Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplements to improve their treatment outcomes, quality of life, and overall survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer survivorship to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information with which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity guidelines during the continuum of cancer care, briefly highlighting important issues during cancer treatment and for patients with advanced cancer, but focusing largely on the needs of the population of individuals who are disease free or who have stable disease following their recovery from treatment. It also discusses select nutrition and physical activity issues such as body weight, food choices, food safety, and dietary supplements; issues related to selected cancer sites; and common questions about diet, physical activity, and cancer survivorship.

The American Cancer Society (ACS) publishes Nutrition and Physical Activity Guidelines to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. These Guidelines, published approximately every 5 years, are developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and they reflect the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS Guidelines focus on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. The ACS Guidelines are consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes, as well as for general health promotion, as defined by the 2010 Dietary Guidelines for Americans and the 2008 Physical Activity Guidelines for Americans.

The American Cancer Society (ACS) publishes Nutrition and Physical ActivityGuidelines to serve as a foundation for its communication, policy, and community strategies and ultimately, to affect dietary and physical activity patterns among Americans. These Guidelines, published every 5 years, are developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and as such, they represent the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS Guidelines include recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or interferes with healthy behaviors. Community efforts are essential to create a social environment that promotes healthy food choices and physical activity. Therefore, this committee presents one key recommendation for community action to accompany the four recommendations for individual choices to reduce cancer risk. This recommendation for community action recognizes that a supportive social environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. The ACS Guidelines are consistent with guidelines from

The indigenous Kuna who live on islands in the Panamanian Caribbean were among the first communities described with little age-related rise m blood pressure or hypertension Our goals in this study were to ascertain whether isolated island-dwelling Kuna continue to show this pattern, whether migration to Panama City and its environs changed the patterns, and whether the island-dwelling Kuna have maintained their normal blood pressure levels despite partial acculturation, reflected in an increased salt intake. We enrolled 316 Kuna participants who ranged in age from 18 to 82 years. In 50, homogeneity was confirmed by documentation of an 0+ blood group In 92 island dwellers, diastolic hypertension was not identified and blood pressure levels were as low m volunteers over 60 years of age as in those between 20 and 30 years of age In Panama City, conversely, hypertension prevalence was 10 7% and exceeded 45% in those over 60 years of age (P< Ol), blood pressure levels were higher in the elderly, and there was a statistically signrficant positive relationship between age and blood pressure (P< 01) In Kuna Nega, a Panama City suburb designed to mamtam a traditional Kuna lifestyle but with access to the city, all findmgs were Intermediate Sodmm mtake and excretion assessed m 50 islanddwelling Kuna averaged 135+ 15 mEq/g creatmme per 24 hours, exceedmg substantially other communities free of hypertension and an age-related rise m blood pressure Despite partial acculturation, the island-dwellmg Kuna Indians are protected from hypertension and thus provide an attractive populatton for exammmg alternative mechamsms (Hypertensron. 1997;29[part 21: 171-176.) Key Words l sodium l potassium l magnesmm l calcium l body mass l obesity l aging T he Kuna Indians who live in the isolated San BlasIsland cham off the Caribbean Coast of Panama were among the first commumttes described m which hypertension is rare. i In their recent review, James and Baker* cited 39 such populations m Africa, the Americas, Asia, and the Pacific Region In many of these communities, the primary evidence that the protective factor is environmental rather than genetic was the blood pressure rise following migration to an urban environment 2-1g Among the many lines of evidence suggestmg a role for salt intake m the pathogenesis of hypertension, particularly compellmg has been the rdentrficatton of these tsolated communities where salt intake 1s low, hypertension is rare, and blood pressure does not rise with age. By 1976, Page3 concluded that all low blood pressure populations have a low salt intake as part of their biology and probably as a maJor causal mechanism and supported that conclusion by citing nme earlier studies. Since that time, a number of confirmatory studies have been reported.a-'2 Salt intake m such "protected" commumtres generally provided less than 40 mBq of sodmm per day, and typrcally much less.Our goals m this study were to ascertain whether we could confirm the absence of hypertension and age-related rise m blood pressure m ...

This study suggests that negative pressure therapy significantly reduces the major wound complication, reoperation, and readmission rates for patients at high risk for groin wound complications. Furthermore, this therapy may lead to a reduction in hospital costs. Negative pressure therapy for all groin incisions considered at high risk for wound complications is recommended.

Limb ischemia complications from ECMO may be decreased by prophylactic placement of an antegrade DPC. Without DPC, continuous monitoring using NIRS may identify limb ischemia, which can be treated subsequently with DPC and or fasciotomy.

The Western dietary pattern is associated with higher risk of colorectal neoplasms. Evolutionary discordance could explain this association. We investigated associations of scores for 2 proposed diet patterns, the "Paleolithic" and the Mediterranean, with incident, sporadic colorectal adenomas in a case-control study of colorectal polyps conducted in Minnesota (1991-1994). Persons with no prior history of colorectal neoplasms completed comprehensive questionnaires prior to elective, outpatient endoscopy; of these individuals, 564 were identified as cases and 1,202 as endoscopy-negative controls. An additional group of community controls frequency-matched on age and sex (n = 535) was also recruited. Both diet scores were calculated for each participant and categorized into quintiles, and associations were estimated using unconditional logistic regression. The multivariable-adjusted odds ratios comparing persons in the highest quintiles of the Paleolithic and Mediterranean diet scores relative to the lowest quintiles were, respectively, 0.71 (95% confidence interval (CI): 0.50, 1.02; Ptrend = 0.02) and 0.74 (95% CI: 0.54, 1.03; Ptrend = 0.05) when comparing cases with endoscopy-negative controls and 0.84 (95% CI: 0.56, 1.26; Ptrend = 0.14) and 0.77 (95% CI: 0.53, 1.11; Ptrend = 0.13) when comparing cases with community controls. These findings suggest that greater adherence to the Paleolithic diet pattern and greater adherence to the Mediterranean diet pattern may be similarly associated with lower risk of incident, sporadic colorectal adenomas.

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