PHNU 610 Advanced Nutrition I Feb.19. 2009

By Park Hae-soon(Esther)

The World Health Organization has determined that dietary factors account for at least 30% of all cancer in Western countries and up to 20 % in developing countries.

Many foods and nutrients have been linked to cancer prevention.

About 30% of cancer deaths can be prevented by changing healthy eating & lifestyle.

( WHO, 2009)

Cancer is a leading cause of death worldwide: it accounted for 7.9 million deaths (around 13% of all deaths) in

2007. Deaths from cancer worldwide are projected to

continue rising, with an estimated 12 million deaths

in 2030. Cancer arises from a change in one single cell.

The change may be started by external agents and inherited genetic factors.

Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year. (WHO,

cancer fact sheet, 2009)

In a study from Italy, a systematic analysis of red meat intake and the risk of 17 cancer sites, including over 10,000 cases and about 8,000 controls, found direct relations between meat intake and the risk of cancers of the stomach, colon, rectum, pancreas, breast, endometrium, ovary, and bladder .

A meta-analysis of case-control studies reported that increased consumption of all meat, red meat, poultry, and processed meat is associated with an increased risk of kidney cancer; consumption of all meat and red meat was associated with 27% and 30% high risk, respectively.

Jinfu Hu et al(2008), Meat and Fish Consumption and Cancer in Canada

Total meat and processed meat were directly related to the risk of stomach, colon, rectum, pancreas, lung, breast (mainly postmenopausal), prostate, testis, kidney, bladder, and leukemia.

Red meat was significantly associated with colon, lung (mainly in men), and bladder cancer.

These findings add further evidence that meat, specifically red and processed meat, plays an unfavorable role in the risk of several cancers. Fish and poultry appear to be favorable diet Indicators

Jinfu Hu et al(2008), Meat and Fish Consumption and Cancer in Canada

Breast cancer is the most common cancer among women, but the risk of breast cancer varies widely, with an approximately five-fold difference between the highest risk, typically seen in women from North America, and the lowest risk, usually found in women from Asia.

The results of the study of Kim et al. (2008) show that a high soy protein intake is associated with a lower risk of breast cancer independent of dietary and non dietary risk factors for breast cancer. They also found that increased tofu intake was associated with reduced breast cancer risk but only in premenopausal women.

Kim et al(2008), Dietary Intake of Soy Protein and Tofu in Association With Breast Cancer Risk Based on a Case-Control Study ,Nutrition and Cancer.

Studies of both isoflavones and soy foods have supported breast cancer-protective effects.

In this case-control study, This study observed an inverse association between breast cancer risk and high consumption of grapes, tomatoes, and pumpkins.

This results are consistent with previous studies reporting a significant inverse association between

breast cancer and consumption of fruits and vegetables.

Do, M.H et al(2007), Intake of Fruits, Vegetables, and Soy Foods in Relation to Breast,Cancer Risk in KoreanWomen: A Case-Control Study,NUTRITION AND CANCER,

The study by Do (2008) showed an inverse association between breast cancer risk and high pumpkin consumption. Pumpkin contains considerable amounts of beta-carotene, fiber, and vitamins B and C.

Isoflavones may also affect breast cancer by competing with endogenous estrogens.

A population-based case-control study reported that consumption of soy food may reduce breast cancer risk in relation to hormone status.

So the potential protective effect of steroid hormone status on soy foods and breast cancer risk should be assessed.

Do, M.H et al(2007), Intake of Fruits, Vegetables, and Soy Foods in Relation to Breast,Cancer Risk in KoreanWomen: A Case-Control Study,NUTRITION AND CANCER,

Overweight and obesity accounted for 14 percent of all cancer deaths in men and 20 percent of those in women.

Significant positive associations were found between obesity and higher death rates for the following cancers: esophagus, colon and rectum, liver, gallbladder, pancreas, kidney, stomach (in men), prostate, breast, uterus, cervix, and ovary.

Over 90,000 cancer deaths per year could be avoided if the adult population all maintained a normal weight (BMI < 25.0).

Clearly, obesity is a major risk factor for cancer.

The case control studies have found consistent increased risk of a high glycemic load with gastric, upper aero digestive tract, endometrial, ovarian, colon or colorectal cancers.

The result from the laboratory study found that elevated fasting glucose, fasting insulin, 2 hour levels of glucose and insulin after an oral glucose challenge, and larger waist circumference were associated with a higher risk of colorectal cancer.

Slattery et al(2004) found an inverse correlation between vegetable, fruit and whole grain intake plant food intake and rectal cancer, while refined grains were associated with increased risk of rectal cancer.

A threshold of about 5 daily servings of vegetables was needed to reduce cancer risk and the effect was stronger among older subjects.

Fats, particularly saturated fats, may affect hormonal status, modify cell membrane structure and function, cell signaling transduction pathways, and gene expression, and they may even modulate functions of the immune system.

  Otman, R.A, (2007) have been suggesting that n-

6 polyunsaturated fatty acids (n-6 PUFA) and saturated fats are more likely to increase the incidence of cancer, whereas monounsaturated fatty acids (MUFA) and n-3 polyunsaturated fatty acids (n-3 PUFA) are more likely to prevent or decrease the chance of carcinogenesis.

Otman, R.A, (2007), Dietary Lipids and Cancer, Libyan Journal of Medicine, AOP: 070831.

 

Omega 3 fats (alpha-linolenic acid, EPA, DHA) have been shown in animal studies to be protect from cancer, while omega 6 fats (linoleic acid, arachidonic acid) have been found to be cancer promoting fats. (Table 1)

Block et al(2007) have reviewed about 200 studies of cancer and fruit and vegetable intake. A statistically significant protective effect of fruits and vegetables was found in 128 of 156 studies that gave relative risks.

For most cancers, people in the lower quartile (1/4 of the population) who ate the least amount of fruits and vegetables had about twice the risk of cancer compared to those who in the upper quartile who ate the most fruits and vegetables.

Vegetables and particularly raw vegetables, were found to be protective; 85% of the studies that queried raw vegetable consumption found a protective effect.

Cruciferous vegetables (broccoli, cauliflower, cabbage, Brussels sprouts) contain sulforophane, which has anticancer properties.

A case-control study in China found that intake of cruciferous vegetables, measured by urinary secretion of isothiocyanates, was inversely related to the risk of breast cancer; the quartile with the highest intake only had 50% of the risk of the lowest intake group.

Also, prostate cancer risk was found to be reduced by cruciferous vegetable consumption in a population-based case control study carried out in western Washington State.

Selenium is a mineral with anti-cancer properties. Many studies in the last several years have shown that selenium is a potent protective nutrient for some forms of cancer. (Table 2)

Vitamin B-12 : Washington Country, Maryland and the Nurses'

Health Study were found a relation between lower vitamin B12 status and statistically significant higher risk of breast cancer.

Folic Acid : (Table 3.4) Many studies have found a significant reduction in

colon, rectal, and breast cancer with higher intakes of folic acid and their related nutrients (vitamin B-6 and B 12). Alcohol is an antagonist of folate, so, drinking alcoholic beverages greatly magnifies the cancer risk of a low-folate diet.

Vitamin D Many studies discovered that vitamin D(exposure

sunshine) has been found to have a protective effect for prostate cancer, ovarian cancer, and breast cancer.

The high levels of antioxidants (particularly beta carotene and vitamin E) in fruits and

vegetables are believed to contribute toward cancer prevention, possibly by inhibiting oxidative stress.

However,Bardia, A, et al(2008) suggests that antioxidant supplementation, particularly with beta carotene and vitamin E does not prevent cancer. Further, beta carotene can increase the risk of smoking-related cancers (lung, head and neck, upper gastrointestinal tract, and bladder cancer) and can increase cancer mortality.

Bardia, A., Tleyjeh, I.M., Cerhan, J.R., Sood, A.K., Limburg,P.J and Montori, V.M, (2008), Efficacy of Antioxidant Supplementation in Reducing Primary Cancer Incidence and Mortality: Systematic Review and Meta-analysis, Mayo Clinic Proceedings. 83(1):23-34

Reduced cancer risk by

Dietary fiber Folic acid Vitamin D and

calcium Antioxidants (?) Soy food Balanced n3:n6

ratio selenium

Increased cancer

risk by Meat consumption Over consumption

of energy Imbalanced

glucose metabolism

Alcohol Salt Total and

unsaturated fat

Evidence

Decreased risk Increased risk

convincing

Physical activity(colon)

Overweight & obesity(Esophagus, colorectum, breast in postmenopausual, endometrium, kidndy)Alcohol(Oral cavity, pharynx, larynx, esophagus, liver, breast)Aflatoxin(liver), Salty food (nasopharynx)

Prabable Fruit and Vegetables(Most GI cancer)Physical activty(Breast)

Preserved meat (colorectum)Salt-preserved foods and salt(stomach)Very hot(thermally) drinks and food (oral cavity, pharynx, esophagus)

Possible Fiber,Soya, Fish, n-3 fatty acid, carotenoid,Vitamines, calcium, zinc and selenium, non-nutrient plant constituets

Animal fatsHeterocyclic aminesPolycyclic aroatic hydrocarbonsnitrisamines

• Adequate, but not excessive calories• 10 or more servings of vegetables a

day• 4 or more servings of fruits a day,• high in fiber,• no refined sugar,no refined flour, no

red meat.• low in total fat, but containing

necessary essential fatty acids,• a balanced ratio of omega 3 and

omega 6 fats and would include DHA,

• supplemented with ~200 μg/day selenium,

• supplemented with 1,000 μg/day vitamin B-12,

• very rich in folic acid (from dark green vegetables),

• adequate sunshine to get vitamin D, or use 1,000 IU/day supplement,

• very rich in antioxidants and phytochemicals from fruits and vegetables, including α-carotene, β-carotene, β-cryptoxanthin,vitamin C (from foods), vitamin E (from foods),

1. Bardia, A., Tleyjeh, I.M., Cerhan, J.R., Sood, A.K., Limburg,P.J and Montori, V.M, (2008), Efficacy of Antioxidant Supplementation in Reducing Primary Cancer Incidence and Mortality: Systematic Review and Meta-analysis,

2.  Do, M.H., Lee, S.S., Jung, P. J and Lee, M.H, (2007), Intake of Fruits, Vegetables, and Soy Foods in Relation to Breast Cancer Risk in Korean Women: A Case-Control Study,Nutrition and Cancer, 57(1), 20–27,

3. Donaldson, M.S.,(2004), Nutrition and cancer: A review of the evidence for an anti-cancer diet, Biomed central Nutrition Journal 3:19, doi:10.1186/1475-2891-3-19

4.Huncharek, M., Muscat, J., Kupelnick,B,(2009), Colorectal Cancer Risk and Dietary Intake of Calcium, Vitamin D, and Dairy Products: A Meta-Analysis of 26,335 Cases From 60 Observational Studies, Nutrition andCancer,61:1,47 - 69, DOI: 10.1080/01635580802395733.

5.Jinfu Hu; Carlo La Vecchia; Marie DesMeules; Eva Negri; Les Mery :(2008), Meat and Fish Consumption and Cancer in Canada, Canadian Cancer Registries Epidemiology Research, 60:3,313-324, DOI: 10.1080/01635580701759724

6. Kim, M.K., Kim, J. H., Nam, S.J., Ryu, S.H., Kong, G.(2008), Dietary Intake of Soy Protein and Tofu in Association With Breast Cancer Risk Based on a Case-Control Study Nutrition and Cancer,60:5,568 - 576, DOI: 10.1080/01635580801966203

7. Lucenteforte, E., Scita,V., Bosetti,C., Bertuccio, P., Negri, E., Vecchia,C.L.,(2008), Food Groups and Alcoholic Beverages and the Risk of Stomach Cancer: A Case-Control Study in Italy, Nutrition and Cancer, 60(5) 577 - 584, DOI: 10.1080/01635580802054512

8. Otman, R.A, (2007), Dietary Lipids and Cancer, Libyan Journal of Medicine,

AOP: 070831.

9. Wright, M.E., Park, Y. K., Subar, A.F., Freedman, N.D., Albanes, D., Hollenbeck, A., Leitzmann, M.F., and Schatzkin , A.,(2008), Intakes of Fruit, Vegetables, and Specific Botanical Groups in Relation to Lung Cancer Risk in the NIH-AARP Diet and Health Study, American Journal of Epidemiology, 168:1024–1034, DOI: 10.1093/aje/kwn212

10. Vecchia,C. L,(2004), Mediterranean diet and cancer, Public Health Nutrition, 7(7), 965–968, DOI: 10.1079/PHN2004562,Mayo Clinic Proceedings. 83(1):23-34

 

Thanks