cancer and diabetes: two epidemics or one? andrea reser, rd/ld
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Cancer and Diabetes: Two Epidemics or One? Andrea Reser, RD/LD Diabetes Program Coordinator/Clinical Dietitian. Overview. Diabetes Epidemic Cancer Statistics Relationship of Diabetes and Cancer Importance of Blood Sugar Control Treatment Challenges Cancer Fighting Diabetic Diet - PowerPoint PPT PresentationTRANSCRIPT
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
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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
29
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.