Hemoglobin A1c Levels Modify Associations Between Dietary Acid Load and Breast Cancer Recurrence

Abstract Objectives Metabolic acidosis promotes cancer metastasis. No prospective studies have examined the association between dietary acid load and breast cancer recurrence among breast cancer survivors, who are susceptible to metabolic acidosis. Hyperglycemia promotes cancer progression and acid formation; however, researchers have not examined whether hyperglycemia can modify the association between dietary acid load and breast cancer recurrence. Methods We studied 3081 early-stage breast cancer survivors enrolled in the Women's Healthy Eating and Living study who provided dietary information through 24-hour recalls at baseline and during follow-up and had measurements of hemoglobin A1c (HbA1c) at baseline. We assessed dietary acid load using two common dietary acid load scores, potential renal acid load (PRAL) score, and net endogenous acid production (NEAP) score. Results After an average of 7.3 years of follow-up, dietary acid load was positively associated with recurrence when baseline HbA1c levels were ≥5.6% (median level) and ≥5.7% (pre-diabetic cut-point). In the stratum with HbA1c ≥ 5.6%, comparing the highest to the lowest quartile of dietary acid load, the multivariable-adjusted hazard ratio was 2.15 (95%CI 1.34–3.48) for PRAL and was 2.31 (95%CI 1.42–3.74) for NEAP. No associations were observed in the stratum with HbA1c levels were <5.6%. P-values for interactions were 0.01 for PRAL and 0.05 for NEAP. Conclusions Our study demonstrated for the first time that even at or above normal to high HbHbA1c levels, dietary acid load was associated increased risk of breast cancer recurrence among breast cancer survivors. Funding Sources California Tobacco Research Foundation NIH/NCI.

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Hemoglobin A1c Levels Modify Associations between Dietary Acid Load and Breast Cancer Recurrence

Nutrients ◽

10.3390/nu12020578 ◽

2020 ◽

Vol 12 (2) ◽

pp. 578 ◽

Cited By ~ 1

Author(s):

Tianying Wu ◽

Fang-Chi Hsu ◽

Shunran Wang ◽

David Luong ◽

John P. Pierce

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cancer Recurrence ◽

Breast Cancer Recurrence ◽

Dietary Acid Load ◽

Dietary Acid ◽

Acid Load ◽

Hba1c Levels

Background: Metabolic acidosis promotes cancer metastasis. No prospective studies have examined the association between dietary acid load and breast cancer recurrence among breast cancer survivors, who are susceptible to metabolic acidosis. Hyperglycemia promotes cancer progression and acid formation; however, researchers have not examined whether hyperglycemia can modify the association between dietary acid load and breast cancer recurrence. Methods: We studied 3081 early-stage breast cancer survivors enrolled in the Women’s Healthy Eating and Living study who provided dietary information through 24-h recalls at baseline and during follow-up and had measurements of hemoglobin A1c (HbA1c) at baseline. We assessed dietary acid load using two common dietary acid load scores, potential renal acid load (PRAL) score and net endogenous acid production (NEAP) score. Results: After an average of 7.3 years of follow-up, dietary acid load was positively associated with recurrence when baseline HbA1c levels were ≥ 5.6% (median level) and ≥5.7% (pre-diabetic cut-point). In the stratum with HbA1c ≥ 5.6%, comparing the highest to the lowest quartile of dietary acid load, the multivariable-adjusted hazard ratio was 2.15 (95% confidence interval [CI] 1.34-3.48) for PRAL and was 2.31 (95% CI 1.42-3.74) for NEAP. No associations were observed in the stratum with HbA1c levels were <5.6%. P-values for interactions were 0.01 for PRAL and 0.05 for NEAP. Conclusions: Our study demonstrated for the first time that even at or above normal to high HbA1c levels, dietary acid load was associated with increased risk of breast cancer recurrence among breast cancer survivors. Impacts: Our study provides strong evidence for developing specific dietary acid load guidelines based on HbA1c levels.

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Dietary Acid Load in Relation to Inflammation and Glycemic Status in Women with Breast Cancer (P18-095-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-095-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Tianying Wu ◽

John Pierce ◽

Phoebe Seaver

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Acid Production ◽

Breast Cancer Survivors ◽

Cancer Recurrence ◽

Breast Cancer Patients ◽

Cross Sectional ◽

Dietary Acid Load ◽

Dietary Acid ◽

Acid Load

Abstract Objectives To determine the associations between dietary acid load and serum C-reactive protein (CRP) and hemoglobin A1c (HbA1c) among breast cancer survivors. We hypothesized that high dietary acid load is positively associated with CRP and HbA1c. Methods Using a cross-sectional design, we analyzed data collected from 3088 breast cancer survivors enrolled in the Women's Healthy Eating and Living (WHEL) Study who had provided detailed four randomly selected self-reported 24-hr dietary recalls over a three-week period followed by a blood sample that was used to validate the dietary self reports and measure of plasma CRP and HbA1c from washed red blood cells. Two commonly used dietary acid load scores were created, namely the potential renal acid load (PRAL) score and net endogenous acid production (NEAP) score. The PRAL score takes into account the intestinal absorption rates for contributing nutrient ionic balances for protein, potassium, calcium and magnesium and the dissociation of phosphate at pH 7.4. The NEAP score uses total protein and potassium intake as the main components involved in acid production. Results PRAL and NEAP were both positively associated with plasma CRP and HbA1c. In multivariable adjusted models, compared to women in the lowest quartile, those in the highest quartile of PRAL and NEAP had 32% and 31% increases in CRP, respectively and 9% and 6% increases in HbA1c, respectively after adjustment for total calorie intakes, age, body mass index, breast cancer stage, hormone receptor status, and type of chemotherapy. Conclusions This is the first demonstration that dietary acid load is associated with CRP and HbA1c in breast cancer patients. Our study identifies a novel dietary factor that may lead to inflammation and hyperglycemia, both of which are strong risk factors for breast cancer recurrence and other comorbidities. Funding Sources SDSU start-up funds.

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Dietary Acid Load, Smoking Intensity and Total Mortality

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_089 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 89-89

Author(s):

Tianying Wu ◽

Fang-Chi Hsu ◽

Shunran Shunran Wang ◽

John Pierece

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Total Mortality ◽

Dietary Acid Load ◽

Smoking Intensity ◽

Dietary Acid ◽

Acid Load ◽

Former Smokers ◽

Never Smokers

Abstract Objectives Former smokers comprise 30–40% among breast cancer survivors. Smoking can cause many biological damages which can still exist in past smokers and make them more susceptible to certain dietary and environmental challenges. Past smokers may have accelerated aging process than never smokers. Limited studies have examined the impacts of dietary acid load total mortality among breast cancer survivors who are never or former smokers. Methods We leveraged an existing cohort, the Women's Healthy Eating and Living (WHEL) Study, which enrolled 3088 women with early stage breast cancer at baseline. This cohort collected dietary information through 24-hour recalls at years 0, 1, and 4, which enabled us to measure dietary acid load accurately and longitudinally. We assessed dietary acid load using two common dietary acid load scores, potential renal acid load (PRAL) score, and net endogenous acid production (NEAP) score. This cohort also assessed past smoking history by pack-years which allowed us to carefully and accurately past smoking intensity. Results In this study, we found that dietary acid load itself was not significantly associated with total mortality among never smokers but significantly associated with total mortality among past smokers who had pack-years >0. When we evaluated the joint impact of dietary acid load and pack-years, women with dietary acid load above median and pack-years ≥15 had 2.38 (95% CI 1.58–3.59) times of risk of total mortality as compared to the reference group (women with dietary acid load below median and pack-years = 0). Conclusions Results from our study will be important for patient care and aid in creating tailored precision nutrition recommendation for breast cancer survivors who are former smoker. Funding Sources University internal funds, NIH/NCI.

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Associations between Dietary Acid Load and Biomarkers of Inflammation and Hyperglycemia in Breast Cancer Survivors

Nutrients ◽

10.3390/nu11081913 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1913 ◽

Cited By ~ 4

Author(s):

Tianying Wu ◽

Phoebe Seaver ◽

Hector Lemus ◽

Kathryn Hollenbach ◽

Emily Wang ◽

...

Keyword(s):

Breast Cancer ◽

Metabolic Acidosis ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Acid Base Balance ◽

Acid Base ◽

Dietary Acid Load ◽

Base Balance ◽

Dietary Acid ◽

Acid Load

Metabolic acidosis can lead to inflammation, tissue damage, and cancer metastasis. Dietary acid load contributes to metabolic acidosis if endogenous acid–base balance is not properly regulated. Breast cancer survivors have reduced capacities to adjust their acid–base balance; yet, the associations between dietary acid load and inflammation and hyperglycemia have not been examined among them. We analyzed data collected from 3042 breast cancer survivors enrolled in the Women’s Healthy Eating and Living (WHEL) Study who had provided detailed dietary intakes and measurements of plasma C-reactive protein (CRP) and hemoglobin A1c (HbA1c). Using a cross-sectional design, we found positive associations between dietary acid load and plasma CRP and HbA1c. In the multivariable-adjusted models, compared to women with the lowest quartile, the intakes of dietary acid load among women with the highest quartile showed 30–33% increases of CRP and 6–9% increases of HbA1c. Our study is the first to demonstrate positive associations between dietary acid load and CRP and HbA1c in breast cancer survivors. Our study identifies a novel dietary factor that may lead to inflammation and hyperglycemia, both of which are strong risk factors for breast cancer recurrence and comorbidities.

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Dietary Acid Load, Past Smoking Intensity and Mortality Among Breast Cancer Survivors

Innovation in Aging ◽

10.1093/geroni/igaa057.480 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 147-147

Author(s):

Tianying Wu ◽

Fang-Chi Hsu ◽

John Pierce

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Dietary Guidelines ◽

Acid Base Balance ◽

Dietary Acid Load ◽

Smoking Intensity ◽

Base Balance ◽

Dietary Acid ◽

Acid Load

Abstract Cancer survivors are at accelerated risk of aging and more susceptible to unhealthy diets and lifestyles than people without cancers. However, current dietary guidelines for cancer survivors not quite different from that for general healthy population. Further, these guidelines are not specific for cancer survivors who are past smokers. Acid-producing diet can accelerate aging and stimulate cancer development if acid-base balance is not regulated properly. Cancer survivors and past smokers have reduced capacities to adjust acid-base balance. Thus, we conducted prospective cohort analyses among 2950 early-stage breast cancer survivors who enrolled in the Women’s Healthy Eating and Living study and provided dietary information through 24-hour recalls at baseline and during follow-up. We assessed dietary acid load using two common dietary acid load scores, potential renal acid load (PRAL) score, and net endogenous acid production (NEAP) score. We assessed past smoking intensity by pack-years of smoking. After an average of 7.3 years of follow-up, there were 295 total death, and 249 breast cancer-specific death. Increased PRAL and NEAP scores were positively associated with total mortality and breast cancer-specific mortality (p for trend <0.1 for PRAL and <0.01 for NEAP). Further, dietary acid load and pack-years of smoking had joint positive associations with mortalities (Comparing the highest to the lowest categories, risk increased by 2.5-3 times; P for trend <0.01 for both PRAL and NEAP). Our study provides valuable evidence for adding dietary acid load to dietary guidelines for breast cancer survivors and developing specific guidelines for past smokers.

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Independent and Joint Impacts of Acid-Producing Diets and Depression on Physical Health among Breast Cancer Survivors

Nutrients ◽

10.3390/nu13072422 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2422

Author(s):

K. Daniel Tessou ◽

Hector Lemus ◽

Fang-Chi Hsu ◽

John Pierce ◽

Suzi Hong ◽

...

Keyword(s):

Breast Cancer ◽

Confidence Interval ◽

Physical Health ◽

Cancer Survivors ◽

Physical Function ◽

Odds Ratio ◽

Breast Cancer Survivors ◽

Dietary Acid Load ◽

Dietary Acid ◽

Acid Load

The purpose of this study was to examine the independent and joint associations of acid-producing diets and depressive symptoms with physical health among breast cancer survivors. We studied a cohort of 2944 early stage breast cancer survivors who provided dietary, physical health, demographic, and lifestyle information at baseline, year 1, and year 4. We assessed the intakes of acid-producing diets via two commonly used dietary acid load scores: potential renal acid load (PRAL) and net endogenous acid production (NEAP). Physical health was measured using the Rand 36-Item Short Form Health Survey (SF-36), consisting of physical functioning, role limitation due to physical function, bodily pain, general health, and overall physical health subscales. Increased dietary acid load and depression were each independently and significantly associated with reduced physical health subscales and overall physical health. Further, dietary acid load and depression were jointly associated with worse physical health. For instance, depressed women with dietary acid load higher than median reported 2.75 times the risk (odds ratio = 2.75; 95% confidence interval: 2.18–3.47) of reduced physical function and 3.10 times the risk of poor physical health (odds ratio = 3.10; 95% confidence interval: 2.53–3.80) compared to non-depressed women with dietary acid load lower than median. Our results highlight the need of controlling acid-producing diets and the access of mental care for breast cancer survivors.

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Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses among Breast Cancer Survivors: A Prospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9061817 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1817 ◽

Cited By ~ 1

Author(s):

Tianying Wu ◽

Fang-Chi Hsu ◽

John P. Pierce

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Total Mortality ◽

Dietary Guidelines ◽

Acid Base Balance ◽

Dietary Acid Load ◽

Smoking Intensity ◽

Dietary Acid ◽

Acid Load

Current dietary guidelines do not consider cancer survivors’ and past smokers’ low capacity to regulate their acid–base balance. People with a low capacity to regulate their acid–base balance are more susceptible to acid-producing diets. We studied a cohort of 2950 early stage breast cancer survivors who provided dietary information at baseline and during follow-up. We assessed the intakes of acid-producing diets via two commonly used dietary acid load scores: potential renal acid load (PRAL) and net endogenous acid production (NEAP). We assessed past smoking intensity by pack-years of smoking. After an average of 7.3 years of follow-up, there were 295 total deaths, 249 breast cancer-specific deaths, and 490 cases of recurrent breast cancer. Increased intakes of dietary acid load and pack-years of smoking were each independently and jointly associated with increased total mortality and breast cancer-specific mortality; tests for trends and overall associations were statistically significant for NEAP and marginally significant for PRAL. Compared to women in the lowest tertile of NEAP and pack-year of smoking = 0, women in the highest tertile of NEAP and pack-years of smoking >15 had the greatest increased risk of total mortality (HR = 3.23, 95%CI 1.99–5.26). Further, dietary acid scores were associated with increased breast cancer recurrence among women with pack-years of smoking >0 but not in those with pack-years of smoking = 0 (p values for interactions <0.05). Our study provides valuable evidence for adding dietary acid load scores to dietary guidelines for breast cancer survivors and developing specific guidelines for past smokers among these survivors.

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Breast cancer recurrence risk reduction beliefs in breast cancer survivors: prevalence and relation to behavior

Psycho-Oncology ◽

10.1002/pon.1925 ◽

2011 ◽

Vol 21 (4) ◽

pp. 427-435 ◽

Cited By ~ 14

Author(s):

Jessica L. Burris ◽

Paul B. Jacobsen ◽

Loretta S. Loftus ◽

Michael A. Andrykowski

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Risk Reduction ◽

Breast Cancer Survivors ◽

Cancer Recurrence ◽

Recurrence Risk ◽

Breast Cancer Recurrence

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Analysis of the Relationship between Diet and Exercise Beliefs and Actual Behaviors among Breast Cancer Survivors in Northwest Ohio

Breast Cancer Basic and Clinical Research ◽

10.4137/bcbcr.s4146 ◽

2010 ◽

Vol 4 ◽

pp. BCBCR.S4146

Author(s):

Jeffrey G. Weiner ◽

Timothy R. Jordan ◽

Amy J. Thompson ◽

Brian N. Fink

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Vegetable Intake ◽

Cancer Recurrence ◽

Fruit And Vegetable Intake ◽

Breast Cancer Recurrence ◽

Fruit And Vegetable ◽

Diet And Exercise

Introduction Studies have shown that a diet high in fruit and vegetable intake, as well as a routine including daily exercise or physical activity, can independently affect relapse rates and survivorship in breast cancer patients. Fruits and vegetables contain powerful anti-oxidant molecules, capable of preventing tumor formation and proliferation. Exercise can lower circulating levels of estrogen, the female hormone responsible for tumor proliferation in the estrogen-sensitive form of the disease. The most beneficial results have been shown in women who exercise and consume a diet rich in fruits and vegetables. We studied the attitudes towards and behaviors related to fruit and vegetable intake and exercise in a cohort of breast cancer survivors in northwest Ohio. Materials and Methods Data were gathered from a survey sent out by the Northwest Ohio Branch of the Susan G. Komen For the Cure Foundation. We assessed and evaluated survivors’ self-reported beliefs, attitudes, and behaviors regarding exercise and fruit and vegetable intake. Results Nearly half of the survivors (46.5%) reported being unsure or in disagreement with the statement “Eating at least 5 servings of fruits and/or vegetables per day will reduce the risk of breast cancer recurrence.” Only 46.8% of those in agreement with the previous statement actually report eating at least 5 fruits and/or vegetables per day. With respect to exercise, 32.9% reported being unsure or in disagreement with the statement “Engaging in regular physical activity will reduce the risk of breast cancer recurrence.” Only 68.5% of those in agreement with the previous statement report any physical activity in the past 30 days. Conclusions Many breast cancer survivors do not appear to be aware of the benefits of diet and exercise. Further, a large proportion of those who are aware of the benefits do not adapt a healthy diet and exercise as part of their lifestyle. A majority of these survivors see a primary care physician, which we believe is the best venue to bridge this education gap. It is apparent by the pattern our data shows that more needs to be done to educate breast cancer survivors about the benefits of exercise and fruit and vegetable intake. Steps need to be taken to ensure that those who are educated also remain motivated to engage in a healthy lifestyle with the hopes of avoiding breast cancer recurrence.

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Acid-Producing Diet and Depressive Symptoms among Breast Cancer Survivors: A Longitudinal Study

Cancers ◽

10.3390/cancers12113183 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3183

Author(s):

Tianying Wu ◽

Fang-Chi Hsu ◽

John P. Pierce

Keyword(s):

Breast Cancer ◽

Depressive Symptoms ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Early Stage ◽

Net Endogenous Acid Production ◽

Practical Strategy ◽

Younger Age ◽

Dietary Acid ◽

Acid Load

The incidence of depression is two-to-three times higher in cancer survivors than the general population. Acid-producing diets may play important roles in the development of depression. Cancer survivors are more susceptible to acid-producing diets, yet few prospective studies have investigated the association of acid-producing diets with depression among breast cancer survivors. We leveraged a large cohort of 2975 early stage breast cancer survivors, which collected detailed dietary data via 24-h recalls. Potential renal acid load (PRAL) and net endogenous acid production (NEAP), two commonly used dietary acid load scores, were used to estimate acid-producing diets. Intakes of PRAL and NEAP were assessed at baseline and years one and four. Increased PRAL and NEAP were each independently associated with increased depression in the longitudinal analyses, after adjusting for covariates. The magnitude of the associations was stronger for PRAL than NEAP. Women with the highest quartile intakes of PRAL had 1.34 (95% CI 1.11–1.62) times the risk of depression compared to women with the lowest quartile. Furthermore, we also observed a joint impact of PRAL and younger age on depression, as well as a joint impact of PRAL and physical activity on depression. Decreasing the consumption of acid-producing diets may be a novel and practical strategy for reducing depressive symptoms among breast cancer survivors, especially those who are younger and have a sedentary lifestyle.

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