A recent study linking diets heavy in junk food and cancer likely gave nurses everywhere pause. Although nurses see the health problems brought on by poor diet choices every day, educating patients and changing their habits is tough.
The study, published in the peer-reviewed PLOS journal found that a diet heavy in junk food was linked with increased cancer rates. Using Nutri-Score, a food labeling system used in parts of Britain and Europe, researchers were able to identify that diets with an overall lower score for nutritional value was associated with increased cancer and other health problems.
Nutri-Score uses different scores and color labels depending on the nutritional quality of foods. At a glance, consumers can identify how nutritious a food is. According to the study, those who consumed the most junk food had “higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women.”
How can nurses use this study to help their patients? While many patients know the risks of a poor diet, they don’t often identify certain foods as less nutritious as others. What’s the difference between stopping for a fast-food burger than making one at home? The difference can be significant based on the choices, but sometimes it has to be explained.
Nurses are in an excellent position to help patients understand that even small tweaks to their food choices and preparation can make a significant difference in their health. Just on the most basic level, meals made at home tend to have less fat and sodium. A burger at home can be made with a leaner ground beef and accompanied by a salad (bagged salads are easy), a piece of fruit, and oven baked fries. It takes some preparation and planning, but even if the swap is made a couple of times a month, the health benefits will add up.
The study was able to adjust for other factors such as family history, lower physical activity, and higher BMI that can also influence cancer rates. Food choices are such an important part of health and one that can be adapted in small doses. Nurses can help patients assess their food intake and show them where small swaps like popcorn for chips, flavored seltzer and juice for soda, or salsa for onion dip can add up.
Patients might also benefit from hearing about fitting more nutritional foods into their diets. Junk food and cancer might be associated, but intake of junk food is controllable. No one has to give up pizza night, but adding vegetables (either on the pizza or as a side salad) will boost the overall nutrition for the meal. A breakfast of cereal gets a boost from a handful of berries. Even using a store-bought prepared chicken as the basis for an at-home meal will give you more control over the total portion, calories, and flavors.
And as a busy nurse, it can help to take some of the ideas to heart. Consider your eating habits and how you might be able to add and subtract to get more bang for your buck. Bring foods to work that are easy and fast to eat, but offer as much nutrition as possible. You’ll find doing so gives you more energy, keeps you feeling full longer, and might even help regulate your fatigue levels, weight, blood pressure, blood sugar, or stress.
If you’re able to notice a few positive changes, you’ll be the best champion of making nutritional changes for your patients. And if they are trying to eat better to gain control over their health now and in the future, each small boost in nutritional food is worthwhile.
The first national study on Hispanic health risks and leading causes of death in the United States by the Centers for Disease Control and Prevention (CDC) showed that similar to non-Hispanic whites (whites), the two leading causes of death in Hispanics are heart disease and cancer. Fewer Hispanics than whites die from the 10 leading causes of death, but Hispanics had higher death rates than whites from diabetes and chronic liver disease and cirrhosis. They have similar death rates from kidney diseases, according to the new Vital Signs.
Health risk can vary by Hispanic subgroup. For example, nearly 66% more Puerto Ricans smoke than Mexicans. Health risk also varies partly by whether Hispanics were born in the United States or in another country. Hispanics are almost three times as likely to be uninsured as whites. Hispanics in the United States are on average nearly 15 years younger than whites, so taking steps now to prevent disease could mean longer, healthier lives for Hispanics.
“Four out of 10 Hispanics die of heart disease or cancer. By not smoking and staying physically active, such as walking briskly for 30 minutes a day, Hispanics can reduce their risk for these chronic diseases and others such as diabetes,” says CDC Director Tom Frieden, MD, MPH. “Health professionals can help Hispanics protect their health by learning about their specific risk factors and addressing barriers to care.”
This Vital Signs report recommends that doctors, nurses, and other health professionals
• work with interpreters to eliminate language barriers when patients prefer to speak Spanish.
• counsel patients with or at high risk for high blood pressure, diabetes, or cancer on weight control and diet.
• ask patients if they smoke and, if they do, help them quit.
• engage community health workers (promotores de salud) to educate and link people to free or low-cost services.
Hispanic and other Spanish-speaking doctors and clinicians, as well as community health workers or promotores de salud, play a key role in helping to provide culturally and linguistically appropriate outreach to Hispanic patients.
The Vital Signs report used recent national census and health surveillance data to determine differences between Hispanics and whites, and among Hispanic subgroups. Hispanics are the largest racial and ethnic minority group in the United States. Currently, nearly one in six people living in the United States (almost 57 million) is Hispanic, and this is projected to increase to nearly one in four (more than 85 million) by 2035.
Despite lower overall death rates, the study stressed that Hispanics may face challenges in getting the care needed to protect their health. Sociodemographic findings include:
• About one in three Hispanics have limited English proficiency.
• About one in four Hispanics live below the poverty line, compared with whites.
• About one in three has not completed high school.
These sociodemographic gaps are even wider for foreign-born Hispanics, but foreign-born Hispanics experience better health and fewer health risks than U.S.-born Hispanics for some key health indicators, such as cancer, heart disease, obesity, hypertension, and smoking, the report said.
The report also found different degrees of health risk among Hispanics by country of origin:
• Mexicans and Puerto Ricans are about twice as likely to die from diabetes as whites. Mexicans also are nearly twice as likely to die from chronic liver disease and cirrhosis as whites.
• Smoking overall among Hispanics (14%) is less common than among whites (24%), but is high among Puerto Rican males (26%) and Cuban males (22%).
• Colorectal cancer screening varies for Hispanics aged 50 to 75 years.
• About 40% of Cubans get screened (29% of men and 49% of women).
• About 58% of Puerto Ricans get screened (54% of men and 61% of women).
• Hispanics are as likely as whites to have high blood pressure. But Hispanic women with high blood pressure are twice as likely as Hispanic men to get it under control.
“This report reinforces the need to sustain strong community, public health, and health care linkages that support Hispanic health,” says CDC Associate Director for Minority Health and Health Equity, Leandris C. Liburd, PhD, MPH, MA.
Breast density, which is associated with breast cancer risk, was found to be higher in black/African American women than white women when measured using novel quantitative methods, according to research presented at the American Association for Cancer Research’s annual meeting, held on April 18-22, 2015.
“Since breast density is associated with breast cancer risk, a better understanding of racial differences in breast density levels could help us identify women at the highest risk for breast cancer and target prevention strategies to those women,” says Anne Marie McCarthy, PhD, a research fellow at Massachusetts General Hospital in Boston.
Black women in the study had a significantly higher absolute area density of 40.1 cm2 compared with 33.1 cm2 in white women. In addition, black women had a significantly higher volumetric density of 187.2 cm3 compared with 181.6 cm3 in white women.
After adjusting for other factors associated with breast density, including age, body mass index, hormone therapy, and reproductive factors, black women were found to have significantly higher breast density than white women across all measures.
According to McCarthy, breast density refers to the amount of fibroglandular tissue in the breast when observed on a mammogram. Fibroglandular tissue appears as white on the mammogram, making it difficult to visually detect breast cancers. Research has shown that women who have the highest breast density have a four-to-six times greater risk for breast cancer compared with women with lower breast density.
Traditionally, radiologists examine mammograms and assign patients a breast density level; however, this assignment can be subjective, McCarthy says. Instead, in this study, McCarthy and colleagues used fully automated computer algorithms to produce both the conventional two-dimensional breast density measurement and a three-dimensional volumetric estimate of breast density. The study included 1,589 black/African American women and 1,256 white women who underwent screening mammography at the University of Pennsylvania from 2010 to 2011.
“Our findings are using a new, quantitative and, perhaps, more reliable way to measure breast density,” McCarthy says. “Our next step will be to see how quantitative density measures and other imaging biomarkers are associated with cancer risk, cancer subtype, and stage of diagnosis by race.”
This study was funded by the National Institutes of Health. The computer software used for breast density estimation has been made publicly available and free for research purposes by the University of Pennsylvania.
Many adults in the United States are not getting the recommended screening tests for colorectal, breast, and cervical cancers, according to data published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. For 2013, screening for these types of cancers either fell behind previous rates or showed no improvement.
Among adults in the age groups recommended for screening, about 1 in 5 women reported not being up-to-date with cervical cancer screening, about 1 in 4 women reported not being up-to-date with breast cancer screening, and about 2 in 5 adults reported not being up-to-date with colorectal cancer screening.
The report found that colorectal cancer testing was essentially unchanged in 2013 compared with 2010. Pap test use among women aged 21 to 65 years was lower than in 2000, and the number of mammography screenings was stagnant, showing very little change from previous years.
“It is concerning to see a stall in colorectal cancer screening rates,” says Lisa C. Richardson, MD, MPH, director of CDC’s Division of Cancer Prevention and Control. “We must find new ways to make people and providers aware that getting tested for colorectal cancer could prevent cancer and save their lives.”
Researchers reviewed data from the National Health Interview Survey 2013, which is used to monitor progress toward Healthy People 2020 goals for cancer screening based on the most recent U.S. Preventive Services Task Force guidelines.
The screening data for 2013 show that 58.2% of adults aged 50 to 75 years reported being screened for colorectal cancer; 72.6% of women aged 50 to 74 had a mammogram; and 80.7% of women aged 21 to 65 had a Pap test. All of these percentages are below the Healthy People 2020 targets.
The report found that adults without insurance or a usual source of health care generally had the lowest screening test use. For example, less than one quarter of adults in these groups reported recent colorectal cancer screening, compared with more than 60% of adults with private insurance or a usual source of health care. More efforts are needed to achieve cancer screening goals and reduce screening disparities.
The authors did report some good news: the proportion of women in the highest education and income groups who were screened for breast cancer exceeded the Healthy People 2020 target, and the proportion of people aged 65 to 75 who were screened for colorectal cancer was also near the target.
Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as screening for some cancers that may be covered with no additional costs. Visit Healthcare.gov to learn more.
Women who drank about four cups of coffee per day appeared to have decreased endometrial cancer risk compared with those who drank less than a cup each day, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.
“We used a ‘nutrient-wide association study,’ a new approach to systematically evaluate the association of dietary factors with endometrial cancer risk,” says Melissa A. Merritt, PhD, a research fellow in cancer epidemiology at Imperial College London in the United Kingdom. “This approach was inspired by genome-wide association studies that look at genetic risk factors for cancer, but in our case we investigated 84 foods and nutrients in place of genes as risk factors for endometrial cancer.
“We confirmed observations from previous studies that having a high versus low intake of coffee was associated with a reduced risk for endometrial cancer, and for most other dietary factors there was no association with endometrial cancer risk,” Merritt adds.
“Coffee intake is worth investigating further to see if coffee can be used for the prevention of endometrial cancer. However, before clinical recommendations can be made, further studies are needed to evaluate this question in other studies and to try to isolate the components of coffee that may be responsible for any influence on endometrial cancer,” Merritt says.
Merritt and colleagues evaluated the association of 84 foods and nutrients based on dietary questionnaires from a prospective cohort study, the European Prospective Investigation Into Cancer and Nutrition (EPIC) Study. They then validated nine foods and nutrients identified from the EPIC study as having associations with endometrial cancer risk in two prospective cohort studies, the Nurses’ Health Study (NHS) and NHSII, two cohorts based at Brigham and Women’s Hospital, Boston, and Harvard School of Public Health, Boston, respectively.
Among the EPIC study participants, those who drank about three cups of coffee per day (750 g/day) had a 19% lower risk for endometrial cancer compared with those who drank less than one cup of coffee per day. Among the NHS/NHSII participants, those who drank about four cups of coffee per day (1,000 g/day) had an 18% lower risk for endometrial cancer compared with those who never drank coffee.
This study focused on 1,303 endometrial cancer cases in the EPIC study, and 1,531 endometrial cancer cases from the NHS/NHSII studies.
The nine foods/nutrients that were found to have associations with endometrial cancer in the EPIC cohort were total fat, monounsaturated fat, carbohydrates, phosphorus, butter, yogurt, cheese, potatoes, and coffee.
Total fat, monounsaturated fat, and phosphorus were associated with decreased risk for endometrial cancer, and carbohydrates and butter intake were associated with increased risk for endometrial cancer in the EPIC cohort, but these findings could not be validated in the NHS/NHSII cohorts.
