M. D. Anderson Cancer Center
Date: April 23, 2012
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Lisa Garvin: Welcome to Cancer Newsline, a podcast series from the University of Texas M. D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment, and prevention providing the latest information on reducing your family's cancer risk. I'm your host, Lisa Garvin. Our guest today is Beverly Gor. She is a postdoctoral fellow here at M. D. Anderson in the Center for Health Equity and Evaluation Research or CHEER. Beverly, welcome!
Dr. Beverly Gor: Thank you very much Lisa.
Lisa Garvin: We're talking today about preventing cancer in children, but not necessarily in children. We're actually talking about setting the stage for a healthy life. Isn't it true that we really can't prevent cancer in children?
Dr. Beverly Gor: I think we're referring to the fact that many of the pediatric cancers are not, not really preventable. They, they come on with pretty much hardly any warning, and so there's, they're not really considered preventable like the leukemias, the gliomas, the brain cancers, and so forth. We're talking more about the adult cancers such as breast and prostate and colorectal that are associated with obesity and diet and lifestyle.
Lisa Garvin: Is it true that the earlier you adopt a healthy diet and lifestyle, the better off you are?
Dr. Beverly Gor: Yes, it is, in fact, we feel like that is the best time to intervene, the earlier the better, because when... we establish our lifestyle habits early in life and usually those are what we stick to pretty much throughout our lives.
Lisa Garvin: Let's start from infancy, I mean, is there a difference between breast milk and formula? Are there suggestions that you would make there?
Dr. Beverly Gor: That's a very good question, Lisa, in fact, people are realizing now that there is a benefit, an additional benefit to breast feeding besides the immune properties that a child gets, it is found that children who are breast fed tend to have less risk of obesity and this is because the child develops a greater sense of appetite control. When they are hungry and they're fed, they will stop when they are full, whereas a mother who is bottle feeding, tends to want to encourage the baby to finish the bottle.
Lisa Garvin: Now what we see happening as toddlers grown up and, and get solid food, they, I call it the fast food, the fast food lure, it's easy for parents to drive to McDonalds and get some Chicken McNuggets to feed their kid who maybe fussy and they don't have anything else. How do you avoid the fast food trap?
Dr. Beverly Gor: Oh, that's, that's a hard one because we live in a very fast paced society and the marketing for fast foods is extremely strong to children so it's like children will ask for those sorts of things, and if we back up a little bit, one of the things that we tell mothers about feeding their infants is delay solid foods till they are about six months old and then when you start feeding solid foods, you know, you want to emphasize the fresh fruits and vegetables and get kids interested in those tastes and, and textures so that they are, they like them, they know them, and then of course setting a, a, an example for your children, being a role model for your children is very important. Now about avoiding fast foods, that is a tough one. I have to say that if you see me at McDonalds one day, please don't judge me. I mean, it's part of our lives, and I think actually there are some good choices we can make at certain fast food restaurants too. The, the problem is just that we are just, we just don't have enough time. We found with the group that I work with called CAN DO Houston that so many parents are working full-time, don't have time to fix a healthy meal for their child, and so the quick and easy thing, just to get the child to be happy and satisfied is to go to a fast food line. So it does take special effort, but I think we, we need to minimize the time so we depend upon fast foods and learn to find shortcuts so that we can prepare healthy foods at home for our families.
Lisa Garvin: Because it seems to me that that the craving for certain kind of foods gets set early in life is that true?
Dr. Beverly Gor: Yes, it does. Patterns get set early in life.
Lisa Garvin: And you know, of course we say kids always love sugar, but I do know friends that have never had any sugar or sweets in the house and the kids don't even know what they're missing. Do we, can we avoid the whole big marketing crush and get them to adopt these healthy habits?
Dr. Beverly Gor: That's a controversial subject too, and I, I, as a registered dietitian I've often been accused of being rather liberal. Because I think, actually, moderate sugar intake in the diet like maybe an occasional cookie or, you know, some desserts, is not a bad thing. My experience has actually been more if, if you forbid sugar in the diet, when a child can get to it, they may feel like this is so, so special, you know, I've got to hoard it, or you know, it's like forbidden fruit is twice as sweet, and so personally, my approach towards sugars and sweets in children's diet is moderation, it is a part of life, I mean, I think foods, you know, some foods are supposed to be sweet, so personally, I would not recommend avoidance of sugar in total.
Lisa Garvin: So let's talk about what would be a typical healthy diet for a young child?
Dr. Beverly Gor: Speaking about a child that's maybe around 2 or 3 years old okay. So they should have a diet that has at least 5 servings of fruits and vegetables a day, and this can be in the form of fruit juice, fresh fruit, cooked vegetables, raw vegetables, and servings for children are, are about a quarter or a half of what an adult size serving should be. We oftentimes think that children need to eat a large quantity, but their stomachs are really very small and so their serving sizes need to be proportional to their size. So that's probably one of the foundational parts as for cancer prevention. And then we want them to have whole grains and this would be like whole wheat bread, oatmeal, we want them to have beans and legumes like black-eyed peas, pinto beans, low fat dairy is considered part of a healthy diet, and then lean proteins like lean chicken, fish, and other meats.
Lisa Garvin: What about parents who might want to start their kids off as vegetarians? What sort of advice do you have?
Dr. Beverly Gor: It's okay, if you want your child to be vegetarian, you do have to be a little more careful about making sure they get adequate protein in the diet and for vegetarians that would have to be like beans and peas, tofu, or some of the other alternates that might be available. So it's a little bit harder to make sure that a child gets an adequate diet if you're going to go on a vegetarian diet, but it's totally possible to do so.
Lisa Garvin: And let's talk about the other side of the diet-nutrition coin, obviously, diet works in tandem with physical activity, so how do we promote an active lifestyle in young kids?
Dr. Beverly Gor: Again, the key is encouraging it as a parent and encouraging it in your children. I have, I'm very blessed in that I have a year old grandchild now, I have a year old granddaughter and she, she likes to dance, you know, it's funny, it's almost like [inaudible] when she hears music with a, with a beat, she'll start moving and, and I find that, you know, children I think naturally want to move and be running and active and, and I realized that as they get older, we almost have to subdue some of that so they're not so rambunctious. But I think if we allowed enough time in the day to allow them to do some free play, running free, then we actually do them a favor because it burns off some of that nervous energy and it helps them to settle down and to sleep, so, you know, I think allowing kids enough opportunity to be physically active and that's another problem with today's society being so fast paced. Parents get home from, from work like 5, 5:30, it's already dark, it's too late to let your kids go out and play, unfortunately, many schools are not allowing enough time for recess and physical activity, because everything is, the emphasis is on academics and yet if we let kids be more physically active, they actually do better in school, so we need to allow time for kids to be physically active.
Lisa Garvin: And I know this is a controversial topic, but there've been a lot of studies about it is the, as the time in front of the computer and playing videogames goes up, the physical activity goes down and obesity often arises.
Dr. Beverly Gor: You are correct Lisa that they have found a correlation between what they call screen time - time in front of the computer or the television - is associated with obesity.
Lisa Garvin: Is there or should they set limits on their children's TV and computer habits?
Dr. Beverly Gor: Yes, they should, and it's very hard because so much is on the computer or computer games that children play that encourage sedentary behaviors. We, we really are, we need to set limits on that, probably no more than, sounds rather ambitious, 30 minutes to 60 minutes a day, but that, in today's society, that's a hard goal to reach, but I think if parents are cognizant of the fact that the more screen time that children have, the less active they are and to try to get kids to go outside and play is a, is a good thing.
Lisa Garvin: And I think outside is the key point because you get the vitamin D, you get the benefit of the, the sunlight as well.
Dr. Beverly Gor: That's right, and we're so, in Houston especially, we're so air conditioned. We stay inside all the time, we very rarely go outside and get some sunshine and I think it's very important that we do that.
Lisa Garvin: Are there ways, if they can't get outside, if there's not a playground nearby, what can they do inside to increase their activities?
Dr. Beverly Gor: Ooh that's a hard one. Actually, some of the computer games that emphasize dance or movement are, are good. I don't want to use any brand names, but those do encourage some physical activity. Even walking up and down stairs, you know, just trying to be active without, you know, throwing balls in the house and breaking things, trying to do things even walking in place, marching in place, watching a, a, a television show that might encourage you to be active those are some things that people might be able to do on a rainy day or when they can't go outside.
Lisa Garvin: And another thing, I guess, it's really important as far as cancer prevention is sun exposure.
Dr. Beverly Gor: Yes.
Lisa Garvin: So let's talk about that babies, everybody needs to be protected from the sun.
Dr. Beverly Gor: Yes and no. You know there is some controversy. In Houston, we do have a lot of sun here, but in, in more Northern climates or when there's less direct sunlight, there, there maybe a need actually for supplemental vitamin D because of less sunlight. So depending upon where people live, they need to be aware of how much sun exposure to get. I've, I've read that everybody needs at least like ten minutes of sun exposure everyday for the vitamin D that anymore than that depending upon the, your pigmentation of your skin, you know, maybe, may put you at risk for like skin cancers.
Lisa Garvin: Should any child be outside without any sort of sun protection factor lotion?
Dr. Beverly Gor: I think it would be on the safe side to have children with a, a, sun protection set with the, a lotion that does protect them from the sun if they're going to be outside for an extended period of time.
Lisa Garvin: If you were to implement all of these preventive strategies early in life, what sorts of cancers does this affect directly?
Dr. Beverly Gor: Well, when we talk about sun protection, of course, it's skin cancers, when we talk about the vitamin D actually there is some research that's showing an association between vitamin D and colorectal cancer, the prevention of it, so we do need some sunlight. Obesity, excessive body fat is associated with breast and, increased risk for breast and prostate and colorectal cancers, and then diet, we do, we do want the fruits and vegetables and the whole grains because those seem to be protective against breast and colorectal cancer as well.
Lisa Garvin: So if you had one piece of advice that you really wanted to drive home to parents of children, what would you say?
Dr. Beverly Gor: Hmmm... I think, you know, it's actually harder for us to encourage kids to be active nowadays. We're pretty good about encouraging the fruits and vegetables, but the physical activity is becoming a harder goal to achieve in today's society and so I would really tell parents try to let their children get in at least 30 minutes of physical activity everyday.
Lisa Garvin: There's something you touched on earlier, you talked about how a portion size for a child is about a half to a quarter of an adult portion, so if they're looking at nutritional labels, do they need to do a little math if they're looking at nutritional labels on foods?
Dr. Beverly Gor: You're right Lisa, because the serving size that is on the label for most adult foods are for an adult, that's the serving, the portion size that's listed there, yes.
Lisa Garvin: Great! Thank you very much! If you have any questions about anything you've heard today on Cancer Newsline, contact Ask M. D. Anderson at 1877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.
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