Diet across the Lifespan and the Association with Breast Density in Adulthood

Table 3

Studies of adult calcium and vitamin D intake and breast density.

Author, year	Study population,; 𝑛	Design	Age	Foods/nutrients of interest	Dietary assessment	Outcome	Major significant results	Adjustments
Bertone-Johnson, et al. 2010 [19]	MDAS: WHI; 𝑛=808 Postmenopausal; (US, 42% NH-White, 39% Black, 20% other races)	CS	50–79 y	Dietary and supplemental vitamin D and Ca	122-item FFQ + supplement inventory	PBD: (mammogram; computer-assisted method)	Null	Age, race/ethnicity, BMI, age at menarche, parity, OC use and duration, previous HT use/duration, HT trial randomization assignment, family hx of BC, education, alcohol, smoking, total energy, PA, Gail risk, MV use
Bertone-Johnson et al. 2012 [20]; (also in Table 8)	WHI CaD trial; 𝑛=330  postmenopausal; women; (US, 48% NH-White, 36% Black, 15% other)	RCT	50–79 y	Daily supplementation of both 1,000 mg of Ca and 400 IU of vitamin D (1y)	122-item FFQ	PBD: (Mammogram: computer-assisted method)	Null	Subgroup analyses: age, race/ethnicity, total vitamin D intake, HT treatment, Gail risk score, BMI, region of residence, category of mammogram density at baseline.
Bérubé et al. 2005 [21]	Premenopausal women: 𝑛=777  Postmenopausal: 𝑛=783  (Canada)	CS	Premenopausal: 46.7 y; Postmenopausal: 61.8 y	Dietary and supplemental vitamin D and Ca	161-item FFQ	PBD: (mammogram; computer-assisted method)	Premenopausal women: dietary vitamin D: β = −1.8; total vitamin D: β = −1.4; dietary calcium: β = −0.7; total calcium: β = −0.8.; 8.5% ↓mean PBD with simultaneous increases in VD and Ca by 400 IU and 1,000 mg, respectively.; Postmenopausal women: null; All women: absolute ↓ in mean PBD𝑄4CaandVitDQ1CaandVitD= 6.9%,	Age, BMI, age at menarche, number of full-term pregnancies, age at first full-term pregnancy, duration of OC and/or HRT use, alcohol, daily energy, PA, family hx of BC in 1st degree relative, personal history of breast biopsies, smoking status, education (supplement use was also a confounder, determined post hoc)
Bérubé et al. 2004 [22]	Pre- and postmenopausal women with extreme densities 𝑛=543(US)	CS	PBD ≤ 30%: 51.4 y; PBD ≥ 70%: 46.1 y	Vitamin D and dietary Ca	232-item FFQ	PBD: (mammogram; visual estimation)	All women: vitamin D: OR𝑄4versus𝑄1= 0.24  (95% CI: 0.11–0.53); calcium: OR𝑄4versus𝑄1 = 0.24 (95% CI: 0.10–0.57); OREXTversusFEWDENSITIES  0.28 (95% CI: 0.15–0.54) (≥100 IU Vit D and ≥750 mg/d Ca)=)premenopausal women: vitamin D:OR𝑄4versus𝑄1 = 0.13; calcium: OR𝑄4versus𝑄1 = 0.13; postmenopausal women: vitamin D: OR𝑄4versus𝑄1 = 0.30 (𝑃 trend = 0.05); calcium: OR𝑄4versus𝑄1 = 0.27; (P-trend = 0.06)	Age, mammography, BMI, age at menarche, number of births and age at first birth combined, OCs, menopausal status and use of HRT combined, family hx of BC, education, alcohol, total energy, smoking status
Diorio et al. 2006 [23]	Premenopausal women; 𝑛=771(Canada)	CS	<48 y (if a nonsmoker); and <46 y (if a smoker)	Dietary and supplemental vitamin D and Ca	FFQ	PBD: (mammogram: computer-assisted method)	Food only: vitamin D: β for 100 IU/d = −1.8; calcium: β for 250 mg/d = −1.8; Food and supp: vitamin D: β for 100 IU/d = −1.4; calcium: β for 250 mg/d = −1.9	Alcohol, total energy, age, BMI, age at menarche, age at first full-term pregnancy, number of full-term pregnancies, number of breast biopsies, duration of past use of OC and of HRT, family history of BC in 1st degree relative, PA, education, smoking status
Masala et al. 2006 [24]; (also in Tables 4, 5, and 7)	Mediterranean population—florence section of EPIC; 𝑛=1, 668; (Italy)	CS	Pre-, post-, and perimenopausal women	Vitamin D and Ca	160-item validated FFQ	Wolfe classification; (P2 + DY versus N1 + P1); and semiquantitative method	All women: P2 + DY versus N1 + P1: calcium OR𝑇3versus𝑇1 = 0.67 (95% CI: 0.47–0.94)	Age, education, BMI, menopausal status, total energy (log), each food separately (tertiles)
Mishra et al. 2008 [14]; (also in Table 1)	BBC; (n’s ranged from 674 to 979 women)   Cross-sectional n:total: 𝑛=287; (England)	PC	36, 43, 53 y/51.5 y	Dietary Ca and vitamin D (age 53 follow-up: included supplement data)	5-day food records	PBD, ADT, ANDT; (mammogram; cumulus)	Null; cross-sectional findings: postmenopausal women: ≥1180 mg/d^−1 versus; ≤699 mg/d^−1, 0.53 s.d. lower PBD (95% CI: 0.03–1.02)	Mammographic view, age at mammogram, BMI at 53, energy, age at menarche,; parity, smoking status, adult SES
Nordevang et al. 1993 [25]; (also in Tables 5 and 7)	BC patients (stage I-II); 𝑛=238  (Sweden)	CS	57.5 y	Ca	Dietary hx interview within 4 months of BC diagnosis	Wolfe classification (N1 + P1 versus P2 + Dy)	Premenopausal women: P2 + Dy versus N1 + P1: calcium (1165 versus 1433 mg/10 MJ)	BMI, age, ER status
Knight et al., 2006 [26]	MBCFCS; 𝑛=487; (US, NH-white)	CS	56.4 y	Vitamin D (25(OH)D) and dietary Ca	FFQ	PBD, TDA (mammogram: Cumulus)	Null	Full model: age, BMI, parity, age at first birth, PA
Tseng et al. 2007 [27]; (also in Tables 4, 5, and 7)	Women with at least one 1st degree or 2nd degree relative with BC or ovarian cancer 𝑛=157; (US, NH-White)	CS	50 y	Vitamin D and Ca	126-item FFQ	PBD: BIRADS	OR: vitamin D intake𝑇3versus𝑇1, 0.5; (95% CI: 0.2–1.1)	Age, BMI, caloric intake, age at menarche, menopausal status, history of HRT, family history category.
Vachon et al., 2000 [9]; (also in Tables 4, 5, and 7)	MBCFCS; 𝑛=1508; (US, NH-White)	CS	61.4 y	Vitamin D and Ca	153-item validated FFQ	PBD (Mammogram: visual estimation)	null	Energy, age, BMI, WHR, PA, age at menarche, age at first birth and number of births (combined), alcohol, smoking, family hx of BC, HRT (all and postmenopausal women) and OC use (premenopausal women)