Etta Finocchiaro

SC Dietetica e Nutrizione Clinica

Azienda Ospedaliera Città della Salute e della Scienza di Torino

ASCO 2015The American Society of Clinical Oncology is

committed to reducing the impact of obesity on cancer and has established a multipronged initiative to accomplish this goal by:

1) increasing education and awareness of the evidence linking obesity and cancer;

2) providing tools and resources to help oncology providers address obesity with their patients;

3) building and fostering a robust research agenda to better understand the pathophysiology of energy balance alterations, evaluate the impact of behavior change on cancer outcomes, and determine the best methods to help cancer survivors make effective and useful changes in lifestyle behaviors; and

4) advocating for policy and systems change to address societal factors contributing to obesity and improve access to weight management services for patients with cancer.

EVIDENCE SUPPORTING LINKS BETWEEN OBESITY AND PROGNOSIS IN SPECIFIC MALIGNANCIES

Cancer Type Evidence Breast • Obesity at diagnosis is linked to a 33% increase in the risk of breast cancer related and overall mortality in pre- and postmenopausal women with early-stage breast cancer.

Poor prognosis in obese breast cancer patients continues to be seen in individuals treated with anthracyclines and taxane-based treatment regimens and aromatase inhibitors, suggesting that the poor outcomes seen in obese individuals are independent of treatment factors.

Colorectal Data regarding the relationship between weight and colon cancer outcomes have been mixed. A recent meta-analysis of seven adjuvant chemotherapy trials for patients with stage II and III colorectal cancer treated with fluorouracil-based therapy found men with class II and III obesity (BMI ≥ 35kg/m2 ) and women with Class I obesity (BMI ≥ 30kg/m2 ) had significantly worse overall survival as compared to normal weight individuals.

Prostate Obesity is associated with the development of biologically more aggressive and advanced prostate cancer.The extent of body fatness and weight gain before/around the time of prostate cancer diagnosis is associated with an increased risk of recurrence and death.Obesity is associated with reduced response to prostate cancer treatment.

Childhood leukemia Obesity may be linked to poor outcomes in children with acute leukemia. Being overweight/obese before hematopoietic cell transplantation is associated with lower survival and higher rates of acute graft-versus-host disease and treatment related mortality.

INCREDIBILE!!!

Aerobic exercise training (AET) is an effective adjunct therapy to attenuate the adverse side-effects of adjuvant chemotherapy in women with early breast cancer. Whether AET interacts with the antitumor efficacy of chemotherapy has received scant attention. We carried out a pilot study to explore the effects of AET in combination with neoadjuvant doxorubicin–cyclophosphamide (AC+AET), relative to AC alone, on: (i) host physiology [exercise capacity (VO2 peak), brachial artery flow-mediated dilation (BA-FMD)], (ii)

Modulation of Circulating Angiogenic Factors and Tumor Biology by Aerobic Training in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

1.                               Lee W. Jones1, 

ATTIVITA' FISICA E INFIAMMAZIONE

Physical activity play an important roles in the protection against diseases associated with a low-grade inflammation:1. contracting skeletal muscle is a major source of circulation IL-1 in response to acute exercise2. the anti-inflammatoy effects of exercise may offer protection against TNF-induced insulin resistance a reduce CPR

Un farmaco eccezionale

Fattori di rischio nutrizionali per la SM

Cibi ad alto Indice Glicemico Bevande alcoliche McAuley J Lip Res 2006 Davies JAMA 2002

Grassi saturi Proteine in eccesso Riccardi Clin Nutr 2004 Tremblay 2007

Acidi grassi trans Sindrome Eccesso di sale Hunter Lipids 2006 metabolica Townsend Clin Sci 2007

Acidi grassi ω-3 Dieta mediterranea Carpentier AJCN 2006 Esposito JAMA 2004

Acidi grassi monoinsaturi Attività fisica Pérez-Jiménez Diabetologia 2001 Barnard 2003

Antagonisti alimentari dell’infiammazione

AGE Cibi a basso IG α-Toc RAGE ω3 Frutta e verdura

IL-1 IL-6 PCR NF-kB

TNF-α EGCG VEGF VEGFR

Antocianine Curcuma PGE2, Leucotrieni

Olio di oliva, ω3 Cicloossigenasi Quercetina, Trichina Riso integrale Lipoossigenasi Apigenina, Genisteina

La dieta è uno dei fattori ambientali di maggiore impatto sui livelli dei markers infiammatori, il calo ponderale e l’invecchiamento si associa ad una riduzione delle concentrazioni plasmatiche di questi indicatori.

Dieta ricca in vitamine minerali, fibra, antiossidanti,folati, flavonoidi e acidi grassi omega-3 e povera in acidi grassi trans e colesterolo correlano in modo inversamente proporzionale ai livelli di PCR IL6-18 TNFµ ed è proporzionale ai livelli di adiponectina

Le evidenze cliniche oggi disponibili, confermano il ruolo della flogosi nell’iniziazione, progressione e

riacutizzazione di diverse malattie cronico-degenerative e nell’obesità

FLOGOSI Malattie croniche degenerative- obesità

Rispetto alle vitamine.. Sostanze fitochimiche hanno un’azione antiossidante maggiore

rispetto alla vitamine tra cui i vari polifenoli, flavonoidi e curcumenoidi

Dieta ad alto contenuto di frutta e verdura è associata ad una riduzione dell’incidenza di cancro e di malattia coronarica

Sono fitonutrienti e si trovano nella frutta, verdura, legumi, noci,erbe, spezie

I polifenoli sono molto studiati e sono presenti in molti alimenti: da tempo è stato riconosciuto un ruolo protettivo nelle forme cardiovascolari e in alcune forme tumorali

Tutti e tre hanno proprietà anti-infiammatorie antiossidante, ipoglicemizzante e potenzialmente antitumorale

Dieta e infiammazioneAssunzione di:• 300 gr di pesce/settimana• Dieta Mediterranea Espostito et al

JAMA 2004

• Acidi grassi Omega-3 Lumeng J Clin Invest 2011

• Bassi livelli di vit B6

• Bassi livelli di Magnesio

• Riduzione della PCR del 33% in chi lo assume Pirro at al Eur J Cardiovasc Prev Rehabil 2004

• Riduzione della PCR.IL6-7-8 e insulinoresistenza Galland et al Eurp J clin Nutr 2006

• Riduzione dei livelli di acido arachidonico, trombossani leucotrieni, fibrinogeno, TNF-alfa

• Accelerazione proliferativa cell endoteliali e minor azione antiossidante Lotto et al BrJ Nutr 2011

• Iperstimolazione ipofisaria e attivazione dell’asse ipotalamo-ipofisi-surrene con maggiore produzione di radicali liberi citokine e aumento rischio di sindrome metabolica

CONCLUSIONI

• Dieta mediterranea a basso indice glicemico

• Attenzione all’apporto micronutrienti• Variare la dieta con gli ingredienti della

stagione• Attività fisica durante e dopo i trattamenti antitumorali