diet, nutrition, physical activity, and cancer: a global ... · • for breast cancer survivors,...

Diet, Nutrition, Physical Activity,

and Cancer: A Global Perspective.

Updated evidence and

Recommendations Elisa V. Bandera, MD, PhD

Professor, Cancer Epidemiology

Rutgers Cancer Institute of New Jersey

Robert Wood Johnson Medical School

2

Declaración de Intereses: No tengo ningún interés que declarar- Nothing to declare

dietandcancerreport.org

• Judging the evidence

• The Cancer Prevention

Recommendations

• Future research directions

Overview

• Evaluación de la evidencia científica

• Las recomendaciones para la

prevención del cáncer

• Áreas de investigación en el futuro


Judging the evidence Evaluación de la evidencia científica


Judging the evidence – Evaluando la evidencia

Criterios definidos “a priori”:

• Número y tipo de estudios

• Congruencia de resultados

• Magnitud de asociaciones

• Calidad de la determinación de los factores causales y efectos o eventos

• Heterogeneidad entre estudios

• Exclusión de resultados aleatorios, sesgos,

y efecto de confusión

• Gradiente biológico en la relación dosis-

respuesta

• Evidencia de mecanismos

wcrf.org/judging-evidence

Pre-defined criteria:

• Number and types of studies

• Consistency

• Magnitude of associations

• Quality of exposure and outcome

assessment

• Heterogeneity

• Exclusion of chance, bias or confounding

• Biological gradient

• Evidence of mechanisms


Judging the evidence – grading criteria

Decreases risk Increases risk

Strong evidence Convincing

Probable

Limited evidence Limited -

suggestive

Limited – no

conclusion

Strong evidence Substantial

effect on risk

unlikely

Basis for Recommendations

Evidence Matrix

wcrf.org/judging-evidence


Diet, nutrition, physical activity and the cancer process

Potential impact of diet, nutrition, physical activity and height in increasing susceptibility to cancer

wcrf.org/cancer-process


The Cancer Prevention Recommendations

Las recomendaciones para la prevención del cáncer


• Cancer Prevention Recommendations

designed to be used as the basis for

action and to inform public health policy

to reduce the incidence of cancer in

general.

• Culturally relevant throughout the world.

• Guidelines on the prevention of other

diseases taken into account.

• Together, they represent an integrated

pattern of behaviours that can be

considered as an overall „package‟.

Principles of the Recommendations

wcrf.org/cancer-prevention-recommendations

• Diseñadas para informar políticas de

salud pública con el fin de reducir la

incidencia del cáncer.

• Aplicables a poblaciones de culturas

diversas en el mundo.

• Los consejos para prevenir otras

enfermedades crónicas tomados en

cuenta.

• Juntas, representan un patrón de estilo de

vida.

Principios de las Recomendaciones


An overall package


Mantenga un

peso sano

Manténgase

físicamente

activo/a

Consuma una dieta

rica en cereales

integrales, verdura,

fruta, y legumbres

Limite el consumo de

“comidas

basura/rápida” y otros

alimentos procesados

altos en grasa,

almidón, y azúcares

Limite el consumo

de carne roja y

procesada

(embutidos)

Limite el consumo

de bebidas

azucaradas

Limite el consumo

de alcohol

No use suplementos

para prevenir el

cáncer

Para madres:

Den el pecho a sus

bebés si pueden

Si le diagnostican

cáncer, si puede, siga

estas recomendaciones


Be a healthy weight


Mantenga un peso sano.

Mantenga su peso dentro de los límites normales

y evite el ganar peso a lo largo de su vida adulta.


Justification

• Strong evidence from the CUP that

greater body fatness is a cause of many

cancers.

• IARC concluded that greater body

fatness is also a cause of thyroid cancer,

multiple myeloma and meningioma.

• Overweight and obesity in childhood and

early life liable to be carried through to

adulthood.

Implications for other diseases

• A causal role in other non-communicable

disease’s (NCD’s): type 2 diabetes,

dyslipidemia, hypertension, stroke and

coronary heart disease (CHD), digestive

and musculoskeletal disorders

• Increased the risk of multiple

comorbidities.


Obesity and cancer: some examples of evidence


Be physically active


Manténgase físicamente activo/a.

Incorpore la actividad física a su vida diaria (siga

consejos nacionales)

– en general: camine más y siéntese menos.


Justification

Strong evidence from the CUP that:

• Physical activity helps protect against several

cancers.

• Physical activity helps protect against weight

gain, overweight and obesity.

• Greater screen time is a cause of weight gain,

overweight and obesity.


• Decreased risk of all-cause mortality, CHD, high

blood pressure, stroke, type 2 diabetes, metabolic

syndrome and depression.

• Weight-bearing and muscle-strengthening exercises

promote bone health and reduce blood pressure.


Eat a diet rich in wholegrains, vegetables, fruit and beans


Consuma una dieta rica en cereales

integrales, verdura, fruta, y legumbres.

Los cereales integrales, verdura, fruta, y

legumbres deben ser una parte principal de su

dieta diaria habitual.


Justification


• Wholegrains help protect against colorectal cancer.

• Non-starchy vegetables and fruit help protect against aerodigestive cancers.

• Dietary fibre helps protect against colorectal cancer and weight gain, overweight and obesity.

Some evidence from the CUP to suggest that:

• Fruit and vegetables might decrease risk of many cancers, weight gain, overweight and obesity.

• People who eat no or low levels of vegetables and fruit, who increase their consumption, may benefit

most from following this Recommendation.


• This Recommendation is supported by evidence on cardiovascular disease (CVD) and type 2 diabetes.


Limit consumption of „fast foods‟ and other processed foods high in fat, starches or sugars


Limite el consumo de “comidas basura/rápida” y otros

alimentos procesados altos en grasa, almidón, y

azúcares.

El limitar estos alimentos ayuda a controlar el consumo de

calorías y a mantener un peso sano.


Limit consumption of sugar sweetened drinks


Limite el consumo de bebidas azucaradas.

Beba principalmente agua y bebidas no azucaradas.


Limit consumption of red and processed meat


Limite el consumo de carne roja y procesada (embutidos).

Consuma solo cantidades moderadas de carne roja, como

ternera, cerdo, y cordero. Coma poco o nada de carne

procesada.


Limit alcohol consumption


Limite el consumo de alcohol.

Para la prevención del cáncer es preferible no beber alcohol.


Limit alcohol consumption

Justification


• Alcohol is a cause of many cancers.

• Alcohol helps protect against kidney cancer but this is far outweighed by the increased risk for

other cancers.


• Small amounts of alcohol may have lower risks of CHD and early death than non drinkers.

• Heavy alcohol use is detrimentally related to many CVD’s, including hypertensive disease,

haemorrhagic stroke and atrial fibrillation.

• Associated with various kinds of liver disease and with an increased risk of pancreatitis.

Despite uncertainties about the effects of moderate alcohol consumption on non-cancer outcomes, drinking

alcohol is not recommended for any health benefit.



Do not use supplements for cancer prevention


No use suplementos para prevenir el cáncer.

Intente cubrir sus necesidades nutricionales solo con

alimentos.


For mothers: breastfeed your baby, if you can


Para madres:

Den el pecho a sus bebés si pueden.

La lactancia es beneficiosa para la mamá y su bebé


After a cancer diagnosis: follow our Recommendations, if you can


Si le diagnostican cáncer, si puede, siga estas

recomendaciones.

Hable con su médico o profesional de la salud sobre lo que es mejor

para su situación personal.


Breast cancer survivors

wcrf.org/cancer-survivors

Supervivientes de cáncer de mama


After a cancer diagnosis: follow our Recommendations, if you can

Justification

• For breast cancer survivors, there is persuasive evidence that nutritional factors and physical

activity reliably predict important outcomes from breast cancer.

• The quality and amount of published studies are limited.

More people are surviving cancer than ever before, living long enough to develop new primary cancers

or other NCDs. Following the Cancer Prevention Recommendations may improve survival and reduce

the risk both of cancer and of other NCDs.


• Following the Cancer Prevention Recommendations is likely to help prevent other NCDs as well as

to help management and control of co-existing NCDs.



• Biological mechanisms by which diet,

nutrition and physical activity affect cancer

processes

• Impact of diet, nutrition and physical activity

throughout the life course on cancer risk

• Better characterization of diet, nutrition,

body composition and physical activity

exposures and cancer-related outcomes

• Better understanding of the role of diet,

nutrition and physical activity on outcomes in

cancer survivors

• Globally representative research on specific

exposures and cancer

Future Research Directions

wcrf.org/future-research-directions

• Mecanismos biológicos por los que la dieta,

nutrición y la actividad física pueden afectar

el cáncer

• Impacto de la dieta, nutrición y la actividad

física en el ciclo de vida en el riesgo del

cáncer

• Mejor caracterización de la dieta, nutrición,

composición corporal, y actividad física y de

efectos relacionados con el cáncer.

• Más información sobre la influencia de estos

factores en el pronóstico de los

supervivientes de cáncer

• Investigación en exposiciones específicas y

cáncer representativa a nivel global

Áreas de investigación en el futuro


WCRF/AICR Expert Panel Alan Jackson CBE MD FRCP FRCPCH (Chair)

University of Southampton, UK

Hilary J Powers PhD RNutr (Deputy Chair)

University of Sheffield, UK

Elisa Bandera MD PhD

Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, US

Steven Clinton MD PhD

The Ohio State University, Columbus, OH, US

Edward Giovannucci MD ScD

Harvard T H Chan School of Public Health, Boston, MA, US

Stephen Hursting PhD MPH

University of North Carolina, NC, US

Michael F Leitzmann MD DrPH

Regensburg University, Germany

Anne McTiernan MD, PhD

Fred Hutchinson Cancer Research Center, Seattle, WA, US

Inger Thune MD PhD

Oslo University Hospital and University of Tromso, Norway

Ricardo Uauy MD PhD

Instituto de Nutricion y Tecnologia de los Alimentos Santiago, Chile

Observers

Elio Riboli MD ScM MPH

Imperial College London, UK

Marc Gunter PhD

International Agency for Research on Cancer, , Lyon, France

https://www.wcrf.org/int/continuous-update-project/about-cup/cup-expert-panel


























twitter.com/wcrfint

facebook.com/wcrfint

wcrf.org/blog

For information on the Third Expert Report:


For more information on our Policy work:

wcrf.org/int/policy/our-policy-work

Contact us: [email protected]

http://www.dietandcancerreport.org

https://www.wcrf.org/int/policy/our-policy-work





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