Reviewer ’s report  
Title: Dietary pattern and health -related quality of life among breast cancer survivors  
 
Version: 0 Date: 18 Sep 2017  
 
Reviewer: Alina Vrieling  
 
Reviewer's report:  
This manuscript addresses an interesting topic about which still relatively little is known. 
However, I do have some concerns and points for further improving this manuscript. Also, the 
quality of written English can be improved.  
 
- It is mentioned that breast cancer survivors were included more that 6 months afte r surgery. 
Could you provide some more information on the time range (median, IQR or range) in 
addition to providing the mean and SD? Did all women complete treatment or were still some 
women undergoing active treatment? Did any women experience recurrence  or were they still 
cancer -free? Both issues may influence HRQOL results.  
- Please provide more information on how much of the variance is explained by these two dietary 
patterns.  
- In the abstract and in the summary at the start of the discussion, the re sult for stage I patients 
for Western pattern and constipation is mentioned but not the other findings for subgroup 
analyses. Why did you make this choice? I would suggest to restrict to findings for healthy 
dietary pattern overall and to mention that some  associations were found only for subgroups 
according to tumour stage, menopausal status, etc.  
- Discussion, page 12, line 17 - page 13, line 30: It is not clear to make why the authors describe 
studies on dietary patterns and breast cancer prognosis, whic h have already been described in 
the introduction and are not the topic of the current paper. I would suggest to leave this whole 
part out.  
- More discussion about the other findings in the results can be added. Can you explain these 
findings or are they l ikely to be due to chance?  
- More discussion about the clinical relevance of the findings can be added. Are these only 
statistically relevant or also clinically relevant differences?  
- More discussion about whether 3 -day dietary records are representative  of habitual dietary 
intake can be added.  
- You investigate two dietary patterns in relation to 22 outcomes. I think the main conclusion is 
that dietary patterns are not related to these outcomes, with a few possible exceptions which 
may also be explained as chance findings. This should be discussed in more detail and I think 
the conclusion needs to be rephrased.  
 
Specific comments:  
- Page 4, line 14/15: "Studies that are related to prognosis..." What is meant here? Please 
rephrase.  
- Page 10, line 12/32: Does this refer to Stage I patients? Please add this information.  
- Page 11, Discussion: There is no need to repeat the composition of the dietary patterns again.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an addition al statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any  way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or i n the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests ' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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