cancer and diabetes: two epidemics or one? andrea reser, rd/ld

Cancer and Diabetes: Two Epidemics or One?

Andrea Reser, RD/LDDiabetes Program Coordinator/Clinical

Dietitian

2

Overview

•Diabetes Epidemic

•Cancer Statistics

•Relationship of Diabetes and Cancer

•Importance of Blood Sugar Control

•Treatment Challenges

•Cancer Fighting Diabetic Diet

•Prevention

•Conclusions

Cancer & Diabetes: The Connection

4

US Mortality

1. Heart disease: 652,091

2. Cancer: 559,312

3. Stroke (cerebrovascular diseases): 143,579

4. Chronic lower respiratory diseases: 130,933

5. Accidents (unintentional injuries): 117,809

6. Diabetes: 75,119

7. Alzheimer's disease: 71,599

8. Influenza/Pneumonia: 63,001

9. Nephritis, nephrotic syndrome, and nephrosis: 43,901

10. Septicemia: 34,136

Source: Centers for Disease Control, 2008, www.cdc.gov

5

Diabetes Overview

•Diabetes

–Disease in which the body does not produce or properly use insulin

Source: American Diabetes Association, 2008 www.diabetes.org

Picture: http://www.medicinenet.com/islet_cell_transplantation/article.htm

6

Major Types of Diabetes

•Type 1 Diabetes

–Results from body’s failure to produce insulin

–5 to 10% of Americans

•Type 2 Diabetes

–Results from insulin resistance (body fails to properly use insulin), combined with relative insulin deficiency

–Most Americans

•Gestational Diabetes

– Immediately after pregnancy 5-10% have Type 2 diabetes

•Pre-diabetes

–Blood glucose levels higher than normal but not enough for diagnosis in Type 2 diabetes

Source: American Diabetes Association, 2008, www.diabetes.org

7

Diabetes Epidemic

• 23.6 million children and adults in United States (8%)

–17.9 million have been diagnosed

–5.7 million are unaware

–57 million prediabetes

• CDC: Last 15 years numbers have more than doubled

Sources: American Diabetes Association, 2008, www.diabetes.org; Centers for Disease Control, 2008, www.cdc.gov

8

Mortality Change

Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2004 Mortality Data: US Mortality Public Use Data Tape, 2004, NCHS, Centers for Disease Control and Prevention, 2006

19.8

180.7

48.1

586.8

193.9

50.0

185.8217.0

0

100

200

300

400

500

600

HeartDiseases

CerebrovascularDiseases

Pneumonia/Influenza

Cancer

1950

2004

Rate Per 100,000

9

2008 Estimated US Cancer Deaths

Source: American Cancer Society, 2008, www.cancer.org

Men294,120

Women271,530

•26% Lung & bronchus

•15% Breast

•9% Colon & rectum

• 6% Pancreas

• 6% Ovary

• 3% Non-Hodgkin lymphoma

• 3% Leukemia

• 3% Uterine corpus

• 2% Liver & bile duct

• 2% Brain/ONS

•25% All other sites

Lung & bronchus 31%

Prostate 10%

Colon & rectum 8%

Pancreas 6%

Liver & intrahepatic 4%bile duct

Leukemia 4%

Esophagus 4%

Urinary bladder 3%

Non-Hodgkin 3% lymphoma

Kidney & renal pelvis 3%

All other sites 24%

10

Lifetime Probability: Men

Site Risk

All sites† 1 in 2

Prostate 1 in 6

Lung and bronchus 1 in 12

Colon and rectum 1 in 17

Urinary bladder‡ 1 in 28

Non-Hodgkin lymphoma 1 in 47

Melanoma 1 in 49

Kidney 1 in 61

Leukemia 1 in 67

Oral Cavity 1 in 72

Stomach 1 in 89

Source: American Cancer Society, 2008, www.cancer.org

11

Lifetime Probability: Women

Site Risk

All sites† 1 in 3

Breast 1 in 8

Lung & bronchus 1 in 16

Colon & rectum 1 in 19

Uterine corpus 1 in 40

Non-Hodgkin lymphoma 1 in 55

Ovary 1 in 69

Melanoma 1 in 73

Pancreas 1 in 79

Urinary bladder‡ 1 in 87

Uterine cervix 1 in 138

Source: American Cancer Society, 2008, www.cancer.org

12

Overview

•Diabetes Epidemic

–Most undiagnosed

•Lifetime Risk:

–Male: 1 in 2

–Female: 1 in 3

8-18% of cancer patients also have diabetes

Source: American Cancer Society, 2008, www.cancer.org

13

Diabetes and Cancer

•Type 1:

–Cervical Cancer

–Stomach Cancer

•Type 2:

–Breast Cancer

–Endometrial Cancer

–Pancreatic Cancer

–Liver Cancer

–Kidney Cancer

–Colon Cancer

14

1992 1995

1998

Less than 50% 50 to 55% More than 55% State did not participate in survey

2005

Obesity Trends

Source: Centers for Disease Control, 2008, www.cdc.gov

15

The Relationship

•Hyperglycemia (high blood sugar)

•Elevated insulin concentrations

•Growth promoting effects of IFG-1

16

Blood Sugar Control

•80-110 mg/dl

•Increased length of stay and cost

•Higher infection rate

•Shorter remission periods

•High morbidity and mortality rates

•Decreased Immune Function

•Decreased Quality of Life

17

Treatment Challenges

•Treatment induced diabetes

•Parenteral and enteral nutrition

•Reduced/omission of dose

•Delays in treatment

•Co-morbidities

•Aftercare and quality of life

•No National Standards

Cancer Fighting Diabetic Diet

19

Nutrition Goals

•Diabetes–Achieve and maintain:

–Blood glucose

–Lipid profile (cholesterol, LDL, HDL, TG)

–Blood pressure

–Prevent/Slow chronic complications

–Address individual nutritional needs

–Maintain pleasure with eating

•Cancer–Achieve and maintain:

–Energy stores

–Lean body mass

–Maximize the Immune System:

–WBC, RBC, platelets

–Prevent/Slow treatment side effects

–Address individual nutritional needs

–Maintain pleasure with eating

20

Carbohydrates (CHO)

•Largest effect on blood sugar

•Encouraged to include

•Low CHO (<130g/day) not recommended

•Monitor CHO intake

–Exchange List

–Carbohydrate counting

–Plate Method

21

Carbohydrates

Carbohydrates

Simple ComplexWhole Grains, Fruit,

VegetablesWhite Refined Products

22

Sweeteners

•Artificial sweeteners

–Aspartame, saccharin, sucralose, acesulfame-K

–No calories

•Sugar Alcohols

–Xylitol, mannitol, sorbitol

–Calories, GI discomfort

•Natural sweeteners

–Stevia, fructose, honey, molasses

23

Carbohydrates (CHO)

•Choose More Often:

–Whole Fruits

–Whole Vegetables

–Whole Grains

–Beans/Legumes

–Natural Sugars

•Choose Less Often:

–White, refined products

–Simple sugars

–Cakes, candy

–Sugar free products

24

Protein Overview

•Building block of our bodies

•Regulates blood sugar

•Builds:

–Immune system–WBC, RBC

–Muscles

–Hormones

–Enzymes

•Specific amount established by Dietitian

25

Protein

•2/3 of Protein in Diet:

–Beans/Legumes

–Nuts/Seeds

–Nut Butters

–Whole Grains

–Soy

–Powders:

–Rice

–Vegetable

–Soy

•1/3 of Protein in Diet:

–Animal Meats

–Red meat <18 oz week

–Dairy

–Eggs

–Powders:

–Whey (Dairy)

–Goat

Builds and Supports Immune System

Source: American Institute for Cancer Research, 2008, www.aicr.org

26

Fat Overview

•Essential in diet

•Regulates blood sugar

•Fat and Cholesterol

–Increase risk for heart disease

–Increase cancer risk

27

Fats

• Saturated Fats

– Solid at room temperature

– Animal Sources

– Linked to cancer

– Limited quantity

• Unsaturated Fats

– Liquid at room temperature

– Plant sources

• Trans Fats

– “Hydrogenated Fats”

– Self stable and frozen products

Fats

SaturatedUnsaturatedTrans Fats

28

Fats (con’t)

•Monounsaturated Fats (MUFA)

•Polyunsaturated Fats (PUFA)

•Omega-3–Fish (from ocean)–Walnuts–Canola Oil–Fortified Foods–Flaxseed

•Omega-6–Fried Foods–Animal Meats–Grains

Unsaturated

MUFA PUFA

Omega-3 Omega-6

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7% 21% 11% 61%

10% 76% 1% 14%

12% 71% 1% 16%

13% 57% 1% 29%

15% 9% 1% 75%

15% 54% 8% 23%

19% 33% 1% 48%

27% 54% 1% 19%

43% 9% 1% 47%

51% 10% 1% 39%

68% 3%1% 28%

91% 2% 7%

Canola oil

Saff low er oil

Sunflow er oil

Corn oil

Olive oil

Soybean oil

Peanut oil

Cottonseed oil

Lard

Palm oil

Butterfat

Coconut oil

Comparison of Dietary Fats

Saturated Fat Omega-6 Omega-3 Monounsaturated Fat

30

Overview: Fats

Fats

Saturated Fats Unsaturated Fats Trans Fats

Monounsaturated FatsPolyunsaturated FatsOmega-3 & 6

Limit Encouraged AVOID

31

Alcohol

•Alcohol

–Increase risk of low blood sugar–Consume with food

–Empty calories

–Increase cancer risk

–Dehydrates body

–Female: one drink

–Male: two drinks

Cancer and Diabetes Prevention

33

Prevention

•Lifestyle modifications

–Maintain a healthy weight–Moderate wt loss (7% of body wt)

–Regular physical activity –At least 30 minutes daily, 5 days week

•Three strategies for weight loss

–Eat a greater proportion of plant based foods

–Watch the size of your portions

–Keep physically active

34

Play with Your Food

Size of fist = one serving

of carbohydrat

esSize of thumb joint = one to

two servings of fat

Size of palm = one serving of meat, poultry, or fish

Eat with your

Hands!

35

Body Mass Index (BMI)

BMI Weight Status

Below 18.5 Underweight

18.5-24.9 Normal

25.0-29.9 Overweight

30.0 and above Obese

BMI = [ Weight in Pounds ] x 703

(Height in inches) x (Height in inches)

Example: [ 150 pounds ] x 703 = 26.5

(63 inches) x (63 inches)

36

Prevention & Diet

•Eat plenty of vegetables and fruits

–Five to Nine a Day–Standard serving ½ cup

–Prevent at least 20% of all cancers

–Fiber–Juice

–Vitamins, Minerals, Phytochemicals–Antioxidants

37

24.2 24.4 24.1 24.4 23.6 24.3

0

5

10

15

20

25

30

35

1994 1996 1998 2000 2003 2005

Year

Pre

vale

nce

(%)

Vegetable and Fruit Servings

Source: American Cancer Society, 2008, www.cancer.org

38

Prevention & Diet

•Select foods low fat and in salt

–Limit processed foods

–Linked to most cancers

39

Cancer & Alcohol

•Drink alcohol only in moderation, if at all

–Can cause cancer–Mouth, esophageal, laryngeal, pharyngeal, breast, and liver cancers

–75-80% of oral cancers frequently used alcohol

–Men: 2 drinks a day; Females: 1 drink per day More alcohol = Higher risk Higher risk if use tobacco

–Empty calories

–Increase appetite

Source: American Cancer Society, 2008, www.cancer.org

40

Protein

Vegetables

Carbohydrate/Fruit

Fats

New American Plate

2/3 (or more) vegetables, fruits, whole grains, and

beans

1/3 (or less)

animal protein

Source: American Institute for Cancer Research, 2008, www.aicr.org

41

Stage 1: Old American Plate Stage 2:

Transitional Plate

Stage 3: The New American Plate

Source: American Institute for Cancer Research, 2008, www.aicr.org

42

Overview

•Maintain a healthy weight and be physically active

•Choose a diet rich in a variety of plant based foods

•Eat plenty of vegetables and fruits

•Drink alcohol only in moderation, if at all

•Select foods low in fat and salt

Source: American Institute for Cancer Research, 2007

Eat with Your Hands!

43

Conclusions

•Diabetes epidemic continues

•Strong correlations with diabetes and cancer

•Control blood sugar = more cancer fighting

•Future of Cancer and Diabetes

–Education gap

–National standards

Thank You!

45

Resources

American Cancer Society:

www.cancer.org

American Diabetes Association:

www.diabetes.org

American Institute for Cancer Research:

www.aicr.org

Cancer Treatment Centers of America:

www.cancercenter.com

46

Resources (con’t)

• AICR ScienceNOW. Summer 2008

• American Cancer Society. Cancer Facts and Figures 2008. Available at: http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf

• American Diabetes Assocation. Nutrition Recommendations and Interventions for Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2007; 30 Suppl 1: S48-S65.

• Basaria S, Muller DC, Carducci MA, Egan J, Dobs AS. Hyperglycemia and Insulin Resistance in Men with Prostate Carcinoma who Receive Androgen-deprivation therapy. Cancer. 2006; 106(3): 581-588

• Bunker K. A Diet-Cancer Connection. Diabetes Forecast. June 2008.• Eyre HJ, Kahn R, Robertson RM. Preventiong Cancer, Cardiovascular Disease, and

Diabetes: A common Agenda for the American Cancer Society, the American Diabetes

Association, and the American Heart Association. CA Cancer J Clin. 2004; 54(4): 190-207. • Garg R, Bhutani H, Alyea E, Pendergrass M. Hyperglycemia and Length of Stay in Patients

Hospitalized for Bone Marrow Transplantation. Diabetes Care. 2007; 30 (4): 993-994

• Grant B and Evert A. Managing Patients Diagnosed with Cancer and Diabetes. Today’s Dietitian, August 2008

• Richardson LC, Pollack LA. Therapy Insight: Influence of Type 2 Diabetes on the Development, Treatment, and Outcomes of Cancer. Nat Clin Pract Oncol. 2005; (2)1: 48-53.