APPENDIX 1: DESCRIPTION OF FOOD GROUPS FOR FACTOR ANALYSIS

FOOD GROUP / FOOD*
1 / HIGH-FAT DAIRY / Whole-fat milk, double cream, condensed milk, whole-fat yogurt, semi-cured, cured or creamy cheese, custard, flan, pudding, ice-cream
2 / LOW FAT DAIRY / Semi-skimmed and skimmed milk, skimmed yogurt, cottage or fresh white cheese
3 / EGGS / Eggs
4 / WHITE MEAT / Chicken with skin, skinless chicken, game (turkey, rabbit, etc.)
5 / RED MEAT / Pork, beef, lamb, liver (beef, pork or chicken), entrails, hamburger
6 / PROCESSED MEAT / Cold meat, sausages, bacon, pâte, foie-gras
7 / WHITE FISH / Fresh white fish (hake, sea bass, sea bream), fish sticks
8 / OILY FISH / Fresh blue fish (Tuna, swordfish, sardines, anchovies, salmon), canned tuna, canned sardines or mackerel, salted and smoked fish
9 / SEAFOOD/SHELLFISH / Clams, mussels, oysters, squid, cuttlefish, octopus, prawn, crab, shrimp, lobster
10 / LEAFY VEGETABLES / Spinach, chard, lettuce, endive, escarole
11 / FRUITING VEGETABLES / Tomato, eggplant, zucchini, cucumber, pepper, artichoke
12 / ROOT VEGETABLES / Carrot, pumpkin
13 / OTHER VEGETABLES / Cooked cabbage, cauliflower or broccoli, onion, green beans, asparagus, corn, garlic
14 / LEGUMES / Legumes
15 / POTATOES / Roasted or boiled potatoes
16 / FRUITS / Orange, mandarin, banana, apple, pear, peach, nectarine, apricot, watermelon, melon, grapes, plums or prunes (dried or fresh), kiwi
17 / NUTS / Almonds, peanuts, pine nuts, hazelnut
18 / REFINED GRAINS / White-flour bread, rice, pasta
19 / WHOLE GRAINS / Whole-grain bread and partial whole-grain bread, breakfast cereals.
20 / OLIVES AND VEGETABLE OIL / Olives, added olive oil to salads, bread and dishes, other vegetable oils (sunflower, corn, soybean)
21 / OTHER EDIBLE FATS / Margarine, butter
22 / SWEETS / Chocolate, sweets, cocoa powder, plain cookies, chocolate cookies, pastries (croissant, donut, cake, pie or similar)
23 / SUGARY / Jam, Honey, Sugar
24 / JUICES / Freshly squeezed orange juice, juice (other than freshly squeezed)
25 / CALORIC DRINKS / Sugar-sweetened soft drinks
26 / CONVENIENCE FOOD
AND SAUCES / Fried potatoes, crisps, pizza, chicken and Serrano ham croquette, mayonnaise, tomato sauce,ketchup

*Log-transformed intake in grams.


APPENDIX 2: DESCRIPTION OF FOOD GROUPS FOR AHEI (0-75) CALCULATION

FOOD GROUP / CRITERIA / SCORE
VEGETABLES: Spinach or chard, lettuce, endive, escarole, tomato, eggplant, zucchini and cucumber, pepper, artichoke, carrot, pumpkin, cooked, cabbage, cauliflower, broccoli, onion, green beans, asparagus, corn, garlic, pizza, tomato sauce, ketchup / 5 serving/d / 10
(-1 point for each 10% under the required intake)
FRUITS: Orange, mandarin, banana, apple, pear, peach, nectarine, apricot, watermelon, melon, grapes, plums, prunes, kiwi, freshly squeezed orange juice, juice (other than freshly squeezed) / 4 serving/d / Same as above
NUTS AND SOY: Almonds, peanuts, pine nuts, hazelnut / 1 serving/d / Same as above
RATIO WHITE/RED MEAT / 4 / Same as above
WHITE MEAT: Chicken with skin, skinless chicken, game (turkey, rabbit, etc.), fresh white fish (hake, sea bass, sea bream), fish sticks, Fresh blue fish (Tuna, swordfish, sardines, anchovies, salmon), canned tuna, canned sardines or mackerel, salted and smoked fish, clams, mussels, oysters, squid, cuttlefish, octopus, prawn, crab, shrimp, lobster
RED MEAT: Pork, beef, lamb, liver (beef, pork or chicken), entrails, hamburger, cold meat, sausages, bacon, pâte, foie-gras
CEREAL FIBER: Whole-grain bread and partial, whole-grain bread, breakfast Cereals / 15g/d / Same as above
trans FAT / ≤0.5% of Energy
0.5%<energy<4.%
≥4.0% / 10
-1 point for each 10% under the required intake for full score
0
RATIO OF POLYUNSATURATED TO SATURATED FAT / ≥1 / 10
(-1 point for each 10% under the required intake for full score)
VITAMIN USE: Multivitamin
Folic Acid
A
E
C
B / Multivitamin use or use of a combination of two or more supplements from folic acid, A, E, C, B. / 5 points for multivitamin consumption

EXCLUDED ALCOHOL SCORE

ALCOHOL: wine, cider, beer and liquor. / 0.5-1.5 servings/day / 10(-1 point for each 10% under or above the required intake for full score)


APPENDIX 3: DESCRIPTION OF FOOD GROUPS FOR AMED (0-8) CALCULATION

FOOD GROUP / CRITERIA FOR 1 POINT
VEGETABLES: Spinach or chard, lettuce, endive, escarole, tomato, eggplant, zucchini, cucumber, pepper, artichoke, carrot, pumpkin, cooked cabbage, cauliflower, broccoli, onion, green beans, asparagus, corn, garlic / Greater than median intake (sv/d)*
LEGUMES: Legumes / Greater than median intake (sv/d)*
FRUITS: Orange, mandarin, banana, apple, pear, peach, nectarine, apricot, watermelon, melon, grapes, plums, prunes, kiwi, freshly squeezed orange juice, juice (other than freshly squeezed) / Greater than median intake (sv/d)*
NUTS: Almonds, peanuts, pine nuts, hazelnuts / Greater than median intake (sv/d)*
WHOLE GRAINS: Whole-grain bread and partial whole-grain bread, breakfast Cereals / Greater than median intake (sv/d)*
RED AND PROCESED MEAT: Pork, beef, lamb, liver (beef, pork or chicken), entrails, hamburger, cold meat, sausages, bacon, pâte, foie-gras / Lower than median intake (sv/d)*
FISH: Fresh white fish (hake, sea bass, sea bream), fish sticks, fresh blue fish (tuna, swordfish, sardines, anchovies, salmon), canned tuna, canned sardines or mackerel, salted and smoked fish, clams, mussels, oysters, squid, cuttlefish, octopus, prawn, crab, shrimp, lobster / Greater than median intake (sv/d)*
RATIO OF MONOUNSATURATED TO SATURATED FAT / Greater than median intake (sv/d)*

* Reference median intake in controls; sv: serving

EXCLUDED ALCOHOL SCORE

ALCOHOL: Total ethanol intake in grs. / 5-25grs/day

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APPENDIX 4: Adjusted OR for the association between BC and AHEI/AMED scores including alcohol by menopausal status.

All Women
n=1946 / Premenopausal
n=1064 / Postmenopausal
n=882
AHEI with Alcohol / CO/CA / OR*(95%CI) / CO/CA / OR*(95%CI) / CO/CA / OR*(95%CI)
Q1 / 247/251 / 1 / 148/154 / 1 / 99/97 / 1
Q2 / 259/269 / 1.02 (0.78;1.33) / 142/153 / 0.99 (0.70;1.41) / 117/116 / 1.07 (0.71;1.62)
Q3 / 244/241 / 0.97 (0.73;1.28) / 114/130 / 1.03 (0.71;1.51) / 130/111 / 0.91 (0.60;1.37)
Q4 / 223/212 / 0.91 (0.68;1.22) / 109/114 / 0.88 (0.60;1.30) / 114/98 / 0.95 (0.61;1.50)
p-trend / 0.48 / 0.60 / 0.61
Per sd increase / 0.93 (0.84;1.04) / 0.93 (0.82;1.07) / 0.94 (0.80;1.10)
aMED with alcohol / CO/CA / OR*(95%CI) / CO/CA / OR*(95%CI) / CO/CA / OR*(95%CI)
Q1 / 316/327 / 1 / 194/188 / 1 / 122/139 / 1
Q2 / 313/343 / 1.07 (0.84;1.35) / 160/198 / 1.23 (0.90;1.68) / 153/145 / 0.88 (0.61;1.26)
Q3 / 223/208 / 0.84 (0.64;1.10) / 105/118 / 1.06 (0.73;1.52) / 118/90 / 0.64 (0.43;0.95)
Q4 / 121/95 / 0.74 (0.52;1.05) / 54/47 / 0.83 (0.51;1.36) / 67/48 / 0.63 (0.38;1.03)
p-trend / 0.05 / 0.69 / 0.01
Per sd increase / 0.92 (0.83;1.02) / 0.99 (0.86;1.13) / 0.85 (0.73;0.98)

*Adjusted for total calories, body mass index from self-reported weight and height (BMI=Kg/m2), average physical activity in the last year, smoking, education, previous history of breast disease other than cancer, family history of BC, age at menarche, age at first delivery and menopausal status.


APPENDIX 5: Adjusted OR for the association between BC and AHEI/AMED scores including alcohol by type of tumor.

ER+/PR+ & HER2-
n=653 / HER2+
n=199 / ER-, PR- & HER2-
n=120
Controls / Cases / OR* (95%IC) / Cases / OR* (95%IC) / Cases / OR* (95%IC)
AHEI with Alcohol
Q1 / 247 / 161 / 1 / 55 / 1 / 35 / 1
Q2 / 259 / 176 / 1.00 (0.75;1.33) / 55 / 0.89 (0.58;1.36) / 38 / 1.07 (0.65;1.78)
Q3 / 244 / 164 / 1.02 (0.76;1.37) / 48 / 0.83 (0.53;1.30) / 29 / 0.92 (0.53;1.60)
Q4 / 223 / 153 / 0.98 (0.72;1.34) / 42 / 0.77 (0.48;1.25) / 17 / 0.59 (0.31;1.13)
p-trend / 0.94 / 0.27 / 0.12
Per sd increase / 0.97 (0.87;1.08) / 0.90 (0.76;1.06) / 0.80 (0.65;0.98)
aMED with alcohol
Q1 / 316 / 214 / 1 / 59 / 1 / 54 / 1
Q2 / 313 / 231 / 1.05 (0.82;1.36) / 77 / 1.30 (0.88;1.91) / 35 / 0.70 (0.44;1.12)
Q3 / 223 / 140 / 0.87 (0.66;1.17) / 45 / 1.02 (0.66;1.59) / 23 / 0.68 (0.40;1.17)
Q4 / 121 / 69 / 0.80 (0.55;1.15) / 19 / 0.83 (0.46;1.50) / 7 / 0.36 (0.15;0.83)
p-trend / 0.16 / 0.58 / 0.01
Per sd increase / 0.94 (0.84;1.05) / 0.98 (0.83;1.15) / 0.80 (0.65;0.98)

*Adjusted for total calories, alcohol consumption, body mass index from self-reported weight and height (BMI=Kg/m2), average physical activity in the last year, smoking, education, previous history of breast disease other than cancer, family history of BC, age at menarche, age at first delivery, menopausal status, age and hospital.

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