Fiber: It Does A Colon Good
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Fiber: It Does A Colon Good

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  • Late-stage colon and rectum cancer incidence rates ranged from 51.0 to 86.5 and were highest in Connecticut, Delaware, Illinois, Iowa, Kentucky, Louisiana,
  • Many people at risk for colorectal cancer are not being screened according to national guidelines Gastroenterologist performs the colonoscopy.
  • Adults aged 50+ who have ever had a sigmoidoscopy or colonoscopy. 59.1 = yes 40.9 = no
  • Study was done in 1986
  • Case-studies show an inverse relationship to colon cancer with high fiber intake, whereas cohort studies show no benefits. (Harvard School of Public Health followed 80,000 nurses for 16 years) NOTE: USE REFERENCE FROM “BEST WEBSITE!!!” # 111 FOR INVERSE RELATIONSHIP
  • The tumor suppressor protein p53 plays a critical role in DNA damage-induced apoptosis with certain anti-cancer medications. http://www.ncbi.nlm.nih.gov/pubmed/20459745 NSC109268 potentiates cisplatin-induced cell death in a p53-independent manner.
  • Their actions may depend not only on their concentration, but upon their interactions with the rest of the diet.
  • Vomiting (black substance prior to and upon admission)
  • As you can see, Mr. Z does not consume very much fiber. His diet is severely lacking in whole grains, vegetables and fruit
  • Ensure Plus is recommended until Mr. Z has reached his usual body weight
  • Factors Associated With a Decreased Risk of Colorectal Cancer Physical activity – Based on solid evidence, regular physical activity is associated with a decreased incidence of CRC.

Fiber: It Does A Colon Good Fiber: It Does A Colon Good Presentation Transcript

  • Fiber: It Does A Colon Good A Case Study by: Cheryl Reining May 20, 2011
  • Colon Cancer Prevalence
    • The CDC estimated that approximately 102,900 new cases of colon cancer would be diagnosed in the U.S. in 2010
      • Annually, approximately 51,370 Americans die of colon cancer; equates to ~ 9 % of all cancer deaths.
    • 90 percent of all colon cancer cases occur after age 50 years.
    • In the U.S., the risk to age 80 is 1 in 10 for males, and 1 in 15 for females, with an increased risk over the age of 80
    • Gradual shift downward of right-sided or proximal colon cancers in the U.S.
      • May be related to improvements in diagnosis and treatment, increased screening and the removal of polyps in the colon
    • True increase in the incidence of ascending colon and cecal cancers (2)
    1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60:277. 2. Troisi RJ, Freedman AN, Devesa SS. Incidence of colorectal carcinoma in the U.S.: an update of trends by gender, race, age, subsite , and stage, 1975-1994. Cancer 1999; 85:1670.
  • Colon Cancer Statistics, 2007
    • Significantly different incidence
    • rates between men and women
    • Black men – highest rates
    • White men – second highest rates
    3. Colorectal (Colon) Cancer Incidence Rates. Available at: http://www.cdc.gov/Features/dsColorectalCancer/ . Accessed May 9, 2011.
  • Demographic Incidence Rates X X X X X X X X X X 4. Cancers Diagnosed at Late Stages Despite Available Screening Tests. Available at: http://www.cdc.gov/cancer/colorectal/what_cdc_is_doing/tests_article.htm . Accessed May 9, 2011. Late-stage colon and rectum cancer Incidence rates ranged from 51.0 to 86.5 and were highest In these 10 states.
  • Adenomatous polyps (Pre-malignant) Small nodules on bowel wall Deletion of tumor suppressor genes on Chromosome 18 Impaired cell cycle Oncogene Colon Cancer (Cecal) Tumor proliferation Increased basal metabolic rate Cancer cachexia Increased recuperation time from illness & infection Obstruction in colon Change in bowel Pain Death Malnutrition Pathophysiology of Colon Cancer 5. Colon Adenocarcinoma: Pathophysiology. Available at: http://emedicine.medscape.com/article/277496-overview#a0104 . Accessed April 25, 2011 .
  • Nutritional Implications and Pathophysiology of Colon Cancer
    • Malnutrition:
        • Loss of appetite
        • Pronounced weight loss w/o dieting
        • Listlessness or apathy
        • Hair and skin changes
        • Swollen abdomen
        • Decreased protein stores -> ↓zinc stores -> ↓ immuno-competence -> ↑ susceptibility to infection
        • General muscle wasting
          • Decreased intestinal function
          • Decreased kidney function
          • Decreased cardiac muscle
    • Decreased gastrointestinal motility
    6. Pathophysiology of Malnutrition in the Adult Cancer Patient. Available at: http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(19861015)58:8%2B%3C1867::AID-CNCR2820581413%3E3.0.CO;2-A/pdf . Accessed April 25, 2011.
  • Preventative Methods
    • Colorectal screening
    • Low saturated fat intake
    • High fiber intake!!!
  • Preventative Methods Cont.
    • Colorectal Cancer Screening:
      • Detects pre-cancerous polyp(s)
        • Removal of polyp(s) – stops cancer from devloping
      • Detects cancerous polyp(s)
        • Surgery required for cancer removal – additional treatment (chemo/radiation) may be required
      • Saves lives
      • Many people at risk for colorectal cancer not being screened
        • Estimated that as many as 60% of colorectal cancer deaths could be prevented if persons aged 50 years and higher were screened routinely
    7. Colorectal Cancer Screening. Available at: http://www.cdc.gov/cancer/colorectal/basic_info/screening/ . Accessed May 7, 2011.
  • Screening 8. Illinois – 2008 Colorectal Cancer Screening. Available at: http://apps.nccd.cdc.gov/brfss/display.asp?cat=CC&yr=2008&qkey=4425&state=IL . Accessed May 7, 2011. 59.1 = yes 40.9 = no
  • Preventative Methods Cont.
    • Low saturated fat diet
      • Studies dating as far back as 1986 show that colorectal cancer is associated with high dietary consumption of red and processed meats
    9. Rose DP, Boyar AP, Wynder EL. International comparisons of mortality rates for cancer of the breast, ovary, prostate, and colon, and per capita food consumption. Cancer 58 (11): 2363-71, 1986.
  • Preventative Methods Cont.
    • Fiber!!!
      • Dietary fiber (soluble and insoluble) exerts a protective role in reducing the incidence of colon cancer
        • Potential mechanisms that modify carcinogenesis in the colon – Fiber:
          • binds to bile acids
          • increases fecal water (possibly diluting carcinogens)
          • acts as a substrate for bacterial fermentation, increasing bacterial mass and SCFAs, as typified by butyrate
            • Butyrate – important fuel for the colonic epithelium
    10. Howe GR, Benito E, Castelleto R, et al. Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case-control studies. J Natl Cancer Inst 84 (24): 1887-96, 1992.
  • Diet High in Fiber High Levels of Butyrate Induction of p21 (p53-independent manner) Growth Inhibition Protection against Colorectal Cancer Apoptosis Differentiation Butyrate 11. Shankar E , Basu C , Adkins B , Siede W , Basu A . NSC109268 potentiates cisplatin-induced cell death in a p53-independent manner. J Mol Signal . 2010 May 10;5:4.
  • Sources of fiber
    • Grains – soluble and insoluble fiber
      • Moves material through the digestive tract
      • Decreases mutagenic activity of fecal contents
    • Vegetables
      • Cruciferous sources also contain isothiocyanates and indoles
      • Onions and garlic also contain sulfides
    • Fruits
      • Also contains flavones
    • Beans
      • Contains phenols
    • Supplements – do not contain additional cancer-fighting constituents
    • Fiber-enriched foods (cereal, bread, pasta)
    12. Potter JD: Epidemiology of diet and cancer: evidence of human maladaptation. In: Micozzi MS, Moon TE, eds.: Macronutrients: Investigating their Role in Cancer. New York: Marcel Dekker, 1992, pp 55-84. 
  • Dietary Fiber Intake for Americans
    • Usual intake of dietary fiber for adults in the United States is only 15 g/day.
    13. Health Implications of Dietary Fiber. Available at: http://www.eatright.org/About/Content.aspx?id=8355&terms=adult+daily+fiber+intake . Accessed May 7, 2011.
  • Fiber Intake Needs
    • 25 grams/day for women
    • 38 grams/day for men
    • After age 50
      • 21 grams/day for women
      • 30 grams/day for men.
    14. Fiber. Available at: http://www.eatright.org/Public/content.aspx?id=6796&terms=fiber+needs . Accessed May 7, 2011 .
  • Risk Factors
    • Heredity
    • Age
    • Smoking
    • Diet
    • Obesity
    • Heavy alcohol use
    • Lack of physical activity
  • Patient Profile: Mr. Z
    • 83 y/o Caucasian male
    • History of tobacco use (65 yrs)
    • Alcohol consumption – 1 beer per week
    • Retired and lives at home with his wife
    • Sedentary lifestyle
  • Current Problem List
    • Stable UGI bleed
    • Vomiting
    • Unintentional weight loss
    • Abdominal pain (right side)
    • Bowel obstruction
    • Alternating constipation and diarrhea
    • Feeling very weak and fatigued
  • Mr. Z’s Diagnoses
    • Ulcer (possibly duodenal), causing UGI bleed
      • Initial reason for hospital admittance
    • Colon (Cecal) Cancer
      • Diagnosed with stage 1 colon cancer on 11-02-2007
      • (after colonoscopy w/biopsy done on 10-31-2007)
      • Hemicolectomy (18 inches of colon) 11-02-2007
    • Malnutrition
      • Severely compromised status prior to surgery
      • Moderately compromised status after surgery
  • Past Medical History
    • Chronic medical Hx: Denies
    • Previous surgeries: Denies
    • Medications: Denies
    • Allergies (food or drug): Denies
  • Pertinent Medications Swelling of the tongue or lips, difficulty in breathing, closing of the throat Anticoagulant (blood thinner) – prevents blood clots Heparin 5000 units subcutaneous q 12 hr Nausea, diarrhea Increases rate of stomach and intestine movement during digestion. Used for the prevention of post-operative nausea and vomiting Reglan Constipation, dry mouth, decreased appetite, nausea, vomiting Note: An increase in fiber can help to relieve the side effects of constipation. Pain reliever Dilaudid .2-.5 IV push every 5 min. to max of 5 mg Diarrhea, stomach upset, nausea Decreases acid in the stomach (to treat UGI Bleed) Protonix 40 g IV daily Nutritional Implications Purpose or Function Medication and Amount
  • Pertinent Lab Values Low - Due to malnutrition and bleeding 3.5-5 g/dL 2.6 g/dL 2.4 g/dL Albumin Low -Due to low albumin level 8.9-10.3 mg/dL   - 7.7 mg/ dL Calcium Low -Protein starvation or liver disease 0.8-1.4 mg/dL .6 mg/ dL .7 mg/dL Creatinine Low -Possible cachexia or liver damage 8-20 mg/dL 7.7mg/ dL 6.3 mg/ dL BUN High -May be due to acute stress reaction 70-110 mg/dL Fasting 119 mg/ dL 127 mg/ dL Glucose Interpretation Normal Value/Range 11-04-07 10-29-07  
  • Anthropometrics
    • Height
      • 5’8” (172.72 cm)
    • Weight
      • 131 lb (59.4 kg)
    • UBW
      • 151 lb (68.6 kg)
    • IBW
      • 154 lb (70kg)
    • % IBW
      • 85%
    • BMI
      • 19.9 = Low Risk
  • Estimated Needs
    • Kcals
      • 30-35 kcal/kg
        • Hospitalized, cancer cachexia, malnutrition
      • 1786 – 2083 kcals/day
    • Protein
      • 1.2-1.5 gm/kg
        • Surgery patient
        • UGI bleed
      • 71.5 – 89 gm/kg
    • Fluid
      • 30 cc/kg
        • Elderly adult
      • 1786 cc/day
  • Current Diet
    • Breakfast ¾ cups cereal (whatever is on sale)
    • ½ cup milk
    • 1 cup coffee (black, no sugar)
    • Lunch 2 slices white bread
    • 2 slices ham (any kind, could be minced ham)
    • Lettuce (iceberg)
    • Tomato slice
    • 1 Tbsp. mayonnaise
    • 12 oz soft drink (cola, regular)
    • Dinner 1 Pork chop (or meatloaf, pizza, steak)
    • ½ cup Mashed potatoes w/butter or gravy (or French fries, rice, fried potatoes)
    • ½ cup green beans (or carrots, peas, mixed vegetables)
    • 12 oz soft drink (cola, regular)
    • Snack Ice cream bar
  • Recommended Diet Breakfast ¾ cups Cheerios ½ banana 1 cup milk 1 cup coffee (black, no sugar) Snack ½ can Ensure Plus with 1 small apple Lunch 2 slices whole-wheat bread 2 slices lean turkey 2 leaves romaine lettuce 2 tomato slices 1 Tbsp. reduced-fat mayonnaise Iced tea Snack ½ can Ensure Plus with ½ cup grapes Dinner ½ baked boneless, skinless chicken breast ½ cup mashed potatoes w/Smart Balance spread ½ cup green beans & ½ cup carrots (steamed) Iced tea Snack Ensure Plus
  • Additional Recommendation
    • Add physical activity into daily routine
      • Regular physical activity is associated with a decrease in the incidence of colorectal cancer
    15. Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention: a meta-analysis. Br J Cancer 100 (4): 611-6, 2009.
  • Dietary Goals
    • Consume at least 75% of meals (short term)
    • Increase vegetable intake (5 per day)
    • Increase whole grain intake (make half of the grains whole)
    • Add fruit into daily diet (3 per day)
    • Consume lean protein sources
    • Limit intake of processed and red meats
    • Limit intake of saturated fats
  • In Summary
    • Plant foods high in fiber reduces the risk of colon cancer
    • Dietary fiber increases transit time – waste product has less carcinogen contact within the colon and the mucosal lining
    • Regular physical activity is associated with a decrease in the incidence of colorectal cancer
    • Colorectal cancer screening saves lives
  • A Bit of Trivia
    • Did you know that…
      • there are 70 million Baby Boomers (age 50 & older) in the United States?
      • this equates to 20% of all Americans?
      • only 59% of this population will be screened for colorectal cancer?
      • a large percentage of this population is seeking nutritional guidance? (What a great opportunity for Dietitians!)
    16. The State of Aging and Health in America, 2004. Available at: http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf. Accessed May 7 , 2011.
  • References
    • Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60:277.
    • Troisi RJ, Freedman AN, Devesa SS. Incidence of colorectal carcinoma in the U.S.: an update of trends by gender, race, age, subsite , and stage, 1975-1994. Cancer 1999; 85:1670
    • Colorectal (Colon) Cancer Incidence Rates. Available at: http://www.cdc.gov/Features/dsColorectalCancer/ . Accessed May 9, 2011.
    • Cancers Diagnosed at Late Stages Despite Available Screening Tests. Available at: http://www.cdc.gov/cancer/colorectal/what_cdc_is_doing/tests_article.htm . Accessed May 9, 2011.
    • Colon Adenocarcinoma: Pathophysiology. Available at: http://emedicine.medscape.com/article/277496-overview#a0104 . Accessed April 25, 2011.
    • Pathophysiology of Malnutrition in the Adult Cancer Patient. Available at: http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(19861015)58:8%2B%3C1867::AID-CNCR2820581413%3E3.0.CO;2-A/pdf . Accessed April 25, 2011.
    • Colorectal Cancer Screening. Available at: http:// www.cdc.gov/cancer/colorectal/basic_info/screening / . Accessed May 7, 2011.
    • Illinois – 2008 Colorectal Cancer Screening. Available at: http:// apps.nccd.cdc.gov/brfss/display.asp?cat = CC&yr =2008&qkey=4425&state=IL . Accessed May 7, 2011.
    • Rose DP, Boyar AP, Wynder EL. International comparisons of mortality rates for cancer of the breast, ovary, prostate, and colon, and per capita food consumption. Cancer 58 (11): 2363-71, 1986.
    • Howe GR, Benito E, Castelleto R. Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case-control studies. J Natl Cancer Inst 84 (24): 1887-96, 1992.
    • Shankar E , Basu C , Adkins B , Siede W , Basu A . NSC109268 potentiates cisplatin-induced cell death in a p53-independent manner. J Mol Signal . 2010 May 10: 5:4.
    • Potter JD. Epidemiology of diet and cancer: evidence of human maladaptation. In: Micozzi MS, Moon TE, eds. Macronutrients: Investigating their Role in Cancer. New York: Marcel Dekker, 1992, pp 55-84. 
    • Health Implications of Dietary Fiber. Available at: http:// www.eatright.org/About/Content.aspx?id =8355&terms= adult+daily+fiber+intake . Accessed May 7, 2011
    • Fiber. Available at: http:// www.eatright.org/Public/content.aspx?id =6796&terms= fiber+needs . Accessed May 7, 201.
    • Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention: a meta-analysis. Br J Cancer 100 (4): 611-6, 2009.
    • The State of Aging and Health in America, 2004. Available at: http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf. Accessed May 7 , 2011.
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