Serum carotenoids and cancer-related fatigue: An analysis of the 2005-2006 National Health and Nutrition Examination Survey

Evaluating the role of dietary interventions in reducing chemotherapy toxicities in cancer patients: a systematic review

PURPOSE

This systematic review synthesizes current literature examining the relationship between various dietary patterns and chemotherapy toxicities among patients currently receiving chemotherapy treatment. It aims to determine the most advantageous dietary pattern for patients with various malignancies.

METHODS

PubMed, CINAHL, and Embase were thoroughly searched to select quantitative studies that answered the research question and met the inclusion criteria as of July 2024.

RESULTS

Fourteen studies were analyzed: 10 randomized control trials (RCTs), 2 quasi-experimental, 1 case series, and 1 cohort study. Analyses were stratified by dietary pattern: fasting; Mediterranean diet; ketogenic diet; plant-based, high-protein diet; and anti-inflammatory diet. The results suggest that these all have the ability to benefit patients' experiences with chemotherapy. Fasting; a Mediterranean diet; a plant-based, high-protein diet; and an anti-inflammatory diet may reduce toxicities such as fatigue, diarrhea, insomnia, and nausea throughout chemotherapy. The ketogenic diet might offer initial advantages in improving diarrhea and physical activity; however, these results may not be sustainable.

CONCLUSIONS

There is insufficient evidence to identify a single dietary intervention as the most effective in reducing chemotherapy toxicities in patients undergoing chemotherapy. Further research is necessary to uncover the most beneficial dietary pattern to recommend as a nutritional strategy for survivors undergoing chemotherapy.

IMPLICATIONS FOR CANCER SURVIVORS

Survivors may benefit from adopting specific dietary patterns to alleviate chemotherapy toxicities. These reductions may improve chemotherapy tolerance, minimize treatment interruptions, and enhance daily functioning.

Adherence to the Mediterranean diet is associated with lower cancer-related fatigue: a cross-sectional analysis from NHANES 2017-2020

Background and objectives

Cancer-related fatigue is a common and distressing symptom experienced by cancer patients, which may persist from the time of diagnosis to the end of life. This fatigue negatively affects patients' physical, emotional, and cognitive well-being. Nutrition plays a key role in managing cancer-related fatigue, and recently, the Mediterranean diet has gained attention as a potential intervention. The present study uses data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association between cancer-related fatigue and the Mediterranean diet.

Methods

Data from the NHANES 2017-2020.03 cycle were selected for this cross-sectional study. The Alternative Mediterranean Diet Adherence (AMED) score was used to evaluate the participants' adherence to the Mediterranean diet. AMED scores were calculated based on data from 24-h dietary recall interviews conducted on both day one and day two. Multiple linear regression modeling was used to explore the association between AMED scores and cancer-related fatigue, as well as the relationship between AMED scores and fatigue in the general population.

Results

A total of 6,413 adults aged 20 years and older were included in the study, with 707 identified as cancer patients. There was a noteworthy inverse relationship found between AMED scores and fatigue, which was more pronounced in cancer patients: β = -0.121, 95% CI: -0.172, -0.071 (p < 0.001) in the unadjusted model. This correlation remained significant after adjusting for all variables in model 3: β = -0.074, 95% CI: -0.127, -0.021 (p = 0.007). A significant dose-dependent relationship was found when AMED scores were expressed in quartiles, with a more pronounced negative association as AMED increased across all models (p for trend <0.05). In the cancer population, the analysis of individual nutrients and fatigue revealed that alcohol was significantly negatively associated with cancer-related fatigue in all models, particularly in the unadjusted model: β = -0.710, 95% CI: -1.058, -0.362 (p < 0.001). Subgroup analyses indicated that diabetes, education level and type of cancer had a significant effect on the relationship between AMED and fatigue, with interaction p-values of 0.010, 0.023 and 0.049, respectively.

Conclusion

The present study suggests that higher adherence to the Mediterranean diet may contribute to reduce fatigue, especially in cancer patients; however, further research is necessary to validate this correlation.

Dietary Composition, Meal Timing, and Cancer-Related Fatigue: Insights From the Women's Healthy Eating and Living Study

BACKGROUND

Cancer-related fatigue is difficult to treat, and dietary interventions are promising yet underused.

OBJECTIVE

We explored associations between dietary patterns and fatigue, and the effect of a dietary intervention versus control on fatigue using Women's Healthy Eating and Living study data, plus mediators and moderators of the intervention effect.

METHODS

The Women's Healthy Eating and Living study was a randomized controlled trial among early-stage breast cancer survivors. The 4-year intervention encouraged fruits, vegetables, fiber, and 15% to 20% calories from fat. Fatigue outcomes included a 9-item energy scale and a single-item tiredness question. Dietary quality was estimated using a modified Healthy Eating Index (24-hour dietary recall) and serum carotenoid concentrations. Nutrient timing was obtained from 4-day food logs.

RESULTS

Among 2914 total participants, lower body mass index was associated with less tiredness and more energy at baseline ( P < .001 for both). Earlier start and end times for daily eating windows were associated with less tiredness ( P = .014 and P = .027, respectively) and greater energy ( P = .006 and P = .102, respectively). The intervention did not lead to improvements in fatigue on average ( P > .125). However, the intervention was more effective for participants who were younger, had fewer comorbidities, and did not have radiation treatment. Mediators included increases in serum carotenoids, increases in the modified Healthy Eating Index, and weight loss/maintenance.

CONCLUSION

Diet quality and earlier eating windows were associated with less fatigue.

IMPLICATIONS FOR PRACTICE

Programs that encourage high diet quality and a morning meal and discourage nighttime eating should be tested for efficacy in reducing cancer-related fatigue in survivorship.

Diet as an Adjunct Therapy in Reducing Chemotherapy Toxicities and Improving Patients Quality of Life: A Systematic Review and Meta-Analysis

This review analyzed existing literature regarding the relationship between different diets and chemotherapy toxicities, as well as the quality of life (QOL) among patients undergoing treatment. It aims to identify the most advantageous diet for cancer patients. PubMed, CINAHL, and Embase were used to select randomized control trials (RCTs) assessing the relationship between a specific diet and chemotherapy toxicities and/or QOL in patients as of October 2023. Out of 1,419 records, 11 RCTs were included. Analyses were stratified by diet type. Pooled odds ratios and 95% confidence intervals (CI) were obtained from the random-effect model using STATA. We included 7 studies testing fasting variations; 1 testing a ketogenic diet; 1 testing a Mediterranean diet; 1 testing a plant-based, high-protein diet; and 1 testing an anti-inflammatory diet. Four fasting studies were in the meta-analysis. The random-effects meta-analysis showed no significant difference in the incidence of chemotherapy toxicities between fasting and non-fasting patients. There is insufficient evidence to determine which dietary intervention is the most advantageous, however, there is evidence that all the diets examined may complement conventional cancer therapy by helping to reduce chemotherapy toxicities. No intervention can be ruled out. More research is needed in this field.

The Effects of a Mediterranean Diet Intervention on Cancer-Related Fatigue for Patients Undergoing Chemotherapy: A Pilot Randomized Controlled Trial

Cancer-related fatigue is a common, burdensome symptom of cancer and a side-effect of chemotherapy. While a Mediterranean Diet (MedDiet) promotes energy metabolism and overall health, its effects on cancer-related fatigue remain unknown. In a randomized controlled trial, we evaluated a rigorous MedDiet intervention for feasibility and safety as well as preliminary effects on cancer-related fatigue and metabolism compared to usual care. Participants had stage I−III cancer and at least six weeks of chemotherapy scheduled. After baseline assessments, randomization occurred 2:1, MedDiet:usual care. Measures were collected at baseline, week 4, and week 8 including MedDiet adherence (score 0−14), dietary intake, and blood-based metabolic measures. Mitochondrial respiration from freshly isolated T cells was measured at baseline and four weeks. Participants (n = 33) were 51.0 ± 14.6 years old, 94% were female, and 91% were being treated for breast cancer. The study was feasible, with 100% completing the study and >70% increasing their MedDiet adherence at four and eight weeks compared to baseline. Overall, the MedDiet intervention vs. usual care had a small-moderate effect on change in fatigue at weeks 4 and 8 (ES = 0.31, 0.25, respectively). For those with a baseline MedDiet score <5 (n = 21), the MedDiet intervention had a moderate-large effect of 0.67 and 0.48 at weeks 4 and 8, respectively. The MedDiet did not affect blood-based lipids, though it had a beneficial effect on fructosamine (ES = −0.55). Fatigue was associated with mitochondrial dysfunction including lower basal respiration, maximal respiration, and spare capacity (p < 0.05 for FACIT-F fatigue subscale and BFI, usual fatigue). In conclusion, the MedDiet was feasible and attenuated cancer-related fatigue among patients undergoing chemotherapy, especially those with lower MedDiet scores at baseline.