Thông tin tài liệu
Food, Nutrition,
Physical Activity,
and the Prevention
of Cancer:
a Global Perspective
World
Cancer
Research Fund
American
Institute for
Cancer Research
Food, Nutrition, Physical Activity, and the
Prevention of Cancer: a Global Perspective
World
Cancer
Research Fund
American
Institute for
Cancer Research
Food, Nutrition,
Physical Activity,
and the Prevention
of Cancer:
a Global Perspective
The most definitive review of the science to date,
and the most authoritative basis for action to
prevent cancer worldwide.
u Recommendations based on expert
judgements of systematic reviews of the
world literature.
u The result of a five-year examination by a
panel of the world’s leading scientists.
u Includes new findings on early life, body
fatness, physical activity, and cancer
survivors.
u Recommendations harmonised with
prevention of other diseases and promotion
of well-being.
u A vital guide for everybody, and the
indispensable text for policy-makers and
researchers.
SECOND EXPERT REPORT
Fonds Mondial
de Recherche
contre le Cancer
World Cancer
Research Fund
World Cancer
Research Fund
Hong Kong
World Cancer
Research Fund
International
Wereld Kanker
Onderzoek Fonds
American Institute
for Cancer Research
www.wcrf.org www.aicr.org www.wcrf-uk.org www.wcrf-nl.org www.wcrf-hk.org www.fmrc.fr
ER HARD FINAL.indd 1 30/10/07 10:07:25
a Global Perspective
FFoooodd,, NNuuttrriittiioonn,,
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Please cite the Report as follows:
World Cancer Research Fund / American Institute for Cancer Research.
Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.
Washington DC: AICR, 2007
First published 2007 by the American Institute for Cancer Research
1759 R St. NW, Washington, DC 20009
© 2007 World Cancer Research Fund International
All rights reserved
Readers may make use of the text and graphic material in this Report
for teaching and personal purposes, provided they give credit to
World Cancer Research Fund and American Institute for Cancer Research.
ISBN: 978-0-9722522-2-5
CIP data in process
Printed in the United States of America by RR Donnelley
a Global Perspective
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A project of
World Cancer Research Fund
International
iv
I am very grateful to the special group of distinguished scientists who made up the Panel
and Secretariat for this major review of the evidence on food, nutrition, physical activity
and cancer. The vision of WCRF International in convening this Panel and confidence in
letting a strong-willed group of scientists have their way is to be highly commended.
In our view, the evidence reviewed here that led to our recommendations provides a
wonderful opportunity to prevent cancer and improve global health. Individuals and
populations have in their hands the means to lead fuller, healthier lives. Achieving that
will take action, globally, nationally, and locally, by communities, families, and
individuals.
It is worth pausing to put this Report in context. Public perception is often that experts
disagree. Why should the public or policy-makers heed advice if experts differ in their
views? Experts do disagree. That is the nature of science and a source of its strength.
Should we throw up our hands and say one opinion is as good as another? Of course not.
Evidence matters. But not evidence unguided by human thought. Hence the process that
was set up for this review: use a systematic approach to examine all the relevant evidence
using predetermined criteria, and assemble an international group of experts who, having
brought their own knowledge to bear and having debated their disagreements, arrive at
judgements as to what this evidence means. Both parts of the exercise were crucial: the
systematic review and, dare I say it, the wisdom of the experts.
The elegance of the process was one of the many attractions to me of assuming the role
of chair of the Panel. I could pretend that it was the major reason, and in a way it was, but
the first reason was enjoyment. What a pleasure and a privilege to spend three years in
the company of a remarkable group of scientists, including world leaders in research on
the epidemiology of cancer, as well as leaders in nutrition and public health and the
biology of cancer, to use a relatively new methodology (systematic literature reviews),
supported by a vigorous and highly effective Secretariat, on an issue of profound
importance to global public health: the prevention of cancer by means of healthy patterns
of eating and physical activity. It was quite as enjoyable as anticipated.
Given this heady mix, the reasons why I might have wanted to take on the role of Panel
chair were obvious. I did question the wisdom of WCRF International in inviting me to do
it. Much of my research has been on cardiovascular disease, not cancer. What I described
as my ignorance, WCRF International kindly labelled impartiality.
WCRF also appreciated the parallels between dietary causes of cardiovascular disease
and cancer. There is a great deal of concordance. In general, recommendations in this
Report to prevent cancer will also be of great relevance to cardiovascular disease. The only
significant contradiction is with alcohol. From the point of view of cancer prevention, the
best level of alcohol consumption is zero. This is not the case for cardiovascular disease,
where the evidence suggests that one to two drinks a day are protective. The Panel
therefore framed its recommendation to take this into account.
The fact that the conclusions and recommendations in this Report are the unanimous
view of the Panel does not imply that, miraculously, experts have stopped disagreeing. The
Panel debated the fine detail of every aspect of its conclusions and recommendations with
remarkable vigour and astonishing stamina. In my view, this was deliberation at its best. If
conclusions could simply fall out of systematic literature reviews, we would not have
needed experts to deliberate. Human judgement was vital; and if human, it cannot be
infallible. But I venture to suggest this process has led to as good an example of evidence-
based public health recommendations as one can find.
Throughout the Panel’s deliberations, it had in mind the global reach of this Report.
Most of the research on diet and cancer comes from high-income countries. But
PPrreeffaaccee
v
noncommunicable diseases, including cancer, are now major public health burdens in
every region of the world. An important part of our deliberations was to ensure the
global applicability of our recommendations.
One last point about disagreement among experts: its relevance to the link between
science and policy. A caricature would be to describe science as precise and policy-makers
as indecisive. In a way, the opposite is the case. Science can say: could be, might be,
some of us think this, and some think that. Policy-makers have either to do it or not
do it — more often, not. Our effort here was to increase the precision of scientific
judgements. As the Report makes clear, many of our conclusions are in the ‘could be’
category. None of our recommendations is based on these ‘could be’ conclusions. All are
based on judgements that evidence was definite or probable. Our recommendations, we
trust, will serve as guides to the population, to scientists, and to opinion-formers.
But what should policy-makers do with our judgements? A year after publication of
this Report, we will publish a second report on policy for diet, nutrition, physical activity,
and the prevention of cancer. As an exercise developing out of this one, we decided to
apply, as far as possible, the same principles of synthesis of evidence to policy-making.
We enhanced the scientific panel that was responsible for this Report with experts in
nutrition and food policy. This policy panel will oversee systematic literature reviews on
food policy, deliberate, and make recommendations.
The current Report and next year’s Policy Report have one overriding aim: to reduce
the global burden of cancer by means of healthier living.
Michael Marmot
vi
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■■ PPAARRTT OONNEE BBAACCKKGGRROOUUNNDD 11
CChhaapptteer
r 11 IInntteerrnnaattiioonnaall vvaarriiaattiioonnss aanndd ttrreennddss 44
1.1 Food systems and diets throughout history 5
1.2 Foods and drinks, physical activity,
body composition 11
1.3 Migrant and other ecological studies 22
1.4 Conclusions 25
CChhaapptteerr 22 TThhee ccaanncceerr pprroocceessss 3300
2.1 Basic concepts and principles 31
2.2 Cellular processes 32
2.3 Carcinogen metabolism 36
2.4 Causes of cancer 37
2.5 Nutrition and cancer 41
2.6 Conclusions 46
CChhaapptteerr 33 JJuuddggiinngg tthhee eevviid
deennccee 4488
3.1 Epidemiological evidence 49
3.2 Experimental evidence 52
3.3 Methods of assessment 55
3.4 Causation and risk 57
3.5 Coming to judgement 58
3.6 Conclusions 62
■■ PPAARRTT TTWWOO EEVVIIDDEENNCCEE AANNDD JJUUDDGGEEMMEENNTTSS 6633
CChhaapptteerr 44 FFooooddss aanndd ddrriinnkkss 6666
4.1 Cereals (grains), roots, tubers and plantains 67
4.2 Vegetables, fruits, pulses (legumes), nuts,
seeds, herbs, spices 75
4.3 Meat, poultry, fish and eggs 116
4.4 Milk, dairy products 129
4.5 Fats and oils 135
4.6 Sugars and salt 141
4.7 Water, fruit juices, soft drinks and hot drinks 148
4.8 Alcoholic drinks 157
4.9 Food production, processing, preservation
and preparation 172
4.10 Dietary constituents and supplements 179
4.11 Dietary patterns 190
CChhaapptteerr 55 PPhhyyssiiccaall a
accttiivviittyy 119988
CChhaapptteerr 66 GGrroowwtthh,, ddeevveellooppmmeenntt,, bbooddyy
ccoommppoossiittiioonn 221100
6.1 Body fatness 211
6.2 Growth and development 229
6.3 Lactation 239
CChhaapptteerr 77 CCaanncceerrss 224444
7.1 Mouth, pharynx and larynx 245
7.2 Nasopharynx 250
7.3 Oesophagus 253
7.4 Lung 259
7.5 Stomach 265
7.6 Pancreas 271
7.7 Gallbladder 275
7.8 Liver 277
7.9 Colon and rectum 280
7.10 Breast 289
7.11 Ovary 296
7.12 Endometrium 299
7.13 Cervix 302
7.14 Prostate 305
7.15 Kidney 310
7.16 Bladder 312
7.17 Skin 315
7.18 Other cancers 318
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oovveerrwweeiigghhtt,, oobbeessiittyy 332222
CChhaapptteerr 99 CCaanncceerr ssuurrvviivvoorrss 334422
CChhaapptteerr 1100 FFiinnddiinnggs
s ooff ootthheerr rreeppoorrtt ss 334488
10.1 Method 349
10.2 Interpretation of the data 350
10.3 Nutritional deficiencies 350
10.4 Infectious diseases 351
10.5 Chronic diseases other than cancer 352
10.6 Cancer 355
10.7 Conclusions 358
CChhaapptteerr 1111 RReesseeaarrcchh iissssuueess 336600
■■ PPAARRTT TTHHRREEEE RREECCOOMMMMEENNDDAATTIIOONNSS 336655
CChhaapptteerr 1122 PPuubbl
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ppeerrssoonnaall rreeccoommmmeennddaattiioonnss 336688
12.1 Principles 369
12.2 Goals and recommendations 373
12.3 Patterns of food, nutrition and
physical activity 391
AAPPPPEENNDDIICCEESS 339955
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GGlloossssaarryy 440022
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CCHHAAPPTTEERR BBOOXXEESS
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CChhaapptteerr 11 IInntteerrnnaattiioonnaall vvaarriiaattiioonnss aanndd ttrreennddss
Box Egypt 6
Box South Africa 8
Box China 10
Box 1.1 Measurement of food supply
and consumption 13
Box India 14
Box Japan 16
Box UK 18
Box 1.2 Measurement of cancer incidence
and mortality 18
Box Poland 20
Box Spain 22
Box USA 24
Box Mexico 26
Box Australia 27
Box Brazil 28
CChhaapptteerr 22 TTh
hee ccaanncceerr pprroocceessss
Box 2.1 Nutrition over the life course 34
Box 2.2 Oncogenes and tumour suppressor genes 35
Box 2.3 Mechanisms for DNA repair 37
Box 2.4 Body fatness and attained height 39
Box 2.5 Energy restriction 46
CChhaapptteerr 33 JJuuddggiinngg tthhee eevviiddeennccee
Box 3.1 Issues concerning interpretation of
the evidence 50
Box 3.2 Dose-response 52
Box 3.3 Forest plots 53
Box 3.4 Systematic literature reviews 54
Box 3.5 Experimental findings 55
Box 3.6 Effect modification 56
Box 3.7 Energy adjustment 57
Box 3.8 Criteria for grading evidence 60
■■ PPAARRTT TTWWOO EEVVIIDDEENNCCEE AANNDD JJUUDDGGEEMMEENNTTSS
CChhaapptteerr 44 FFo
oooddss aanndd ddrriinnkkss
Box 4.1.1 Wholegrain and refined cereals and
their products 69
Box 4.1.2 Foods containing dietary fibre 69
Box 4.1.3 Glycaemic index and load 69
Box 4.1.4 Aflatoxins 70
Box 4.2.1 Micronutrients and other bioactive
compounds and cancer risk 78
Box 4.2.2 Phytochemicals 79
Box 4.2.3 Preparation of vegetables and nutrient
bioavailability 79
Box 4.2.4 Foods containing dietary fibre 80
Box 4.3.1 Processed meat 117
Box 4.3.2 Nitrates, nitrites and N-nitroso
compounds 118
Box 4.3.3 Foods containing iron 118
Box 4.3.4 Heterocyclic amines and polycyclic
aromatic hydrocarbons 119
Box 4.3.5 Cantonese-style salted fish 120
Box 4.4.1 Foods containing calcium 131
Box 4.5.1 Hydrogenation and trans-fatty acids 137
Box 4.6.1 Sugar, sugars, sugary foods and drinks 142
Box 4.6.2 Salt and salty, salted and salt-preserved
foods 143
Box 4.6.3 Chemical sweeteners 143
Box 4.6.4 Refrigeration 144
Box 4.7.1 High temperature, and irritant drinks
and foods 150
Box 4.7.2 Contamination of water, and of foods
and other drinks 150
Box 4.8.1 Types of alcoholic drink 159
Box 4.9.1 Food systems 173
Box 4.9.2 ‘Organic’ farming 174
Box 4.9.3 Regulation of additives and
contaminants 175
Box 4.9.4 Water fluoridation 176
Box 4.10.1 Food fortification 182
Box 4.10.2 Functional foods 182
Box 4.10.3 Levels of supplementation 183
CChhaapptteerr 55 PPhhyyssiiccaall aaccttiivviittyy
Box 5.1 Energy cost and intensity of activity 200
Box 5.2 Sedentary ways of life 201
CChhaapptteerr 66 GGrroowwtthh,, ddeevveellooppmmeenntt,, bbood
dyy ccoommppoossiittiioonn
Box 6.2.1 Sexual maturity 232
Box 6.2.2 Age at menarche and risk of
breast cancer 232
CChhaapptteerr 77 CCaanncceerrss
Box 7.1.1 Cancer incidence and survival 246
Box 7.2.1 Epstein-Barr virus 251
Box 7.5.1 Helicobacter pylori 266
Box 7.8.1 Hepatitis viruses 278
Box 7.13.1 Human papilloma viruses 303
CChhaapptteerr 88 DDeetteerrmmiinnaannttss ooff wweeiigghhtt ggaaiinn,,
oovveerrwweeiigghhtt,, oobbeessiittyy
Box 8.1 Energy density 324
Box 8.2 Fast food 325
Box 8.3 Body fatness in childhood 326
Box 8.4 Television viewing 331
CC
hhaapptteerr 99 CCaanncceerr ssuurrvviivvoorrss
Box 9.1 Conventional and unconventional
therapies 345
Box 9.2 Use of supplements by cancer survivors 346
CChhaapptteerr 1100 FFiinnddiinnggss ooff ootthheerr rreeppoorrtt ss
CChhaapptteerr 1111 RReesseeaarrcchh iissssuueess
■■ PPAARRTT TTHHR
REEEE RREECCOOMMMMEENNDDAATTIIOONNSS
CChhaapptteerr 1122 PPuubblliicc hheeaalltthh ggooaallss aanndd ppeerrssoonnaall
rreeccoommmmeennddaattiioonnss
Box 12.1 Quantification 371
Box 12.2 Making gradual changes 372
Box 12.3 Height, weight and ranges of BMI 375
Box 12.4 When supplements are advisable 387
Box 12.5 Regional and special circumstances 392
viii
FOOD, NUTRITION, PHYSICAL ACTIVITY, AND THE PREVENTION OF CANCER: A GLOBAL PERSPECTIVE
Panel
Sir Michael Marmot
MB BS MPH PhD FRCP FFPH
Chair
University College London
UK
Tola Atinmo PhD
University of Ibadan, Nigeria
Tim Byers MD MPH
University of Colorado Health
Sciences Center
Denver, CO, USA
Junshi Chen MD
Chinese Centre for Disease
Control and Prevention
Beijing, People’s Republic of
China
Tomio Hirohata MD
DrScHyg PhD
Kyushu University
Fukuoka City, Japan
Alan Jackson CBE MD FRCP
FRCPCH FRCPath
University of Southampton
UK
W Philip T James CBE MD
DSc FRSE FRCP
International Obesity Task
Force
London, UK
Laurence N Kolonel MD PhD
University of Hawai’i
Honolulu, HI, USA
Shiriki Kumanyika PhD MPH
University of Pennsylvania
Philadelphia, PA, USA
Claus Leitzmann PhD
Justus Liebig University
Giessen, Germany
Jim Mann DM PhD FFPH
FRACP
University of Otago
Dunedin, New Zealand
Hilary J Powers PhD RNutr
University of Sheffield, UK
K Srinath Reddy MD DM MSc
Institute of Medical Sciences
New Delhi, India
Elio Riboli MD ScM MPH
Was at: International Agency
for Research on Cancer
(IARC), Lyon, France
Now at: Imperial College
London, UK
Juan A Rivera PhD
Instituto Nacional de Salud
Publica
Cuernavaca, Mexico
Arthur Schatzkin MD DrPH
National Cancer Institute
Rockville, MD, USA
Jacob C Seidell PhD
Free University Amsterdam
The Netherlands
David E G Shuker PhD FRSC
The Open University
Milton Keynes, UK
Ricardo Uauy MD PhD
Instituto de Nutricion y
Tecnologia de los Alimentos
Santiago, Chile
Walter C Willett MD DrPH
Harvard School of Public
Health
Boston, MA, USA
Steven H Zeisel MD PhD
University of North Carolina
Chapel Hill, NC, USA
Robert Beaglehole ONZM
FRSNZ DSc
Chair 2003
Was at: World Health
Organization (WHO)
Geneva, Switzerland
Now at: University of
Auckland, New Zealand
Panel observers
Food and Agriculture
Organization of the United
Nations (FAO)
Rome, Italy
Guy Nantel PhD
Prakash Shetty MD PhD
International Food Policy
Research Institute (IFPRI)
Washington DC, USA
Lawrence Haddad PhD
Marie Ruel PhD
International Union of
Nutritional Sciences (IUNS)
Mark Wahlqvist MD AO
Mechanisms Working Group
John Milner PhD
Methodology Task Force
Jos Kleijnen MD PhD
Gillian Reeves PhD
Union Internationale Contre
le Cancer (UICC)
Geneva, Switzerland
Annie Anderson PhD
Curtis Mettlin PhD
Harald zur Hausen MD DSc
United Nations Children’s
Fund (UNICEF)
New York, NY, USA
Ian Darnton-Hill MD MPH
Rainer Gross Dr Agr
World Health Organization
(WHO)
Geneva, Switzerland
Denise Coitinho PhD
Ruth Bonita MD
Chizuru Nishida PhD MA
Pirjo Pietinen DSc
Additional
members for policy
panel
Barry Popkin PhD MSc BSc
Carolina Population Center,
University of North Carolina,
Chapel Hill, NC, USA
Jane Wardle PhD MPhil
University College London, UK
Nick Cavill MPH
British Heart Foundation
Health Promotion
Research Group
University of Oxford, UK
AAcckknnoowwlleeddggeemmeennttss
ix
ACKNOWLEDGEMENTS
Systematic
Literature Review
Centres
UUnniivveerrssiittyy ooff BBrriissttooll,, UUKK
George Davey Smith
FMedSci FRCP DSc
University of Bristol , UK
Jonathan Sterne PhD MSc
MA
University of Bristol, UK
Chris Bain MB BS MS MPH
University of Queensland
Brisbane, Australia
Nahida Banu MB BS
University of Bristol, UK
Trudy Bekkering PhD
University of Bristol, UK
Rebecca Beynon MA BSc
University of Bristol, UK
Margaret Burke MSc
University of Bristol, UK
David de Berker MB BS MRCP
United Bristol Healthcare
Trust, UK
Anna A Davies MSc BSc
University of Bristol, UK
Roger Harbord MSc
University of Bristol, UK
Ross Harris MSc
University of Bristol, UK
Lee Hooper PhD SRD
University of East Anglia
Norwich, UK
Anne-Marie Mayer PhD MSc
University of Bristol, UK
Andy Ness PhD FFPHM MRCP
University of Bristol, UK
Rajendra Persad ChM FEBU
FRCS
United Bristol Healthcare
Trust & Bristol Urological
Institute, UK
Massimo Pignatelli MD PhD
FRCPath
University of Bristol, UK
Jelena Savovic PhD
University of Bristol, UK
Steve Thomas MB BS PhD
FRCS
University of Bristol, UK
Tim Whittlestone MA MD
FRCS
United Bristol Healthcare
Trust, UK
Luisa Zuccolo MSc
University of Bristol, UK
IIssttiittuuttoo NNaazziioonnaallee
TTuummoorrii MMiillaann,
, IIttaallyy
Franco Berrino MD
Istituto Nazionale Tumori
Milan, Italy
Patrizia Pasanisi MD MSc
Istituto Nazionale Tumori
Milan, Italy
Claudia Agnoli ScD
Istituto Nazionale Tumori
Milan, Italy
Silvana Canevari ScD
Istituto Nazionale Tumori
Milan, Italy
Giovanni Casazza ScD
Istituto Nazionale Tumori
Milan, Italy
Elisabetta Fusconi ScD
Istituto Nazionale Tumori
Milan, Italy
Carlos A Gonzalez PhD MPH
MD
Catalan Institute of Oncology
Barcelona, Spain
Vittorio Krogh MD MSc
Istituto Nazionale Tumori
Milan, Italy
Sylvie Menard ScD
Istituto Nazionale Tumori
Milan, Italy
Eugenio Mugno ScD
Istituto Nazionale Tumori
Milan, Italy
Valeria Pala ScD
Istituto Nazionale Tumori
Milan, Italy
Sabina Sieri ScD
Istituto Nazionale Tumori
Milan, Italy
JJoohhnnss HHooppkkiinnss
UUnniivveerrssiittyy,, BBaallttiimmoorree,,
MMDD,, UUSSAA
Anthony J Alberg PhD MPH
University of South Carolina
Columbia, SC, USA
Kristina Boyd MS
Johns Hopkins University
Baltimore, MD, USA
Laura Caulfield PhD
Johns Hopkins University
Baltimore, MD, USA
Eliseo Guallar MD DrPH
Johns Hopkins University
Baltimore, MD, USA
James Herman MD
Johns Hopkins University
Baltimore, MD, USA
Genevieve Matanoski MD
DrPH
Johns Hopkins University
Baltimore, MD, USA
Karen Robinson MSc
Johns Hopkins University
Baltimore, MD, USA
Xuguang (Grant) Tao MD
PhD
Johns Hopkins University
Baltimore, MD, USA
UUnniiv
veerrssiittyy ooff LLeeeeddss,, UUKK
David Forman PhD FFPH
University of Leeds, UK
Victoria J Burley PhD MSc
RPHNutr
University of Leeds, UK
Janet E Cade PhD BSc
RPHNutr
University of Leeds, UK
Darren C Greenwood MSc
University of Leeds, UK
Doris S M Chan MSc
University of Leeds, UK
Jennifer A Moreton PhD MSc
University of Leeds, UK
James D Thomas
University of Leeds, UK
Yu-Kang Tu PhD MSc DDS
University of Leeds, UK
Iris Gordon MSc
University of Leeds, UK
Kenneth E L McColl FRSE
FMedSci FRCP
Western Infirmary
Glasgow, UK
Lisa Dyson MSc
University of Leeds, UK
[...]... such as cassava (manioc), yams, potatoes, and also plantains Pulses (legumes) are also farmed to ensure agricultural and nutritional balance; and other crops such as vegetables and fruits are also cultivated Birds and animals are domesticated and bred for food, and fish and seafood contribute to the diets of communities living beside water.57 As with gatherer–hunters, the diets of peasant–agricultural... within Africa, Asia, and Latin America have generally experienced comparatively high rates of cancers of the upper 4 aerodigestive tract (of the mouth, pharynx, larynx, nasopharynx, and oesophagus), and of the stomach, liver (primary), and cervix Rates of some cancers, especially stomach cancer, are now generally decreasing In contrast, high-income countries, and urbanised and industrialised areas of middle-... shifts in patterns of diet and physical activity.53 These points generally also apply to pastoralist societies 1.1.2 Peasant–agricultural In recent millennia, and until very recently in history, almost all human populations have been rural and mostly peasant–agricultural, and the majority still are in most regions of Asia, many regions of Africa, and some parts of Latin America Peasant–agricultural food... and South Africa (Africa); China, India, and Japan (Asia); the UK, Poland, and Spain (Europe); the USA, Brazil, and Mexico (the Americas); and Australia (AsiaPacific).1-47 A N D T R E N D S 1.1 Food systems and diets: historical and current Throughout history, food systems, and thus human diets, have been and are shaped by climate, terrain, seasons, location, culture, and technology They can be grouped... clearing of land to rear cattle and sheep, and the development of railways, refrigeration, and other technologies, have made meat, milk, and their products cheap and plentiful all year round Sugar derived from cane is the most profitable edible cash crop, and sugars and syrups made from cane, beet, and now also corn are used to sweeten and preserve breakfast foods, baked foods, desserts, soft drinks, and a. .. sedentary ways of life are a cause of these cancers and of weight gain, overweight, and obesity Weight gain, overweight, and obesity are also causes of some cancers independently of the level of physical activity Further details of evidence and judgements can be found in Chapters 5, 6, and 8 The evidence summarised in Chapter 10 also shows that physical activity protects against other diseases and that... the incidence of cancer P a r t 1 — B a c k g ro u n d Chapter 1 shows that patterns of production and consumption of food and drink, of physical activity, and of body composition have changed greatly throughout human history Remarkable changes have taken place as a result of urbanisation and industrialisation, at first in Europe, North America, and other economically advanced countries, and increasingly... that patterns of production and consumption of food and drink, of physical activity, and of body composition have changed greatly throughout different periods of human history Remarkable changes have taken place as a result of urbanisation and industrialisation, at first in Europe, North America, and other economically advanced countries, and increasingly in most countries in the world With the establishment... the locally recommended four portions of fruits and vegetables each day, while a quarter eats none.10 from rural to urban areas, there have been rapid and profound changes in both the nature and quality of their foods and drinks, and the patterns of diseases they suffer.71 Urban–industrial food systems have evidently improved people’s strength and health in early life They are also a factor in the doubling... composition and stature, their life expectancy, and patterns of disease, including cancer With the move to urban–industrial ways of life, populations have become taller and heavier, their life expectancy has increased, and they are usually adequately nourished (although poverty, and even destitution, remains a major problem in most big cities) On the other hand, urban populations are at increased risk of chronic . nutritional and other
biological and associated factors that modify the risk of can-
cer. The Panel is aware that as with other diseases, the risk
of cancer. elegance of the process was one of the many attractions to me of assuming the role
of chair of the Panel. I could pretend that it was the major reason, and
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