ArticleBMC medicine2023
Association of Mediterranean diet with survival after breast cancer diagnosis in women from nine European countries: results from the EPIC cohort study.
Article in BMC medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07007169 (Mediterranean Diet and Inequality in Early Breast Cancer), which is not on this map. Cited by 19 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Mediterranean Diet and Inequality in Early Breast Cancer: A Multicenter Randomized Clinical Trial
Who cites it
19 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Post-Diagnostic Diet and Breast Cancer Outcomes: A Comprehensive Systematic Review of Prospective Cohort Studies and Randomized Clinical Trials.Nutrients · 2026Pooled it
- Coffee and tea intake and survival of cancer patients: a systematic review and meta-analysis.Cancer causes & control : CCC · 2025Pooled it
- Associations Between Dietary Factors and Breast Cancer Risk: A Systematic Review of Evidence from the MENA Region.Nutrients · 2025Pooled it
- The Effect of Diet on Breast Cancer Recurrence: The DIANA-5 Randomized Trial.Clinical cancer research : an official journal of the American Association for Cancer Research · 2024Trial
- Time-Dependent Multimechanistic Antitumor Effects of Olive Oil Phenolics in a Triple-Negative Breast Cancer Mouse Model.Nutrients · 2026Article
- A review of dietary patterns and the colorectal polyp-to-carcinoma sequence: polyp occurrence, polyp recurrence, and colorectal cancer.Frontiers in nutrition · 2026Review
- Psychosocial factors of dietary self-management behavior based on Integrated Theory of Health Behavior Change in elderly breast cancer patients treated with chemotherapy: a multicenter cross-sectional study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- Dietary habits in relation to outcome and therapy-related toxicity in patients with glioblastoma - a retrospective cohort study.Journal of neuro-oncology · 2025Article
- The Microbiota-Diet-Immunity Axis in Cancer Care: From Prevention to Treatment Modulation and Survivorship.Nutrients · 2025Review
- Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC.JAMA network open · 2025Article
- The dual role of the gut microbiota in breast cancer: from pathogenic mechanisms to emerging therapeutic.Frontiers in microbiology · 2025Review
- Association of dietary inflammatory index, composite dietary antioxidant index and risk of death among adult cancer survivors: findings from the National Health and Nutrition Examination Survey 2001-2018.Frontiers in immunology · 2025Article
- Nutrition Intervention and Microbiome Modulation in the Management of Breast Cancer.Nutrients · 2024Review
- Review
- Review
- Dietary Patterns Associated with Breast Cancer in the Middle East: A Scoping Review.Nutrients · 2024Article
- Analysis of dietary inflammatory potential and mortality in cancer survivors using NHANES data.Frontiers in nutrition · 2024Article
- Effects of Functional and Nutraceutical Foods in the Context of the Mediterranean Diet in Patients Diagnosed with Breast Cancer.Antioxidants (Basel, Switzerland) · 2023Review
- Diet-driven microbiome changes and physical activity in cancer patients.Frontiers in nutrition · 2023Review
Corrections and comments
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Authors and funding
34 authors.
Funding
Abstract
backgroundThe 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.
methodsA 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.
resultsAfter 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 (HR
conclusionsConsuming 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.
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