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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, 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!
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