Full Report - Food, Nutrition, and the Prevention of Cancer

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CHAPTER 4 • FOODS AND DRINKS The Panel is aware that since the conclusion of the SLR, two case-control studies 84 85 have been published. This new information does not change the Panel judgement (see box 3.8). 4.6.6 Comparison with previous report The judgement of the previous report on sugars and colorectal cancer was in effect similar to that in this Report. The previous report judged that salt and also salting are probable causes of stomach cancer. This judgement is also much the same as that in this Report. 4.6.7 Conclusions The Panel concludes: Salt is a probable cause of stomach cancer. Salted and salty foods are also a probable cause of stomach cancer. There is limited evidence suggesting that sugars are a cause of colorectal cancer. 147
Water is essential. Without water, people die in a matter of days. As well as adequate supplies of water, a major public health issue throughout the world is the safety of domestic and other water. Water quality may be compromised by chemical or microbiological contamination. Fruit juices made from fruits or fruit pulps are often concentrated for storage and transport, then diluted with water to produce the final product. Sugar and other ingredients are frequently added in this final reconstitution process. Soft drinks are usually made from water, sugar, colourings, flavourings, and mixtures of herbs and other ingredients, to give a distinctive taste and character. Consumption of branded, carbonated soft drinks, and cola drinks in particular, has increased greatly in the 20th century, and continues to increase throughout the world. The rise is most marked in lower income groups. Tea and coffee are now the main hot drinks consumed worldwide. Both contain stimulants and other bioactive constituents, and many people add milk and sugar. A great variety of herbal infusions are also drunk, including maté, the traditional hot drink in parts of South America. Overall, the Panel judges that the direct evidence relating non-alcoholic drinks to cancer is contamination of water supplies with inorganic arsenic and irritation of the oral 148 P ART 2 • EVIDENCE AND JUDGEMENTS 4.7 Water, fruit juices and other soft drinks, and hot drinks WATER, FRUIT JUICES, SOFT DRINKS, HOT DRINKS, AND THE RISK OF CANCER In the judgement of the Panel, the factors listed below modify the risk of cancer. Judgements are graded according to the strength of the evidence. DECREASES RISK INCREASES RISK Exposure Cancer site Exposure Cancer site Convincing Arsenic in drinking water 1 Lung Probable Arsenic in drinking water 1 Skin Maté 2 Oesophagus Limited — Arsenic in drinking water 1 Kidney suggestive Bladder Substantial effect on risk Coffee: pancreas; kidney unlikely Maté 2 Mouth, pharynx, larynx High-temperature drinks Oesophagus 1 The International Agency for Research on Cancer has graded arsenic and arsenic compounds as class 1 carcinogens. The grading for this entry applies specifically to inorganic arsenic in drinking water. 2 As drunk traditionally in parts of South America, scalding hot through a metal straw. Any increased risk of cancer is judged to be caused by epithelial damage resulting from the heat, and not by the herb itself. For an explanation of all the terms used in the matrix, please see chapter 3.5.1, the text of this section, and the glossary. cavity by maté, and possibly by other very hightemperature drinks. For evidence relating sugared soft drinks to body fatness, see Chapter 8. The Panel judges as follows: The evidence that inorganic arsenic in drinking water is a cause of lung cancer is convincing. Water contaminated in this way is probably a cause of skin cancer. Arsenic and arsenic compounds are recognised carcinogens. There is limited evidence suggesting that water contaminated in this way is a cause of cancers of the kidney and bladder. Maté, a herbal infusion, as drunk traditionally in parts of Latin America, is probably a cause of oesophageal cancer. Damage caused by the very high temperature of the drink, rather than by the herb itself, is judged to be responsible. There is limited evidence suggesting that maté is a cause of cancers of the mouth, pharynx, and larynx, for the same reason. There is also limited evidence suggesting that high-temperature drinks are a cause of oesophageal cancer. It is unlikely that coffee has any substantial effect on the risk of cancer either of the pancreas or of the kidney. Within the remit of this Report, the strongest evidence, corresponding to judgements of ‘convincing’ or ‘probable’, shows that inorganic arsenic in drinking water is a cause
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World Cancer Research Fund Food, Nu
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Please cite the Report as follows:
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Preface I am very grateful to the s
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Contents Preface i v Contents v i A
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Panel viii FOOD, NUTRITION, PHYSICA
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x FOOD, NUTRITION, PHYSICAL ACTIVIT
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xii FOOD, NUTRITION, PHYSICAL ACTIV
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xiv FOOD, NUTRITION, PHYSICAL ACTIV
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xvi FOOD, NUTRITION, PHYSICAL ACTIV
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xviii FOOD, NUTRITION, PHYSICAL ACT
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xx FOOD, NUTRITION, PHYSICAL ACTIVI
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xxii FOOD, NUTRITION, PHYSICAL ACTI
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xxiv FOOD, NUTRITION, PHYSICAL ACTI
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important and can be modified. Thes
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CHAPTER 1 • INTERNATIONAL VARIATI
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Data from World Health Organization
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C HAPTER 2 • THE CANCER PROCESS T
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C HAPTER 2 • THE CANCER PROCESS s
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C HAPTER 2 • THE CANCER PROCESS 2
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C HAPTER 2 • THE CANCER PROCESS B
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C HAPTER 2 • THE CANCER PROCESS B
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C HAPTER 2 • THE CANCER PROCESS o
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C HAPTER 2 • THE CANCER PROCESS N
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C HAPTER 2 • THE CANCER PROCESS 4
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C H A P T E R 3 Judging the evidenc
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Box 3.1 Issues concerning interpret
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Box 3.2 Dose response ‘Dose respo
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Box 3.4 Systematic literature revie
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harvesting conditions, animal feed,
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3.4.2 The ‘portfolio’ approach
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Box 3.8 Criteria for grading eviden
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excluded. Usually this evidence cam
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EVIDENCE AND JUDGEMENTS PART 2 64 I
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C H A P T E R 4 Foods and drinks Th
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countries with hot, damp climates a
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70 Box 4.1.4 Aflatoxins Mycotoxins
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72 Figure 4.1.1 Dietary fibre and c
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4.2). All of these are highest in d
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VEGETABLES, 1 FRUITS, 1 PULSES (LEG
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content, and the oils produced from
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80 Box 4.2.4 Foods containing dieta
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4.2.4.2 Specific Considerations spe
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assessed carrots, but some looked a
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Non-starchy root vegetables and tub
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cohort and case-control data on gre
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Non-starchy vegetables and fruits A
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Green, leafy vegetables All three c
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94 Figure 4.2.16 Garlic consumption
Page 121 and 122: studies, 33 85 86 88 90 97 105 111
Page 123 and 124: cancer cases) showed a statisticall
Page 125 and 126: 504 508 511 506 and in men but not
Page 127 and 128: Figure 4.2.29 Carotenoids and lung
Page 129 and 130: Figure 4.2.31 Lycopene and prostate
Page 131 and 132: somal breakage and rearrangement ca
Page 133 and 134: Figure 4.2.35 Vitamin C and oesopha
Page 135 and 136: Dietary selenium One cohort study s
Page 137 and 138: Selenoproteins appear to reach thei
Page 139 and 140: tected against cancers of the liver
Page 141 and 142: These animal foods are sources of p
Page 143 and 144: those of birds; because they are ge
Page 145 and 146: Box 4.3.5 Cantonese-style salted fi
Page 147 and 148: The single cohort study showed incr
Page 149 and 150: 124 There is limited evidence, most
Page 151 and 152: Figure 4.3.11 Salted fish and nasop
Page 153 and 154: 128 There is limited, inconsistent
Page 155 and 156: From the late 19th century, consump
Page 157 and 158: Seven case-control studies showed i
Page 159 and 160: on three and two cohort studies, re
Page 161 and 162: heart disease, and cancers of some
Page 163 and 164: 4.5.4.2 Specific Some consideration
Page 165 and 166: cause of lung cancer or postmenopau
Page 167 and 168: taste preference promotes energy co
Page 169 and 170: Box 4.6.4 Refrigeration Freezing an
Page 171: preserved foods may be eaten more b
Page 175 and 176: specifically the infusion of the dr
Page 177 and 178: 4.7.4.2 Specific Classification. Di
Page 179 and 180: cant decreased risk in men. 74 Meta
Page 181 and 182: Figure 4.7.4 Maté and oesophageal
Page 183 and 184: since the effects on mood of the fe
Page 185 and 186: Figure 4.8.1 Alcoholic drinks and m
Page 187 and 188: showed increased risk, which was st
Page 189 and 190: 94 106 184 198 studies were in the
Page 191 and 192: control studies, 280 282 317 318 33
Page 193 and 194: influencing hormone levels and oest
Page 195 and 196: Spirits Two cohort studies6 486 425
Page 197 and 198: Practically all food and drink is c
Page 199 and 200: Box 4.9.2 ‘Organic’ farming So-
Page 201 and 202: Box 4.9.4 Water fluoridation In the
Page 203 and 204: and in these cases, the Panel’s j
Page 205 and 206: corresponding to judgements of ‘c
Page 207 and 208: Box 4.10.1 Food fortification Food
Page 209 and 210: 4.10.6.4.1 Retinol Skin Two RCTs in
Page 211 and 212: Table 4.10.4 Beta-carotene suppleme
Page 213 and 214: analysis was possible on two of the
Page 215 and 216: 4.11 Dietary patterns The nature, q
Page 217 and 218: elatively costly. In some tradition
Page 219 and 220: meat, fish, and olive oil) was asso
Page 221 and 222: meals. But none of these studies de
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CHAPTER 5 • PHYSICAL ACTIVITY PHY
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CHAPTER 5 • PHYSICAL ACTIVITY Box
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CHAPTER 5 • PHYSICAL ACTIVITY Fig
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CHAPTER 5 • PHYSICAL ACTIVITY Fou
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CHAPTER 5 • PHYSICAL ACTIVITY the
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CHAPTER 5 • PHYSICAL ACTIVITY cer
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CHAPTER 6 • BODY COMPOSITION, GRO
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C H A P T E R 7 Cancers Every year
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7.1.1 Trends, incidence, and surviv
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Studies that reported on combined i
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7.2 Nasopharynx Cancer of the nasop
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Six case-control studies investigat
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epithelial cells, from which adenoc
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7.3.5.4 Foods containing folate (Al
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oesophageal cancer. High body fatne
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7.4.1 Trends, incidence, and surviv
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plasma or serum selenium; and 3 coh
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The Panel is aware that since the c
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— increased, notably in high-inco
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The evidence, though not copious an
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studies showed increased risk with
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elatively high in some countries in
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of being overweight or obese are ou
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mation caused by other factors (suc
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Box 7.8.1 Hepatitis viruses Hepatit
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ulates the body’s inflammatory re
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include mucinous carcinomas and ade
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There is a substantial amount of ev
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7.9.5.13 Cheese (Also see chapter 4
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cumference, or a 30 per cent increa
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The Panel judges as follows: The ev
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7.10.5.2 Lactation (Also see chapte
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The Panel is aware that since the c
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7.11 Ovary Ovarian cancer is the se
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nutrition, altered hormone profiles
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7.12.2 Pathogenesis Type 1 endometr
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case-control studies, and the mecha
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7.13.3 Other established causes (Al
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y environmental factors. Although s
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The evidence from cohort and case-c
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7.15 Kidney Cancer of the kidney is
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per 5 kg/m2 ; meta-analysis of case
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7.16.5 Evidence and judgements In t
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Despite the considerably higher inc
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7.18 Other cancers The Panel also c
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Tobacco use, infection with human T
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C H A P T E R 8 This chapter examin
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Box 8.1 Energy density A concept ce
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326 Table 8.2 Approximate relative
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food, using up oxygen in the proces
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Figure 8.4 Relationship between BMI
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density (box 8.1). Therefore, the P
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Table 8.5 Physical activity interve
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were 0.70 (95% CI 0.54-0.91; minima
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iours examined, including physical
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there was no statistically signific
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C H A P T E R 9 Cancer survivors Ca
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After recovery • People who are a
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Box 9.2 Use of supplements by cance
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C H A P T E R 1 0 348 P ART 2 • E
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other interested parties were exclu
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Milk and dairy products. One report
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adults, 16 30 35 36 40 41 44 46 56
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Table 10.1 Recommendations to preve
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10.6.3 Foods and drinks Cereals (gr
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CHAPTER 11 • RESEARCH ISSUES 11.1
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CHAPTER 11 • RESEARCH ISSUES Crit
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RECOMMENDATIONS PART 3 366 Introduc
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C H A P T E R 1 2 This Report is co
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12.1.4 Cancer in general This Repor
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12.1.7 Challenging The Panel emphas
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to enable them to increase their av
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Personal recommendations The points
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Guidance Most people can readily bu
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380 RECOMMENDATION 4 PLANT FOODS Ea
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382 RECOMMENDATION 5 ANIMAL FOODS L
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depending on the type of drink. Thi
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for a relatively long time in warm,
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388 SPECIAL RECOMMENDATION 1 BREAST
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ecommendations in this Report would
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ishing, and only the evidence on re
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�� Appe
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APPENDIX A • PROJECT PROCESS canc
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APPENDIX B • THE FIRST WCRF/AICR
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APPENDIX C• THE WORLD CANCER RESE
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GLOSSARY Cantonese-style salted fis
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GLOSSARY Exposure A factor to which
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GLOSSARY Mineral An inorganic compo
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GLOSSARY Smoking (foods) Smoking is
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REFERENCES 41. Joint United Nations
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REFERENCES 18. Romney SL, Ho GY, Pa
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REFERENCES from postmenopausal wome
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REFERENCES 50. Black RJ, Bray F, Fe
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REFERENCES possible factor in the e
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REFERENCES 1992;69:860-5. 93. Su W,
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REFERENCES Causes Control 2004;15:6
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REFERENCES 292. Miller AB, Altenbur
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REFERENCES 386. Bosetti C, Negri E,
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REFERENCES [Correlation between nut
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REFERENCES cancer patients and heal
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REFERENCES Serum beta-carotene and
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REFERENCES Epidemiol 1991;1:385-93.
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REFERENCES and potential risk modif
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REFERENCES 1982;68:401-5. 134. Llop
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REFERENCES 225. Risch HA, Jain M, C
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REFERENCES Control 2003;14:1-12. 77
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REFERENCES 25. Pillow PC, Hursting
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REFERENCES factors and cancer incid
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REFERENCES al. A prospective study
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REFERENCES methylation and bladder
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REFERENCES southern Brazil: a case-
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REFERENCES 8. 59. Rao DN, Desai PB,
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REFERENCES [Alcoholism, smoking and
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REFERENCES vitamin D metabolites an
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REFERENCES alcohol consumption in p
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REFERENCES diseases. Hepatogastroen
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REFERENCES National Academy Press,
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REFERENCES Food patterns and risk o
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REFERENCES 35. Gerhardsson M, Norel
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REFERENCES endometrial cancer risk.
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REFERENCES 44. Batty GD, Shipley MJ
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REFERENCES Epidemiol Biomarkers Pre
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REFERENCES 225. Chie WC, Li CY, Hua
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REFERENCES folate intake and breast
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REFERENCES 413. Potischman N, Hoove
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REFERENCES The Netherlands. Eur J C
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REFERENCES 598. Leon DA, Lithell HO
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REFERENCES amenorrhoea: studies amo
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REFERENCES oropharyngeal squamous c
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REFERENCES 115. Cottam DR, Mattar S
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REFERENCES 2005;16:839-50. 207. Eng
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REFERENCES Renal cystic diseases: a
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REFERENCES predicting mortality amo
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REFERENCES 2006;48:1865-70. 155. Ki
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REFERENCES Chapter 9 1. Hewitt M, G
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REFERENCES Chapter 10 1. Cannon G.
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REFERENCES Council (Australia). 200
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INDEX classification, 214 colorecta
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INDEX weight gain determinants, 337
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INDEX Interleukin 6 (IL-6), 39 Inte
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INDEX adipose tissue-derived, 221 O
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INDEX stomach cancer, 146, 269-70 S
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INDEX trends, 324-7 Western diets,
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