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most data linking diet and cancer is epidemiological (case control, cohort, or cross-sectional studies) It is estimated that one third of the cancer deaths each year in the US can be attributed to nutrition and other lifestyle factors (not including smoking)
and added in food preparation and preservation Inhibitors of carcinogenesis: antioxidants, phytochemicals Enhancers of carcinogenesis Latency period between initiation and promotion
extends life span in animals Positive associations between overweight and cancers of the breast, endometrium, kidney, colon, prostate, and others Overweight increases risk of cancer recurrence and decreases survival Physical activity is inversely associated with cancer
Data from Heber D: Vegetables, fruits and phytoestrogens in the prevention of diseases, F Postgrad Med 50:145, 2004.
of carcinogenesis Animal studies also test the effect of food and nutrition on cancer and provide guidance for epidemiological studies
Fat
High intake of total and saturated fat is associated
with increased risk of breast, colon, lung and prostate cancers High fat diets are associated with obesity, which is linked with cancer of the colon, rectum, esophagus, gall bladder, breast, endometrium, pancreas, and kidney Animal fat (from meat and dairy) was associated with increased risk of breast cancer in the Nurses Health study and others Higher omega-3 vs omega 6 may reduce risk of breast cancer Low fat diet (<20% fat) may reduce risk of recurrence of breast cancer
with breast cancer in postmenopausal women Physical activity may have a protective effect Women who spent an average 3.8 hours per week in physical activities had lower risk of colon, reproductive cancers
Kidney
Is also a risk
Endometrium
Esophagus
Protein
Difficult to isolate effects of protein, since
protein diets are in fat and in fiber Low protein diets seem to reduce the risk of cancer, while risk is increased by very high protein intakes Increased meat intake is associated with increased risk of colon cancer and advanced prostate cancer
Fiber
Observational studies and case control
studies indicate that fiber-rich diets are associated with a protective effect in colon cancer Higher intakes of vegetables were inversely associated with colon cancer risk in one study But high fiber diets also tend to be lower in meat, fat, and refined carbohydrates
Fiber
Two intervention trials evaluating the effect
of fiber on polyp and adenoma recurrence failed to show an effect of high fiber vs low fiber diets Recommendation is to eat high fiber foods despite lack of conclusive evidence re cancer
increased risk of cancers including ovarian, endometrial, breast, colorectal, pancreas, and lung Limit processed foods and refined sugars and emphasize whole grains and low GI foods
with lower risk in 128 of 156 dietary studies Increased consumption of fruits and vegetables is associated with lower risk of cancers of the oral cavity, esophagus, stomach, colon, rectum, and bladder Evidence less strong for hormone-related cancers such as breast and prostate cancer
vitamins, minerals Good sources of antioxidants (vitamins C, E, selenium, phytochemicals such as carotenoids, flavonoids, plant sterols, allium compounds, indoles, phenols, terpenes Do not yet know what is the protective agent(s) so best to use food sources
tumor formation and protecting genetic material from carcinogenic agents Suppressing free radical production Serving as bulking agents to dilute carcinogens and decrease gastrointestinal transit time Stimulators of physiologically active and anti-cancer enzymes
Mobley C. Nutrition and cancer prevention. In McCallum and Polisena, The Clinical Guide to Oncology Nutrition. Oncology Nutrition Dietetic Practice Group, 2000.
smokers was associated with a 16% higher incidence of lung cancer Heavy alcohol intake seemed to enhance negative effects However, diet studies suggest that high fruit and vegetable consumption, particularly carotenoids, tomatoes, and tomato-based products may reduce risk of lung cancer
micronutrients and very high risk of esophageal and gastric cancer -carotene, vitamin E, and selenium at 5X the RDA was associated with significantly lower mortality from all cancers
calcium may reduce the risk for colorectal cancer and that calcium supplements may reduce the formation of colorectal polyps However, there is evidence that high calcium intake, especially supplements, is associated with increased risk of prostate cancer Bottom line: get calcium through food sources
in tomatoes and tomato-based foods Several studies show that consuming tomato products reduces the risk of some cancers, but unclear whether lycopene is responsible Absorption of lycopene is enhanced when lycopene-containing vegetables are cooked and eaten with fat No evidence that supplements are safe and effective in cancer prevention.
Source: American Cancer Society, accessed 2005
preserved meat to increased risk of colorectal and stomach cancers May or may not be due to nitrites Nitrites can be converted in the stomach to carcinogenic nitrosamines, which may increase the risk of stomach cancer Vegetables and fruit retard the conversion of nitrites to nitrosamines
temperatures creates chemicals that might increase cancer risk (cause cancer in animals) Use techniques such as braising, steaming, poaching, stewing and microwaving
(phytoestrogens) which have weak estrogen activity and appear to protect against hormonedependent cancers in animal studies No evidence shows soy supplements reduce cancer risk High doses of soy may increase the risk of estrogen-responsive cancers, such as breast or endometrial cancers in certain women Breast cancer survivors should consume only moderate amounts
Alcohol
Alcohol associated with carcinogenesis in
cancers of the mouth, pharynx, larynx, esophagus, lung, colon, rectum, liver and breast (USDHHS, 2000) Appears to act synergistically with tobacco Malnutrition associated with alcoholism may also be implicated
risk factor for a variety of cancers, but does not appear to be associated with increased cancer Regular drinking of green tea and other sources of polyphenols may reduce the risk of stomach cancer Consumption of very hot drinks may increase the risk of esophageal cancer
Artificial Sweeteners
Cyclamate banned as food additive in US in
1969 and saccharine in 1977 after being associated with bladder cancer in mice Under public pressure, saccharine returned to the market; it was reviewed and taken off the list of potential carcinogens in 2000 Aspartame: no evidence implicating it in increased cancer risk
Artifical Sweeteners
Five artificial sweeteners on the market: Acesulfame-K Aspartame Neotame Saccharine Sucralose
hyperinsulinemia and metabolic syndrome Insulin resistance/hyperinsulinemia, higher estrogen levels, and insulin-like growth factor I may act synergistically to promote tumor growth, particularly mammary tumors.
in peanuts, safrol in plant oils, tannins in grains and grapes, benzopyrene formed by smoking meat and fish) Naturally found in plant foods like celery, parsley, figs, mustard, pepper, citrus oils Pesticides
leaves before eating Use proper food storage to prevent growth of fungal carcinogens Marinate protein foods to decrease cooking time Use cooking methods to avoid contact of foods and food drippings with flames Use lower cooking temperatures with protein foods
Mobley C. Nutrition and cancer prevention. In McCallum and Polisena, The Clinical Guide to Oncology Nutrition. Oncology Nutrition Dietetic Practice Group, 2000
based foods Eat plenty of vegetables and fruits. Maintain a healthy weight and be physically active. Drink alcohol only in moderation, if at all. Select foods low in fat and salt. Prepare and store food safely.
sources.
Eat five or more servings of a variety of vegetables and fruits each day.
Include vegetables and fruits at every meal and for snacks.
Eat a variety of vegetables and fruits.
products.
Choose 100% juice if you drink fruit or vegetable juices.
portions.
Prepare meat by baking, broiling, or poaching,
low fat or fat free does not mean low calorie and that low-fat cakes, cookies, and similar foods are often high in calories.
for calorie-dense foods such as French fries, cheeseburgers, pizza, ice cream, doughnuts, and other sweets.
fruits daily.
Stomach cancer rates are falling due to
disseminated cancer cells A cured cancer pt is at increased risk for other primary cancers in the same organ or other organs General dietary guidelines are also appropriate for recovering cancer pts Dietary regimens should a) avoid stimulating growth and spread of remaining tumor cells and b) provide maximum prevention against new primary tumors
Nixon DW. Nutrition during cancer recovery. In McCallum and Polisena, The Clinical Guide to Oncology Nutrition. Chicago, The American Dietetic Association, 2000.
calories. Monounsaturated fats are preferred. Aim for 10-12 daily servings of a variety of whole vegetables and fruits. Consume 4-6 servings of whole grains daily. Breast cancer pts should eliminate or severely restrict alcohol intake
IU/day to replace deficit from reduced fat intake Standard dose multivit daily (not to exceed 100% RDA). This does not replace cancerfighting foods Exercise moderately (30 minute daily walk, for example) Maintain desirable body weight