I was very pleased to receive my February edition of the Journal of Academy of Nutrition and Dietetics because listed on the front page were several articles pertaining to the topic of cancer.  So I set my journal aside and flagged the article titled Adherence to the Mediterranean Diet and Overall Cancer Incidence.  Jackpot! CVD risk reduction and cancer risk reduction all with the same eating pattern! With all the positive coverage that the Mediterranean Diet has been receiving regarding CVD risk reduction it seemed plausible that the Mediterranean Diet would also play a role in overall cancer risk reduction as the plant-based foods linked to CVD risk reduction: whole grains, fruits and vegetables have also been recommended by the AICR to reduce cancer risk reduction.  This study is important because it attempts to determine if Mediterranean Diet adherence is associated with overall cancer risk reduction in men and women.   Since alcohol consumption has been linked to cancer risk the researchers an alternate Mediterranean diet score without alcohol.  

The key finding from this study was that middle compared with low adherence to the Med Diet was significantly associated with a reduced overall cancer risk in women but not for men.  The authors of the research speculate that sex-specific hormones may influence the rate of tumor development and that sex-related differences regarding exposure to risk factors and carcinogen metabolism may also influence the association of dietary factors with cancer risk.  The authors also note that other studies have not identified a difference in association between males and females.  More research is recommended.  

The goal of this research was to provide perspective on a cancer patient’s experience in the context of nutritional advice and care, during and after their treatment journey.  The research is important to providing a better understanding of the desired nutritional support needs of a cancer patient, along with the support they actually receive, to determine if there are gaps in acute care treatment and how these might be filled, to provide better nutritional support to cancer patients when needed.

Key findings and nutritional science: Overall findings concluded that although many cancer patients feel that nutrition is important, they are not being given appropriate access to a dietitian and nutrition counseling during the time of cancer treatment or in survivorship, even though they may be experiencing “serious diet-related problems including weight and muscle loss”.  Many patients are confused regarding proper nutritional advice and have tried alternative dietary strategies or supplementation.

Clinical implications: This study was conducted in Ireland, where the authors noted that oncology dietetic services are “severely under-resourced”. Perhaps this has some impact on the results of the study; however, a family member of mine in the US experienced a similar lack of support when diagnosed with cancer and commencing treatment, therefore I feel the conclusions may be applicable here in the US as well.  

According to this article, malnutrition and muscle loss are common in and have a negative impact on clinical outcome for cancer patients.  Even post treatment, metabolic changes can prompt insulin resistance and weight gain, both associated with risks of cancer recurrence.  If there are low rates of nutritional screening in the clinical setting, there are lost opportunities to impact the overall survival or quality of life of some patients, either by managing an acute dietary related issue such as muscle loss, or by providing evidence based strategies for nutritional management and thereby minimizing dietary confusion for many patients.  

The study of how nutrition affects cancer risk has been ongoing for some time. The review states that multiple studies indicate that dietary microRNAs and exosomes may have a role in cancer prevention. I one thing they stated was that there was no evidence for recommending supplements of vitamins A, C, E, selenium for the prevention of lung cancer. This lined up with what we learned in the lecture and our readings this week, in which supplements have not been shown to affect cancer risk/prevention. 

They conclude that dietary compounds including curcumin, green tea components, carotenoids, and micronutrients could affect a variety of cellular and molecular targets which are involved in cancer initiation and progression. However, they associated milk with an increased level of IL-6 and IL-6's association with cancer. This claim is up for debate since other studies show that milk has anti-inflammatory properties (Bordoni et al., 2017). 

Food compounds have a large impact on our body's processes. If we can understand how different food compounds affect our disease risk we can come up with better treatments. 

Additional reference:
Bordoni A, Danesi F, Dardevet D, Dupont D, Fernandez AS, Gille D, Nunes Dos Santos C, Pinto P, Re R, Rémond D, Shahar DR, Vergères G. Dairy products and inflammation: A review of the clinical evidence. Crit Rev Food Sci Nutr. 2017 Aug 13;57(12):2497-2525. doi: 10.1080/10408398.2014.967385. PMID: 26287637.

Prostate cancer (PCa) is common in North America and Europe, 80-100/100,000, while 10-20/100,000 in Asia and Africa. It is men’s second highest mortality rate among cancer, and Western diet is known to increase the risk of PCa, especially cow milk. Japan after WWII saw a drastic increase in the death from PCa as much as 25-fold, which correlates to  increased consumption of milk (20-fold). Calcium lowers serum concentrations and may increase prostate carcinogenesis: When a man intake dairy proteins 35g/day more, the risk of PCa increases by 32%. Interestingly, the risk factor from calcium is only from dairy products like milk and cheese, not from other foods. 

This study is to find evidence that dairy protein-derived amino acids’ impact as the cancer promoting effect through mTORC1-signaling system.    

Cow’s milk overstimulates mTORC1 activity from increased insulin/IGF-1 signaling and substantial leucine, stimuli of amino acid-mediated mTORC1 activation.  The leucine consists 3.3 g/L in cow´s milk and 0.9 g/L in human’s, which shows a large difference between breast-feeding and cow´s milk-based infant formula. Also, recent studies report that PCa is promoted by estrogens which are contained in commercialized milk. 

This study concludes with suggestion of plant-based diet over animal products consumption: Plant-based diets, for example, more cruciferous vegetables and tomatoes, are important for preventing PCa by decreasing mTORC1 activation and by providing natural plant-derived inhibitors of mTORC1.

This study was interesting to me, because I have an office mate and a sister in law who are in the recent post-breast cancer stage, and this topic has come up multiple times in conversation. This study is a review of current literature and found, as anticipated that there are mixed findings on the effects of soy intake post-breast cancer. One key finding of this review was that multiple studies found that there was a decrease in tumor bulk and multiplicity in rats fed a strictly soy protein diet as opposed to a more standard diet. This is contrary to the commonly belief, as both my colleague and sister in law were told to avoid soy in the diet. There are several landmark studies referenced that have been the foundation of the soy avoidance, however there is still controversial data being discovered daily. It was interesting that rats break down soy into a certain isoflavonoid that only 1/3 of humans produce with the same diet.  There is certainly more work and research that needs to be done in this area, as breast cancer is extremely common and encountered frequently in both inpatient and primary medicine. 

 
This study is important because it looks at how the Mediterranean diet impacts breast cancer risk in a population of women who are at high cardiovascular risk. The researchers did a randomized clinical trial to look at how the Mediterranean diet influences breast cancer risk from 2003 to 2009. Over four thousand women were recruited for the study and were assigned one of three diets. The first diet was a Mediterranean diet with extra-virgin olive oil. The next diet was a Mediterranean diet with mixed nuts. The last diet was a control diet, but participants in this diet were asked to decrease dietary fat intake.  

 One key finding in this study is that the breast cancer incidence rate (new cases) was 1.1 in the Mediterranean diet with extra-virgin olive oil. The breast cancer incidence rate for the Mediterranean diet with mixed nuts was 1.8. Lastly, the breast cancer incidence rate was 2.9 for the control group.

This study is important clinically because it suggests that consuming a Mediterranean diet might decrease breast cancer risk for female patients with high cardiovascular risk. The patients who consumed the Mediterranean diet with extra-virgin olive oil had the lowest rates of breast cancer. The women who consumed the control diet had a higher breast cancer rate. 

Key study question: 

To investigate the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 malignancies

Key clinical finding:

Added sugars were positively associated with risk of esophageal adenocarcinoma (95% CI: 1.07–2.45; Ptrend = 0.01); added fructose was associated with risk of small intestine cancer (95% CI: 1.16–4.16; Ptrend = 0.009); and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer.

Study importance:

Added sugars had a strong positive association with oesophageal cancer, even after eliminating BMI from the model analysis. This suggests an independent association between added sugars and esophageal cancer. The strong association between malignancies and added sugars was explained by few mechanisms; synthesis of insulin and IGF-I induced by the glycemic effect of diets high in added sugars may enhance tumour development through promoting cell proliferation and inhibiting apoptosis. The association is intriguing and may point towards a broader adverse effect added sugars may exert play than just in metabolic syndrome and obesity. 

This literature review is important because anywhere from 14 – 81% of patients undergoing chemotherapy, depending on dosage, suffer from oral mucositis. Despite the high frequency, and often debilitating occurrence, strategies to support optimal nutrition in these patients is lacking. The evidence supporting current recommendations, bland food and avoiding tart/acidic/spicy food, has proven inconsistent. 

The article found nine nutrition interventions for oral mucositis that included oral cryotherapy, consumption of various supplements/vitamins and glutamine. They found that oral cryotherapy had a moderate certainty of being beneficial. It is thought that vasoconstriction of cells caused by cooling of the mouth prevents delivery of cytotoxic drugs to oral tissues which reduces the risk of oral mucositis development. 

This is clinically important because this suggests that oral cryotherapy can be used to maintain optimal nutrition status in individuals suffering from this condition. Reducing the occurrence of this condition will allow patients to eat appropriate foods and not limit their diet.

 

This trial studies the action of Curcumin (active compound in Turmeric) on colon carcinogenesis. Finding any, and all food ingredients that may prevent cancer progression is important in developing nutrition guidelines to include safe and effective chemopreventive nutrients.

A key finding was the curcumin enriched diet fed to mice that had introduction of a tumor-inducing chemical, inhibited colon tumor development. Curcumin included in the diet before, during and after chemical AOM administration, significantly inhibited noninvasive adenocarcinomas, invasive adenocarcinomas, and total adenocarcinomas of the colon. Initiating the curcumin diet 14 weeks after chemical AOM administration also significantly inhibited the incidence of invasive adenocarcinomas. Administration of a higher curcumin diet 14 weeks after the tumor induction noninvasive, invasive, and total adenocarcinomas. The curcumin was found to inhibit tumor development and progression by its action to increase apoptosis in the colon tumors.

 By including turmeric in the diet, incidence of colon tumor development and progression was decreased in mice. Turmeric has been shown to have multiple benefits including anti-inflammatory and antioxidant properties. This study also shows support for including turmeric as a chemopreventive nutrient. 

•       Acute lymphoblastic leukemia (ALL) is curable in more than 90% of cases; research focus has shifted to long-term health outcomes of ALL survivors.

•       With 95.5% of cancer survivors experiencing at least one chronic disease by 45 years of age.
This is an important study because it aimed to characterize BMI trends in a multi-ethnic cohort of childhood ALL patients during therapy and determine whether early changes in BMI in treatment were associated with post-treatment weight status.

 

The key finding of this study is that at diagnosis, 60% of patients were normal weight and 11% underweight. By 5 years post-diagnosis, most patients were either overweight (22%) or obese (35%). Moreover, at the diagnosis, overweight and obese children: Hispanic 37% and 20% non-Hispanic whites. By 5-years post-diagnosis, the overweight and obesity rate increased to 60% of Hispanics and 52% of non-Hispanic whites.

 

The clinical implication of this study is that the one-year time point is an appropriate time to screen for significant BMI changes. 

 

One key finding from the study was that the mother’s nutritional status had an impact on the severity of the infants acute lymphoblastic leukemia. This information suggests that some cancer mutations begin to develop in utero and that nutrition had an impact on fetal genome and immune development. For example, heavy weight infants were also at a higher risk of developing lymphoblastic leukemia, perhaps through epigenetic modifications that occurred during fetal development.   

 

I think the clinical implication from this study was that having an understanding of the extent of how early in life should we really be concerned about cancer development and what can be done to help modulate its progression. This speaks most clearly to mother’s nutrition but also the importance of other factors such as physical activity, stress, and other life style choices. Groups that are genetically predisposed to blood cancers should be aware of strategies that they can implement to help modulate cancer risk in their future offspring.