Educational nutritional intervention program improved the quality of diet of women with breast cancer in adjuvant treatment

DE LIZ, Sheyla; VIEIRA, Francilene Gracieli Kunradi; GERALDO, Ana Paula Gines; ASSIS, Maria Alice Altenburg de; DI PIETRO, Patricia Faria

doi:10.1590/1678-9865202033e190145

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Sumário

Original • Rev Nutr 33 • 2020 • https://doi.org/10.1590/1678-9865202033e190145 copy

Educational nutritional intervention program improved the quality of diet of women with breast cancer in adjuvant treatment

Programa de intervenção nutricional educativa melhorou a qualidade da dieta de mulheres com câncer de mama em tratamento adjuvante

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To assess the outcome of an educational nutritional intervention in the quality of diet of women with breast cancer in adjuvant treatment.

Methods

Women with breast cancer and admitted for surgical treatment were divided in an intervention group (n=18) and a comparison group (n=78), and participated in a nonrandomized clinical trial. Participants were assessed before and after the treatment and/or intervention. A food frequency questionnaire was applied and the quality of diet was calculated using the Brazilian Healthy Eating Index Revised. The educational nutritional intervention lasted 12 months and was carried out through phone calls twice a month, personal meetings, and monthly handouts. It oriented an intake of at least 400g of vegetables and fruits per day and at most 500g of red/processed meat per week.

Results

We observed a significant improvement in the diet quality of the intervention group (+5.7). Nutritional education in the intervention group reached its objectives, with a rise in the intake of vegetables and fruits reflecting a significant increase in the score of total fruits (+1.9) and whole fruits (+1.1), and a decrease in the score of meat, eggs, and legumes (-3.3) by means of a reduction in the intake of red/processed meat (p<0.05). Also, a rise in the punctuation of calories from solid fats, alcohol, and added sugar was observed (+5.0, p<0.05) due to lower intake of these components. The comparison group presented no significant differences.

Conclusion

The nutritional intervention contributed to improving the quality of the diet during breast cancer treatment and possibly altered these women’s prognoses.

Keywords
Breast neoplasms; Cancer survivors; Clinical trial; Food consumption; Food habit

Characteristics		IG (n=18)		CG (n=78)		p
Characteristics		Mean	±SD	Mean	±SD	p
Age (years)		49.6	±10.9	51.9	±11.4	0.446^‡ ‡ t test;
Weight (Kg)		72.0	±14.7	69.3	±12.7	0.431^‡ ‡ t test;
BMI (Kg/m²)		28.9	±4.6	27.7	±4.8	0.356^‡ ‡ t test;
		n	%	n	%
Tumor classification						0.641^* * Fisher’s exact test;
	Invasive carcinoma	16	88.9	72	92.3
	Carcinoma in situ	2	11.1	6	7.7
Tumor stage						0.918^† † Chi-square test;
	0	1	5.6	2	2.6
	I	6	33.3	27	34.6
	II	7	38.9	29	37.2
	III	4	22.2	20	25.6
Axillary lymph node involvement						0.345^† † Chi-square test;
	Positive	5	27.8	31	39.7
	Negative	13	72.2	47	60.3
Surgical procedure						0.562^† † Chi-square test;
	Radical mastectomy¹ 1 Complete removal of breast and axillary lymph nodes;	6	42.9	40	51.3
	Partial mastectomy or axillary lymphadenectomy² 2 Quadrantectomy or sector resection with Sentinel Lymph node Biopsy (SLB) and/or complete removal of axillary lymph nodes;	8	57.1	38	48.7
Radiotherapy and/or chemotherapy						0.362^† † Chi-square test;
	Yes
	Radiotherapy	3	16.7	18	23.1
	Chemotherapy	2	11.1	21	26.9
	Radiotherapy in association with chemotherapy	11	61.1	34	43.6
	No	2	11.1	5	6.4
Hormone therapy³ 3 IG: n=17. BMI: Body Mass Index; CG: Comparison Group; IG: Intervention Group; SD: Standard Deviation.						0.820^† † Chi-square test;
	Yes
	Tamoxifen	12	70.6	50	64.1
	Aromatase inhibitor	1	5.9	8	10.3
	No	4	23.5	20	25.6

BHEI-R and components		T0		T1		p ^† † Wilcoxon test.	Change		p ^# # Mann-Whitney test. T0: Before nutritional intervention and/or adjuvant treatment; T1: After nutritional intervention and/or adjuvant treatment. BHEI-R: Brazilian Healthy Eating Index Revised; CG: Comparison Group; IG: Intervention Group; IR: Interquartile Range; M: Mean; SD: Standard Deviation; SoFAAS: total dietary energy derived from solid fats, alcohol, and added sugar.
BHEI-R and components		M	±SD	M	±SD	p ^† † Wilcoxon test.	Median	IR
BHEI-R total score
	IG	72.0	±8.7	77.7	±6.9	0.021^$ $ Paired t test.	6.2	1.6; 10.0	<0.007
	CG	75.7	±8.7	75.2	±8.9	0.645^$ $ Paired t test.	0.4	-4.9; 5.0

BHEI-R components scores
Whole fruits
	IG	3.6	±1.4	4.7	±1.0	0.002^$ $ Paired t test.	0.9	0.0; 1.9	<0.001
	CG	4.6	±0.9	4.5	±1.0	0.173^$ $ Paired t test.	0.0	0.0; 0.0

		Median	IR	Median	IR		Median	IR
Total fruits
	IG	3.1	1.6; 3.6	5.0	3.0; 5.0	0.012	-1.0	0.0; 2.4	<0.002
	CG	4.8	3.4; 5.0	4.9	2.5; 5.0	0.343	-0.0	-0.6; 0.3
Total vegetables
	IG	5.0	2.5; 5.0	4.4	2.5; 5.0	0.824	-0.0	-0.8; 0.9	<0.226
	CG	5.0	2.9; 5.0	3.3	2.1; 5.0	0.012	-0.0	-1.7; 0.3
Dark green and orange vegetables and legumes
	IG	5.0	4.6;5.0	5.0	4.4; 5.0	0.700	-0.0	0.0; 0.0	<0.225
	CG	5.0	4.5;5.0	5.0	3.6; 5.0	0.050	-0.0	-1.0; 0.0
Total grains
	IG	5.0	5.0; 5.0	5.0	5.0; 5.0	0.181	-0.0	0.0; 0.0	<0.397
	CG	5.0	5.0; 5.0	5.0	5.0; 5.0	0.603	-0.0	0.0; 0.0
Whole grains
	IG	0.0	0.0; 0.2	0.1	0.0; 0.8	0.303	-0.0	0.0; 0.0	<0.360
	CG	0.0	0.0; 0.5	0.0	0.0; 0.5	0.842	-0.0	0.0; 0.0
Milk and Dairy products
	IG	4.4	3.0-6.0	3.6	2.3-4.6	0.249	-0.7	-2.7; 1.1	<0.993
	CG	4.7	2.8-7.3	3.5	2.5-5.5	0.003	--0.3	-2.3; 0.5
Oils
	IG	10.0	10.0; 10.0	10.0	10.0; 10.0	0.317	-0.0	0.0; 0.0	<0.692
	CG	10.0	10.0; 10.0	10.0	10.0; 10.0	0.421	-0.0	0.0; 0.0
Sodium
	IG	8.5	7.4; 8.9	9.7	7.4; 10.0	0.191	-0.9	-0.4; 1.5	<0.511
	CG	8.7	7.1; 9.5	9.8	8.6; 10.0	<0.001	-0.8	-0.0; 2.0
Saturated fat
	IG	6.6	4.5; 8.8	9.1	7.0; 10.0	0.001	-1.5	0.5; 4.2	<0.091
	CG	6.9	4.3; 9.1	8.6	7.0; 10.0	<0.001	-0.7	-0.3; 3.2
SoFAAS
	IG	14.2	10.6; 17.7	19.2	16.4-20.0	0.033	-2.5	0.0; 6.7	<0.030
	CG	17.4	13.5; 20.0	17.8	13.9-20.0	0.843	-0.0	-2.3; 2.5
Meat, eggs and legumes
	IG	10.0	8.1; 10.0	6.7	5.9; 9.8	<0.001	-1.8	-3.6; 0.0	<0.251
	CG	8.8	6.8; 10.0	7.0	4.8; 9.6	<0.001	-1.1	-2.3; 0.0

Food subgroups		T0		T1		p ^† † Wilcoxon test; p	Change		p ^# # Mann-Whitney test;
Food subgroups		Median	IR	Median	IR	p ^† † Wilcoxon test; p	Median	IR	p ^# # Mann-Whitney test;
Red and processed meat¹ 1 Beef or pork with or without fat, hamburger/ground beef, sausage, ham, mortadella, and offal (liver, stomach, heart, and viscera);
	IG	4.0	3.6; 5.5	2.1	1.4; 3.0	0.001	-1.7	-3.6; -1.0	0.146
	CG	3.7	1.9; 5.4	2.1	1.2; 4.2	0.003	-1.0	-2.9; 0.8
Other meats² 2 Fried or boiled eggs; chicken (with or without fat), fish (with or without fat); and seafood (shrimp, oysters, sardines, tuna, cockle, and mussel); T0: Before nutritional intervention and/or adjuvant treatment; T1: After nutritional intervention and/or adjuvant treatment. CG: Comparison Group; IG: Intervention Group; IR: Interquartile Range.
	IG	4.0	3.3; 5.6	3.8	3.3; 5.3	0.711	-0.3	-1.6; 0.4	0.822
	CG	3.2	2.2; 4.6	3.2	2.4; 4.9	0.475	-0.3	-1.4; 1.3

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[1] Correspondence to: FGK VIEIRA.E-mail: francilene.vieira@ufsc.br.