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@ARTICLE{CastroEspin:277119,
      author       = {C. Castro-Espin and C. Bonet and M. Crous-Bou and N.
                      Nadal-Zaragoza and A. Tjønneland and L. Mellemkjær and M.
                      Hajji-Louati and T. Truong and V. Katzke$^*$ and C. Le
                      Cornet$^*$ and M. B. Schulze and F. Jannasch and G. Masala
                      and S. Sieri and S. Panico and C. Di Girolamo and G. Skeie
                      and K. B. Borch and K. S. Olsen and M.-J. Sánchez and P.
                      Amiano and M.-D. Chirlaque and M. Guevara and M. Sund and S.
                      Bodén and M. J. Gunter and E. M. Gonzalez-Gil and E.
                      Weiderpass and I. Aguilera-Buenosvinos and K. K. Tsilidis
                      and A. K. Heath and D. Aune and L. Dossus and A. Agudo},
      title        = {{A}ssociation of {M}editerranean diet with survival after
                      breast cancer diagnosis in women from nine {E}uropean
                      countries: results from the {EPIC} cohort study.},
      journal      = {BMC medicine},
      volume       = {21},
      number       = {1},
      issn         = {1741-7015},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer},
      reportid     = {DKFZ-2023-01284},
      pages        = {225},
      year         = {2023},
      abstract     = {The Mediterranean diet has been associated with lower risk
                      of breast cancer (BC) but evidence from prospective studies
                      on the role of Mediterranean diet on BC survival remains
                      sparse and conflicting. We aimed to investigate whether
                      adherence to Mediterranean diet prior to diagnosis is
                      associated with overall and BC-specific mortality.A total of
                      13,270 incident breast cancer cases were identified from an
                      initial sample of 318,686 women in 9 countries from the
                      European Prospective Investigation into Cancer and Nutrition
                      (EPIC) study. Adherence to Mediterranean diet was estimated
                      through the adapted relative Mediterranean diet (arMED), a
                      16-point score that includes 8 key components of the
                      Mediterranean diet and excludes alcohol. The degree of
                      adherence to arMED was classified as low (score 0-5), medium
                      (score 6-8), and high (score 9-16). Multivariable Cox
                      proportional hazards models were used to analyze the
                      association between the arMED score and overall mortality,
                      and Fine-Gray competing risks models were applied for
                      BC-specific mortality.After a mean follow-up of 8.6 years
                      from diagnosis, 2340 women died, including 1475 from breast
                      cancer. Among all BC survivors, low compared to medium
                      adherence to arMED score was associated with a $13\%$ higher
                      risk of all-cause mortality (HR 1.13, $95\%CI$ 1.01-1.26).
                      High compared to medium adherence to arMED showed a
                      non-statistically significant association (HR 0.94; $95\%$
                      CI 0.84-1.05). With no statistically significant departures
                      from linearity, on a continuous scale, a 3-unit increase in
                      the arMED score was associated with an $8\%$ reduced risk of
                      overall mortality (HR3-unit 0.92, $95\%$ CI: 0.87-0.97).
                      This result sustained when restricted to postmenopausal
                      women and was stronger among metastatic BC cases (HR3-unit
                      0.81, $95\%$ CI: 0.72-0.91).Consuming a Mediterranean diet
                      before BC diagnosis may improve long-term prognosis,
                      particularly after menopause and in cases of metastatic
                      breast cancer. Well-designed dietary interventions are
                      needed to confirm these findings and define specific dietary
                      recommendations.},
      keywords     = {Breast cancer (Other) / Cancer survivors (Other) / Dietary
                      patterns (Other) / Mediterranean diet (Other) / Prospective
                      studies (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37365585},
      doi          = {10.1186/s12916-023-02934-3},
      url          = {https://inrepo02.dkfz.de/record/277119},
}