Nutrition & Physical Activity to Reduce Cancer Risk: Finding Our Focus

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1 Nutrition & Physical Activity to Reduce Cancer Risk: Finding Our Focus Women in Government Healthcare Summit November 14, 2013 Karen Collins, MS, RDN, CDN Nutrition Advisor American Institute for Cancer Research

2 Annual Report to the Nation 2013 Cancer Deaths in Men, Women & Children Cancer Incidence Men: 0.6% per year 1994 to 2009 Women: 0.5% per year from 1998 to 2006; from 2006 through 2009 Colorectal cancer: Men & Women Breast cancer: , J National Cancer Inst, Feb 6, 2013;105(3):

3 1,437,199 2,220,692 55% increase in expected cancer incidence by 2030 compared to 2008 *Based on Demographics

4 Obesity Among U.S. Adults (BRFSS, CDC)

5 Percentage of Civilian, Noninstitutionalized U.S. Population with Diagnosed Diabetes, % Increase U.S. CDC

6 Paradigm Shift Treatment Early Detection Reduce Risk Preventable through Diet, Physical Activity, Healthy Weight: 50% Colorectal Cancer 38% Breast Cancer 59% Endometrial Cancer Overall: ~ 374,464 U.S. Cancer Cases per Year

7 Paradigm Shift Treatment Early Detection Reduce Risk Heart Disease Type 2 Diabetes Cancer

8 Policies and Actions with Biggest Impact

9 Strength of Evidence: A Key Issue

10 Nutrition & Physical Activity to Reduce Cancer Risk: Recommendations and their Implementation

11 Body Fat: What s the Cancer Link? Insulin & Insulin-related Growth Factors Bioavailable Estrogen Inflammatory Cytokines Leptin Adiponectin

12 Percentage of U.S. Cancers that Could Be Prevented by Staying Lean Endometrium 49% Esophagus 35% Kidney 24% Gallbladder 21% Pancreas 19% Breast 17% (post-menopause) Colorectal 16% AICR/WRCF, Policy and Action for Cancer Prevention 2009 (updated August 2012) and National Cancer Institute estimated cancer rates

13 RECOMMENDATION: (to promote a healthy weight) Avoid sugary drinks Limit consumption of calorie-dense foods Be physically active daily

14 Implications of Calorie Density Two strategies: each totals 1575 calories Courtesy: Laboratory for the Study of Human Ingestive Behavior, Penn State

15 Low Calorie Density in Practice Limit added fats and high-fat foods Moderate amounts of oils & nuts as part of a healthy diet are not linked to weight gain Use vegetables and fruits to replace some foods high in calorie density Often the most powerful step Blatt, Am J Clin Nutr 2011 Rolls, J Amer Diet Assoc 2005 Ledikwe, AJCN 2006

16 Promoting Healthy Weight: Thinking Big Picture, Broad Options Healthful Drinks Reducing visibility & availability of sugar-sweetened drinks Fresh, potable water widely available Food Choices & Portions Vegetables & fruits visible, accessible, delicious at schools Teaching about healthy foods & how to fix them: schools, public health programs, programs for seniors Government worksite cafeterias & wellness messages Wellness teams shaping school cafeterias & fundraiser sales

17 Physical Activity: What s the Cancer Link? Weight gain & easier maintenance of healthy body fat Improved insulin function & healthier levels Decreased estrogen levels Improved gut function Improved immune function

18 Physical Activity to Reduce Cancer Risk Strongest links: Colorectal cancer Breast (post-menopause) Endometrial Limited evidence: Lung Pancreas, Pre-menopausal breast

19 Recommendations At least 30 minutes moderate activity every day (such as brisk walking) Work up to at least 60 minutes moderate or 30 minutes vigorous activity daily Limit sedentary habits such as watching TV

20 Promoting Physical Activity: Thinking Big Picture, Broad Options Recreation School physical education, recess, after school Community use of schools Senior groups Parks Transportation Walk to school Active commute to work Occupation Worksites with active breaks, after-work options New outlook: Reduce sitting time Household Chores Promote home & community gardens

21 Dietary Strategy: Putting Together the Pieces The Simplest Message: Eat more plant foods Limit red meat; avoid processed meat

22 Diet Acts Throughout the Cancer Process DNA Damage & Repair Inflammation Hormones & Growth Factors Changing Gene Expression Supporting Healthful Gut Microbes

23 Key Message: Eat More & Eat More Variety

24 Whole Grains and Legumes More than Fiber 24

25 Recommendations At least 5 servings of non-starchy vegetables & fruits daily Relatively unprocessed grains &/or legumes with every meal Limit refined starchy foods

26 To Reduce Risk of Colorectal Cancer: Limit Red Meat and Avoid Processed Meat Red Meat: No more than 18 oz per week Limit Beef, Lamb, Pork Avoid Processed Meat Smoked Salt-cured Nitrite & Nitrate Preservatives

27 Promoting Healthful Food Choices: Thinking Big Picture, Broad Options

28 Barrier: Perception of High Cost Reduce high-cost, low-nutrient choices: soft drinks, snack foods Less meat, more vegetables & beans Fewer processed convenience foods Look beyond healthy labels Reduce over-buying

29 Barrier: Perception of Time Demand Perception of Difficulty Simple additions: vegetables / more vegetables Substitutions: whole grains for refined poultry, seafood or beans for red meat Skills can be taught: flexible meal planning grocery shopping for meals basic cooking skills not just reading package labels

30 Cancers Associated with Alcohol Consumption Convincingly Increases Risk: colorectal (men), breast (pre- and post-menopausal) mouth, larynx, pharynx, esophagus, Probably Increases Risk: colorectal (women), liver

31 Alcohol: If consumed at all, limit: 2 for men and 1 for women a day 5 ounces of wine 12 ounces of beer ounces of 80 proof liquor One Drink

32 Synergistic Potential: Enormous Reach and maintain a healthy weight Physical activity at least 30 minutes/day Abundance and Variety: Vegetables, Fruits, Whole Grains Limit Red & Processed Meat Limit Alcohol High versus low scores: 48-58% lower CVD mortality 24-30% lower cancer mortality McCullough, Cancer Epid Biom Prev

33 Putting Recommendations Into Action

34 Accessibility Affordability Acceptability AICR/WCRF, 2009

35 Three AICR Guidelines Choose mostly plant foods, Limit red meat & avoid processed meat. Be physically active every day in any way for 30 minutes or more Aim to be a healthy weight throughout life

36 Your Key Questions Does this program or idea promote physical activity as an integral and routine part of life? Or does it create barriers to being active? Does this support healthy food and beverage options as the routine, easy choice? Or does it make healthy choices harder?

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38 Reducing Cancer Risk

39 Key Resources from AICR The American Institute for Cancer Research Food, Nutrition, Physical Activity, and the Prevention of Cancer - AICR/WCRF Expert Report (2007) & Continuous Update Project Reports Policy and Action for Cancer Prevention AICR/WCRF Policy Report (2009)

40 More Resources from AICR AICR Recommendations for Cancer Prevention AICR Guidelines to Reduce Your Cancer Risk (Three guidelines that simplify the message of the AICR recommendations) AICR s New American Plate AICR Brochures & Other Publications Infographics Useful for Messages & Campaigns

41 Additional Resources Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Institute of Medicine Report, May American Cancer Society Guidelines on Nutrition & Physical Activity for Cancer Prevention (CA: Cancer J Clin :30-67) Smart Bytes blog by Karen Collins, MS, RDN, CDN

42 AICR Recommendations for Cancer Prevention 1. Be as lean as possible without becoming underweight. 2. Be physically active for at least 30 minutes every day. 3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat). 4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans. 5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. 6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day. 7. Limit consumption of salty foods and foods processed with salt (sodium). 8. Don't use supplements to protect against cancer. Special Populations Recommendations 9. It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods. 10. After treatment, cancer survivors should follow the recommendations for cancer prevention. And always remember do not smoke or chew tobacco.

43 IOM Report 2012 Solving the Weight of the Nation

44 Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation Five Goals Make physical activity an integral & routine part of life Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice Transform messages about physical activity & nutrition Expand the roles of health care providers, insurers, and employers Make schools a national focal point Institute of Medicine Consensus Report; May 8, 2012