IJE Advance Access originally published online on May 3, 2006
International Journal of Epidemiology 2006 35(4):1011-1021; doi:10.1093/ije/dyl085
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Published by Oxford University Press 2006
Cancer |
A comparison of two dietary instruments for evaluating the fat–breast cancer relationship
1 Gertner Institute for Epidemiology, Tel Hashomer, Israel
2 Division of Cancer Control and Population Studies, National Cancer Institute, Bethesda, MD, USA
3 Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
4 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
5 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
6 Department of Statistics, Texas A&M University, College Station, TX, USA
* Corresponding author. National Cancer Institute, 6130 Executive Blvd, Suite 3124, Rockville, MD 20852, USA. E-mail: victor_kipnis{at}nih.gov
Background Previous research suggests food diaries may be more efficient than food frequency questionnaires (FFQ) in detecting a dietary fat–breast cancer relationship. We assessed this further using 4 day food records (FRs) and FFQs in a large sample.
Methods Participants were from the non-intervention group of the dietary modification component of the Women's Health Initiative Clinical Trial: 603 breast cancer cases and 1206 controls matched on age, clinic, and length of follow-up. Relative risks (RRs) were estimated using unconditional logistic regression, adjusted for confounders and for the selection into the trial of women with an FFQ report exceeding 32% calories from fat. Direct comparison of the statistical power of the two instruments used the standardized log RR. An alternative analysis after removing subjects with missing covariate data was also conducted.
Results The RR estimate for breast cancer in the top quintile of total fat intake, adjusted for confounders and total energy, was 1.82 (P for trend 0.02) for the FR but 0.67 for the FFQ (P for trend 0.24). Following adjustment for selection, estimates were 2.09 (P for trend 0.008) for the FR (alternative: 2.54, P for trend 0.006) and 1.71 (P for trend 0.18) for the FFQ (alternative: 1.24, P for trend 0.41). Similar results were seen for fat subtypes, particularly unsaturated fats. Comparisons showed higher statistical power for the FR than the FFQ (e.g. total fat, P = 0.08: alternative P = 0.01).
Conclusions Alternative instruments, such as FRs, may be preferable to FFQs for evaluating diet–disease relationships in cohort studies. The results support a positive association between dietary fat and breast cancer.
Keywords Breast cancer, dietary fat, food frequency questionnaire, multiple-day food record
Accepted 4 March 2006
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