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Ingredients

Nutritional Status and Breast Cancer :

Obesity perspective

Obesity and Energy Metabolism

You are What You Eat Concept

Take Home Messages

Breast Cancer in Indonesia

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Breast Cancer

65.858 incidence in 2020

Cervical cancer

36.633 incidence in 2020

Colorectal cancer

34.189 incidence in 2020

Lung cancer

34.783 incidence in 2020

16.6%

9.2%

8.8 %

8.6%

World Health Organization. Globocan, 2020

Breast Cancer in Indonesia

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Breast Cancer in West Java

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Natural History of Breast Cancer

Recurrence

Diagnostic

Early Detection

Risk Factor

1^st Preventive

Survive

Mortality

Curative

Palliative

Curative

Promotive

1^st Preventive

Rehabilitative

2^nd Preventive

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Nutritional Status and Breast Cancer

The importance of this risk factor, not only

in influencing breast cancer incidence, but also its association

with poorer clinical outcomes after diagnosis, it

is crucial to characterize more precisely the aspects of

body composition, or associated metabolic or physiological

factors, that underlie the observed association.

It is then important to identify how it can be assessed

clinically, whether it can be influenced and whether this

can reduce risk and improve outcomes.

James FR, et al. Obesity in breast cancer – What is the risk factor ? Eur J Cancer, 2015

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Obesity promotion of the incidence and progression of breast cancer poses a significant public health hazard. Delineation of the mechanisms through which obesity drives cancer progression or immune evasion is critical for the development of interventions to effectively disrupt obesity-driven cancer with minimum toxicity. Dietary interventions remain of considerable interest due to their co-targeting of metabolic disruptions. Breaking the obesity and breast cancer link will require interventions that limit the protumor effects of obesity-associated adipose dysregulation and that consider other biological and genetic mediators and structural determinants of health disparities. Moreover, given the high and rising rates of obesity in many parts of the world, emphasis should be placed on the development of safe and effective interventions that are acceptable and accessible to all women to reduce the burden of obesity on breast cancer.

The Obesity- Breast Cancer Link

Deveriks EN, et al. The obesity-breast cancer link: a multidisciplinary perspective. Cancer and Metastatis Rev, 2022

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Obesity and Energy Metabolism

Obesity is characterized by the increase of body fat stores, as a result of chronic positive energy balance��

Obesity

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Basic concept of energy balance

Law of thermodynamics says energy can neither be created nor be destroyed. It can be transferred from one form to another.

Calories Out

Calories In

Tubuh manusia itu pada esensinya, dia bekerja seperti alam ini bekerja, berusaha untuk menjaga keseimbangannya.

Sehingga untuk menjaga keseimbangannya, energy intake harus sama dengan energy output.

Energy intake, didapatkan dari makanan dan minuman yang berkalori, makanan yang mengandung substrat energy seperti karbohidrat, lemak dan protein. 1 gram karbohidrat akan menyumbang 4 kkal, 1 gram lemak 9 kkal, dan 1 gram protein 4 kkal.

Berdasarkan Hukum termodinamik, energi tidak dapat dicipatkan atau dimusnahkan, namun dirubah dalam bentuk yang lain. Maka tubuh kita bekerja untuk merubah asupan energi tadi dalam bentuk yang lain, menjadi energi untuk metabolisme basal, menjadi energi untuk mengolah makanan tadi melalui thermic effect of food atau thermogenesis, dan energi untuk beraktifitas fisik.

Mari kita bahas satu-satu

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24-hr Dietary recall

Calories In

Food / Beverage Items	Portion	Gram	Energy
-
-
Total Daily Energy Intake

Hunger – Satiety Mechanism

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Calories Out

Estimated Energy Requirement

Men 19 years and older:

EER = [662 - (9.53 X age)] + PA [(15.91 X wt) + (539.6 X ht)]

Women 19 years and older:

EER 5 [354 - (6.91 X age)] + PA [(9.36 X wt) + (726 X ht)]

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Body Mass Index (BMI) as an international parameter to determine obesity

Classification (WHO Asia Pasific)	BMI (kg/m2)	Risk of co-morbidities
		Waist circumference
		< 90 cm (men)	≥ 90 cm (men)
		< 80 cm (women)	≥ 80 cm (women)
Underweight	< 18.5	Low (but increase risk of other clinical problems)	Average
Normal range	18.5 – 22.9	Average	Increase
Overweight	≥ 23.0
- At risk	23.0 – 24.9	Increased	Moderate
- Obese I	25.0 – 29.9	Moderate	Severe
- Obese II	≥ 30.0	Severe	Very severe

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You Are What You Eat Concept

The human body is made of compounds similar to those found in foods—mostly water (60%) and

some fat with carbohydrate, protein, vitamins, minerals, and other minor constituents making up the remainder

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“Apakah jenis makanan tertentu dapat menurunkan risiko kanker payudara?”

“Apakah jenis diet tertentu baik dilakukan saat menjalani kemoterapi ?”

“Apakah jenis makanan tertentu dapat mencegah rekurensi kanker payudara?”

“Apakah harus menurunkan berat badan saat menjalani pengobatan kanker payudara pada pasien obesitas ?

Etc.

Information about the nutritional content of food often forms a public opinion

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Take Home Message

“

There is growing evidence that lifestyle factors, including diet, body weight, and obesity, may be associated with higher breast cancer risk. Nutritional intervention in patients may be considered an integral part of the multimodal therapeutic approach. However, the effect of dietary factors on breast cancer recurrence and mortality is not clearly understood, so further research related to nutrition and dietary in large population is required to definitively establish effective treatments in these patients, to improve long-term survival and quality of life.

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