The importance of maintaining a healthy

weight to lower the risk of cancer has
been reinforced in the latest review of the
evidence on ovarian cancer, which has found
a link for the first time [1].
With 61 per cent of adults and 57 per
cent of women in the UK now overweight or
obese, this is an important message.
Although smoking and use of Hormone
Replacement Therapy (HRT) are known
to increase risk of ovarian cancer, many
of the other recognised risk factors are
uncontrollable, such as age and family
history. Now, by maintaining a healthy
weight, women can take positive steps to
reduce their risk.
What is ovarian cancer?
The ovaries are the sites of ovum (egg)
production in women. They are also the
main source of the hormones oestrogen and
progesterone in premenopausal women.
There are three types of ovarian tissue
that can produce cancers: epithelial cells,
which cover the ovary; stromal cells, which
produce hormones; and germ cells, which
become ova. About 85 to 90 per cent of
ovarian cancers are epithelial carcinomas.
How common is ovarian cancer?
There are around 7,100 cases of ovarian
cancer in the UK each year and around
4,300 women die from the disease. Ovarian
cancer often has no symptoms at the
early stages, so the disease is generally
advanced when diagnosed.
What are the symptoms of ovarian cancer?
The Be Clear on Cancer Campaign advises
that if a woman feels bloated on most days
for three weeks or more, she should see
her GP [2]. Other symptoms women may
notice include back pain, changes in bowel
habits (diarrhoea or constipation) or feeling
tired all the time [3]. These symptoms can
also be quite common in women without
"St oppi ng cancer bef or e i t st ar t s"
cancer, so may be nothing to worry about.
However, the lack of clear symptoms is
one reason why diagnosis is often delayed.
For more information on the symptoms of
ovarian cancer visit Ovarian Cancer Action
at ovarian.org.uk.
How can women reduce their risk of
ovarian cancer?
Our groundbreaking report shows that
maintaining a healthy body weight can
help reduce the risk of ovarian cancer
as well as cancers of the bowel, breast
(in postmenopausal women), womb,
oesophagus, kidney, pancreas and
gallbladder.
Other risk factors for ovarian cancer
include smoking, HRT, family history and
age. Ovarian cancer is more common
in women who have been through the
menopause and in those who have a close
relative who has had breast or ovarian
cancer. Having a close relative who has
suffered cancer doesn't necessarily mean
that someone will get cancer, but if they are
concerned they should speak to their GP.
How did the report
reach these conclusions?
There were 128 ovarian
cancer articles included
in the Continuous Update
Project (CUP) analyses.
A panel of independent
experts assessed the
evidence and found that there was a six
per cent increased risk per five BMI units.
The CUP is the largest project of its kind
in the world and is helping define public
health advice on reducing cancer risk.
What can health professionals do?
Health professionals can encourage
women to maintain a healthy weight or
lose weight by:
- Eating a plant-based diet.
- Avoiding energy-dense foods and sugary
drinks.
- Keeping an eye on portion sizes.
- Limiting alcohol intake.
- Being physically active for at least
30 minutes every day.
Health professionals can also encourage
women to not smoke and raise awareness
of the symptoms of ovarian cancer,
focusing on the message that if women
experience any of the symptoms on most
days for three weeks or more, they should
see their GP.
Our weight diary is an ideal tool for helping
patients achieve and maintain a healthy
weight. Download it for free from our eShop:
shop.wcrf-uk.org
References
1. WCRF/AICR. Ovarian Cancer 2014 Report.
Food, nutrition, physical activity and the
prevention of ovarian cancer. [online]. 2014.
Available at: www.dietandcancerreport.org/
cancer_resource_center/downloads/cu/Ovarian-
Cancer-2014-Report.pdf
2. NHS Choices. Be clear on cancer [online].
2014. Available at: www.nhs.uk/be-clear-on-
cancer/ovarian-cancer/home
3. Ovarian cancer action. What are the symptoms
of ovarian cancer? [online]. 2014. Available at:
www.ovarian.org.uk/about-ovarian-cancer/what-
are-the-symptoms-of-ovarian-cancer
For the first time, scientists have linked ovarian cancer – the most deadly gynaecological cancer in
the UK – to being overweight. This was the key finding from our latest Continuous Update Project (CUP)
report, published in March.
Body weight linked to ovarian cancer for first time
Informed Summer 2014
Informed
News on diet, lifestyle and cancer prevention
54
News on diet, lifestyle and cancer prevention
Informed
FOR HEALTH PROFESSIONALS


Sugar is this year's hot topic, with some
media reports claiming we should cut it almost
completely from our diets. The heightened
interest in this topic follows the formation
of Action on Sugar, a group of specialists
who are urging the Government and the food
industry to reduce the amount of added sugar
in processed foods. We look at the truth
behind the sugar debate.
What is sugar?
Sugar is a carbohydrate, which is typically
the body’s main source of energy. Some
carbohydrates are made of just one or two
sugar molecules and are digested rapidly,
providing the body with energy quickly – for
example, honey and table sugar. Other more
complex carbohydrates are long chains of
sugar molecules [1]. They take longer for the
body to digest and release energy more slowly.
The starch in some foods, such as potatoes
and bread, is a complex carbohydrate. Other
less digestible complex carbohydrates are
the main component of dietary fibre. It is the
simple carbohydrates, or sugars, that have
stimulated recent debate.
Good sugar vs bad sugar?
Naturally occurring sugar in foods such as
whole fruits, vegetables and milk shouldn’t be
a cause of concern. It’s the type we add to our
cups of tea and food manufacturers add to
processed foods – often called “added sugar”
– that we should be worrying about, as well
as some so-called “natural" sugars like those
in honey, or which have been released from
the cells that usually contain them (as in fruit
juices or smoothies). Together these are called
non-milk extrinsic sugars (NMES). Although
this type of sugar is not inherently worse for
our health than the sugars in whole fruit and
vegetables, the processed foods and drinks
that it tends to be added to, such as cakes
and fizzy drinks, can be high in calories and
have little or no nutritional value.
Whole foods that naturally contain sugar,
such as fruit and vegetables as well as milk,
also provide nutrients that are important for
our health such as vitamins, fibre and calcium.
They tend to be less energy dense than highly
processed foods because of their high water
content. And because the sugars are part
of the cellular structure of the food, they are
absorbed more slowly.
Sugar and cancer
There is no strong evidence to suggest that
sugar itself is directly linked to increased
cancer risk. However foods that are energy
dense, particularly those that are highly
processed, and sugary drinks, increase the
risk of overweight and obesity. And being
Informed Sugar 54 Informed Eating well 54

Around 12.5 million people in England are
failing to raise their heart rate for more
than just half an hour per week, according
to a new report by UK Active [1], and a
quarter of adults are not doing enough
physical activity to benefit their health [2].
The cost of physical inactivity
The financial case is clear: inactive
people spend 38 per cent more days in
hospital than active people and visit the
doctor almost six per cent more often.
According to the All-Party Commission on
Physical Activity, inactivity is costing the
economy around £20 billion per year [3].
Who is most
inactive?
The study found
that there is a
broad relationship
between physical
inactivity levels
and socio-
economic status.
Areas of high
deprivation are almost 10 per cent more
likely to be inactive than areas of low
deprivation. The report found that
the North West was the most inactive
area of the UK, with Manchester being the
most inactive city, and the South East
the most active area of the UK.
Areas with high levels of inactivity
have on average a third fewer facilities
such as leisure centres. However, it was
found that the utilisation of green space,
rather than its volume, is the determining
factor in reducing inactivity in this case.
How can the cost be reduced?
Current annual spending by local
authorities on physical activity is low, at
less than three per cent of their public
health budgets. Reducing inactivity by
just one per cent per year over a five
year period could save local authorities
around £1.2 billion. Evidence shows
that the most significant health and
clinical benefits are gained by an inactive
person currently doing no physical
activity starting to do even a little.
What can health professionals do?
Health professionals can encourage
people to utilise their local green spaces
in order to achieve at least 30 minutes of
physical activity every day. They can also
remind people that any activity is better
than none and even short periods of
activity yield health benefits. Walking and
gardening are ideal starting activities. Our
physical activity diary is a great tool to get
people started. Download it from our
eShop: shop.wcrf-uk.org
References
1. UK Active. Turning the tide of inactivity.
[online]. 2014. Available at: www.ukactive.
com/downloads/managed/Turning_the_tide_
of_inactivity.pdf
2. Sport England. Active People Survey,
Survey 7. [online]. 2013. Available at: www.
sportengland.org/research/active_people_
survey/active_people_survey_7 aspx
3. All-Party Commission. Tackling Physical
Inactivity— A Coordinated Approach. [online].
2014. Available at: www.bhfactive.org.uk/
userfiles/Documents/commission_report.pdf
Informed Physical activity 54
Is it time for a new healthy eating model?
As the eating habits of the nation appear
to continue to decline, the Government's
Eatwell plate has come under scrutiny [1].
Treating the impact of diet-related
illnesses costs the NHS around £5 billion
every year [2]. Recent surveys show that
as a nation we are eating too much fat,
sugar and salt and too little vegetables
and fruits, wholegrains and oil-rich fish [3].
Some people are arguing that the Eatwell
plate, used to model a healthy diet, is
having little impact.
Limitations of the Eatwell plate
Limitations of the model have recently
been highlighted, including the lack of
guidance on plant-based proteins, which
would tie into goals to improve both health
and food sustainability in the UK.
Shifting towards a plant-based model
If followed, a plant-based model could help
to lower intakes of red and processed meat
which are linked to an increased bowel
cancer risk. WCRF recommends eating no
more than 500g of red meat a week (cooked
weight) and to avoid processed meat where
possible. A plant-based diet could also help
people to maintain a healthy weight.
Turning the tide of inactivity: a new report
The truth behind the sugar debate
Health professionals can advise people
to fill their plates with at least two-thirds
plant foods. Find our two-thirds plate on our
website: wcrf-uk.org/makeithappen
References
1. e nutrition news. New Year - A New Look
Eatwell Plate? [online]. 2014. Available at:
www.enjoyalpro.com/Assets/emails
2. Peter Scarborough et al. The economic
burden of ill health due to diet, physical
inactivity, smoking, alcohol and obesity in the
UK: an update to 2006–07 NHS costs. Oxford J.
2011;33(4):527-535
3. Department of Health. National Diet and
Nutrition Survey. [online]. 2012. Available at:
www.gov.uk/government/publications/national-
diet-and-nutrition-survey-headline-results-
from-years-1-2-and-3-combined-of-the-rolling-
programme-200809-201011


Informed Sugar
The truth behind the sugar debate
overweight or obese increases the risk of eight
common cancers including bowel and breast
cancer.
Evidence also suggests that eating
nutrient-dense foods that are low in energy
density, such as fruits and vegetables, can
help to protect against some cancers such as
those of the mouth, pharynx and larynx, upper
oesophagus and stomach.
How much sugar should we be having?
It’s recommended that no more than
10 per cent of our daily calories should come
from NMES – that’s around 70g (14 sugar
cubes) for men and 50g (10 sugar cubes)
for women a day [2]. Unfortunately the daily
Reference Intake (RI) on front-of-pack nutrition
labels only refers to total sugars. The best
advice is to try to avoid food and drinks high in
added sugar.
Nutrition labelling
If a food contains less than five grams of
sugar per 100 grams this means it has a low
sugar content, and if it contains over 22.5g
per 100g it has a high sugar content.
Some labels will show a high or medium
content for sugar, but could also be marked
to show that the food or drink contains ‘no
added sugar’. For example, natural orange
juice is high in natural sugars but is unlikely to
have had sugar added by the manufacturer. A
limited amount of fruit juice is still a healthy
choice but because it does contain NMES
it can contribute to weight gain if drunk
frequently or in large amounts.
What can health professionals do?
Health professionals can advise people to:
• Swap sugary soft drinks, such as cola, for
lower calorie alternatives or water.
• Avoid adding sugar to tea or coffee or use
sweeteners.
• Look at the food labels of breakfast cereals.
Even those that aren’t obviously sugary may
contain a lot of added sugar.
• Avoid snacking on highly processed sugary
snacks like cakes, biscuits and chocolate.
Choose fruit and vegetables where possible or
unsalted popcorn and rice cakes.
• Avoid flavoured milks, as they tend to
contain a lot of added sugar.
• Avoid drinking more than one small glass
(150ml) of (unsweetened) fruit juice a day.
References
1. WCRF/AICR. Food, Nutrition, Physical Activity,
and the Prevention of Cancer: a Global Perspective.
Washington DC: AICR; 2007
2. NHS. How much sugar is good for me? [online].
2013. Available at: www.nhs.uk/chq/pages/1139.
aspx?categoryid=51&subcategoryid=167
Informed Obesity 54
Obesity prevention during pregnancy
Helping women to manage their weight
during pregnancy may help to lower
obesity risk in their children, according to
an article in the New England Journal of
Medicine [1].
Excessive weight gain in pregnancy
(along with other factors like gestational
diabetes) can affect a baby’s growth and
metabolism and increase their risk of
becoming overweight in the future.
If that baby is a girl, and grows up to be
obese, she may go on to predispose her
own children to obesity. Managing weight in
pregnancy may help to break this cycle.
Pregnancy: an ideal time for change
Pregnancy can be an effective time to
promote behaviour change, as women
tend to be more motivated to look after
their health while pregnant. They also see
health professionals more often as part of
their routine appointments.
Pregnancy is also a relatively short
period, and studies have shown that
behaviour change interventions tend to be
most successful in the short term.
Other factors
There appear to be a number of other
factors in pregnancy and infancy that
also affect a child’s risk of obesity.
Research shows that children whose
mothers smoked during pregnancy are
more likely to be obese than those whose
mothers didn’t smoke. In fact, in one
analysis of 14 studies, smoking during
pregnancy was associated with a 50 per
cent higher risk of childhood obesity [2].
Other studies have found that breastfeeding
and sleep in infancy can help to protect
against obesity in later years [3].
Obesity and cancer
These findings are important because being
overweight can increase our risk of eight
common cancers such as those of the
bowel and breast, as well as a number of
other diseases.
What can health professionals do?
Health professionals can encourage women
to avoid smoking during pregnancy, to choose
a healthy plant-based diet and exercise
regularly to help manage their weight.
For healthy recipes, healthy eating tips and
more, visit our website: wcrf-uk.org.
References
1. Gillman MW and Ludwig DS. How Early
Should Obesity Prevention Start. N Engl J Med.
2013;369:2173-217.
2. Harvard School of Public Health. Prenatal and
early life influences [online]. 2014. Available
at: www.hsph.harvard.edu/obesity-prevention-
source/obesity-causes/prenatal-postnatal-
obesity/
3. Gillman MW et al. Developmental origins of
childhood overweight: potential public health
impact. Obesity (Silver Spring). 2008;16:1651-6.
3 glasses of orange juice
( unsweetened)
1
2
/
3
blueberry muffin
1 bottle of cola
( 500 ml )
5
1
/
2
bowls of granola (no milk)
10
1
/
2
chocolate
digestives
3
3
/
4
heaped teaspoons
of honey
What does 50g of sugar look like?
Here are 6 examples. Try not to have more than 50g (women)
or 70g (men) of non-milk extrinsic sugars (NMES) a day*
50g = 10 sugar cubes
* NMES includes all added sugars, as well as sugars in honey, fruit juice and smoothies.
Informed WCRF UK FREE regional event for health professionals 54
Calling health professionals
near Manchester
With worldwide cancer cases expected to increase by 70 per cent in the next 20 years, it
has never been more important to put cancer prevention at the top of the health agenda.
What will be covered on the day?
We will be busting the myth that there's nothing people can do to prevent cancer.
Topics will include:
uThe latest evidence on cancer prevention
u How you can start someone on their journey
to better health
uYour local network – who can offer support?
uWhat can we learn from others’ successes?
Who will benefit from attending?
Anyone working to improve the health
of their local community is welcome
to attend. E.g. Community Health
Workers, Health Visitors
and Health Improvement Specialists.
Book your place today
If you are based in or around
Manchester and would like to attend,
please register online at
www.eventsforce.net/wcrf or email
informed@wcrf.org for more information.
WCRF UK's first regional event for health professionals is to
be held on 17 September in Manchester.
Informed Free publication offer 54
"St oppi ng cancer bef or e i t st ar t s"
Everyday Eating cookbook
Our new cookbook contains eight
healthy and delicious recipes to
suit any day of
the week.
Order your FREE
copy today. See
accompanying
letter for more
details.
Please circulate this newsletter to
colleagues to help us spread the
message that cancer is a largely
preventable disease.
Informed is available free of charge
to all health professionals.
World Cancer Research Fund (WCRF UK)
22 Bedford Square, London WC1B 3HH
Tel: 020 7343 4200 Fax: 020 7343 4201
Web: www.wcrf-uk.org Email: wcrf@wcrf.org
Registered with the Charity Commission in England
and Wales (Registered Charity No: 1000739)
Registered Office: 22 Bedford Square, London
WC1B 3HH. WCRF UK is part of the WCRF
global network.
Editorial committee
Chief Executive: Marilyn Gentry
Head of Health Information: Kate Mendoza
Editor: Rachel Clark
Newsletter copy reviewers
Paul Rumsby PhD, Dr Chris Stray, Dr Jason Jones,
Becky Day RNutr, Pippa Burge RD, Amy Hall APHNutr,
Jaqui Walker RGN and members of the WCRF
Science Team and WCRF UK’s Executive Committee.
Design and production
Geoff Simmons and Hanna Michalak
ISSN 1472-6335 ©2014 World Cancer Research Fund
Informed 2 Check list 54
Please contact WCRF UK by emailing
informed@wcrf.org to join the mailing
list or to sign up to receive
WCRF UK's health professionals eNews.
shop.wcrf-uk.org
Informed On the website 54
Stay in shape for life
You
can!
Helping You to Reduce Your Cancer Risk
Informed Conferences 54






RCN Congress Exhibition 2014
15-19 June 2014, Liverpool
www.rcn.org.uk/newsevents/congress
Nutrition Society Irish Section Meeting 2014: Changing dietary behaviour:
physiology through to practice
18-20 June 2014, Coleraine
www.nutritionsociety.org/nutrition-society-irish-section-meeting-2014
National Nurses Nutrition Group Conference 2014
7-8 July 2014, Warwick
www.nnng.org.uk/nnng-conference-2014
Nutrition Society Summer Meeting 2014: Carbohydrates in health
14-17 July 2014, Glasgow
www.nutritionsociety.org/events
Nursing in Practice 2014
2 September 2014, London
www.nursinginpractice.com/events
WCRF UK will be exhibiting at this event
Public Health England Annual Conference 2014
16-17 September 2014, Warwick
www.phe-conference.org.uk
WCRF UK's Regional Event for Health Professionals
17 September 2014, Manchester
www.eventsforce.net/wcrf

Visit our eShop
All of our publications can now be ordered,
and downloaded for free, from our handy
eShop. The eShop lets you browse our
resources, add items to your shopping cart
and purchase them with one click. Visit
today at shop.wcrf-uk.org
Use your discount code to get 20% off all
orders until 30 September 2014: IN5420