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Prognosis of breast cancer is associated with one-carbon metabolism related nutrients among Korean women

Yunhee Lee1, Sang-Ah Lee2, Ji-Yeob Choi1, Minkyo Song1, Hyuna Sung1, Sujee Jeon3, Sue K Park4, Keun-Young Yoo4, Dong-Young Noh5, Sei-Hyun Ahn6 and Daehee Kang47*

Author Affiliations

1 Department of Biomedical Sciences, Seoul National University, Seoul, Republic of Korea

2 Department of Preventive Medicine, Kangwon National University School of Medicine, Kangwon, Republic of Korea

3 Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine or College of Pharmacy, Seoul, Republic of Korea

4 Department of Preventive Medicine, Seoul National University, Seoul, Republic of Korea

5 Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

6 Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Ulsan, Republic of Korea

7 Department of Preventive Medicine, Seoul National University College of Medicine, 103 Yongon (Daehangno), Jongno-gu, Seoul, Republic of Korea

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Nutrition Journal 2012, 11:59  doi:10.1186/1475-2891-11-59

Published: 28 August 2012



The 5-year survival rate for breast cancer among Korean women has increased steadily; however, breast cancer remains the leading cause of cancer mortality among women. One-carbon metabolism, which requires an adequate supply of methyl group donors and B vitamins, may affect the prognosis of breast cancer. This aim of this study was to investigate the associations of dietary intake of vitamin B2, vitamin B6 and folate before diagnosis on the prognosis of breast cancer.


We assessed the dietary intake using a food frequency questionnaire with 980 women who were newly diagnosed and histopathologically confirmed to have primary breast cancer from hospitals in Korea, and 141 disease progression events occurred. Cox’s proportional hazard regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) adjusting for age, education, recruitment sites, TNM stage, hormone status, nuclear grade and total calorie.


There was no significant association between any one-carbon metabolism related nutrients (vitamin B2, B6 and folate) and the progression of breast cancer overall. However, one-carbon metabolism related nutrients were associated with disease progression in breast cancer patients stratified by subtypes. In ER + and/or PR + breast cancers, no association was observed; however, in ER–/PR– breast cancers, a high intake of vitamin B2 and folate statistically elevated the HR of breast cancer progression (HR = 2.28; 95% CI, 1.20-4.35, HR = 1.84; 95% CI, 1.02-3.32, respectively) compared to a low intake. This positive association between the ER/PR status and progression of the disease was profound when the nutrient intakes were categorized in a combined score (Pinteraction = 0.018). In ER–/PR– breast cancers, high combined scores were associated with a significantly poor DFS compared to those belonging to the low score group (HR = 3.84; 95% CI, 1.70-8.71).


In conclusion, our results suggest that one-carbon related nutrients have a role in the prognosis of breast cancer depending on the ER/PR status.

Breast cancer prognosis; One-carbon metabolism; Vitamin B2; Vitamin B6; Folate