understanding nutrition’s role in cancer outcomes...science behind the headlines resources you can...
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Understanding nutrition’s role
in cancer outcomes
insights from breast cancer
Barbara Parry MSc RD
Senior Research Dietitian
Hampshire Hospitals NHS Foundation Trust
and featuring “The Tracks of My Years”
a focus on obesity
‘True Colours’
Cyndi Lauper
1986
Senior Research Dietitian
Folk singer, musician and music lover
Avid Radio 2 Listener
‘Absolute Beginners’
David Bowie
1986
Nutrition after diagnosis
Factors influencing food choice
Science behind the headlines
Resources you can rely on
‘What’s Going On’
Marvin Gaye
1971
Ref: Macmillan Cancer Support, 2015/16 data; Health Survey for England, 2015; CRUK, 2016
Ref: Macmillan Cancer Support, 2015/16 data; Health Survey for England, 2015; CRUK, 2016
FRIEND ?
FOOD
FOE ?
‘You’ve Got a Friend’
Carole King
1971
‘Stairway to Heaven’
Led Zeppelin
1971
‘Highway 61 Revisited’?
Bob Dylan
1965
• Pre-diagnosis impact of the disease
• Psychological impact of diagnosis
Presenting nutritional status
• Surgery
• Chemotherapy
• Radiotherapy
• Drugs
Impact of treatment
• Food tolerance
• Taste changes
• Physical and psychological side-effects
• Other conditions
Survivorship/
Palliative care
‘Secondhand News’
Fleetwood Mac
1977
From the Sunday Times October 28, 2007
Diet fights cancer
From the Daily Telegraph November 1, 2007
Red meat and alcohol
“increase cancer risk”
From the Sun November 1, 2007
Save our bacon:
butty battle
From the Daily Express October 31, 2007
“Ban bacon” say
cancer experts
From the Times November 1, 2007
The new rules for defeating cancer From the Guardian
November 2, 2007
Blame it on the bacon From the Independent
November 3, 2007
Warning: scientists’ advice about
diet...a recipe for confusion
From the Evening Standard November 4, 2007
Keep eating the bacon butties!
From the Daily Mail November 1, 2007
Is anything safe to eat?
‘Supercalifragilisticexpialidocious’
Mary Poppins
1964
INGREDIENTS include:
quinic acid, 2-phenylethyl acetate, hexyl propionate, methyl acetate, ethyl 2-methylbutyrate, amyl acetate, furfural,
acetaldehyde, alpha-oxoglutaric acid, malic acid, cyanidin-3-galactoside
‘[What’s it all about] Alfie’
Cilla Black
1966
Nutritional needs
Eating behaviour
Social role Psychological
factors
Future health
what
with whom
why
how when
where
Breast Cancer
Treatment side-effects
Weight gain
during treatment
Nutrition as part of treatment
Incidence, opinion
and experience
Generally less
severe
Secondary
consideration?
A familiar
diagnosis
Common
experience
Ref: Shaw (ed.), 2011
‘For All We Know’
The Carpenters
1971
FOOD AND
NUTRITION
better treatment tolerance
better response
to treatment
better weight
manage-ment
better survival
plant-based eating
whole foods
rather than supplements
Ref: WCRF/AICR, 2007
Ref: WCRF/AICR, 2007
↓physical activity
obesity diet
↑breast cancer incidence
physical activity
treatment
↑adipose tissue ↓ lean mass
↑ oestrogen ↓ SHBG
↑ proliferation, angiogenesis, cell survival
↑ proliferation, angiogenesis
↑ leptin
↑ insulin ↑ IGF-1
↑ invasion, recurrence, mortality, metabolic comorbidities
↑ proliferation, differentiation, cell survival, migration, invasion, angiogenesis
‘A Little Less Conversation
(A Little More Action)’
Elvis Presley
1968
‘All About that Bass’?
Meghan Trainor
2014
• Energy Balance – a dynamic relationship
between biology and behaviour
• More than just a simplistic “energy in versus
energy out” system
• Some evidence that, as adipose tissue
accumulates, appetite control becomes more
difficult
• Physical activity’s effect on the sensitivity of
appetite regulation may be paramount
Ref: Hopkins and Blundell, 2016, Clinical Science 130(80): 1615-1628
‘I’m an Apeman’
The Kinks
1970
Ref: Blomquist C et al. Eur J Nutr (2017). https://doi.org/10.1007/s00394-017-1558-0
Ramos-Lopez O et al. J Nutrigenet Nutrigenomics 2017;10:43–62
Genes Nutrition
• Disease risk
prediction
• Therapy
responsiveness
• Physiological
characteristics
• Effects of
nutrients/other
food components
• Whole diet effects
• Individually
tailored guidance
nutri-genetics
nutri-genomics
nutri-epigenetics
Ref: WCRF/AICR, 2007
‘Just Around the Corner’
Mary Black
1991
‘How Do You Do It?’
Gerry and the Pacemakers
1963
• Determine personal nutrition priorities
• Recognise food is more than just a source of
nutrients
• Reduce energy-density but enhance nutrient-
density
• Modify eating behaviour to support dietary
changes and encourage satiety
• Physical activity is a “win-win”
• Person-centred, tailored guidance including
portion control strategies
WORLD CANCER RESEARCH FUND (UK)
www.wcrf-uk.org
and
AMERICAN INSTITUTE FOR CANCER RESEARCH (USA)
www.aicr.org
CANCER RESEARCH UK
www.cancerresearchuk.org
Available from www.chemocookeryclub.com
Support for ALL people undergoing cancer
treatment
Support for people undergoing BREAST
cancer treatment
‘Question(s)’
Moody Blues
1970
Barbara Parry MSc RD
Senior Research Dietitian
Breast Unit Hampshire Hospitals NHS Foundation Trust
Royal Hampshire County Hospital
Winchester SO22 5DG
Tel: 01962 825080 Email: [email protected]