Nutrition et prévention : Données issues des cohortes et des études d intervention

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1 CESP Center for Research in Epidemiology and Population Health Nutrition et prévention : Données issues des cohortes et des études d intervention Dr Marie-Christine Boutron-Ruault Inserm U1018 équipe 9, Université Paris 11 et Institut Gustave Roussy et Hôpital Antoine Béclère, Clamart iceps Conference, Montpellier mars 2015 Mécanismes activateurs et protecteurs D après : Alimentation, nutrition et prévention des cancers, une perspective mondiale : applications au contexte français, Nacre WCRF,

2 Meta-analysis of available studies nd WCRF-AICR expert report (World Cancer Research Fund American Institute for Cancer Research) +Continuous Update Program 3 Alcohol and cancer: WCRF recommendations Evidence on cancer justifies not to drink alcoholic drinks; for people that consume alcohol, limit to one drink per day in women and two drinks/d in men Evidence is convincing for Mouth, pharynx and larynx Esophagus Breast Colorectal (men) 2

3 Alcohol and breast cancer: Cohort Studies Plant Foods 3

4 Fruit & vegetables and cancer risk Cohort studies Breast Lung Bladder Colon, rectum Stomach Case-control studies Breast Lung Bladder Colon, rectum Stomach Œsophagus Larynx Mouth and pharynx RR (95% Confidence Interval) 0.99 ( ) 0.92 ( ) 0.92 ( ) 0.96 ( ) 0.88 ( ) RR per 100 g/day increment for F&V 0.86 ( ) 0.86 ( ) 0.90 ( ) 0.87 ( ) 0.77 ( ) 0.91 ( ) 0.92 ( ) 0.84 ( ) RR Riboli E & Norat T. Am J Clin Nutr Sep;78(3 Suppl):559S-569S. 7 4

5 Fruit and lung cancer risk (WCRF) Cruciferous vegetables consumption and the risk of female lung cancer: a prospective study and a meta-analysis Ann Oncol 2013, Wu QJ et al 10 5

6 Dietary fibre and colorectal cancer risk Breast cancer and dietary phyto-estrogens (soy isoflavones) Trock et al., JNCI (7):

7 Olive oil consumption and cancer risk Psaltopulou T et al., Lipids health Dis Animal products and cancer risk Since the mid-1990 s, the results of cohort studies have strengthened the evidence on red meat and processed meat as causes of colorectal cancer. WCRF recommendations : Limit the consumption of red meat (< 500 g/week) Avoid the consumption of processed meat 7

8 CONVINCING CONVINCING 8

9 PROBABLE 9

10 CONFLICTING PROBABLE NO RECOMMENDATION for MILK, CHEESE, OTHER DAIRY PRODUCTS 10

11 Obesity and cancer risk in American women 22 11

12 Cancers associated with large BMI Post menopausal breast Endometrial Colorectal Esophageal Pancreas Renal Liver BMI and Breast Cancer 12

13 Energy Density of Selected Foods Lettuce Vegetable soup Skim milk Apple Black beans White fish Yogurt Vegetable lasagna Roast chicken White bread Pretzels Cheddar cheese Salad dressing Potato chips Bacon Butter Energy Density (kcal/g) Reprinted from Klein S, et al. Gastroenterology. 2002: 123: with permission from Elsevier. Dietary Supplements Dietary supplements can modulate cancer risk (protect or enhance) Effects may be restricted to the study population Uncertain benefit/risk balance 13

14 Dietary supplements and cancer risk Convincing: high dose ß carotene increases lung cancer in smokers Probable: calcium protects against colorectal cancer high dose selenium protects against prostate cancer Unlikely: ß carotene affects risk of skin or prostate cancer ß carotene supplements and lung cancer: trials Also: CARET 1.28 ( ) De Klerk 1.50 ( ) 14

15 29 Folic acid and risk of prostate cancer: results from a randomized controlled trial. (Figueiredo JC, JNCI 2009) 30 15

16 Folic acid supplementation and cancer risk: meta-analysis of randomized controlled trials (IJC 2013) Vitamin D supplements and cancer incidence and mortality: a meta-analysis (Keum N, Giovannucci E, BJC 2015) 32 16

17 Calcium, Vitamin D and breast cancer risk, the WHI study Cauley et al, J Womens Health 2013 Menopausal women (N=36,282) randomisation: 7 y.-intervention: 1g calcium IU vitamin D FU of the survivers for 4.9 years post intervention Risk of colorectal cancer: HR=0.95 (95% CI: 0.80, 1.13). No risk difference for invasive breast cancer, cardiovascular diseases, osteoporotic factures BUT : Risk reduction for in situ breast cancer in the supplemented group: HR=0.82 (95% CI: 0.68, 0.99) Invasive breast cancer : heterogeneity according to baseline vitamin D intake: For baseline vitamin D intake > 600 IU/d : HR=1.28 (95%CI; 1.03, 1.60). 33 Dietary supplements and risk of cancer death the Iowa Women s Health Study (Mursu J et al, Arch Int Med 2011) 34 17

18 Les 10 recommandations du WCRF pour la prévention du cancer 35 Polyphenol-rich supplement and PSA progression in prostate cancer patients, the U.K. NCRN Pomi-T study. Thomas R et al Prostate Cancer Prostatic Dis A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer--the U.K. NCRN Pomi-T study

19 Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer: The Women's Healthy Eating and Living (WHEL) Randomized Trial JAMA 2007, Pierce J P et al 37 On-going randomized controlled trials in cancer patients Pilot study evaluating broccoli sprouts in advanced pancreatic cancer (POUDER trial) - study protocol for a randomized controlled trial. Lozanovski VJ et al, Trials The COLON study: Colorectal cancer: Longitudinal, Observational study on Nutritional and lifestyle factors that may influence colorectal tumour recurrence, survival and quality of life. Winkels RM et al, BMC Cancer Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. Robidoux A et al, J Clin Oncol ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Rieger J, et al, Int J Oncol

20 Conclusion Importance of diet and dietary patterns in cancer prevention Potential danger of dietary supplements because of differences in dosage and metabolism compared with micronutrients from foods Potential importance of dietary factors in prognosis, but further studies needed because of differences in normal cell and cancer cell metabolisms When considering needs for supplementation (eg. Vitamin D), never forget that we don t treat biological concentrations but subjects 39 Thank you for your attention 20