Five-a-day keeps the Doctor Away
The European Prospective Investigation into Cancer and Nutrition (EPIC) published some of its findings last month.1 The diet of nearly 500,000 men and women from 10 European countries including the United Kindgom (UK), who developed approx 30,000 cancers at all sites combined, over nearly 9 years of follow up were investigated. Data suggested that those eating an increment of 200g of total fruits and vegetables per day (which corresponds to <2 extra servings daily) had an approximately 4% lower incidence of all cancers combined.1 According to the World Cancer Research Fund, this would equate to approx 7000 fewer cases of cancer per year in the UK.
In 1990, the World Health organisation (WHO) recommended consumption of at least 400g fruits and vegetables a day to prevent cancer and other chronic diseases, which equates to approx 5 servings per day (Table 1, below). The WHO claimed to have found convincing evidence for the protective effect of high intake of fruits and vegetables against a number of respiratory and digestive cancers,2 with potential reductions as large as 50% suggested.3 These most recent findings by EPIC does not support these claims, however, in this same population of men and women, the incidence of coronary heart disease or stroke was 30% lower for those consuming ≥5 servings per day compared to those eating ≥1.5 servings.4
When considering the risk of developing cancer, it is important to take into account lifestyle changes which can reduce the incidence of cancer such as; giving up smoking, increasing physical activity and maintaining a healthy weight. Obesity is an established risk factor for the development and increased mortality from certain cancers.2,5 Eating more fruit and vegetables rather than more sugary and fatty energy dense foods will help to maintain a healthier weight, and reduce other health risks associated with obesity. This, in conjunction to incorporating more physical activity in your daily routine helps to reduce overall coronary heart disease, stroke, and cancer risk. But most importantly for our patients, is it aids in achieving their weight loss goals.
Many patients on the Counterweight Programme express a desire to increase their fruit and vegetable intake and media headlines that may appear to discredit the benefits could give patients conflicting messages, leading to confusion. Using the goals approach can help patients identify changes they wish to make changes to their diet and lifestyle.
Goal: To increase intake of fruits and vegetables
Ask the patient to consider the pros and cons of eating more fruit and vegetables
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Pros – advantages of making a change
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Cons the disadvantages of making a change
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Feel healthier
Add variety to my diet
Help me to lose weight
Convenient snack instead of chocolate
Reduce the risk of cancer by 4%
Reduce my incidence of stroke and coronary heart disease
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Unsure of where to start
Hassle of cooking
I like my chocolate break at work
Time
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Encourage the patient to make their goal a SMART goal ie Specific, Measurable, Attainable, Reaistic and Time-bound.
S I will try and eat more fruit
M I will bring fruit to work for my snack break mid-morning
A I always take a break about 11 so I can eat my fruit at that time
R I like fruit it’s just sometimes I don’t bother with it
T I work 3 days per-week so these will be the days I try to eat more fruit. I will start this on my first day back at work.
TOP TIPS
Put vegetables on the plate first when serving a meal (aim for half the plate to be vegetables)
Add vegetables to meat dishes such as casseroles and stew, e.g. carrots,onions, peas
Have a vegetable based soup at lunchtime, e.g.carrot and coriander, vegetable, broth
Add lettuce, tomatoes, onions and/or cucumber to sandwiches
Snack on fruit if hungry between meals, have fruit bowl at home or work
Cut up vegetables to snack on if you’re feeling peckish between meals
Table 1: What's in a serving?
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1 Serving of Fruit (60calories) and Vegetables (30 calories) equals:
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1 apple, pear, banana or orange
½ grapefruit
2 plums, satsumas, clementines
1 large slice, approx 2 inches melon or pineapple
3 heaped tablespoons vegetables, raw, fresh, frozen or tinned
3 heaped tablespoons fruit salad, fresh or tinned in juice
1 heaped tablespoon dried fruit such as raisins, sultanas, currants, apricots or dates
10-12 grapes
Dessert bowl of salad
150ml fruit juice
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References
1. Boffetta P, Couto E, Wichmann J et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2010; 102: 529-537.
2. World Cancer Research Fund/American Institute for Cancer research. Food Nutrition and the prevention of cancer: A Global Perspective. Washington DC. AICR; 1997.
3. Block G, Patterson B, Subar A. Fruit , vegetables and cancer prevention: a review of the epidemiological evidence. Nutr Cancer. 1992; 18(1): 1-29.
4. Hung HC, Joshipura KJ, Jiang F et al. Fruit and vegetable intake and risk of major chronic disease. J. Natl cancer Inst. 2004; 96(21):1577-1584.
5. Calle E et al. Overweight, obesity and mortality from cancer in a prospectively studied cohort of U.S adults. NEJM 348 (17):1625-38
6. www.eatwell.gov.uk/healthydiet. Accessed May 2010.