@misc{10481/84918,
year = {26},
month = {6},
url = {https://hdl.handle.net/10481/84918},
abstract = {A total of 13,270 incident breast cancer cases were identified from an initial sample of 318,686 women in 9 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Adherence to Mediterranean diet was estimated through the adapted relative Mediterranean diet (arMED), a 16-point score that includes 8 key components of the Mediterranean diet and excludes alcohol. The degree of adherence to arMED was classified as low (score 0–5), medium (score 6–8), and high (score 9–16). Multivariable Cox proportional hazards models were used to analyze the association between the arMED score and overall mortality, and Fine-Gray competing risks models were applied for BC-specific mortality.

Results
After a mean follow-up of 8.6 years from diagnosis, 2340 women died, including 1475 from breast cancer. Among all BC survivors, low compared to medium adherence to arMED score was associated with a 13% higher risk of all-cause mortality (HR 1.13, 95%CI 1.01–1.26). High compared to medium adherence to arMED showed a non-statistically significant association (HR 0.94; 95% CI 0.84–1.05). With no statistically significant departures from linearity, on a continuous scale, a 3-unit increase in the arMED score was associated with an 8% reduced risk of overall mortality (HR3-unit 0.92, 95% CI: 0.87–0.97). This result sustained when restricted to postmenopausal women and was stronger among metastatic BC cases (HR3-unit 0.81, 95% CI: 0.72–0.91).

Conclusions
Consuming a Mediterranean diet before BC diagnosis may improve long-term prognosis, particularly after menopause and in cases of metastatic breast cancer. Well-designed dietary interventions are needed to confirm these findings and define specific dietary recommendations.},
organization = {Instituto de Salud Carlos III
Spanish Government	FI19/00197},
organization = {European Social Fund (ESF)},
organization = {AECC Scientific Foundation	PRYES211366AGUD},
organization = {World Health Organization},
organization = {Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London},
organization = {Cancer Research UK	14136
C8221/A29017},
organization = {UK Research & Innovation (UKRI)
Medical Research Council UK (MRC)	1000143
MR/M012190/1},
publisher = {Springer Nature},
keywords = {Mediterranean diet},
keywords = {Breast cancer},
keywords = {Cancer survivors},
keywords = {Dietary patterns},
keywords = {Prospective studies},
title = {Association of Mediterranean diet with survival after breast cancer diagnosis in women from nine European countries: results from the EPIC cohort study},
doi = {10.1186/s12916-023-02934-3},
author = {Castro Espín, Carlota and Sánchez Pérez, María José},
}