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October 21, 1992, Vol 268, No. 15 >
ARTICLE | October 21, 1992

Dietary Fat and Fiber in Relation to Risk of Breast Cancer: Title and subTitle BreakAn 8-Year Follow-up FREE

Walter C. Willett, MD; David J. Hunter, MB,BS; Meir J. Stampfer, MD; Graham Colditz, MB,BS; JoAnn E. Manson, MD; Donna Spiegelman, DSc; Bernard Rosner, PhD; Charles H. Hennekens, MD; Frank E. Speizer, MD
[+] Author Affiliations

Reprint requests to Channing Laboratory, 180 Longwood Ave, Boston, MA 02215 (Dr Willett).


JAMA. 1992;268(15):2037-2044. doi:10.1001/jama.1992.03490150089030
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Published online
Article
References

Objective.  —To address the hypotheses that dietary fat increases and fiber decreases the risk of breast cancer.

Design.  —Prospective cohort study with dietary assessment at baseline, using a validated, self-administered food frequency questionnaire.

Setting/Participants.  —89 494 women in the Nurses' Health Study who were 34 through 59 years of age in 1980 and who were followed up for 8 years (>95% complete).

Results.  —1439 incident cases of breast cancer were diagnosed, including 774 among postmenopausal women. After adjustment for age, established risk factors, and total energy intake, we observed no evidence of any positive association between total fat intake and breast cancer incidence (relative risks [RRs] for increasing quintiles of fat intake were 1.0, 0.85, 0.96, 0.91, and 0.90; 95% confidence interval for highest vs lowest quintile, 0.77 to 1.07). Among postmenopausal women alone, corresponding RRs were 1.0, 0.89,1.00, 0.95, and 0.91. Comparing extreme deciles of total fat intake (≥49% vs <29% of total energy intake), the RR was 0.86 (95% confidence interval, 0.67 to 1.08). A similar absence of any positive association was observed without adjustment for energy intake; for tumors less than 2 cm as well as 2 cm or greater in diameter; for saturated, monounsaturated, and polyunsaturated fat; and after excluding the first 4 years of follow-up. Also, we found no suggestion of any positive association when using a more detailed and precise dietary questionnaire completed in 1984 (666 subsequent cases), even when women consuming less than 25% of energy from fat were used as the comparison group. No suggestion of a protective effect of dietary fiber was observed (RRs for increasing quintiles were 1.0, 0.95, 0.93, 1.02, and 1.02).

Conclusions.  —These data provide evidence against both an adverse influence of fat intake and a protective effect of fiber consumption by middle-aged women on breast cancer incidence over 8 years. Nevertheless, the positive association between intake of animal fat and risk of colon cancer observed in many studies provides ample reason to limit this source of energy.(JAMA. 1992;268:2037-2044)

REFERENCES

1 +
Armstrong B, Doll R.  Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer . 1975;;15:617-631.
2 +
Prentice RL, Sheppard L.  Dietary fat and cancer: consistency of the epidemiology data, and disease prevention that may follow from a practical reduction in fat consumption. Cancer Causes Control . 1990;;1:81-97.
3 +
Birt DF.  Dietary fat and experimental carcinogenesis: a summary of recent in vivo studies. Adv Exp Med Biol . 1986;;206:69-84.
4 +
Freedman LS, Clifford C, Messina M.  Analysis of dietary fat, calories, body weight, and the development of mammary tumors in rats and mice: a review. Cancer Res . 1990;;50:5710-5719.
5 +
Boissonneault GA, Elson CE, Pariza MW.  Net energy effects of dietary fat on chemically induced mammary carcinogenesis in F344 rats. J Natl Cancer Inst . 1986;;76:335-338.
6 +
Appleton BS, Landers RE.  Oil gavage effects on tumor incidence in the national toxicology program's 2-year carcinogenesis bioassay. Adv Exp Med Biol . 1985;;206:99-104.
7 +
Prentice RL, Thompson D, Clifford C, Gorbach S, Goldin B, Byar D.  Dietary fat reduction and plasma estradiol concentration in healthy postmenopausal women. J Natl Cancer Inst . 1990;;82:129-134.
8 +
Boyar AP, Rose DP, Loughridge JR, et al.  Response to a diet low in total fat in women with postmenopausal breast cancer. Nutr Cancer . 1988;; 11:93-99.
9 +
Rose DP, Boyar AP, Cohen C, Strong LE.  Effect of a low fat diet on hormone levels in women with cystic breast disease, I: serum steroids and gonadotropins. J Natl Cancer Inst . 1987;;78:623-626.
10 +
Cohen LA, Kendall ME, Zang E. Meschter C, Rose DP.  Modulation of N-nitrosomethylurea-induced mammary tumor promotion by dietary fiber and fat. J Natl Cancer Inst . 1991;;83:496-501.
11 +
Goodwin PJ, Boyd NF.  Critical appraisal of the evidence that dietary fat intake is related to breast cancer risk in humans. J Natl Cancer Inst . 1987;; 79:473-485.
12 +
Howe GR, Hirohata T, Hislop TG, et al.  Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies. J Natl Cancer Inst . 1990;; 82:561-569.
13 +
Jones DY, Schatzkin A, Green SB, et al.  Dietary fat and breast cancer in the National Health and Nutrition Examination Survey, I: epidemiologic follow-up study. J Natl Cancer Inst . 1987;;79: 465-471.
14 +
Mills PK, Beeson WL, Phillips RL, Fraser GE.  Dietary habits and breast cancer incidence among Seventh-Day Adventists. Cancer . 1989;;64:582-590.
15 +
Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Hennekens CH, Speizer FE.  Dietary fat and the risk of breast cancer. N Engl J Med . 1987;;316: 22-28.
16 +
Knekt P, Albanes D, Seppanen R, et al.  Dietary fat and risk of breast cancer. Am J Clin Nutr . 1990;;52:903-908.
17 +
Howe GR, Friedenreich CM, Jain M, Miller AB.  A cohort study of fat intake and risk of breast cancer. J Natl Cancer Inst . 1991;;83:336-340.
18 +
Sun M.  Debate rages over breast cancer study. Science . 1988;;239:17-18.
19 +
Prentice RL, Kakar F, Hursting S, Sheppard L, Klein R, Kushi LH.  Aspects of the rationale for the Women's Health Trial. J Natl Cancer Inst . 1988;;80:802-814.
20 +
Hebert JR, Miller DR.  Methodologic considerations for investigating the diet-cancer link. Am J Clin Nutr . 1988;;47:1068-1077.
21 +
Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE.  Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med . 1990;;323:1664-1672.
22 +
Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH.  A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med . 1985;;313:1044-1049.
23 +
Willett W. Nutritional Epidemiology . New York, NY: Oxford University Press; 1990;.
24 +
Willett WC, Sampson L, Stampfer MJ, et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol . 1985;;122:51-65.
25 +
Willett WC, Sampson L, Browne ML, et al.  The use of a self-administered questionnaire to assess diet four years in the past. Am J Epidemiol . 1988;; 127:188-199.
26 +
Composition of Foods: Raw, Processed, and Prepared . Washington, DC: Department of Agriculture; 1963-1988;. Agricultural Handbook No. 8 Series.
27 +
Paul AA, Southgate DA. McCance and Widdowson's the Composition of Foods . 4th ed revised. London, England: Her Majesty's Stationery Office; 1978;.
28 +
Willett W, Stampfer MJ.  Total energy intake: implications for epidemiologic analyses. Am J Epidemiol . 1986;;124:17-27.
29 +
Stampfer MJ, Willett WC, Speizer FE, et al.  Test of the National Death Index. Am J Epidemiol . 1984;;119:837-839.
30 +
Rosner B, Spiegelman D, Willett WC.  Correction of logistic regression relative risk estimates and confidence intervals for measurement error: the case of multiple covariates measured with error. Am J Epidemiol . 1990;;132:734-745.
31 +
Stephan AM, Wald NJ.  Trends in individual consumption of dietary fat in the United States, 1920-1984. Am J Clin Nutr . 1990;;52:457-469.
32 +
Kushi LH, Sellers TA, Potter JG, et al.  Dietary fat, breast cancer, adjustment for energy intake and categorization of risk. J Natl Cancer Inst . 1992;; 84:1092-1099.
33 +
Giovannucci E, Stampfer MJ, Colditz GA, et al.  A comparison of prospective and retrospective assessments of diet in the study of breast cancer. Am J Epidemiol . 1991;;134:714. Abstract.
34 +
Willett WC, Stampfer MJ.  Dietary fat and cancer: another view. Cancer Causes Control . 1990;;1: 103-109.
35 +
Welsch CW.  Relationship between dietary fat and experimental mammary gland tumorigenesis: a review and critique. Cancer Res . 1992;;52( (suppl 7) ):2040s-2048s.
36 +
Micozzi MS.  Nutrition, body size, and breast cancer. Yearbook Phys Anthropol . 1985;;28:175-206.
37 +
Valaoras VG, MacMahon B, Trichopoulos D, Polychronopoulou A.  Lactation and reproductive histories of breast cancer patients in greater Athens, 1965-67. Int J Cancer . 1969;;4:350-363.
38 +
Swanson CA, Jones DY, Schatzkin A, et al.  Breast cancer risk assessed by anthropometry in the NHANES I epidemiological follow-up study. Cancer Res . 1988;;48:5363-5367.
39 +
Vatten LJ, Kvinnsland S.  Body height and risk of breast cancer: a prospective study of 23,831 Norwegian women. Br J Cancer . 1990;;61:881-885.
40 +
Welsch CW, Aylsworth SF.  Enhancement of murine mammary tumorigenesis by feeding of high levels of dietary fat: a hormonal mechanism? J Natl Cancer Inst . 1983;;70:215-221.
41 +
Cohen LA, Wynder EI.  Do dietary monounsaturated fatty acids play a protective role in carcinogenesis and cardiovascular disease? Med Hypotheses . 1990;;31:83-89.
42 +
Stryker WS, Salvini S, Sampson L, Stampfer MJ, Colditz GA, Willett WC.  Contribution of specific foods to absolute intake and between-person variation of nutrient consumption. J Am Diet Assoc . 1991;;91:172-178.
43 +
Roels DA, Trout M, Dujacquier R.  Carotene balances on boys in Ruanda where vitamin A deficiency is prevalent. J Nutr . 1958;;65:115-127.
44 +
Hunter DJ, Stampfer MJ, Colditz GA, et al.  A prospective study of consumption of vitamins A, C, and E and breast cancer risk. Am J Epidemiol . 1991;;134:715. Abstract.
45 +
Graham S, Marshall J, Mettlin C, Rzepka T, Nemoto T, Byers T.  Diet in the epidemiology of breast cancer. Am J Epidemiol . 1982;;116:68-75.
46 +
Goldin BR, Aldercreutz H, Gorbach SL, et al.  Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Engl J Med . 1982;;307:1542-1547.
47 +
Committee on Diet and Health. Diet and Health . Washington, DC: National Academy Press; 1989;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Armstrong B, Doll R.  Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer . 1975;;15:617-631.
2 +
Prentice RL, Sheppard L.  Dietary fat and cancer: consistency of the epidemiology data, and disease prevention that may follow from a practical reduction in fat consumption. Cancer Causes Control . 1990;;1:81-97.
3 +
Birt DF.  Dietary fat and experimental carcinogenesis: a summary of recent in vivo studies. Adv Exp Med Biol . 1986;;206:69-84.
4 +
Freedman LS, Clifford C, Messina M.  Analysis of dietary fat, calories, body weight, and the development of mammary tumors in rats and mice: a review. Cancer Res . 1990;;50:5710-5719.
5 +
Boissonneault GA, Elson CE, Pariza MW.  Net energy effects of dietary fat on chemically induced mammary carcinogenesis in F344 rats. J Natl Cancer Inst . 1986;;76:335-338.
6 +
Appleton BS, Landers RE.  Oil gavage effects on tumor incidence in the national toxicology program's 2-year carcinogenesis bioassay. Adv Exp Med Biol . 1985;;206:99-104.
7 +
Prentice RL, Thompson D, Clifford C, Gorbach S, Goldin B, Byar D.  Dietary fat reduction and plasma estradiol concentration in healthy postmenopausal women. J Natl Cancer Inst . 1990;;82:129-134.
8 +
Boyar AP, Rose DP, Loughridge JR, et al.  Response to a diet low in total fat in women with postmenopausal breast cancer. Nutr Cancer . 1988;; 11:93-99.
9 +
Rose DP, Boyar AP, Cohen C, Strong LE.  Effect of a low fat diet on hormone levels in women with cystic breast disease, I: serum steroids and gonadotropins. J Natl Cancer Inst . 1987;;78:623-626.
10 +
Cohen LA, Kendall ME, Zang E. Meschter C, Rose DP.  Modulation of N-nitrosomethylurea-induced mammary tumor promotion by dietary fiber and fat. J Natl Cancer Inst . 1991;;83:496-501.
11 +
Goodwin PJ, Boyd NF.  Critical appraisal of the evidence that dietary fat intake is related to breast cancer risk in humans. J Natl Cancer Inst . 1987;; 79:473-485.
12 +
Howe GR, Hirohata T, Hislop TG, et al.  Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies. J Natl Cancer Inst . 1990;; 82:561-569.
13 +
Jones DY, Schatzkin A, Green SB, et al.  Dietary fat and breast cancer in the National Health and Nutrition Examination Survey, I: epidemiologic follow-up study. J Natl Cancer Inst . 1987;;79: 465-471.
14 +
Mills PK, Beeson WL, Phillips RL, Fraser GE.  Dietary habits and breast cancer incidence among Seventh-Day Adventists. Cancer . 1989;;64:582-590.
15 +
Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Hennekens CH, Speizer FE.  Dietary fat and the risk of breast cancer. N Engl J Med . 1987;;316: 22-28.
16 +
Knekt P, Albanes D, Seppanen R, et al.  Dietary fat and risk of breast cancer. Am J Clin Nutr . 1990;;52:903-908.
17 +
Howe GR, Friedenreich CM, Jain M, Miller AB.  A cohort study of fat intake and risk of breast cancer. J Natl Cancer Inst . 1991;;83:336-340.
18 +
Sun M.  Debate rages over breast cancer study. Science . 1988;;239:17-18.
19 +
Prentice RL, Kakar F, Hursting S, Sheppard L, Klein R, Kushi LH.  Aspects of the rationale for the Women's Health Trial. J Natl Cancer Inst . 1988;;80:802-814.
20 +
Hebert JR, Miller DR.  Methodologic considerations for investigating the diet-cancer link. Am J Clin Nutr . 1988;;47:1068-1077.
21 +
Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE.  Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med . 1990;;323:1664-1672.
22 +
Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH.  A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med . 1985;;313:1044-1049.
23 +
Willett W. Nutritional Epidemiology . New York, NY: Oxford University Press; 1990;.
24 +
Willett WC, Sampson L, Stampfer MJ, et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol . 1985;;122:51-65.
25 +
Willett WC, Sampson L, Browne ML, et al.  The use of a self-administered questionnaire to assess diet four years in the past. Am J Epidemiol . 1988;; 127:188-199.
26 +
Composition of Foods: Raw, Processed, and Prepared . Washington, DC: Department of Agriculture; 1963-1988;. Agricultural Handbook No. 8 Series.
27 +
Paul AA, Southgate DA. McCance and Widdowson's the Composition of Foods . 4th ed revised. London, England: Her Majesty's Stationery Office; 1978;.
28 +
Willett W, Stampfer MJ.  Total energy intake: implications for epidemiologic analyses. Am J Epidemiol . 1986;;124:17-27.
29 +
Stampfer MJ, Willett WC, Speizer FE, et al.  Test of the National Death Index. Am J Epidemiol . 1984;;119:837-839.
30 +
Rosner B, Spiegelman D, Willett WC.  Correction of logistic regression relative risk estimates and confidence intervals for measurement error: the case of multiple covariates measured with error. Am J Epidemiol . 1990;;132:734-745.
31 +
Stephan AM, Wald NJ.  Trends in individual consumption of dietary fat in the United States, 1920-1984. Am J Clin Nutr . 1990;;52:457-469.
32 +
Kushi LH, Sellers TA, Potter JG, et al.  Dietary fat, breast cancer, adjustment for energy intake and categorization of risk. J Natl Cancer Inst . 1992;; 84:1092-1099.
33 +
Giovannucci E, Stampfer MJ, Colditz GA, et al.  A comparison of prospective and retrospective assessments of diet in the study of breast cancer. Am J Epidemiol . 1991;;134:714. Abstract.
34 +
Willett WC, Stampfer MJ.  Dietary fat and cancer: another view. Cancer Causes Control . 1990;;1: 103-109.
35 +
Welsch CW.  Relationship between dietary fat and experimental mammary gland tumorigenesis: a review and critique. Cancer Res . 1992;;52( (suppl 7) ):2040s-2048s.
36 +
Micozzi MS.  Nutrition, body size, and breast cancer. Yearbook Phys Anthropol . 1985;;28:175-206.
37 +
Valaoras VG, MacMahon B, Trichopoulos D, Polychronopoulou A.  Lactation and reproductive histories of breast cancer patients in greater Athens, 1965-67. Int J Cancer . 1969;;4:350-363.
38 +
Swanson CA, Jones DY, Schatzkin A, et al.  Breast cancer risk assessed by anthropometry in the NHANES I epidemiological follow-up study. Cancer Res . 1988;;48:5363-5367.
39 +
Vatten LJ, Kvinnsland S.  Body height and risk of breast cancer: a prospective study of 23,831 Norwegian women. Br J Cancer . 1990;;61:881-885.
40 +
Welsch CW, Aylsworth SF.  Enhancement of murine mammary tumorigenesis by feeding of high levels of dietary fat: a hormonal mechanism? J Natl Cancer Inst . 1983;;70:215-221.
41 +
Cohen LA, Wynder EI.  Do dietary monounsaturated fatty acids play a protective role in carcinogenesis and cardiovascular disease? Med Hypotheses . 1990;;31:83-89.
42 +
Stryker WS, Salvini S, Sampson L, Stampfer MJ, Colditz GA, Willett WC.  Contribution of specific foods to absolute intake and between-person variation of nutrient consumption. J Am Diet Assoc . 1991;;91:172-178.
43 +
Roels DA, Trout M, Dujacquier R.  Carotene balances on boys in Ruanda where vitamin A deficiency is prevalent. J Nutr . 1958;;65:115-127.
44 +
Hunter DJ, Stampfer MJ, Colditz GA, et al.  A prospective study of consumption of vitamins A, C, and E and breast cancer risk. Am J Epidemiol . 1991;;134:715. Abstract.
45 +
Graham S, Marshall J, Mettlin C, Rzepka T, Nemoto T, Byers T.  Diet in the epidemiology of breast cancer. Am J Epidemiol . 1982;;116:68-75.
46 +
Goldin BR, Aldercreutz H, Gorbach SL, et al.  Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Engl J Med . 1982;;307:1542-1547.
47 +
Committee on Diet and Health. Diet and Health . Washington, DC: National Academy Press; 1989;.

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