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Can Dietary Factors Influence Survival? 飲食對癌症存活的影響

Can Dietary Factors Influence Survival? 飲食對癌症存活的影響. by Frances Ma RD, MS. EdD. 張仙平 博士 台灣益富營養中心. Myths and Facts 迷思及實證. Soy Food Intake and Breast Cancer Survival. ( Shanghai Breast Cancer Survival Study). (5042 BC survivors recruited between 2002-2006 median F/U 3.9yr.).

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Can Dietary Factors Influence Survival? 飲食對癌症存活的影響

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  1. Can Dietary Factors Influence Survival?飲食對癌症存活的影響 by Frances Ma RD, MS. EdD. 張仙平 博士 台灣益富營養中心

  2. Myths and Facts 迷思及實證

  3. Soy Food Intake and Breast Cancer Survival (Shanghai Breast Cancer Survival Study) (5042 BC survivors recruited between 2002-2006 median F/U 3.9yr.) JAMA 2009; 302(22): 2437-2443

  4. Soy food intake was treated as a time-dependent variable. Hazard ratios were adjusted for age at diagnosis, TNM stage, chemotherapy, radiotherapy, type of surgery received, body mass index, menopausal status,ER and progesterone receptor status, tamoxifen use, education level, income, cruciferous vegetable intake, total meat intake, vitamin supplement use, tea consumption, and physical activity. JAMA 2009; 302(22):2437-2443

  5. A Soy food intake was treated as a time-dependent variable. Hazard ratios were adjusted for age at diagnosis. TNM stage, chemotherapy. type of surgery received, body mass index, progesterone receptor status, education level, income, cruciferous vegetable intake , total meat vitamin supplement use, tea consumption, and physical activity. JAMA 2009;302(22):2437-2443

  6. (1490 treated BC recruited between 1991-2000 F/U 8.7yr.) J.Clin Oncol 2007, 25:2345-2351

  7. Fig 1. Kaplan-Meier survival after Women’s Healthy Eating and Living(WHEL)Study enrollment by four diet and physical activity categories. Low vegetables fruits (VF), less than 5 servings/d; high VF, ≧5 servings/d;. low physical activity (PA), less than 540 metabolic equivalent task (MET)-min/wk; high PA, ≧540 MET-min/wk(equivalent to walking 30 minute 6d/wk). Survival is plotted as a function of number of years enrolled in WHEL Study. J. Clin Oncol 2007 , 5:2345-2351

  8. (4441 diagnosed BC between 1987-1999)

  9. Association of total energy and macronutrient intake with all-cause and breast cancer survival, CWLS*

  10. Dietary Pattern and Lifestyle among Early-Stage Breast Cancer Survivors in Taiwan Formosan Journal of Medicine Vol.14 No.3 May 2010 常傳訓 殷秀妙 董道興 張仙平 (396 treated breast Cancer)

  11. Healthy Eating and Lifestyle Assessment(HELA) Scores of Breast Cancer Survivors in Taiwan Proper behavior(10) Improper behavior(7) modified from Formosom J Med. 2010 ,14(3): 241-9

  12. Conclusion The data showed <1> the HELA score of proper behavior were lower . <2> the score of improper dietary behavior were higher. It means people werefocusing on “not to do” more, but missing the healthy dietary and lifestyle that they “should do”.

  13. Conclusion <3> the longer the patient history, the lower the score and the more weight gain It means people has not built up the healthy lifestyle through the years. 乳癌存活者病程越久，分數則越低，增加的體重就越多 患者著重在少做“不該做的事”，而忽略”該做的事” 且未建立起健康的生活型態。

  14. I am a breast cancer survivor. 我是癌症存活者 也是美國註冊營養師 (American Registered Dietitian)

  15. I was diagnosed with a triple negativeStage Ⅲ breast cancer (T3N3M0) in March, 3.2010. 2010, 3月我被診斷罹患乳癌第3期

  16. I have gone through total mastectomy, lymphectomy, 9 chemotherapies and 35 radiation therapies. 我做了兩側乳房全切手術, 淋巴擴清術，9次化療,35次放療。

  17. How I survived through breast cancer therapy 我如何通過乳癌治療

  18. Personal beliefs: In sickness depends on doctors, In health depends on ourselves. 治療靠醫生，保健靠自己

  19. Nutrition Strategies-- During Treatment (治療中)

  20. Problems (during treatment) 治療中實際問題 一、Angry and horrified: This is “the End”?? 生氣，恐懼，”人生就這樣了?” 二、Other than eat and sleep, there is nothing else to do. 除了吃就是睡，生活沒重心，尤其是職業婦女，”不用上班了?” 三、 Feel tired all the time , too weak to exercise. 總是很累，沒有力氣運動，但必須動 四、Always feel too full to eat, no appetite at all 總是覺得很飽，沒食慾，不想吃，但必須吃

  21. Problems (during treatment) 治療中實際問題 五、Hard to eat enough protein and energy foods. 很難吃到足夠蛋白質及熱量的食物 1. Meat is too tough.4. Vegetable is too coarse. 肉太硬蔬菜太粗， 咬不動，吞不下 2. Sea food istoo fishy.5. High carbohydrate food is too bulky. 魚或海鮮很腥 ，噁心 澱粉類(米麵)量太大，吃不下 3. Milk causes flatulence. 喝奶會脹氣

  22. Nutrition Strategies-- During Treatment (治療中)

  23. Personal Experience (During Treatment) 一、Tips to achieve a high protein adequate calorie diet 攝食足夠熱量高蛋白飲食 1. Eat freshly cooked meals(They tasted best.) (Left over dishes are other families members’ responsibilities.) 吃當餐準備的食物 (剩菜由家人負責吃完) 2. Eat protein foods first , then starchy foods , vegetables last. 攝食順序：先吃蛋白質食物，再吃碳水化合物，最後吃蔬菜 3. Use whey and nutrition formula products to help to achieve protein goal. 利用乳清蛋白及配方食品來達成每日營養不足的蛋白質需求 4. Eat protein food with gravy or sauce. 有汁的肉類較易吞嚥

  24. Personal Experience (During Treatment) 5. Sipping water with glutamine to avoid ulcer in the mouth (mucositis) 隨時啜加入麩醯胺酸的水，可避免口腔潰瘍，又可改善口乾 6. Eat more, especially protein food whenever have appetite. 有胃口時，吃多些，尤其蛋白質食物 7.  When do not have appetite, instead of trying to eat a whole meal , drink nutrition formulas. 沒胃口時，喝營養配方食品 (尤其化療日及次日) 8. Use fiber supplements to help normalizing bowel movement. 用纖維補充劑(補充不足)促進正常排便 9. Measure and record foods before eating . 每餐吃前先秤該攝食食物的量並記錄，可知自己實際攝食狀況

  25. Personal Experience (During Treatment) 二、Most helpful foods 1. Protein foods : egg , shrimp , ground pork , bean products. ( 蛋、鮮蝦、絞肉、豆腐、豆皮、百頁 、毛豆、豆板) 2. Carbohydrate foods : banana , rice.(香蕉、白飯) 3. Fruits : banana , papaya , grape.(香蕉、木瓜、葡萄) 4. Vegetables : tomato , Chinese cabbage.(蕃茄、大白菜) 5. Other foods 其他 a. Golden clam黃金蜆(汁) b. Pork liver豬肝

  26. Personal Experience (During Treatment) 三、Nutrition Formula營養配方 ＊Nu-Immu, Nutri-Aid HF Plus , Whey-Aid , and Nu-Recovery use as nutrition supplements daily : 2-3 times a day. 免疫增,益力康高纖Plus , 益富匯 , 福惜素: 每日2-3次 ＊Chemo days and the day after chemo day have no appetite : Drink only formula 5-6 times a day 化療當日及次日完全無食慾：可只喝配方每日6-7次(1500-1800卡) 四、Multi-Vits & Mins : one a day to meet 100% DRIs. 每日一粒達100%DRIs的多種維生素及礦物質補充劑 五、Normacol plus (natural high fiber plus gentle laxative):To assure normal bowel movement. 確實每日正常排便

  27. Nutrition Strategies-- After Treatment (治療後) 多吃植物食物 蔬果 黃豆(適量) 全穀

  28. Exercise 運動 1.Get up early to take a brisk walk everyday. 每日早起快走運動 2. Wear a pedometer aimed at 10,000 step a day. 使用計步器 3.To extend the exercise time a little everyday until it reaches the goal (one hour / day). 每日增加一點時間或量 直到達目標 4. Fit exercise into daily activity. 將運動融入日常生活時間表 5.Stretch everyday 每日做伸展運動

  29. Obesity, Physical Activity, and Diet Associations with Breast Cancer Overall or Cancer-Specific Survival Not consistent Not consistent J Clin Oncol 2010 , 28:4074-4080

  30. 4th PENSA會議 2000 圓山晚宴

  31. “Discipline becomes habit, Habit becomes nature.” “勉強成習慣，習慣成自然” 馬英九總統 President Ma, 2000

  32. Dietary RecommendationsforCancerPrevention癌症預防飲食建議 1. Be as lean as possible without becoming underweight. 盡可能降低體重 但不可至過輕 2. Be physically active for at least 30 minutes every day. 盡可能每日至少運動30分鐘 3.Avoidsugary drinks. Limit consumption of energy-dense foods. 避免含糖飲料 高熱量食物 4.Eat more of a variety of vegetables, fruits, whole grains, and legumes such as beans. 多吃蔬菜 水果 全穀 及 豆類 WCRF/AICR Second Expert Report,2008

  33. Dietary RecommendationsforCancerPrevention癌症預防飲食建議至 5.Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. 少吃紅肉 (牛豬羊)及醃製肉類 6.If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day. 少喝酒 (如喝:每日男士限2杯, 女士限1杯) 7.Limit consumption of salty foods and foods processed with salt. 少吃醃製食品 8.Don’t use supplements to protect against cancer. 勿用健康食品保護抗癌 WCRF/AICR Second Expert Report,2008

  34. My motto 我的座右銘 Face it, accept it and deal with it. 面對它，接受它，處理它

  35. We can’t change the wind , But, we can adjust our sails. 當我無法改變風向時，我可以調整我的帆

  36. Wish everyone good health and happiness 祝 大家 健康!! 快樂 !!

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