***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE The purpose of this study was to evaluate associations between hormonal therapy for breast cancer and subsequent diabetes incidence . METHODS The Surveillance , Epidemiology and End Results -Medicare linked data were used . Stage I-III breast cancer patients 65 years or older who filled at least two prescriptions for an aromatase inhibitor ( AI ) or tamoxifen by the end of 2008 , and within 12 months of breast cancer diagnosis , were selected . Women without cancer from a 5 % r and om sample of Medicare beneficiaries were frequency matched to patients by age group , and new onset diabetes was monitored for 24 months postbaseline in both groups of women . RESULTS Cox-proportional hazards analysis failed to show an association between AI use and subsequent diabetes onset after adjusting for age , race , and comorbidity ( hazard ratio : 0.99 ; 95 % confidence interval : 0.84 - 1.18 ) . This study also failed to show an association between tamoxifen use and diabetes onset ( hazard ratio : 0.79 ; 95 % confidence interval : 0.54 - 1.17 ) . CONCLUSIONS Study findings provide evidence that postmenopausal AI and tamoxifen users do not experience an increased risk of diabetes in the 2 years after treatment initiation . Whether these findings will hold with longer duration follow-up deserves a closer look PURPOSE Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer . The Exercise and Nutrition to Enhance Recovery and Good Health for You ( ENERGY ) study is the largest weight loss intervention trial among survivors of breast cancer to date . METHODS In this multicenter trial , 692 overweight/obese women who were , on average , 2 years since primary treatment for early-stage breast cancer were r and omly assigned to either a group-based behavioral intervention , supplemented with telephone counseling and tailored newsletters , to support weight loss or a less intensive control intervention and observed for 2 years . Weight and blood pressure were measured at 6 , 12 , 18 , and 24 months . Longitudinal mixed models were used to analyze change over time . RESULTS At 12 months , mean weight loss was 6.0 % of initial weight in the intervention group and 1.5 % in the control group ( P<.001 ) . At 24 months , mean weight loss in the intervention and control groups was 3.7 % and 1.3 % , respectively ( P<.001 ) . Favorable effects of the intervention on physical activity and blood pressure were observed . The weight loss intervention was more effective among women older than 55 years than among younger women . CONCLUSION A behavioral weight loss intervention can lead to clinical ly meaningful weight loss in overweight/obese survivors of breast cancer . These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival OBJECTIVE To evaluate insulin values , insulin resistance , growth factors and cytokine levels in women suffering from breast cancer and the effect of chemotherapy on these parameters . DESIGN In a prospect i ve study ,  glucose and insulin values were determined in ten previously undiagnosed diabetic postmenopausal women with stage IV breast cancer ( hepatic metastases excluded ) during an oral glucose tolerance test ( OGTT ) carried out after a glucose load of 75 g. At baseline , leptin , Interleukin-1 ( IL-1 ) , Interleukin-6 ( IL-6 ) , Interleukin-8 ( IL-8 ) , Insulin-Growth Factor-1 ( IGF-1 ) , Tumor-Necrosis-Factor-alpha ( TNF-alpha ) , Vascular Endothelial Growth Factor ( VEGF ) and Platelet Derived Growth Factor ( PDGF ) levels were also determined using appropriate method olody . Insulin resistance and beta-cell function were calculated ( HOMA-model ) . All women were evaluated prior to and after chemotherapy applied for 6 months . RESULTS 1 ) Insulin levels at 120 minutes of the OGTT were higher before compared to post-chemotherapy ( Mean+/-SD : 170.39+/-78.07 vs 111.75+/-76.19 , p=0.037 ) . 2 ) Body mass index ( BMI ) was an important predictor of post-glucose load insulin levels both before ( coefficient=1.051 , p=0.004 ) and after chemotherapy ( coefficient=0.711 , p=0.003 ) . 3 ) Before  chemotherapy BMI values were positively related to PDGF levels ( rs=0.685 , p=0.029 ) , while after chemotherapy this relationship became non-significant ( rs=0.188 , p=0.603 ) . Before chemotherapy there was a negative relationship between VEGF and waist circumference ( coefficient= -0.542 , p=0.023 ) . CONCLUSIONS Post-glucose load insulin values significantly decrease after chemotherapy . There is a positive relationship between BMI and post-glucose load insulin before and after chemotherapy . The contribution of the reduction in insulin , a known growth factor , to the outcome of chemotherapy in these patients remains speculative at present Tamoxifen is a nonsteroidal anti-estrogenic drug used for adjuvant treatment of breast cancer and recently as a chemopreventative agent for breast cancer and , on an investigational basis , for other cancers . To date there are case reports of hypertriglyceridemia and fatty liver disease in  tamoxifen users .  Fatty liver is associated with visceral obesity and other components of the metabolic syndrome . Here we evaluated steatosis and adipose tissue distribution by CT scan in a cross-sectional study of 32 women on tamoxifen and 39 control women . Tamoxifen users had more visceral adipose tissue ( VAT ) and more liver fat than controls . This is the first study to demonstrate that fatty liver and intra-abdominal fat accumulation are common in breast cancer patients receiving tamoxifen . Prospect i ve studies of tamoxifen should monitor metabolic changes in obese women with or without breast cancer Introduction Research has been limited in circadian activity rhythms and their relationship with health status in early-stage breast cancer survivors . Maintaining strong circadian parameters may reduce symptoms and improve physical functioning and disease-free survival . Methods This is a descriptive , correlational , secondary analysis of data from a r and omized controlled trial collected 1 year after the first chemotherapy treatment ; n = 156 cases with 7 days of wrist actigraph data of six circadian activity rhythm parameters ; measures of function , fatigue , sleep , and anxiety/depression ; and demographic/medical data including body mass index ( BMI )  . Results In the total sample and three BMI categories , acrophase was the only circadian parameter that reached means established in healthy adults . In the total sample , phase-delayed acrophase was associated with higher depression ( r = 0.180 , p = 0.025 ) and lower morning energy ( r = −0.194 , p = 0.016 ) and trended for higher fatigue ( r = 0.153 , p = 0.057 ) . Lower morning energy was also associated with a lower circadian quotient ( r = 0.158 , p = 0.05 ) . As BMI increased , weaker circadian parameters were recorded consistently . When compared with women in normal BMI categories , obese women ’s amplitude and 24-h autocorrelation coefficient were significantly weaker ( p = 0.011–0.015 ) . In obese women , phase-delayed acrophase was correlated with higher fatigue and anxiety and with lower morning energy and physical functioning . Discussion / conclusions Amplitude and 24-h autocorrelation parameters were significantly weaker , and phase-delayed acrophase was linked to several more intense symptoms and lower physical functioning in obese women . Implication s for cancer survivorsClinicians need to target high-risk women with phase-delayed rhythms , higher symptoms , and lower physical functioning for intervention Obese breast cancer patients have a higher risk of lymph node metastasis and a poorer prognosis compared to patients with normal weight . For obese women with node-positive breast cancer , an association between body weight and prognosis remains unclear . In this retrospective study , we analyzed patient data from the Phase-III ADEBAR trial , in which high-risk breast cancer patients ( pT1–4 , pN2–3 , pM0 ) were r and omized into a docetaxel-based versus epirubicin-based chemotherapy regimen .  Patients were grouped according to their BMI value as underweight/normal weight ( BMI < 25 kg/m2 ; n = 543 ) , overweight ( BMI 25–29.9 kg/m2 ; n = 482 ) or obese ( BMI ≥ 30 kg/m2 ; n = 285 ) . Overweight and obese patients were older , had larger tumors and were more likely to be postmenopausal at the time of diagnosis compared to underweight/normal-weight patients ( all p < 0.001 ) . Multivariate Cox regression analyses adjusting for age and histopathological tumor features showed that obese patients had a significantly shorter disease-free survival ( DFS ; HR 1.43 ; 95 % CI 1.11–1.86 ; p = 0.006 ) and overall survival ( OS ; HR 1.56 ; 95 % CI 1.14–2.14 ; p = 0.006 ) than non-obese patients . Subgroup analyses revealed that the differences in DFS and OS were significant for postmenopausal but not for premenopausal patients , and that the survival benefit of non-obese patients was more pronounced in women with hormone-receptor-positive disease . Obesity constitutes an independent , adverse prognostic factor in high-risk node-positive breast cancer patients , in particular for postmenopausal women and women with hormone-receptor-positive disease Certain food groups are often rejected during chemotherapy ( CT ) due to the side effects of treatment , which may interfere with adequate diet and nutritional status . The aim of this study was to evaluate the treatment impact on the diet and nutritional status of women with breast cancer ( BC ) . In this prospect i ve longitudinal study , conducted in 2014–2015 , 55 women diagnosed with BC , with a mean age 51.5±10.1 years , were followed and data were collected at three different times .  Anthropometric and dietary assessment s  were performed , the latter by applying nine 24h dietary recalls , by using the Brazilian Healthy Eating Index Revised ( BHEI-R ) , and calculating the prevalence of inadequacy by the EAR cut-off point method . Regarding the BHEI-R analysis , the majority of women had a “ diet requires modification ’ , both at the beginning ( T0 , 58.2 % , n = 32 ) and during treatment ( T1 , 54.5 % , n = 30 ) . However , after the end of the CT , the greater percentage of patients ( T2 , 49.1 % , n = 27 ) were classified as having an " inadequate diet " , since the Total Fruit consumption as well as the Dark Green and Orange Vegetable and Legume consumption decreased significantly during treatment ( p = 0.043 and p = 0.026 , respectively ) . There was a significant reduction in the intake of macro and micronutrients , with a high prevalence of inadequacy , of up to 100 % , for calcium , iron , phosphorus , magnesium , niacin , riboflavin , thiamin , vitamin B6 , vitamin C and zinc . Assessment of the nutritional status indicated that 56 % ( n = 31 ) of patients were overweight at these three different times . Weight , BMI and Waist Circumference increased significantly , indicating a worse nutritional status , and there was a correlation between poor diet quality and higher values for BMI , Waist-Hip Ratio and Waist-to-Height Ratio  . Chemotherapy interferes in the patients ’ diet generating a negative impact on the quality and intake of micro and macronutrients , as well as an impact on their nutritional status , with an increase in anthropometric measurements Purpose Breast cancer treatments have been associated with an increased risk of multiple health-related adverse outcomes , but the relationship with diabetes remains unclear . This study investigated the association between hormone therapy and diabetes risk in breast cancer survivors . Patients and Methods We performed a case-cohort study of 2,246 female survivors recruited from the Leumit health care fund who were diagnosed with primary nonmetastatic invasive breast cancer in 2002 through 2012 . A 20 % r and om subcohort was sample d at baseline , and all diabetes cases were identified . Adjusted hazard ratios ( HRs ) with 95 % CIs were estimated by weighted Cox proportional hazards regression models . Results Of 2,246 breast cancer survivors , 324 developed diabetes over a mean follow-up of 5.9 years . The crude cumulative incidence of diabetes that accounted for death as a competing risk was 20.9 % ( 95 % CI , 18.3 % to 23.7 % ) . In multivariable-adjusted models , hormone therapy was associated with increased diabetes risk ( HR , 2.40 ; 95 % CI , 1.26 to 4.55 ; P = .008 ) . The hazard for  tamoxifen  use ( 
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RESULTS A general trend of increased glucose and insulin is seen and likely to be caused by weight gain and /or changes in body composition as a consequence of adjuvant treatment of BC .