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Nutrition, metabolic health, cancer and NCDs
Elio Riboli, Imperial College London, England
Thursday, Sept. 28, 2017 · 2:27 p.m. · 58m 16s
Session 2: Demographics and Epidemiology
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your internet thank you for the invitation a great pleasure thing yeah um
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fantastic opportunity to meet with the product from very different the this
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it planes in the air and try to understand it
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um no this is just an an overview of my presentation a lot
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the something in common with what steve presented because i will try to drive you
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up through to dictates on a of research on
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the duration intense and they will touch another
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uh i'm a chronic disease in turn out on
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how profoundly our thinking of change the on
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on what might be the relationship as it might be that should of diet nutrition
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and cans but because we're in a very me uh let's say uh
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multi disciplinary audience i just use the first few slide three or four five
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to give you one message well all all all the idea
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about died can consist started the in the mid seventies
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uh in a few places around uh uh let's say europe or
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north america a box for the uh and heart of another
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so we we we know very well that the frequency uh with which different cancel
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curse is very different so some cans and more frequent other stuff less frequent
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uh the sub very rare enforce some of them we have the reasonable um
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understanding uh or whoever came later there is about understanding what the cost
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could be i would just show your four or five slides on and not that they mention
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yeah then mention uh which is the one which is really fundamental and this
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one change my personal and professional life is the extent to which
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the frequency of cancer incidence that is that
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um operations for example for lung cancer
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uh what is more frequent the this the frequencies express the number of new places but one
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hundred thousand per year is just the way i guess it be the knowledge is expressed
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so i guess is it is much much more frequent what they say much
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more frequently i mean sixty seventy times much more frequent in the dark
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yeah yes that and much less in other areas we now
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large understand that these is ninety five percent you dude
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differences in tobacco consumption uh plus a few other
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factors operation exporters and uh pollution but
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you know essentially we we know where lung cancer come from tanks to the work done in the fifties and the sixties
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by search of dog has had next window and other buyers
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no breast cancer show was almost the same range over valuation
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it goes from you know something around one under one hundred thousand
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korea to five ten per hundred thousand probably um the probability of getting breast
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cancer for a women in a western europe please about twelve percent now
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if they don't i've something yeah something like the age of eighty
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um in a breast cancer remains extremely rating some population
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it was extremely rare for example in in the until recently
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and what is most interesting is that we men opal him population migrates
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from one and it when now that the population that my face from
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a low incidence that yeah we like why the high incidence
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the same cat that is the end despite having done a lot of research on cancer genetics myself
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i just reminded at all of us that people migrate with their
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genes only the jeans a tool they call with jeans
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okay so if people go with their genes in the in the in the in the in one generation
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yeah the incidence of uh uh or breast cancer increases by
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one one thousand percent by ten for that it means that at the population
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level that they're the frequency is not determined by the population genetic predisposition
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but by environmental factors local factors like right next time we d. in the population than the
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difference between those who get best guess it'll dawn easy but uh genetically that uh
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so that is extremely important to think in terms of vinyl analysis of variance
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so that is the variation between population which is larger environment that and everybody some between population
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which is environmental lifestyle last jeanette does what an ethic comes into play what i can say is the
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it's like breast cancer basically does he says you know whatever
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european said idea to move around and setup colonies
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they they brought with them with them you know they had it's it's enough
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america's automate thinks it in the in the current more of a sense
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and now if you look at stomach cannes uh is the other way around look at this
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you know the lowest incidence of stomach as in the plan it is in england
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and then you you criticising because for that you know i email up one of
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the highest incidence of stomach cancer in europe is in a task any
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and they sent a part of spain and there's been like that for a long time
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so thought my cancer was the most frequent cancer in european population and deal
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the end of it in on the beginning of nineteen under has gone down dramatically like this
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and uh nobody can claim any method for this but every man's now we know what to
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do remains very much associated in other some population with a very high salt intake
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yeah maybe very early exposure to already compact applauding life but he is a is is
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not black and white we can set is not a privilege of what's been work
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is different lee that can so dizzy that cancer in women that is
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less affected by alcohol consumption that in in in my men essential
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is a is a is is related to it but that is b. and c. so again is another dimension
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and then a cervical cancer again is another dimension uh it's it's uh well basically the only cancer for
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which we know that there is uh in the sense of the course is the only one
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what they're another cup of them but this is the only one well we know that exporter
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repeated are exposed to human popular writers is needed
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to develop cervical cancer so we're one hundred percent basically
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of are attributable risk not all women were
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whether that uh you might popular among writers infection gets it okay but
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basically you without the human popular uh does it why we introduce
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the proxy nation now the big problem is that we vaccinate here
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and here where there is less need that we should put all
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the effort vaccine it down there that is a public health
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problem is not this entity problem is that there's a problem with
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sources nowadays in france and you and you pay just
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on a two two quarter that i bought the nine nine but to one thousand that barrier
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of uh um subject from cervical cancer out of one to ten feet thousand that's
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the area in the work that our whole down so that's that's this
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um now so cast a variation on wonderfully around the world
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we know that population in my case i don't bring with them their own characteristics
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all that it it it it widely characteristic of the local population started
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something which is to say essentially is also that
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the frequency of cancer changed dramatically over time
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uh yes park was i picked up with this data from nineteen thirty to nineteen ninety in united states
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just to show how stomach cancer was the most frequent cancer
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and the last century is going down because of the improvement would believe in a ah you know it's
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going down with the refrigeration is going down with every generation yes replacing chord change that of soul
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has gone down with age any condition of adapt and adjust the infection to republic that a lot of chronic ear infection
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this means uh uh somewhere that is a cancer of the uterus right
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so 'cause of the users as gone down match before there was an introduction
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of pop test any at least screening has gone down because all soul
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but showers and personal hygiene because is sexually transmitted the disease right so
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you just get accordingly for people to be clean before they
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or you know endeavour never in a normal life and that is less and
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less likely for a man to transmit the virus to uh use file
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so we're now fighting to go down down down here so this is
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this is was the thinking we hadn't be a couple of
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decades ago about cancer which basically says what courses cancer and and what we know for
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sure is that that and number off okay make us that we call carcinogens
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in the uh and uh you know very well that and the student and number
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of physical cosine nonsensical dressed as for example
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an actual physical carcinogen some viruses
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very important some part aside known working on two digit should break
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for the drawing of the man you're in it a lot you know and you're nice introduction
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so until like not fried ago we were thinking that if there is cancer
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that must be casinos and there is no cancer with a classic
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and this is a is a profoundly influenced i was thinking about that i
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think i said maybe thinking about that i think as about single food
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that must course can set in single food at the mac attack a set se that i think
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uh but what i was saying that the the the other single foot single
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mood in there and help that belong to the past eight so
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and why they don't do it but what belongs the past in cancelled by the four because uh
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about twenty years ago when we started understanding better this went before the valuation around the planet
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and the variations about migrant populations you know the japanese going to cut for yeah the chinese going
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many other places the canyon migrate into california and
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acquiring the local characteristics in terms of consequences
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we we wear completely start to explain the variation on it
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ah the variation in cancer of the breast crossed the call and correct them in the
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midterm kidney pancreas i can make a longer at least for all of the expense
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forty yes all desert as not ended up in identifying one single casino join
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that would explain it twenty four the difference in incidents
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and this is where a different thinking guys emerged and the big
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fundamental question that i ask myself when i got was
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that's customer genesis right while exhausted most environment that actually dance
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oh is it possible can we imagine that like at the last like diseases
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i sense that can uh can can can start to fall then progress
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by these regulation of androgynous metabolic processes these regulation of
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sets cycle cycle control ah these regulation of
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controller of uh of uh um uh it's a mile in the the clones and so
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and then the question is what could be the these are the person this is
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how we ended up thinking it maybe if we would maybe physical activity maybe
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early and excessive uh uh access is the wrong word but a rapid
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early growth you you are probably not very well that high
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if i we have one yep outrage stuff uh i it's
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it's really in any associated with increased the risk of
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dying for cancer so the older you are the friday series is about one point five
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is about forty percent increase respect for people older than one eighty five
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compared to people short that one sixty both men and women but good no is is that if you worked on one eighty five
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you haven't forty thirty percent reduction in your risk of dying or cardiovascular disease
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so it's you know it's it's s. probably all to do with the growth effect right so uh
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and that a productive life it aged first try first put
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can pregnancy number of pregnancy lactation and and so
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so this is why we ended up with cancer now talking about metabolic
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now that the problem is how do we investigate the side because people would
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be is believe it or not we where he'll make it uh
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cost that started being the elaborate that that almost thirty years ago that yes it was very simple
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i was working with my post doc would love cats and we worked on
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the paper and that was that is installed in the missing link
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between that intense so there's been a lot of uh
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work that come from a um hum laboratory experiments uh
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experimenting mice and rats tandem either cannonball a gigantic
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wind if late forties early fifties conducted a series
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of experiments inch cat on dozens of rodents
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the most of it in good faith overeating excess calorie f. to access it
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energy intake uh and so on and so on and the protective effect of physical activity he made
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mm mice running on it will ensure that if you over feed mice but you put them one way
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that he's this so uh you'd of cans used lower nineteen forty eight a cancer research volume one
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so that being geniuses and i had the chance that yes it all over
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reading this paper and that was that a revolution because i thought well
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then we can not to do clinical starts to understand that
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uh the relationship between cancer and uh died darken kids
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we have to do population studies like other than emblem was doing with these mice which means
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uh look at people with different died with different physical that the the different level b. b.
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and for them different is that not the animal in chicago could uh randomly assign user audience
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well we can not randomly assigned human beings so we're in
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the case where randomised clinical is that it's a nightmare
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practically possible nor it should end is online the closest we can get there is to
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follow up people would dawn pair of cancer but have different
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characteristics in the e. d. d. jewel in the region
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that's the difference between correlation and this type of research and presenting it individually will understand the
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characteristic the critics occur so it's so this one how in the mid nineties early nineties
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i let the creation of the european a prospect investigation cans current diseases
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i was working in the next i just before is that some tense
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in those days so was a great opportunity to do it
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that was the first time in the world that we collected the data very detailed
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the that on lifestyle died physical act the we even measure blood pressure
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uh in uh and we designed this so to we will be will be able to follow up these people
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on lights that changes and on their noses used so once you have spent about ten or twelve years
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doing this then you for do that a lot and that's fine you can get some
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results now okay yeah from it now uh it because it is it the collaboration
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uh of twenty three centres and we collected the date on
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half a million people in the nine mid nineties
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we collected last samples on four hundred thousand people and that was the first lot by bank for
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population by bank for a medical investigation uh ever done
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and we have we have now falling got this people with then it twenty or fall out
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about ninety thousand of this often enough people develop cancer and uh it
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about twenty five thousand develop some cardiovascular diseases to rock and so
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on and then we have a follow up on that because
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so uh that he is that with what looks like to uh by bank was
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and now it seems obvious uh twenty years ago was not obvious to convince
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the uh a european commission to invest in sporting then you don't samples
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we have used about one point five million samples by the way
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um in the end that is the rationale that you have
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a baseline you you measure what people do you collect blood samples
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you at the d. then you but biological then engine
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then you can use this that's simple to do some studies done by marcus overexposure
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but because people get a disease that you may also use this data for the
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needed by marcus of breeze and the uh really uh effect on cancer
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no i would now you you choose one i've chosen one
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can such as one can switches product that cancer
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to give an example of what is today uh how today we do
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the research an accretion or in cancer by bringing together a biochemist
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a physiologist in the clean all the just keep it in your budget and
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uh and and try to you know come by all the dimensions
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um
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so i you will see just like three times so this is a
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theoretical model we've been building little by little well with the it
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we had this morning or or what what goes wrong and i you know um
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too much fat diet categorised by degrees the fat total fat
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content i'm of that red and process me it
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they uh uh let's say uh no that was all that that fibre um
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insufficient consumption fruit and vegetables in sufficient easy but you put all this into
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a in a crock that meets their needs that instead of looking at them one by one in then
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you say let's see how this impacts on obesity
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and energy balance and how that impacts on
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some regulation that have to do with inflammation but have to do also it's a cycle prefer action
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now we go quickly through a series of life that each of slide is the result of this badly
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in which eight of this report does this have been observation ollie constant now
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then mentally come from you and how we think that these pathways
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are they oh together explain most of the valuation in
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the individual and between population of these cars will be developing colour okay
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so we don't know busy the and and urging balance uh okay well
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this is the match centred on the concept of metabolic syndrome components
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rather than clinical definition but we want to understand what are the components have to
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do with the with k. so first of all that the fibre very quickly
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we consistently have found the baptist and uh we confirmed that consumption
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of five better look at the uh the red line
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read uses substantially varies all correct okay so you will see and number of
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slides uh whether they usually turn out right at the base of observation
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so this is the probability the probability of developing can set it during the follow up the idea that
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so many this point eight means twenty percent reduction point six is forty percent of that
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and this is the exporter so basically it says that if everybody in europe
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with a bit consume between thirty and forty grams of total fibre with the product that the answer would be around three
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thirty five forty percent less frequent than these
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people consume twenty grams of fibre
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and these uh protection is practically every then for cancer of the colon and not much for cancer or them
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did they did made the the output of a hot potato or of other than process made
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this remains the cornerstone started that justified the the debris show
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this season to name right in process made as a
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as associated with an increased risk of cancer it it it it is has
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more effect it is a relatively small one point two one point three
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if you smoke a pack of see i'm sure you don't but those who don't smoke a pack of cigarettes
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there is problem cancer increases by for the times receives cues
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for t. uses one point two one point three so
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eating red meat is not like smoking uses more component that head whipped back them
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that overall that it increases substantially and the good news is that p. d.
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reviews that i that new trout or me maybe even slightly protective
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she can and board that is not bad because it's an absolute flat line
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that i bought thirty or forty b. population studies in the world
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well the consumption is not the trip would have core this was a
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long debate whether our colour is not not associated with increased that
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so the way to rate base is that this is there is a input mm baseline a two four degrees
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so you need the population like we have in your of people
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webbing drinking substantial does at graham so that'll basically close to
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a bottle of wine per day in agreement which is not that much yeah
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i think that that people who are you to drink an update if
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or maybe the at lunch then they have maybe a bit in the evening and then
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i have two glasses of wine that's it uses the grammar that don't know
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so i guess i've not done yeah that's these are normal people with the car
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and then that that was very scope will call on products
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this is just to say a metabolic syndrome is something
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absolutely fascinating or our thinking start the from here
00:24:06
there was a lot of all the not made a member seem them
00:24:09
x. c. m. x. was in the late seventies early eighties
00:24:14
this concept of lean b. would be quite good at these clean beep
00:24:19
where where do you think right that they get i give aspect because they
00:24:25
have me but dammit that are that are metabolism is like lingo beach
00:24:30
and we will show on that you have a substantial proportion of people
00:24:34
won't be my lean back metabolic ali let's call them all these
00:24:40
in and that is the thought about colon cancer so this is
00:24:43
the how dare east of cotton 'cause goes up you know
00:24:48
basically one forty percent sixty percent that one must
00:24:52
dabbling with going with a um being obvious
00:24:56
our contribution to this dog is is is that i
00:24:59
don because until recently for the general agreement was
00:25:04
bingo basing these basic very against inanimate nineteen we because in women you have to take waste
00:25:11
he's only abdominal obesity is clearly associated man
00:25:16
tend to be abdominal b. is in only part of the women went
00:25:20
there be allowed only obese they would try not to be good
00:25:23
so this is the one that is associated with increased duties and the number of other metabolic about that
00:25:29
now when you combine waste and say that by that
00:25:34
then you get a sense in which is really interesting from a you see all agenda mechanism point
00:25:41
of view because basically say what we see is that if we take people who are lean
00:25:47
and have a link here and have low level of super tight as
00:25:51
a marker of chronic production of injury no he principally name yeah
00:25:55
a definition your resistance by separation you basically say that for each level always
00:26:02
there is a couple of years ago was out you know one fifty
00:26:06
percent double c. uh with increasing levels it but that that
00:26:11
and so it looks like see that that is the having much more the region
00:26:16
then a waste accepting people what really you know i've got everything
00:26:21
wrong basically they're really overweight and that they are high steep
00:26:26
but basically that be that babbling hobby incidents down very being between
00:26:31
being lean a normal user interface yeah a sensitive
00:26:36
and being will be uh uh don't obviously p. it means languages
00:26:41
no quickly draw the pore size and the inflammation
00:26:47
so this is possibly one of the most exciting way to understand why
00:26:53
is not the single foot but uses his apartment because we have a
00:26:58
we we think that uh you know a base got people making
00:27:03
is seen as a protective around in a plastic anti probably for that you
00:27:06
want your purported characterised anderson within uh energy uh almost as is
00:27:13
no one would expect a deep or neck going to
00:27:16
be a nowhere in people who develop colon cancer
00:27:21
in the this is exactly the case so basically we show
00:27:25
that higher level are the one acting within normal range
00:27:29
associated with the nothing that the percent of the ducks under the school developing content
00:27:35
letting him if it's the other way around in the only because
00:27:40
uh it's seems to be percussion or janet is a um
00:27:46
is greater from from a positive associated with that forced the issue in there's a yeah
00:27:53
some proper he stimulates set recuperation uh andy changes
00:27:58
incest survivor so it wasn't young wrong directions are in we did yes the start and what we found is that
00:28:04
ah actually lebanese now now in this for all three million people is not associated
00:28:09
with that any difference in a cancer this gives you one flat everybody's
00:28:14
but the solar bowlers sent out that binds for what we understand
00:28:19
late in in the last by opting for his okay so
00:28:22
if you have a lead in but you're lacking is not that
00:28:26
the the other forty percent reduction in collective correction risk
00:28:31
inflammation our graeme having had the chance of war collaborating
00:28:35
for ten years with the marks element the
00:28:39
the colleague who will we we invent but you know the entity in this file for a a or
00:28:44
when it computer project might be more work on it that way up in internet file for
00:28:49
but it happens that on blood samples border for twenty years
00:28:53
and not with the proper way for this measurement
00:28:56
measuring interlocking young to pick up the high level small deluxe so we have um
00:29:03
to to say something to the to the various them see that the protein
00:29:07
source of protein used by the lever and then by are the problem
00:29:12
and it shows that the people have chronic inflammation which means high
00:29:17
levels directly protein every fifty percent increase in collectors risk
00:29:22
and if people have higher a reactive oxygen multiple i forgot that products that distressed
00:29:27
at increased risk so that is the conclusion problem can so that saves
00:29:32
starting from the the yeah twenty years ago that you know some food that may have an impact
00:29:38
now we understand the data a number of forces have an impact dozing green which
00:29:44
reduce the risk adverse that increase that is correct me process made ah oh
00:29:49
but most importantly is this side is the right side of the story
00:29:53
we do understand that the driving to the driving force he's had the metabolic factors which
00:29:59
are influenced by nutrition but also that physical activity and by the type of work
00:30:05
so now we can say this can be that b. is is i'll send
00:30:09
giving bases however a much more broader or the fit prevention strategy
00:30:14
and because it's factor this same that are of interest for crappie rascal diseases
00:30:19
in the end for them as we did them however on exercise of this simple seven
00:30:25
that nancy was a sighting okay but we're gonna have a cholesterol so it ended up being the simple six
00:30:32
in the end and so this is twenty s. follow up half a million people
00:30:38
the curve is our observation no it's not mathematical uh
00:30:43
more during that only three per se show you the first one show of your peers
00:30:48
women have a better survive so the condition is to be a lot of stuff from the observation if that helps
00:30:55
and then this is the probability of remaining alive ah wage seventy seven point so
00:31:01
it shows that women have a much better probability of order being alive
00:31:06
twenty years later then man but that down here
00:31:10
no we then divided by smoker and more smokers and that is the first interesting
00:31:15
story because then you see that into a separate non smokers and smokers
00:31:21
man ever lower probability of being alive but is not
00:31:25
that automatically low a lot is explained by smoking
00:31:30
and he yeah came the big surprise the really big surprise that we are almost didn't believe it
00:31:36
so if no uh with separate people by the fact that in their
00:31:40
forties and fifties and early sixties they had they had done it
00:31:45
the one we recommend a a moderate drinkers model physically active
00:31:50
whether lean and normal blood pressure compared to the opposite
00:31:55
oh any difference between men and women disappears
00:31:59
man have a nine women have ninety percent probability of being alive man ninety seven
00:32:06
so it or short that the difference between men and women in terms of
00:32:12
yeah life expectancy by for between these two age groups age ranges is
00:32:18
probably not the way to the fact of being men a minute
00:32:21
the men of being a woman is that women are much more clever than matt this
00:32:26
is it is as simple as that that they have less extreme stupid behaviour
00:32:32
and the uh and and you see that that men have down down
00:32:36
here is not even when there's more men need to smoke cigarettes
00:32:40
if if there's more women tend to smoke fifteen and they die less so that's that is
00:32:46
very practical so basically it says that yes twenty percent that's percent of them are
00:32:52
but i'm not sure that is due to smoking but then diaper as a substantial way hybrid preference on the show
00:32:59
so this is math means exactly the the same data we bust it four years ago
00:33:06
when we look at fifty point million better on the word with my colleague yeah
00:33:10
um as you that that the end we look like courses of that
00:33:14
a hobby scores of that could be able to do that to non risk
00:33:16
factors and from the word word level high blood pressure comes up
00:33:21
about tobacco because the backup prevalence is going down in many parts of the
00:33:26
war not everybody is more about everybody has a secret police system
00:33:30
and then a high blood glucose for physical inactivity
00:33:35
um hi by the in my cholesterol are colour and no foot in the
00:33:40
so basically that explains with uh the of that and means that if i mean we can save life but we
00:33:47
can postpone that isn't it so we can make people meeting a little bit longer in a better health
00:33:53
uh probably only anything about that that's not the big west
00:33:56
any final you is that any whole i mean
00:34:01
having this go over the and number of courses and modified or modified causes of disease
00:34:07
is that any chance we can prevent it yes weekend has been said there this morning be the beeper in
00:34:14
many companies on the anti tobacco no uh campaigns that
00:34:19
there's no let so many millions of man
00:34:23
to give up smoking as a as as maybe it's fantastic next rather preventative
00:34:29
um you know uh yeah stab you see this is the more data for lung cancer
00:34:35
is dropped now in my many candidates to what it was in nineteen fifty
00:34:39
what we had was in the bottle using men women i just the analysts the data for you play and presented them with the
00:34:45
mouse then i guess austin london so the prediction is that in
00:34:49
five years like this season you play with the higher than
00:34:54
but i conclude with one slide as it cancelled yeah desert uh uh s. l. a. p. d. normal just
00:35:01
i want to pay tribute to the colleague who worked on uh a captive after diseases
00:35:06
because they have demonstrated without any doubt that you can substantially reduce
00:35:12
the mortality for cardiovascular diseases would be in a generation
00:35:17
bringing down from levels which where one point two percent area of that
00:35:22
in the population down to zero point three zero point four in both men and women
00:35:28
so the draining is between fifteen twenty years we will be able to look
00:35:33
at some data on cancer that there's going down the same way
00:35:38
the most that there's going down for cardiovascular diseases because prevention as possible e. if we combine
00:35:44
person intervention with source item measures we cannot put all the blame on the individuals
00:35:50
and we cannot expect that everything would be shouldered by energy solution has to
00:35:55
be a combination eighty like there's been for for uh for tobacco
00:35:59
and the industry yeah as a fantastic opportunity here to
00:36:02
play a positive or think of whatever things up
00:36:13
thank you very much ooh extremely interesting yeah i think
00:36:16
it's something you're the new one to one
00:36:25
change i you know i see you on the p. c. which is
00:36:39
see it's cool okay let's talk a lot
00:36:47
one area which is actually like at a random mutation
00:36:53
it's hard for transcription uh like if you start
00:36:58
oh that's right i much most which just such
00:37:05
uh the rest actually how to achieve that
00:37:11
about expert yeah ah yes extra cost while um
00:37:16
thank you i had them one on my slide about variations
00:37:21
i yeah the something that was ironical uh which is taken out to be serious
00:37:26
and uh i was saying is it difference environmental factors or these bad luck
00:37:33
that was all just thought about that and is this thought about iraq uh in the yeah
00:37:39
now that there's been a number of our discussions i this simple my personal vision is that
00:37:48
if you look within the population and you look within a normal genus population
00:37:54
what is a predicted by changes in behaviour between individuals
00:38:01
you end up probably that give allegations you can see
00:38:05
is the variation within a group of canyons or
00:38:09
uh people from united states and so on in there for you look at evaluation in that respect
00:38:16
in the say so much is explained by the natural
00:38:21
variation of making a ever seen unit applications
00:38:25
in stem cell so it is the natural background out of a cell cycle going wrong
00:38:31
um no if you instead of looking at it evaluation within
00:38:36
united states of america you look at this variations
00:38:43
then it's a difference thought because these are thirty
00:38:49
four variations so i it's it's all that
00:38:53
well the constant bach analysis of variance you know you have a variance i much of your
00:38:58
that bottle that ensues explain but that now if you had a variance is like these
00:39:04
a small that fact that explain more about the evaluation that l. p. i. v.
00:39:11
c. u. two behaviour factor for colorectal cancer is not two or three
00:39:18
is that the so the western isn't that fantastic work done by i'm
00:39:23
a i'm a force time and the in and products in isn't
00:39:30
is great back to my my opinion that is a huge over estimation of
00:39:35
the role of in o. d. and don't you know it's bad luck
00:39:41
it is an opinion isn't more than what it was in the weather sense scientific or a start this this is p.
00:39:53
so you can't say it's it's it's
00:39:57
oh yeah it's it's it does it still feel i guess
00:40:07
explains does pay off it's just sell locales
00:40:16
actual six calls it
00:40:22
okay justin i can answer with one word or no
00:40:27
uh it's all it's all about number see that's the type or see that's the dapper inhalation
00:40:33
ah the ah the changes seen the type of lung cancer there's you know
00:40:38
you know when i started working on lung cancer thirty years ago that was my beginning or so
00:40:44
don't predominantly was a spinner several accuracy norma was broadcasting on a horse clyde
00:40:49
better one which means in the central part was due to heavy tobacco
00:40:54
with a lot of ah of ah and uh with the cup deposited them
00:40:59
in the central part of now and jason now it's nothing like that
00:41:04
these other nuggets normalise but it but if it out is a
00:41:07
credit to time because you smoke very light see that it's
00:41:12
you need a unit that deeply that because it's line you don't need it and so on
00:41:18
so you have a different type of cancer a wee man
00:41:23
this is a good one and the same explain why
00:41:27
the thing by d. r. a. of tobacco smoking by young women
00:41:34
and you see the back while i get asked the in your generation to people like me and want uh
00:41:41
what do you think that where smokers yeah giving up so you i mean that may
00:41:45
okay i have to see the the short term benefit when people uh e. when anti smoking campaign
00:41:52
shortened benefit is people small give up smoking we didn't we didn't four five six years
00:41:58
director of a bit of getting like cancer goes down and people give
00:42:02
up smoking competitive get get smoking that is the short term
00:42:08
the long term benefit is that young people don't give up some but
00:42:12
you will get that for that one would be okay so
00:42:18
women that were not that many women one now saving fuel so when smoking
00:42:24
so we don't have the benefit of those who gave up smoking
00:42:27
but we have all of the new generation of women who started smoking only twenty thirty as well
00:42:33
in now which which i think is right in maine goes down you know or what
00:42:41
i don't have it there is no evidence in my knowledge of any
00:42:46
gender difference i mean that was the high point is that women would be more a consistent
00:42:52
but because uh all studies were wrong i mean the they were wrongly estimated hey just thought
00:42:59
number cigarettes in type of tobacco i'm exposed to the same chemical carcinogen men and women
00:43:07
get the same probably out of the same probably they're getting and guess but different because the sega seven four
00:43:15
yeah
00:43:19
i i i i i i i i i well
00:43:34
ah
00:43:42
s. o.
00:43:48
is
00:44:00
oh
00:44:11
o. f. this f.
00:44:18
so how much of a thanks uh it's an important western but it's also difficult question a lot
00:44:37
i'll try to answer to the best of my knowledge and understanding soak
00:44:41
storm i can see is certainly seem very very multi factorial
00:44:47
disease ah he's unlikely that's one of the factors we
00:44:52
know he said as a dominant role like
00:44:56
a tobacco smoking okay so what we know now he's really go back to play laurie
00:45:03
is not necessity and is not sufficient but this mom
00:45:07
said leap helping let's say pretty sporting preparing go
00:45:13
the song to um to something going wrong by you know a meat appreciation shall we
00:45:22
excessive salt intake i think there is overwhelming evidence that having it died twenty
00:45:29
five grams thirty grams of salt per day as it used to be
00:45:35
in japan what they had by far the highest incidence of stomach and seen the planet
00:45:40
or in areas like columbia so where sort was traditionally
00:45:45
use it to preserve food but then it become
00:45:48
he part of the night so people got used to have a baby can cease
00:45:53
yeah prepared with a very high salt intake so so for sure
00:45:59
consumption of fruit and vegetables i think that the moderate but the fact
00:46:04
protective thing of fruit and vegetable is there has been seen consistently
00:46:09
he he it's about the design of the action movies cover the order of thirty forty percent
00:46:15
and given that be like your fruit and vegetables over the past century has an almost an increase that
00:46:22
yeah there was a hoover and the chance of reading about diet
00:46:27
in the service of the forties me in may know that the consumption
00:46:32
of fruit and vegetables was high anything towns thinking rather yes
00:46:37
'cause we you fruit fruit and vegetables if somebody bring them to the shop when you leave
00:46:43
if you live in a rural yeah you only eat what you with a growing right
00:46:48
and the stomach insisted that going down first indices and
00:46:52
then in the right now so i'll it's
00:46:56
as far as we know these three factors combine the user of the consumption off
00:47:03
meet preserve we'd sold by tradition you know italian i'm partial to whatever it is it
00:47:09
uh the sony amiga yeah it's it was a necessity
00:47:14
you you you had the for that you need to preserve the full for the winter uh there was there was nothing to it in the winter
00:47:19
no yeah so all these s. progressively changed in this has been in natural experiment
00:47:26
nobody can claim any mandate in these decrees justice has come true
00:47:31
everywhere in the planted even in japan is his point has come down by half
00:47:36
of what used to be when it away to us thirty forty years
00:47:44
yes thank you for that a very nice that discussion that i use anger caesars
00:47:50
cursor genesis i think as your where saudi coming up for air maybe common
00:47:56
ah all of programming reprogramming happens and sells what's the conch answers
00:48:02
so what what does that say have you all look at all um i
00:48:07
i environmental or nutritional factors that affect uh on progression or korean
00:48:19
well i have i have been known to say uh progress you lay the
00:48:26
or even dating my interest in to how diet physical activity on for
00:48:33
palm at three and the really could be a view of
00:48:37
could at least it's me or so fact can socially
00:48:40
viable after the that's the the frontline treatment
00:48:45
and this you know that there are a number of studies going on now randomised clinical trials practically on that
00:48:53
patients who live successfully treated for breast cancer and colon cancer and collect
00:48:59
the cans desert two main groups of start cancer being investigated
00:49:05
so although not a number of most descent the cat and the most clinical trials that look at
00:49:10
the fact that we controlled physical activity improve that
00:49:14
um we are of the a weighting the the
00:49:18
results of this first generation of trials
00:49:22
and um there are a few conducting you pay that is the one coordinated by colleagues
00:49:28
from a can of them with the same topic north america in the in europe
00:49:33
there is a observation against that women will have created for that instance uh
00:49:41
and then gain weight ah that completed the sound
00:49:45
via subtly teeny or and hormonal treatment
00:49:49
uh they put on weight they have a higher probability of that uh looking
00:49:54
at that stage this is what's the whole and the same appeals for
00:50:00
column which which to some extent makes sense in the disease
00:50:04
more third pilot growth thank those environment
00:50:10
that steam what is a cancer cells that are orgy hanging around
00:50:15
uh in use by the saturday and uh in the
00:50:22
all the way they act shapes shape it i i i i was
00:50:34
i i got fifteen start at the top
00:50:41
for t. i.
00:50:51
thanks to beat act just small t. i. c. s. strong
00:51:02
christ i i. s. ha ha ha ha h. h. h. p. right
00:51:17
i i just said well that's it like i see i see just such
00:51:26
thank you very much for saying or what you have said that um
00:51:30
and uh no i was not not mind penchant one that played
00:51:34
this actually this is probably one of the results of the study that
00:51:38
time marks it's more uh closer you know that's because uh
00:51:44
hi you're really spend a lot of time to try to destroy these results you know
00:51:50
what it means is important when you find something which is really changes the way
00:51:56
i think they're trying to say that must be an arrow that's to be analysed in in many ways in the um so i
00:52:04
was a person involved in the data analysis which went on much more than normally does
00:52:09
and i personally convinced that this association is extremely strong and there's no way to get rid of it
00:52:16
um eighty grams eighty uh eighty two more grams
00:52:21
of of red meat but days not reveal
00:52:24
is not prevail because basically says consuming a a set a
00:52:28
good portion of red meat there every other day
00:52:32
um we we we if you push up after a hundred and sixty grams uh they have they
00:52:39
the least keeps going up so it goes to one point it's
00:52:42
eight something like this so it's not really a little um
00:52:48
my personal vision of a health and the environment is that
00:52:53
we should make it be the effort to reduce
00:52:57
you know a reading a a room in ounce for our own consumption
00:53:02
i think would be good for our health part of the planet
00:53:06
so i'm very much attached to this and simply saying
00:53:10
you know in terms of strengths of the association
00:53:15
it's one out of four five factors that combine that explain why colorectal cancer
00:53:21
has become so frequent today is the most frequent cancer for
00:53:25
example in southeast asian population singapore is number one can't
00:53:30
in chinese population you know it was extremely right you know western style has brought
00:53:35
this so i get with i don't want all the play but the uh
00:53:40
yes this month of understanding in the multi fuck buddy out yeah yeah you just fall out
00:53:45
because what what even wanna look at it right now i i can't figure out what goes
00:53:51
compensate each other show yeah that i just that's what it's others so basically says
00:53:57
so basically if there's let's imagine a um so what we have are done
00:54:03
yeah is that we haven't just the addressee properly i draw the the
00:54:08
uh for each other and for fruit and vegetables fibre consumption be
00:54:14
yeah mine physical activity for i think they go along
00:54:19
we're not a million people you can have the next doing that so basically said that if you need
00:54:26
eighty grams of me you always goes up by one point two five twenty percent increase
00:54:33
but if you are in their stuff you're absolutely is
00:54:37
goes down by thirty five percent use with six
00:54:40
so if you alternate uh you he's one day and meted yeah that they uh they end up being used so
00:54:53
very good so we going to pick stuff happens
00:55:03
stuff it just okay
00:55:08
they almost all actually if such which led by a state
00:55:15
with questions so i'll i'll in almost fall a button to pick publication from it big
00:55:22
we published the overall risk and they're either in the main paper or in
00:55:27
and it's a ah visual material we always pops the relative
00:55:31
risk in each of the ten counters right i um
00:55:37
you have here for example i think with the base for
00:55:40
ross isn't it is absolutely homogeneous and the same thanks
00:55:45
for process that led me into ten campus in even if we subdivided in twenty three regions
00:55:52
d. a protective effect of fatigue is a bit more encouraging us in the sense that the uh
00:55:59
number of counties where a v. h. c. i. d. that usually there
00:56:04
is not significantly and and where the more significant reduce it's
00:56:10
so the effect of fish had more between can't evaluation was all in the same direction
00:56:17
no where fish was bad like nowhere process and red meat was good for reducing the risk
00:56:24
but was more that they were genus we don't understand why we don't understand why
00:56:31
uh one explanation is the total amount of fish consume in that company um
00:56:37
and the close with this one of the difficult in the p. d. knowledge
00:56:40
e. use when you want to find anything associated with a small
00:56:44
variation is like if you have a study with mice and you see the the doors are
00:56:50
programs and two point one grams even if there isn't it said not
00:56:56
you would go to for a sixty you know try to go
00:57:00
german a jamaica it so we had countless within which there is very
00:57:06
marcus consumption of fish and very little variation between individuals and that is what is
00:57:12
more variation we tend to see what that is more variation is it
00:57:17
i still believe that fish or make a three and one
00:57:21
story we all do very well it's it's it's a
00:57:25
good source of of who that uh that this say four is good for health and good for kids
00:57:34
well we we still have time for questions still push the question
00:57:39
i think it's a great until actually for if i questions
00:57:44
i yeah i'm a couple issue you take my take on this
00:57:51
is the case i population it's just i i ha
00:57:59
oh for the shape who else i yeah i i
00:58:03
actually think they can have very so thank you
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