“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, LDN Professor: 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% 2004 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. 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, colorectal, uterine, pancreatic, hepatic, prostatic, biliary, renal, & breast cancers, & multiple myeloma & nonHodgkin’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 1.8 1.4 1.2 1 recurrence breast cancer mortality all cause mortality 0.8 Relative Risk 1.6 0.6 0.4 0.2 >0.5 loss maintain 0.5-2.0 gain >2.0 gain 0 Change in BMI Kroenke et al. JCO 23: 1370-8, 2005 • 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 day in 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 Bagel 1980 vs. 2000 210 Calorie Difference 140 Calories 3” diam. 350 Calories 6” diam. French Fries 1980 vs. 2000 400 Calorie Difference 210 Calories 2.4 oz. http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm and http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2 610 Calories 6.9 oz. 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. Herbal Calcium Miracle • 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 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. Reach Out to ENhancE Wellness in Older Survivors (R01 CA106919) • 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 Thank you!