Convegno la mela nel mondo interpoma bz - 17-11-2012 5 - eva negri


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Convegno la mela nel mondo interpoma bz - 17-11-2012 5 - eva negri

  1. 1. Apples and their components and cancer risk[Mele e loro componenti e rischio di cancro] Bolzano/Bozen 17 November 2012 Eva Negri Dipartimento di Epidemiologia Istituto di Ricerche Farmacologiche “Mario Negri” - Milano
  2. 2. Traditional Mediterranean diet • Abundant and variable plant foods • High consumption of cereals • Olive oil as the main (added) fat • Low intake of (red) meat • Moderate consumption of wine 2
  3. 3. Fruit and vegetables A diet rich in fruit and vegetables protects against common epithelial cancers, including in particular those of the digestive tract. 3
  4. 4. VEGETABLE consumption - Relative risks ofvarious cancers. Italian case-control studies 4
  5. 5. FRUIT consumption - Relative risks ofvarious cancers. Italian case-control studies 5
  6. 6. Fruit and vegetables and cancer risk Evidence for a risk reduction Probable Limited Vegetables Vegetables Mouth and pharynx Nasopharynx Larynx Lung Esophagus Colorectum Stomach Ovary Endometrium Fruit Fruit Mouth and pharynx Nasopharynx Larynx Pancreas Esophagus Liver Lung Colorectum Stomach (World Cancer Research Fund, 2007) 6
  7. 7. Fruit and vegetableconsumptionAbout 20 al 40% of cancers of the digestivetract in Italy may be attributable to lowconsumption of fruit and vegetables.For most cancers adding one portion per dayof fruit or vegetable leads to a decrease inrisk of about 10-20%. 7
  8. 8. Fruit and vegetableconsumption These data are at the basis of the reccommendation to eat at least 5 portions (about 400 gr) of fruit and vegetables per day. 8
  9. 9. ApplesApples are a source of several phytochemicals,including flavonoids (in particular, catechins andflavonols) and phenolic acids. When compared withother commonly consumed fruits, apples had thesecond highest level of antioxidant activity (aftercranberries) and phenolic compounds, and thehighest level of free phenolic compounds 9
  10. 10. Apples and cancerTo understand better the role of apples on risk ofcancer at several sites, we considered data from alarge and integrated network of case–controlstudies conducted in Italy, including detailedinformation on several fruit items, as well as on alarge number of potential confounding factors. 10
  11. 11. An apple a day…Compared with subjects reporting consumption of <1apple/day, the ORs for ≥1 apple/day were 0.79 (95% CI0.62–1.00) for cancers of the oral cavity and pharynx,0.75 (95% CI 0.54–1.03) for oesophagus, 0.80 (95% CI0.71–0.90) for colorectum, 0.58 (95% CI 0.44–0.76) forlarynx, 0.82 (95% CI 0.73–0.92) for breast, 0.85 (95%CI 0.72–1.00) for ovary and 0.91 (95% CI 0.77–1.07)for prostate. 12
  12. 12. An apple a day… 13
  13. 13. Fruit and vegetable consumption biologic mechanismThe protective effect of fruit and vegetables oncancers of the oral cavity, larynx, esophagus,stomach and colorectum suggests commonaspects of cancerogenesis at the digestive andrespiratory tract level, at least in part mitigated bya beneficial effect of vitamins or other compounds 14
  14. 14. MicronutrientsLow fruit and vegetable consumption leads to low availability of several compounds that:a) Neutralize carcinogens;b) diluite carcinogen formation;c) Reduce the proliferative ability of transformed cells;e) Act as antioxidants. 15
  15. 15. Micronutrients It is still uncertain which compounds are mostlyresponsible for the beneficial effect of fruit andvegetables (vitamins, carotenoids, folates,flavonoids) 16
  16. 16. ProanthocyanidinsProanthocyanidins are a group of monomers and polymers of flavanols (without added sugars). Proanthocyanidins (or condensed tannins) are mainly dimers and polymers that are bound together by links between C4 and C8 (or C6). They are contained in apples.Proanthocyanidins have strong antioxidant properties, and could have favorable effects on cancer. 17
  17. 17. Main sources of flavonoinds and proanthocyanidins 1 2 3Flavonoids Tea Apples and pears WineFlavanols (50%) (20%) (15%) Citrus fruit Fruit juicesFlavanons - (88%) (11%) Apples and pears Fennels Mixed saladFlavonols (16%) (16%) (12%) Strawberries and Wine OnionsAntocianidins cherries (46%) (7%) (37%) Vegetable soups TeaFlavons Green leafy veg (29%) (17%) (15%) Soy milk Soy Vegetable soupsIsoflavons (45%) (21%) (12%) Citrus fruit Tea Apples and pearsSum of the above (28%) (22%) (11%)Proanthocianidins Wine Apples and pears Peaches, apricots andMono- & di-mers (52%) (22%) plums (6%) Apples and pears Wine Vegetable soups≥ 3 mers (43%) (13%) (12%) 18
  18. 18. Proanthocyanidins (≥ 3 mers) and cancer risk** **ORs for the highest versus the lowest quintile of intake *Monomers and dimers 19
  19. 19. ProanthocyanidinsThe findings of this large series of Italian case- control studies provide support for a protective role of proanthocyanidins on gastric, colorectal, pancreatic and endometerial cancer. 20
  20. 20. Total antioxidant activity (TAC) Several methods were developed recently for measuring the total antioxidant capacity of food and beverages. These assays differ in their chemistry and in the way end points are measured Because different antioxidant compounds may act in vivo through different mechanisms, no single method can fully evaluate the TAC of foods. (Pellegrini N, Serafini M, Colombi B et al. Total antioxidant capacity of plant foods, beverages and oils consumed in 21 Italy assessed by three different in vitro assays. J Nutr 2003; 133: 2812-9.)
  21. 21. Total antioxidant activity (TAC) We evaluate the TAC of diet in relation to colorectal cancer risk using 3 different indexes TEAC (Trolox equivalent antioxidant capacity) TRAP (Total Radical-trapping Antioxidant Parameter) FRAP (Ferric Reducing-Antioxidant Power) (Pellegrini N, Serafini M, Colombi B et al. Total antioxidant capacity of plant foods, beverages and oils consumed in 22 Italy assessed by three different in vitro assays. J Nutr 2003; 133: 2812-9.)
  22. 22. TAC and colorectal cancer riskORs for the highest quintile compared to the lowest one 0.0 0.5 1.0 2.0 Colon-retto 1.5 TEAC TRAP FRAP TEAC: 0.78 TRAP: 0.74 FRAP: 0.78 (p-trend: 0.002) (p-trend: 0.001) (p-trend: 0.003) 23
  23. 23. Conclusions•A diet rich in foods of plant origin is associated with a lower risk of cancer.•Apples are a fruit of specific interest, since they are cheap and easy tostore and transport.•Epidemiologic studies have specifically found lower risk of cancer in highapple consumers.•Research to identify compounds responsible for this protection is stillunderway Apples are an ally in cancer prevention 24
  24. 24. THANK YOU 25