A recently published paper is challenging conventional assumptions surrounding diet and disease. Raphael E. Cuomo, Ph.D., professor and scientist in the UC San Diego School of Medicine Department of Anesthesiology, evaluated findings across numerous studies in his latest paper, The nutritional epidemiology risk–survival paradox, published in The Journal of Nutrition.

The paper introduces a newly described phenomenon demonstrating that nutritional exposures commonly seen as detrimental to health, such as obesity, moderate alcohol consumption, elevated cholesterol and certain antioxidant supplements, can paradoxically predict better survival in some individuals who develop cancer or cardiovascular disease.

Repeated findings show that dietary exposures linked to disease risk are associated with better survival once disease is present. This paper formalises the general principle, which the scientific community has named 'Cuomo’s Paradox', that nutritional factors which help prevent cancer or cardiovascular disease can be neutral or even show the opposite association with survival after diagnosis. The behaviour that helps avoid disease may not be the behaviour that helps patients live longer after diagnosis.

Prof Cuomo highlights that his research has uncovered pre-diagnosis versus post-diagnosis as a core variable in nutrition. It has became clear with this research that prevention advice and survivorship advice must be separated and healthy should be defined relative to a person’s stage in life and goals. Cuomo’s Paradox reframes health as prevention versus survival. 

Whilst talking about other factors that impact health for individuals Prof Cuomo says, "It's always important to consider when other factors might be influencing the results, but even when studies account for things like smoking, age, existing health problems and treatment, we still see patterns that line up with Cuomo’s Paradox."

Millions are living with advanced cancer or heart disease; Cuomo’s Paradox gives clinicians a rationale to individualise recommendations for patients rather than copy prevention rules. The boundaries of this paradox have yet to be uncovered, though it is expected that it will have applications outside of cancer and cardiovascular disease. 

Big health databases that track heart failure patients already have the information needed to explore Cuomo’s Paradox using methods that mimic clinical trials although there is less evidence that this applies to those with diabetes or hypertension. Prof Cuomo says, "Researchers should also consider running practical nutrition studies that look at how diet affects survival. This principle will help to guide targets that differ before and after diagnosis."

Cuomo’s Paradox seeks longer and better life, not narrow gains at new costs. Pairing any stage-specific target for novel dietary guidelines with safety labs and secondary morbidity tracking can safeguard patients form any sudden guidance shifts.

Source: University of California