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Cancer Facts

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-cancer has many causes primarily linked to the environment and heredity -diet is a factor that influences the development of most types of cancer -diets based on plant foods that include lean meats, fish, and low-fat dairy products, regular physical activity, and normal levels of body fat reduce cancer risk -Largely preventable, but there are no absolute guarantees that an individual will not develop cancer

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cancer

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second leading cause of death in the U.S., is a group of conditions that result from the uncontrolled growth of abnormal cells

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cancer phases: initiation

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something alters DNA in certain cells

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cancer phases: promotion

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cancer cells with altered DNA divide, producing large numbers of abnormal cells (takes place 10-30 years)

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cancer phases: progression

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-abnormal cells continue to divide unless corrected by some means -Body loses control over abnormal cells, numbers increase rapidly -Eventually cells become so numerous they erode normal functions of the body in the sites of growth -Abnormal cells can migrate to other tissues and cause DNA damage and abnormal cell development

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what causes cancer?

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-80-90% of cancers are initiated by environmental factors that alter DNA -Diet is a major environmental factor and may account for 40% of cancer risk -Most factors are modifiable

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dietary factors that cause cancer

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Westernization of dietary intake and lifestyle increases the risk of many types of cancer

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genetic factors for cancer

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-Some people have tendency toward cancer -They develop cancer if regularly exposed to certain substances in the diet or environment

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lifestyle risks of cancer

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-Cancer-promoting diets are low in vegetables and fruits -High saturated fat, regular intake of charred and nitrate-cured meats, and excessive alcohol are associated with cancer -Low intakes of whole grains, dried beans, nuts, and seeds increase cancer risk -Other risk factors include smoking, physical inactivity, and excess body fat

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cancer prevention

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-Cancer is a largely preventable disease -Increasing rates of new cases of cancer took a turn for the better after 1992 and correspond to declines in rates of tobacco use -Other improvements in lifestyles and diets will lead to further declines in cancer

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good food for cancer prevention

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-Frequent consumption of certain foods are strongly related to certain cancers -Consumption of tomato products related to decreased risk of prostate cancer -Green tea contributes to breast cancer reduction -Diets and lifestyles that prevent cancer are represented by characteristics, not hard rules about specific foods, dietary restrictions, or types of physical activities

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fruits, vegetables, and cancer

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-People who consume plenty of vegetables and fruits (5 or more servings daily) have a lower risk of developing a number of types of cancer than people who eat few -Cancer continues to decline as intake of fruits and vegetables increases -Some experts advise people to consume 5 to 9 servings daily It is not clear why fruits and vegetables have this effect

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antioxidants

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Vitamin C, beta-carotene, vitamin E, and selenium are antioxidants in vegetables and fruits

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phytochemicals

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in vegetables and fruits may participate in cancer prevention by protecting cells from damage due to oxidation and by inhibiting the multiplication of abnormal cells

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how much of phytochemicals?

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-3 cruciferous (broccoli, cabbage, cauliflower, and brussel sprouts) vegetable servings per week reduce the risk of lung, bladder, and prostate cancer -Phytochemicals act as antioxidants -Phytochemicals participating in cancer prevention are brightly colored -Select and consume colorful vegetables and fruits

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whole grains and cancer

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-Whole grains have vitamins, minerals, fiber, unsaturated fatty acids, and phytochemicals that work in cancer prevention -Effect on cancer risk is related to the combined action of these substances -Isolation of a single substance destroys its ability to function in cancer prevention -Americans are advised to include three or more whole grain products in their daily diet

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saturated fat and cancer

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High saturated fats from meats and dairy products increase risk of cancer

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diet and cancer guidelines

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-Dietary patterns and lifestyles to reduce risk of cancer are compatible with dietary recommendations to reduce the risk of heart disease -Considered together, recommendations for cancer prevention can be transferred to dietary intake by proper selection of foods

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body fat and cancer

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Central obesity increases the risk of cancer at several sites

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improve your odds

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-not smoking or drinking -consuming five or more fruits and vegetables daily -sticking to a low-saturated-fat diet -being physically active -maintaining a normal level of body fat

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simple steps to prevent cancer

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-Choose a diet rich in a variety of plant-based foods -Eat plenty of vegetables and fruits -Maintain a healthy weight and be physically active -Drink alcohol only in moderation, if at all -Select foods low in fat and salt -Prepare and store food safely

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bmi ranges

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below 18.5 = underweight 18.5-24.9 = healthy weight 25-29.9 = overweight 30+ = obese

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obesity

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-Overweight and obesity result from an energy imbalance. This involves eating too many calories and not getting enough physical activity. -Body weight is the result of Genes Metabolism Behavior Environment Culture Socioeconomic status -Behavior and environment play a large role causing people to be overweight and obese. These are the greatest areas for prevention and treatment actions.

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genetic factors for obesity

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-Inborn errors in metabolism (rare) -Predisposing traits triggered by environmental factors -5-50% genetics play a role

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environmental triggers for obesity

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inactivity, high-fat diet, or high-sodium intake that causes a genetic tendency to be expressed

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diet and obesity

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weight gain results when more energy is consumed than expended

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caloric utilization

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-Resting Metabolic Rate -Physical Activity Occupational work Household chores Leisure time activity -Thermic Effect of Food

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bmi

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-An indicator of body weight status based on a person's height -Calculated as kilograms per meter squared -Estimate of body fat content

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obesity = increased risk of...

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-Hypertension -Type 2 diabetes -Coronary heart disease -Gallbladder disease -Certain cancers -Elevated cholesterol -Low HDL-cholesterol -Stroke -Osteoarthritis -Sleep apnea -Shorter life expectancy

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weight loss benefits

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Loss of 5-10% of body weight benefits the overweight and obese: -Lowers blood insulin, triglycerides, glucose, and C-reactive protein -Increases insulin sensitivity and HDL cholesterol -Reduces risk of heart disease and diabetes -Decreased severity of sleep apnea -Reduced symptoms of degenerative joint disease -Improved gynecological conditions

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waist circumference

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High risk: Men >102 cm (40 in.) Women >88 cm (35 in.)

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strategies for weight loss and maintenance

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-Dietary therapy -Physical activity -Behavior therapy -"Combined" therapy -Pharmacotherapy -Weight loss surgery

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increase physical activity

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-Most important in preventing weight regain -Health benefits independent of weight loss

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pharmacotherapy

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Drugs approved for long-term use by the FDA may be used as part of a comprehensive weight loss program including diet and physical activity. *drugs should never be used alone

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who needs pharmacotherapy

answer

-For patients with a BMI of 30 or above with no concomitant risk factors or diseases -For patients with a BMI of 27 or above for those with concomitant risk factors or diseases (hypertension, dyslipidemia, CHD, type 2 diabetes, sleep apnea)

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bariatric surgery

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-BMI >40 or >35 with comorbid conditions -Reserved for patients in whom medical therapy has failed -Gastric restriction or gastric bypass

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gastric bypass surgery

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-most effective method for weight loss and maintenance -Results in loss of 50-60% excess weight -Resolution of weight-related health problems

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common weight loss strategies

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-Eat a diet low in total fat -Frequent self-monitoring of body weight and food intake -High levels of regular physical activity

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vegan

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A food plan consisting only of plant foods

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lacto-vegetarian

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A food plan consisting of plant foods plus dairy products

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quasi-vegetarian

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exclude beef, pork, and poultry, include fish, eggs, dairy products, and plant foods

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far-vegetarian

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excludes red meat

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flexitarian/semi-vegetarian

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eat a mostly veg diet, but occasionally eat meat

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benefits of vegetarianism

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-Lower intake saturated fat and cholesterol -Higher intake dietary fiber, magnesium, potassium, folate, antioxidants, and phytochemicals -Lower Body Mass Index (BMI) -Lower blood cholesterol and LDL levels -Lower blood pressure -Lower risk of obesity, heart disease, stroke, hypertension, type 2 diabetes, -chronic bronchitis, gallstones, and kidney stones

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nutrition consideration for veg

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Protein Iron Zinc Calcium Vitamin D Riboflavin (B2) Vitamin B12 Vitamin A/beta carotene Omega-3 fatty acids Iodine

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complete proteins

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Proteins that contain all nine essential amino acids in the amounts needed to support protein tissue construction

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complementary protein sources

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Plant sources of protein that together provide sufficient quantities of the nine essential amino acids (example: beans/legumes combined with a grain source)

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soy and health

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-Excellent source of protein -"Unique" source of isoflavones -Heart Disease: Soy low in serum cholesterol, may have other possible coronary benefits -Cancer: Possibly protective against breast (early intake) and prostate cancer

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key components of mediterranean diet

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-Eating a generous amount of fruits and vegetables -Consuming healthy fats such as olive oil and canola oil -Eating small portions of nuts -Drinking red wine, in moderation, for some -Consuming very little red meat, recommended only about once per month -Eating fish on a regular basis

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cardiac risk factors

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age, family history, gender, post-menopausal modifiable: prior CVD, HTN, obesity, diabetes, dyslipidemia, CKD, sedentary lifestyle, smoking, stress, PAD, sleep disorders

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good cholesterol

answer

HDL (high-density lipoprotein) —it may help remove extra cholesterol from plaques and arteries. -A high HDL can protect you against heart disease. -But a low HDL can put you at risk for heart disease! -So, think "H" for "healthy," or "high," which is what you want your HDL to be!

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triglycerides

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-Triglycerides are another type of fat in the blood. -High triglycerides can cause many problems, and have been associated with heart disease. -People with diabetes often have high triglycerides and low HDL

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ideal cholesterol

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less than 200

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declining heart disease

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-50% drop in deaths from heart disease related to: declines in blood cholesterol levels reduced rates of smoking improved blood pressure control advances in medical care -Rising obesity slowing improvements in CVD

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gender differences in heart disease

answer

-Risk for heart disease in women increases substantially after menopause -Menopause brings declines of estrogen and HDL and increases in LDL -Women have higher HDL and total blood cholesterol than men

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atherosclerosis or coronary heart disease (CHD)

answer

-A slow, complex disease that begins in childhood and progresses with age -Theorized to begin with an injury to the endothelium (inner most layer of the artery) -The most common form of cardiovascular disease -Characterized by the accumulation of plaques along the inner walls of the coronary arteries -Plaques may grow large enough to significantly reduce the blood flow through an artery

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cholesterol and heart disease

answer

-Generally, the higher the blood cholesterol level, the more plaque builds up -Diets high in saturated fat and cholesterol raise blood cholesterol -Trans fat raises cholesterol levels more than saturated fat -Clinically defined as > 240 mg/dl -All individuals should be screened -Requires diet and/or drug therapy for elevated levels

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unmodifiable risk factors for HD

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age, gender, heredity

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modifiable risk factors for HD

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-Tobacco smoke *risk of heart attack is more than twice that of nonsmokers -High blood cholesterol -High blood pressure -Diabetes Mellitus -Obesity -Physical inactivity

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LDL

answer

-bad cholesterol -Primary carrier for cholesterol in the blood -Associated with increased risk for heart disease -Elevated levels injure arteries and promote plaque formation/progression of CHD

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HDL

answer

-good cholesterol -Transports 25-35% blood cholesterol -Associated with reduced risk for heart disease -Plays a role in transporting cholesterol away from arterial walls -HDL above 60 considered a "negative" risk factor, actually statistically removing one risk factor total risk factor profile

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higher HDL levels

answer

Women vs. men *HDL levels in women fall after menopause Lean individuals vs. obese Active individuals vs. sedentary Moderate alcohol use vs. abstinence Nonsmokers vs. smokers Nondiabetics vs. diabetics

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high blood pressure

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-Defined as blood pressure exceeding 140/90 mm Hg for an extended time -Increases heart's workload

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high BP lifestyle modifications

answer

-Weight control -Physical activity -Moderation in alcohol intake Moderate sodium restriction

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diabetes

answer

-Even with controlled blood glucose levels, diabetes greatly increases risk -Often associated with obesity, high blood pressure, and elevated cholesterol; which compounds risk

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obesity

answer

-Independent risk factor for heart disease -Risk significantly associated with: weight gain during young adult life intra-abdominal fat or waist circumference -Also increases risk for: hypertension or high blood pressure elevated cholesterol or LDL levels elevated triglyceride levels diabetes stroke

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sedentary lifestyle

answer

doubles the risk of HD

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regular physical activity benefits

answer

Lower blood pressure Lower heart rate Increase HDL-cholesterol Promote healthier body weight Improve insulin sensitivity Improve glycemic control Enhance fibrinolysis Increase years of independence and quality life

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elevated triglycerides

answer

-Elevated triglycerides levels associated with: low HDL cholesterol levels diabetes, elevated blood glucose levels increased likelihood of blood clot formation more dangerous forms of LDL cholesterol; small, dense LDL or Lp(a) -To lower triglyceride levels: blood glucose control weight reduction a low-fat diet rich in complex carbohydrates inclusion of fish high in omega-3 fatty acids avoid alcohol physical activity

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preventing HD

answer

-Heart healthy diet and food choices fruit and vegetable consumption dietary fiber fish consumption soy protein -Moderate alcohol intake -Stress management and positive coping skills

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DHA and EPA

answer

-Fatty fish from cold waters are sources of DHA and EPA -Omega-3 fatty acids protect against heart disease by: decreasing blood clotting decreasing blocked arteries decreasing plaque build-up decreasing blood pressure decreasing blood triglyceride levels

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wine and heart disease

answer

-Moderate intake is associated with reduced risk -Wine and alcohol are nonessential dietary components with significant health hazards -Wine drinkers tend to be leaner, exercise more, and drink with meals as compared to beer and spirits drinkers -No clear evidence that wine is more beneficial than other forms of alcohol -Wine's risk reduction through its antioxidant properties is an unproved strategy -AHA maintains that alcohol use is an item for consideration between patient and physician

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nutrition attitude and behaviors

answer

-Most food preferences are learned -Food choices are not driven by need for nutrients or food selection genes -Value one assigns to eating right has more effect on dietary behaviors than knowledge about how to eat right -Food habits can and do change -The smaller and more acceptable the dietary change, the longer it lasts -Behavior and mental performance can be affected by diet -But humans are born with mechanisms to help decide when and how much to eat

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why do people eat as they do?

answer

-Food items develop strong symbolic, emotional, and cultural meanings -Comfort foods, health foods, junk foods, fun foods, soul foods, fattening foods, mood foods, and pig-out foods have been identified in the US

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food choices

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-Strong symbolic, emotional, and cultural meanings of food dictate food preferences -We choose foods that give us pleasure -Foods relieve our hunger pains, delight our taste buds, or provide comfort and a sense of security

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do choices change?

answer

-Knowledge, attitudes, and values help promote change -Change most likely to succeed when benefits outweigh disadvantages

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nutrition values

answer

The value individuals place on diet and health is reflected in the food choices they make

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successful changes in food choices

answer

-make a specific plan -start with small, easy changes -be prepared for relapses

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college and nutrition

answer

75% report weight gain during freshman year (men: ~5.5 pounds; women: ~4.5 pounds)

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alcohol facts

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-is a food = contains carbs -is a drug = modifies body functions, harmful in high doses

question

positives of alcohol

answer

Moderate alcohol consumption Men: 2 drinks/day, women:1 drink /day Reduces risk of heart disease, type 2 diabetes, hypertension, stroke, dementia Increases HDL cholesterol Improves glucose utilization Decreases chronic inflammation Improves cognitive function

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alcoholism

answer

Illness characterized by dependence on alcohol and a level of alcohol intake that interferes with health, family, social relationships, and job performance

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alcohol poisoning

answer

-Life-threatening condition due to excess alcohol consumption; a medical emergency -Characterized by mental confusion, vomiting, seizures, slow or irregular breathing, and low body temperature

question

signs of alc poisoning

answer

Alcohol depresses nerves that control involuntary actions such as breathing, the heartbeat and the gag reflex that prevents choking. May experience one or more of the following: Mental confusion, stupor, coma, unable to rouse the person No response to pinching the skin Vomiting while sleeping or unresponsive Seizures Slowed breathing (fewer than 8 breaths per minute) Irregular breathing (10 seconds or more between breaths) Hypothermia (low body temperature), bluish skin color, paleness

question

drinking during pregnancy

answer

-Fetal alcohol syndrome causes long-term mental and growth retardation -There is no safe level of alcohol intake during pregnancy

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alcohol effects

answer

-As calories from alcohol increase, quality of the diet decreases -Heavy drinkers receive too little thiamin, vitamins A and C, calcium, and iron

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the body and alc

answer

-Alcohol easily and rapidly absorbed in stomach and small intestine -Due to lag time between intake and utilization, blood levels of alcohol build up

question

increased effects of alc

answer

-Blood alcohol levels increase faster in women than in men -Women experience intoxicating effects of alcohol on lower amounts of alcohol than men require

question

alc and adolescents

answer

-Underage drinking accounts for 20% of all alcohol consumed in the US

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binge drinking

answer

Defined as consuming 5 or more drinks in a row for men; 4 or more drinks in a row for women

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CAGE questionnaire

answer

Cut down Annoyed you Guilt Eye-opener

question

dietary supplement

answer

As defined by Congress in the Dietary Supplement Health and Education Act, which became law in 1994: Intended to supplement the diet not substitute for healthy foods Contains one or more dietary ingredients or their constituents Vitamins Minerals Herbs or other botanicals Amino acids Other dietary substances such as enzymes Is intended to be taken by mouth as a pill, capsule, tablet, liquid, or powder; and Is labeled on the front panel as being a dietary supplement.

question

new dietary ingredient

answer

A dietary ingredient that was not sold in the US in a dietary supplement before October 15, 1994

question

GRAS

answer

generally recognized as safe -Dietary supplement ingredients (and food additives) that have been present in the food supply prior to October 15, 1994 are presumed safe and thus "grandfathered"

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regulation of dietary supplements

answer

regulated like food rather than drugs

question

health claims

answer

-characterizes the relationship of any substance to a disease or health-related condition. -Requires Significant Scientific Agreement (SSA) based on publicly available evidence

question

quality assurance

answer

No government body monitors contents of dietary or herbal supplements New regulations for dietary supplements are being considered by FDA

question

FDA does not require

answer

Testing for: safety effectiveness interaction Approval before supplement is produced and sold

question

manufacturer expected to ensure

answer

safety of ingredients label information is accurate declared contents matches container contents

question

new FDA action

answer

Banned the weight-loss/stimulant herb ephedra in December 2003

question

things to consider before purchasing/taking dietary sup

answer

Your own dietary intake and personal health status (including any medications you may be taking) What are the supplement's claims, and are they valid? How do the active ingredients work in the body? How much of the ingredient does the supplement contain? Is there scientific evidence to support the claims? How much, how often, and for how long is it safe for you to take this supplement? What are the potential risks or side effects? Is the cost worth the benefit?

question

bioavailability

answer

Amount of a nutrient consumed that is available for absorption and use by the body

question

Who should take multi-vitamin-mineral supplements?

answer

Pregnant and lactating women - increased need for some nutrients, of note iron & folate Women with heavy menstrual bleeding iron (vitamin C) Women of childbearing age/premenopausal women folate, iron, calcium Smokers B vitamins, vitamin C Individuals who abuse alcohol multivitamin-mineral supplement (Vitamin B1, folate, B6, C) Individuals with restricted or limited diets multivitamin-mineral supplement Vegetarians calcium, iron, zinc, vitamin B2 and B12, vitamin D Individuals with limited milk intake and/or sun exposure calcium, vitamin D Older adults (> 70 years of age) calcium, vitamin D, vitamin B6 and B12, zinc Individuals with a health condition that affects nutrient utilization or absorption Individuals with compromised immune function Some infants Vitamin D (breastfed infants), fluoride, iron

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precautions for sup

answer

Don't view as replacements for healthful foods Choose a combination that contains < 100% DV for your age and gender Avoid "mega"-doses or high potency formulas For economy, consider the generic brand and skip the extra ingredients that add to the cost, but offer no proven nutritional benefits Check the expiration date Take only in recommended doses

question

natural v synthetic

answer

Natural and synthetic forms generally have the same chemical makeup and have no differences in absorption, utilization, or effectiveness

question

high potency

answer

Significantly in excess of the Daily Values for one or more nutrients/ingredients Sometimes in excess of the "UL" (Tolerable Upper Intake Level) No current law prohibits supplement potency, except for potassium Taking high levels for a prolonged time can be toxic fat-soluble vitamins (A and D) Can result in nutrient-nutrient imbalances/interactions high doses of some nutrients may reduce absorption and utilization of other nutrients

question

herbal sup

answer

Herbs in the field of medicine can be defined as: Crude drugs of vegetable origin utilized for the treatment of disease states or to attain or maintain a condition of improved health In the medicinal sense, herbs are "diluted" drugs Herbal supplements are regulated by FDA as foods and do not undergo the same stringent approval process as drugs Many herbs contain toxins in addition to active "useful" components

question

effects of herbal remedies

answer

-Herbals have active ingredients -Knowledge of risks and benefits incomplete -Herbs' risk to health depends on: amount and duration of use age and health status of user other factors

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functional foods

answer

-contain nutrients or other constituents that enhance their contribution to health and disease prevention -May be whole foods or processed foods that are modified or formulated to improve health or enhance longevity

question

how are foods made functional

answer

-Taking out potential harmful components -Adding or increasing potentially beneficially nutrients or other constituents -Using beneficial substances in food production or products

question

examples of functional foods

answer

-Whole (or conventional) foods Vegetables, fish, nuts, oats.... "Super" foods -Enriched foods Cereals and other grain products..... -Fortified foods Juices, grains, milk.... -Enhanced foods Beverages, sports bars, spreads....

question

super foods

answer

-functional foods that have been identified as providing optimal nutrition along with additional health benefits -Nutrient-dense foods that may also contain disease fighting phytochemicals :Plant-based biologically active constituents in food. May play a role in risk reduction of cancer and other diseases.

question

affliction of affluence?

answer

US has most bountiful food supply in the world US has highest calorie intake per capita Diseases of over-consumption have become focus of nutrition research and policy

question

diet relates to:

answer

-development of vitamin and mineral deficiency diseases -compromised growth and impaired mental development in children -body's ability to fight off infectious diseases

question

Dietary Guidelines

answer

-updated every 5 years -Science-based guidelines to promote health and reduce risk for major chronic disease -Stresses consumption of nutrient-dense foods, balancing caloric intake and output, and increasing physical activity

question

sources of nutrition info

answer

-Reliable sources use the standards of proof required by science -These are based on multiple studies and arrived at by "scientific consensus" -Majority opinion of knowledgeable scientists -Nutrition recommendations are based on this consensus of scientific opinion

question

types of research design

answer

Epidemiological studies identify conditions and specific health events Clinical trials test the effects of a treatment or intervention Clinical trials require an experimental group compared to a control group Don't trust results of study without both! A double-blind procedure eliminates bias Randomized Controlled Trial (RCT) employs strong methodology Placebo-effect can influence what happens, and the results of the research

question

evidence based med

answer

The conscientious, explicit, and judicious use of the current best evidence in making decisions about health care of individuals

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