Trolley Trends: Shifting the nation towards healthier shopping

On behalf of Cancer Research UK, British Heart Foundation and Diabetes UK, March 2023

It is widely accepted that within the UK the consumption of saturated fat, sugar, salt and
calories is too high. Diets which are high in fat, salt, and/or sugar (HFSS) and/or calories
increase the risk of obesity and overweight as well as other risk factors for a range of
health conditions, including heart and circulatory diseases, type 2 diabetes and some
cancers.
Cancer Research UK, British Heart Foundation and Diabetes UK partnered with the major
UK retailer Tesco in 2018, with the aim of ‘Helping you to live healthier’. The four-way UK
health partnership aims to inspire, empower and support Tesco colleagues, customers,
and their families to shift towards a healthier diet to reduce the risk of cancer, heart and
circulatory diseases, and type 2 diabetes.
In March 2022, the three charities independently commissioned YouGov to conduct
research to explore attitudes and behaviours around healthy eating and food shopping. As
part of the health partnership, Tesco provided a sample of anonymised customer Clubcard
data which also allowed YouGov to explore actual purchasing behaviours.
This research delivered insights that underpinned a policy discussion authored by the
three charities, with recommendations for how supermarkets and government can
positively impact the supermarket environment to make a healthy diet more available,
affordable, appealing and accessible to all.

Read the Report – Trolley Trends: Shifting the nation towards healthier shopping

Prehabilitation for people with cancer

Prehabilitation for people with cancer: principles and guidance for prehabilitation within the management and support of people with cancer | The Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration

This document calls for changes to the delivery of cancer care across the UK, with a greater focus on prehabilitation including nutrition, physical activity and psychological support.

What is prehabilitation?

Prehabilitation supports people living with cancer to prepare for treatment. It promotes healthy behaviours and prescribes exercise, nutrition and psychological interventions based on a person’s needs, to help them find their best way through.

When should it be implemented?

Prehabilitation should be implemented in the early stages of the patient pathway, ideally soon after diagnosis and well in advance of treatment for maximum benefit. It should be seen as part of the rehabilitation pathway, as a way to optimise a person’s health and wellbeing, maximising their resilience to treatment throughout the cancer journey.

What are the benefits?

Prehabilitation offers patients and care givers three main benefits:

• Personal empowerment: A sense of control and purpose, which prepares people for treatment and improves their quality of life
• Physical and psychological resilience: An opportunity to improve physiological function and psychological wellbeing, which offers resilience to the effects of cancer treatment, enhances the quality of recovery and helps people to live life as fully as they can
• Long-term health: An opportunity to reflect on the role of healthy lifestyle practices after a cancer diagnosis, to promote positive health behaviour change.

Further detail at Macmillan Cancer Support

Full document: Prehabilitation for people with cancer: principles and guidance for prehabilitation within the management and support of people with cancer

Diet and colorectal cancer in UK Biobank: a prospective study

Bradbury, K.E.,  Murphy, N., Key, T. | 2019| Diet and colorectal cancer in UK Biobank: a prospective study|  International Journal of Epidemiology| dyz064| https://doi.org/10.1093/ije/dyz064

A research team behind a study into diet and the impact of diet on colorectal cancer used data from the UK Biobank research project in conjunction with  questionnaires to learn about the dietary habits of men and women aged between 40- 69 years and their potential risk of developing colorectal cancer. 

At follow up five years later the participants who had consumed (on average) 76g of red meat, compared to 21g, had a higher risk of developing cancer than other participants.

Participants who ate red meat on four or more occasions a week had a fifth increased risk of developing colorectal cancer compared with subjects who ate red meat twice weekly. 

Subjects who consumed the most wholegrains had a 14% lower risk of developing  colorectal cancer.

 

Key Messages

• Previous studies have found an increased risk of colorectal cancer in those with high intakes of red and processed meat. Most previous studies collected information on dietary intakes during the 1990s or earlier and patterns in meat consumption have since changed.
• In addition, few studies have used re-measured intakes to reduce the impact of measurement error, and to quantify the amount of red and processed meat that is associated with an increased risk. Measurement error generally biases the associations towards the null value; the associations observed in previous studies that did not re-measure intakes may be underestimated.
• Our study found that people who were consuming red and processed meat four or more times per week, had a 20% increased risk of colorectal cancer compared with those who were consuming red and processed meat less than twice a week.

Abstract

Background

Most of the previous studies on diet and colorectal cancer were based on diets consumed during the 1990s.

Methods

We used Cox-regression models to estimate adjusted hazard ratios for colorectal cancer by dietary factors in the UK Biobank study. Men and women aged 40–69 years at recruitment (2006–10) reported their diet on a short food-frequency questionnaire (n = 475 581). Dietary intakes were re-measured in a large sub-sample (n = 175 402) who completed an online 24-hour dietary assessment during follow-up. Trends in risk across the baseline categories were calculated by assigning re-measured intakes to allow for measurement error and changes in intake over time.

Results

During an average of 5.7 years of follow-up, 2609 cases of colorectal cancer occurred. Participants who reported consuming an average of 76 g/day of red and processed meat compared with 21 g/day had a 20% higher risk of colorectal cancer. Participants in the highest fifth of intake of fibre from bread and breakfast cereals had a 14% lower risk of colorectal cancer. Alcohol was associated with an 8% higher risk per 10 g/day higher intake. Fish, poultry, cheese, fruit, vegetables, tea and coffee were not associated with colorectal-cancer risk.

Conclusions

Consumption of red and processed meat at an average level of 76 g/d that meets the current UK government recommendation (less than or equal to 90 g/day) was associated with an increased risk of colorectal cancer. Alcohol was also associated with an increased risk of colorectal cancer, whereas fibre from bread and breakfast cereals was associated with a reduced risk.

 

The article is available to read in full in the International Journal of Epidemiology 

In the news:

The Independent Even government guideline amounts of red meat and bacon increase risk of bowel cancer, study finds 

The Guardian Even moderate intake of red meat raises cancer risk, study finds

BBC News A rasher of bacon a day ‘ups cancer risk’ 

How diet, nutrition and physical activity affect cancer risk

The World Cancer Research Fund have published an interactive infographic summarising risk factors for certain cancers.

The full report summarises the wealth of evidence on how diet, nutrition and physical activity can influence the biological processes that underpin the development and progression of cancer.

The report contains the following 10 exposure sections, covering definitions and background information, issues relating to interpretation of the evidence, the evidence itself ( and judgements on the evidence.

• Wholegrains, vegetables and fruit
• Meat, fish and dairy products
• Preservation and processing of foods
• Non-alcoholic drinks
• Alcoholic drinks
• Other dietary exposures
• Physical activity
• Body fatness and weight gain
• Height and birthweight
• Lactation

View the Interactive Cancer Risk Matrix

Full report: Diet, Nutrition, Physical Activity and Cancer: a Global Perspective

Consumption of ultra-processed foods linked to higher cancer risk

A new study published in the BMJ, has reported an association between comsuming a diet high in utlra-processed foods and a higher overall cancer risk.  The ultra- processed foods, sugary breakfast cereals, pizza, cakes and pre-sliced bread, may increase the risk of cancer.  The results demonstrated that if consumption of ultra-processed foods increased by 10%, was associated with a greater than 10% risk in overall and breast cancer.
During the study:

• On average, 18% of people’s diet was ultra-processed
• On average, there were 79 cancers per 10,000 people each year
• Upping the proportion of processed food by 10% would lead to nine extra cancers per 10,000 people per year

The researchers concluded: “These results suggest that the rapidly increasing consumption of ultra-processed foods may drive an increasing burden of cancer in the next decades.”

You can listen to the podcast below

The full article is also available to read at the BMJ

Abstract

Objective To assess the prospective associations between consumption of ultra-processed food and risk of cancer.

Design Population based cohort study.

 

Setting and participants
104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort. Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification.

Main outcome measures Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors.

 

Results Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis).

 

Conclusions In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations.

Full reference: BMJ 2018; k322
The following news stories may also be of interest:

The Independent Processed food, sugary cereals and sliced bread may contribute to cancer risk, study claims

BBC News Ultra-processed foods ‘linked to cancer’ 

Eating plenty of wholegrains cuts your risk of bowel cancer, according to a new report.

Wholegrains and bowel cancer – what you need to know | CRUK

Eating plenty of wholegrains cuts your risk of bowel cancer, according to a new report. And it seems we can reap the benefits without making wild changes to our diets .

The news comes from a report produced by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR), outlining the latest evidence on how we can reduce our risk of bowel cancer.

It focusses on the effects of diet, weight, physical activity and alcohol on bowel cancer risk. And with bowel cancer being the fourth most common cancer in the UK, finding ways to reduce our risk of the disease are important.

The WCRF studies all the evidence on a potential cause of cancer and decides whether that evidence is strong enough to support recommendations on ways we can reduce our risk.

• Overview via Cancer Research UK
• Original research report

Drinking coffee may help prevent liver cancer, study suggests

People who drink more coffee are less likely to develop liver cancer, an analysis of data from 26 studies has found | Story via The Guardian | BMJ

Researchers have found that people who drink more coffee are less likely to develop hepatocellular cancer (HCC), the most common form of primary liver cancer – and the effect was also found in decaffeinated coffee.

Experts from the University of Southampton and the University of Edinburgh examined data from 26 studies involving more than 2.25 million participants.  Compared with people who drank no coffee, those who drank one cup a day had a 20% lower risk of developing HCC, according to the study, published in the journal BMJ Open.

Those who consumed two cups a day had a 35% reduced risk and for those who drank five cups, the risk was halved. They found the protective effect for decaf was “smaller and less certain than for caffeinated coffee”

Full story via The Guardian

Full reference: Kennedy OJ, Roderick P, Buchanan R, et al. Coffee, including caffeinated and decaffeinated coffee, and the risk of hepatocellular carcinoma: a systematic review and dose–response meta-analysis. BMJ Open 2017;7:e013739.

Chance of colon cancer recurrence nearly cut in half in people who eat nuts

Something as simple as eating tree nuts may make a difference in the long-term survival of patients with colon cancer, a new study concludes.American Society of Clinical Oncology (ASCO) | ScienceDaily | 18th May 2017

An observational study of 826 patients with stage III colon cancer showed that those who consumed two ounces or more of nuts per week had a 42% lower chance of cancer recurrence and 57% lower chance of death than those who did not eat nuts.

A secondary analysis revealed the benefit of nut consumption was limited to tree nuts. Tree nuts include almonds, walnuts, hazelnuts, cashews, and pecans, among others. These findings will be presented at the upcoming 2017 ASCO Annual Meeting in Chicago.

Read more at ScienceDaily

Coffee consumption linked to reduced risk of liver cancer

Kennedy, O.J. et al. (2017) Coffee, including caffeinated and decaffeinated coffee, and the risk of hepatocellular carcinoma: a systematic review and dose–response meta-analysis. BMJ Open. 7:e013739

Objectives: To examine the association between coffee, including caffeinated and decaffeinated coffee, with hepatocellular carcinoma (HCC) and assess the influence of HCC aetiology and pre-existing liver disease.

Conclusions: Increased consumption of caffeinated coffee and, to a lesser extent, decaffeinated coffee are associated with reduced risk of HCC, including in pre-existing liver disease. These findings are important given the increasing incidence of HCC globally and its poor prognosis.

Read the full article here

Obesity linked to heightened risk of certain cancers

Obesity is strongly linked to the risk of developing certain major cancers, according to a re-analysis of research published in The BMJ | OnMedica | BMJ

Links between obesity and cancer risk are strongest for 11 cancers related to digestive organs and hormones, says the review. Obesity could also be linked to other cancers, but the quality of the evidence is not sufficiently strong to draw those conclusions yet.

Obesity prevalence has more than doubled over the past 40 years, and the evidence to date suggests that it is linked to a heightened risk of developing particular cancers, but methodological flaws in some published studies have weakened the strength of the associations found.

To better gauge the quality of the evidence and the strength of these associations, the researchers comprehensively reviewed published studies looking at obesity and cancer risk.

From among 204 reviews that analysed obesity measurements, such as body mass index (BMI), weight gain, and waist circumference, and the risk of 36 cancers, 95 included continuous measures of obesity.

Only 13% of the associations for nine cancers were based on strong evidence, meaning the results were statistically significant and excluded bias.

Strong associations were found in studies that looked at heightened risk of oesophageal, bone marrow, colon (in men), rectal (in men), biliary tract system, pancreatic, endometrial (in premenopausal women), and kidney cancers.

Read more via OnMedica

Link to the research: Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. BMJ 2017;356:j477. DOI: 10.1136/bmj.j477