Sihan Song; Hyun Jo Youn; So-Youn Jung; Eunsook Lee; Zisun Kim; Jihyoung Cho; Young Bum Yoo; Hyeong-Gon Moon; Dong-Young Noh; Jung Eun Lee

doi:10.5720/kjcn.2016.21.6.533

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Dietary Changes After Breast Cancer Diagnosis: Associations with Physical Activity, Anthropometry, and Health-related Quality of life Among Korean Breast Cancer Survivors: Sihan Song, Hyun Jo Youn, So-Youn Jung, Eunsook Lee, Zisun Kim, Jihyoung Cho, Young Bum Yoo, Hyeong-Gon Moon, Dong-Young Noh, Jung Eun Lee; Korean Journal of Community Nutrition 2016;21(6):533-544.
DOI: https://doi.org/10.5720/kjcn.2016.21.6.533
Published online: December 31, 2016

¹Department of Food and Nutrition, College of Human Ecology, Sookmyung Women's University, Seoul, Korea.

²Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea.

³Center for Breast Cancer, National Cancer Center, Goyang, Korea.

⁴Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.

⁵Department of Surgery, Keimyung University School of Medicine, Daegu, Korea.

⁶Department of Surgery, Konkuk University School of Medicine, Seoul, Korea.

⁷Breast Care Center, Seoul National University Hospital, Seoul, Korea.

⁸Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

⁹Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea.

Corresponding author: Jung Eun Lee. Department of Food and Nutrition, Seoul National University, College of Human Ecology, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea. Tel: (02) 880-6834, Fax: (02) 880-0305, jungelee@snu.ac.kr

• Received: December 6, 2016 • Revised: December 21, 2016 • Accepted: December 21, 2016

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Acknowledgments
Acknowledgments
REFERENCES

Abstract

Objectives
We aimed to examine levels of physical activity, anthropometric features, and health-related quality of life (HRQoL) among Korean breast cancer survivors who reported changes in their diet after diagnosis.
Methods
A total of 380 women who had been diagnosed with stage I to III breast cancer and had breast cancer surgery at least six months before the interview were included. Participants provided information on dietary change after diagnosis, post-diagnostic diet, physical activity, anthropometric measures, and HRQoL through face-to-face interview. We assessed HRQoL levels of breast cancer survivors using a validated Korean version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Breast Cancer Module (BR23). We used the logistic regression and generalized linear models to identify the associations of dietary changes in relation with physical activity, anthropometry, and HRQoL.
Results
The majority of participants (72.6%) reported that they have changed their diet to a healthier diet after diagnosis. Breast cancer survivors who reported to have change to a healthy diet had higher intakes of vegetables and fruits and lower intakes of red and processed meats, and refined grains than those who did not. Also, survivors with a healthy change in their diet were more likely to engage in physical activity (top vs. bottom tertile: odds ratio [OR], 1.85; 95% confidence interval [95% CI], 1.02-3.36) and have lower body mass index (BMI) (OR, 0.90; 95% CI, 0.82-0.98 for one kg/m² increment in BMI) compared to those who did not. We found that a healthy change in diet was associated with higher scores of physical functioning (p=0.02) and lower scores of constipation (p=0.04) and diarrhea (p=0.006) compared to those who did not.
Conclusions
Healthy changes in diet after breast cancer diagnosis may be associated with lower levels of BMI, and higher levels of physical activity and HRQoL.
Keywords: breast cancer survivors; dietary change; physical activity; anthropometric features; health-related quality of life

Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2014R1A2A2A01007794).

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Table 1

Demographic, clinical and lifestyle characteristics of study participants according to change to a healthy diet after diagnosis of breast cancer

1) Log transformed t-test was used for continuous variables and chi-square test was used for categorical variables.

2) SD: standard deviation

3) Number of participants did not equal to 380 because some participants did not provide the relevent information.

4) AJCC: American Joint Committee on Cancer

5) BMI: body mass index

6) NA: Not available

7) Fisher exact test was used.

Table 2

Adherence score of American Cancer Society (ACS) or World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines and intake of food groups at interview according to change to a healthy diet after diagnosis of breast cancer (n=380)

1) T-test was used for comparing two groups.

2) SD: standard deviation

3) Among 380, one participant was excluded.

4) Wilcoxon-Mann-Whitney test was used for comparing two groups.

5) Energy dense diet denotes energy intake per amount of total food intake (kcal per 100 g).

Table 3

Odds ratio (OR) and 95% confidence interval (CI) for change to a healthy diet by physical activity and anthropometric measures (n=380)

1) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current).

2) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current). For physical activity, BMI at diagnosis (<23, 23-<25, ≥25 kg/m²) was additionally adjusted. For BMI or weight change, physical activity (MET hours/week, tertile) was additionally adjusted.

3) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current), physical activity (MET hours/week, tertile), and BMI at diagnosis (<23, 23-<25, ≥25 kg/m²).

4) MET: metabolic equivalent task.

5) P for trend was calculated by assigning median or ordinal value as continuous variable.

6) Number of participants did not equal to 380 because some participants did not provide the relevant information.

7) BMI: body mass index

8) SD: standard deviation

Table 4

Health-related quality of life (HRQoL) scores according to change to a healthy diet after diagnosis of breast cancer (n=204)

1) LS means: least-squares means

2) 95% CI: 95% confidence interval

3) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index at diagnosis (<23, 23-<25, ≥25 kg/m²), marital status (married or cohabitation, unmarried or divorced or widowed), current menopausal status (premenopausal, postmenopausal), education level (middle school or below, high school, and college or above), stage of breast cancer (I, II, III), time from breast cancer surgery (6 month-<1 year, 1 year-<5 years, ≥5 years), and alcohol intake (never, former, current).

4) EORTC QLQ-30: EUROPEAN Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30

5) BR23: breast cancer module

Figure & Data

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Dietary Changes After Breast Cancer Diagnosis: Associations with Physical Activity, Anthropometry, and Health-related Quality of life Among Korean Breast Cancer Survivors

Korean J Community Nutr. 2016;21(6):533-544. Published online December 31, 2016

DOI: https://doi.org/10.5720/kjcn.2016.21.6.533

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Dietary Changes After Breast Cancer Diagnosis: Associations with Physical Activity, Anthropometry, and Health-related Quality of life Among Korean Breast Cancer Survivors

Table 1

Demographic, clinical and lifestyle characteristics of study participants according to change to a healthy diet after diagnosis of breast cancer

1) Log transformed t-test was used for continuous variables and chi-square test was used for categorical variables.

2) SD: standard deviation

3) Number of participants did not equal to 380 because some participants did not provide the relevent information.

4) AJCC: American Joint Committee on Cancer

5) BMI: body mass index

6) NA: Not available

7) Fisher exact test was used.

Table 2

Adherence score of American Cancer Society (ACS) or World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines and intake of food groups at interview according to change to a healthy diet after diagnosis of breast cancer (n=380)

1) T-test was used for comparing two groups.

2) SD: standard deviation

3) Among 380, one participant was excluded.

4) Wilcoxon-Mann-Whitney test was used for comparing two groups.

5) Energy dense diet denotes energy intake per amount of total food intake (kcal per 100 g).

Table 3

Odds ratio (OR) and 95% confidence interval (CI) for change to a healthy diet by physical activity and anthropometric measures (n=380)

1) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current).

4) MET: metabolic equivalent task.

5) P for trend was calculated by assigning median or ordinal value as continuous variable.

6) Number of participants did not equal to 380 because some participants did not provide the relevant information.

7) BMI: body mass index

8) SD: standard deviation

Table 4

Health-related quality of life (HRQoL) scores according to change to a healthy diet after diagnosis of breast cancer (n=204)

1) LS means: least-squares means

2) 95% CI: 95% confidence interval

4) EORTC QLQ-30: EUROPEAN Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30

5) BR23: breast cancer module

Table 1 Demographic, clinical and lifestyle characteristics of study participants according to change to a healthy diet after diagnosis of breast cancer

1) Log transformed t-test was used for continuous variables and chi-square test was used for categorical variables.

2) SD: standard deviation

3) Number of participants did not equal to 380 because some participants did not provide the relevent information.

4) AJCC: American Joint Committee on Cancer

5) BMI: body mass index

6) NA: Not available

7) Fisher exact test was used.

Table 2 Adherence score of American Cancer Society (ACS) or World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines and intake of food groups at interview according to change to a healthy diet after diagnosis of breast cancer (n=380)

1) T-test was used for comparing two groups.

2) SD: standard deviation

3) Among 380, one participant was excluded.

4) Wilcoxon-Mann-Whitney test was used for comparing two groups.

5) Energy dense diet denotes energy intake per amount of total food intake (kcal per 100 g).

Table 3 Odds ratio (OR) and 95% confidence interval (CI) for change to a healthy diet by physical activity and anthropometric measures (n=380)

1) Models were adjusted for age (year; continuous), energy intake (kcal/day; continuous), stage of breast cancer (I, II, III), and alcohol intake (never, former, current).

4) MET: metabolic equivalent task.

5) P for trend was calculated by assigning median or ordinal value as continuous variable.

6) Number of participants did not equal to 380 because some participants did not provide the relevant information.

7) BMI: body mass index

8) SD: standard deviation

Table 4 Health-related quality of life (HRQoL) scores according to change to a healthy diet after diagnosis of breast cancer (n=204)

1) LS means: least-squares means

2) 95% CI: 95% confidence interval

4) EORTC QLQ-30: EUROPEAN Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30