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Prevention of Non Communicable Diseases

Palaeolithic diet score and risk of breast cancer among postmenopausal women overall and by hormone receptor and histologic subtypes

European Journal of Clinical Nutrition volume 77, pages 596–602 (2023)Cite this article

Subjects

Abstract

Background

The Palaeolithic diet (PD) has gained popularity globally. There is emerging evidence of its putative health benefits as short-term effects on chronic diseases have been reported. We evaluated the association between long-term adherence to the PD and breast cancer (BC) risk among postmenopausal women.

Methods

65,574 women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort were followed from 1993 to 2014. Incident BC cases were identified and validated. The PD score was calculated using dietary intake self-reported at baseline (1993) and follow-up (2005) or baseline only if censored before follow-up. Multivariable Cox proportional hazards regression models were used to estimate BC hazard ratios (HR) and 95% confidence intervals (CI).

Results

Over a mean follow-up of 20 years, 3968 incident BC cases occurred. An increase of 1 standard deviation in the PD score was associated with an 8% lower BC risk, fully-adjusted model: HR1-SD 0.92, 95% CI; 0.89, 0.95. Compared to women with low adherence to the PD, women with high adherence had a 17% lower BC risk, HRQ5 vs Q1 0.83, 95% CI; 0.75, 0.92, Ptrend < 0.01. When considering BC subtypes, we observed the same pattern of association (Pheterogeneity > 0.10 for all).

Conclusions

High adherence to a PD characterised by fruit, vegetables, nuts, fish, and lean meat and limited in dairy, grains, legumes, refined sugar, and alcohol was associated with a lower BC risk. The lack of heterogeneity according to BC subtypes could indicate the involvement of non-hormonal mechanisms. The protocol is registered at clinicaltrials.gov as NCT03285230.

Registry

The protocol is registered at clinicaltrials.gov as NCT03285230.

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Fig. 1: The Palaeolithic diet score and breast cancer risk, overall and by subtypes among postmenopausal women, E3N cohort (N = 65,574).
Fig. 2: Associations of the Palaeolithic diet score with breast cancer fitted with restricted cubic splines (5 knots placed at the 5th, 27.5th, 50th, 72.5th, and 95th percentiles).

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Data availability

The datasets generated during and/or analysed for the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The research was carried out using data from INSERM (French National Institutes for Health and Medical Research) E3N cohort, which was established and maintained with the support of the Mutuelle Générale de l’Education Nationale (MGEN), Gustave Roussy, and the French League against Cancer (LNCC). E3N-E4N is also supported by the French National Research Agency (ANR) under the Investment for the Future Programme (PIA) (ANR-10-COHO-0006) and by the French Ministry of Higher Education, Research and Innovation (subsidy for public service charges n°2103 586016). The authors are indebted to all participants for their continued participation. They are also grateful to all members of the E3N study group.

Funding

This research was carried out using data from INSERM’S E3N cohort with the support of the MGEN, Institut Gustave Roussy and the “Ligue contre le Cancer” for the constitution and maintenance of the E3N cohort. This work has also benefited from State aid managed by the National Research Agency under the programme “Investissement d’avenir” under the reference ANR-10-COHO-0006 as well as a subsidy from the “Ministère de l’enseignement supérieur de la recherche et de l’innovation” for public service charges under the reference n°2103 586016. SS is supported by a doctoral funding from l’Ecole Doctorale de Santé Publique, Ministère de l’enseignement supérieur, de la recherche et de l’innovation.

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Author notes

  1. These authors contributed equally: Marie-Christine Boutron-Ruault, Nasser Laouali.

Authors and Affiliations

  1. Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESP, F-94805, Villejuif, France

    Sanam Shah, Mariem Hajji-Louati, Emmanuelle Correia, Marie-Christine Boutron-Ruault & Nasser Laouali

  2. International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372, CEDEX 08, Lyon, France

    Yahya Mahamat-Saleh

  3. Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA

    Youssef Oulhote & Nasser Laouali

  4. Scripps Institution of Oceanography, University of California, San Diego, CA, USA

    Nasser Laouali

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Contributions

SS, MCBR, and NL conceived and designed the study. MCBR and NL contributed equally as the last authors. SS performed the statistical analysis and drafted the original manuscript. All authors contributed to the interpretation of data discussed in the manuscript, revised it, and approved its final version to be published. NL is the guarantor of this work and, as such, has full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.

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Correspondence to Marie-Christine Boutron-Ruault.

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The study participants provided written informed consent, and the cohort study received ethical approval from the French National Commission for Computerized Data and Individual Freedom.

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Shah, S., Mahamat-Saleh, Y., Hajji-Louati, M. et al. Palaeolithic diet score and risk of breast cancer among postmenopausal women overall and by hormone receptor and histologic subtypes. Eur J Clin Nutr 77, 596–602 (2023). https://doi.org/10.1038/s41430-023-01267-x

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