Block 5: Nutrition & Cancer

Does protein supplementation or nutritional counseling improve outcomes/caloric intake in patients being treated for cancer?

nutritional counseling

Function of indoles and isothiocyanate

protect cells from DNA damage inactivate carcinogens antiviral/antibacterial effects induce cell death (apoptosis) inhibit tumor angiogenesis & metastasis

Mechanism of alcohol in increased cancer risk?

Damages DNA d/t acetaldehyde which is a toxic metabolite produced in the breakdown of alcohol. Produces ROS Increases blood levels of estrogen --> increase breast CA risk Causes tissue damage, inflammation, interactions with folate, and interference with estrogen pathways

Tx of diarrhea during CA treatment

Drink at least 1 cup of liquid after Eat small frequent meals Bland foods (avoid greasy, caffeine, ETOH, spicy) Limit foods that cause gas Eat foods high in pectin like applesauce/bananas

Indoles and isothiocyanate

Chemicals found in vegetables and fruits that have been shown to inhibit development of cancer in several organs in rats and mice (studies in humans have shown mixed results)

What treatment of cancer has the greatest prevalence of side effects related to malnutrition?

Chemotherapy (radiation a close second)

Calcium/dairy foods reduce risk of

Colorectal CA

Physical activity reduces risk of

Colorectal, breast, esophagus, pancreas, liver, and endometrial CA

Obesity has a convincing association with what forms of cancer?

Colorectal, breast, prostate, and endometrial

Grilled/BBQ foods increase risk of

Colorectal, stomach CA

Anthocyanins

Contained in blueberries; destroy free radicals

Allyl sulfides

Contained in garlic/onion/asparagus; destroy cancer cells, reduce metastasis, support immune health

Reseveratrol

Contained in grapes, wine; may decrease estrogen production

Lycopene

Contained in tomatoes/watermelon; antioxidant that cuts prostate CA risk

What type of veggie is specifically anti-carcinogenic?

Cruciferous vegetables like broccoli/brussel sprouts

Tx for Taste changes during CA treatment

Rinse mouth before meals Plastic utensils Experiment with herbs/spices Too salty ---> add sweetener Too sweet ---> add salt

Recommendations for cancer survivors?

Same as cancer prevention

Alcohol has a convincing associated with what forms of cancer?

head and neck

Red meat increases risk of

Colorectal CA

Moderate physical activity has convincing evidence in the decrease of what types of cancer?

Colorectal and breast

Aflatoxin increases risk of

Liver CA

Selenium reduces risk of

Lung, colorectal, prostate CA

Dietary/lifestyle methods to reduce cancer risk?

Reduce ETOH Maintain healthy body weight Increase physical activity Adopt a plant-based diet

Benefits of a plant based diet?

Rich in phytochemicals, vitamins, and minerals that protect against cancer (anti-oxidants)

Lactation reduces risk of

breast CA

Fiber reduces risk of

colorectal, esophagus CA

For people who are already overweight/obese, there are benefits from even a _______ reduction in weight

modest

BMI and cancer have a ________ correlation

positive

Waist circumference associated with cancer risk

37+ in men 31.5+ in women

BMI associated with cancer risk

40+

What percentage of patients undergoing cancer treatment experience malnutrition?

40-80%

According to ASPEN malnutrition guidelines, what is considered a severe amount of weight loss?

5% weight loss over 1 month

Mechanism of dietary antioxidants in cancer risk reduction?

Antioxidants neutralize free radicals in the body preventing cancer initiation, proliferation, and angiogenesis

Dietary antioxidants

Beta-carotene, lycopene, vitamins A/C/E (tocopherol) *Selenium thought to be an antioxidant, but research shows it's more likely that the proteins that use Se are antioxidants (indirect antioxidant)

Tx of constipation during CA treatment

Eat same time each day Drink a hot beverage or eat hot cereal Drink at least 8 cups of fluid per day More fiber Exercise

Folate reduces risk of

Esophagus, pancreas, and colorectal CA

Cancer-related defects in fat metabolism

Excess body fat depletion relative to protein loss Decreased free fatty acids and glycerol turnover Hyperlipidemia Decreased serum lipoprotein lipase activity

Dietary fiber mechanism in colorectal cancer risk reduction

Fiber may bind, dilute, or rapidly remove potential carcinogens in the GI tract Phytochemicals present might also fight ROS/carcinogens

Tx for nausea/vomiting during CA treatment

Ginger Avoid favorite foods Suck on tart hard candies Bland foods Small frequent meals

Cancer-related defects in carb metabolism

Glucose intolerance Insulin resistance Abnormal insulin secretion Delayed glucose clearance Increased glucose production Variable disorders of the metabolic cycle

Mechanism of increased cancer risk in obesity?

Increased insulin ---> insulin growth factor-1 + sex steroids Reflux (esophageal CA) Chronic inflammation (oxidative stressors)

Cancer-related defects in protein metabolism

Increased whole body protein turnover Persistent muscle protein breakdown Decreased plasma branched chain amino acids

Recommendations for cancer prevention

Keep healthy weight/stay physically active Limit red/processed meats/sugar/ETOH Eat diet rich in whole grains/veggies/fruits

Tx for fatigue during CA treatment

Light physical activity Prepare frozen meals on good days Ask for help Nutritional supplementation

What carcinogens do processed/preserved meats contain?

Nitrosamines (nitrites/nitrates)

Are dietary supplements supported as a reliable mechanism to decrease cancer?

No

Very hot foods/drinks increase risk of

Oral cavity, esophageal CA

Alcohol increases risk of

Oral cavity, esophageal, liver, colorectal, and breast CA

Fruits & veggies reduce risk of

Oral cavity, esophagus, lung, stomach, and colorectal CA

Cancers with the highest prevalence of malnutrition?

Pancreas & stomach

What carcinogens are produced by charring/smoking meat?

Polycyclic aromatic hydrocarbons (PAHs) and heterocyclic amines (HCAs)

Salted foods increase risk of

Stomach, nasopharynx CA

Tx for Sore mouth or throat during CA treatment

Straw Soft/pureed foods Rinse mouth with water/salt/baking soda

What is a measure of both subQ and metabolically active fat stores?

Waist circumference

Fish and garlic are associated with

a general reduction of cancer risk (no particular types)

Obesity increases risk of

esophagus, pancreas, colorectal, breast, endometrial, and kidney CA