Fatigue, Inflammation, and ω-3 and ω-6 Fatty Acid Intake Among Breast Cancer Survivors
Evidence suggests that inflammation may drive fatigue in cancer survivors. Research in healthy populations has shown reduced inflammation with higher dietary intake of ω-3 polyunsaturated fatty acids (PUFAs), which could potentially reduce fatigue. This study investigated fatigue, inflammation, and intake of ω-3 and ω-6 PUFAs among breast cancer survivors.
Six hundred thirty-three survivors (mean age, 56 years; stage I to IIIA) participating in the Health, Eating, Activity, and Lifestyle Study completed a food frequency/dietary supplement questionnaire and provided a blood sample assayed for C-reactive protein (CRP) and serum amyloid A (30 months after diagnosis) and completed the Piper Fatigue Scale and Short Form-36 (SF-36) vitality scale (39 months after diagnosis). Analysis of covariance and logistic regression models tested relationships between inflammation and fatigue, inflammation and ω-3 and ω-6 PUFA intake, and PUFA intake and fatigue, controlling for three incremental levels of confounders. Fatigue was analyzed continuously (Piper scales) and dichotomously (SF-36 vitality ≤ 50).
Behavioral (P = .003) and sensory (P = .001) fatigue scale scores were higher by increasing CRP tertile; relationships were attenuated after adjustment for medication use and comorbidity. Survivors with high CRP had 1.8 times greater odds of fatigue after full adjustment (P < .05). Higher intake of ω-6 relative to ω-3 PUFAs was associated with greater CRP (P = .01 after full adjustment) and greater odds of fatigue (odds ratio, 2.6 for the highest v lowest intake; P < .05).
Results link higher intake of ω-3 PUFAs, decreased inflammation, and decreased physical aspects of fatigue. Future studies should test whether ω-3 supplementation may reduce fatigue among significantly fatigued breast cancer survivors.
- Received April 11, 2011.
- Accepted December 22, 2011.
- Catherine M. Alfano⇓
- Ikuyo Imayama
- Marian L. Neuhouser
- Janice K. Kiecolt-Glaser
- Ashley Wilder Smith
- Kathleen Meeske
- Anne McTiernan
- Leslie Bernstein
- Kathy B. Baumgartner
- Cornelia M. Ulrich
- Rachel Ballard-Barbash
- Catherine M. Alfano, Ashley Wilder Smith, and Rachel Ballard-Barbash, National Cancer Institute, National Institutes of Health, Bethesda, MD; Ikuyo Imayama, Marian L. Neuhouser, Anne McTiernan, and Cornelia M. Ulrich, Fred Hutchinson Cancer Research Center; Anne McTiernan, University of Washington, Seattle, WA; Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine, Columbus, OH; Kathleen Meeske, University of Southern California, Los Angeles; Leslie Bernstein, City of Hope National Medical Center, Duarte, CA; Kathy B. Baumgartner, University of Louisville, Louisville, KY; and Cornelia M. Ulrich, German Cancer Research Center, Heidelberg, Germany.
- Corresponding author: Catherine M. Alfano, PhD, Office of Cancer Survivorship, National Cancer Institute, 6116 Executive Blvd, Ste 404, Bethesda, MD 20892-8336; e-mail: [email protected].