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Nutricin Hospitalaria

versin impresa ISSN 0212-1611

Nutr. Hosp. vol.26 no.4 Madrid jul.-ago. 2011

ORIGINAL

Dietary intake and oxidative stress in breast cancer: before and after treatments Ingestin diettica y estrs oxidativo en cncer de mama: antes y des !s de" tratamiento

G# Rockenbac$%&'& (# )# Di (ietro %& *# Ambrosi%& +# *# +# +oavent!ra %& )# G# ,# -ieira%& *# G# *ri a.& /# L# Da 0i"va%&1 and 2#a A# )a!sto3
1 2

Nutrition Pos-Graduate Program. Federal Uni ersit! o" Santa #atarina. $ra%il. &pidemiolog! Pos-Graduate Program. Federal Uni ersit! o" 'io Grande do Sul. $ra%il. ( )edicine *epartment. Federal Uni ersit! o" Santa #atarina. $ra%il. + *epartment o" #linical ,nal!sis. Federal Uni ersit! o" Santa #atarina. $ra%il. Food *epartment. Federal Uni ersit! o" .uro Preto. $ra%il. #orrespondence

A+04RA*4 Ob5ective: /0e aim o" t0is stud! 1as to in estigate c0anges in dietar! inta2e3 ant0ropometric parameters and mar2ers o" o4idati e stress in +0 1omen 10o under1ent surger!3 c0emot0erap! or radiation t0erap! "or 5reast cancer. 2et$ods: Pretreatment and post-treatment measurements included data collected t0roug0 a "ood "re6uenc! 6uestionnaire3 1eig0t and 0eig0t to calculate t0e 5od! mass inde4 7$)I8 and o4idati e stress mar2ers assessed "rom 5lood reduced glutat0ione 7GSH83 serum antio4idant capacit! 7,#83 plasma t0io5ar5ituric acid reacti e su5stances 7/$,'S83 serum lipid 0!dropero4ides 79H8 and plasma car5on!ls. *i""erences 1ere compared using paired Student:s t-test or paired ;ilco4on:s test. Res!"ts: , signi"icant increase 7P < 0.0-8 in t0e inta2e o" t0e "ood groups= meat

and eggs3 dair! products3 5eans3 oils and "ats3 as 1ell as "ood "rom t0e su5groups= red meat3 mil2 and ot0er dair! products ric0 in "at3 "ruit ric0 in itamin # and egeta5le "ats 1as "ound a"ter treatments. /0ere 1as a signi"icant increase in 5od! 1eig0t 7P < 0.0-83 $)I 7P < 0.0-83 le els o" /$,'S 7P < 0.000183 9H 7P < 0.00-8 and car5on!ls 7P < 0.00018 and a signi"icant decrease o" le els o" ,# 7P < 0.00-8 and GSH 7P < 0.00018. *onc"!sion: $reast cancer diagnosis and treatments 1ere associated 1it0 dietar! inta2e c0anges and increased 5od! 1eig0t3 $)I and o4idati e stress. /0ese potential c0anges 0a e important implications "or pre enti e nutrition counseling. ,ey 6ords: $reast cancer. *ietar! inta2e. ,nt0ropometric parameters. .4idati e stress. /reatment.

R/072/N Ob5etivo: &l propsito de este estudio "ue in estigar los cam5ios en la ingesta diet>tica3 los par?metros antropom>tricos ! los marcadores del estr>s o4idati o en +0 mu@eres sometidas a cirugAa3 6uimioterapia o radioterapia por c?ncer de mama. 2todos: 9os datos recogidos antes ! despu>s del tratamiento "ueron un cuestionario de "recuencia de consumo de alimentos3 el peso ! la talla para calcular el Andice de masa corporal 7I)#8 ! los marcadores de estr>s o4idati o e aluados mediante el glutatin reducido 7GSH8 en sangre3 la capacidad antio4idante s>rica 7#,83 las sustancias reacti as del ?cido tio5ar5itBrico en el plasma 7S',/83 los 0idroper4idos lipAdicos 7HP98 s>ricos ! los car5onilos plasm?ticos. Se compararon las di"erencias usando la prue5a t de Student o la prue5a pareada de ;ilco4on. Res!"tados: *espu>s de los tratamientos se 0all un aumento signi"icati o 7P < 030-8 en el consumo de los grupos de alimentos= carne ! 0ue os3 l?cteos3 legum5res3 aceites ! grasas3 asA como de los su5grupos= carnes ro@as3 lec0e ! otros l?cteos ricos en grasas3 "ruta rica en itamina # ! grasas egetales. Hu5o un aumento signi"icati o en el peso corporal 7P < 030-83 el I)# 7P < 030-83 las concentraciones de S',/ 7P < 03000183 HP9 7P < 0300-8 ! car5onilos 7P < 0300018 ! un descenso signi"icati o de la #, 7P < 0300-8 ! de GSH 7P < 0300018. *onc"!sin: &l diagnstico de c?ncer de mama ! sus tratamientos se asociaron con cam5ios en la ingesta diet>tica ! un aumento del peso corporal3 el I)# ! el estr>s o4idati o. &stos cam5ios potenciales tienen implicaciones importantes para el conse@o so5re nutricin pre enti a. (a"abras c"ave: #?ncer de mama. Ingesta diet>tica. Par?metros antropom>tricos. &str>s o4idati o. /ratamiento.

Abbreviations ,#= ,ntio4idant $)I= $od! GSH= 'educed 9H= 9ipid /$,'S= /0io5ar5ituric acid FFC= Food "re6uenc! 6uestionnaire.

mass reacti e

capacit!. inde4. glutat0ione. 0!dropero4ides. su5stances.

Introd!ction

$reast cancer is one o" t0e most important pu5lic 0ealt0 pro5lems due to its gro1ing incidence and mortalit! rates. In all o er t0e 1orld3 5reast cancer is considered t0e most "re6uent t!pe o" cancer among 1omen. & er! !ear3 5reast cancer accounts "or 22D o" ne1 cancers "ound in 1omen. In $ra%il3 +E.2+0 ne1 5reast cancer cases 1ere e4pected "or 20103 1it0 an estimated ris2 o" +E cases per 100.000 1omen. For t0e Santa #atarina State3 in sout0ern $ra%il3 1.-F0 ne1 5reast cancer cases 1ere e4pected "or 20103 1it0 an estimated ris2 o" -0 cases per 100.000 1omen. In spite o" its 0ig0 incidence3 5reast cancer can 5e considered a disease 1it0 a good prognosis i" an earl! diagnose and appropriate treatment are done. /0e estimated a erage sur i al a"ter "i e !ears o" 5reast cancer is appro4imatel! 61D.1 $reast cancer is a disease 1it0 multiple etiological "actors lin2ed to genetic3 en ironmental3 social demograp0ic3 5e0a ioral3 ps!c0ological and 0ormonal "actors.2-+ ." t0e ris2 "actors3 nutritional "actors can 5e associated to (0-+0D o" disease cases.- In t0e recent decades3 researc0es 0as studied t0e relations0ip 5et1een nutritional and li"e st!le "actors and t0e de elopment andGor progression o" 5reast cancer. .riginal studies and literature re ie1s 1ere carried out to clari"! 10ic0 elements in t0e diet could pla! a protecti e or determining role in t0e disease--E3 as 1ell as t0e mec0anisms t0roug0 10ic0 nutrients could 5e in ol ed in t0e progression3 recurrence or mortalit! "rom 5reast cancer.10-11 ,dditionall!3 nutritional "actors mig0t 5e directl! related to t0e generation o" reacti e o4!gen species in t0e 5od!3 triggering o4idati e stress3 causing cell o4idati e damage and t0ere"ore increasing t0e ris2 o" disease.11-1+ $esides to en0ance3 at least partiall!3 t0e progression o" 5reast cancer3 o4idati e stress can also 5e in ol ed in cancer treatment e""icac!. 1- ,ccording to pre ious reports3 c0emot0erap! andGor radiation t0erap! induced apoptosis 5! increasing t0e amount o" reacti e o4!gen species in cancer cells. 1--16 Ho1e er3 e4cess production o" reacti e o4!gen species can also damage 0ealt0! cells3 t0ere"ore a diet ric0 in antio4idant ma! 5e important to minimi%e side e""ects resulted "rom o4idati e damage caused 5! treatment1-3 in addition to reduce t0e pro5a5ilit! o" recurrence.1F In addition3 cancer treatment ma! 0a e a direct e""ect on nutritional status 1H3 dietar! inta2e1E and in t0e de elopment o" "ood a ersion.1E-20 /0ere"ore3 t0e present stud! 1as conducted to in estigate t0e possi5le c0anges in dietar! inta2e3 ant0ropometric parameters and o4idati e stress mar2ers promoted 5! 5reast cancer treatment in 1omen li ing in t0e state o" Santa #atarina3 sout0ern $ra%il.

0!b5ects and met$ods Study characterization and design /0is is a non-randomi%ed clinical stud! conducted at t0e #armela *utra )aternit! Hospital in Florianopolis #it!3 Santa #atarina3 sout0ern $ra%il3 "rom .cto5er 2006 to Iune 200H. #linical3 ant0ropometric3 social demograp0ic3 dietar! inta2e data and o4idati e stress mar2ers 1ere eri"ied in a con enience sample o" 1omen 1it0 5reast cancer in t1o p0ases= a8 $aseline p0ase3 conducted at t0e time o" 5reast cancer diagnosis3 5e"ore cancer treatment 7surger!3 radiation t0erap! andGor c0emot0erap!8 and 58 Post-treatment p0ase3 a"ter t0e end o" t0e cancer treatment 7considering a ma4imum period o" 20 mont0s8.

;omen 1it0 pre ious 0istor! o" cancer andGor 5enign tumors 1it0out suspicion o" malignanc!3 10o 0ad alread! undergone 5reast surger!3 in addition to 1omen 10o 0ad alread! started some t!pe o" neoad@u ant cancer treatment 1ere e4cluded "rom t0e stud!. .nl! 1omen 1it0 5reast cancer diagnosis con"irmed 5! pat0ological e4aminations and li ing in t0e state o" Santa #atarina 1ere included in t0e 5aseline p0ase t0e stud!. $ased on t0ese criteria3 -- 1omen 1ere considered eligi5le to participate in t0e 5aseline p0ase. .ut o" t0ese3 si4 1ere e4cluded "rom t0e second p0ase o" t0e stud! 7post-treatment p0ase8 5ecause t0e! 1ere still under radiation t0erap! andGor c0emot0erap! a"ter Iune 200H. ,dditionall!3 nine participants 1ere lost to "ollo1-up in t0e post-treatment p0ase "or t0e "ollo1ing reasons= t1o 1omen re"used to return a"ter t0e end o" treatment and se en could not 5e "ound a"ter "our attempts to contact t0em 5! telep0one. /0ere"ore3 a total o" +0 1omen 1it0 5reast cancer participated o" t0e stud!. ,ll participants signed a "ree and in"ormed consent "orm and t0e researc0 1as appro ed 5! t0e &t0ics #ommittee o" t0e #armela *utra )aternit! Hospital and 5! t0e &t0ics #ommittee on 'esearc0 1it0 Humans o" t0e Federal Uni ersit! o" Santa #atarina 7protocol num5er 0EEG0H8. Clinical data In order to o5tain social demograp0ic and clinical data3 a 6uestionnaire adapted "rom t0e stud! conducted 5! *i Pietro et al. 21 1as administered in an inter ie1. /0e 6uestionnaire contained identi"ication and clinical 0istor! in"ormation3 social demograp0ic and reproducti e 0istor! 6uestions. *isease:s stage 1as e aluated "rom pat0ological e4amination results according to t0e /umor-Node-)etastasis s!stem.22 ,dditionall!3 in"ormation a5out t0e t!pe and duration o" cancer treatment 1as collected in t0e second p0ase o" t0e stud!. Anthropometric assessment /o measure 5od! 1eig0t and 0eig0t3 a mec0anical scale 1it0 a measuring rod 7Fili%ola Industr! SG,3 Sao Paulo3 $ra%il83 1it0 a capacit! "or 1-0 2g and 100 g graduation3 1as used. ,nt0ropometric measurements at t0e 5aseline and posttreatment p0ases 1ere assessed according to t0e tec0ni6ues recommended 5! t0e ;orld Healt0 .rgani%ation. $od! 1eig0t and 0eig0t measurements 1ere used to calculate t0e 5od! mass inde4 7$)I8.2( Dietary intake assessment Ha5itual dietar! inta2e in"ormation 1as collected in t0e t1o stud! p0ases 5! t0e administration o" a "ood "re6uenc! 6uestionnaire 7FFC8 adapted "rom t0e Sic0ieri and & er0art alidated 6uestionnaire. 2+ /0e 6uestionnaire 1as administered 5! pre iousl! trained nutritionists or undergraduate nutrition students. /o 0elp participants identi"! and report t0e "ood inta2e amounts3 1ere used pictures 2- and arious si%ed 0ouse0old utensils 7dis0es3 glasses3 cups and spoons8. /0e amounts o" "ood reported as 0ome measures 1ere con erted into t0eir respecti e 1eig0ts and olumes3 in grams 7g8 or milliliters 7m983 respecti el!3 5ased on t0e 1or2s pre iousl! pu5lis0ed 5! Pin0eiro et al.26 and $en.2F ,dditionall!3 0ome measurement con ersions 7g or m98 o" "ruit3 doug0nuts3 lard3 cream and !er5a mate in"usion 1ere made 5! assessing olume and 1eig0ing measurements using t0e tec0ni6ue descri5ed 5! Gris1old2H at t0e *ietar! /ec0ni6ue 9a5orator! at t0e Federal Uni ersit! o" Santa #atarina. Seasonal "oods suc0 as "ruits and egeta5les 0ad t0eir estimated dail! inta2e calculated considering t0e season. *ietar! inta2e o" all "ood items o5tained 5! t0e FFC use 1as classi"ied and anal!%ed "or eig0t "ood groups descri5ed in t0e *ietar! Guide "or t0e $ra%ilian Population= cerealsJ tu5ers and

rootsJ meat and eggsJ mil2 and ot0er dair! productsJ "ruitsJ 5eansJ egeta5lesJ oils and "atsJ sugars and s1eets.2E /0e amount o" 5e erages 7in m98 1it0 or 1it0out alco0ol t0at 1ere not descri5ed in t0e *ietar! Guide 1as also recorded. ,dditionall!3 to anal!%e in"ormation a5out t0e inta2e o" more speci"ic "ood3 su5groups 1ere created "rom t0e eig0t "ood groups t0at ma2e up t0e *ietar! Guide3 suc0 as pastr! cerealsJ red meatJ "is0J poultr!J processed meatJ "att! meatJ lo1-"at meatJ mil2 and dair! products ric0 in "atJ lean mil2 and dair! productsJ "ruits ric0 in itamin #J "ruits ric0 in carotenoidsJ cruci"erous egeta5lesJ egeta5les ric0 in carotenoidsJ egeta5le "atsJ and animal "ats. ,ll 5reast cancer patients did not recei ed an! dietar! treatment andGor ad ice during t0e stud!J t0e! onl! got guidance on 0ealt0! eating at t0e time o" t0e inter ie1 in t0e 5aseline p0ase. Biochemical analysis For t0e assessment o" o4idati e stress mar2ers3 5lood samples 71- m98 1ere collected "rom participants t0roug0 a puncture o" t0e intermediate arm ein in tu5es 1it0 or 1it0out &*/, to o5tain plasma and serum3 respecti el!3 5! centri"ugation 71000 4 gG10 min8. , 10ole 5lood ali6uot 1as used "or immediate measurement o" 5lood reduced glutat0ione 7GSH83 a"ter red 5lood cell l!ses and protein precipitation 1it0 20D tric0loroacetic acid. (0)easurement o" serum antio4idant capacit!3 t0io5ar5ituric reacti e su5stances in plasma3 and serum lipid 0!dropero4ides le els 1ere made immediatel! a"ter sample collection3 10ile plasma le els o" car5on!ls 7a mar2er o" plasma protein o4idation8 1as determined a"ter sample stored at -F0 o# "or no longer t0an (0 da!s. Serum antio4idant capacit! 1as measured using t0e "erric reducing antio4idant potential 7F',P8 assa!3 according to t0e tec0ni6ue proposed 5! $en%ie and Strain.(1 $lood GSH concentration 1as assessed using t0e met0od proposed 5! $eutler et al.(0 Plasma lipid pero4idation 1as determined 5! detecting t0e su5stances t0at react 1it0 t0io5ar5ituric acid 7/$,'S83 particularl! malondialde0!de3 5ased on t0e met0od descri5ed 5! &ster5auer and #0eeseman.(2 /0e lipid 0!dropero4ides 79H8 present in t0e serum 1ere 6uanti"ied 5! t0e "errous o4idation met0od and comple4 "ormation 1it0 4!lenol orange3 as descri5ed 5! Nouroo% Kade0 et al.(( #ar5on!ls 1ere measured "ollo1ing t0e met0od descri5ed 5! 9e ine et al.(+ ,ll 5ioc0emical tests 1ere made in duplicates. Statistical analysis #ollected data 1ere organi%ed in a dou5le entr! data5ase "or later statistical anal!sis 1it0 S/,/, E.0 so"t1are3 and in all cases t0e le el o" signi"icance 1as esta5lis0ed at -D. #ontinuous data 1ere presented as median3 mean and standard de iation and categorical data in t0e "orm o" a5solute and relati e "re6uenc!. Normalit! o" data distri5ution 1as assessed using t0e S0apiro-;il2 test. Laria5les 1it0 normal distri5ution 1ere compared using t0e paired Student:s t-test3 10ile t0e data 1it0 non-parametric distri5ution 1ere compared using t0e paired ;ilco4on:s test.

Res!"ts

, erage age o" t0e participants in t0e 5eginning o" t0e stud! 1as -1.- M E.E !ears 7range o" (- to FF !ears8. )ost 1omen participating in t0e stud! 1ere #aucasians 7E2.-D8 and t0ere 1as a predominance o" married 1omen 7--.0D8. /0e mean inter al o" time 5et1een t0e t1o assessments 1as 1(.2- M 2.E2 mont0s 7F to 20 mont0s8. #linical and t0erapeutic c0aracteristics o" t0e +0 1omen 1it0 5reast cancer are s0o1ed in ta5le I. /0ere 1as a pre alence o" 1omen 1it0 in asi e carcinoma 7E-.0D83 stage I or II tumor 7F-.0D8 1it0out in ol ement o" a4illar! l!mp0 nodes 762.-D8. 'egarding t0e t!pe o" surger! per"ormed3 -2.-D o" 1omen under1ent radical mastectom!3 10ile +F.-D under1ent partial mastectom! 1it0 sentinel l!mp0 node 5iops! or a4illar! l!mp0adenectom!. .ut o" t0e +0 participants studied3 (2 7H0.0D8 reported 0ormone t0erap! and 2F out o" t0ose reported treatment 1it0 tamo4i"en and "i e 1it0 aromatase in0i5itor 7anastro%ole8. In respect to t0erapies3 radiation t0erap! alone 1as applied to nine 722.-D8 participants3 c0emot0erap! alone 1as used 5! t1el e 7(0.0D8 1omen and a com5ination o" 5ot0 c0emot0erap! and radiation t0erap! 1as used 5! "i"teen 7(F.-D8 1omen. Four 710D8 1omen did not recei ed eit0er c0emot0erap! or radiation t0erap!. ,dditionall!3 t0ree 7F.-D8 patients reported t0erap! 1it0 monoclonal anti5odies 7trastu%uma58.

/0e ant0ropometric parameters are s0o1n in ta5le II. , signi"icant increase in t0e mean 5od! 1eig0t 7P < 0.00-8 1as "ound at t0e end o" cancer treatments3 10ic0 0ad a direct e""ect on t0e mean $)I alue 7P < 0.00-8 7ta5le II8. 'egarding dietar! inta2e3 a signi"icant increase in t0e inta2e o" t0e "ollo1ing "ood groups= meat and eggs 7P N 0.0283 mil2 and dair! products 7P N 0.0183 "ruits 7P < 0.00-83 5eans 7P N 0.0+8 and oils and "ats 7P N 0.0183 as 1ell as in t0e "ollo1ing su5groups= read meat 7P N 0.0(83 mil2 and dair! products ric0 in "at 7P N 0.0(83 "ruits ric0 in itamin # 7P N 0.018 and egeta5le "ats 7P N 0.028 1as o5ser ed a"ter treatment 7ta5le III8. 'esults "or t0e ot0er "ood groups and su5groups studied 1ere not statisticall! signi"icant 7data not s0o1n8.

/a5le IL s0o1s t0e results "or 5ioc0emical mar2ers o" o4idati e stress in t0e 5aseline and post-treatment p0ases. /0ere 1as a signi"icant decrease in t0e serum antio4idant capacit! 7P < 0.00-8 and GSH le els 7P < 0.000183 10ereas /$,'S 7P < 0.000183 9H 7P < 0.00-8 and car5on!ls 7P < 0.00018 le els increased signi"icantl! a"ter treatments.

Disc!ssion *uring cancer treatment3 agents used in t0e c0emot0erap! and radiation t0erap! can lead to t0e generation o" reacti e o4!gen species 10ic0 ma! damage 0ealt0! cells.1-316 &4cess production o" reacti e o4!gen species and t0e resulting increase in o4idati e stress in t0e 5od! o" cancer patients ma! a""ect treatment response and contri5ute to tumor recurrence.(- /0ere"ore3 t0e importance o" a diet ric0 in antio4idant "ood s0ould 5e emp0asi%ed3 not onl! as a 1a! to protect against disease de elopment and progression3 5ut also to pre ent 5reast cancer recurrence during and a"ter treatment.1-31F In t0is stud! 1e clearl! s0o1ed t0at surger!3 c0emot0erap! andGor radiation t0erap! increased t0e le els o" o4idati e stress 5iomar2ers in 1omen 1it0 5reast cancer3 10ic0 could 5e seen in t0e signi"icant decrease o" antio4idant de"ense mar2ers 7,# and GSH8 and increased concentrations o" lipid 7/$,'S and 9H8 and protein 7car5on!ls8 o4idation mar2ers a"ter treatment. Similar results 0a e 5een reported 5! ot0er aut0ors 10o "ound a reduction in total plasma antio4idant capacit!(6 and increased lipid o4idation(63(F in cancer patients a"ter c0emot0erap! andGor radiation t0erap!. /0e results o" t0is stud! 0a e also s0o1n se eral c0anges in t0e dietar! inta2e "rom t0e time o" disease diagnosis to t0e end o" cancer treatment3 particularl! an increase in t0e inta2e o" meats and "ats3 "ruits and 5eans. /0e increased consumption o" meat and "at 5! t0e participants o" t0is stud! is not in agreement 1it0 data pre iousl! reported3 10ere 5reast cancer patients 0ad a signi"icant decrease in t0e inta2e o" "ats (H3(E3 meats in general(Hand red meat in particular(E a"ter disease diagnosis andGor during cancer treatment. .n t0e ot0er 0and3 t0e increased "ruit inta2e 5! t0e participants is in agreement 1it0 results pre iousl! reported 5! )as2arinec et al. (H3 Salminen et al.(E and /0omson et al.+0 ,ccording to e idences in t0e literature3 some 1omen diagnosed 1it0 and treated "or 5reast cancer start a 0ealt0ier diet to impro e t0eir 0ealt0 status3 pre ent disease recurrence or t0e emergence o" ne1 tumors and ot0er related diseases.(H3(E , "a ora5le "inding in t0is stud! 1as t0at t0e increased inta2e o" "ruits and 5eans is in agreement 1it0 t0e recommendations descri5ed in t0e glo5al perspecti e report on "ood3 nutrition and cancer pre ention produced 5! t0e ;orld #ancer 'esearc0 Fund and t0e ,merican Institute "or #ancer 'esearc0. +1 ,ccording to t0is document3 t0e increased consumption o" "ruits3 non-starc0! egeta5les3 non-processed grains and 5eans contri5utes to t0e pre ention o" se eral t!pes o" cancer and t0ese recommendations s0ould 5e also "ollo1ed 5! cancer sur i ors3 5ot0 during acti e treatment3 10en treatment is directed to t0e tumor in order to prolong patient:s sur i al3 and a"ter treatment completion. /0e signi"icant increase in t0e dietar! inta2e o" "ruit "ound in t0is stud!3 particularl! "ruits ric0 in itamin #3 can also 0elp t0e 5od!:s de"ense mec0anism against t0e damage caused 5! reacti e o4!gen species3 as pre iousl! s0o1n in 5reast cancer sur i ors. , diet ric0 in carotenoids3 or "ruits in general3 0as decreased o4idati e

stress andGor impro ed prognosis in 1omen pre iousl! treated "or 5reast cancer.1131F Ho1e er3 t0e increased inta2e o" meats and "ats 5! t0e participants o" t0is stud! is contrar! to t0e recommendations o" reports on t0e glo5al perspecti e on "ood3 nutrition and cancer pre ention.+1 *ietar! "at is one o" t0e most in estigated nutrients in relation to 5reast cancer in epidemiological3 e4perimental and clinical studies and se eral studies 0a e alread! pro en t0e positi e association 5et1een 0ig0 "at inta2e and carcinogenesis.1231+ ,dditionall!3 it 0as 5een suggested t0at dietar! "at can stimulate lipid pero4idation3 t0us "a oring o4idati e stress in cancer patients.1231+ Some studies 0a e also s0o1n t0at reduced "at inta2e is associated to lo1er recurrence rates and longer sur i al a"ter 5reast cancer diagnosis.10 'egarding e4cess meat inta2e3 particularl! red meat3 some studies 0a e suggested t0at t0ese "ood items represent a ris2 "actor "or 5reast cancer. 21 It s0ould also 5e mentioned t0at t0e inta2e o" red meat 5! t0e participants o" t0is stud! 1as a5o e t0e recommended le el o" -00 g per 1ee2. ,ccording to t0e ;orld #ancer 'esearc0 Fund and t0e ,merican Institute "or #ancer 'esearc03 t0e inta2e o" red meat and processed meat s0ould 5e limited as a minimum in order to pre ent primar! and recurrent cancer.+1 /0e present stud! s0o1ed a signi"icant increase in t0e a erage inta2e o" mil2 and dair! products ric0 in "at 5! t0e participants during treatment. Ho1e er3 studies t0at associated t0e inta2e o" dair! products 1it0 disease 0a e s0o1n contradictor! results.+2 'egardless3 it seems desira5le to a oid t0e inta2e o" dair! products ric0 in "at3 suc0 as 10ole mil23 some t!pes o" c0eese and cream during and a"ter treatment3 since "ood ric0 in saturated "at can3 generall! spea2ing3 "a or disease recurrence.10 Here3 1e s0o1ed a signi"icant en0ancement o" 1eig0t a"ter treatment3 resulting in a mean $)I o" 2H.6F 2gGm 23 10ic0 corresponds to an a erage increase o" 2.-+ 2g in 5od! 1eig0t a"ter cancer treatment. Similar results 1ere "ound in t0e studies 5! *el 'io et al.1H and Ingram and $ro1n+(. ,ccording to *emar2-;a0ne"ried et al.++3 1eig0t gain generall! ranges "rom 2.- to 6.2 2g in t0e "irst !ear a"ter 5reast cancer diagnosis3 particularl! in 1omen 10o undergo c0emot0erap! as part o" t0eir treatment. ,lt0oug0 t0e relations0ip 5et1een e4cess 5od! 1eig0t and t0e de elopment o" 5reast cancer 0as not 5een "ull! clari"ied3 it s0ould 5e mentioned t0at t0ere is e idence s0o1ing t0at 1eig0t gain a"ter disease diagnosis can a""ect sur i al and recurrence in 1omen 1it0 5reast cancer. 11,dditionall!3 t0e a erage $)I o" t0e participants 1as not according to t0e o""icial recommendations o" t0e glo5al perspecti e report on "ood3 nutrition and cancer pre ention in an! o" t0e stud! p0ases3 since t0e $)I recommendation "or 5reast cancer pre ention ranges "rom 1H.- to 2+.E 2gGm23 1it0 a median "rom 21 to 2( 2gGm2.+1 /0e signi"icant increased in 5od! 1eig0t and $)I3 as 1ell as t0e inta2e o" meat and "ood ric0 in "at and t0e increase in o4idati e stress mar2ers in t0ese 1omen deser e special attention3 since t0ese nutritional and clinical aspects are 2no1n ris2 "actors "or disease recurrence in addition to t0e alread! e4isting ris2s lin2ed to treatment procedures per"ormed a"ter disease diagnosis. $ased on t0ese data3 t0e importance o" nutritional "ollo1-up during and a"ter treatment 5ecomes e ident in order to minimi%e t0e pro5a5ilit! o" recurrence or t0e de elopment o" ot0er t!pes o" cancer in t0ese sur i ors. /0ere"ore3 ad ice on a 5alanced diet ric0 in antio4idant nutrients t0at results in 1eig0t maintenance ma! a""ect positi el! cancer treatment e""ecti eness in addition to diminis0 o4idati e and p0!siological damage caused 5! cancer treatment.

Finall!3 some met0odological limitations s0ould 5e considered 10en interpreting t0e results o" t0is stud!. /0e FFC used "or dietar! data collection is considered to 5e an instrument t0at estimates pre ious usual inta2e in population groups. Ho1e er3 t0e accurate estimate o" usual dietar! inta2e t0roug0 t0is instrument is di""icult 5ecause it relies on t0e memor! o" t0e inter ie1ee to properl! estimate inta2e "re6uenc! and t0e si%e o" "ood portions.+,lt0oug0 some ariation in t0e estimati e o" dietar! inta2e needs to 5e ta2en into account 10en e aluating our stud!3 it s0ould 5e emp0asi%ed t0at care 1as ta2en to minimi%e t0e potential measurement errors t0at could result "rom t0e instruments o" measure3 since isual resources 1ere used in order to "acilitate t0e reporting o" t0e dietar! inta2e amounts. ,dditionall!3 t0e FFC administration3 ant0ropometric assessment and 5ioc0emical tests 1ere per"ormed 5! pro"essionals and nutrition students 10o 1ere pre iousl! trained in data collection met0ods and instruments. /0is en0ances t0e relia5ilit! o" t0e researc0 and ena5les t0e comparison 5et1een t0e assessments o" t0e studied population. , second limitation re"ers to t0e "act t0e di""erences in disease stages and t0e resulting e4posure to di""erent treatment protocols did not allo1 "or t0e identi"ication o" t0e e""ects o" di""erent treatments in relation to 5ioc0emical and nutritional results. ,dditionall!3 t0e relations0ip 5et1een c0anges in dietar! inta2e and c0anges in o4idati e stress in eac0 t!pe o" treatment or protocol could not 5e determined3 particularl! due to t0e small sample si%e. /0ere"ore3 ne1 studies s0ould 5e conducted 1it0 larger num5er o" participants in order to con"irm t0ese results and get more solid e idence o" t0e e""ect o" di""erent treatment t!pes on dietar! inta2e3 ant0ropometric parameters and o4idati e stress in 1omen 1it0 5reast cancer.

*onc"!sion /0e results o" t0is stud! s0o1ed t0at 1omen undergoing 5reast cancer treatment3 suc0 as surger!3 c0emot0erap! or radiation t0erap!3 increased t0eir inta2e o" meats3 "ats3 dair! products3 "ruits and 5eans3 0ad increased 5od! 1eig0t and $)I and increased le els o" o4idati e stress mar2ers.

Ackno6"edgements /0e aut0ors 1ould li2e to t0an2 t0e $ra%ilian Federal ,genc! "or Support and & aluation o" Graduate &ducation 7#,P&SGP'.F83 Foundation "or t0e Support o" Scienti"ic and /ec0nological 'esearc0 o" t0e State o" Santa #atarina 7F,P&S#83 #armela *utra )aternit! Hospital3 AP Anatoma Patolgica 9a5orator!3 Nutrition Pos-Graduate Program at t0e Federal Uni ersit! o" Santa #atarina and t0e National #ouncil "or Scienti"ic and /ec0nological *e elopment 7#NP68 "or t0e support gi en to t0is researc0.

References

1. $rasil. )inisterio da SaBde. Secretaria de ,tenOPo Q SaBde. Instituto Nacional do #Rncer. #oordenaOPo de Pre enOPo e LigilRncia. &stimati a 2010= IncidSncia de cRncer no $rasil. 'io de Ianeiro= IN#,J 200E. T 9in2s U 2. *umitrescu 'G3 #otarla I. Understanding 5reast cancer ris2 - 10ere do 1e stand in 200-V I Cell Mol Med 200-J E= 20H-21. T 9in2s U (. N2ond@oc2 ,3 G0adirian P. 'is2 "actors and ris2 reduction o" 5reast cancer. Med Sci 200-J 21= 1F--H0. T 9in2s U +. )cP0erson W3 Steel #)3 *i4on I). $reast cancer-epidemiolog!3 ris2 "actors3 and genetics. BMJ 2000J (21= 62+-2H. T 9in2s U -. *i isi *3 *i /ommaso S3 Sal emini S3 Garramone )3 #risci '. *iet and cancer. Acta Biomed 2006J FF= 11H-2(. T 9in2s U 6. *onaldson )S. Nutrition and cancer= a re ie1 o" t0e e idence "or an anti-cancer diet. utr J 200+J (= 1E. T 9in2s U F. Gon%?le% #,. Nutrition and cancer= t0e current epidemiological e idence. Br J utr 2006J E6 7Suppl. 18= S+2--. T 9in2s U H. We! /I3 ,llen N&3 Spencer cancer. Breast 200(J 12= +12-16. &,3 /ra is T 9in2s U '#. Nutrition and 5reast

E. K0ang S3 Hunter *I3 Forman )'3 'osner $,3 Spei%er F&3 #oldit%3 G, et al. *ietar! carotenoids and itamins ,3 #3 and & and ris2 o" 5reast cancer. J at! Cancer "nst 1EEEJ E1= -+F--6. T 9in2s U 10. Sa4e G,3 'oc2 #93 ;ic0a )S3 Sc0otten"eld *. *iet and ris2 "or 5reast cancer recurrence and sur i al. Breast Cancer #es $reat 1EEEJ -(= 2+1--(. T 9in2s U 11. 'oc2 #93 *emar2-;a0ne"ried ;. Nutrition and sur i al a"ter t0e diagnosis o" 5reast cancer= a re ie1 o" t0e e idence. J Clin %ncol 2002J 20= ((02-16. T 9in2s U 12. ;!nder &93 #o0en 9,3 )uscat I&3 ;inters $3 *1!er I/3 $lac25urn G. $reast cancer= 1eig0ing t0e e idence "or a promoting role o" dietar! "at. J atl Cancer "nst 1EEFJ HE= F66-F-. T 9in2s U 1(. 9o"t S3 Poulsen H&. #ancer ris2 and o4idati e *N, damage in man. J Mol Med 1EE6J F+= 2EF-12. T 9in2s U 1+. Lieira FGL3 *i Pietro PF3 $oa entura $#$3 ,m5rosi #3 'oc2en5ac0 G3 Fausto ), et al. Factors associated 1it0 o4idati e stress in 1omen 1it0 5reast cancer. utr &osp 2011J 26= -2H-(6. T 9in2s U 1-. $ore2 #. *ietar! antio4idants and 0uman cancer. "ntegr Cancer $her 200+J (= (((-+1. T 9in2s U 16. $ore2 #. ,ntio4idants and radiation t0erap!. J T 9in2s U utr 200+J 1(+= (20FS-0ES.

1F. /0omson #,3 Stendell-Hollis N'3 'oc2 #93 #ussler &#3 Flatt S;3 Pierce IP. Plasma and dietar! carotenoids are associated 1it0 reduced o4idati e stress in

1omen pre iousl! treated Prev 200FJ 16= 200H-1-.

"or 5reast T 9in2s U

cancer. Cancer

'pidemiol

Biomarkers

1H. *el 'io G3 Kironi S3 Laleriani 93 )eno%%i '3 $ondi )3 $ertolini )3 et al. ;eig0t gain in 1omen 1it0 5reast cancer treated 1it0 ad@u ant c!clop0osp0omide3 met0otre4ate and --"luorouracil. ,nal!sis o" resting energ! e4penditure and 5od! composition. Breast Cancer #es $reat 2002J F(= 26F-F(. T 9in2s U 1E. 9anc0eros 93 Gam5a )3 Gon%?le% H3 S?nc0e% '. #aracteri%acin de la e olucin del estado nutricional de pacientes con c?ncer de mama en tratamiento 6uimioterap>utico. #ev Colom( Cancerol 200+J H= 11-22. T 9in2s U 20. ,mes HG3 Gee )I3 Ha1r!s0 KI. /aste perception and 5reast cancer= e idence o" a role "or diet. J Am Diet Assoc 1EE(J E(= -+1-+6. T 9in2s U 21. *i Pietro PF3 )edeiros NI3 Lieira FG3 Fausto ),3 $ello-Wlein ,. $reast cancer in sout0ern $ra%il= association 1it0 past dietar! inta2e. utr &osp 200FJ 22= -6--F2. T 9in2s U 22. $rasil. )inisterio da SaBde. Secretaria de ,tenOPo Q SaBde. Instituto Nacional de #Rncer. /N)= classi"icaOPo de tumores malignos. 6. ed. 'io de Ianeiro= IN#,J 200+. T 9in2s U 2(. ;orld Healt0 .rgani%ation. P0isical Status= t0e use and interpretation o" ant0ropometr!3 ;H. tec0nical report3 series H-+. Gene a= ;H.J 1EE-. T 9in2s U 2+. Sic0ieri '3 & er0art )*. Lalidit! o" a 5ra%ilian "re6uenc! 6uestionnaire against dietar! recalls and estimated energ! inta2e. utr #es 1EEHJ 1E= 16+E--E. T 9in2s U 2-. Ka5otto #$. 'egistro "otogr?"ico UnicampJ 1EE6. T 9in2s U para in6u>ritos diet>ticos. #ampinas=

26. Pin0eiro ,$L3 9acerda &),3 $en%ecr! &H3 Gomes )#S3 #osta L). /a5ela para a aliaOPo de consumo alimentar em medidas caseiras. 2 t0 ed. SPo Paulo= ,t0eneuJ 200+. T 9in2s U 2F. $en )9. Cuanto pesaV= ta5ela de pesos e medidas de alimentos. Porto ,legre= &diplatJ 200F. T 9in2s U 2H. Gris1old '). &studo &4perimental dos ,limentos. SPo Paulo= &dgard $lXc0erJ 1EF2. T 9in2s U 2E. $rasil. )inist>rio da SaBde. Secretaria de ,tenOPo Q SaBde. *epartamento de ,tenOPo $?sica. #oordenaOPo-Geral da PolAtica de ,limentaOPo e NutriOPo. Guia ,limentar para a populaOPo 5rasileira= promo endo a alimentaOPo saud? el. $rasilia= )inist>rio da SaBdeJ 2006. T 9in2s U (0. $eutler &3 *uron .3 Well! $). Impro ed met0od "or t0e determination o" 5lood glutat0ione. J )a( Clin Med1E6(J 61= HH2-E0. T 9in2s U (1. $en%ie IFF3 Strain II. /0e "erric reducing a5ilit! o" plasma 7"rap8 as a measure o" antio4idant po1er= t0e "rap assa!. Anal Biochem 1EE6J 2(E= F0-F6. T 9in2s U

(2. &ster5auer H3 #0eeseman W. *etermination o" alde0!dic lipid pero4idation products= malonalde0!de and +-0!dro4!nonenal. Method 'nzymol 1EE0J 1H6= +0F21. T 9in2s U ((. Nouroo%-Kade0 I3 /a@addini-Sarmadi I3 ;ol"" SP. )easurement o" plasma 0!dropero4ide concentrations 5! t0e "errous o4idation-4!lenol orange assa! in con@unction 1it0 trip0en!lp0osp0ine. Anal Biochem 1EE+J 220= +0(-0E. T 9in2s U (+. 9e ine '93 Garland *3 .li er #N3 ,mici ,3 #liment I3 9en% ,G et al. *etermination o" car5on!l content in o4idati el! modi"ied proteins. Methods 'nzymol 1EE0J 1H6= +6+-FH. T 9in2s U (-. #on2lin W,. #0emot0erap!-associated o4idati e stress= impact on 0emot0erapeutic e""ecti eness. "ntegr Cancer $her 200+J (= 2E+-(00. T 9in2s U (6. *ur2en )3 Herrnring #3 Finc20 $3 Nagel S3 Nielsen P3 Fisc0er ' et al. Impaired plasma antio4idati e de"ense and increased nontrans"errin-5ound iron during 0ig0dose c0emot0erap! and radioc0emot0erap! preceding 5one marro1 transplantation. *ree #adi! Biol Med 2000J 2H= HHF-E+. T 9in2s U (F. #etin /3 ,rpaci F3 Yilma% )I3 Saglam W3 .%tur2 $3 Womurcu S et al. .4idati e stress in patients undergoing 0ig0-dose c0emot0erap! plus perip0eral 5lood stem cell transplantation. Biol $race 'lem #es 200+J EF= 2(F-+F. T 9in2s U (H. )as2arinec G3 )urp0! S3 S0uma! *)3 Wa2ai H. *ietar! c0anges among cancer sur i ors. 'ur J Cancer Care2001J 10= 12-20. T 9in2s U (E. Salminen &3 Hei22ila S3 Poussa /3 9agstrom H3 Saario '3 Salminen S. Female patients tend to alter t0eir diet "ollo1ing t0e diagnosis o" r0eumatoid art0ritis and 5reast cancer. Prev Med 2002J (+= -2E-(-. T 9in2s U +0. /0omson #,3 Flatt S;3 'oc2 #93 'iten5aug0 #3 Ne1man L3 Pierce IP. Increased "ruit3 egeta5le and "i5er inta2e and lo1er "at inta2e reported among 1omen pre iousl! treated "or in asi e 5reast cancer. J Am Diet Assoc2002J 102= H01-0H. T 9in2s U +1. ;orld #ancer 'esearc0 FundJ ,merican Institute For #ancer 'esearc0. Food3 nutrition3 p0!sical acti it!3 and t0e pre ention o" cancer= a glo5al perspecti e. ;as0ington3 *#= ,I#'J 200F. T 9in2s U +2. )oorman PG3 /err! P*. #onsumption o" dair! products and t0e ris2 o" 5reast cancer= a re ie1 o" t0e literature. Am J Clin utr 200+J H0= --1+. T 9in2s U +(. Ingram #3 $ro1n IW. Patterns o" 1eig0t and 5od! composition c0ange in premenopausal 1omen 1it0 earl! stage 5reast cancer= 0as 1eig0t gain 5een o erestimatedV Cancer urs 200+J 2F= +H(-E0. T 9in2s U ++. *emar2-;a0ne"ried ;3 'imer $W3 ;iner &P. ;eig0t gain in 1omen diagnosed 1it0 5reast cancer. J Am Diet Assoc 1EEFJ EF= -1E-2E. T 9in2s U +-. ;illet ;#. Nutritional &pidemiolog!. Ne1 Yor2= .4"ord Uni ersit!J 1EEH. T 9in2s U

*orres ondence: Patricia Faria *i Programa de Ps-GraduaOPo em #entro de #iSncias da Uni ersidade Federal de Santa #ampus Uni ersitario. #ep HH0+0-E00 FlorianopolisGS# &-mail= "ariadipietroZgmail.com 'eci5ido= ,ceptado= F-[I-2010.

Pietro. NutriOPo. SaBde. #atarina. /rindade. $ra%il.

1H-[-2010.