HLT 138 Unit 22
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Transcript of HLT 138 Unit 22
Unit 22 – Diet and Cancer 1
Cancer
Group of >100 different diseases
Characterized by uncontrolled cell growth
Individual cancers differ by:
- where they develop
- how quickly they grow
- type of treatment
- impact on nutritional status
2nd leading cause of death in the US
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Cancer Progression 3
Estimated Cancer Prevalence 2007
Brain/CNS Breast
Endometrial/Uterine Colon/Rectum
Cervix
Esophagus Hodgkin Disease
Kidney
Larynx Leukemia
Liver and bile duct Lung
Melanoma of Skin Multiple Myeloma
Lymphoma Oral Cavity and Pharynx
Ovary Pancreas
Prostate Stomach
Testis Thyroid
Urinary Bladder
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What Causes Cancer?
80-90% of cancers are initiated by environmental factors that alter DNA
Most factors are modifiable
Causes of Cancer
Aflatoxins – toxin made my Aspergillus fungi
Ethanol - alcoholic beverages
Coal-tars
Herbal remedies containing plant species of the genus Aristolochia
Salted fish (Chinese-style)
Soot
Tobacco, smokeless
Wood dust
Arsenic
Asbestos
Chromium hexavalent cpds
Hepatitis B and C virus
Human papilloma viruses: some genital-mucosal types
Mustard gas
Solar radiation
Sunlamps or sunbeds
X-radiation and gamma radiation
Nitrates
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What Causes Cancer?
Diet accounts for approx. 40% of cancer risk
- Westernized dietary intake and lifestyle increase risk
of many types of cancer
Genetic factors account for approx. 5-42% of risk
for some cancers
- Prostate, breast, and pancreatic cancers
Nutrition and Cancer
Prevention 1/3 of all cancers are
related to dietary factors
Intake/utilization
impairment of nutrients
Absorption/metabolism
impairment
Cancer
and/or
treatment
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Nutrition in Cancer Prevention
Eat a variety of fruits and veggies
- 5-9 servings per day
Antioxidants and anti-inflammatory
compounds may protect DNA from
damage
Damaged DNA may direct abnormal cell
multiplication
Nutrition in Cancer Prevention
Limit red meats and processed
meats
High intakes of saturated fats from
meat and dairy products increase
cancer risk
Plant proteins provide unsaturated
fats plus vitamins, minerals, fiber,
and phytochemicals
Nutrition in Cancer Prevention
Excess body weight and physical inactivity
↑ risk of esophageal, colon/rectal, postmenopausal
breast, endometrial, and renal cancers
Increases hormones that promote cancer cell growth
Promotes insulin resistance and hyperinsulinism
Promotes low levels of inflammation which can
promote cancer cell growth and development
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Nutrition in Cancer Prevention
Link between excess body weight,
exercise, and cancer risk so strong that:
Recommended BMI range:
between 21 and 23
Limit energy-dense foods:
(particularly processed foods high in
sugar and fat, and low in fiber)
Physical activity:
at least 30 minutes every day
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American Institute for Cancer Research
Recommendations
Avoid sugary drinks
Limit foods high in salt
Limit alcohol to 1-2 drinks per day (if any at all)
Don’t use supplements to protect against cancer
Breastfeed up to 6 months
Do not smoke or chew tobacco
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Impact of Cancer on Nutrition
Site Potential Effects
Brain/CNS Eating disabilities, chewing/swallowing difficulty
Head and Neck Chewing/swallowing difficulty
Esophagus Dysphagia related to obstruction, GERD
Stomach Early satiety, N&V, impaired motility,
obstruction – may require EN or PN
Bowel Maldigestion/malabsorption,
obstruction – may require EN or PN
Liver Diarrhea
Pancreas Maldigestion/malabsorption, DM
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Impact of Cancer on Nutrition
Metabolic Changes
alter use of fuels (CHO, pro, fat)
promote loss of weight and lean body mass
Glucose intolerance / insulin resistance
Increased energy expenditure
Increased protein turnover
Reduced muscle protein synthesis
Accelerated fat breakdown
Kcal and nutrients redirected to supporting growth of tumor vs. fueling the body
Increased inflammatory/immune response increase metabolism
15
Impact of Cancer on Nutrition
Anorexia
Contributing factor to weight loss and malnutrition
Potential causes:
- pain, depression, anxiety, fatigue, early satiety, N&V
Treatments contribute:
- taste alterations, loss of taste, sore mouth, dry mouth,
thick saliva, esophagitis, fatigue
Optimizing intake:
- texture/temp modification, scheduled eating, meds to
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Impact of Cancer on Nutrition
Cachexia:
wasting syndrome marked by weakness,
progressive loss of body weight, fat, and muscle
Present in approx. 80% cancer related deaths
Hard to reverse
Nutrition aimed at preserving muscle and fat stores - improves quality of life - does not guarantee increased length of survival
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Nutrition Therapy During Treatment
Improve tolerance to treatment
Enhance immune function
Aid in recovery
Improve quality of life
Enhance well-being
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Nutrition Therapy during Treatment
Calories
- Nonambulatory/sedentary
25-30 kcal/kg body weight
- Hypermetabolic/weight gain
30-35 kcal/kg body weight
- Hypermetabolic, severely stressed, malabsorption
35 kcal/kg body weight
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Nutrition Therapy during Treatment
Protein
- Nonambulatory/sedentary
1.0-1.2 g/kg body weight
- Hypermetabolic/weight gain
1.2-1.5 g/kg body weight
- Hypermetabolic, severely stressed, malabsorption
1.5-2.5 g/kg body weight
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Tips to increase kcals and protein
Add cheese - to toast, crackers, sandwiches, baked potatoes, veggies, soups, and noodles
Add peanut butter - to toast, bread, English muffins, fruit - blended into chocolate or vanilla milkshake
Add nuts and seeds: - sprinkled over cereals, fruit, desserts, veggies, salads, and pasta
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Altered Taste/Smell
Taste/smell impairment occurs in more than ¾ PTs
Can interfere with enjoyment of eating
↓ tolerance of bitter foods
↑ tolerance of sweet foods
Can significantly reduce intake
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Strategies to Reduce Food-borne
Illness Risk – Neutropenic Diet
Proper hand washing
Cook meat to “well-done”
No raw eggs, even in dressings, “over-easy” eggs
No sushi, raw seafood, raw meats, unpasteurized milk
Wash fruits/veggies thoroughly
Thaw food in fridge-not on counter or in sink
Refrigerate leftovers immediately and discard after 3d
Avoid salad bars and buffets when eating out
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Low-Bacterial / Low-Microbial Diet
Order is up to the discretion of the physician
Foods not allowed:
- fresh fruits and vegetables
- nuts and dried fruits
- foods from multi-serving containers
- deli meats and undercooked meats
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For More Information
www.cancer.org
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