Cancer and Diabetes: Two
Epidemics or One?
Andrea Reser, RD/LD
Diabetes Program Coordinator/Clinical
Dietitian
Overview
• Diabetes Epidemic
• Cancer Statistics
• Relationship of Diabetes and Cancer
• Importance of Blood Sugar Control
• Treatment Challenges
• Cancer Fighting Diabetic Diet
• Prevention
• Conclusions
2
Cancer & Diabetes: The
Connection
US Mortality
1.
Heart disease: 652,091
2.
Cancer: 559,312
3.
Stroke (cerebrovascular diseases): 143,579
4.
Chronic lower respiratory diseases: 130,933
5.
Accidents (unintentional injuries): 117,809
6.
Diabetes: 75,119
7.
Alzheimer's disease: 71,599
8.
Influenza/Pneumonia: 63,001
9.
Nephritis, nephrotic syndrome, and nephrosis: 43,901
10. Septicemia: 34,136
Source: Centers for Disease Control, 2008, www.cdc.gov
4
Diabetes Overview
• Diabetes
–Disease in which the body does not produce or properly
use insulin
Source: American Diabetes Association, 2008 www.diabetes.org
Picture: http://www.medicinenet.com/islet_cell_transplantation/article.htm
5
Major Types of Diabetes
• Type 1 Diabetes
–Results from body’s failure to produce insulin
–5 to 10% of Americans
• Type 2 Diabetes
–Results from insulin resistance (body fails to properly use insulin),
combined with relative insulin deficiency
–Most Americans
• Gestational Diabetes
–Immediately after pregnancy 5-10% have Type 2 diabetes
• Pre-diabetes
–Blood glucose levels higher than normal but not enough for
diagnosis in Type 2 diabetes
Source: American Diabetes Association, 2008, www.diabetes.org
6
Diabetes Epidemic
• 23.6 million children and
adults in United States
(8%)
–17.9 million have been
diagnosed
–5.7 million are unaware
–57 million prediabetes
• CDC: Last 15 years
numbers have more than
doubled
Sources: American Diabetes Association, 2008, www.diabetes.org; Centers for
Disease Control, 2008, www.cdc.gov
7
Mortality Change
Rate Per 100,000
600
586.8
1950
500
2004
400
300
217.0
193.9
180.7
200
185.8
100
50.0
48.1
19.8
0
Heart
Diseases
Cerebrovascular
Diseases
Pneumonia/
Influenza
Cancer
Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.
2004 Mortality Data: US Mortality Public Use Data Tape, 2004, NCHS, Centers for Disease Control and
8
Prevention, 2006
2008 Estimated US Cancer Deaths
Lung & bronchus
31%
Prostate
10%
Men
294,120
Women
271,530
•26% Lung & bronchus
•15% Breast
Colon & rectum
8%
•9%
Pancreas
6%
• 6% Pancreas
Liver & intrahepatic
bile duct
4%
• 6% Ovary
Leukemia
4%
• 3% Non-Hodgkin
lymphoma
Esophagus
4%
Urinary bladder
3%
Non-Hodgkin
lymphoma
3%
Kidney & renal pelvis
3%
All other sites
24%
Source: American Cancer Society, 2008, www.cancer.org
Colon & rectum
• 3% Leukemia
• 3% Uterine corpus
• 2%
Liver & bile duct
• 2% Brain/ONS
•25%
All other sites
9
Lifetime Probability: Men
Site
Risk
All sites†
Prostate
1 in 2
1 in 6
Lung and bronchus
1 in 12
Colon and rectum
1 in 17
Urinary bladder‡
1 in 28
Non-Hodgkin lymphoma
1 in 47
Melanoma
1 in 49
Kidney
1 in 61
Leukemia
1 in 67
Oral Cavity
1 in 72
Stomach
1 in 89
Source: American Cancer Society, 2008, www.cancer.org
10
Lifetime Probability: Women
Site
Risk
All sites†
Breast
1 in 3
1 in 8
Lung & bronchus
1 in 16
Colon & rectum
1 in 19
Uterine corpus
1 in 40
Non-Hodgkin lymphoma
1 in 55
Ovary
1 in 69
Melanoma
1 in 73
Pancreas
1 in 79
Urinary bladder‡
1 in 87
Uterine cervix
1 in 138
Source: American Cancer Society, 2008, www.cancer.org
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Overview
• Diabetes Epidemic
–Most undiagnosed
• Lifetime Risk:
–Male: 1 in 2
–Female: 1 in 3
8-18% of cancer patients also have
diabetes
Source: American Cancer Society, 2008, www.cancer.org
12
Diabetes and Cancer
• Type 1:
–Cervical Cancer
–Stomach Cancer
• Type 2:
–Breast Cancer
–Endometrial Cancer
–Pancreatic Cancer
–Liver Cancer
–Kidney Cancer
–Colon Cancer
13
Obesity Trends
1992
1995
1998
2005
Less than 50%
50 to 55%
More than 55%
State did not participate in survey
Source: Centers for Disease Control, 2008, www.cdc.gov
14
The Relationship
• Hyperglycemia (high blood sugar)
• Elevated insulin concentrations
• Growth promoting effects of IFG-1
15
Blood Sugar Control
• 80-110 mg/dl
• Increased length of stay and cost
• Higher infection rate
• Shorter remission periods
• High morbidity and mortality rates
• Decreased Immune Function
• Decreased Quality of Life
16
Treatment Challenges
• Treatment induced diabetes
• Parenteral and enteral nutrition
• Reduced/omission of dose
• Delays in treatment
• Co-morbidities
• Aftercare and quality of life
• No National Standards
17
Cancer Fighting Diabetic Diet
Nutrition Goals
• Diabetes
–Achieve and maintain:
–Blood glucose
–Lipid profile (cholesterol,
LDL, HDL, TG)
–Blood pressure
–Prevent/Slow chronic
complications
–Address individual nutritional
needs
–Maintain pleasure with eating
• Cancer
–Achieve and maintain:
–Energy stores
–Lean body mass
–Maximize the Immune
System:
–WBC, RBC, platelets
–Prevent/Slow treatment side
effects
–Address individual nutritional
needs
–Maintain pleasure with eating
19
Carbohydrates (CHO)
• Largest effect on blood sugar
• Encouraged to include
• Low CHO (<130g/day) not recommended
• Monitor CHO intake
–Exchange List
–Carbohydrate counting
–Plate Method
20
Carbohydrates
Carbohydrates
Simple
Complex
Whole Grains, Fruit, Vegetables
White Refined Products
21
Sweeteners
• Artificial sweeteners
–Aspartame, saccharin, sucralose, acesulfame-K
–No calories
• Sugar Alcohols
–Xylitol, mannitol, sorbitol
–Calories, GI discomfort
• Natural sweeteners
–Stevia, fructose, honey, molasses
22
Carbohydrates (CHO)
• Choose More Often:
–Whole Fruits
–Whole Vegetables
–Whole Grains
–Beans/Legumes
–Natural Sugars
• Choose Less Often:
–White, refined products
–Simple sugars
–Cakes, candy
–Sugar free products
23
Protein Overview
• Building block of our bodies
• Regulates blood sugar
• Builds:
–Immune system
–WBC, RBC
–Muscles
–Hormones
–Enzymes
• Specific amount established by Dietitian
24
Protein
• 2/3 of Protein in Diet:
–Beans/Legumes
–Nuts/Seeds
–Nut Butters
–Whole Grains
–Soy
–Powders:
–Rice
–Vegetable
–Soy
• 1/3 of Protein in Diet:
–Animal Meats
–Red meat <18 oz week
–Dairy
–Eggs
–Powders:
–Whey (Dairy)
–Goat
Builds and Supports Immune
System
Source: American Institute for Cancer Research, 2008, www.aicr.org
25
Fat Overview
• Essential in diet
• Regulates blood sugar
• Fat and Cholesterol
–Increase risk for heart disease
–Increase cancer risk
26
Fats
• Saturated Fats
– Solid at room temperature
– Animal Sources
Fats
– Linked to cancer
– Limited quantity
• Unsaturated Fats
– Liquid at room temperature
– Plant sources
• Trans Fats
– “Hydrogenated Fats”
– Self stable and frozen products
Saturated
Unsaturated
Trans Fats
27
Fats (con’t)
• Monounsaturated Fats (MUFA)
• Polyunsaturated Fats (PUFA)
Unsaturated
• Omega-3
–Fish (from ocean)
–Walnuts
–Canola Oil
–Fortified Foods
–Flaxseed
MUFA
PUFA
• Omega-6
–Fried Foods
–Animal Meats
–Grains
Omega-3
Omega-6
28
Comparison of Dietary Fats
91%
Coconut oil
68%
Butterfat
10%
43%
Lard
9%
27%
Cottonseed oil
Soybean oil
15%
Olive oil
15%
Corn oil
13%
Sunflow er oil
12%
33%
Saturated Fat
39%
1%
47%
1%
1%
48%
23%
75%
57%
1%
71%
1%
11%
Omega-6
29%
1%
76%
21%
19%
8%
1%
10%
7%
1%
54%
9%
7%
28%
54%
19%
Peanut oil
Canola oil
3%1%
51%
Palm oil
Safflow er oil
2%
16%
14%
61%
Omega-3
Monounsaturated Fat
29
Overview: Fats
Fats
Saturated Fats
Unsaturated Fats
Trans Fats
Limit
Encouraged
AVOID
Monounsaturated Fats
Polyunsaturated Fats
Omega-3 & 6
30
Alcohol
• Alcohol
–Increase risk of low blood sugar
–Consume with food
–Empty calories
–Increase cancer risk
–Dehydrates body
–Female: one drink
–Male: two drinks
31
Cancer and Diabetes
Prevention
Prevention
• Lifestyle modifications
–Maintain a healthy weight
–Moderate wt loss (7% of body wt)
–Regular physical activity
–At least 30 minutes daily, 5 days week
• Three strategies for weight loss
–Eat a greater proportion of plant based foods
–Watch the size of your portions
–Keep physically active
33
Play with Your Food
Size of fist = one
serving of
carbohydrates
Size of thumb joint = one
to two servings of fat
Eat with your
Hands!
Size of palm = one serving
of meat, poultry, or fish
34
Body Mass Index (BMI)
BMI
Weight Status
Below 18.5
Underweight
18.5-24.9
Normal
25.0-29.9
Overweight
30.0 and above
Obese
BMI =
[
Weight in Pounds
]
x 703
(Height in inches) x (Height in inches)
Example:
[
150 pounds
] x 703 = 26.5
(63 inches) x (63 inches)
35
Prevention & Diet
• Eat plenty of vegetables and fruits
–Five to Nine a Day
–Standard serving ½ cup
–Prevent at least 20% of all cancers
–Fiber
–Juice
–Vitamins, Minerals, Phytochemicals
–Antioxidants
36
Vegetable and Fruit Servings
35
Prevalence (%)
30
25
24.2
24.4
24.1
24.4
23.6
24.3
1994
1996
1998
2000
2003
2005
20
15
10
5
0
Year
Source: American Cancer Society, 2008, www.cancer.org
37
Prevention & Diet
• Select foods low fat and in salt
–Limit processed foods
–Linked to most cancers
38
Cancer & Alcohol
• Drink alcohol only in moderation, if at all
–Can cause cancer
–Mouth, esophageal, laryngeal, pharyngeal, breast, and liver
cancers
–75-80% of oral cancers frequently used alcohol
–Men: 2 drinks a day; Females: 1 drink per day
 More alcohol = Higher risk
 Higher risk if use tobacco
–Empty calories
–Increase appetite
Source: American Cancer Society, 2008, www.cancer.org
39
New American Plate
1/3 (or less)
animal
protein
2/3 (or more)
vegetables, fruits,
whole grains, and
beans
Protein
Vegetables
Carbohydrate/Fruit
Fats
Source: American Institute for Cancer Research, 2008, www.aicr.org
40
Stage 1: Old American Plate
Stage 2: Transitional Plate
Stage 3: The New American Plate
Source: American Institute for Cancer Research, 2008, www.aicr.org
41
Overview
• Maintain a healthy weight and be physically active
• Choose a diet rich in a variety of plant based foods
• Eat plenty of vegetables and fruits
• Drink alcohol only in moderation, if at all
• Select foods low in fat and salt
Eat with Your
Hands!
Source: American Institute for Cancer Research, 2007
42
Conclusions
• Diabetes epidemic continues
• Strong correlations with diabetes and cancer
• Control blood sugar = more cancer fighting
• Future of Cancer and Diabetes
–Education gap
–National standards
43
Thank You!
Resources
American Cancer Society:
www.cancer.org
American Diabetes Association:
www.diabetes.org
American Institute for Cancer Research:
www.aicr.org
Cancer Treatment Centers of America:
www.cancercenter.com
45
Resources (con’t)
• AICR ScienceNOW. Summer 2008
• American Cancer Society. Cancer Facts and Figures 2008. Available at:
http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
• American Diabetes Assocation. Nutrition Recommendations and Interventions for Diabetes: A Position
Statement of the American Diabetes Association. Diabetes Care. 2007; 30 Suppl 1: S48-S65.
• Basaria S, Muller DC, Carducci MA, Egan J, Dobs AS. Hyperglycemia and Insulin Resistance in Men
with Prostate Carcinoma who Receive Androgen-deprivation therapy. Cancer. 2006; 106(3): 581-588
.
• Bunker K. A Diet-Cancer Connection. Diabetes Forecast. June 2008
• Eyre HJ, Kahn R, Robertson RM. Preventiong Cancer, Cardiovascular Disease, and Diabetes: A
common Agenda for the American Cancer Society, the American Diabetes Association, and the
American Heart Association. CA Cancer J Clin. 2004; 54(4): 190-207.
• Garg R, Bhutani H, Alyea E, Pendergrass M. Hyperglycemia and Length of Stay in Patients
Hospitalized for Bone Marrow Transplantation. Diabetes Care. 2007; 30 (4): 993-994
• Grant B and Evert A. Managing Patients Diagnosed with Cancer and Diabetes. Today’s Dietitian,
August 2008
• Richardson LC, Pollack LA. Therapy Insight: Influence of Type 2 Diabetes on the Development,
Treatment, and Outcomes of Cancer. Nat Clin Pract Oncol. 2005; (2)1: 48-53.
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