National Association Reports
    Adding the preventive nutritional approach to WHO 'Smart in the Sun' guidelines
    Vol. 17 Issue 2
    Country: Israel
    Following extensive work regarding the potential of a nutritional contribution to sun protection recently published by Dr. Niva Shapira, member of the Israeli Dietetic Association (Nutrition Reviews (2009; 68(2):75-86), the Israel Cancer Association adopted the nutritional approach and included it in their ‘Smart in the Sun’ WHO guidelines for the first time, with a press conference and release on May 3, 2010 to coincide with the beginning of national Skin Cancer Awareness Month. There has since been of high public interest including multiple media interviews and communications, with people adopting the concept that ‘Smart in the Sun’ also includes a nutritional dimension with associated dietary guidelines.

    External strategies attained limited compliance and risk reduction
    Where external sun protection strategies recommended by the WHO’s widely publicized ‘Smart in the Sun’ program – including avoiding peak illumination hours, wearing appropriate body cover, and frequent application of sunscreen – have not attenuated the globally increasing epidemic of skin cancers (especially melanoma), research has shown that some nutrients reduce sun-induced photo-oxidative damage, while others may increase it, suggesting that a nutritional approach could play a preventive role.

    Critical role of diet in sun-protection
    The nutritional approach to sun protection recently became relevant following the understanding of the photoxidation sun-damage mechanism, whereby ultraviolet radiation oxidizes skin DNA, protein, and membrane lipids, initiating oxidative radical damage that triggers inflammatory and potential carcinogenic processes and undermines the immune system, compromising both skin repair and general health. A highly antioxidative diet combining dietary antioxidant vitamins, minerals, and phytochemicals – especially those accumulated in skin, i.e. carotenoids lycopene and beta-carotene plus factors supporting antioxidative enzymes – with anti-inflammatory n-3 polyunsaturated fatty acids, especially from marine sources, and anti-genotoxic n-9 monounsaturated fatty acids from extra-virgin olive oil, as well as low-fat dairy products and low amounts of pro-inflammatory n-6 polyunsaturated fatty acids, red meat, and alcohol (save for red wine), has been associated with reduction in risk of skin cancer processes.

    These elements in the traditional Greek-style Mediterranean diet (in addition to long-advised good sun habits and medium-sensitive skin type) may have contributed to the low rates of melanoma in Crete, Greece, and in other Mediterranean countries, despite high regional levels of solar radiation. Application of such a nutritional model is expected to be relevant to other populations for lifelong internal support of sun-protection mechanisms. Dr. Shapira and the Israel Cancer Association are currently working toward expanding the nutritional dimension to WHO’s international ‘Smart in the Sun’ guidelines and educational efforts.

    Nutrition research leading a policy change in health behavior
    This is an example of how nutrition research conducted by clinical dietitians can initiate national policy and expand it further to the international level.
    ICDA is a most relevant stage to present the dietary approach to sun-protection, in conjunction with Australia’s own advanced research in this direction and dietitians and scientists the world over, to empower the profession and promotion of health behavior.

    Dr. Niva Shapira
    Clinical Dietitian
    Institute for Nutrition Research, Rabin Medical Center/Beilinson Hospital, Petah Tikva, Israel
    Consultant to the Israel Cancer Association