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BACKGROUND: The Mediterranean diet has been associated with lower risk of breast cancer (BC) but evidence from prospective studies on the role of Mediterranean diet on BC survival remains sparse and conflicting. We aimed to investigate whether adherence to Mediterranean diet prior to diagnosis is associated with overall and BC-specific mortality. METHODS: A total of 13,270 incident breast cancer cases were identified from an initial sample of 318,686 women in 9 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Adherence to Mediterranean diet was estimated through the adapted relative Mediterranean diet (arMED), a 16-point score that includes 8 key components of the Mediterranean diet and excludes alcohol. The degree of adherence to arMED was classified as low (score 0-5), medium (score 6-8), and high (score 9-16). Multivariable Cox proportional hazards models were used to analyze the association between the arMED score and overall mortality, and Fine-Gray competing risks models were applied for BC-specific mortality. RESULTS: After a mean follow-up of 8.6 years from diagnosis, 2340 women died, including 1475 from breast cancer. Among all BC survivors, low compared to medium adherence to arMED score was associated with a 13% higher risk of all-cause mortality (HR 1.13, 95%CI 1.01-1.26). High compared to medium adherence to arMED showed a non-statistically significant association (HR 0.94; 95% CI 0.84-1.05). With no statistically significant departures from linearity, on a continuous scale, a 3-unit increase in the arMED score was associated with an 8% reduced risk of overall mortality (HR3-unit 0.92, 95% CI: 0.87-0.97). This result sustained when restricted to postmenopausal women and was stronger among metastatic BC cases (HR3-unit 0.81, 95% CI: 0.72-0.91). CONCLUSIONS: Consuming a Mediterranean diet before BC diagnosis may improve long-term prognosis, particularly after menopause and in cases of metastatic breast cancer. Well-designed dietary interventions are needed to confirm these findings and define specific dietary recommendations.

In order to enhance and develop inland fisheries and to create exploratory ichthyic stocks in reservoirs, the introduction of freshwater fishes in Tunisia began since the 1960s. However, stocking programs are usually conducted without any following assessment of the potential success of the exercise. Within the context of studying the genetic status of introduced populations, this paper describes the genetic variation of two domesticated varieties of common carp, scaly and mirror, introduced into five Tunisian reservoirs using six allozyme and four microsatellite loci. Although the genetic diversity observed with microsatellites was higher than that observed with allozyme markers, it remained lower compared to wild European populations. The lowest genetic diversity was observed in the mirror carp population of Nebhana reservoir. Both marker types highlighted significant heterogeneity among the two mirror carp populations and between the two varieties except between the two sympatric scaly and mirror carp populations of Sidi Salem reservoir. Nebhana population was found to be the most differentiated and this can be explained by genetic differences that already exist between the introduced populations, and which were increased by genetic drift and/or selection. Within scaly carp populations, homogeneity was revealed only between populations of the Mellegue and Bir M’cherga reservoirs. The significant differentiation of the scaly carp population of Sidi Salem reservoir might be due to hybridization with mirror carp sympatric in this reservoir.