| PurposeOn the basis of systematic reviewing the relationship between BMI evaluation nutritional status results and its prognostic implication in breast cancer patients, the investigation is to estimate body composition s and dietary intakes in breast cancer patients during endocrine therapy, to improve unhealthy living habits in these patients, which may be providing objective basis for nutritional health education strategies in future.Methods 1Systematic review: Computer searched the Cochrane Library, American Guideline, Pubmed, Ovid, Rano, CBM, CNKI and Wanfang databases from 1990 to June 2014,to collect cohort studies, case-control studies, those assessed the prognostic relevance of body mass index in breast cancer patients, and screened literature references.2 Investigation research: This study by using the convenience sampling in 183 cases during endocrine therapy, to survey with food frequency questionnaire(FFQ) and multi-frequency bioelectrical impedance body composition analyzer(Inbody S10), on the base of describing the current body composition and dietary intake status, using multi linear regression to explore the main factors influencing the body composition changes of breast cancer patients; Then 42 cases of patients were followed up for 3 months, repeated body composition measurement and questionnaire, described the dietary intake and body composition changes.Results 1 Meta-analysis of the relationship between body mass index evaluation results and its prognostic implication in breast cancer patient : A total of 45 studies(cohort studies) including 149192 patients were eligible for final analyses.(1)compared with normal weight women, for BMI before diagnosis, obesity can caused all causes mortality mortality increased 32%[PHR=1.32[95%CI(1.22~1.44),P=0.00] and breast cancer specific mortality increased 19%[PHR=1.19[95%CI(1.11 ~ 1.28),P=0.000]for obese respectively;(2) compared with normal weight women, for BMI before diagnosis, the underweight and overweight patients all had no effect on all-cause mortality(P > 0.05).(3)For BMI post-diagnosis, abnormal weight(including underweight, overweight and obese) could increased all-cause mortality 18%[PHRtotal=1.18,95%CI(1.12 ~ 1.24),P=0.000], reduced disease-free survival [PHRtotal=1.11,95%CI(1.06~1.17),P=0.000];(4)compared with normal weight women,for BMI post-diagnosis,the pooled HR of breast cancer mortality were 1.14 [95%CI(1.03 ~1.26),P=0.011] for overweight and 1.27 for obese [95%CI(1.13~1.43),P=0.000], reduced overall survival[PHRoverweight=1.10,95%CI(1.05 ~ 1.16),P=0.000;PHRobesity=1.19,95%CI(1.13~1.26),P=0.000].(4)No matter of menopausal, all-cause mortality were increased 23% with obese breast cancer patients.2 Body composition of breast cancer patients during endocrine therapy: This group of patients(1) the average weight of the patients was 59.37±8.45kg(42.00 to 102.00 kg), the average body fat was 20.27±6.15 kg(8.50 to 51.70 kg), the average free fat mass was 39.09±4.02 kg(29.50 to 53.00 kg);.(2)Body Water: Intracellular Water with an average of 17.52±1.83L(13.40 to 23.80 L), extracellular water with an average of 11.27±1.21L(8.30 to 15.50 L), total body water with an average of 28.79 ±2.99L(21.70 to 39.20 L);(3)the average BMI was 23.29±3.21 kg/m2,50.82% of patients were in the excessive nutrition, including overweight and obesity(I and II);(4) the PBF was 33.57±6.16% on average, 81.42% of the patients in the excessive condition;(5) the WC with an average of 81.09±8.0 cm,49.73% of patients in a state of the excessive(?80cm);(6)44.26% of patients' visceral fat area were in the excessive state(?100cm2).3.Dietary intake status of breast cancer patients during endocrine therapy: Compared with China's dietary reference intakes of nutrients or the adequate Intakes, some vitamin(vitamin A, vitamin B1, vitamin PP) and some minerals(calcium, magnesium, copper, selenium) are insufficient(P < 0.05); the intake of dietary total energy and protein are also insufficient, but there was no statistically significant difference; dietary fiber was lower in 96.72% patients,but energy from fat was excessive in 65.03% patients.4 Dietary pattern of breast cancer patients during endocrine therapy: Compared with Chinese balance diet pagoda, the intake of poultry and meat, fish and shrimp, soybeans and dairy products were inadequate(P<0.05); cereals was short and oil was excessive,but there were no statistically significant difference(P>0.05).5 The influence of endocrine therapy for breast cancer patients nutrition status :(1) 15.85% of breast cancer patients accepting SERM for adjuvant endocrine therapy, the remaining 84.15% of patients receiving AIs for treatment;(2)there were not statistically significant in intracellular cell water, extracellular cell water and total body water between two different endocrine therapies(P>0.05);but patients with AIs group higher than SERM group in the moisture content ECW/TBW(P=0.02).(3)The body composition including waist circumference, body fat, percent body fat, body mass index, visceral fat area, arm circumference, arm muscle circumference, TBW/FFM were statistically significant(P < 0.05);and AIs group on above these indicators were higher than SERM group;(4) compare different endocrine therapy drugs(Toremifene group, Letrozole group, Anastrozole group, Exemestane group, Tamoxifen group), body composition including body fat, percent body fat, body mass index, waist circumference, visceral fat area, arm muscle circumference, ECW/TBW, TBW/FFM were statistically significant, especially Toremifene group on above these indicators are the lowest when compared with the other 4 drug groups(P < 0.05).(5) there were no statistically significant difference of patients with three energy nutrients and dietary pattern(P>0.05);6 The analysis of the related factors for body composition changes in Breast cancer patients during endocrine therapy:(1) weight gain were significantly related to the increase of age, higher dietary fat intake, fewer vegetables intake;(2)body fat increased were significantly related to the increase of age, higher soy intake,higher milk and dairy products intake;(3)soft lean mass increased were significantly related to higher dietary fat intake;(4) percent body fat increased were significantly related to the increase of age, higher soy intake;(5)arm circumference and arm muscle circumference increased were significantly related to the increase of age, higher oil intake, fewer vegetables intake;(6)waist circumference increased were significantly related to the increase of age, higher oil intake;(7)visceral fat area increased was significantly related to the increase of age;(8)ECW/TBW increased were significantly related to the increase of age, invasive breast cancer(as reference by non invasive breast cancer), jobless(working as reference);(9)TBW/FFM increased were significantly related to the increase of age, radiotherapy, AIs for adjuvant endocrine therapy(SERM as reference). 7 Body composition changes in breast cancer during endocrine therapy: 42 cases of patients were followed up for 3 months were found that the increase of body weight, body mass index, body fat were statistically significant(P < 0.05), TBW/FFM decreased was statistically significant(P < 0.05).8 The investigation of dietary intake and dietary pattern changes in patients of breast cancer during endocrine therapy :42 cases of patients were followed up for 3 months, compare with the results found for the first time:(1)energy nutrients: protein, fat, carbohydrate and energy intake were increased, but did not show statistical difference(P > 0.05);(2)dietary fiber intake increased significantly(P = 0.00);(3) the excessive proportion of patients for energy from fat was decreased,but there was no statistically significant difference(P > 0.05);(4)vitamins: the intake of vitamin A, vitamin C, vitamin E were significantly higher(P < 0.05), no statistical difference were found for other energy food intake.(5)minerals: only the intake of copper was obviously higher(P < 0.05), other changes no statistical difference(P > 0.05);(6)dietary pattern: except the oil intake was higher(P < 0.05), while the others energy nutrients changes were found no statistical difference(P > 0.05).Conclusion 1Compared with the normal weight patients, abnormal weight(including underweight,overweight or obesity) were associated with poorer breast cancer prognosis, performed for all-cause mortality and breast cancer specific mortality were higher, overall survival and disease-free survival in patients shortened Breast cancer patients during endocrine therapy exist the phenomena of excessive nutrition, represent for overweight and obesity,excess of body fat percentage and waist circumference.3 Dietary intake and dietary pattern of breast cancer patients during endocrine therapy remain to be improved, represent for the intake of dietary total energy and protein are also insufficient, energy from fat was excessive in 65.03% patients, some minerals and some vitamins are insufficient; dairy products were inadequate and oil was excessive and so on, but the research had no found direct evidence of different endocrine therapies on three energy nutrients and dietary pattern..4 Endocrine therapy have influence on nutrition status, showd as in the BMI, body fat, body fat percentage, visceral fat area, waist circumference, arm muscle circumference, ECW/TBW, TBW/FFM significantly.5 Age, fewer vegetables intake,higher dietary fat intake, higher oil intake are the commom determinants of body composition changes in patients for breast cancer during endocrine therapy but many more multicenter and large sample research for further argument still need. |
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