Purpose of Review This review summarizes a selection of epidemiologic research assessing the associations between carbohydrate intake and cancer incidence and survival. Evidence for plausible biological mechanisms is also considered. Recent Findings The mechanistic paradigm explaining the relationship between carbohydrates and cancer risk has been contested by numerous observational studies. Summary Carbohydrates have conventionally been ascribed a deleterious role in the field of cancer research due to previous preclinical findings. A breadth of studies suggests that complex carbohydrate intake is inversely associated with risk of a number of cancer types. Data from studies assessing simple carbohydrates and cancer risk are mixed. Furthermore, recommendations for subsequent studies are framed.
Introduction: Food insecurity (FI) has been associated with negative health outcomes, including poor quality of life (QOL) and chronic diseases such as cardiovascular disease and diabetes. However, the association between FI and cancer is largely unknown. No comprehensive practice guidelines or consensus criteria currently exist regarding screening for and addressing FI in oncology clinics. Registered Dietitian Nutritionists (RDNs) are on the front lines of nutritional care provided to patients across the cancer continuum, but it is unknown if and how oncology RDNs address FI with their patients. The purpose of this study was to assess oncology RDNs’ knowledge, attitudes and practices related to FI among cancer patients. Methods: One-on-one, semi-structured interviews were conducted with 41 oncology RDNs working at various types of cancer centers across the U.S. and recruited through the Oncology Nutrition Dietetics Practice Group of the Academy of Nutrition and Dietetics. Interviews were conducted by telephone using Microsoft Lync and recorded using the audio software program, Audacity®. Interviews lasted an average of 60 minutes and were conducted by a research specialist trained according to the Ecocultural Family Interview protocol. The interviews were coded by research specialists using a semantic approach to thematic analysis. Data were analyzed using Dedoose. Results: Findings revealed that oncology RDNs are generally aware of the term “food insecurity” and can accurately define it. RDNs believe that FI is a problem for many of their patients and that cancer patients are more likely to be negatively affected by FI compared to healthy adults. RDNs identified potential adverse consequences of FI for cancer outcomes such as poor nutritional status, QOL and tolerance to treatment. Few RDNs reported that they regularly ask their patients about their ability to afford necessary food. Further, the vast majority of RDNs had not heard of or used a validated assessment tool to identify food insecure cancer patients. Conclusions: Most oncology RDNs are knowledgeable about FI and are concerned about the potential negative impact on cancer outcomes. However, most do not use a validated assessment tool to identify cancer patients who may be food insecure. These findings can inform observational or intervention work focused on screening for and addressing FI in oncology settings. Citation Format: Amirah A Burton-Obanla, Stephanie Sloane, Brenda Koester, Craig Gundersen, Barbara H Fiese, Anna E Arthur. Oncology Registered Dietitians’ knowledge, attitudes and practices related to food insecurity among cancer patients: A qualitative study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A050.
(1) Background: Food insecurity (FI) is a public health and sociodemographic phenomenon that besets many cancer survivors in the United States. FI in cancer survivors may arise as a consequence of financial toxicity stemming from treatment costs, physical impairment, labor force egress, or a combination of those factors. To our knowledge, an understanding of the dietary intake practices of this population has not been delineated but is imperative for addressing the needs of this vulnerable population; (2) Methods: Using data from NHANES, 1999–2018, we characterized major dietary patterns in the food insecure cancer survivor population using: i. penalized logistic regression (logit) and ii. principal components analysis (PCA). We validated these patterns by examining the association of those patterns with food insecurity in the cancer population; (3) Results: Four dietary patterns were extracted with penalized logit and two with PCA. In the pattern validation phase, we found several patterns exhibited strong associations with FI. The FI, SNAP, and Household Size patterns (all extracted with penalized logit) harbored the strongest associations and there was evidence of stronger associations in those moderately removed from a cancer diagnosis (≥2 and <6 years since diagnosis); (4) Conclusions: FI may play an influential role on the dietary intake patterns of cancer survivors in the U.S. The results highlight the relevance of FI screening and monitoring for cancer survivors.
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