Low Serum Carotenoids Are Associated with Inflammatory Markers and Subjective Cognitive Impairments in Breast Cancer Survivors
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Cancer related cognitive impairment (CRCI) can have significant and persistent impacts on quality of life in cancer survivors. Recent evidence has reported cognitive impairments are associated with inflammation due to cancer and its treatment Modifiable factors, such as diet, may reduce the risk or severity of CRCI. Carotenoids, primarily found in fruits and vegetables (F&Vs), have shown promise in reducing the risk of age-related cognitive decline, potentially via anti-inflammatory activities. In this cross-sectional study, sixty-seven women (29 BCS; 38 controls) were recruited from the Central Texas area. BCS had to have been diagnosed with breast cancer and completed primary treatment (either chemotherapy, radiotherapy or both) within the past 5 years, and healthy controls must have had no previous cancer diagnosis. Dietary intake was assessed with a food frequency questionnaire. Cognitive function was assessed with the NIH Toolbox Cognition Battery. The Functional Assessment of Cancer Therapy-Cognitive Function Questionnaire assessed perceived cognitive impairment. Serum levels of carotenoids were measured by HPLC-PDA, and serum soluble TNF receptor type II (sTNF-RII), interleukin-6 (IL-6), and interleukin-1 receptor agonist (IL-1ra) were measured by immunoassay. BCS were split into two groups: (1) BCS with serum carotenoid levels lower than, and including, the median; and (2) BCS with serum carotenoid levels above the median. A median split analysis was also conducted for the non-cancer controls. Univariate ANCOVA, including age as a covariate, was conducted to compare different between BCS and controls. Reported F&V intake was positively correlated with serum carotenoid levels (r=.407, p=0.001). BCS performed similarly to controls on objective cognitive measures. Both high and low carotenoid BCS had significantly more cognitive complaints than high and low carotenoid controls (p<0.05); however, high carotenoid BCS had significantly fewer cognitive complaints than low carotenoid BCS (p=0.036). Partial correlations, controlling for age and BMI, demonstrated that higher serum carotenoid levels were associated with lower sTNF-RII and IL-6 levels (p=0.002), but not IL-1ra. Higher serum carotenoid levels may have cognitive and anti-inflammatory benefits in BCS. Future research should continue to identify dietary patterns that can reduce memory complaints and support cognitive health in cancer survivors.