Sugar and cancer: The relationship between diet and chronic disease
About half of all American adults— million individuals—have one or more preventable chronic diseases, many of which are related to poor quality eating. Objective. This study was aimed to identify the dietary patterns among Chinese adults in Baoji and explore the association between these dietary patterns and. Diet, as well as other factors such as physical activity and tobacco use, can affect health throughout life.
Bell, Roe, and Rolls In children, an increase in soda consumption of one serving per day was associated with an odds ratio of 1.
Reductions in dietary fiber and increases in the dietary glycemic load large amounts of rapidly absorbed carbohydrates from refined starches and sugar may also contribute to obesity Ebbeling and others ; Swinburn and others Aspects of the food supply unrelated to its macronutrient composition are also likely to be contributing to the global rise in obesity. Inexpensive food energy from refined grains, sugar, and vegetable oils has become extremely plentiful in most countries.
Food manufacturers and suppliers use carefully researched methods to make products based on these cheap ingredients maximally convenient and attractive. Maintain Daily Physical Activity and Limit Television Watching Contemporary life in developed nations has markedly reduced people's opportunities to expend energy, whether in moving from place to place, in the work environment, or at home Koplan and Dietz Dramatic reductions in physical activity are also occurring in developing countries because of urbanization, increased availability of motorized transportation to replace walking and bicycle riding, and mechanization of labor.
However, regular physical activity is a key element in weight control and prevention of obesity IARC ; Swinburn and others For example, among middle-aged West African women, more walking was associated with a three-unit lower BMI Sobngwi, Gautier, and Mbanyaand in China, car owners are 80 percent more likely to be obese Hu In addition to its key role in maintaining a healthy weight, regular physical activity reduces the risk of CAD, stroke, type 2 diabetes, colon and breast cancer, osteoporotic fractures, osteoarthritis, depression, and erectile dysfunction table Important health benefits have even been associated with walking for half an hour per day, but greater reductions in risk are seen with longer durations of physical activity and more intense activity.
The number of hours of television watched per day is associated with increased obesity rates among both children and adults Hernandez and others ; Ruangdaraganon and others and with a higher risk of type 2 diabetes and gallstones F. Hu, Leitzmann, and others ; Leitzmann and others This association is likely attributable both to reduced physical activity and to increased consumption of foods and beverages high in calories, which are typically those promoted on television.
Decreases in television watching reduce weight Robinsonand the American Academy of Pediatrics recommends a maximum of two hours of television watching per day.
Eat a Healthy Diet Medical experts have long recognized the effects of diet on the risk of CVD, but the relationship between diet and many other conditions, including specific cancers, diabetes, cataracts, macular degeneration, cholelithiasis, renal stones, dental disease, and birth defects, have been documented more recently.
The following list discusses six aspects of diet for which strong evidence indicates important health implications table Replace saturated and trans fats with unsaturated fats, including sources of omega-3 fatty acids. Replacing saturated fats with unsaturated fats will reduce the risk of CAD F.
Also, polyunsaturated fats including the long-chain omega-3 fish oils and probably alpha-linoleic acid, the primary plant omega-3 fatty acid can prevent ventricular arrhythmias and thereby reduce fatal CAD. In a case-control study in Costa Rica, where fish intake was extremely low, the risk of myocardial infarction was 80 percent lower in those with the highest alpha-linoleic acid intake Baylin and others Intakes of omega-3 fatty acids are suboptimal in many populations, particularly if fish intake is low and the primary oils consumed are low in omega-3 fatty acids for example, partially hydrogenated soybean, corn, sunflower, or palm oil.
These findings have major implications, because changes in the type of oil used for food preparation are often quite feasible and not expensive. Trans fatty acids produced by the partial hydrogenation of vegetable oils have uniquely adverse effects on blood lipids F.
Hu and Willett ; on a gram-for-gram basis, both the effects on blood lipids and the relationship with CAD risk are considerably more adverse than for saturated fat.
In many developing countries, trans fat consumption is high because partially hydrogenated soybean oil is among the cheapest fats available. In South Asia, vegetable ghee, which has largely replaced traditional ghee, contains approximately 50 percent trans fatty acids Ascherio and others Independent of other risk factors, higher intakes of trans fat and lower intakes of polyunsaturated fat increase risk of type 2 diabetes F.
Hu, van Dam, and Liu Ensure generous consumption of fruits and vegetables and adequate folic acid intake. Strong evidence indicates that high intakes of fruits and vegetables will reduce the risk of CAD and stroke Conlin Some of this benefit is mediated by higher intakes of potassium, but folic acid probably also plays a role F.
Hu and Willett Supplementation with folic acid reduces the risk of neural tube defect pregnancies. Substantial evidence also suggests that low folic acid intake is associated with greater risk of colon—and possibly breast—cancer and that use of multiple vitamins containing folic acid reduces the risk of these cancers Giovannucci Findings relating folic acid intake to CVD and some cancers have major implications for many parts of the developing world.
In many areas, consumption of fruits and vegetables is low. For example, in northern China, approximately half the adult population is deficient in folic acid Hao and others Consume cereal products in their whole-grain, high-fiber form. Consuming grains in a whole-grain, high-fiber form has double benefits.
First, consumption of fiber from cereal products has consistently been associated with lower risks of CAD and type 2 diabetes F. Hu, van Dam, and Liu ; F. Hu and Willettwhich may be because of both the fiber itself and the vitamins and minerals naturally present in whole grains. High consumption of refined starches exacerbates the metabolic syndrome and is associated with higher risks of CAD F.
Hu and Willett and type 2 diabetes F. Second, higher consumption of dietary fiber also appears to facilitate weight control Swinburn and others and helps prevent constipation. Limit consumption of sugar and sugar-based beverages. Sugar free sugars refined from sugarcane or sugar beets and high-fructose corn sweeteners has no nutritional value except for calories and, thus, has negative health implications for those at risk of overweight.
Furthermore, sugar contributes to the dietary glycemic load, which exacerbates the metabolic syndrome and is related to the risk of diabetes and CAD F. Hu and Willett ; Schulze and others WHO has suggested an upper limit of 10 percent of energy from sugar, but lower intakes are usually desirable because of the adverse metabolic effects and empty calories.
Limit excessive caloric intake from any source. Given the importance of obesity and overweight in the causation of many chronic diseases, avoiding excessive consumption of energy from any source is fundamentally important. Because calories consumed as beverages are less well-regulated than calories from solid food, limiting the consumption of sugar-sweetened beverages is particularly important. The principle justification for limiting sodium is its effect on blood pressure, a major risk factor for stroke and coronary disease chapter WHO has suggested an upper limit of 1.
Potential of Dietary and Lifestyle Factors to Prevent Chronic Diseases Several lines of evidence indicate that realistic modifications of diet and lifestyle can prevent most CAD, stroke, diabetes, colon cancer, and smoking-related cancers.
Less progress has been made in identifying practically modifiable causes of breast and prostate cancers. One line of evidence is based on declines in CAD in countries that have implemented preventive programs. The most dramatic example is that of Finland box Finland provides one of the best-documented examples of a community intervention. InFinland had the world's highest CVD mortality rate. Planners examined the policy and environmental factors contributing to CVD and sought appropriate more Other evidence derives from randomized intervention studies.
These often have serious limitations for estimating the potential magnitude of benefits, because typically only one or a few factors are modified, durations are usually only a few years, and noncompliance with lifestyle change is often substantial. Nevertheless, some examples are illustrative of the potential benefit. In two randomized studies among adults at high risk of type 2 diabetes, those assigned to a program emphasizing dietary changes, weight loss, and physical activity experienced only half the risk of incident diabetes Knowler and others ; Tuomilehto and others The Lyon Heart Study, conducted among those with existing heart disease, found a Mediterranean-type diet high in omega-3 fatty acids reduced recurrent infarction by 70 percent compared with an American Heart Association diet de Lorgeril and others A third approach is to estimate the percentage of disease that is potentially preventable by reducing multiple behavioral risk factors using prospective cohort studies.
Sugar and cancer: The relationship between diet and chronic disease
Collectively, these findings indicate that the low rates of these diseases suggested by international comparisons and time trends are attainable by realistic, moderate changes that are compatible with 21st-century lifestyles. Interventions Interventions aimed at changing diet and lifestyle factors include educating individuals, changing the environment, modifying the food supply, undertaking community interventions, and implementing economic policies.
In most cases, quantifying the effects of the intervention is difficult, because behavioral changes may take many years and synergies are potentially important but hard to estimate in formal studies. Substantial nihilism often exists regarding the ability to change populations' diets or behaviors, but major changes are possible over extended periods of time.
For example, per capita egg consumption in the United States decreased from approximately to per year between and following recommendations for preventing CAD though in reality, the evidence for benefits was meager. Similarly, the prevalence of smoking, despite its being a physically addictive behavior, halved among men in the United States between and Because changing behaviors related to diet and lifestyle require sustained efforts, long-term persistence is needed.
However, opportunities exist that do not require individual behavior changes, and these can lead to more rapid benefits. Educational Interventions Efforts to change diets, physical activity patterns, and other aspects of lifestyle have traditionally attempted to educate individuals through schools, health care providers, worksites, and general media.
Diet & Nutrition: 3. How are chronic diseases linked to diet and nutrition?
These efforts will continue to play an important role, but they can be strongly reinforced by policy and environmental changes. School-based Programs School-based programs include the roles of nutrition and physical activity in maintaining physical and mental health box School food services should provide healthy meals, both because they directly affect health and because they provide a special opportunity to teach by example.
In many countries, school-based physical education remains a significant source of physical activity for young people. In China, 72 percent of children age 6 to 18 engage in moderate to vigorous physical activity for a median of 90 to minutes per week Tudor-Locke and others Maintaining these programs should be a high priority because they have likely contributed to the historically low rates of obesity in such countries.
The Planet Health Program. Planet Health, developed for middle school students, in the United States, has an immediate goal of reducing television viewing time with the long-range goal of preventing unhealthy weight gain Gortmaker and others Worksite Interventions Worksite interventions can efficiently include a wide variety of health promotion activities because workers spend a large portion of their waking hours and eat a large percentage of their food there.
Interventions can include educating employees; screening them for behavioral risk factors; offering incentive programs to walk, ride a bicycle, or take public transportation to work; offering exercise programs during breaks or after work; improving the physical environment to promote activity; and providing healthier foods in cafeterias box Worksite health promotion can result in a positive return on investment through lower health costs and fewer sick days.
Inthe company integrated its health and wellness program with more Interventions by Health Care Providers Controlled intervention trials for smoking cessation and physical activity have shown that physician counseling, especially when accompanied by supporting written material, can be efficacious in modifying behavior.
Studies of dietary counseling by physicians indicate that even brief messages about nutrition can influence behavior and that the magnitude of the effect is related to the intensity of the intervention Pignone and others Identifying patients who are overweight or obese, or who are gaining weight but are not yet overweight, is an initial step in preventing and treating overweight. However, many physicians are not well trained to measure and calculate BMI and identify weight problems.
Transportation Policy and Environmental Design Transportation policies and the design of urban environments are fundamental determinants of physical activity and therefore influence the risks of obesity and other chronic diseases.
Countries can take a number of steps to make positive changes. Limit the Role of Automobiles In wealthy countries, the automobile has strongly influenced the trend toward low-density, automobile-based suburban developments, many built without sidewalks.
These sprawling settlements tend to have few services within walking distance and are usually not linked to public transporationt.
Dependence on automobiles affects physical activity, because those who use public transportation tend to walk more. In a prospective study in eight provinces in China, 14 percent of households acquired a car between andand the likelihood of men becoming obese during the same period was twice as great in households that acquired a car than in those that did not A.
Bell, Ge, and Popkin National policies strongly influence automobile use and dependency. In the United States, low taxes on gasoline, free parking, and wide streets encourage car ownership: In contrast, in most of Western Europe, narrow streets, limited parking, and high gasoline prices make the costs of automobile use almost double those in the United States Pucher and Dijkstra As a result, Europeans walk or bike more and use their cars approximately 50 percent less than their American counterparts.
Investment in roads rather than in public transportation creates a vicious cycle: As car use grows, injuries and deaths associated with automobile accidents also grow. In China, the number of four-wheeled vehicles increased from about 60, to more than 50 million between andand traffic fatalities increased from about 6, to more thanS.
Wang and others Many innovative strategies have been developed to discourage private automobile use and to promote public transportation, walking, and bicycling see box Singapore has long been in the lead in relation to such efforts: Other nations and regions are now enacting similar road pricing systems or congestion taxes. Since its inception inthe charge has reduced congestion in the city and is expected to channel funds back into the city's transportation facilities.
Curitiba, Brazil, provides an example of the benefits of a strategy that reduces automobile use and increases use of public transportation. Incity planners adopted a master plan that promoted development along more Unfortunately some countries, particularly China, have taken a different approach to their future transportation needs. Government initiatives that encourage families to buy automobiles include lowering taxes, simplifying registration procedures, and allowing foreign financing.
In Beijing alone, residents purchasedcars in Promote Walking and Bicycle Riding Walking or cycling for transportation and leisure are effective and practical means of engaging in physical activity and are still the most common ways to travel in many developing countries. In Bangkok and Manila, only 25 percent of travel is by car, motorcycle, or taxi, compared with 75 percent by public transportation or walking Pendakur In Madras, India, only 8 percent of the population travels by private, motorized transportation; 22 percent of people walk; 20 percent bike; and the rest use public transportation Pendakur In China, approximately 90 percent of the urban population walks or rides a bicycle to work, shopping, or school each day G.
Hu and others Walking or biking is more likely to be prevalent in smaller cities—that is, those with 1 million to 5 million people—than in larger ones. Bicycle riding and walking are also important for children's health.
Most American children do not walk or bike to school, even when distances are short box In contrast, almost 90 percent of Chinese children under 12 walk or ride a bicycle to school Hu One of the most effective ways to promote walking and cycling is through local schools.
Association between Dietary Patterns and Chronic Diseases among Chinese Adults in Baoji
Mandatory labeling of the trans fat content in foods became effective January 1,making it easier for consumers to shop wisely. However, numerous companies have begun producing trans fat-free products. In addition to fat, salt is linked to heart disease through its role in elevating blood pressure and increasing the risk of stroke in susceptible individuals. This increases to The Nutrition Facts labels on foods list the sodium content per serving.
Most salt in the American diet comes from processed foods and salt added during preparation. The Dietary Approaches to Stop Hypertension diet is effective for reducing blood pressure through an increase in the servings of fruits, vegetables, and whole grains in the diet.
Fruits and Vegetables Combat Cancer Increased longevity increases the risk of developing cancer. For example, men aged 60 to 69 have a one in six chance of developing cancer, increasing to one in three by the time they reach the age of 70, according to American Cancer Society Surveillance Research published in For women, the risk is one in 10 from the age of 60 to 69, increasing to one in four by the time they turn Prostate cancer is the top cancer killer for men, while breast cancer ranks highest for women, with lung and colon or rectal cancers ranking second and third, respectively, for both sexes.
Whether choosing to undergo treatment or not, loss of weight and muscle mass also means a loss of quality of life and faster demise.
It can also increase the risk of stroke, heart disease, and other circulatory problems. Inthe prevalence of diagnosed diabetes among people aged 65 to 74 was about 12 times that of people under the age of 45 Diabetes treatment calls for controlling blood sugar, though there is controversy about the tightness of this control. In addition, a study conducted in Germany showed that close-to-normal blood sugar control helped prevent symptoms of geriatric syndrome e.
On the other hand, the chief concern about tight blood sugar control in older adults is the risk of hypoglycemia low blood sugar.
Hypoglycemia in elders is associated with an increased risk for stroke, heart attack, and seizures. Ideally, healthful eating, regular exercise, and loss of excess weight can control blood sugar, resorting to medication only if necessary.
I tell my older patients to focus more on whole grains, fruits, and vegetables and less on refined flours and sugars.
If they need to control their weight or have difficulty controlling their blood sugar if they are already diabetic, I recommend counting carbohydrates and spacing their carbohydrate intake evenly in meals and snacks throughout the day.