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“Living Your Best After Cancer: Healthy Diet Choices”
Wendy Demark-Wahnefried, PhD, RD, LDN
• Professor, Duke University School of Nursing & Duke University Medical Center’s Dept. of Surgery
• Nationally-recognized nutritionist with research focusing on the relationship between diet and cancer diagnosis and treatment
• 2003-2005—Director of the Cancer Prevention, Detection & Control Research Program at Duke Comprehensive Cancer Center
• 2003—Named Susan G. Komen Professor of Survivorship
Living Your Best After Cancer: Healthy Diet Choices
Wendy Demark-Wahnefried, PhD, RD, LDNProfessor: School of Nursing & Dept. of Surgery
Duke University Medical Center
Outline
• How important is diet for the cancer survivor?
• What dietary changes are the most helpful?
ACS Dietary Recommendations
Achieve or maintain a healthful weight. Choose foods that help maintain a healthful weight. Adopt a physically active lifestyle.
Eat a variety of healthful foods, with an emphasis on plant sources. - eat 5 or more servings of a variety of vegetables & fruit each day.
- choose whole grains in preference to processed (refined) grains & sugars.
- limit consumption of red meats, especially those high in fat & processed.
If you drink alcoholic beverages, limit consumption.
Striving for a
Healthy Weight
Body Mass Index
BMI = _ (Weight in Pounds) X 703 (Height in inches) x (Height in inches)
If 25 or over: Overweight
If 30 or over: Obese
Trends in Overweight* Prevalence (%) Adults 18 & Older, 1992-2004
1992 1995
1998
Less than 50% 50 to 55% More than 55% State did not participate in survey
*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005.
2004
Weight Management
& Energy Balance
Anorexia/Cachexia • Patients with select
respiratory, G.I. & childhood cancers
• Patients living with advanced cancer
• Increasing weight to desired range important for recovery, well-being, functional status
• Diet & exercise key roles +/- pharmacotherapy
Overweight/Obesity • Overweight a risk factor for
cancers of endometrium, colon, esophagus, kidney,& breast(post-menopausal)–high proportion overweight (71% of breast/prostate survivors)
• Overweight at dx poor prognostic indicator for cancer overall & cervical, esophageal, gastric, colo-rectal, uterine, pancreatic, hepatic, prostatic, biliary, renal, & breast cancers, & multiple myeloma & non-Hodgkin’s lymphoma
• Weight gain common during & after treatment–linked with co-morbidity, functional decline & maybe recurrent/progressive CA
Weight Change After Diagnosis & Association with Recurrence & Mortality
Data from Cohort of 5204 Breast Cancer Survivors in Nurse’s Health Study
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
>0.5 loss maintain 0.5-2.0gain
>2.0 gain
recurrencebreast cancer mortalityall cause mortality
Change in BMI
Kroenke et al. JCO 23: 1370-8, 2005
Re
lativ
e R
isk
• Maintain a healthful weight throughout life.
• Balance caloric intake with physical activity
• Lose weight if currently overweight or obese
How are we doing???On any given day in the United States...
815 billion calories are consumed (200 billion more than needed)
47 million hot dogs
4 million pounds of bacon
60 million pounds of red meat
170 million eggs
On any given dayin the United States...
3 million gallons of ice cream
10 million pounds of candy
16 million gallons of beer and ale
1.5 million gallons of hard liquor (enough to make 26 million people drunk!)
Remember Portion Size
210 Calories2.4 oz.
610 Calories6.9 oz.
350 Calories6” diam.
French Fries 1980 vs. 2000400 Calorie Difference
Bagel1980 vs. 2000210 Calorie Difference
http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm and http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2
140 Calories3” diam.
Think Volumetrics -Choose Lower Calorie Foods that Fill-you-up
…6 potato chips or 3 cups of popcorn
To date there are limited data showing a benefit of a healthful diet on cancer-related survival, however data show that cancer survivors who eat a plant-based diet have lower death rates from other diseases Compared with those who eat a Western diet
Kroenke et al JCO 23:9295-303, 2005
Choose whole grains in preference to processed (refined) grains and sugars.
Include grain products such as breads, cereals rice, pasta, or beans in every meal.
Eat other foods from plant sources several times each day.
Limit consumption of refined carbohydrates, including pastries, sweetened cereals, soft drinks, and sugars.
Eat AT LEAST 5 or more servings of vegetables and fruits each day
Include vegetables or fruits in every meal and for snacks.
Limit french fries, snack chips, and other fried vegetable products.
Choose 100% juice if you drink fruit or vegetable juices.
Alcohol among Cancer Survivor
Alcohol linked to cancers of the kidney, head & neck and breast.
Head & neck survivors who continue to drink have more complications, higher recurrence, other diseases and death
Alcohol protects against heart disease, so survivors need to weigh risks. If do drink alcohol, do so in moderation (ACS)
Survivors and Supplements
• No supplements have proven benefit on cancer-related outcomes, though some may reduce anxiety, etc.
• Refer to responsible sources of information, i.e., National Center for Complementary & Alternative Medicine (http://nccam.nih.gov)
• Rely on food as a source of nutrients
Calcium Herbal Miracle
60-89% of survivors take supplements
40-50% begin additional supplements after diagnosis
A healthful body weight & healthy diet are important for the
cancer survivor
• Achieve/maintain a healthful weight
• Consume a plant-based, nutrient-dense diet
• Moderate alcohol intake
• Seek local, regional or national programs that can provide support (i.e., ACS, NCCAM, clinical trials, hospital-based or community initiatives.
• Test the impact of a diet-exercise mailed material/telephone counseling program on weight loss & physical functioning in 640 prostate, colorectal & breast cancer survivors
• 65+ years of age
• 5+ years out from diagnosis
• No progressive disease
Reach Out to ENhancE Wellness in Older Survivors
(R01 CA106919)
Thank you!