20.5 | 18.1 | ||
AJCC stage at diagnosis | 0.056 | 0.533 | ||||||
I | 33.1 | 30.2 | 31.4 | 30.1 | 32.5 | 32.1 | ||
II | 51.4 | 48.8 | 44.4 | 50.6 | 46.2 | 47.8 | ||
III | 15.5 | 20.3 | 24.0 | 18.6 | 21.3 | 19.4 | ||
I–III without detail | 0.5 | 0.7 | 0.2 | 0.7 | 0 | 0.7 | ||
Histology, % | 0.668 | 0.798 | ||||||
IDC | 90.0 | 90.0 | 89.0 | 89.0 | 90.5 | 89.5 | ||
ILC | 2.2 | 3.7 | 3.4 | 3.9 | 2.7 | 2.7 | ||
Others | 7.8 | 6.3 | 7.6 | 7.1 | 6.8 | 7.8 | ||
ER status, % | 0.204 | 0.036 | ||||||
Positive | 75.2 | 74.6 | 70.9 | 71.6 | 77.2 | 71.8 | ||
Negative | 23.3 | 22.9 | 25.2 | 24.2 | 21.8 | 25.5 | ||
Missing | 1.5 | 2.4 | 3.9 | 4.2 | 1.0 | 2.7 | ||
PR status, % | 0.397 | 0.015 | ||||||
Positive | 56.6 | 59.1 | 53.7 | 55.7 | 57.9 | 55.6 | ||
Negative | 41.2 | 38.0 | 42.4 | 39.1 | 41.1 | 41.4 | ||
Missing | 2.2 | 2.9 | 3.9 | 5.1 | 1.0 | 2.9 | ||
HER2 status, % | 0.479 | 0.579 | ||||||
Positive | 29.9 | 27.1 | 24.5 | 25.7 | 29.1 | 26.7 | ||
Negative | 66.9 | 70.0 | 71.6 | 70.4 | 67.2 | 70.8 | ||
Missing | 3.2 | 2.9 | 3.9 | 3.9 | 3.7 | 2.5 | ||
Type of surgery | 0.949 | 0.596 | ||||||
Mastectomy | 65.4 | 64.4 | 64.7 | 66.7 | 64.3 | 63.4 | ||
Conservation | 34.6 | 35.6 | 35.3 | 33.3 | 35.7 | 36.5 | ||
Chemotherapy, % | 0.062 | 0.666 | ||||||
Yes | 77.5 | 83.7 | 82.1 | 82.4 | 80.0 | 80.9 | ||
No | 22.5 | 16.3 | 17.9 | 17.6 | 20.0 | 19.1 | ||
Radiation therapy, % | 0.141 | 0.476 | ||||||
Yes | 66.9 | 72.2 | 72.5 | 71.1 | 72.1 | 68.4 | ||
No | 33.1 | 27.8 | 27.5 | 28.9 | 27.9 | 31.6 | ||
Hormone therapy, % | 0.108 | 0.579 | ||||||
Yes | 77.9 | 72.9 | 78.7 | 76.0 | 78.2 | 75.2 | ||
No | 22.1 | 27.1 | 21.3 | 24.0 | 21.8 | 24.8 | ||
Physical activity level, MET-hours/week, mean (SD) | 10.9 (12.8) | 10.0 (13.6) | 9.5 (13.6) | 0.314 | 7.5 (11.4) | 10.0 (12.2) | 13.0 (15.5) | < 0.0001 |
Energy intake, kcal/day, mean (SD) | 1083.7 (252.5) | 1314.7 (251.2) | 1686.8 (389.2) | < 0.0001 | 1155.1 (279.7) | 1354.7 (355.1) | 1575.7 (413.0) | < 0.0001 |
Cross-sectional investigation of the association between post-diagnosis dietary pattern and QoL at 18-month follow-up
EORTC QLQ-C30 | Univariate analysis | Model 1 | Model 2 | |||
---|---|---|---|---|---|---|
B (95%CI) | P | B (95%CI) | P | B (95%CI) | P | |
Global health status/QoL | − 0.679 (− 1.664 to − 0.306) | 0.262 | − 0.786 (− 2.255 to 0.682) | 0.551 | 0.825 (− 0.935 to 2.586) | 0.226 |
Functioning | ||||||
Physical functioning | − 0.064 (− 0.696 to 0.568) | 0.831 | 0.343 (− 0.602 to 1.287) | 0.555 | 0.886 (− 0.249 to 2.022) | 0.176 |
Role functioning | − 1.531 (− 2.349 to − 0.712) | 0.012 | − 0.676 (− 1.911 to − 0.559) | 0.326 | − 0.610 (− 2.097 to 0.876) | 0.682 |
Emotional functioning | − 0.950 (− 2.001 to 0.100) | 0.466 | 0.078 (− 1.493 to 1.648) | 0.978 | 1.099 (− 0.788 to 2.987) | 0.472 |
Cognitive functioning | 0.031 (− 1.037 to 1.099) | 0.822 | 1.168 (− 0.445 to 2.781) | 0.180 | 1.618 (− 0.323 to 3.559) | 0.104 |
Social functioning | − 0.696 (− 1.570 to 0.178) | 0.141 | 0.385 (− 0.933 to 1.703) | 0.855 | 0.473 (− 1.113 to 2.060) | 0.745 |
Symptoms | ||||||
Fatigue | 0.443 (− 0.664 to 1.550) | 0.440 | − 1.775 (− 3.431 to − 0.119) | 0.044 | − 2.238 (− 4.230 to − 0.245) | 0.010 |
Nausea and vomiting | 0.227 (− 1.138 to 0.591) | 0.057 | 0.048 (− 0.499 to 0.594) | 0.654 | − 0.186 (− 0.844 to 0.472) | 0.974 |
Pain | 0.916 (− 3.373 to 2.204) | 0.163 | − 0.877 (− 2.792 to 1.039) | 0.444 | − 1.209 (− 3.515 to 1.097) | 0.261 |
Dyspnea | 0.138 (− 0.812 to 1.087) | 0.608 | − 1.438 (− 2.862 to − 0.013) | 0.048 | − 1.986 (− 3.700 to − 0.272) | 0.024 |
Insomnia | − 0.493 (− 2.100 to 1.114) | 0.643 | − 1.029 (− 3.467 to 1.049) | 0.803 | − 1.068 (− 4.002 to 1.866) | 0.540 |
Loss of appetite | 0.043 (− 0.691 to 0.776) | 0.783 | − 0.378 (− 1.486 to 0.729) | 0.847 | − 1.155 (− 2.486 to 0.176) | 0.193 |
Constipation | 0.043 (− 1.061 to 1.148) | 0.546 | 0.544 (− 1.130 to 2.218) | 0.347 | − 0.296 (− 2.309 to 1.717) | 0.899 |
Diarrhea | 0.508 (− 0.193 to 1.209) | 0.084 | 0.696 (− 0.349 to 1.742) | 0.144 | − 0.289 (− 1.543 to 0.965) | 0.810 |
Financial impact | 0.799 (− 0.530 to 2.128) | 0.054 | − 1.632 (− 3.598 to 0.334) | 0.192 | − 1.074 (− 3.440 to 1.292) | 0.281 |
EORTC QLQ-C30 | Univariate analysis | Model 1 | Model 2 | |||
---|---|---|---|---|---|---|
B (95%CI) | P | B (95%CI) | P | B (95%CI) | P | |
Global health status/QoL | 1.693 (− 0.712 to 2.674) | 0.003 | 1.847 (0.739 to 2.956) | 0.004 | 2.195 (0.862 to 3.529) | 0.002 |
Functioning | ||||||
Physical functioning | 0.487 (− 0.144 to 1.118) | 0.132 | 0.367 (− 0.348 to 1.082) | 0.337 | 0.741 (− 0.120 to 1.601) | 0.121 |
Role functioning | − 0.259 (− 1.082 to 0.564) | 0.790 | 0.346 (− 0.589 to 1.282) | 0.249 | 0.089 (− 1.037 to 1.215) | 0.465 |
Emotional functioning | 0.411 (− 0.640 to 1.462) | 0.363 | 0.928 (− 0.261 to 2.116) | 0.305 | 1.391 (− 0.039 to 2.821) | 0.210 |
Cognitive functioning | − 0.074 (− 1.142 to 0.993) | 0.865 | − 0.069 (− 1.291 to 1.154) | 0.983 | 0.613 (− 0.857 to 2.083) | 0.357 |
Social functioning | − 0.457 (− 1.332 to 0.417) | 0.327 | − 0.079 (− 1.078 to 0.919) | 0.873 | 0.120 (− 1.082 to 1.322) | 0.754 |
Symptoms | ||||||
Fatigue | 0.453 (− 0.653 to 1.560) | 0.873 | 0.313 (− 0.944 to 1.569) | 0.815 | − 0.630 (− 2.139 to 0.879) | 0.102 |
Nausea and vomiting | − 0.228 (− 0.592 to 0.137) | 0.517 | − 0.240 (− 0.654 to 0.174) | 0.449 | − 0.318 (− 0.816 to 0.180) | 0.542 |
Pain | 0.321 (− 0.968 to 1.610) | 0.892 | 0.056 (− 1.395 to 1.508) | 0.763 | − 0.453 (− 2.200 to 1.293) | 0.381 |
Dyspnea | 0.188 (− 0.761 to 1.138) | 0.683 | 0.090 (− 0.991 to 1.171) | 0.959 | − 0.747 (− 2.046 to 0.552) | 0.224 |
Insomnia | 0.121 (− 1.486 to 1.728) | 0.699 | 0.397 (− 1.450 to 2.244) | 0.641 | − 0.053 (− 2.276 to 2.170) | 0.467 |
Loss of appetite | − 0.570 (− 1.303 to 0.162) | 0.068 | − 0.571 (− 1.410 to 0.268) | 0.110 | − 1.058 (− 2.066 to − 0.049) | 0.040 |
Constipation | − 1.088 (− 2.191 to 0.015) | 0.054 | − 1.020 (− 2.286 to 0.247) | 0.060 | − 1.144 (− 2.669 to 0.381) | 0.102 |
Diarrhea | − 1.090 (− 1.788 to − 0.391) | 0.004 | − 1.220 (− 2.010 to − 0.431) | 0.003 | − 1.342 (− 2.292 to − 0.392) | 0.009 |
Financial impact | 1.636 (0.309 to 2.963) | 0.031 | 1.212 (− 0.277 to 2.702) | 0.463 | 0.760 (− 1.032 to 2.552) | 0.992 |
Longitudinal investigation of the association between each dietary pattern and QoL over four follow-ups
EORTC QLQ-C30 | Univariate analysis | Model 1 | Model 2 | |||
---|---|---|---|---|---|---|
B (95%CI) | P | B (95%CI) | P | B (95%CI) | P | |
Global health status/QoL | − 0.691 (− 1.323 to − 0.058) | 0.032 | − 0.349 (− 1.112 to 0.413) | 0.370 | 0.114 (− 0.665 to 0.892) | 0.775 |
Functioning | ||||||
Physical functioning | − 0.612 (− 1.021 to − 0.204) | 0.003 | − 0.319 (− 0.838 to 0.200) | 0.228 | − 0.122 (− 0.676 to 0.431) | 0.665 |
Role functioning | − 1.293 (− 1.852 to − 0.734) | < 0.001 | − 0.891 (− 1.583 to − 0.199) | 0.012 | − 0.744 (− 0.147 to − 0.017) | 0.045 |
Emotional functioning | − 1.323 (− 1.978 to − 0.667) | < 0.001 | 0.020 (0.020 to 0.020) | < 0.001 | 0.535 (1.382 to 1.528) | 0.216 |
Cognitive functioning | − 0.602 (− 1.237 to − 0.033) | 0.063 | 0.423 (0.423 to 0.423) | < 0.001 | 0.720 (− 0.144 to 1.583) | 0.102 |
Social functioning | − 1.111 (− 1.685 to − 0.536) | < 0.001 | − 0.284 (− 1.001 to 0.432) | 0.436 | − 0.049 (− 0.829 to 0.731) | 0.902 |
Symptoms | ||||||
Fatigue | 1.141 (0.435 to 1.847) | 0.002 | − 0.199 (− 1.085 to 0.688) | 0.661 | − 0.491 (− 1.439 to 0.457) | 0.311 |
Nausea and vomiting | 0.230 (− 0.039 to 0.500) | 0.094 | − 0.050 (− 0.332 to 0.123) | 0.726 | − 0.188 (− 0.513 to 0.137) | 0.256 |
Pain | 1.486 (0.737 to 2.236) | < 0.001 | 0.543 (− 0.415 to 1.501) | 0.267 | 0.534 (− 0.468 to 1.536) | 0.296 |
Dyspnea | 1.033 (0.432 to 1.634) | < 0.001 | 0.113 (0.113 to 0.113) | < 0.001 | − 0.092 (− 0.092 to − 0.092) | < 0.001 |
Insomnia | − 0.147 (− 1.096 to 0.802) | 0.762 | − 0.653 (− 1.821 to 0.514) | 0.273 | − 1.163 (− 2.373 to 0.047) | 0.060 |
Loss of appetite | 0.319 (− 0.158 to 0.796) | 0.190 | 0.279 (− 0.294 to 0.852) | 0.340 | 0.019 (− 0.617 to 0.654) | 0.954 |
Constipation | 0.241 (− 0.379 to 0.851) | 0.447 | − 0.623 (− 0.623 to − 0.623) | < 0.001 | − 1.355 (− 2.174 to − 0.536) | 0.001 |
Diarrhea | 0.815 (0.384 to 1.246) | < 0.001 | 0.400 (− 0.112 to 0.911) | 0.126 | 0.065 (− 0.498 to 0.627) | 0.822 |
Financial impact | 1.122 (0.301 to 1.944) | 0.007 | − 0.392 (− 1.266 to 0.481) | 0.379 | − 0.456 (− 1.365 to 0.453) | 0.325 |
EORTC QLQ-C30 | Univariate analysis | Model 1 | Model 2 | |||
---|---|---|---|---|---|---|
B (95%CI) | P | B (95%CI) | P | B (95%CI) | P | |
Global health status/QoL | 1.104 (0.400 to 1.807) | 0.002 | 1.251 (0.535 to 1.967) | 0.001 | 1.282 (0.545 to 2.019) | 0.001 |
Functioning | ||||||
Physical functioning | 0.493 (0.033 to 0.953) | 0.036 | 0.578 (0.101 to 1.056) | 0.018 | 0.545 (0.037 to 1.053) | 0.035 |
Role functioning | 0.163 (− 0.465 to 0.732) | 0.610 | 0.609 (− 0.065 to 1.282) | 0.077 | 0.406 (− 0.301 to 1.114) | 0.260 |
Emotional functioning | 0.542 (− 0.159 to 1.243) | 0.130 | 1.282 (0.539 to 2.023) | 0.001 | 1.426 (0.653 to 2.200) | < 0.001 |
Cognitive functioning | 0.110 (− 0.611 to 0.831) | 0.765 | 0.626 (− 0.129 to 1.382) | 0.104 | 0.822 (0.007 to 1.637) | 0.048 |
Social functioning | 0.172 (− 0.457 to 0.801) | 0.591 | 0.666 (0.013 to 1.318) | 0.045 | 0.652 (− 0.054 to 1.358) | 0.070 |
Symptoms | ||||||
Fatigue | − 0.181 (− 0.929 to 0.567) | 0.635 | − 0.676 (− 1.454 to 0.102) | 0.088 | − 0.810 (− 1.637 to 0.018) | 0.055 |
Nausea and vomiting | − 0.255 (− 0.507 to − 0.003) | 0.047 | − 0.331 (− 0.605 to − 0.057) | 0.018 | − 0.382 (− 0.694 to − 0.071) | 0.016 |
Pain | 0.382 (− 0.414 to 1.178) | 0.347 | − 0.169 (− 0.998 to 0.661) | 0.690 | − 0.024 (− 0.892 to 0.845) | 0.957 |
Dyspnea | − 0.043 (− 0.718 to 0.633) | 0.902 | − 0.545 (− 0.545 to − 0.545) | < 0.001 | − 0.570 (− 0.570 to − 0.570) | < 0.001 |
Insomnia | − 0.672 (− 1.781 to 0.437) | 0.235 | − 1.096 (− 2.287 to 0.095) | 0.071 | − 1.412 (− 2.647 to − 0.177) | 0.025 |
Loss of appetite | − 0.668 (− 1.188 to − 0.148) | 0.012 | − 0.727 (− 1.264 to − 0.189) | 0.008 | − 0.722 (− 1.311 to − 0.132) | 0.016 |
Constipation | − 1.103 (− 1.797 to − 0.409) | 0.002 | − 1.659 (− 2.372 to 0.947) | < 0.001 | − 2.028 (− 2.775 to − 1.281) | < 0.001 |
Diarrhea | − 0.590 (− 1.031 to − 0.148) | 0.009 | − 0.946 (− 1.450 to − 0.442) | < 0.001 | − 0.929 (− 1.481 to − 0.377) | 0.001 |
Financial impact | 0.625 (− 0.278 to 0.175) | 0.175 | − 0.052 (− 0.939 to 0.834) | 0.908 | − 0.176 (− 1.102 to 0.749) | 0.709 |