Research highlights the need to incorporate nutritional counseling in cancer treatment

Philadelphia, February 3, 2021 – New research and analysis appearing in the Journal of the Academy of Nutrition and Dietetics, published by Elsevier, highlights the barriers cancer survivors face in maintaining a healthy diet, as well as the role nutrition may play in cancer risk and treatment.

A new study finds poor diet is common in American adult cancer survivors with significant sociodemographic disparities. Researchers looked at the association of the Healthy Eating Index (HEI) score, a measure of diet quality and adherence to the USDA’s Dietary Guidelines for Americans, with demographic, lifestyle, and health-related factors of 1,971 cancer survivors. Significant disparities were observed across sociodemographic and lifestyle factors, particularly education levels, body mass index, and smoking status. The study found that cancer survivors tended to underconsume whole grains and greens and beans and overconsume sodium and saturated fats. “These findings can inform the development of specific nutrition intervention strategies to improve diet quality in high-risk populations of cancer survivors,” says lead investigator Eunkyung Lee, PhD, RDN, Assistant Professor, Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando, FL, USA.

“Evaluation of Diet Quality Among American Adult Cancer Survivors: Results From 2005-2016 National Health and Nutrition Examination Survey,” by Eunkyung Lee, PhD, RDN; Jianbin Zhu, PhD; Julia Velazquez, BS; Rachael Bernardo, BS; Jeanette Garcia, PhD; Michael Rovito, PhD; and Robert B. Hines, PhD, MPH (DOI: https://doi.org/10.1016/j.jand.2020.08.086)

Author contact: Eunkyung Lee at [email protected]

Researchers reviewed 25 studies to understand whether changes in taste are associated with cancer diagnosis or method of treatment in adults. They found that cancer diagnosis alone did not appear to influence taste function. However, taste changes consistently appeared early after the start of radiotherapy treatment and had long-lasting effects. During chemotherapy, taste changes were less consistently reported. “Cancer-related malnutrition is associated with serious adverse health outcomes,” notes lead investigator Sze-Yen Tan, PhD, AdvAPD, Senior Lecturer, School of Exercise and Nutrition Sciences and Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia. “Further research is needed to support dietitians in identifying taste alterations, understanding the contributing factors, and developing effective medical nutrition therapies.”

“Taste Function in Adults Undergoing Cancer Radiotherapy or Chemotherapy, and Implications for Nutrition Management: A Systematic Review,” by Nicole Kiss, PhD, AdvAPD; Kate Symons; Jessie Hewitt; Hannah Davis; Christy Ting; Angela Lee; Anna Boltong, PhD; Robin M. Tucker, PhD, RD, FAND; and Sze-Yen Tan, PhD, AdvAPD (DOI: https://doi.org/10.1016/j.jand.2020.08.014)

Author contact: Sze-Yen Tan at [email protected]

A new study found that a high percentage of breast cancer survivors report that they’ve made positive changes to improve their diet and physical activity after cancer diagnosis or treatment. However, the proportion of those eating the recommended amount of whole grains and staying physically active remained low. Many patients experienced fatigue, stress, and treatment-related changes in eating habits, and pain or discomfort as a barrier to exercise. The study also found that the majority of patients searched the internet for nutrition advice, and fewer than half reported seeking nutrition advice from healthcare providers. Lead investigator Fang Fang Zhang, MD, PhD, Professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA, says, “This disconnection underscores the need for integrating nutrition into cancer care in outpatient oncology clinics.”

“Self-Reported Changes and Perceived Barriers to Healthy Eating and Physical Activity among Global Breast Cancer Survivors: Results from an Exploratory Online Novel Survey,” by Laura Keaver, MPH, RD; Aisling M. McGough, MSc; Mengxi Du, MS, MPH, RD; Winnie Chang; Virginia Chomitz, PhD, FACS; Jennifer D. Allen, ScD, MPH; Deanna J. Attai, MD, FACS; Lisa Gualtieri, PhD; and Fang Fang Zhang, MD, PhD (DOI: https://doi.org/10.1016/j.jand.2020.09.031)

Author contact: Fang Fang Zhang at [email protected]

A Mediterranean style diet, rich in vegetables and olive oil, and low to moderate consumption of meat and dairy, has been associated with a reduced rate of certain types of cancer. In a new study, researchers looked at the association of the diet with overall cancer risk in men and women. They found that woman who ate moderate amounts of food associated with the Mediterranean diet had a significantly reduced risk for cancer overall compared with women who consumed the least. The difference between women with the highest adherence to the diet and women with moderate adherence was not significantly significant. In men, there was no evidence of association between eating a Mediterranean diet and overall cancer risk. Lead investigator Piet A. van den Brandt, PhD, Professor, Department of Epidemiology, GROW–School for Oncology and Developmental Biology; and Professor, Department of Epidemiology, CAPHRI–School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands, observes that the study drew on the non-Mediterranean study population of the Netherlands Cohort Study, and results might be different in areas where the diet is more commonly followed.

“Adherence to the Mediterranean Diet and Overall Cancer Incidence: The Netherlands Cohort Study,” by Maya Schulpen, PhD; and Piet A. van den Brandt, PhD (DOI: https://doi.org/10.1016/j.jand.2020.07.025).

Author contact: Piet A. van den Brandt at [email protected]

A growing body of evidence suggests that flavonoids in chocolate have the potential to decrease the risk of cancer in humans, but most of the evidence is from laboratory and animal studies. Using data from the Women’s Health Initiative Study, a large long-term study of disease in American women, researchers looked at empirical evidence on the association between chocolate consumption and the risk of cancer in postmenopausal women. They found no significant association between chocolate consumption for cancer overall, or for breast cancer specifically. However, women who consumed at least 1.5 ounces of chocolate per week had a moderate 18 percent higher risk of invasive colorectal cancer. Lead investigator James A. Greenberg, PhD, Emeritus Professor, Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY, USA, notes, “Given that obesity is an established risk factor for colorectal cancer, this result may be attributable to the excess adiposity associated with frequent chocolate candy consumption. Women who were more frequent consumers of chocolate also consumed more dietary energy and food of lower dietary quality.” He says that more rigorous controlled prospective trials are needed to test the validity of the study.

“Chocolate Candy and Incident Invasive Cancer Risk in the Women’s Health Initiative: An Observational Prospective Analysis,” by James A. Greenberg, PhD; Marian L. Neuhouser, PhD, RD; Lesley F. Tinker, PhD, RD; Dorothy S. Lane, MD, PhD; Electra D. Paskett, MSPH, PHD; Linda V. Van Horn, PhD; Sylvia Wassertheil-Smoller, PhD; James M. Shikany, DrPH; Lihong Qi, PhD; Shawnita Sealy-Jefferson, PhD, MPH; and JoAnn E. Manson, MD, DrPH (DOI https://doi.org/10.1016/j.jand.2020.06.014)

Author contact: James A. Greenberg at [email protected]

An analysis of evidence finds increased dietary fiber intake may have potential benefits to improve the gastrointestinal side effects of pelvic radiation in the treatment of gynecological cancers. While some evidence suggests improvement in the incidence and severity of diarrhea and bowel symptoms, it is insufficient to form specific recommendations for clinical practice. “Definitive recommendations regarding the type, amount, frequency of supplementation, or daily fiber target are not yet possible,” explains lead investigator Judy Bauer, PhD, AdvAPD, Associate Professor, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia. “Future research may further clarify the role of fiber in a therapeutic setting and the role of nutrition and dietetics practitioners in the delivery of specialized nutrition counseling.”

“The Efficacy of Dietary Fiber in Managing Gastrointestinal Toxicity Symptoms in Patients with Gynecologic Cancers undergoing Pelvic Radiotherapy: A Systematic Review,” by Emilie Croisier, MDietSt, APD; Teresa Brown, PhD, AdvAPD; and Judy Bauer, PhD, AdvAPD (DOI https://doi.org/10.1016/j.jand.2020.08.077)

Author contact: Emilie Croisier at [email protected]

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