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Diet, Nutrition, and Carlcer
Directions for Research
Committee on Diet, Nutrition, and Cancer
Commission on Life Sciences
National Research Council
NATIONAL ACADEMY PRESS
Washington, D.C. 1983
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NOTICE: The project that is the subject of this report was approved by
the Governing Board of the National Research Council, whose nembers are
drawn from the Councils of the National Academy of Sciences, the
National Academy of Engineering, and the Institute of Medicine. The
members of the committee responsible for the report were chosen for
their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors
according to procedures approved by a Report Review Committee consist-
ing of members of the National Academy of Sciences, the National Academy
of Engineering, and the Institute of Medicine.
The National Research Council was established by the National
Academy of Sciences in 1916 to associate the broad community of science
and technology with the Academy's purposes of furthering knowledge and
of advising the federal government. The Council operates in accordance
with general policies determined by the Academy under the authority of
its Congressional charter of 1863, which establishes the Academy as a
private, nonprofit, self-governing membership corporation. The Council
has become the principal operating agency for both the National Academy
of Sciences and the National Academy of Engineering in the conduct of
their services to the government, the public, and the scientific and
engineering communities. It is administered jointly by both Academies
and the Institute of Medicine. The National Academy of Engineering and
the Institute of Medicine were established in 1964 and 1970, respec-
tively, under the charter of the National Academy of Sciences.
The work on which this publication is based was performed pursuant
to Contract No. NO1-CP-05603 with the National Cancer Institute.
Library of Congress Catalog Card Number 83-61699
Inte rn ati on al S tandard B ook Nurnbe r 0 - 30 9 -0 3 3 85 - 3
Available from
-
NATIONAL ACADEMY P ~:S S
2101 Constitution Ave., NW
Washington, DC 20418
Printed in the United States of America
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Comm~ttee on Diet, Nutntion, ar~d Car~cer1
CLIFFORD GROBSTEIN, Chairman
JOHN CA IRNS, Vi c e Cha i rma n
SELWYN A. BROITMAN
T. COLIi~J CAI4PBELL
JOAN ]) . GUS S OW
LAURENCE N. KOLONEL
DAVID KRI TCtIENIS KY
WALTER MERTZ
AI]THONY B . MI LLER
MI CHAE L J . PRIVAL
THOLIAS SLAGA
LEE WATTENBER&
TAKASHI SUGIMURA, Ad vi sor
Nat iona 1 Re sea rch Counci 1 S taf f:
SUStIMA PALMER, Project Director
KULBIR BAKSHI, S taf f Of f icer
ROBERT HILTON, Researe.h Associat
e
FRANCES M. PETER, Editor
See Appendix A for further inforination on committee members and
staf f .
·~.
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Preface
In June 1980, the National Cancer Institute (NCI) commissioned the
National Research Council (NRC) to conduct a comprehensive study of the
scientific literature about diet, nutrition, and cancer. The NCI re-
quested that a study committee be constituted to carry out three tasks:
(1) "review ... the state of knowledge and information pertinent to
diet/nutrition and the incidence of cancer"; (2) "develop a series of
recommendations related to dietary components (nutrients and toxic
contaminants) and nutritional factors which can be communicated to the
public"; and (3) "based on the above state-of-the-art appraisals and
the identification of gap areas, develop a series of research recom-
mendations related to dietary components and nutritional factors and
the incidence of cancer."
The NRC Governing Board assigned administrative responsibility for
the overall project to the Executive Office of the Assembly of Life
Sciences, now the Commission on Life Sciences. Subsequently, a 13-
member Committee on Diet, Nutrition, and Cancer and one advisor were
appointed to conduct the study. The co~nittee's first two tasks were
completed in June 1982 with the publication of a 496-page report en-
titled Diet, Nutrition, and Cancer. The specific boundaries of the
territory surveyed under the general heading of diet, nutrition, and
cancer were defined in this report, which concentrated on the relation-
ship between the nutritive and nonnutritive components of diet and the
etiology and prevention of cancer. The report also included several
interim dietary guidelines for dissemination to the public.
The committee responsible for the third task, i.e., the development
of recommendations for research, included 12 of the 13 original members
and one advisor. The group provided a broad range of expertise in such
disciplines as biochemistry, embryology, epidemiology, experimental
oncology, microbial genetics, microbiology, molecular biology, molecu-
lar genetics, nutrition, nutrition education, pathology, public health,
and toxicology. Institutional affiliations and major research interests
of these committee members and the NRC staff are presented in Appendix
A at the end of this report.
The Committee on Diet, Nutrition, and Cancer is indebted to the
many scientists who contributed their ideas on directions for re-
search and to those who participated in the miniconference on
future research. Their names appear in Appendix B. It is also
grateful to those who reviewed selected sections of this report
at the request of the NRC. The committee particularly takes note of
the excellent support received frown the NRC staff headed by Dr. Sushma
Palmer and consisting of Dr. Kulbir Bakshi, Mrs. Frances Peter, Mr.
v
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vi Preface
Robert Hilton, Us. Susan Barron, and Mrs. Denise Belgrave. The support
and a ssi stance of Dr s. Diane Fi nk, Andrew Chiarodo, and William DeWys,
the past and present NCI pro ject officers for thi s study, are also
acknowledged. /~\.
Go
CLIFFORD GROBSTE IN
Chai roan
Committee on Diet, Nutrition, and Cancer
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Contents
Page
CHAPTER 1 - OVERVIEW AND MAJOR RECOMMENDATIOl'JS 1
Strategic Objectives and Priorities for Research...
CHAPTER 2 - APPROACH TO THE
3
CHAPTER 3 - DIET AND THE MECHANISMS OF CARCINOGENESIS 9
Research Recommendations 11
CHAPTER 4 - EPIDEMIOLOGICAL METHODSe.~.o. 12
Research Recommendations ~ 15
As se s spent of Di e tary Expo sure s .................
Type s of Epidemiological S tudy..................
Analysi s of
CHAPTER 5 - LABORATORY
Methods for Identifying Dietary Initiators and
15
16
17
19
Modifiers of Carcinogenesis 20
Methods for Assessing the Effects of Nutrients
on Carcinogenesi s.
Methods for Identifying Markers Related to
Neoplasia i n Hu~nans..............................
22
Re search Recommendations 23
Initiators and Modifiers of Carcinogenesis......
The Ef fects of Nutrients on Carcinogenesis......
Markers Related to Neoplasia in Hu~nans..........
23
:23
23
CHAPTER 6 - MACROCONSTITUENTS . . . . . . . . . . . . . . . . . eat 25
Fats.
PrOteinee e.
J ~ ~ ~ ~
Di etary Fi be ~
28
· ~
V11
28
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viii Contents
CHAPTER 6 (Continued)
Total Caloric
Research Recolumendationse e e e e e e e e e e e e e e ~ e
General Recommendations for Epidemiological
Research. e e e e e e e e e e e e e e e e e e e e e e e e e ~ e e e e e e e e
General Recommendations for Laboratory
Researche e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e
Specif ic Rec.ommendationse
CHAPTER 7 - VIT~IItIS, MINERALS, AND NONNUTRITINIE
INHIBITORS OF CARCINOGENESIS e e e e e e e e e e e e e e e e e
Vi tamins, Carotenes, and Ret inoid se
Vitamin A, Carotenes, and Retinoidseeeeeeeeee
Vitamin C (Ascorbic Acid) . e e e ~ e e e e e e e e e e e e e e
Selenium ar~d Other Trace Minerals.
Molybdenum, Zinc, Iron, Iodine, and
Arsenice e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e
Nonnutritive Inhibitors of
Page
30
30
31
32
32
36
36
36
37
38
38
39
41
Carcinogenesi se e e e e ~ e
41
General Research Recommendations. e e e e e e e ~ e e e e e e e 42
Specific Re search Recommendationse
Vitamin A and Carotenese
Vitamin C (Ascorbic Acid) e e e e e e e e e e e e e e e e e ~ e e
Vitamin Ee e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e
43
44
44
44
Selenium and Other Trace Element se e e e e e ~ ~ ~ e e e 45
Nonnutritive Inhibitors of Carcinogenesiseeee 46
CHAPTER 8 - FOOD ADDITIVES, CONTALIINANTS, CARCINOGENS,
AND MUTAGENS e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e
Re search ~^^^~ ~- ^~
47
l~t::~Jllllll~llUct~l~Jll;:,e e e e e e e e e e e e e e e e e e e e e e e e 50
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Contents ix
Page
CHAPTER 9 - CONS UMER BEHAV IOR
Re search Re co~nmend
56
REFERENCES. e e e e e e e e e e e e e e e e e e e e e e ~ e e e e e e e e e e e e e e e e e e e e e e e e e 58
APPENDIX A - COLIMITTEE ON DIET' NUTRITION, ANT) CANCEEL--
AFFILIATIONS AND MAJOR RESEARCH INTERESTS . e 67
APPENDIX B — ACKNOWLEDGMENTS e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e 69
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Diet, Nutrition, and Cancer:
Directions for Research
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