For breast cancer prevention, not all plant-based diets are created equal

Culinary medicine in medical education: a pilot study targeting cancer risk reduction strategies through culinary and lifestyle medicine education

Introduction

Culinary Medicine (CM) is an avenue for interdisciplinary nutrition education intervention utilizing the expertise of dietitians, physicians, and other health care professionals (HCP). Despite the positive impacts that CM interventions can have on health, physician CM knowledge is lacking due in part to inadequate nutrition education in medical school curriculum. CM as a nutrition education modality promotes health and disease management for patients and providers, so it is critical to increase competency in CM. This pilot study evaluated the impact of a cancer prevention specific CM curriculum on medical students' (i) cancer risk reduction (CRR) knowledge, (ii) CRR assessment/counseling attitudes and self-efficacy in clinical care, and (iii) personal health behaviors and cooking skills.

Methods

Thirty-one 2nd year medical students (CALM students) participated in seven, 3-hour CRR focused CM education sessions and were compared to 55 non-enrolled students (control group). Education sessions incorporated a lecture, learning activity, and cooking experience focused on topics including dietary patterns, gut health, inflammation, metabolic health, hormone balance, environmental exposures, and prevention in practice/at home. A 46-item online pre-test (09/23) and post-test (03/24) survey assessed standardized measures of general nutrition/cancer knowledge, attitudes/beliefs, perceived control and self-efficacy around CRR diet/ lifestyle modifications; and intentions of integrating CRR strategies in practice.

Results

78 students (91%) completed both surveys and the findings indicate that CALM students showed significant improvement over their peers in knowledge scores (β = 0.265, t = 2.14, p < 0.05), attitudes toward nutrition in the clinical setting (β = 0.203, t = 2.00, p < 0.05) and confidence in integrating CRR strategies in patient care (β = 0.401, t = 4.05, p < 0.001). Most significant changes occurred in confidence of being able to make a CRR plan and follow through with patients on the plan (p < 0.001).

Discussion

This pilot study is among the first to incorporate and evaluate CRR-specific CM competencies in medical education. Given that the lifetime risk for developing cancer is high for Americans (~40%), education and implementation of CRR strategies among patients and providers must be emphasized. If research continues to demonstrate curriculum success in future cohorts, it is an innovative approach to teaching nutrition and CM competencies to HCP that is applicable to numerous disease states.

Macronutrient composition of plant-based diets and breast cancer risk: the E3N prospective cohort study

PURPOSE

Recent evidence suggests that plant-based diets may reduce the risk of breast cancer (BC). However, the macronutrient composition of plant-based diets and its potential impact on BC risk has not been well explored. This analysis investigated the association of macronutrient composition with BC risk across a spectrum of plant-based diet indexes using a multidimensional approach.

DESIGN

This study followed 64,655 participants from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) cohort from 1993 to 2014. Diets were evaluated using validated 208-item diet history questionnaires at baseline (1993) and follow-up (2005), to calculate adherence to the overall plant-based diet (PDI), healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). The association of macronutrient composition with BC risk was assessed via generalized additive time-dependent Cox models across different levels of these indexes. Response surfaces were generated to visualize compositional associations at the 25th, 50th, and 75th percentile of each index (low, moderate, and high).

RESULTS

A total of 3,932 incident BC cases were identified during the 21-year follow-up. There was a significant association between macronutrient composition and BC risk for hPDI, uPDI, and PDI (all P < 0.001). Akaike information criterion favored the hPDI model for characterizing the association between macronutrients and BC. BC risk was highest for individuals with a lower hPDI score who also consumed a diet containing lower protein (10%), lower carbohydrate (35%), and higher fat (55%). The lowest risk of BC was observed in those with higher hPDI scores with the lowest intake of protein (10%). At higher PDI and uPDI, diets containing higher protein (30%) and fat (45%) had the highest BC risk.

CONCLUSION

These results demonstrate a complex relationship between macronutrient composition, plant-based diet quality, and BC risk. Further research is needed to examine specific foods that may be driving these associations.

REGISTRY

The protocol is registered at clinicaltrials.gov as NCT03285230.