2012 ACS 癌症预防的营养与运动指南

AmericanCancerSocietyGuidelinesonNutritionandPhysicalActivityforCancerPreventionReducingtheRiskofCancerWithHealthyFoodChoicesandPhysicalActivityLawrenceH.Kushi,ScD1;ColleenDoyle,MS,RD2;MarjiMcCullough,ScD,RD3;CherylL.Rock,PhD,RD4;WendyDemark-Wahnefried,PhD,RD5;ElisaV.Bandera,MD,PhD6;SusanGapstur,PhD,MPH7;AlpaV.Patel,PhD8;KimberlyAndrews9;TedGansler,MD,MBA,MPH10andTheAmericanCancerSociety2010NutritionandPhysicalActivityGuidelinesAdvisoryCommitteeAbstractTheAmericanCancerSociety(ACS)publishesNutritionandPhysicalActivityGuidelinestoserveasafoundationforitscommunication,policy,andcommunitystrategiesand,ultimately,toaffectdietaryandphysicalactivitypatternsamongAmericans.TheseGuidelines,publishedapproximatelyevery5years,aredevelopedbyanationalpanelofexpertsincancerresearch,prevention,epidemiology,publichealth,andpolicy,andtheyreflectthemostcurrentscientificevidencerelatedtodietaryandactivitypatternsandcancerrisk.TheACSGuidelinesfocusonrecommen-dationsforindividualchoicesregardingdietandphysicalactivitypatterns,butthosechoicesoccurwithinacommu-nitycontextthateitherfacilitatesorcreatesbarrierstohealthybehaviors.Therefore,thiscommitteepresentsrecommendationsforcommunityactiontoaccompanythe4recommendationsforindividualchoicestoreducecan-cerrisk.Theserecommendationsforcommunityactionrecognizethatasupportivesocialandphysicalenvironmentisindispensableifindividualsatalllevelsofsocietyaretohavegenuineopportunitiestochoosehealthybehaviors.TheACSGuidelinesareconsistentwithguidelinesfromtheAmericanHeartAssociationandtheAmericanDiabetesAssociationforthepreventionofcoronaryheartdiseaseanddiabetes,aswellasforgeneralhealthpromotion,asdefinedbythe2010DietaryGuidelinesforAmericansandthe2008PhysicalActivityGuidelinesforAmericans.CACancerJClin2012;62:30–67.VC2012AmericanCancerSociety.IntroductionTheImportanceofWeightControl,PhysicalActivity,andDietinCancerPreventionForthegreatmajorityofAmericanswhodonotusetobacco,themostimportantmodifiabledeterminantsofcan-cerriskareweightcontrol,dietarychoices,andlevelsofphysicalactivity.1,2One-thirdofthemorethan572,000cancerdeathsthatoccurintheUnitedStateseachyearcanbeattributedtodietandphysicalactivityhabits,includ-ingoverweightandobesity,whileanotherone-thirdiscausedbyexposuretotobaccoproducts.2Althoughgeneticsusceptibilityinfluencestheriskofcancer,mostofthevariationincancerriskacrosspopulationsandamongindividualsisduetofactorsthatarenotinherited.3,4Behaviorssuchasavoidingexposuretotobaccoproducts,1AssociateDirectorforEtiologyandPreventionResearch,DivisionofResearch,KaiserPermanente,Oakland,CA;2Director,NutritionandPhysicalActivity,CancerControlScience,AmericanCancerSociety,Atlanta,GA;3StrategicDirector,NutritionalEpidemiology,AmericanCancerSociety,Atlanta,GA;4Professor,DepartmentofFamilyandPreventiveMedicine,SchoolofMedicine,UniversityofCaliforniaatSanDiego,SanDiego,CA;5ProfessorandWebbEndowedChairofNutritionSciences,UniversityofAlabamaatBirmingham,Birmingham,AL;6AssistantProfessor,TheCancerInstituteofNewJersey,NewBrunswick,NJ;7VicePresident,EpidemiologyResearchProgram,AmericanCancerSociety,Atlanta,GA;8StrategicDirector,CancerPreventionStudy-3,AmericanCancerSociety,Atlanta,GA;9ResearchAssociate,AmericanCancerSociety,Atlanta,GA;10DirectorofMedicalContent,AmericanCancerSociety,Atlanta,GA.Correspondingauthor:ColleenDoyle,MS,RD,DirectorofNutritionandPhysicalActivity,CancerControlScience,AmericanCancerSociety,250WilliamsSt,NW,Suite600,Atlanta,GA30303;[e-mail]:Theauthorsreportnoconflictsofinterest.ThisreportwasapprovedbytheAmericanCancerSocietyNationalBoardofDirectorsonAugust5,2011.VC2012AmericanCancerSociety,Inc.doi:10.3322/caac.20140.Availableonlineat’slifetimeriskofdeveloping,5,6ordyingfrom,5,7cancer.2,8-11Thesesamebehaviorsarealsoassociatedwithadecreasedriskofdevelopingcardiovasculardiseaseanddiabetes.12Indeed,arecentstudydemonstratedthatnonsmoking(formerandneversmokers)adultmenandwomenwhoselifestylesweremostconsistentwiththe2006AmericanCancerSociety(ACS)cancerpreventionguidelinesforweightcontrol,diet,physicalactivity,andalcoholhadasignificantlylowerriskofdyingfromcancer,cardio-vasculardisease,orallcausescombined.7Althoughthesehealthychoicesaremadebyindi-viduals,theymaybefacilitatedorimpededbythesocial,physical,economic,andregulatoryenviron-mentinwhichpeoplelive.Communityeffortsarethereforeessentialtocreateanenvironmentthatfacilitateshealthyfoodchoicesandphysicalactivity.OverviewoftheGuidelinesTheACSpublishesNutritionandPhysicalActivityGuidelinestoadvisehealthcareprofessionals,policy-makers,andthegeneralpublicaboutdietaryandotherlifestylepracticesthatreducecancerrisk.13TheseGuidelines,updatedin2012bytheACSNutritionandPhysicalActivityGuidelinesAdvisoryCommittee,arebasedonsynthesisofthecurrentscientificevidenceondietandphysicalactivityinrelationt