Nutritional Factors during and after Cancer: Impacts on Survival and Quality of Life

The French National Cancer Institute conducted a collective expertise study with researchers and clinical experts from the French Network for Nutrition And Cancer Research (NACRe Network). The objective was to update the state of knowledge on the impacts of nutritional factors on clinical endpoints during or after cancer. Data from 150 meta-analyses, pooled analyses or intervention trials and 93 cohort studies were examined; they concerned 8 nutritional factors, 6 clinical events and 20 cancer locations. This report shows that some nutritional factors have impacts on mortality and on the risks of recurrence or second primary cancer in cancer patients. Therefore, high-risk nutritional conditions can be encountered for certain cancer sites: from the diagnosis and throughout the health care pathways, weight loss (lung and esophageal cancers), malnutrition (lung, esophageal, colorectal, pancreatic, gastric and liver cancers), weight gain (colorectal, breast and kidney cancers) and alcohol consumption (upper aerodigestive cancers) should be monitored; and after cancer treatments, excess weight should be detected (colorectal, breast and kidney cancers). These situations require nutritional assessments, and even support or management by health care professionals, in the context of tertiary prevention. This report also highlights some limitations regarding the existing literature and some needs for future research.

[Impact of nutritional factors during and after cancer]

Nutritional factors (diet, weight, alcohol, physical activity) are identified as factors having an impact on the onset of several cancer sites. Less abundant scientific data also underline their impact on the tumor progression. A review of the scientific literature was carried out by a group of experts established by the French National Cancer Institute (INCa) to better document the influence of nutritional factors during and after cancer on outcomes such as overall mortality, cancer specific mortality, recurrence, second primary cancers and quality of life. This analysis of the literature completes messages of reduction of alcohol consumption, prevention of undernutrition or excess weight and adherence to dietary recommendations, avoiding the use of dietary supplements, fasting or restrictive diets and strengthens messages promoting the practice of physical activity and the fight against sedentary lifestyle.

[During and after cancer: identification of high-risk nutritional situations]

"During and after cancer: identification of high-risk nutritional situations At the end of 2020, the French National Cancer Institute published a report presenting the state of knowledge on the impact of nutritional factors on clinical endpoints during or after cancer. This report is the result of a collective expertise by an expert group from the French Network for Nutrition And Cancer Research (NACRe Network, www.inrae.fr/nacre). This report shows that some nutritional factors have an impact on the mortality, and the risk of recurrence or second primary cancer in cancer patients. Therefore, high-risk nutritional situations can be encountered for certain cancer sites: from the diagnosis and throughout the healthcare circuit, weight loss (for lung and esophageal cancers), malnutrition (for lung, esophageal, colorectal, pancreatic, gastric and liver cancers), weight gain (for colorectal, breast and kidney cancers), or alcohol consumption (upper aerodigestive cancers) should be monitored; and after cancer treatments, excess weight should be detected (colorectal, breast and kidney cancers). These situations require nutritional assessments, or even support or management by healthcare professionals, in the context of tertiary prevention."

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents

Background: Differences in weight status by socioeconomic position occur during adolescence and is known as weight social gradient (WSG). The PRALIMAP (Promotion de l'ALIMentation et de l'Activité Physique) trial highlighted that a universal intervention was effective in reducing overweight and obesity prevalence among adolescents. However, its ability to reduce the WSG is unclear. This study aimed to evaluate the impact of the PRALIMAP intervention on the WSG among adolescents. Methods: Data were obtained from 3504 adolescents who participated in the school-based PRALIMAP trial between 2006 and 2009. The PRALIMAP study consisted of three interventional strategies: educational, environmental, screening and care. Weight status was assessed by body mass index (BMI) z-score and overweight and obesity prevalence. The "indice de position sociale des élèves" was used to measure adolescents' socioeconomic status. Linear regression and hierarchical models were used to assess the WSG and its evolution, respectively. Results: Among all adolescents (14-18 years old), significant WSG was identified at baseline: BMI z-score (β = -0.06; p < 0.0001), overweight and obesity prevalence (β = -2.86; p < 0.0001). Overall, the intervention conferred no significant reduction in the WSG: BMI z-score (β = -0.01 [-0.02 to 0.01], p = 0.48), overweight and obesity prevalence (β = -0.01 [-0.07 to 0.05], p = 0.73). Similar results were observed for adolescents whatever the interventional strategy they benefited from in the PRALIMAP trial. Conclusions: This study provided no evidence that the PRALIMAP universal intervention was effective in reducing the socioeconomic inequalities in weight status among adolescents. Different interventions that account for social differences should be considered to tackle these inequalities.

Alcohol and cancer: risk perception among the French population

Key messages

Population’s beliefs to deny the cancer risks due to alcohol use are common in France. It’s necessary to adress public information about the risks of alcohol.

[Benefits of physical activity for cancer patients]

The prescription of physical activity for patients living with a long-term condition has been enshrined in legislation since 2016. The French National Cancer Institute published a literature review on the expected effects of physical activity in patients living with cancer. The benefits are prevention or correction of physical deconditioning, a preservation and/or a normalization of body composition, a reduction of cancerrelated fatigue, an overall quality-of-life improvement, the improvement of treatments tolerance and their medium and long-term effects, an increased life expectancy and a lower risk of cancer recurrence. These effects can be observed for a mixed physical activity program -cardio respiratory fitness and muscular strength-, with moderate to vigorous intensity activity, 30 minutes a day at least 5 days a week. The benefits are all the more important as physical activity starts early. Health professionals have an important part to play in helping patients engage in physical activity, with a regular even moderate practice which is always beneficial as compared with sedentary behaviors.