酒精、坚果、纤维与良性乳腺疾病风险
既往研究发现，青春期饮酒与不饮酒的成年女性相比，增生型良性乳腺疾病和乳腺浸润癌的发病风险显著较高。此外，青春期坚果和膳食纤维摄入量较高与较低的成年女性相比，乳腺良性病变和绝经前乳腺癌的发病风险显著较低。因此，有人推测，坚果、膳食纤维可能减少酒精相关良性乳腺疾病的发病风险。
2020年11月23日，英国《自然》旗下《乳腺癌》在线发表美国哈佛大学医学院、布莱根医院和波士顿妇女医院、哈佛大学陈曾熙公共卫生学院、达纳法伯癌症研究院、康奈尔大学威尔医学院、圣路易斯华盛顿大学、塞特曼癌症中心、澳大利亚墨尔本大学的研究报告，探讨了青春期酒精、坚果和膳食纤维摄入量对年轻女性良性乳腺疾病风险的综合影响。
该前瞻队列研究于1996～2001年入组9～15岁女性9031例，分别于1996～2001、2003、2005、2007、2010、2013、2014年进行问卷调查。1996～2001年，全部参加者完成食物频次调查问卷。2005年，年龄≥18岁的173例参与者开始报告活检确诊的良性乳腺疾病。通过多因素逻辑回归模型，推算良性乳腺疾病与14～17岁时酒精和花生酱或坚果、总膳食纤维交叉分类摄入量之间的相关性。
结果，仅19%的参与者中学时饮酒，与不饮酒的参与者相比，良性乳腺疾病风险高75%（比值比：1.75，95%置信区间：1.20～2.56，P=0.004）。
食用与不食用坚果或花生酱的参与者相比，良性乳腺疾病风险低36%（比值比：0.64，95%置信区间：0.45～0.90，P=0.01）。
膳食纤维摄入量最高的四分之三与最低的四分之一参与者相比，良性乳腺疾病风险低43%（比值比：0.57，95%置信区间：0.40～0.81，P=0.002）。
对于中学时饮酒女性，食用与不食用坚果或花生酱相比，良性乳腺疾病风险低53%（风险比：0.47，95%置信区间：0.24～0.89，P=0.02）。
对于中学时饮酒女性，膳食纤维摄入量最高的四分之三与最低的四分之一参与者相比，良性乳腺疾病风险相似（风险比：0.67，95%置信区间：0.34～1.32，P=0.25）。
因此，该研究结果表明，对于中学时饮酒的女性，食用坚果可能减少良性乳腺疾病风险。由于中学时饮酒的参与者数量较少，故有必要开展进一步研究对青春期或成年女性进行验证。不过，可以鼓励中学生吃坚果和膳食纤维、避免饮酒，有助减少乳腺良性疾病风险，有利整体健康获益。
NPJ Breast Cancer. 2020 Nov 23. Online ahead of print.
Adolescent alcohol, nuts, and fiber: combined effects on benign breast disease risk in young women.
Catherine S. Berkey, Rulla M. Tamimi, Walter C. Willett, Bernard Rosner, Martha Hickey, Adetunji T. Toriola, A. Lindsay Frazier, Graham A. Colditz.
Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA; Weill Cornell Medicine, New York, NY, USA; Washington University School of Medicine and Alvin J Siteman Cancer Center, St. Louis, MO, USA; University of Melbourne, Parkville, VIC, Australia.
Adolescent drinking is associated with higher risks of proliferative benign breast disease (BBD) and invasive breast cancer (BC). Furthermore, adolescent nut and fiber consumptions are associated with lower risks of benign lesions and premenopausal BC. We hypothesize that diet (nuts, fiber) may mitigate the elevated BBD risk associated with alcohol. A prospective cohort of 9031 females, 9-15 years at baseline, completed questionnaires in 1996-2001, 2003, 2005, 2007, 2010, 2013, and 2014. Participants completed food frequency questionnaires in 1996-2001. In 2005, participants (>=18 years) began reporting biopsy-confirmed BBD (N=173 cases). Multivariable logistic regression estimated associations between BBD and cross-classified intakes (14-17 years) of alcohol and peanut butter/nuts (separately, total dietary fiber). Only 19% of participants drank in high school; drinking was associated with elevated BBD risk (OR=1.75, 95% CI: 1.20-2.56; p=0.004) compared to nondrinkers. Participants consuming any nuts/butter had lower BBD risk (OR=0.64, 95% CI: 0.45-0.90; p=0.01) compared to those consuming none. Participants in top 75% fiber intake had lower risk (OR=0.57, 95% CI: 0.40-0.81; p=0.002) compared to bottom quartile. Testing our hypothesis that consuming nuts/butter mitigates the elevated alcohol risk, analyzing alcohol and nuts combined found that those who consumed both had lower risk (RR=0.47, 95% CI: 0.24-0.89; p=0.02) compared to drinkers eating no nuts. Our analysis of alcohol and fiber together did not demonstrate risk mitigation by fiber. For high school females who drink, their BBD risk may be attenuated by consuming nuts. Due to modest numbers, future studies need to replicate our findings in adolescent/adult females. However, high school students may be encouraged to eat nuts and fiber, and to avoid alcohol, to reduce risk of BBD and for general health benefits.
DOI: 10.1038/s41523-020-00206-4