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Association Between Western and Mediterranean Dietary Patterns and Mammographic Density

Castelló, Adela PhD; Ascunce, Nieves MD; Salas-Trejo, Dolores PhD; Vidal, Carmen MD; Sanchez-Contador, Carmen MD; Santamariña, Carmen MD; Pedraz-Pingarrón, Carmen MD; Moreno, Maria Pilar MD; Pérez-Gómez, Beatriz PhD; Lope, Virginia PhD; Aragonés, Nuria PhD; Vioque, Jesús PhD; Pollán, Marina PhD

doi: 10.1097/AOG.0000000000001589
Contents: Original Research

OBJECTIVE: To examine the association between two dietary patterns (Western and Mediterranean), previously linked to breast cancer risk, and mammographic density.

METHODS: This cross-sectional study included 3,584 women attending population-based breast cancer screening programs and recruited between October 7, 2007, and July 14, 2008 (participation rate 74.5%). Collected data included anthropometric measurements; demographic, obstetric, and gynecologic characteristics; family and personal health history; and diet in the preceding year. Mammographic density was blindly assessed by a single radiologist and classified into four categories: less than 10%, 10–25%, 25–50%, and greater than 50%. The association between adherence to either a Western or a Mediterranean dietary pattern and mammographic density was explored using multivariable ordinal logistic regression models with random center-specific intercepts. Models were adjusted for age, body mass index, parity, menopause, smoking, family history, hormonal treatment, and calorie and alcohol intake. Differences according to women's characteristics were tested including interaction terms.

RESULTS: Women with a higher adherence to the Western dietary pattern were more likely to have high mammographic density (n=242 [27%]) than women with low adherence (n=169 [19%]) with a fully adjusted odds ratio (ORQ4vsQ1) of 1.25 (95% confidence interval [CI] 1.03–1.52). This association was confined to overweight–obese women (adjusted ORQ4vsQ1 [95% CI] 1.41 [1.13–1.76]). No association between Mediterranean dietary pattern and mammographic density was observed.

CONCLUSION: The Western dietary pattern was associated with increased mammographic density among overweight–obese women. Our results might inform specific dietary recommendations for women with high mammographic density.

High adherence to the Western dietary pattern is associated with higher mammographic density; however, the Mediterranean dietary pattern is not.

Cancer Epidemiology Unit, National Center for Epidemiology, and the Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, the Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, the Navarre Breast Cancer Screening Program, Public Health Institute, Pamplona, the Valencian Breast Cancer Screening Program, General Directorate of Public Health, Valencia, the Cancer Prevention and Control Unit, Catalonian Institute of Oncology (ICO), Barcelona, the Balearic Islands Breast Cancer Screening Program, Directorate General of Public Health and Participation, Palma de Mallorca, Illes Balears, the Galician Breast Cancer Screening Program, Galician Regional Health Authority, A Coruña, the Castile-León Breast Cancer Screening Program, General Directorate of Public Health, Burgos, the Aragón Breast Cancer Screening Program, Aragon Health Service, Zaragoza, and Universidad Miguel Hernandez, Sant Joan D'Alacant, Spain.

Corresponding author: Adela Castelló, PhD, Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Avenida Monforte de Lemos, 5, 28029 Madrid, Spain; e-mail:

Supported by Carlos III Institute of Health FIS (Spanish Public Health Research Fund: PI060386 FIS; PS09/00790 and PI15CIII/0029 research grants); the Spanish Ministry of Health (EC11-273); the Spanish Ministry of Economy and Competitiveness (IJCI-2014-20900); the Spanish Federation of Breast Cancer Patients (FECMA: EPY 1169-10); and the Association of Women with Breast Cancer from Elche (AMACMEC: EPY 1394/15).

Financial Disclosure The authors did not report any potential conflicts of interest.

* For a list of the membership of the DDM-Spain Research Group, see Appendix 1 online at

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.