by Jenna Koroly, MS, RD, CSOWM, CDN
Below we review key findings and takeaways from the research studies we featured on our Science Nook in 2021. Some common themes across the featured studies this year include the benefits of increased fiber intake from vegetables, fruits, legumes, nuts, and whole grains for cancer survivorship, as well as cancer survivors’ interest in dietitian support.
In a prospective study, higher total intake of fruits, vegetables, and legumes was inversely associated with CVD mortality, cancer incidence, cancer mortality, and all-cause mortality in model 1 (minimally adjusted model) [i].
In this study, legumes included beans, lentils, chickpeas, black beans, peas, and black-eyed peas. One serving was defined as 125 g of fruits, 125 g of vegetables, and 150 g of cooked beans. Four to five servings of these foods per day may look like:
Consider how many servings per day you have of fruits, vegetables, and legumes. For tips on how to increase consumption of these nutritious foods, check out our recipes.
In a pooled analysis of 21 prospective cohort studies, there were no significant associations between dairy intake or calcium intake (including food and supplements) and overall breast cancer risk. There were significant inverse associations between cottage cheese/ricotta cheese intake (25 grams or more per day compared to less than 1 gram per day) and yogurt intake (60 grams or more per day compared to less than 1 gram per day) and ER-negative breast cancer risk [ii]. One 4 oz container of cottage cheese is 113 grams and one 5.3 oz container of Greek yogurt is 150 grams. There was a significant inverse trend between calcium intake from food and overall breast cancer risk, although there was no significant association for the highest intake category of 1400 mg per day [ii].
In an Interventionist-Guided program and a Self-Guided program for African American breast cancer survivors, there was no association between stress and change in physical activity in either group during the 6 month intervention or maintenance phase. There was also no association between stress and change in HEI score or central adiposity in either group during the 6 month intervention or maintenance phase [iii]. This may be due to involvement in Moving Forward, where participants may have learned to apply skills to manage stress.
In breast cancer survivors, nut consumers had higher overall survival and disease-free survival rates compared to non-consumers at 10-years post-diagnosis. Similar survival differences were found for peanut, walnut, and other nut consumption [iv].
In colorectal cancer survivors, consumption of whole grains, nuts, legumes, and vegetable oils showed some evidence of an inverse association with all-cause mortality. Of these, a significant inverse association was found only for nuts. Consumption of sugar-sweetened beverages was associated with a higher risk of all-cause mortality, while moderate fruit juice consumption was significantly associated with a lower risk of all-cause mortality compared to low fruit juice consumption. Greater animal fat consumption was associated with a higher risk of all-cause mortality compared with lower animal fat consumption [v].
Individuals with a higher prudent pattern score had a decreased risk of early-onset adenoma. There were suggestions of higher DASH, AMED, and AHEI-2010 scores being associated with a decreased risk of early-onset adenoma. There was a stronger association between Western dietary pattern and risk of advanced adenomas specifically in the distal colon and rectum, but not in the proximal colon [vi].
Higher dietary fiber intake was associated with lower risk of any complications and surgical complications in colorectal cancer surgery [vii].
Higher intake of fiber was associated with a lower risk of lung cancer in a dose response pattern (30.5 g compared to 8.8 g) in a prospective study. Higher intake of whole grains was associated with a lower risk of lung cancer in a dose response pattern (2.3 servings compared to 0.3 servings) [viii].
Of those in the highest genetic risk group, a healthy lifestyle was associated with a decreased risk of lethal prostate cancer. These individuals had a 3% lifetime cumulative lethal prostate cancer incidence, compared to 6% for those in the least healthy lifestyle group. A high healthy lifestyle score included maintaining a healthy weight, engaging in vigorous physical activity, intake of fatty fish and tomatoes, decreased intake of processed meats, and lack of smoking [ix].
E-Health and Access to Nutrition Care
In a survey of over 1000 cancer survivors, 39% of participants met with a dietitian, with 74% reporting the visit to be very/extremely helpful. 56.7% of participants who did not meet with a dietitian reported that they would have liked more support regarding eating pattern [x].
In a study on E-Health tools, 89% of participants mostly, or completely, agreed that patient-reported outcome measures through tablets should be integrated into routine clinical care. Younger participants agreed significantly more than older participants. 38.2% of all participants requested nutrition supportive care on the same day after completing the questionnaires. 48.8% of those who were malnourished and distressed requested same day supportive care [xi].
In a cross-sectional retrospective study, those with vitamin D deficiency were 4.6 times more likely to be positive for COVID-19 [xii]. Although additional research is needed on vitamin D supplementation for preventing and treating COVID-19, you may consider adding vitamin D rich foods into your eating pattern. These include salmon, mushrooms, fortified milks and dairy free milks, and fortified breakfast cereals. Less commonly consumed is cod liver oil, with 1 tablespoon containing 170% of the daily value of vitamin D. The next time you have your annual physical, you may want to ask your provider to check your vitamin D levels to determine if supplementation is appropriate.
[i] Liu W, Hu B, Dehghan M, Mente A, Wang C, Yan R…on behalf of PURE-China Investigators. (2021). Fruit, vegetable, and legume intake and the risk of all-cause, cardiovascular, and cancer mortality: A prospective study. Clinical Nutrition. https://doi.org/10.1016/j.clnut.2021.01.016
[ii] Wu Y, Huang R, Wang M, Bernstein L, Bethea TN, Chen C…Smith-Warner SA. (2021). Dairy foods, calcium, and risk of breast cancer overall and for subtypes defined by estrogen receptor status: a pooled analysis of 21 cohort studies. The American Journal of Clinical Nutrition;0:1-12, https://doi.org/10.1093/ajcn/nqab097
[iii] Kwarteng JL, Matthews L, Banerjee A, Sharp LK, Gerber BS, Stolley MR. (2021). The association of stressful life events on weight loss efforts among African American breast cancer survivors. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-021-01054-2
[iv] Wang C, Gu K, Wang F, Cai H, Zheng W, Bao P, Shu X (2021). Nut consumption in association with overall mortality and recurrence/disease-specific mortality among long-term breast cancer survivors. Cancer Epidemiology. https://doi.org/10.1002/ijc.33824
[v] Ratjen I, Enderle J, Burmeister G, Koch M, Nothlings U, Hampe J, Lieb W. (2021). Post-diagnostic reliance on plant- compared with animal-based foods and all-cause mortality in omnivorous long-term colorectal cancer survivors. The American Journal of Clinical Nutrition, nqab061, https://doi.org/10.1093/ajcn/nqab061
[vi] Zheng X, Hur J, Nguyen LH, Liu J, Song M, Wu K…Cao Y (2021). Comprehensive assessment of diet quality and risk of precursors of early-onset colorectal cancer. Journal of National Cancer Institute, 113(5). https://doi.org/10.1093/jnci/djaa164
[vii] Kok DE, Arron MNN, Huibregtse T, Kruyt FM, Bac DJ, van Halteren HK…Kampman E (2021). Association of habitual preoperative dietary fiber intake with complications after colorectal cancer surgery. JAMA Surgery, 156(9):827-835. https://doi.org/10.1001/jamasurg.2021.2311
[viii] Tao J, Jatoi A, Crawford J, Lam WWT, Ho JC, Wang X, and Pang H. (2021). Role of dietary carbohydrates on risk of lung cancer. Lung Cancer. https://doi.org/10.1016/j.lungcan.2021.03.009
[ix] Plym A, Zhang Y, Stopsack K, Delcoigne B, Kibel AS, Giovannucci E…Mucci LA. (2021). Can the genetic risk of prostate cancer be attenuated by a healthy lifestyle? [abstract]. In: Proceedings of the 112th Annual Meeting of the American Association for Cancer Research; 2021 April 10-15. Philadelphia (PA): AACR; 2021. Abstract nr 822. https://www.abstractsonline.com/pp8/#!/9325/presentation/1890
[x] Sullivan ES, Rice N, Kingston E, Kelly A, Reynolds JV, Feighan J…Ryan AM. (2020). A national survey of oncology survivors examining nutrition attitudes, problems and behaviors, and access to dietetic care throughout the cancer journey. Clinical Nutrition ESPEN, 1-9. https://doi.org/10.1016/j.clnesp.2020.10.023
[xi] Erickson N, Schinkoethe T, Eckhardt C, Storck L, Joos A, Liu L…Heinemann V (2021). Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study). Supportive Care in Cancer, 29(12):7715-7724. https://doi.org/10.1007/s00520-021-06351-1
[xii] Katz J, Yue S, Xue W. (2021). Increased risk for COVID-19 in patients with vitamin D deficiency. Nutrition, 84. https://doi.org/10.1016/j.nut.2020.111106