prevenzione oncologica - aiom
TRANSCRIPT
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Ruolo dell’alimentazione nella
Prevenzione Oncologica
Sabina Sieri
Unità di Epidemiologia e Prevenzione
Fondazione IRCCS Istituto Nazionale dei
Tumori - Milano
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Diminuito Rischio
• Fibre
• Vitamine
Antiossidanti e
Minerali
• PUFA, n-3
• Verdura
• Frutta
• Cereali integrali
• Pesce
Aumentato Rischio
• Grassi totali
• Grassi saturi
• PUFA, n-6/n-3
• Proteine (animali)
• Mono- e disaccaridi
• Sale
• Carne
• Prodotti della pirolisi
Principali ipotesi su Nutrizione e Cancro sviluppate negli anni ‘70 E ‘80
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ALIMENTI
PATTERNS
NUTRIENTI
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NUTRIENTI
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Sostanze Antiossidanti (es Vitamina A, E, C e polifenoli)
indoli
Fibre
Acido Folico
Possibile effetto sinergico fra i componenti
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ALIMENTI
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PATTERN ALIMENTARI
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Perché studiare la relazione dieta-malattia con i pattern?
Le persone non mangiano singoli nutrienti o alimenti, ma una vasta gamma di alimenti con complesse combinazioni di nutrienti.
L’effetto di un singolo nutriente/alimento potrebbe essere troppo piccolo per essere rilevato.
Possibili effetti sinergici o antagonisti di alimenti e nutrienti
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Descrivono la qualità complessiva della dieta con diversi criteri:
l’adesione alle linee guida nazionali per una sana alimentazione (es HEI, AHEI)
aspetti di salute specifici (es. DASH) aspetti specifici di una cultura (es. dieta
mediterranea)
PATTERN ALIMENTARI
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Index
Component
HEI AHEI
Index Component HEI
Alcohol
Empty calories
Fish
Fruit
Legumes
Low-fat dairy
Nuts
Oil vs.fats
Red and Processed meat
Refined grain
Sodium
Sugar-sweetened beverage
Total protein
Vegetable (no potatoes)
Whole grains
Healthy Eating Index
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Index
Component
HEI AHEI
Index Component AHEI
Alcohol
Empty calories
Fish
Fruit
Legumes
Low-fat dairy
Nuts
Oil vs.fats
Red and Processed meat
Refined grain
Sodium
Sugar-sweetened beverage
Total protein
Vegetable (no potatoes)
Whole grains
Alternate Healthy Eating Index
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Index
Component
HEI AHEI
Index Component MED
Alcohol
Empty calories
Fish
Fruit
Legumes
Low-fat dairy
Nuts
Oil vs.fats
Red and Processed meat
Refined grain
Sodium
Sugar-sweetened beverage
Total protein
Vegetable (no potatoes)
Whole grains
Mediterranean Index
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Index
Component
HEI AHEI
Index Component DASH
Alcohol
Empty calories
Fish
Fruit
Legumes
Low-fat dairy
Nuts
Oil vs.fats
Red and Processed meat
Refined grain
Sodium
Sugar-sweetened beverage
Total protein foods
Vegetable (no potatoes)
Whole grains
Dietary Approaches to Stop Hypertension
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Index
Component
HEI AHEI
Index Component HEI AHEI MED DASH
Alcohol
Empty calories
Fish
Fruit
Legumes
Low-fat dairy
Nuts
Oil vs.fats
Red and Processed meat
Refined grain
Sodium
Sugar-sweetened beverage
Total protein
Vegetable (no potatoes)
Whole grains
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Healthy Eating Index e tumori
Schwingshackl et al. J Acad Nutr Diet. 2015;115:780-800
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Alternate Healthy Eating Index e tumori
Schwingshackl et al. J Acad Nutr Diet. 2015;115:780-800
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DASH Index e tumori
Schwingshackl et al. J Acad Nutr Diet. 2015;115:780-800
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Dieta mediterranea e tumori
Sofi F. Public Health Nutrition 2014;17: 2769-2782.
Meta-analisi in continuo su 14 studi di coorte
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I.A.R.C. LYON
PARIS
FLORENCE
MILAN
RAGUSA
TURIN
NAPLES
BARCELONA
OVIEDO
GRANADA
MURCIA
PAMPLONA
SAN SEBASTIAN
CAMBRIDGE
OXFORD BILTHOVEN
UTRECHT
ATHENS
HEIDELBERG
POTSDA
M
MALMO
UMEA
AARHUS
COPENHAGEN
TROMSO
UK: OXFORD
CAMBRIDGE
NETHERLANDS: UTRECHT
RIVM
GERMANY: POTSDAM
HEIDELBERG
FRANCE: PARIS
ITALY: TURIN
MILAN
FLORENCE
NAPLES
RAGUSA
SPAIN OVIEDO
SAN SEBASTIAN
PAMPLONA
MURCIA
GRANADA
GREECE ATHENS SWEDEN: UMEA
MALMO
DENMARK: AARHUS
COPENHAGEN
NORWAY: TROMSO
European Prospective Investigation Into Cancer and Nutrition - EPIC
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Dieta Mediterranea: risultati in EPIC
HR (95%CI) Alto vs basso: 0.93 (0.90-0.96)
4.7%M e 2.4%F di tumori evitabili con score ≥6.
Senza componente alcol HR (95%CI) alto vs basso Totale: 0.94 (0.88-1.00)
Postmenopausa: 0.93 (0.87-0.99) Premenopausa: 0.97 (0.81-1.15)
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Dieta Mediterranea: risultati in EPIC
HR (95%CI) Alto vs basso: 0.67 (0.47-0.94)
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Dieta Mediterranea: risultati in EPIC
HR (95%CI) alto vs basso Totale: 0.84 (0.69-1.03)
Fumatori: 0.66 (0.47-0.93)
Senza componente alcol HR (95%CI)
Alto vs basso: 0.99 (0.77-1.26)
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HR (95%CI) Alto vs basso: 0.78 (0.64-0.94)
Dieta Mediterranea: risultati in EPIC
HR (95%CI) per 2 punti Totale: 0.88 (0.75-1.03)
Postmenopausa: 0.78 (0.62-0.98) Premenopausa: 1.01 (0.80-1.28)
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HR for developing colorectal cancer in relation to
adherence to the Italian Mediterranean Index
0
0,5
1
1,5
Score category
HR
Total 1 0,49 0,58 0,5
Men 1 0,7 0,72 0,54
Women 1 0,36 0,49 0,46
1 (0-1) 2 (2-3) 3 (4-5) 4 (6-11)
Dieta Mediterranea: risultati in EPIC ITALIA
Agnoli C. Int J Cancer 2013;132: 1404-11
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Aderenza alle Raccomandazioni del WCRF
Consuma molti e vari cereali integrali, legumi, frutta e verdura
Limita i cibi ad elevato contenuto calorico (alimenti ricchi di zuccheri o grassi) ed evita le bevande zuccherate
Evita le carni conservate; limita il consumo di carni rosse e di alimenti ad elevato contenuto di sale
Limita il consumo di alcol
Attivati per mantenere un peso sano
Svolgi attività fisica ogni giorno. Limita il tempo che trascorri seduto.
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HRs (95% CIs) for total cancer and specific cancer types associated with a 1-point increment in WCRF/AICR score (range: 0–6 in men, 0–7 in women).
Romaguera D et al. Am J Clin Nutr 2012;96:150-163
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Rischio di Morte associato all’aderenza alle raccomandazioni del WCRF
WCRF score n. morti/n.
soggetti HR (95% CI)
1 5468/70578 1
2 6713/98183 0.87 (0.83-0.90)
3 8108/138520 0.77 (0.74-0.79)
4 3103/61714 0.70 (0.67-0.74)
5 436/9869 0.66 (0.60-0.73)
P trend <0.0001
Vergnaud A et al. Am J Clin Nutr 2013;97:1107-20
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Conclusioni
Le evidenze solide sull’associazione tra singoli alimenti e tumori sono poche (e.g. alimenti ricchi in fibra,
carni rosse e conservate, bevande alcoliche)
Lo studio della dieta nel suo complesso ci ha permesso di individuare pattern alimentari (e.g. HEI,
AHEI,DASH, MED, WCRF) associati ad un minor rischio di cancro che seppur diversi identificano tutti uno stile alimentare basato principalmente su alimenti di origine vegetale e ricco in fibre.
Le raccomandazioni per la prevenzione oncologica sono coerenti con quelle per la prevenzione di altre malattie croniche
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GRAZIE PER L’ATTENZIONE