Clin Nutr Res.  2014 Jan;3(1):39-47. 10.7762/cnr.2014.3.1.39.

Effect of 8-Week Nutrition Counseling to Increase Phytochemical Rich Fruit and Vegetable Consumption in Korean Breast Cancer Patients: A Randomized Controlled Trial

• Cho SW
• Kim JH
• Lee SM
• Lee SM
• Choi EJ
• Jeong J
• Park YK

• KMID: 2279620
• DOI: http://doi.org/10.7762/cnr.2014.3.1.39

Abstract

High fruit and vegetable consumption is associated with a lower risk of breast cancer. The incidence of breast cancer is continuously increasing in Korea, but only a few studies on nutrition intervention in breast cancer patients has been reported. The aim of this study was to investigate whether an 8-week nutrition intervention based on dietary counseling can promote fruit and vegetable consumption, increase serum antioxidant nutrient levels, and improve quality of life in Korean breast cancer patients. Sixty-one breast cancer patients received either standard care (n = 31) or nutrition counseling (n = 30). The standard care group was given brochures recommending phytochemical rich diet. The intervention group was provided with two nutrition counseling sessions and one cooking class session, thereby encouraged subjects to eat at least 10 or more servings of fruits and vegetables per day. After 8-week intervention, waist circumference in the intervention group was significantly decreased (p < 0.001) even though no difference was reported for body mass index. Energy intake (p = 0.007), fiber (p < 0.001), and antioxidant nutrient (vitamin A, C, E, and beta-carotene, p < 0.001, respectively) intakes were significantly increased. Serum antioxidant level was also increased significantly, i.e., vitamin A (p = 0.048); vitamin E (p = 0.004). Total vegetable intake (excluding kimchi intake) in the intervention group was increased from 425 g to 761 g (p < 0.001), fruit consumption was also increased from 232 g to 334 g (p < 0.001), while standard care group did not show any significant change. Our study showed that nutrition counseling and providing cooking tips helped to encourage the patient to consume and maintain more fruit and vegetable intakes.

Keyword

Counseling; Breast neoplasms; Fruits; Vegetables; Antioxidants

MeSH Terms

Antioxidants
beta Carotene
Body Mass Index
Breast Neoplasms*
Breast*
Cooking
Counseling*
Diet
Energy Intake
Fruit*
Humans
Incidence
Korea
Pamphlets
Quality of Life
Vegetables*
Vitamin A
Vitamin E
Vitamins
Waist Circumference
Antioxidants
Vitamin A
Vitamin E
Vitamins
beta Carotene

Figure

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  Figure 1 Flowchart of the study.

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  Figure 2 Daily fruit and vegetable intake between standard care control group and intervention group. The statistical significance measured by paired t-test. *Significant difference between baseline and 8 week (p < 0.001).

Reference

1. Ministry of Health & Welfare. National Cancer Center, Korea Central Cancer Registry. Annual report of cancer statistics in Korea in 2010. Goyang: Korea Central Cancer Registry;2012.

2. Park SK, Kang D, Kim Y, Yoo KY. Epidemiologic characteristics of the breast cancer in Korea. J Korean Med Assoc. 2009; 52:937–945.

3. Ahn SH. Korean Breast Cancer Society. Clinical characteristics of breast cancer patients in Korea in 2000. Arch Surg. 2004; 139:27–30.

4. Son BH, Kwak BS, Kim JK, Kim HJ, Hong SJ, Lee JS, Hwang UK, Yoon HS, Ahn SH. Changing patterns in the clinical characteristics of Korean patients with breast cancer during the last 15 years. Arch Surg. 2006; 141:155–160.

5. Bessaoud F, Daurès JP, Gerber M. Dietary factors and breast cancer risk: a case control study among a population in Southern France. Nutr Cancer. 2008; 60:177–187.

6. Edefonti V, Randi G, Decarli A, La Vecchia C, Bosetti C, Franceschi S, Dal Maso L, Ferraroni M. Clustering dietary habits and the risk of breast and ovarian cancers. Ann Oncol. 2009; 20:581–590.

7. Zhang CX, Ho SC, Chen YM, Fu JH, Cheng SZ, Lin FY. Greater vegetable and fruit intake is associated with a lower risk of breast cancer among Chinese women. Int J Cancer. 2009; 125:181–188.

8. Smith-Warner SA, Spiegelman D, Yaun SS, Adami HO, Beeson WL, van den Brandt PA, Folsom AR, Fraser GE, Freudenheim JL, Goldbohm RA, Graham S, Miller AB, Potter JD, Rohan TE, Speizer FE, Toniolo P, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Hunter DJ. Intake of fruits and vegetables and risk of breast cancer: a pooled analysis of cohort studies. JAMA. 2001; 285:769–776.

9. Wang C, Baumgartner RN, Yang D, Slattery ML, Murtaugh MA, Byers T, Hines LM, Giuliano AR, Baumgartner KB. No evidence of association between breast cancer risk and dietary carotenoids, retinols, vitamin C and tocopherols in Southwestern Hispanic and non-Hispanic White women. Breast Cancer Res Treat. 2009; 114:137–145.

10. van Gils CH, Peeters PH, Bueno-de-Mesquita HB, Boshuizen HC, Lahmann PH, Clavel-Chapelon F, Thiébaut A, Kesse E, Sieri S, Palli D, Tumino R, Panico S, Vineis P, Gonzalez CA, Ardanaz E, Sánchez MJ, Amiano P, Navarro C, Quirós JR, Key TJ, Allen N, Khaw KT, Bingham SA, Psaltopoulou T, Koliva M, Trichopoulou A, Nagel G, Linseisen J, Boeing H, Berglund G, Wirfält E, Hallmans G, Lenner P, Overvad K, Tjønneland A, Olsen A, Lund E, Engeset D, Alsaker E, Norat T, Kaaks R, Slimani N, Riboli E. Consumption of vegetables and fruits and risk of breast cancer. JAMA. 2005; 293:183–193.

11. Liu RH. Potential synergy of phytochemicals in cancer prevention: mechanism of action. J Nutr. 2004; 134:3479S–3485S.

12. Thomson CA, Stendell-Hollis NR, Rock CL, Cussler EC, Flatt SW, Pierce JP. Plasma and dietary carotenoids are associated with reduced oxidative stress in women previously treated for breast cancer. Cancer Epidemiol Biomarkers Prev. 2007; 16:2008–2015.

13. Winters BL, Mitchell DC, Smiciklas-Wright H, Grosvenor MB, Liu W, Blackburn GL. Dietary patterns in women treated for breast cancer who successfully reduce fat intake: the Women's Intervention Nutrition Study (WINS). J Am Diet Assoc. 2004; 104:551–559.

14. Pierce JP, Newman VA, Natarajan L, Flatt SW, Al-Delaimy WK, Caan BJ, Emond JA, Faerber S, Gold EB, Hajek RA, Hollenbach K, Jones LA, Karanja N, Kealey S, Madlensky L, Marshall J, Ritenbaugh C, Rock CL, Stefanick ML, Thomson C, Wasserman L, Parker BA. Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern. J Nutr. 2007; 137:2291–2296.

15. Newman VA, Thomson CA, Rock CL, Flatt SW, Kealey S, Bardwell WA, Caan BJ, Pierce JP. Women's Healthy Eating and Living (WHEL) Study Group. Achieving substantial changes in eating behavior among women previously treated for breast cancer--an overview of the intervention. J Am Diet Assoc. 2005; 105:382–391.

16. Wayne SJ, Baumgartner K, Baumgartner RN, Bernstein L, Bowen DJ, Ballard-Barbash R. Diet quality is directly associated with quality of life in breast cancer survivors. Breast Cancer Res Treat. 2006; 96:227–232.

17. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005; 23:1431–1438.

18. Corle DK, Sharbaugh C, Mateski DJ, Coyne T, Paskett ED, Cahill J, Daston C, Lanza E, Schatzkin A. PPT Study Group. Polyp Prevention Trial. Self-rated quality of life measures: effect of change to a low-fat, high-fiber, fruit and vegetable enriched diet. Ann Behav Med. 2001; 23:198–207.

19. Ministry of Health and Welfare, Korea Institute for Health and Social Affairs. Korea Health Industry Development Institute. Korea Centers for Disease Control and Prevention. The Third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005. Seoul: Korea Institute for Health and Social Affairs;2006.

20. Do MH, Lee SS, Jung PJ, Lee MH. The effect of individual nutrition counseling on diet and nutrition status of postoperative breast cancer patients. Korean J Nutr. 2004; 37:557–565.

21. Bieri JG, Tolliver TJ, Catignani GL. Simultaneous determination of alpha-tocopherol and retinol in plasma or red cells by high pressure liquid chromatography. Am J Clin Nutr. 1979; 32:2143–2149.

22. Functional Assessment of Chronic Illness Therapy (US). Functional assessment of cancer therapy-breast cancer version 4-Korean version. Elmhurst (IL): Functional Assessment of Chronic Illness Therapy;2008. cited 2013 December. Availble from: http://www.facit.org/FACITOrg/Questionnaires.

23. World Health Organization (CH). Food and Agriculture Organization (US). Diet, nutrition and the prevention of chronic diseases. Report of a joint WHO/FAO expert consultation. WHO technical report series No. 916. Geneva: World Health Organization;2003.

24. World Cancer Research Fund. American Institute for Cancer Research. Food, nutrition, and the prevention of cancer: a global perspective. Washington DC: American Institute for Cancer Research;2007.

25. Pierce JP, Newman VA, Flatt SW, Faerber S, Rock CL, Natarajan L, Caan BJ, Gold EB, Hollenbach KA, Wasserman L, Jones L, Ritenbaugh C, Stefanick ML, Thomson CA, Kealey S. Women's Healthy Eating and Living (WHEL) Study Group. Telephone counseling intervention increases intakes of micronutrient- and phytochemical-rich vegetables, fruit and fiber in breast cancer survivors. J Nutr. 2004; 134:452–458.

26. Smith-Warner SA, Elmer PJ, Tharp TM, Fosdick L, Randall B, Gross M, Wood J, Potter JD. Increasing vegetable and fruit intake: randomized intervention and monitoring in an at-risk population. Cancer Epidemiol Biomarkers Prev. 2000; 9:307–317.

27. Al-Delaimy WK, Ferrari P, Slimani N, Pala V, Johansson I, Nilsson S, Mattisson I, Wirfalt E, Galasso R, Palli D, Vineis P, Tumino R, Dorronsoro M, Pera G, Ocké MC, Bueno-de-Mesquita HB, Overvad K, Chirlaque M, Trichopoulou A, Naska A, Tjønneland A, Olsen A, Lund E, Alsaker EH, Barricarte A, Kesse E, Boutron-Ruault MC, Clavel-Chapelon F, Key TJ, Spencer E, Bingham S, Welch AA, Sanchez-Perez MJ, Nagel G, Linseisen J, Quirós JR, Peeters PH, van Gils CH, Boeing H, van Kappel AL, Steghens JP, Riboli E. Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr. 2005; 59:1387–1396.

28. McEligot AJ, Rock CL, Flatt SW, Newman V, Faerber S, Pierce JP. Plasma carotenoids are biomarkers of long-term high vegetable intake in women with breast cancer. J Nutr. 1999; 129:2258–2263.

29. Pan SY, Zhou J, Gibbons L, Morrison H, Wen SW. Canadian Cancer Registries Epidemiology Research Group [CCRERG]. Antioxidants and breast cancer risk- a population-based case-control study in Canada. BMC Cancer. 2011; 11:372.

30. Duncan AM. The role of nutrition in the prevention of breast cancer. AACN Clin Issues. 2004; 15:119–135.

31. Gandini S, Merzenich H, Robertson C, Boyle P. Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Eur J Cancer. 2000; 36:636–646.

32. Sato R, Helzlsouer KJ, Alberg AJ, Hoffman SC, Norkus EP, Comstock GW. Prospective study of carotenoids, tocopherols, and retinoid concentrations and the risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 2002; 11:451–457.

33. Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer. 2004; 91:447–452.

34. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005; 23:1431–1438.

35. Steptoe A, Perkins-Porras L, Hilton S, Rink E, Cappuccio FP. Quality of life and self-rated health in relation to changes in fruit and vegetable intake and in plasma vitamins C and E in a randomised trial of behavioural and nutritional education counselling. Br J Nutr. 2004; 92:177–184.

36. Marín Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007; 26:289–301.

37. Halfdanarson TR, Thordardottir E, West CP, Jatoi A. Does dietary counseling improve quality of life in cancer patients? A systematic review and meta-analysis. J Support Oncol. 2008; 6:234–237.

38. Persson CR, Johansson BB, Sjöden PO, Glimelius BL. A randomized study of nutritional support in patients with colorectal and gastric cancer. Nutr Cancer. 2002; 42:48–58.

39. Hajian-Tilaki KO, Gholizadehpasha AR, Bozorgzadeh S, Hajian-Tilaki E. Body mass index and waist circumference are predictor biomarkers of breast cancer risk in Iranian women. Med Oncol. 2011; 28:1296–1301.

40. Wang Y, Jacobs EJ, Patel AV, Rodríguez C, McCullough ML, Thun MJ, Calle EE. A prospective study of waist circumference and body mass index in relation to colorectal cancer incidence. Cancer Causes Control. 2008; 19:783–792.

41. Moore LL, Bradlee ML, Singer MR, Splansky GL, Proctor MH, Ellison RC, Kreger BE. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord. 2004; 28:559–567.