Anthropometry and lipid profile in women with breast cancer: a case-control study

Abstracts

OBJECTIVE: To assess body composition and lipid profile of women with and without breast cancer. METHODS: We conducted a case-control study matched by age, including 62 women, 31 being newly diagnosed with breast cancer and 31 with benign breast changes. Data were collected through direct interview, with recording of sociodemographic characteristics, body composition assessment by anthropometry, including skinfolds (DC) and circumference, bioelectrical impedance (BIA) and ultrasonography (USG), as well as lipid profile evaluation. Statistical analysis used: Kolmogorov-Smirnov test (normally distributed variables), "t" test, chi-square test for trend (Mann-Whitney U), chi-square test, Fisher's exact test and Yates correction and "odds ratio". RESULTS: When compared with controls, women with breast cancer (cases) had lower height (1.56 m ± 5.68 versus 1.59 m ± 6.92), p <0.03; higher percentage of body fat, assessed by Bioelectric Impedance (39.87% ± 8.26 versus 36.00% ± 6.85), p <0.049; and higher triceps skinfold thickness (27.55 mm ± 8.37 versus 22.81 ± 5.72 mm; p <0.01), respectively. CONCLUSION: Women with breast cancer had lower height, higher body fat percentage and higher triceps skinfold thickness. There was no difference in body mass index and waist circumference. There was no association between lipid profile and the occurrence of breast cancer.

Breast neoplasms; Epidemiology; Anthropometry; Body composition; Nutritional status

OBJETIVO: avaliar a composição corporal e o perfil lipídico de mulheres com e sem câncer de mama. MÉTODOS: estudo caso-controle pareado por idade, incluindo 62 mulheres, sendo 31 recém-diagnosticadas com câncer de mama e 31 com alterações mamárias benignas. Os dados foram coletados por meio de entrevista direta, com caracterização sociodemográfica, avaliação da composição corporal por antropometria, incluindo dobras cutâneas (DC) e circunferências, bioimpedância (BIA) e ultrassonografia (USG), além da avaliação do perfil lipídico. Utilizou-se na análise dos dados: Teste de Kolmogorov-smirnov (distribuição normal das variáveis), teste "t" de Student, Qui-quadrado de tendência (U de Mann-Whitney), Qui-quadrado de Pearson, Teste Exato de Fisher e Correção de Yates e "odds ratio". RESULTADOS: comparadas aos controles, mulheres com câncer de mama (casos) apresentaram menor estatura (1,56m±5,68) e (1,59m±6,92), p<0,03; maior porcentagem de gordura corporal, avaliada pela Impedância Bioelétrica (39,87% ±8,26) e (36,00%±6,85), p<0,049; maior dobra cutânea tricipital (27,55mm±8,37 e 22,81mm±5,72; p<0,01), respectivamente. CONCLUSÃO: Mulheres com câncer de mama apresentaram menor estatura, maior porcentagem de gordura corporal e maior dobra cutânea tricipital. Não se observou diferença no Índice de Massa Corporal e na Circunferência da Cintura. Não foi encontrada associação entre o perfil lipídico e a ocorrência de câncer de mama.

Neoplasias da mama; Epidemiologia; Antropometria; Composição corporal; Estado nutricional

ORIGINAL ARTICLE

Anthropometry and lipid profile in women with breast cancer: a case-control study

Karine Anusca Martins^I; Ruffo Freitas-Junior, TCBC-GO^II; Estelamaris Tronco Monego^I; Régis Resende Paulinelli^II

^IPh.D., Associate Professor, School of Nutrition, Federal University of Goiás – UFG

^IIPh.D., Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Federal University of Goiás – UFG

Address for correspondence

ABSTRACT

OBJECTIVE: To assess body composition and lipid profile of women with and without breast cancer.

METHODS: We conducted a case-control study matched by age, including 62 women, 31 being newly diagnosed with breast cancer and 31 with benign breast changes. Data were collected through direct interview, with recording of sociodemographic characteristics, body composition assessment by anthropometry, including skinfolds (SF) and circumference, bioelectrical impedance (BIA) and ultrasonography (USG), as well as lipid profile evaluation. Statistical analysis used: Kolmogorov-Smirnov test (normally distributed variables), "t" test, chi-square test for trend (Mann-Whitney U), chi-square test, Fisher's exact test and Yates correction and "odds ratio".

RESULTS: When compared with controls, women with breast cancer (cases) had lower height (1.56 m ± 5.68 versus 1.59 m ± 6.92), p <0.03; higher percentage of body fat, assessed by Bioelectric Impedance (39.87% ± 8.26 versus 36.00% ± 6.85), p <0.049; and higher triceps skinfold thickness (27.55 mm ± 8.37 versus 22.81 ± 5.72 mm; p <0.01), respectively.

CONCLUSION: Women with breast cancer had lower height, higher body fat percentage and higher triceps skinfold thickness. There was no difference in body mass index and waist circumference. There was no association between lipid profile and the occurrence of breast cancer.

Key words: Breast neoplasms. Epidemiology. Anthropometry. Body composition. Nutritional status.

INTRODUCTION

Breast cancer has been researched worldwide in recent years due to its high prevalence and incidence; it is the leading cause of cancer death among women¹, although advances in early detection and new therapeutic forms used have evolved over the last decades².

Among the aspects classically considered as risk factors for developing breast cancer are advanced age, low parity, early menarche, late menopause, obesity, alcoholism and increased height³. Among those linked to nutritional status, those related to body composition, such as obesity and/or overweight and inadequate distribution of body fat, especially in the post-menopause, are noteworthy⁴.

Lipid profile seems to influence the development of female breast cancer, especially in the presence of an increased body mass index⁵.

Among the techniques used in the determination of body composition in patients with cancer, there is anthropometry, an easy to perform, affordable and accurate exam, which allows obtaining reliable results^6-8.

In Brazil and other countries with large racial variation, anthropometric information related to body fat in women⁹, especially those with breast cancer^7,10, have limitations that may be related to available resources, including technology and more precise equipment, or even to reasons of racial differences per se¹¹.

Given the above, the objective of this study was to determine the body composition and nutritional status of Brazilian women by using anthropometry and lipid profile. The individuals, with and without breast cancer, were from the mid-west region of the country an were followed by two reference centers in breast disease, belonging to the Goiás Mastology Research Network.

METHODS

This is a case-control study, with a sample that included women with breast cancer, with a 1:1 age matcd with controls without breast cancer.

We age-matched women newly diagnosed with breast cancer (cases) and women with benign breast changes (controls) at two referral services for diagnosis and treatment of cancer in Goiânia, (Goiás State capital): Mastology Program of the Hospital of the Federal University of Goiás-HC/UFG (22 cases and 27 controls, n = 49) and Gynecology and Breast Service of Jorge Araújo Hospital (nine cases and four controls, n = 13).

We used a questionnaire for direct interview with sociodemographic characteristics and assessed nutritional status, including percent body fat, obtained by the sum of skinfolds, bioelectrical impedance (BIA) and central fat, by abdominal ultrasonography.

We studied sociodemographic (age, marital status, place of residence, education level and family income) and anthropometric variables (weight, height, arm circumference, arm muscle circumference, waist circumference, biceps skinfold, triceps skinfold, suprailiac skinfold and subscapularis skinfold.

We calculated the Body Mass Index (BMI), fat percentage, lean body mass and body water, and we obtained measurements of the thickness of the subcutaneous fat and intra-abdominal fat by ultrasonography. Information was collected on menarche and menopause.

The interviewers and evaluators responsible for data collection were previously trained, using a manual Interviewer / anthropometrist with standardized collection of anthropometric measures previously validated by Habicht¹². The previous training and completion of pilot study allowed greater reliability of results.

For anthropometric measurements, we observed the following standards classification: weight in kilograms and height in meters according to the techniques proposed by Lohman et al. ¹³, body mass index (BMI) calculated as weight divided by squared height and expressed in kg/m², obeying the cutoff points proposed by the World Health Organization¹⁴; waist circumference in centimeters: measurement performed according to the validated technique¹³, whose classification indicates risk of metabolic complications associated with obesity ¹⁴; percentage of body fat: the resulting body composition analysis using the sum of skinfolds and bioelectrical impedance; skinfold thickness in millimeters: using a caliper (Lange Skinfold Caliper), we performed measurements in triplicate of he triceps (TSF), biceps (DCB), subscapular (DCSE) and suprailiac (DCSI) skinfolds, with reference to the technique proposed by Lohman et al.¹³. The values obtained were compared with the reference standard¹⁵, which allowed an indirect estimate of body fat percentage, using the sum of four skinfolds and the formulas proposed by Durnin and Womersley¹⁶ and Siri¹⁷. For bioelectrical impedance (BIA) we gathered values of fat mass, lean mass and body water in percentage and kilograms using a bioimpedance device model 1500 Bodystat with simple frequency. To determine the nutritional status according to the percentage of body fat, we adopted the classification of Lohman et al.¹⁸; arm circumference in centimeters, a technique proposed by Lohman et al.¹³, where the measurements were compared to the reference standard¹⁵; arm muscle circumference (AMC) in centimeters, estimated by the formula: AMC = BS - 3.14 x TS, whose results were compared with the reference standard¹⁵; thickness of abdominal fat (subcutaneous and intra-abdominal) measured by ultrasonography, according to a validated technique¹⁹. We obtained the estimation of visceral fat with the patient fasting for at least six hours, in the supine position, at the umbilicus, in the xifoumbilical line, with the minimum pressure necessary, by means of an ultrasound equipment.

In the data analysis we used the "t" test for continuous variables which displayed normal distribution according to the Kolmogorov-Smirnov test, while for nominal (categorical) variables we used nonparametric tests, such as chi- square for trend (Mann-Whitney U), Pearson chi-square test, Fisher exact test and Yates correction, considering the statistical significance of p <0.05. In bivariate analysis of the case-control study, we calculated the measure of association "odds ratio", with a confidence interval of 95%.

The study was approved by the Ethics Committee on Human and Animal Research of the Hospital of the Federal University of Goiás (Protocol 073/2008 of 06.27.2008) and the Association Against Cancer of Goiás of the Araújo Jorge Hospital (Protocol 001/09 of 02.26.2009).

RESULTS

The 62 evaluated patients (31 cases and 31 controls) had a mean age of 48.19 years (± 8.99) in both groups, as they were matched by age. Twenty-eight (45.16%) women were aged between 50 and 65 years.

Most study participants, either cases or controls, had low education. Only one patient was illiterate, 20 cases (64.5%) and 23 controls (74.1%) had primary education and three cases (9.6%) and two controls (6.4%) had a college degree. There was no statistically significant difference between cases and controls.

The monthly income of study participants showed that 17 cases (54.8%) and 10 (32.2%) controls had family income of less than 0.5 minimum wage (MW) per capita; nine cases (29.0% ) and 14 controls (45.1%) had a per capita income between 0.5 and 1.0 MW per month, 26 (83.8%) cases and 24 (77.4%) controls had a monthly per capita income above 1.0 MW. There was no significant difference (p=0.46) between cases and controls in relation to monthly income.

Although the majority of women live in Goiânia, about a third (32.2%) was from other Goiás cities or eventhe Midwest Region. Twenty-five (80.6%) cases and 22 (70.9%) controls were married or kept a consensual stable union, with no significant difference in these variables.

The average age of menarche ranged from 13.2 (± 1.5) for cases and 12.6 (± 1.4) years for controls, respectively, with no statistical difference (p = 0.16) between groups. It was observed that 46.7% of the population was postmenopausal. No cases and only two (3.2%) controls were in peri-menopause (no menses for less than one year), with no statistically significant difference.

The descriptive values of the anthropometric variables are shown in table 1. The average weight ranged between 67.4 kg (± 12.1) in the control group and 69.3 kg (± 18.2) in the case group. Significant differences between cases and controls were found for measures of height, body fat percentage (BF%), triceps skinfold thickness (TST) and lean muscle mass (LMM). The remaining variables did not show statistically significant differences between the two groups.

When analyzing BMI and Waist Circumference (WC) among women of groups with and without cancer, no significant difference was observed (Table 2).

With regard to the distribution of cases and controls according to reproductive and anthropometric variables, none of the studied variables showed a statistically significant association with breast cancer in the bivariate analysis (Table 3). There was no association between lipid profile and incidence of breast cancer (Table 4).

DISCUSSION

Although breast cancer is more detected in women from urban areas with more favorable socio-economic conditions²⁰, possibly due to ampler access to tests that enable early detection²¹, the present study was conducted with a group of women with low education and low income. This profile of women seen in two specialized centers in the central region of Brazil resemble those of a previous study carried out in the south region of the country²².

Through anthropometric measurements, we observed that the average weight of women was not significantly different between cases and controls. It was found that those with cancer had significantly lower average stature than controls, suggesting that women in this study, being shorter, showed a higher risk of breast cancer. These data are conflicting with studies in North American countries, which showed that taller women have higher risk of developing breast cancer²³. In Brazil, considering the population of the south / southeast, in some studies height did not influence the risk for breast cancer^7,24.

The Household Budget Survey (Pesquisa de Orçamentos Familiares – POF)²⁵, conducted by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística – IBGE) shows that there are population differences between the regions south/southeast and center of the country, suggesting that the profile of the women⁹ from the latter region, also differs from the former, especially regarding breast cancer²⁶.

This situation can be explained by the mixing of races, as well as regional differences in food habits and culture, which may influence the development of this disease²⁷. The findings related to the stature of women in the central region of the country are unprecedented and had not been previously observed by any other study.

When comparing the percentage of body fat, it was observed that regardless of the method of assessment (sum of skinfolds or BIA), cases had higher values than controls, with a statistically significant difference between in the BIA findings. Unlike the found by other authors^4,11, in this study no association was found between total body fat and increased occurrence of breast cancer.

The values of percentage body fat measured by BIA and sum of skinfolds showed statistically significant differences between cases and controls. These measures allow greater reliability in measuring body composition as opposed to weight ^6,18.

Other parameters for assessing the nutritional status of women were arm circumference and arm muscle circumference, where cases and controls were within normal limits¹⁵, with no significant differences between groups.

Despite not being the objective of the present work, it was observed by exploratory analysis that both women with cancer and in the control group showed increased prevalence of excess weight (overweight and obesity), reflecting the nutritional status of the population, which provides a historical trend of increase in body weight and BMI⁹.

BMI assessed in this study proved not to be an important factor in the development of breast cancer, although other studies have demonstrated this association²⁸. A prospective cohort study conducted in Paris²⁸ with 14,709 women with breast cancer aimed at establishing and validating the most appropriate cutoff points for different indicators of body size that may be associated with the prognosis of breast cancer. The authors suggest that, in order to avoid a worse prognosis, increased recurrence and shorter survival in cases of breast cancer, health experts should use the following cutoff points for identifying patients at higher risk of unfavorable prognosis: BMI of 25.00Kg/m², 60Kg of weight, ideal body weight ratio of 20% and body surface area of 1.70 m².

As in the present study, cases and controls had weight and BMI values greater than the cutoff points recommended¹⁴. It reinforces the importance of exercise caution and care in monitoring patients evaluated in both services and the development of health promotion activities and awareness about the risk of overweight.

Waist circumference is measured to assess abdominal fat (central adiposity) and is designed to estimate an additional risk for chronic diseases, especially cardiovascular ones¹⁴. The relationship between body fat and breast cancer has been observed for some years, in particular the increased abdominal or visceral fat (central adiposity), which is related to a higher likelihood of relapse and shorter survival, particularly in post -menopause, where the risk is higher^10,23.

The distribution of body fat (abdominal fat) exerts a greater influence on the metabolic risk factors than total body fat²⁹. In the present study we observed that both cases and controls had greatly increased waist circumference (> 88cm), indicating additional risk related to metabolic risk factors¹⁴.

It has been found in a previous study that increased rates of total cholesterol and triglyceride levels may be related to increased risk of breast cancer⁵. The lipid profile evaluation performed in this study showed no association with breast cancer. It is possible that this result was influenced by the sample size, but the differentiated condition in fat consumption, typical of this population, may have influenced serum lipoproteins^22,25.

Brazilian women of the central region of the country with breast cancer had lower height, higher body fat and greater total value of triceps skinfold thickness than controls. The lipid profile showed no correlation with breast cancer. There was no association between lipid profile and the occurrence of breast cancer.

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Publication Dates

• Publication in this collection
  13 Nov 2012
• Date of issue
  Oct 2012

History

• Received
  02 Apr 2012
• Accepted
  06 June 2012