Nutritional Epide
miology of Breast Cancer. (In Spanish)

Alvaro L. Ronco, MD and colls: Eduardo De Stéfani, MD, Hugo Deneo-Pellegrini, MD, María S. Mendilaharsu, Dr.Soc.Sci. Ediciones De la Plaza, Montevideo, Uruguay, 2008. Limited edition.
Awarded in 2007 with the EL PAIS Prize by the National Academy of Medicine of Uruguay.


Breast cancer (BC) -the most frequent malignant tumor for the female gender in the whole world- is also the first cancer among Uruguayan women due to its incidence as well as to its mortality and their respective rates locate this country among the top countries all over the world. This cancer can be considered as a paradygm of a multifactorial and polygenic disease in which environmental –mostly lifestyle- factors are responsible of a major proportion of its occurrence. Among the environmental factors that probably are more important because of their influence in BC genesis and development, diet prevails notably, for which a responsibility between 30 and 35% has been recognized.

The book summarizes an update on diet, anthropometry and BC. First, international literature is quoted exploring the possible role of calories, carbohydrates, fats, proteins, alcohol, vitamins, bioactive compounds, vegetables and fruits, meats, dairy products and different beverages. Next, the book presents the most outstanding findings that came out from the whole series of epidemiological studies in which the authors have been working since 1994, referred to nutritional factors and BC. Most of such studies, mainly case-control type ones, were carried out from a database whose cases and controls proceeded from the major public hospitals in Montevideo, the capital city. Patients were interviewed with a questionnaire that was specifically designed for the aims of the research, which involved a large number of dietary items and also beverage and supplements.

Research has shown that certain consumptions were associated with an increase of BC risk: meats, their cooking methods, fatty foods, fats, heterocyclic amines. Inversely, the association in a protective way was shown by: vegetables and fruits, fiber, nutrients like carotenoids and phytoestrogens. Some of these findings were joined together to the existing literature and others have contributed as original results. The results of studies on the possible role of dairy products, white meat, Ω-6/Ω-3 fatty acids and fruits, performed at the Uruguayan prepaid healthcare system, are described. The associations between insulin resistance and BC risk are exposed in detail. Besides, some original findings derived from the anthropometric analysis of Uruguayan women are presented. Somatotype and body composition –this latter through the fat/muscle ratio- have shed some light on anthropometric features of Uruguayan female population and their risk of BC. Uruguayan research has shown that nutritional factors can have a very good discriminant capability between BC cases and women without cancer.

Finally, the background of a proposal for changing some dietary habits in the Uruguayan woman is mentioned due to the results of the performed research. It is stated how, when and how much the dietary profile should change. Assuming the importance of nutrition as something of local or regional value –diet is based on patterns and not on isolated foods-, the authors give a basis for primary prevention of BC, something that is recognized as a real challenge. A high value is given to the notion that the proposed changes not only do not mean health risks but, moreover, they appear as a prevention beyond the limits of BC and they also would protect from other pathologies.

Nowadays, health is an award to moderation and balance.





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