The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and Cancer

12th European Nutrition Conference FENS 2015Michael LeitzmannDept. of Epidemiology and Preventive Medicine, University of Regensburg Continuous Update Project Panel member

Conflict of interestregarding this presentation:

I have no conflict of interest to report in relation to this presentation.

Outline

Prostate cancer

Kidney cancer

Liver cancer

Gallbladder cancer

Breast cancer survivors

Epidemiologic studies of diet, nutrition, physical activity and cancer

Outline

Prostate cancer

Kidney cancer

Liver cancer

Gallbladder cancer

Breast cancer survivors

Diet, nutrition, physical activity and cancer

BMI Waist circumference Waist to hip ratio

Adv

ance

dN

on-a

dvan

ced

Adv

ance

dN

on-a

dvan

ced

Adv

ance

dN

on-a

dvan

ced

RR=1.12 (1.04-1.21) RR=1.15 (1.03-1.28)

RR=1.01 (0.90-1.12) RR=0.99 (0.90-1.09)

RR=1.08 (1.04-1.12)

Dose-response meta-analysis of body fatness and prostate cancer

RR=0.95 (0.92-0.98)

Allott et al., Eur Urol. 2013;63:800–9

Obesity-related biologic mechanisms and detection biases contributing to the association between obesity and aggressive prostate cancer

Dose-response meta-analysis of height and prostate cancer, per 5 cm

RR=1.04 (1.03-1.05)

Height and prostate cancer risk

Height should be thought of as a marker for exposure(s) that influence cancer risk and not as a risk factor itself

Adult height is determined both by genetics and by early life exposures1

Greater intakes of total energy and milk protein during childhood and adolescence are positively associated with adult height2,3

Relations with total energy and milk protein may be mediated by alterations in levels of growth factors and insulin2,3

Height is associated with greater organ size, which may place more cells at risk for malignant transformation4

1. Renehan, Lancet Oncol 2011;12:716-72. Wadsworth et al., Int J Epidem 2002;31:383-903. Berkey et al., CEBP 2009;18:1881-74. Albanes & Winick, JNCI 1998;80:772-4

Dose-response meta-analysis of dietary beta-carotene and prostate cancer, per 700 ug/d

Supplemental beta-carotene and prostate cancer: randomized controlled trials

Outline

Prostate cancer

Kidney cancer

Liver cancer

Gallbladder cancer

Breast cancer survivors

Diet, nutrition, physical activity and cancer

Dose-response meta-analysis of alcohol and kidney cancer, per 10 g per day

Potential biologic mechanisms linking alcohol to decreased kidney cancer risk

Alcohol

Diureticeffect

Kidney cancer risk

Antioxidant phenolic

compounds

Insulinresistance 1

1. Davies et al., JAMA 2002;287:2559-622. Halliwell et al., Lancet 1994;344:721-43. Lee et al., CEBP 2004;15:1204-11

23

Dose-response meta-analysis of BMI and kidney cancer, per 5 kg/m2

Dose-response meta-analysis of height and kidney cancer, per 5 cm

Outline

Prostate cancer

Kidney cancer

Liver cancer

Gallbladder cancer

Breast cancer survivors

Diet, nutrition, physical activity and cancer

Dose-response meta-analysis of coffee and liver cancer, per one cup per day

Potential biologic mechanisms linking coffee to decreased liver cancer risk

Coffee Angiogenesis Liver cancer risk

Apoptosis

DNA damage 1

1. Majer et al., Food Chem Toxicol 2005;43:433-412. Cardin et al., Dig Liver Dis 2013;45:499-5043. Bohn et al., Mol Nutr Food Res 2014;58:915-304. Tunnicliffe & Shearer, Appl Physiol Nutr Metab 2008;33:1290-300

2

3

Insulin sensitivity

Chronic inflammation3

4

Aflatoxins and liver cancer

Dose-response meta-analysis of alcohol and liver cancer, per 10 g per day

Potential biologic mechanisms linking alcohol to increased liver cancer risk

Seitz & Stickel, Biol Chem 2006;387:349-60

Oxidative stress and impaired antioxidant defense

Chronic inflammation

Direct DNA damage and inhibition of DNA repair

Interference with methyl group transfer, thereby altering gene expression

Ability to act as a solvent, facilitating enhanced penetration of carcinogens

Dose-response meta-analysis of BMI and liver cancer, per 5 kg/m2

Outline

Prostate cancer

Kidney cancer

Liver cancer

Gallbladder cancer

Breast cancer survivors

Diet, nutrition, physical activity and cancer

Non-linear dose-response association of BMI and gallbladder cancer

Outline

Prostate cancer

Kidney cancer

Liver cancer

Gallbladder cancer

Breast cancer survivors

Diet, nutrition, physical activity and cancer

Breast Cancer Survivors Report 2014

Report available at: http://www.wcrf.org/sites/default/files/Breast-Cancer-Survivors-2014-Report.pdf

85 papers included in the report

164,416 women

42,572 cases of mortality

Future directions

Studies of cancer incidence:

Improve measurements of diet, nutrition, and physical activity

Perform analyses by cancer molecular subtypes

Examine potential interactions with genetic predisposition

Elucidate underlying biologic mechanisms

Studies of cancer survival:

Address potential confounding by cancer stage, treatment, and comorbidities

Investigate timing in life of exposures in relation to cancer diagnosis and treatment

Prostate cancer

Kidney cancer

Liver cancer

Gallbladder cancer

Breast cancer

survivorsBody fatnessHeightAlcoholCoffeeAflatoxinsBeta-caroteneTotal fatSaturated fatFoods containing soyFiberPhysical activity

Increased risk Decreased risk Substantial effect on risk unlikely

Summary

Limited-suggestiveevidence

Thank you for your attention!

For further information

@wcrfintfacebook.com/wcrfint

www.wcrf.org

Michael Leitzmann – Continuous Update Project Panel memberDept. of Epidemiology and Preventive Medicine, University of Regensburg

Michael.Leitzmann@ukr.de