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 www.karencollinsnutrition.com
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 1999-2008 Breast cancer: 1999-2004, 2004-2009 J National Cancer Inst, Feb 6, 2013;105(3):175-201
1,437,199 2,220,692 55% increase in expected cancer incidence by 2030 compared to 2008 *Based on Demographics
Obesity Among U.S. Adults (BRFSS, CDC)
Percentage of Civilian, Noninstitutionalized U.S. Population with Diagnosed Diabetes, 1980 2011 176% Increase U.S. CDC
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
Paradigm Shift Treatment Early Detection Reduce Risk Heart Disease Type 2 Diabetes Cancer
Policies and Actions with Biggest Impact www.dietandcancerreport.org
Strength of Evidence: A Key Issue
Nutrition & Physical Activity to Reduce Cancer Risk: Recommendations and their Implementation
Body Fat: What s the Cancer Link? Insulin & Insulin-related Growth Factors Bioavailable Estrogen Inflammatory Cytokines Leptin Adiponectin
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
RECOMMENDATION: (to promote a healthy weight) Avoid sugary drinks Limit consumption of calorie-dense foods Be physically active daily
Implications of Calorie Density Two strategies: each totals 1575 calories Courtesy: Laboratory for the Study of Human Ingestive Behavior, Penn State
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
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
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
Physical Activity to Reduce Cancer Risk Strongest links: Colorectal cancer Breast (post-menopause) Endometrial Limited evidence: Lung Pancreas, Pre-menopausal breast
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
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
Dietary Strategy: Putting Together the Pieces The Simplest Message: Eat more plant foods Limit red meat; avoid processed meat
Diet Acts Throughout the Cancer Process DNA Damage & Repair Inflammation Hormones & Growth Factors Changing Gene Expression Supporting Healthful Gut Microbes
Key Message: Eat More & Eat More Variety
Whole Grains and Legumes More than Fiber 24
Recommendations At least 5 servings of non-starchy vegetables & fruits daily Relatively unprocessed grains &/or legumes with every meal Limit refined starchy foods
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
Promoting Healthful Food Choices: Thinking Big Picture, Broad Options
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
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
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
Alcohol: If consumed at all, limit: 2 for men and 1 for women a day 5 ounces of wine 12 ounces of beer 1 1 2 ounces of 80 proof liquor One Drink
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 2011 32
Putting Recommendations Into Action
Accessibility Affordability Acceptability www.dietandcancerreport.org AICR/WCRF, 2009
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
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?
Reducing Cancer Risk
Key Resources from AICR The American Institute for Cancer Research http://www.aicr.org Food, Nutrition, Physical Activity, and the Prevention of Cancer - AICR/WCRF Expert Report (2007) & Continuous Update Project Reports http://www.dietandcancerreport.org/ Policy and Action for Cancer Prevention AICR/WCRF Policy Report (2009) http://www.dietandcancerreport.org/policy_report/index.php
More Resources from AICR AICR Recommendations for Cancer Prevention http://www.aicr.org/reduce-your-cancer-risk/recommendations-for-cancerprevention/index.html AICR Guidelines to Reduce Your Cancer Risk (Three guidelines that simplify the message of the AICR recommendations) http://www.aicr.org/reduce-your-cancer-risk/ AICR s New American Plate http://www.aicr.org/new-american-plate/ AICR Brochures & Other Publications http://www.aicr.org/publications/ Infographics Useful for Messages & Campaigns http://www.aicr.org/learn-more-about-cancer/cancer-infographics.html
Additional Resources Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Institute of Medicine Report, May 2012. http://www.iom.edu/reports/2012/accelerating-progressin-obesity-prevention.aspx American Cancer Society Guidelines on Nutrition & Physical Activity for Cancer Prevention (CA: Cancer J Clin 2012. 62:30-67) http://onlinelibrary.wiley.com/doi/10.3322/caac.20140/pdf Smart Bytes blog by Karen Collins, MS, RDN, CDN http://www.karencollinsnutrition.com/smartbytes/
AICR Recommendations for Cancer Prevention http://www.aicr.org/reduce-your-cancer-risk/recommendations-for-cancerprevention/index.html 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.
IOM Report 2012 Solving the Weight of the Nation
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