Diet & exercise & breast cancer Mary Pegington Research Dietitian Genesis Prevention Centre & Nightingale Breast Screening Centre, University Hospital.

Slides:



Advertisements
Similar presentations
Overview of diet related diseases
Advertisements

Diet, Exercise, and Cancer Risk
Preventing breast cancer and its recurrence with diet and exercise Dr Michelle Harvie Transforming Knowledge: Closing the Research Evidence-Practice Gap.
Egg Nutrition Center Cardiovascular Disease Presentation.
Assessment of Overweight and Obesity and the Need for Weight Loss Dr. David L. Gee FCSN/PE 446 Nutrition, Weight Control & Exercise.
DO YOU HAVE THE METABOLIC SYNDROME? You're never too young to have it Jacqueline A. Eberstein, R.N.
CONTROLLING YOUR RISK FACTORS Taking the Steps to a Healthy Heart.
10 Points to Remember for the Management of Overweight and Obesity in Adults Management of Overweight and Obesity in Adults Summary Prepared by Elizabeth.
Cardio-Metabolic Syndrome Guidelines on Education, Detection and Early Treatment  Heval Mohamed Kelli, PGY-2 Emory Internal Medicine Residency no conflict.
SUPERSIZED NATION By Jennifer Ericksen August 24, 2007.
© Food – a fact of life 2009 Diet and cancer prevention Extension.
Epidemiology of Peripheral Vascular Disease Sohail Ahmed School of Population and Health Sciences.
OBESITY and CHD Nathan Wong. OBESITY AHA and NIH have recognized obesity as a major modifiable risk factor for CHD Obesity is a risk factor for development.
OBESITY AND ASTHMA Dr. Enrico Heffler MD, Specialist in Allergy and Clinical Immunology Allergy and Clinical Immunology - University.
Obesity and Hypertension in Pregnancy: Does it matter afterwards? Prof Leonie Callaway.
Inequalities in Health: Lifestyle Factors.
What women can do to stay healthy Valerie Beral University of Oxford THE MILLION WOMEN STUDY.
Obesity and Cancer: The Link. The Panel’s Recommendation.
Introductions Name address Favorite type of food Least favorite food Magazine you read most often All-time favorite movie Concert/performance you’d.
Health 4250 Eating Disorders Adapted from a presentation by Gordon James, Jennifer Turley & Kim Hyatt Weber State University.
Diet and Health Chapter 11. Cancer Facts  US men have a 1 in 2 lifetime risk  US women have a 1 in 3 lifetime risk  1,220,000 new malignant cancer.
Special Diabetes Program for Indians Competitive Grant Program SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Clinical Goals for the Healthy.
ADVICE. Advice Strongly advise adherence to diet and medication Smoking cessation, exercise, weight reduction Ensure diabetes education and advise Diabetes.
Baseline. Caloric Balance Caloric Intake + Expenditure = +/- Caloric Balance.
Physical Activity and Reduction of Breast Cancer Risk.
Physical Activity and Reduction of Colon Cancer Risk.
HEALTHY EATING And LIVING Kenneth E. Nixon MD. Problem Overweight and Obesity 97 million adults are overweight or obese Medical Problems Associated with.
Health Disparities in Cardiovascular Disease Paula A. Johnson, MD, MPH Chief, Division of Women’s Health; Executive Director, Connors Center for Women’s.
Minimally Invasive Surgery Symposium Modest Weight Loss in T2 DM: Lessons from the Look AHEAD Trial Donna H. Ryan, MD Pennington Biomedical Research Center.
Tt HRB Centre for Health and Diet Research The burden of hypertension Ivan J Perry, Dept. of Epidemiology and Public Health, University College Cork. Institute.
CONSEQUENCES WHAT DOES THE WORD MEAN TO YOU?. ARE ALL CONSEQUENCES NEGATIVE?
Chapter 10: Special Topics in Adults & Chronic Diseases: Nutrition and Public Health Judith Sharlin, PhD, RD.
LIFESTYLE INTERVENTION You CAN’T change where you came from…….. You CAN change where you are going……
Risk factors to the Cardiovascular System. Learning Outcomes Describe modifiable risk factors: diet, smoking, activity, obesity Describe non-modifiable.
4%4-6%6% n/a Source: Mokdad et al., Diabetes Care 2000;23: Prevalence of Diabetes among U.S. Adults, BRFSS, 1990.
Medical Management of obesity Perinatal ANGELS Conference Feb 17, 2005 Philip A. Kern.
Leveraging Weight Loss in the Treatment of Type 2 Diabetes Part 1 of 4.
Beyond Standard Adjuvant Therapy for Colon Cancer: Role of Nonstandard Interventions Jeffrey Meyerhardt, MD, MPH Dana-Farber Cancer Institute Boston, MA.
VA/DoD 2006 Clinical Practice Guideline For Screening and Management of Overweight and Obesity Guideline Summary: Key Elements.
Module 2 LIVING FIT: OBESITY & WEIGHT CONTROL. 2 Session I: Obesity Workshop Objectives and Aims To become familiar with issues and causes of obesity.
Dietary and Lifestyle Adjuncts to Active Surveillance Stephen J. Freedland, M.D. Assistant Professor of Urology and Pathology Duke Prostate Center Durham.
MAKING INFORMED CHOICES ABOUT HEALTHY, ACTIVE LIFESTYLES.
END Obesity Dr Gul Bano © S Nussey. What is obesity?
Oncology in midlife and beyond 2013 Oncology in midlife and beyond.
Low Fat Center for Energy Balance Journal Club Shannon Armbruster MD Gynecologic Oncology October 15, 2015.
Exercise and adult women’s health Amos Pines. Exercise improves cardiovascular risk profile Body mass index Total, abdominal (subcutaneous and visceral)
Can lifestyle moderate the burden of CVD? Evangelos Polychronopoulos, MD, MPH, PhD Asst Professor of Preventive Medicine Harokopio University.
CHAPTER 7: Obesity in Women. Introduction 68% of U.S. population is overweight or obese. Resulting medical and psychosocial difficulties can be debilitating.
DIET – IT’S A LIFESTYLE!. Key stages in life Why does the body require different amounts of energy during different stages? age; gender; body size; level.
P.E. PROFESSIONAL DEVELOPMENT TRAINING. WHAT ARE THE BIGGEST CONCERNS YOU HAVE ABOUT THE PHYSICAL WELL-BEING OF KIDS FROM THIS GENERATION?
Cancer Risk Factors in Ontario Healthy Weights, Healthy Eating and Active Living.
Bariatric surgery is the surgery to cut off excessive fat from the body.
UNDERSTANDING WEIGHT GAIN AT MENOPAUSE. Key issues  For women aged 55–65 years, weight gain is one of their major health concerns  Is weight gain at.
Overview of Nutrition Related Diseases
Understanding weight gain at menopause
QOL surveys every 2 months for 2 years.
Overview of diet related diseases
Peak oxygen uptake and prevalence of cardiovascular disease risk factors in breast cancer survivors Lahart1, I.M., Metsios1, G.S., Nevill1, A.M., Kitas1,2,
Prevention of the rising incidence of breast cancer in Asian women?
A Low Carbohydrate Nutritional Program Improves Weight, Insulin, and Estrogenic Parameters in Obese Patients with Estrogen Receptor Positive Endometrial.
Healthy Eating Predicts Lower Risks of Cardiometabolic Diseases in Chinese A report from the Shanghai Women’s and Men’s Health Studies Danxia Yu1, Xiao-Ou.
Structured Education for Type 2 diabetes: expensive and unproven?
Chapter 10 Diet and Health
Exercise and adult women’s health
Obesity Extension.
Obesity Extension.
Physiology, Health & Exercise
Obesity Eppie Habashi.
Nutrition Assignment Due next week to your lab instructor.
Prepared by staff in Prevention and Cancer Control.
Presentation transcript:

Diet & exercise & breast cancer Mary Pegington Research Dietitian Genesis Prevention Centre & Nightingale Breast Screening Centre, University Hospital of South Manchester

Breast cancer rates are increasing 1-2% per year 2011 : 50,285 cases / year

Breast cancer incidence trends Bray et al Breast Cancer Research 6: 229, 2004 Europe Year Age standardised rate (world) Americas Year Age standardised rate (world) Asia/Oceania Year Age standardised rate (world) UK FINLAND SPAIN SLOVAKIA USA CANADA PUERTO RICO COLUMBIA AUSTRALIA JAPAN INDIA

Western lifestyle & breast cancer risk

loss or gain 2.0 gain gain gain >20.0 Weight gain (kg) Multivariate RR Adult weight gain increases risk of post menopausal breast cancer Huang et al JAMA 287: 1407, 1997, Colditz GA et al Arch Int Med 122: 481, 1995

loss or gain 2.0 gain gain gain >20.0 Weight gain (kg) Multivariate RR Adult weight gain increases risk of post menopausal breast cancer Diabetes 3 Cardiovascular disease Huang et al JAMA 287: 1407, 1997, Colditz GA et al Arch Int Med 122: 481, 1995 Willett W et al JAMA 273: 461, 1995 Aleksandrova K et al Eur J Cancer : Colorectal cancer

Weight loss reduces breast cancer incidence Cohort studiesPopulationWeight lossRR Harvie et al ,000 postmenopausal women >5% ~3.5 kg 0.61 (0.46 – 0.80) Eliassen et al ,000 postmenopausal women >10kg ~ 15% 0.43 (0.25 – 0.86) Prentice et al ,835 postmenopausal women 2 kg ~3% 0.91 (0.83 – 1.01) Teras et al 2011 Bariatric surgery 13,055 overweight & obese postmenopausal women >5 kg ~7% 0.78 (0.55 – 1.10)

Obesity and Cancer Hursting SD & Hursting MJ Arterioscle Thomb Vasc Biol 32: 1766, 2012

Premenopausal weight is important Excess weight increases risk age >35yrs - General population (Peacock et al Am J Epidemiol. 1999) - Family History (Cecchini et al Cancer Prev Res 2012) Pre menopausal weight gain increases postmenopausal risk UK data shows 10/12 kg of adult weight gain occurs by age of 50 (Health Survey England 2012)

Exercise & breast cancer Each hour of exercise/ week reduces risk of breast cancer by 6% Aim for 3 hours of exercise / week Friedenreich Recent Results Cancer Res. 2011;188:125-39

-27% -24% -18% <1% < >30 Friedenreich Recent Results Cancer Res. 2011;188: BC risk reduction BMI “Fit and Fat” does not protect against breast cancer

Alcohol 10 units / week vs. no drinking increases BC risk by 10% BUT No alcohol increases risk of heart disease by 40% No alcohol increases risk of dying from any cause by 13% Lowest risk for dying from any cause with 3–15 g/day Higher risk for dying from any cause with >60 g/day Ronksley P E et al. BMJ 2011;342:bmj.d671

Recommended Mediterranean diet

Weight control and energy restriction after diagnosis

Niraula S et al Breast Cancer Res Treat : Obesity & overall survival Obesity & breast cancer survival 20% more likely to die from any cause 26% more likely to die from breast cancer

Weight gain after diagnosis % of patients gain weight after diagnosis Most weight gained during first year Weight gain persists - long term problem Greatest weight gain in: premenopausal, adjuvant chemotherapy, thinner women, chemotherapy induced menopause

Dietary interventions - RCT WINS – WHEL N Age 48 – Time post diagnosisUp to 1 yearUp to 4 years Intervention 5 years Sustained fat reduction 20% vs 29% 6 years Transient fat reduction 20% vs 29% 12 vs 6 fruit & veg / day Weight change- kg-2.7 vs vs +0.4 Disease free survival 0.76 (0.6 – 0.98)0.96 (0.8 – 1.14)

Kwan ML et al CEBP (1): 32–41. Trend for increased alcohol & reduced overall mortality & cardiovascular mortality Alcohol after diagnosis

2.5 hours of moderate activity /week & outcome (n = 13,302) RecurrenceBreast cancer mortality All cause mortality Normal weight 0.93 (0.81 – 1.07) 0.72 (0.61 – 0.86) 0.72 (0.63 – 0.83) Overweight 0.98 (0.85 – 1.14) 0.78 (0.65 – 0.94) 0.69 (0.59 – 0.81) Obese 0.96 (0.77 – 1.19) 0.72 (0.61 – 0.86) 0.86 (0.7 – 1.06) Beasley et al Breast Cancer Res Treat 2012 ; 131 :

Calorie restriction is difficult to achieve and maintain in humans! 25-30% adherence to low cal diets at 12 months 20%-40 achieve > 5% weight loss at 1 year Only 20% of our women at high risk of breast cancer maintain > 5% weight loss at 5 years Dansinger et al. JAMA 2005;293:43-53.

Our first intermittent study RCT of IER vs. daily restriction Is intermittent energy restriction acceptable & easier to follow than daily restriction? 2. Does IER have better effects on risk markers for breast cancer, diabetes, CVD compared to daily restriction?

Change in weight & body fat including drop outs (N = 115) P<0.05 P<0.01

Intermittent diet study 2 - Summary IER superior to daily restriction for reducing body fat and insulin. IER superior to daily restriction for reducing body fat and insulin. 1 day of restriction / week maintains weight loss 1 day of restriction / week maintains weight loss

Intermittent diets may reduce chemotherapy toxicity Animal studies and case studies suggest IER may reduce chemotherapy toxicity May reduce oxidative stress & upregulate stress response mechanisms. B-AHEAD 2 will look at the effects on chemotherapy toxicity: self report data and two novel blood biomarkers Safdie et al Aging (Albany NY) : Lee et al Sci Transl Med ;4 (124)

B-AHEAD 2 Study Outcomes 3 weeks post final chemotherapy Weight, body fat (DXA), waist, hips Breast cancer prognosis marker – insulin Oxidative stress markers Chemotherapy toxicity (self report & Cytokeratin 18 & FMS Like Tyrosine Kinase 3 ligand markers) CVD risk parameters: lipids, blood pressure Fitness, Quality of life, Dietary intake, Physical activity n = 170 Scheduled to receive adjuvant or neoadjuvant chemotherapy 2 day / week IER (& exercise) Individual advice and telephone support Group 1: n = 85 Group 2: n = 85 Daily energy restricted diet (& exercise) Individual advice and telephone support 4 ½ to 6 months of chemotherapy

Acknowledgements FAMILY HISTORY CLINIC/PROCAS Tony Howell Gareth Evans Paula Stavrinos Louise Donnelly R Greenhalgh Jenny Affen Jayne Beesley LIFESTYLE Michelle Harvie Mary Pegington Debbie McMullen Kath Sellers Ellen Mitchell Pam Coates Lesley Coates Cheryl Barlow Nina Brogden Genesis Volunteers FUNDING FUNDING Genesis Breast Cancer Prevention National Institute of Health Research Breast Cancer Campaign WCRF Breast Cancer Research Trust Rob Clarke – Patterson Institute Kath Spence – Patterson Institute Andy Sims – Breakthrough Edinburgh Roy Goodacre - UOM Mark Mattson – NIH Baltimore COLLABORATORS The Patients

Any questions?