Evidence-Based Nutrition Guidelines Needed For Cancer Survivors

Cancer survivors die of non-cancer-related causes at much higher rates than the general public. In 2008, the U.S. economic burden of cancer totaled over $228 billion but only 41% of these costs involved direct cancer care. The majority of expenses were attributed to increased morbidity, lost productivity, and premature mortality. A commentary published in the March 2011 issue of the Journal of the American Dietetic Association examines the current evidence supporting nutrition recommendations for preventing cancer recurrence and managing chronic conditions prevalent in cancer survivors, as well as improving quality of life and decreasing health care costs. The commentary also describes knowledge gaps and suggests future nutrition research directions.

"As the number of cancer survivors continues to increase, opportunities to conduct longer-term research are expanding," commented lead author Kim Robien, PhD, RD, Assistant Professor, Division of Epidemiology and Community Health; and Member, Cancer Outcomes and Survivorship Program, Masonic Cancer Center, University of Minnesota, Minneapolis. "With over 12 million American cancer survivors (about 4% of the population), it is time to concentrate on guidelines to help patients avoid the other complications that lead to death. Data support the hypothesis that nutrition interventions are not only likely to help with cancer outcomes, but can also be important in preventing and managing some of the chronic health conditions that can occur after cancer treatment, such as cardiovascular complications, weight gain, diabetes and other endocrine disorders, functional impairment, osteopenia and osteoporosis."

The authors discuss current recommendations for cancer survivors, which emphasize achieving and maintaining a healthy weight; encouraging regular physical activity (for adults at least 30 minutes of moderate to vigorous physical activity every day); eating a diet rich in vegetables, fruits, and whole grains; and limiting red and processed meats and alcohol consumption. Further, the current recommendations are that cancer survivors try and obtain their nutrients from foods, rather than supplements since there have been several studies that have linked supplement intake with higher cancer-specific and all-cause mortality among cancer survivors.

Important knowledge gaps that call for further research are identified. Because most cancer patients have one or more comorbid conditions, management of these comorbidities by nutritional interventions may improve quality of life for these individuals. Another area of investigation is whether specific cancers require specific nutritional guidelines.

Finally, the authors recognize that any nutritional intervention must work with the individual patient. Despite efforts by the American Cancer Society and the World Cancer Research Fund/American Institute for Cancer Research to encourage cancer survivors to follow diet and lifestyle recommendations for cancer prevention, evidence suggests that few cancer survivors are doing so. Further research is needed to determine the optimal method and timing of interventions to promote healthy lifestyle behaviors among cancer survivors.

Body Weight Influences Risk Of Death Among Asians

A study of more than 1 million Asians found that those who were a normal weight were far less likely to die from any cause than individuals whose body-mass index (BMI) was too high or low. A similar association was seen between BMI and the risk of death from cancer, cardiovascular disease or other causes.

The study, led by Wei Zheng, M.D., Ph.D., M.P.H., Ingram Professor of Cancer Research at Vanderbilt-Ingram Cancer Center, Nashville, Tenn., Paolo Boffetta, M.D., M.P.H., professor, Mount Sinai School of Medicine, New York, N.Y., and John D. Potter, M.D., Ph.D., member and senior adviser, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Wash., was published in this week's issue of The New England Journal of Medicine.

"Previous studies that evaluated the association between BMI and the risk of death have been conducted primarily in populations of European descent, and the current definition of overweight and obesity is based essentially on criteria derived from those studies," said Zheng, director of the Vanderbilt Epidemiology Center. "The validity of these criteria in Asian populations has yet to be determined. A large proportion of Asians are very thin and the impact of a severely low BMI on the risk of death has not been well evaluated until now."

The World Health Organization estimates that more than 1 billion adults worldwide are overweight and at least 300 million are obese. Fat tissue has been recognized as an active endocrine organ, capable of releasing a number of biologically active factors that may contribute to obesity-related diseases, including type 2 diabetes, hypertension, coronary artery disease, stroke and several types of cancer.

The research, conducted as part of the Asia Cohort Consortium, included health status and mortality information on more than 1.1 million individuals from East and South Asia. In the cohorts of East Asians, including Chinese, Japanese and Koreans, the lowest risk of death was seen among individuals with a BMI in the range of 22.6 to 27.5, which is considered normal to slightly overweight (BMI is defined as weight in kilograms divided by the square of height in meters).

Chinese, Japanese and Korean populations were much like groups in other parts of the world. These East Asians with a raised BMI of 35.0 or higher had a 50 percent higher risk of death. The same was not true for Indians and Bangladeshis, indicating that a high BMI did not affect all ethnic groups in a similar way.

Being severely underweight was even more dangerous among all of the Asian populations studied. The risk of death was increased by a factor of 2.8 among those whose BMI was very low, that is, 15.0 or less.

"The most unexpected finding was that obesity among sub-continent Indians was not associated with excess mortality," said Potter. "This may be because many obese people in sub-continent India have a higher socioeconomic status and so have better access to health care."

"Our findings capture two different aspects of a rapidly evolving pattern; severe underweight was highly prevalent in Asia in the past, and we can still observe its important impact on mortality," explained Boffetta. "Looking into the future, however, prevention of overweight and obesity deserves the highest priority."

The authors conclude that this study provides strong evidence supporting the biologic plausibility that excess weight contributes to a higher risk of death.

"This confirms that most people are at a higher risk for dying early if they are obese and is a clear message not to gain weight as we age," said Potter.

Nearly 50 researchers from seven countries contributed to this study. Data analysis for the project was conducted by the Asia Cohort Consortium Coordinating Center, which is supported, in part, by Fred Hutchinson Cancer Research Center and the National Cancer Institute.

 

Millions Of Overweight People Unaware Of Cardiometabolic Dangers

Experts meeting at the 2nd International Congress on Abdominal Obesity (ICAO) issued a warning that millions of individuals around the globe are at risk from the cardiometabolic consequences of being overweight. Worryingly, the experts suggest that these people are not being identified by their doctors.

The International Chair on Cardiometabolic Risk (ICCR) released the statement from the ICAO, at a symposium sponsored by GlaxoSmithKline. The statement suggests that the media tends to focus on extremes when discussing obesity: either skinny celebrities who gain or lose a few pounds or the morbidly obese who need the help of fire-fighters to leave their homes. As the proportion of the general population which is overweight or obese increases, so the perception of what is the norm of a healthy weight is being reset. In the minds of society as a whole, including healthcare practitioners, the mental picture of an overweight or obese person has been reset inaccurately to a far heavier model.

Yet it is the millions across the world with BMIs above 25 who may already be suffering the early stages of high blood pressure, dyslipidemia and diabetes, who could benefit most from early intervention, say ICCR.

"Many primary care doctors may be treating obese patients with BMIs of 30 and above for the symptoms related to increased cardiometabolic risk, like pre-diabetes, dyslipidemia and hypertension, but not treating them for the underlying cause, their excess visceral adiposity," commented Professor Jean-Pierre Després, Scientific Director of ICCR and Professor, Faculty of Medicine, University Laval, Québec, Canada. Visceral adiposity is fat stored in the abdomen and around the vital organs. Excess visceral fat increases the risk of serious diseases, such as type 2 diabetes, stroke and heart disease.

"A patient with a BMI of 29 or 31 is the norm today yet when we think of an obese person, we tend to visualise someone with a much higher BMI of 40 plus. Patients with lower BMIs but higher levels of hidden, visceral fat are more difficult to identify yet can be at as much cardiometabolic risk as more obviously obese individuals", continued Professor Després. ICCR emphasised the need for urgent action to target these at-risk patients in order to slow the increasing rate of obesity across the world and stem the rising levels of diabetes and cardiovascular disease.

New research released at the Congress from the INternational Study of Prediction of Intra-abdominal adiposity and its RElationships with cardioMEtabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA) supports the ICCR's position. INSPIRE ME IAA recruited 4,504 patients from 29 countries and showed harmful cardiometabolic risk profiles among non-diabetic, study participants, even among sub-groups of moderately overweight patients with an excess of visceral adipose tissue.

ICCR called for a renewed focus on what actually constitutes a healthy weight and how healthcare professionals support people in attaining and maintaining it. "In addition to patients who are clearly obese, we need to pay attention to overweight patients with visceral obesity who do not realise the potential dangers of the fat within their abdomen. Their doctor may not make this connection either. Yet a modest weight loss of just five or ten percent could result in a substantial loss of visceral adipose tissue and make all the difference to these people" stated Professor Després.

Modest gradual weight loss is recognised by most experts as the best way to lose and keep off weight, yet the diet industry and media fuel unrealistic expectations by promoting 'crash diets' and extreme dieters who slim to a fraction of their previous size. A lack of information and guidance on realistic approaches to and interventions which support modest weight loss is also considered by ICCR as a factor in the failure to reverse the tide of obesity.

As an organisation which strongly advocates a multidisciplinary approach to treating cardiometabolic risk factors, ICCR believes it is in a strong position to drive a renewed effort to overcome the multi-factorial barriers preventing healthcare professionals from turning the tide in the battle against obesity. ICCR also told the Congress it will seek to encourage and broaden the conversation around the concept of healthy weight in the hope of resetting the conversation around abdominal obesity, realistic weight loss and health.

Breastfeeding Babies Exposed To Diabetes In Utero Protects Against Childhood Obesity

Breastfeeding a baby exposed to diabetes in utero may help protect that infant from becoming obese during childhood, according to a study published in the February issue of Diabetes Care and an accompanying editorial, which noted that population-wide detection and treatment of gestational diabetes takes on even greater importance due to these findings.

Babies that were breastfed for six months or more, after exposure to maternal diabetes in utero, were no more likely to put on extra weight as children (ages 6-13) than those who were not exposed to diabetes, the study found. This effect was not realized, however, for babies breastfed less than six months. The results were consistent across ethnicities.

"Our data suggest that breastfeeding promotion may be an effective strategy for reducing the increased risk of childhood obesity in offspring of mothers with diabetes during pregnancy," said Dr. Dana Dabelea, Associate Professor in the Department of Epidemiology, Colorado School of Public Health, and lead researcher on the study. "Since childhood obesity and in utero exposure to maternal diabetes have both been associated with later development of type 2 diabetes, it follows that breastfeeding these children may also help reduce their future risk for developing type 2. However, further research would be needed to confirm that added protection."

The study also suggests that the early postnatal period may be a critical period for determining future obesity and diabetes risk, the researchers concluded. "The macronutrient composition of breastmilk (i.e. protein, fat, carbohydrate) and bioactive substances not present in formula may influence metabolic programming and regulation of body fatness and growth rate," they wrote.

Previous research has shown that children born to mothers who had diabetes during pregnancy are more prone to childhood obesity than those who are not, perhaps because they are "programmed" to put on extra weight due to exposure to their mother's excessive glucose levels during these critical stages of prenatal development.

In an editorial accompanying this study, Dr. Andreas Plagemann, of the Clinic of Obstetrics, Division of Experimental Obstetrics, Charite-University Medicine Berlin, wrote that the study reinforced the importance of breastfeeding and of testing and treating pregnant women for diabetes "to enhance not only the prenatal but also the neonatal nutritional environment of the offspring."

"Beyond its important role for mother-child binding, breastfeeding as compared to formula has a considerable number of positive short and long term effects on human development, such as a decreased incidence of high respiratory infections, a lower risk of asthma and atopy, and a decreased risk of high blood pressure, type 2 diabetes as well as type 1 diabetes," he wrote. "Moreover, profound evidence exists that breastfeeding has the potential to permanently decrease the long-term risk of developing obesity, as shown by the results of at least for meta-analyses on this issue."

 

Six Easy, Fun Steps To Better Health

CIGNA and Healthy Kids Challenge, working together since 2004 to fight obesity, announced the launch of their latest initiative - an online CIGNA Mix Six for Healthy Balance Toolkit offering real-life ways for individuals, families and employers to incorporate better health into their daily routines.

Despite all of the dialogue about obesity, some 86 percent of Americans are expected to be overweight or obese by 2030.1 Businesses, individuals and families pay the price not only in higher health care costs but in human terms as well: loss of productivity, a shorter life expectancy due to conditions caused by obesity and poor health in general. The CIGNA and Healthy Kids Challenge collaboration is designed to help reverse the obesity trend through online coaching and interactive programs.

"It is critical that we continue to get the message out about the effects that everyday choices have on our health and on overall costs to the health care system," said Patty Caballero, director of sponsorships, CIGNA. "This toolkit is a great resource to reinforce this message in a fun and engaging - and hopefully habit-forming - way."

Drawing on CIGNA's experience with wellness in the workplace and Healthy Kids Challenge's expertise on children's health, the new collaborative toolkit offers simple, actionable solutions at a variety of levels. The goal is to enable everyone to eat healthier and exercise more both at home and at work. The educational and interactive materials can be adapted in any chronological order, therefore, Mix Six for Healthy Balance:

- Colorful Plates: Diets rich in fruits and vegetables not only keep weight in check but can lower the risk for stroke, cardiovascular disease, diabetes and even some cancers. Yet fewer than two in 10 adults - and fewer than one in 10 kids - eat the daily recommended amount of fruits and vegetables. Colorful Plates helps users add fruits and vegetables to their diets simply by adding color to their plates.

- Minutes in Motion: Regular physical activity lowers risk for stroke, heart attack, diabetes, and bone fractures and can help people stay mentally sharp as they age. Experts recommend 30 minutes of daily physical activity and agree that most adults are not meeting that goal. Minutes in Motion offers fun activities to help people of all ages get moving.

- Power Breakfast: Parents were right: breakfast is the most important meal of the day. Eating breakfast improves concentration, problem-solving ability, mental performance, memory and mood and helps people maintain a healthy weight. Power Breakfast offers easy tips and meal ideas to begin any day the right way.

- Snack Attack: It's estimated that in the U.S., one-quarter of daily calorie intake comes from snacks. An extra 100 sugary calories daily can add up to more than 10 pounds in a year. Snack Attack helps people learn how to make healthy snack choices by planning ahead and understanding which snacks are both nutritionally worthy and tasty.

- Smart Servings: Super-sized meals are not a value when you consider your waistline. Smart Servings helps users recognize eating distractions so that they can better watch what they eat and also shows how to better estimate serving sizes.

- Drink Think: Coffee used to cost a quarter - and came with a quarter of the calories when compared to today's café mochas. Drinks are often an overlooked culprit when it comes to weight control. Drink Think challenges users to assess calories in a particular drink to help them downsize or choose an alternate beverage.

"The new CIGNA Mix Six for Healthy Balance Toolkit features up-to-date, relevant and fun information and activities for a variety of ages, in a variety of settings," said Vickie James, RD, LD, executive director, Healthy Kids Challenge. "This latest initiative has been another great opportunity to partner with CIGNA to work towards our shared goal of improving health."

1 According to researchers at the Johns Hopkins Bloomberg School of Public Health, the Agency for Healthcare Research and Quality and the University of Pennsylvania School of Medicine.

FDA Decision Endorsed By Leading Texas LAP-BAND Team True Results

The True Results team of gastric band surgeons and medical weight loss experts is pleased the U.S. Food and Drug Administration (FDA) has recognized the long-standing safety and effectiveness record of the LAP-BAND® System. This ruling will now allow millions of additional Americans to qualify for earlier weight-loss intervention. Additionally, the LAP-BAND is now the first and only FDA-approved device for bariatric surgery in patients with a body mass index (BMI) of 30-35 and one or more obesity related comorbid condition such as type 2 diabetes, heart disease, hypertension or sleep apnea.

With this ruling, the LAP-BAND device is now approved for use on patients that are generally more than 50 pounds overweight (classified as obese), which is approximately 30 percent of the U.S. adult population. For example, a person 5-feet, 2-inches tall, weighing 165 pounds with one comorbid condition, that has not been successful on diet and exercise programs, is now eligible for the LAP-BAND procedure. Previously, this person needed to weigh at least 192 pounds with one medical condition or 220 pounds without any medical conditions.

"The FDA endorsement of the LAP-BAND as a safe and effective treatment for the mild to moderately obese is very gratifying. It is the culmination of a process that began with a major clinical trial we performed in Australia five years ago," said Dr. Paul O'Brien, True Results National Medical Director and world-renowned surgeon that played a key role in the development of the LAP-BAND. "It is pleasing to see obesity acknowledged as a disease that deserves treatment and have the LAP-BAND recognized as the most appropriate surgical weight loss option for this group. Nearly 26 million more Americans can now benefit from this safe, gentle and effective treatment to reach and maintain a healthy weight."

Medical research has found that, if left untreated, those individuals who are currently obese (BMI of 30-40) will likely remain obese without intervention. Obesity is the second-leading cause of preventable death in the United States, second only to smoking, and given the correlation between obesity and life-threatening conditions, such as heart disease, Type 2 diabetes and high blood pressure, it is a disease that requires medical treatment.

Texas Survey Findings Support National Medical Data

The lowering of BMI requirements for the LAP-BAND procedure has become necessary to combat the U.S. obesity epidemic. For overweight people, the problem is not personal weakness or lack of willpower - often times it's hereditary or diet programs themselves. Fifty years of research shows that dieting fails at providing significant long-term weight-loss. Many times dieters stop one diet program and move onto the next, gaining weight in the process.

In fact, a recent True Results survey found that nearly a quarter of Texans have tried 10 or more diets in their lifetime. The rate of frequent dieting (10+ diets) increased to 37 percent for obese respondents (BMI = 30-40) and 45 percent for morbidly obese respondents (BMI = 40+).

"The LAP-BAND is not a quick fix, it is a tool to help patients achieve the long-term weight loss they have not been able to sustain with other methods," said Jessica Diaz, nutritionist and exercise physiologist for True Results. "The patient must still undergo a complete lifestyle change in order to achieve long-lasting results. That's why True Results provides complete aftercare including nutrition and exercise support throughout the patient's weight loss journey."

The poll also showed that 71 percent of Texans feel the LAP-BAND procedure is the safest medical weight loss procedure as compared to gastric bypass or gastric sleeve. Half of Texans feel LAP-BAND is the most effective weight loss procedure.

True Results LAP-BAND Experts

True Results specializes in the gastric band procedure due to its safety record and long-term effectiveness. The LAP-BAND has been proven in studies to significantly reduce weight and body mass steadily and consistently with patients maintaining their weight-loss over time. The LAP-BAND is 10 times safer than gastric bypass and gastric sleeve and achieves nearly identical long-term weight loss. Because the LAP-BAND is a restrictive device and requires no cutting, stapling, or removal of any part of the stomach, it is completely reversible and adjustable, unlike gastric bypass or gastric sleeve.

About the Survey

The statewide survey was conducted by Promark Research Corporation, a public opinion research firm, from January 6 to 13, on behalf of True Results. A total of 802 residents of Texas were surveyed online. Results are considered accurate to +/- 3.46% 19 times out of 20.

 

Knee Pain From Common Arthritic Condition Eased By Weight Loss

Knee pain related to osteoarthritis (OA) is a common complaint among obese individuals and retired professional athletes, especially former NFL players, but researchers presenting their work at the American Orthopaedic Society for Sports Medicine's Specialty Day program said they have a simple solution: lose weight.

"Our research on patients who were obese with early-onset knee osteoarthritis showed that those individuals who underwent isolated weight loss via bariatric surgery and lost an average of 57 pounds within the first six months significantly improved their knee pain, stiffness and physical function. Quality of life, activities of daily living and sports activity also improved; all of this without other arthritic treatments," said lead researcher Christopher Edwards of the Penn State College of Medicine.

OA of the knee is one of the five leading causes of disability among elderly men and women in the U.S., and costs $185 billion in out-of-pocket expenditures each year. Obesity is one of the leading risk factors for the disease.

The study followed 24 adult patients who ranged in age from 30-67 and were diagnosed as obese with clinical and radiographic evidence of knee OA. The Western Ontario and McMaster (WOMAC) Index of Osteoarthritis and Knee and Osteoarthritis Outcome Score (KOOS) surveys were administered at a pre-bariatric surgery baseline and at six and 12 months post surgery.

"Each individual had some kind of improvement in their pain from losing weight, some more than others. There are few studies that have investigated the role of isolated weight loss in the absence of additional arthritis treatment on those individuals with radiographically confirmed OA. Further research still needs to be performed to investigate whether knee arthritis symptom improvement continues over time and are applicable to those individuals who are simply overweight, but our research suggests a strong possibility of improvement," said Edwards.