Purpose While several studies have evaluated the association of combined lifestyle factors on breast cancer-specific mortality, few have included Hispanic women. We constructed a “healthy behavior index” (HBI) and evaluated its associations with mortality in non-Hispanic White (NHW) and Hispanic women diagnosed with breast cancer from the southwestern U.S. Methods Diet and lifestyle questionnaires were analyzed for 837 women diagnosed with invasive breast cancer (1999–2004) in New Mexico as part of the 4-Corners Women’s Health Study. An HBI score ranging from 0 to 12 was based on dietary pattern, physical activity, smoking, alcohol consumption, and body size and shape, with increasing scores representing less healthy characteristics. Hazard ratios for mortality over 14 years of follow-up were estimated for HBI quartiles using Cox proportional hazards models adjusting for education and stratified by ethnicity and stage at diagnosis. Results A significant increasing trend was observed across HBI quartiles among all women, NHW women, and those diagnosed with localized or regional/distant stage of disease for all-cause (AC) mortality (p-trend = 0.006, 0.002, 0.03, respectively). AC mortality was increased >2-fold for all women and NHW women in HBI Q4 versus Q1 (HR = 2.18, 2.65, respectively). The association was stronger in women with regional/distant than localized stage of disease (HR = 2.62, 1.94, respectively). Associations for Hispanics or breast cancer-specific mortality were not significant. Conclusions These findings indicate the associations between the HBI and AC mortality, which appear to differ by ethnicity and stage at diagnosis. Interventions for breast cancer survivors should address the combination of lifestyle factors on prognosis.

ObjectiveWe sought to investigate the relationship of serum 25-hydroxyvitamin D (25(OH)D) level with weight change and the risk of weight gain in an adult population who had normal weight at baseline and were followed up for 11 years.DesignA population-based prospective cohort study.SettingNord-Trøndelag, Norway.ParticipantsThe study included 1501 adults who participated in the second and third surveys of the Nord-Trøndelag Health Study (HUNT2 (1995–1997) and HUNT3 (2006–2008)) and had a normal body mass index ≥18.5 and <25.0 kg/m2 at baseline.Primary and secondary outcome measuresRelative weight change (%) was calculated as ((HUNT3 weight−HUNT2 weight)/HUNT2 weight×100). Relative annual weight change (%) was calculated as (relative weight change/follow-up years×100). Clinical weight gain was defined as relative weight change ≥5% over the 11 years, while annual weight gain was defined as relative annual weight change >1.25%.MethodsMultiple regression models were used to estimate adjusted coefficients for the relative annual weight change and risk ratios (RRs) for the risk of clinical weight gain and of annual weight gain.ResultsEach 25 nmol/L increase in season-standardised serum 25(OH)D level at baseline was associated with a reduction of 0.05% (95% CI −0.11 to 0.01) for relative annual weight change, a 10% (RR 0.90, 95% CI 0.82 to 0.97) reduced risk of clinical weight gain, and a 19% (RR 0.81, 95% CI 0.65 to 1.00) reduced risk of annual weight gain. A statistically significant trend was evident for the risk of clinical weight gain when 25(OH)D levels were treated as a categorical variable (p=0.006).ConclusionsThe findings suggested an inverse association of serum 25(OH)D level with the risk of clinical weight gain in adults who had normal weight at baseline over 11 years’ follow-up.