American Cancer Society Guidelines on Nutrition and ...

1 ACS Guidelines on Nutrition and physical activity for Cancer Prevention92 CAA Cancer Journal for Clinicians ABSTRACT The American Cancer Society (ACS) has set aggressive challenge goals for thenation to decrease Cancer incidence and mortality and to improve the quality of life of cancersurvivors by the year 2015. To address these critical goals, the ACS publishes the Nutrition and physical ActivityGuidelines to serve as a foundation for its communication, policy, and community strategiesand ultimately, to affect dietary and physical activity patterns among Americans. These Guidelines , published every five years, are developed by a national panel of expertsin Cancer research, prevention , epidemiology, public health, and policy, and as such, theyrepresent the most current scientific evidence related to dietary and activity patterns andcancer American Cancer Society Guidelines include recommendations for individual choicesregarding diet and physical activity patterns, but those choices occur within a communitycontext that either facilitates or interferes with healthy behaviors.

2 Therefore, this committeepresents one key recommendation for community action to accompany the fourrecommendations for individual choices for Nutrition and physical activity to reduce cancerrisk. This recommendation for community action underscores just how important communitymeasures are to the support of healthy behaviors by means of increasing access to healthfulfood choices and opportunities to be physically ACS Guidelines are consistent with Guidelines from the American Heart Association forthe prevention of coronary heart disease as well as for general health promotion, as definedby the Department of Health and Human Services 2000 Dietary Guidelines for ,2(CA Cancer J Clin 2002;52:92-119.)Dr. Byers is Professor, PreventiveMedicine, University of ColoradoHealth Science Center, Denver, Nestle is Professor and Chair,Department of Nutrition and FoodStudies, New York University, NewYork, McTiernan is AssociateMember, Fred Hutchinson CancerResearch Center, Seattle, Doyle is Director, Nutrition andPhysical activity , American CancerSociety, Atlanta, Currie-Williams is Manager, Nutrition and physical activity , American Cancer Society , Atlanta, Gansler is Director of MedicalStrategies, American CancerSociety, Atlanta, GA, and Editor of Thun is Vice President,Epidemiology and SurveillanceResearch, American Cancer Society ,Atlanta, following report was approvedby the American Cancer SocietyNational Board of Directors onNovember 1.

3 Article is also available online Cancer Society Guidelineson Nutrition and physical activity forCancer prevention : Reducing the Risk of Cancer with Healthy FoodChoices and physical ActivityTim Byers, MD, MPH; Marion Nestle, PhD, MPH; Anne McTiernan, MD, PhD;Colleen Doyle, MS, RD; Alexis Currie-Williams, MPH, CHES;Ted Gansler, MD;Michael Thun, MD; and the American Cancer Society 2001 Nutrition and physical ActivityGuidelines Advisory Committee**See pages 104 and Importance of Diet and physical activity inCancer PreventionFor the great majority of Americans who donot smoke cigarettes, dietary choices andphysical activity are the most importantmodifiable determinants of Cancer suggests that one third of the morethan 500,000 Cancer deaths that occur in theUnited States each year can be attributed todiet and physical activity habits, with anotherthird due to cigarette smoking.

4 Althoughgenetic inheritance influences the risk ofcancer, and Cancer arises from geneticmutations in cells, most of the variation incancer risk across populations and amongindividuals is due to factors that are notinherited. Behavioral factors such as smokingcigarettes, consuming foods along certainpatterns of diet, and staying active across thelifespan can substantially affect one s risk ofdeveloping ,5,6 Because healthfulindividual behaviors are most effectivelyenabled by social and environmental supportwithin communities, these 2001 guidelinesinclude, for the first time, an explicitrecommendation for community OF THE GUIDELINESThe American Cancer Society publishesnutrition and physical activity Guidelines toadvise health care professionals and the generalpublic about dietary and other lifestylepractices that reduce Cancer , updated in 2001 by the AmericanCancer Society Nutrition and physical ActivityGuidelines Advisory Committee.

5 Are based onexisting scientific evidence that relates diet andphysical activity to Cancer risk in humanpopulation studies as well as in Guidelines reflect the current state ofthe scientific evidence. For many issues, theevidence is not definitive either because studiesare not yet available, or current findings areinconsistent. Although the randomized,controlled trial is often considered the goldstandard for scientific conclusions, suchevidence is not presently available and maynever become available for many dietaryfactors associated with Cancer risk. Inferencesabout the many complex interrelationshipsamong diet, physical activity , and Cancer riskare based, for the most part, on observationalstudies coupled with advancing understandingof the biology of Cancer . The relative strengthof current scientific evidence linking majorcomponents of diet to common Cancer sites issummarized later in Table 5.

6 In considering thetotality of evidence from a variety of sources,these Guidelines take into consideration boththe benefits to Cancer risk reduction andoverall health benefits. Although no diet canguarantee full protection against any disease,these Guidelines offer the best informationcurrently available about how diet and physicalactivity can reduce the risk of ACSguidelines are consistent with Guidelines fromthe American Heart Association for theprevention of coronary heart disease as well asfor general health promotion, as defined by theDepartment of Health and Human Services 2000 Dietary Guidelines for ,2 The American Cancer Society guidelinesinclude recommendations for individualchoices regarding diet and physical activitypatterns, but those choices occur within acommunity context that either facilitates orinterferes with healthy behaviors.

7 Therefore,this committee presents one keyrecommendation for community action toaccompany the four recommendations forindividual choices for Nutrition and physicalactivity to reduce Cancer risk (Table 1). Thisrecommendation for community actionunderscores the importance of communityVolume 52 Number 2 March/April 200293CA Cancer J Clin 2002;52:92-119measures to support healthy behaviors byincreasing access to healthful food choices andopportunities to be physically Cancer Society Guidelines FORNUTRITION AND physical ACTIVITYR ecommendation for Community ActionSocial, economic, and cultural factorsstrongly influence individual choices aboutdiet and physical activity . While mostAmericans would like to adopt a healthfullifestyle, many encounter substantial barriersthat make it difficult to follow diet and activityguidelines. Indeed, current trends towardincreasing consumption of high-calorieconvenience foods and restaurant meals, anddeclining levels of physical activity arecontributing to an alarming epidemic ofobesity among Americans of all ages and acrossall population workdays andmore households with multiple wage earnersreduce the amount of time available forpreparation of meals, with a resulting shifttoward increased consumption of food outsidethe home often processed foods, fast foods,and snack foods.

8 Reduced leisure time,increased reliance on automobiles for94 CAA Cancer Journal for Clinicians ACS Guidelines on Nutrition and physical activity for Cancer PreventionAmerican Cancer Society (ACS) Guidelines on Nutrition and physical activity for Cancer PreventionACS Recommendations for Individual Choices1. Eat a variety of healthful foods, with an emphasis on plant sources. Eat five or more servings of a variety of vegetables and fruits each day. Choose whole grains in preference to processed (refined) grains and sugars. Limit consumption of red meats, especially those high in fat and processed. Choose foods that help maintain a healthful Adopt a physically active lifestyle. Adults: engage in at least moderate activity for 30 minutes or more on five or more days of the week; 45 minutes or moreof moderate-to-vigorous activity on five or more days per week may further enhance reductions in the risk of breast andcolon Cancer .

9 Children and adolescents: engage in at least 60 minutes per day of moderate-to-vigorous physical activity at least five days per Maintain a healthful weight throughout life. Balance caloric intake with physical activity . Lose weight if currently overweight or If you drink alcoholic beverages, limit Recommendation for Community ActionPublic, private, and community organizations should work to create social and physical environments that support the adoptionand maintenance of healthful Nutrition and physical activity behaviors. Increase access to healthful foods in schools, worksites, and communities. Provide safe, enjoyable, and accessible environments for physical activity in schools, and for transportation and recreation in 1transportation, and increased availability ofelectronic entertainment and communicationsmedia all contribute to a less active andincreasingly sedentary trends areof particular concern, especially with regard tothe adverse effects they have on the long-termhealth of children, who are establishing lifetimepatterns of diet and physical activity , as well ason the poor, who live in communities with lessaccess to safe and healthful lifestyle improved diet and increasedphysical activity patterns will require multiplestrategies, ranging from the implementation ofcommunity and work-site health promotionprograms to policies that affect communityplanning, transportation, school-based physicaleducation, and food services.

10 Particular effortswill be needed to ensure that all populationgroups have access to healthful food choicesand opportunities for physical activity . Bothpublic and private organizations at the local,state, and national levels will have to developnew policies and will need to raise or reallocateresources to facilitate needed changes. Healthcare professionals, who can be especiallypersuasive on matters of lifestyle change, canprovide leadership in promoting policychanges in their decline in cigarette use by adultsprovides a useful analogy for the power of socialcontext in changing health behaviors. Adult-per-capita cigarette consumption began asustained decline after the 1964 SurgeonGeneral s Report, which publicized the healthhazards of that time on, othercommunity-wide social and political factorshave become increasingly important in reducingsmoking.