Professor Annie S. AndersonCentre for Public Health Nutrition Research

Centre for Research into Cancer Prevention and Screening

Ninewells Medical School,

University of Dundee

email: a.s.anderson@dundee.ac.uk

The importance of diet and exercise for cancer patients

Supported by The Scottish Cancer Foundation

www.cancerpreventionscotland.co.uk/

The Scottish Cancer Prevention Network

Nutrition throughout the lifecycle –

cancer model

Uuay & Solomons

Reducing the risk- current evidence

If there was a drug that reduced kidney

cancer risk by 19% with

– No known side effects

– Decreased risk of heart disease and diabetes

Should we know about it?

Should it be marketed and promoted?

Should we discuss it with health teams?

Would we want people of all ages to take

it in order to “stack the odds” in favour of

not developing cancer?

Cancers of 17 sites – 80% of incidence and deaths worldwide

http://www.dietandcancerreport.org

Review Evidence

How many cases of cancer could be prevented

in the UK if everyone was a healthy weight?

Type of cancer % Number

Oesphagus 31 2700

Pancreas 15 1300

Gallbladder 16 280

Bowel 14 6000

Breast 16 8100

Womb 38 3200

Kidney 19 1900

Ovary 4 270

Total for 8 cancers

combined

17 23,550

http://www.wcrf-uk.org/uk/preventing-cancer/lifestyle-statistics/body-

fatness

The Panel

emphasises the

importance of not

smoking and of

avoiding

exposure to

tobacco smoke

WCRF Global

Recommendations

Lifestyle and health outcomes in

cancer survivorsReduced risk of cancer recurrence?

Improved overall morbidity and mortality

Quality of life

Fatigue

Depression

Self esteem

Physical functioning

The Panel

emphasises the

importance of not

smoking and of

avoiding

exposure to

tobacco smoke

WCRF Global

Recommendations

Energy dense foods and drinks

Principally drinks with “added

sugar”•Colas, squashes, sodas

•Fruit juices (limited)

2007 to the future…•Milk Shakes (2160 kcals)

•Fruit Smoothies no sugar added… (120 to 190kcals)

•With “Health added” e.g. Orange Juice Drink with 'Five

Added Nutrients'

Sugary Drinks- definitions

Low Energy Dense

10 to 100kcals/100g

vegetables, fruit

Energy Density- definitions

Low Energy Dense

60 to 150kcals/100g

Grains,Legumes,

Porridge

Low Energy Dense

100 to 220 kcals/100g

Bread,

lean meat, fish

High Energy Dense

>225 to 275 kcals +/100g

Energy Density-definitions

High Energy Dense

>225 to 275 kcals+/100g

High Energy Dense

>225 to 275 kcals+/100g

Fast Foods

Readily available convenience foods

- Energy dense

- Consumed frequently

- Large portions

1420 Kcal

Fast foods- definitions

No Exercise trials with survivorship endpoints

Exercise is a safe and effective way to provide

rehabilitation for cancer survivors

Short term interventions HAVE demonstrated

– Improved aerobic capacity

– Strength

– Body composition

– Quality of life

– Reduced fatigue

– Emotional distress

– Lymphedema symptoms

Include resistance training for body composition

Physical activity

What are the current recommendations?

Aim to be active daily!• 150mins moderate intensity activity /wk in bouts of ≥10 mins

• Or 75 mins of vigorous activity / week

• Or a combination of the two

Activity to improve muscle strength ≥ 2 days / week

Older adults at risk of falls to incorporate activity to improve balance and coordination ≥ 2 days / week

Minimise time spent being sedentary (sitting) for extended periods

UK Department of Health, 2011

Walking + pedometers?

Pedometers have been identified as the single most effective method of physical activity promotion (Heath et al., 2012).

Plant foods

Five a day… minimum

Fibre from unprocessed cereals /whole

grains and/or pulses with every meal

Limit refined starchy foods (white

flour, pastry, biscuits, baked goods)

US Dietary Guidelines for Americans

3 x 16g servings of wholegrain per day

Equivalent to:

“Make half your grains whole”

UK: Median daily adult intake 20g and 17%

adults eat none*

30g 1 tbsp3 tbsp

*Mann et al 2014

Fruit and Vegetable portions

1. Which of the following contains 1 portion

fruit/veg

a) 6 slices cucumber

b) 1 grape

c) 2 tablespoons tomato ketchup

d) 7 strawberries

e) None of the above

Fruit and Vegetable portions

2. How many fruit and veg portions in a

salad which contains:

4 lettuce leaves, 2 slices cucumber, 2 slices

of tomato and one slice of beetroot

a) 0 portions

b) 1 portion

c) 2 portions

d) 3 portions

e) 4 portions

What is meant by five a day ?

Quantity, Variety and Quality???

Animal Foods•300g cooked (40g/day) =

400-450g raw per week

•500g cooked (70g/day) =

700-750g raw per week

•Red meat need not be a

daily food

•One average portion red

meat every other day

•Poultry, fish and eggs-

little risk

Processed meat..no level of intake not

associated with risk

Risk and choices………..Health

advisors 2007, Policy 2008

Alcoholic drinks

Communication

Consistency

Keep intakes low

Cardiovascular

disease

Brief Intervention

Risk and

choices………..

Don’t forget the calories….?

Don’t forget the calories….?

Don’t forget the calories….?

Don’t forget the calories….?

Don’t forget the calories….?

Dietary Supplements

BEWARE!!!

57 to 87% US cancer survivors initiate

supplements after diagnosis

Unlikely to improve prognosis

May make things worseMay be a role for standard multi vitamins/minerals during

and after cancer treatments if defeciency or cannot take

meet nutritional needs through diet- not routine needs

Misinformation

Omega -3

Micronutrient testing

Organics

Deodorants/antiperspirants

One study doesn’t make a summer!

Lay beliefs (knock!)

Thinking of losing weight?

• A modest 5-10% weight loss MAINTAINED LONG TERM can

significantly improve a person’s health (and wellbeing)

• BUT

Improving health risks

Many men

think

slimming

and dieting

are just “for

women”

Men often prefer to control their weight through exercise

Camelon 24/03/09

Most men avoid weight loss groups

Weight-management for men through increasing

physical activity and eating a healthier diet

Free of charge, group-based programme

12, weekly sessions with ‘classroom’ education

and ‘training’ at Scotland's top football clubs

PLUS

Daily pedometer-based homework

THEN

Light touch ongoing maintenance to 12 months

(6 email prompts and 1 reunion session at club)

Appeals to men

1) Healthy eating, not a diet, focus on PA and alcohol

2) Football clubs, male-only, club community coaches

3) Interactive, informal, banter Gray, Hunt, Mutrie et al,

BMC Public Health 2013

Who did FFIT attract?

Men at high risk of ill health

Mean age: 47 yrs

Mean BMI: 35 kg/m2

Mean BP: 140/89mmHg (elevated140/90mmHg)

BMI Category

Overweight (BMI 28-

29.9)

8%

Obese I (BMI 30-34.9) 44%

Obese II (BMI 35-39.9) 31%

Obese III (BMI ≥40) 17%

• Weight loss activities in last 3 monthsCommercial

programme

NHS Services

Not at all 96% 98%

Coaches did a great job: 86%

of key tasks delivered

High attendance: 80% of men

at 6 or more sessions

Results: Was FFIT effective?

Weight loss (kg)

Between-group difference 12 weeks 5 kg p<.0001

Between-group difference 12 months 5 kg p<.0001

5.8 5.6

0.4 0.6

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

12 weeks 12 months

Mean

Weig

ht

loss

Intervention

Waist reduction

6.77.3

1.02.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

12 weeks 12 months

Mean

red

ucti

on

wais

t (c

m)

Intervention

Comparison

Results: Other 12 month outcomes

Lower blood pressure

7.9

4.6

6.6

3.8

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Systolic Diastolic

BP

red

ucti

on

at

12 m

on

ths (

mm

Hg

)

Intervention

1219

375

0

200

400

600

800

1000

1200

1400

Med

ian

in

cre

ase i

n t

ota

l P

A

at

12 m

on

ths (

ME

T-m

ins/w

eek)

Intervention

Comparison

Fitter and more active

A healthier diet

-4.5

0.8

-1.3

-1.7

0.3

-0.5

-5.0

-4.0

-3.0

-2.0

-1.0

0.0

1.0

Mean

ch

an

ge in

die

t at

12 m

on

thss

Intervention

Fatty Fruit and Sugary

foods vegetables foods

Drinking less alcohol

-4.2

-2.2

-4.5

-4.0

-3.5

-3.0

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

Me

an

ch

an

ge 7 d

ay t

ota

l a

lco

ho

l c

on

su

mp

tio

n a

t 12 m

on

ths (

un

its)

Intervention

“I feel better in myself….”

0.0

0.1

0.2

0.3

Incre

ased

self

este

em

0.0

0.1

0.2

0.3

Incre

ased

po

sit

ive a

ffect

0

0.5

1

1.5

2

2.5

Bett

er

qu

ality

of

life

P1: I would just have said it was one of

the

best twelve weeks.

P5: Aye, it was brilliant.

P2: That’s one of the best things I’ve

ever

done in my life.

P4: To me, it’s life changing. It was life

changing, you know? Hopefully, you

know, that you know, it will keep it up.

I know I’m determined I will keep it

up.

Building the evidence

Conclusions

Current recommendations for people living

with cancer highlight

Body weight – building healthy bodies

Being Physically Active

Healthy diet, high in wholegrains and plant

foods, low in animal fats

For good health, well being and stacking the

odds against cancer recurrence