Nutritional risk factors and status of serum 25(OH)D levels in patients with breast cancer: A case control study in India

Highlights

• Nutritional risk factors in breast cancer among women in India.

• Few nutritional risk like frequency of consumption for mushrooms and fruits and type of fat was found to be associated with the risk of breast cancer.

• India has no guidelines for defining vitamin D deficiency. The cutoffs used were adopted from US Endocrine society.

• A significant association with breast cancer was observed after comparing serum levels of 25(OH)D of <20 ng/ml with ≥20 ng/ml.

Abstract

To study the nutritional risk factors and status of serum 25(OH)D levels in patients with breast cancer. A total of 100 women (cases) with confirmed breast cancer (BC) matched with equal number of healthy females (controls) of similar age and socioeconomic status (SES) were included in study. Controls included were nonbreast cancer patients who accompanied the patients to a tertiary care hospital. All the subjects (cases and controls) were administered a questionnaires to collect data on socioeconomic status, dietary pattern and the frequency of food consumption using a validated food frequency questionnaire. Anthropometric assessment was done for waist and hip circumference to calculate waist to hip ratio (WHR). Non fasting blood samples were collected for serum 25-hydroxyvitamin D [25(OH)D] levels estimation using chemiluminescent immunoassay technique and total serum calcium levels by colorimetric assay technique. Serum 25(OH)D and total calcium levels were expressed in ng/ml and mg/dl. Vitamin D deficiency was defined as per the guidelines set by United States Endocrine Society. The mean age of cases and controls was 45 ± 9 and 46 ± 10 years respectively. On multivariate analysis, an inverse association with BC was found for less frequency of fruits consumption with an adjusted (ORs, 95% CI) (2.7, 0.5–15.7) respectively. Mushroom intake was inversely associated with risk of BC (ORs, 95% CI) (5.6, 1.9–16.6). Saturated fat intake and high WHR were significantly associated with high risk of BC with adjusted ORs, 95% CI of (3.4, 1.4–8.1) and (5, 1.4–17). A significant association (p < 0.05) was found between low serum 25(OH)D levels and the risk of BC with adjusted ORs, 95% CI of (2.5, 0.9–7.4). Majority of the patients with BC were suffering from vitamin D deficiency. Dietary intake of mushrooms containing vitamin D naturally was found to be associated with decreased risk of breast cancer. A significant association was found between low serum 25(OH)D levels (<20 ng/ml) with the risk of BC. Obesity as a consequence of nutritional risk factors determined by higher WHR was found to be significantly associated with the risk of BC.

Introduction

Cancer is a major public health problem and cause of death worldwide. According to WHO, cancer accounted for 7.6 million deaths in 2008, which is projected to rise with an estimated 13.1 million deaths in 2030. Breast cancer (BC) is the most common cancer among women, accounting for 25% of all new cancer cases [1]. In India, BC is the leading cancer diagnosed in women overtaking cervical cancer [2]. A number of risk factors are associated with BC like age, family history, genetic mutation, breast density, reproductive factors, nutritional status, obesity, alcohol use and socioeconomic status (SES). Epidemiological and clinical evidence supports that nutrition in its broadest sense, plays a role in BC [3], [4]. Evidence suggests that vitamin D intake (ergocalciferol and cholecalciferol) in association with calcium may be protective against BC [5], [6], [7]. Women with 25(OH)D concentrations ≥40 ng/ml have a significantly lower risk of cancer (∼70%) compared with concentrations <20 ng/ml [8].

Vitamin D has been shown to have anti-carcinogenic properties like effects on cell proliferation and differentiation [9]. Synthesis of 1,25-dihydroxyvitamin D in breast tissue may contribute to maintenance of normal cell function, which could be impaired in vitamin D deficiency. A large number of Indian women are affected with BC. The literature available on the nutritional risk factors in BC has provided mixed results [10]. Hence, the present case control study aimed to investigate the nutritional factors and status of serum 25(OH)D levels and the risk of BC was conducted.