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Champ CE, Peluso C, Carenter DJ, Rosenberg J, Velasquez F, Annichine A, Matsko K, Hyde PN, Diaz AK, Beriwal S, Hilton C. EXERT-BC: Prospective Study of an Exercise Regimen After Treatment for Breast Cancer. Sports Med Int Open 2024; 8:a21930922. [PMID: 38312924 PMCID: PMC10832577 DOI: 10.1055/a-2193-0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose EXERT-BC is a dose-escalated resistance training regimen created to improve body composition, strength, and balance in women treated for breast cancer (BC). Herein, we report the interim analysis. Women treated for BC underwent this 3-month exercise regimen in an exercise oncology facility with continual monitoring of load and strength. Twenty women completed the IRB-approved protocol, with a mean age of 57 years (range 41-74). Concurrent therapies included anti-estrogen therapy (73%), chemotherapy (14%), and radiotherapy (23%). 27% of women endorsed prior exercise. Subjects missed an average of 1.75 classes (range 0-7), with all meeting adherence over 75%. No injuries or adverse events were reported aside from muscle soreness and 2 days of knee pain. Significant differences in body composition at completion included reduced body fat (38.2% vs. 36.7%, p=0.003), and increased muscle mass (33.1% vs. 37.1%, p<0.001), functional mobility screening (9.82 vs. 11.73, p=0.018), and Y-balance (left: 72.4 vs. 85.3, p=0.001; right: 70.3 vs. 85.2. p<0.001). Significant increases in load were demonstrated: split squat (p<0.001), trap bar deadlift (p=0.035), inclined dumbbell press (p<0.001), and bird dog rows (p<0.001). Dose-escalated resistance training in women with BC is safe and feasible, endorsing significant improvements across body composition, balance, and strength.
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Affiliation(s)
- Colin E. Champ
- Exercise Oncology and Resiliency Center, Allegheny Health Network,
Pittsburgh, United States
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh,
United States
| | - Chris Peluso
- Exercise Oncology and Resiliency Center, Allegheny Health Network,
Pittsburgh, United States
| | - David J. Carenter
- Radiation Oncology, Duke University Medical Center, Durham, United
States
- Department of Radiation Oncology, Wellstar Paulding Medical Center,
Hiram, GA
| | - Jared Rosenberg
- Department of Exercise Science, Syracuse University, Syracuse, United
States
| | - Frank Velasquez
- Exercise Oncology and Resiliency Center, Allegheny Health Network,
Pittsburgh, United States
| | - Adam Annichine
- Exercise Oncology and Resiliency Center, Allegheny Health Network,
Pittsburgh, United States
| | - Krista Matsko
- Exercise Oncology and Resiliency Center, Allegheny Health Network,
Pittsburgh, United States
| | - Parker N. Hyde
- Department of Kinesiology, University of North Georgia, Dahlonega,
United States
| | - Alexander K. Diaz
- Radiation Oncology, Duke University Medical Center, Durham, United
States
- Department of Radiation Oncology, Murray-Calloway County Hospital,
Murray, KY
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh,
United States
| | - Christie Hilton
- Medical Oncology, Allegheny Health Network, Pittsburgh, United
States
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Poltronieri TS, Pérsico RS, Falcetta FS, Viana LV. Changes in Body Adiposity in Women Undergoing Breast Cancer Treatment: A Scoping Review. Nutr Cancer 2022; 74:3431-3445. [DOI: 10.1080/01635581.2022.2081341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Taiara S. Poltronieri
- Graduate Program in Medical Sciences, Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raquel S. Pérsico
- Graduate Program in Medical Sciences, Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Frederico S. Falcetta
- Graduate Program in Medical Sciences, Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana V. Viana
- Graduate Program in Medical Sciences, Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Evaluation of Effect of Honey Sugars Analogue Therapy against Breast Cancer Induced by 1-Methyl-1-nitrosourea in In Vivo Breast Cancer Model. JOURNAL OF ONCOLOGY 2022; 2022:6457266. [PMID: 35386216 PMCID: PMC8977312 DOI: 10.1155/2022/6457266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 11/21/2022]
Abstract
The use of honey as a complementary and alternative medicine is associated with vast range of therapeutic promises. It is established that it exhibits potential innumerable medicinal effects which is attributed to it phenolic, flavonoids, and other diverse compounds profile. However, the effect of honey sugars analogue as its major constituent has not been investigated. This study examined the effect of honey sugars analogue (HSA) namely fructose, glucose, maltose, and sucrose in breast cancer-induced albino Sprague–Dawley (SD) rat models. The treatment was administered when first palpable tumour reached 10–12 mm in size by dividing nulliparous rats (n = 30) into following groups: Group 0 (negative control, n = 10), Group 1 (positive control, n = 10), and Group 2 (received 1.0 g/kg body HSA, n = 10) over a period of 120 days. The effect of treatment against breast cancer was observed with a slower tumour progression, a lower median tumour size, multiplicity, and weight (p < 0.05). The anticancer effect was through amelioration of tumour growth, tumour grading, and haematological parameters. Data also show that HSA administration induces an increased susceptibility of expression of proapoptotic proteins such as Apaf-1, caspase-9, IFN-γ, IFNGR1, and p53, and a reduced expression of antiapoptotic proteins such as E2, ESR1, TNF-α, COX-2, and Bcl-xL 1 in their mechanisms of action. HSA behaves akin to honey. Thus, HSA may modulate breast cancer as an analogue or major profile of honey.
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Taftian M, Beigrezaei S, Arabi V, Salehi-Abargouei A. The Effect of Ketogenic Diet on Weight Loss in Adult Patients with Cancer: A Systematic Review and Meta-Analysis of Controlled Clinical Trials. Nutr Cancer 2022; 74:1222-1234. [DOI: 10.1080/01635581.2021.1942081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marzieh Taftian
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sara Beigrezaei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Vahid Arabi
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Pimiento JM, Kraemer WJ. Dudrick Research Symposium: Expanding the boundaries of cancer care through nutrition support. JPEN J Parenter Enteral Nutr 2021; 45:1683-1689. [PMID: 34633094 DOI: 10.1002/jpen.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 2020 Dudrick Research Symposium, entitled "Expanding the Boundaries of Cancer Care Through Nutritional Support," was held on March 30, at the American Society for Parenteral and Enteral Nutrition (ASPEN), Nutrition Science & Practice Conference. It was scheduled to take place in Tampa, Florida, but had to be held virtually. The Dudrick Symposium honors the many pivotal and innovative contributions made by the late Dr Stanley J. Dudrick, physician scientist, academic leader, and a founding member of ASPEN. This year, in addition to honoring his legacy, we honored his life. As the 2019 recipient of the Dudrick Research Scholar Award, Dr Pimiento chaired the symposium. The presentations focused on discussing the history, the present and future frontiers in the overlapping fields of nutrition support and cancer care. The late Dr John Daly opened the presentation with a moving tribute to Dr Dudrick's life and then spoke about the impact of nutrition support on surgical care and outcomes for cancer patients. Dr Pimiento discussed the role of nutraceuticals for cancer chemoprevention, and the level 1 clinical evidence surrounding this topic. Dr Kraemer explored the role of exercise physiology for optimal nutrient utilization and the overlap between targeted physical activity and nutrition support to obtain better outcomes on the cancer population. The symposium was closed by Dr Stephen Hursting, who discussed the impact of obesity in the soaring cancer rates and its relationship with clinical outcomes. In this article, we cover the presentations by Drs Pimiento and Kraemer.
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Affiliation(s)
- Jose M Pimiento
- Gastrointestinal Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
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Gomes SL, Bobby Z, Ganesan P, Saroja K, Parameswari G R. Metabolic syndrome and its related biochemical derangements in breast cancer patients who received neoadjuvant chemotherapy: A study from a tertiary care oncology centre from Puducherry, South India. Diabetes Metab Syndr 2021; 15:975-980. [PMID: 33962149 DOI: 10.1016/j.dsx.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Comparison of the existence of metabolic syndrome, its components and their related biochemical complications between newly diagnosed and treated breast cancer patients. METHODS Forty newly diagnosed untreated breast cancer patients and forty breast cancer patients who had received 7 cycles of neoadjuvant chemotherapy were recruited as group 1 and group 2 respectively. Height, weight, blood pressure, hormonal status, and tumor size were noted. The fasting blood glucose and lipid profile were estimated in AU 5811 Beckman coulter Clinical chemistry analyzer. Fasting insulin was estimated using Beckman Coulter access immunoassay system (UnicelDxI600). HbA1c assay was carried out in HPLC based ion exchange chromatography (Tosoh automated glycohemoglobin analyzer G8. Homeostasis Model Assessment 2-IR (HOMA 2-IR), HOMA-% B and HOMA-% S were calculated using an online calculator HOMA CALCULATOR [Oxford University]. Serum hsCRP and MDA were estimated by ELISA. FRAP assay was carried out manually to measure antioxidant status. RESULTS The existence of metabolic syndrome as well as type 2 diabetes was higher in the treated group when compared to the untreated patients. However, there were no significant differences in the indices of glucose homeostasis, low grade inflammation, oxidative stress and individual components of metabolic syndrome between the two groups. The triple negative patients were more prone to develop metabolic syndrome when compared to the triple positive patients. CONCLUSION Suitable therapeutic approaches may be planned out to address the metabolic syndrome and its related complications among breast cancer patients especially during the course of treatment.
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Rosenberg J, Hyde PN, Yancy WS, Ford KM, Champ CE. Quantity of Resistance Exercise for Breast Cancer Patients: Does the Dose Match the Objective? J Strength Cond Res 2021; 35:1467-1476. [PMID: 33900267 DOI: 10.1519/jsc.0000000000003996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Rosenberg, J, Hyde, PN, Yancy, WS, Ford, KM, and Champ, CE. Quantity of resistance exercise for breast cancer patients: does the dose match the objective? J Strength Cond Res 35(5): 1467-1476, 2021-There is currently a lack of consensus as to what defines exercise and resistance training in the cancer setting and whether current studies comply with exercise guidelines. This study aimed to quantify the available research studies using resistance training exercise interventions in the breast cancer setting for future clinical trial utilization. We systemically reviewed all available resistance exercise studies during and after breast cancer treatment in an attempt to quantify to the prescribed dose and whether regimens aligned with general exercise guidelines to improve functional mobility, body composition, and metabolic function. They were then compared with recommendations set forth by the national committees that create evidence-based exercise guidelines. Fifty studies met the initial criteria, with 35 meeting analysis criteria for evaluation. Fifteen studies evaluated an exercise regimen during cancer treatment, and 20 evaluated a regimen after treatment. The average adherence rates were 84% for all studies. Only 23 studies listed specific exercises used within the protocol. Most exercise regimens relied on open chain movements and machine exercises. Around half of studies met criteria to achieve hypertrophy, and 66% met American College of Sports Medicine exercise guidelines for cancer patients. A minority of breast cancer studies implementing a resistance training exercise regimen prescribed a regimen or specific dose that follows general exercise guidelines. This study highlights a potential deficiency in exercise programs designed for patients with breast cancer, and these findings should be considered in future study design.
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Affiliation(s)
- Jared Rosenberg
- Duke Diet and Fitness Center, Durham, North Carolina
- Department of Exercise Science, Syracuse University, Syracuse, New York
| | - Parker N Hyde
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
- Department of Kinesiology, University of North Georgia, Dahlonega, Georgia
| | | | - Kenneth M Ford
- Institute for Human and Machine Cognition, Pensacola, Florida; and
| | - Colin E Champ
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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Low Carb and Ketogenic Diets Increase Quality of Life, Physical Performance, Body Composition, and Metabolic Health of Women with Breast Cancer. Nutrients 2021; 13:nu13031029. [PMID: 33806775 PMCID: PMC8004887 DOI: 10.3390/nu13031029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Breast cancer (BC) patients often ask for a healthy diet. Here, we investigated a healthy standard diet (SD), a low carb diet (LCD), and a ketogenic diet (KD) for BC patients during the rehabilitation phase. KOLIBRI was an open-label non-randomized one-site nutritional intervention trial, combining inpatient and outpatient phases for 20 weeks. Female BC patients (n = 152; mean age 51.7 years) could select their diet. Data collected were: Quality of life (QoL), spiroergometry, body composition, and blood parameters. In total 30, 92, and 30 patients started the KD, LCD, and SD, respectively. Of those, 20, 76, and 25 completed the final examination. Patients rated all diets as feasible in daily life. All groups enhanced QoL, body composition, and physical performance. LCD participants showed the most impressive improvement in QoL aspects. KD participants finished with a very good physical performance and muscle/fat ratio. Despite increased cholesterol levels, KD patients had the best triglyceride/high-density lipoprotein (HDL) ratio and homeostatic model assessment of insulin resistance index (HOMA-IR). Most metabolic parameters significantly improved in the LCD group. SD participants ended with remarkably low cholesterol levels but did not improve triglyceride/HDL or HOMA-IR. In conclusion, both well-defined KDs and LCDs are safe and beneficial for BC patients and can be recommended during the rehabilitation phase.
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Godinho-Mota JCM, Mota JF, Gonçalves LV, Soares LR, Schincaglia RM, Prado CM, Martins KA, Freitas-Junior R. Chemotherapy negatively impacts body composition, physical function and metabolic profile in patients with breast cancer. Clin Nutr 2020; 40:3421-3428. [PMID: 33309160 DOI: 10.1016/j.clnu.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/22/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence suggests that chemotherapy (CT) leads to unfavorable outcomes on nutritional and metabolic profile; however, this is poorly understood. OBJECTIVE To evaluate the impact of CT on body composition, bone mineral density (BMD), insulin resistance, lipid markers related to atherosclerotic cardiovascular diseases in women recently diagnosed with breast cancer according to menopausal status. METHODS This is a prospective study that enrolled women newly diagnosed with stage II-III breast cancer (2014-18). Body composition were measured by dual-energy x-ray absorptiometry. Blood samples were collected to assess lipid profile, insulin resistance and sensitivity, visceral adiposity index and lipid accumulation product were calculated. Dietary intake, physical activity and function were also evaluated at the time of breast cancer diagnosis and after CT completion. RESULTS Ninety-nine women (40.4% in the premenopausal stage) aged 51 ± 1 years took part in this study. CT duration was 197 ± 27 days and main regimen was anthracyclines with taxanes (88.9%). CT was associated with an increase in total and central adiposity, insulin resistance, and all lipid-related markers, and a decrease in appendicular lean mass index, BMD and HDL-c concentration. Premenopausal women experienced greater unfavorable outcomes on adiposity markers and BMD compared to postmenopausal women (p < 0.01). No changes were observed in dietary intake and physical activity after CT. CONCLUSIONS Breast cancer CT negatively impacted body composition and metabolic profile. Premenopausal women experienced greater unfavorable impact on adiposity markers and BMD.
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Affiliation(s)
| | - Joao Felipe Mota
- Clinical and Sports Nutrition Research Laboratory (Labince), School of Nutrition, Federal University of Goiás, Goiania, GO, Brazil.
| | - Larissa Vaz Gonçalves
- Centro Avançado de Diagnóstico da Mama, Hospital das Clínicas, Federal University of Goiás, Goiania, GO, Brazil
| | - Leonardo Ribeiro Soares
- Centro Avançado de Diagnóstico da Mama, Hospital das Clínicas, Federal University of Goiás, Goiania, GO, Brazil
| | - Raquel Machado Schincaglia
- Clinical and Sports Nutrition Research Laboratory (Labince), School of Nutrition, Federal University of Goiás, Goiania, GO, Brazil
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Karine Anuska Martins
- Centro Avançado de Diagnóstico da Mama, Hospital das Clínicas, Federal University of Goiás, Goiania, GO, Brazil
| | - Ruffo Freitas-Junior
- Centro Avançado de Diagnóstico da Mama, Hospital das Clínicas, Federal University of Goiás, Goiania, GO, Brazil
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Champ CE, Klement RJ. Assessing successful completion of calorie restriction studies for the prevention and treatment of cancer. Nutrition 2020; 78:110829. [DOI: 10.1016/j.nut.2020.110829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/06/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
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Khodabakhshi A, Seyfried TN, Kalamian M, Beheshti M, Davoodi SH. Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial. Nutr J 2020; 19:87. [PMID: 32828130 PMCID: PMC7443288 DOI: 10.1186/s12937-020-00596-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Despite recent interest in the use of ketogenic diets (KDs) for cancer, evidence of beneficial effects is lacking. This study examined the impact of a randomly assigned KD on quality of life, physical activity and biomarkers in patients with breast cancer. Method A total of 80 patients with locally advanced or metastatic breast cancer and without a history of renal disease or diabetes were randomly assigned to either a KD or a control group for this 12-week trial. Concurrent with the first, third, and fifth chemotherapy sessions, quality of life, physical activity, and biomarkers (thyroid function tests, electrolytes, albumin, ammonia, ALP, lactate and serum ketones) were assessed. Dietary intake was also recorded on admission and the end of the treatment. Results No significant differences were seen in quality of life or physical activity scores between the two groups after 12 weeks; however, the KD group showed higher global quality of life and physical activity scores compared to the control group at 6 weeks (P = 0.02 P = 0.01). Also, serum lactate and ALP levels decreased significantly in the KD group compared to the control group at the end of the intervention (10.7 ± 3 vs 13.3 ± 4, 149 ± 71 vs 240 ± 164, P = 0.02 and P = 0.007, respectively). A significant inverse association was observed between total carbohydrate intake and serum beta-hydroxybutyrate at 12 weeks (r = − 0.77 P < 0.001). No significant differences between groups were observed in thyroid hormones, electrolytes, albumin, LDH or ammonia. Compliance among KD subjects ranged from 66.7 to 79.2% as assessed by dietary intake and serum ketones levels of > 0.5. Conclusion According to our results, besides a higher global quality of life and physical activity scores compared to the control group at 6 weeks, KD diet combined to chemotherapy in patients with breast cancer does not bring additional benefit about quality of life and physical activity at 12 weeks. However, decreases seen in levels of lactate and ALP in the KD group suggest that a KD may benefit patients with breast cancer. Trial registration This trial has been registered on Iranian Registry of Clinical Trials (IRCT) under the identification code: IRCT20171105037259N2 https://www.irct.ir/trial/30755
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Affiliation(s)
- Adeleh Khodabakhshi
- Department of Nutrition, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.,Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Maryam Beheshti
- Department of Nutrition and Dietetics, Mofid children's hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayed Hossein Davoodi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Cellular and Molecular Nutrition, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Klement RJ, Champ CE, Kämmerer U, Koebrunner PS, Krage K, Schäfer G, Weigel M, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: III-final results of the KETOCOMP study for breast cancer patients. Breast Cancer Res 2020; 22:94. [PMID: 32819413 PMCID: PMC7441712 DOI: 10.1186/s13058-020-01331-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023] Open
Abstract
Background Obesity and low muscle mass are associated with worse outcomes of breast cancer patients. We conducted a controlled trial to study the impact of a ketogenic diet (KD) based on natural foods versus an unspecified standard diet (SD) on body composition in breast cancer patients undergoing radiotherapy. Methods Patients with non-metastasized breast cancer were allocated to either the KD (N = 32) or the SD (N = 31) during radiotherapy. Body composition was measured weekly by bioimpedance analysis. Blood parameters and quality of life were assessed before, during, and at the end of radiotherapy. Results A total of 29 KD and 30 SD patients completed the study. During radiotherapy, mean and median fasting BHB concentrations in the KD group were 0.72 and 0.49 mmol/l (range 0.06–4.9) which was significantly higher than those in the SD group (p < 2.2 × 10−16). There was a very small and insignificant increase in body weight and fat mass in the SD group, as well as a decrease of fat free mass. In contrast, patients in the KD group lost body weight and fat free and skeletal muscle mass quickly after diet onset, which for the most part was related to water losses. The KD did not cause further substantial changes in fat free or skeletal muscle mass, but was associated with a gradual decrease of 0.4 kg body weight and fat mass per week (p < 0.0001). The KD significantly decreased free T3 levels by 0.06 pg/ml/week (p = 6.3 × 10−5). Global quality of life remained stable in the SD group but increased in the KD group from a score of 66.7 to 75.0 (p = 0.20). Conclusions In breast cancer patients undergoing curative radiotherapy, a KD based on natural foods is feasible. After initial water losses, the KD tends to reduce body weight and fat mass while preserving fat free and skeletal muscle mass. Trial registration ClinicalTrials.gov identifier: NCT02516501, registered on August 06, 2015.
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Affiliation(s)
- Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany.
| | - Colin E Champ
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Ulrike Kämmerer
- Department of Obstetrics and Gynaecology, University Hospital of Würzburg, Würzburg, Germany
| | - Petra S Koebrunner
- Department of Radiation Oncology, Leopoldina Hospital, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
| | - Kelley Krage
- Department of Radiation Oncology, Leopoldina Hospital, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
| | - Gabriele Schäfer
- Department of Radiation Oncology, Leopoldina Hospital, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
| | - M Weigel
- Department of Obstetrics and Gynaecology, Leopoldina Hospital, Breast Cancer Centre, Schweinfurt, Germany
| | - Reinhart A Sweeney
- Department of Radiation Oncology, Leopoldina Hospital, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
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Garófolo A, Qiao L, Maia-Lemos PDS. Approach to Nutrition in Cancer Patients in the Context of the Coronavirus Disease 2019 (COVID-19) Pandemic: Perspectives. Nutr Cancer 2020; 73:1293-1301. [PMID: 32696665 DOI: 10.1080/01635581.2020.1797126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is a new pandemic that originated in China in December 2019. Cancer patients are immunosuppressed and very susceptive to acquiring infections; thus, they are at greater risk of developing more severe forms of COVID-19. People infected with COVID-19 display increased plasma levels of pro-inflammatory cytokines. Excessive inflammation may cause damage to the body's tissues, thereby potentially contributing to alveolar damage and the severity of COVID-19. We hypothesize that since a pro-inflammatory state may worsen COVID-19 prognosis, modulating systemic inflammation through dietary modification may be efficacious in improving the clinical sequelae of COVID-19. The aim of this review is to present current nutritional and dietary approaches in the context of inflammation with a specific focus on cancer patients with and without COVID-19. The main topics reviewed include nutrition in inflammation and immunity. A systematic literature search on Google Scholar, Medline, and PubMed databases was performed between March 22, 2020 and May 6, 2020 using the keywords "COVID-19," "coronavirus," "cancer," "inflammation," "probiotics," "vitamin D," and "nutrition prevention." Healthy dietary habits, omega-3-rich diets, probiotics use, and vitamin D supplementation, as well as obesity prevention, are likely the most efficacious preventive approaches to controlling hyperinflammation, improving immune function, and decreasing the severity of inflammatory diseases.
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Affiliation(s)
- Adriana Garófolo
- Support Group for Adolescents and Children with Cancer (GRAACC), Department of Pediatrics, Federal University of São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Lyon Qiao
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Zhang J, Deng Y, Khoo BL. Fasting to enhance Cancer treatment in models: the next steps. J Biomed Sci 2020; 27:58. [PMID: 32370764 PMCID: PMC7201989 DOI: 10.1186/s12929-020-00651-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Abstract
Short-term fasting (STF) is a technique to reduce nutrient intake for a specific period. Since metabolism plays a pivotal role in tumor progression, it can be hypothesized that STF can improve the efficacy of chemotherapy. Recent studies have demonstrated the efficacy of STF in cell and animal tumor models. However, large-scale clinical trials must be conducted to verify the safety and effectiveness of these diets. In this review, we re-examine the concept of how metabolism affects pathophysiological pathways. Next, we provided a comprehensive discussion of the specific mechanisms of STF on tumor progression, derived through studies carried out with tumor models. There are currently at least four active clinical trials on fasting and cancer treatment. Based on these studies, we highlight the potential caveats of fasting in clinical applications, including the onset of metabolic syndrome and other metabolic complications during chemotherapy, with a particular focus on the regulation of the epithelial to mesenchymal pathway and cancer heterogeneity. We further discuss the advantages and disadvantages of the current state-of-art tumor models for assessing the impact of STF on cancer treatment. Finally, we explored upcoming fasting strategies that could complement existing chemotherapy and immunotherapy strategies to enable personalized medicine. Overall, these studies have the potential for breakthroughs in cancer management.
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Affiliation(s)
- Jing Zhang
- Department of Biomedical Engineering, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Hong Kong
| | - Yanlin Deng
- Department of Biomedical Engineering, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Hong Kong
| | - Bee Luan Khoo
- Department of Biomedical Engineering, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Hong Kong.
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Yu Y, Ke L, Xia WX, Xiang Y, Lv X, Bu J. Elevated Levels of TNF-α and Decreased Levels of CD68-Positive Macrophages in Primary Tumor Tissues Are Unfavorable for the Survival of Patients With Nasopharyngeal Carcinoma. Technol Cancer Res Treat 2020; 18:1533033819874807. [PMID: 31522611 PMCID: PMC6747870 DOI: 10.1177/1533033819874807] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Due to the critical role of inflammation in nasopharyngeal carcinoma, we aim to investigate the correlation between nasopharyngeal carcinoma prognosis and the levels of tumor necrosis factor α and macrophages for the development of new prognostic models. The levels of tumor necrosis factor-α and CD68-positive macrophages were measured in 111 primary nasopharyngeal carcinoma specimens by immunohistochemistry. Kaplan-Meier analysis showed that, compared with nonelevated tumor necrosis factor-α levels, elevated tumor necrosis factor α levels were correlated with poorer 10-year distant metastasis-free survival (24.5% vs 5.2%, P = .004) and bone metastasis-free survival (17.0% vs 0.0%, P = .001). Multivariate analysis revealed that tumor necrosis factor α level was an independent prognostic factor for distant metastasis-free survival (hazard ratio = 16.765, P = .001), while the level of CD68-positive macrophages was a favorable independent prognostic factor for cancer-specific survival (hazard ratio = 0.481, P = .023) and disease-free survival (hazard ratio = 0.403, P = .010). Additionally, several prognostic models that considered tumor-node-metastasis stage alone or in combination with tumor necrosis factor α and/or CD68-positive macrophage levels were compared by receiver operating characteristic curve analysis. Interestingly, the T_score model, which considered the tumor necrosis factor α level alone, could better predict the distant metastasis-free survival and bone metastasis-free survival, whereas the MT model, which considered the combination of T stage and CD68-positive macrophage level, could better predict the cancer-specific survival and disease-free survival of patients with nasopharyngeal carcinoma. Elevated tumor necrosis factor-α levels and decreased CD68-positive macrophage levels in primary nasopharyngeal carcinoma tissues are unfavorable prognostic indicators in nasopharyngeal carcinoma. The T_score model or the MT model could be better prognostic models than those currently available for nasopharyngeal carcinoma and could be used to select high-risk patients and aid in the design of individualized immunotherapy.
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Affiliation(s)
- Yahui Yu
- Department of Radiation Oncology, Oncology Center, Zhujiang Hospital, Southern Medical University, Zhujiang Hospital, Guangzhou, China.,Yahui Yu, Liangru Ke, Weixiong Xia contributed equally to this work
| | - Liangru Ke
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Yahui Yu, Liangru Ke, Weixiong Xia contributed equally to this work
| | - Wei-Xiong Xia
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.,Yahui Yu, Liangru Ke, Weixiong Xia contributed equally to this work
| | - Yanqun Xiang
- Department of Diagnostic Radiology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xing Lv
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Junguo Bu
- Department of Radiation Oncology, Oncology Center, Zhujiang Hospital, Southern Medical University, Zhujiang Hospital, Guangzhou, China
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Ahmad MM, Parveen F, Akhter N, Siddiqui JA, Shukla NK, Husain SA. Genetic Polymorphism in TNF-α-308 G/A and TNF-β +252 A/G, as Prognostic Biomarker in Breast Cancer Patients among Indian Population. Asian Pac J Cancer Prev 2020; 21:301-308. [PMID: 32102503 PMCID: PMC7332152 DOI: 10.31557/apjcp.2020.21.2.301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/03/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cytokines are the key regulator molecules that modulate immune response. Tumor necrosis factor (TNF- α-308 G/A and TNF-β +252 A/G ) are inflammatory cytokine that control the progression of several types of cancer. They play a vital role in both tumor progression and destruction based on their concentrations. The role of TNF-α-308 G/A and TNF-β +252 A/G gene polymorphism in the etiology of breast cancer (BC) is not clearly understood. Therefore, present study investigates the association of TNF-α -308 G/A and TNF-β +252 A/G and the clinical features with Breast cancer patients. METHODS In a case- control study, we have investigated 150 breast cancer patients and 300 age and ethnically matched healthy controls for duration of 3 years from North India. Promoter polymorphisms of tumor necrosis factor gene (TNF-α -308 G/A and TNF-β +252 A/G) were genotyped using allele specific oligonucleotide polymerase chain reaction ASO and restriction fragment length polymorphism (PCR-RFLP). The associations were evaluated by calculating the pooled odds ratio (OR) with 95% confidence interval (95% CI) using SPSS. RESULTS Patients with different clinico-pathological variables and healthy controls were analyzed. Significant association was observed in A allele of TNF-α -308 G/A in breast cancer patients as compared to healthy controls (p<0.0001). However, no association was seen in TNF-β +252 A/G both at genotypic and allelic level. The GG genotype of TNF-β +252A/G is higher in grades III (p<0.01) patients. CONCLUSION Our results suggest that TNF-α-308G/A polymorphism showed significant association with breast cancer patients.
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Affiliation(s)
| | | | | | | | - Nootan Kumar Shukla
- Department of Surgical Oncology, BRA IRCH, All India Institute of Medical Sciences, New Delhi, India.
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Inulin Supplementation Reduces Systolic Blood Pressure in Women with Breast Cancer Undergoing Neoadjuvant Chemotherapy. Cardiovasc Ther 2019; 2019:5707150. [PMID: 31772611 PMCID: PMC6739761 DOI: 10.1155/2019/5707150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/05/2019] [Accepted: 05/12/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction Breast cancer is the most frequently diagnosed malignancy in women, and comorbidities like hypertension and obesity diminish their quality of life and negatively affect their response to chemotherapy. Furthermore, inulin supplementation is associated with the reduction of cardiovascular diseases (CVD) risk. Objective To determine whether inulin supplementation prevents the elevation of blood pressure in women with breast cancer undergoing neoadjuvant therapy with cyclophosphamide and doxorubicin. Methods This was a randomized, double-blind placebo controlled trial which included women with early-stage breast cancer undergoing neoadjuvant therapy (n=38). Patients were randomly assigned to participate in two different groups to receive either 15 g of inulin or 15 g of placebo (maltodextrin) for 21 days. Body composition and blood pressure were evaluated before and after the supplementation period. Results Women in the inulin group showed a lower systolic blood pressure (SBP) after the supplementation (-4.21 mmHg, p<0.001). However, SBP increased in the placebo supplemented group. Diastolic blood pressure (DBP) nonsignificantly decreased in the inulin group. Inulin supplementation also increased BMI (p<0.001) but reduced BFP (p=0.288). Furthermore, confounding variables, such as BMI, baseline fasting glucose, age, menopause status, vomiting, constipation, and chronic medication did not have a statistical influence over the inulin effect on SBP. Conclusion Inulin supplementation reduces SBP and prevents increases in DBP in women with breast cancer. This could be an innovative nutraceutical approach to prevent hypertension present in women with this type of cancer at an early stage and may improve the quality of life of the patients and their prognostic development through chemotherapy. Trial Registration Number This trial is registered with ACTRN12616001532493.
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Khodabakhshi A, Akbari ME, Mirzaei HR, Mehrad-Majd H, Kalamian M, Davoodi SH. Feasibility, Safety, and Beneficial Effects of MCT-Based Ketogenic Diet for Breast Cancer Treatment: A Randomized Controlled Trial Study. Nutr Cancer 2019; 72:627-634. [DOI: 10.1080/01635581.2019.1650942] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Adeleh Khodabakhshi
- Department of Nutrition, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Cellular and Molecular Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamid Reza Mirzaei
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Mehrad-Majd
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Sayed Hossein Davoodi
- Department of Cellular and Molecular Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lifestyle change experiences among breast cancer survivors participating in a pilot intervention: A narrative thematic analysis. Eur J Oncol Nurs 2019; 41:97-103. [PMID: 31358264 DOI: 10.1016/j.ejon.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Healthy lifestyle adoption among breast cancer (BC) survivors remains a poorly understood process. This study aimed to qualitatively examine the unique change trajectories of BC survivors who partook in a pilot version of the Healthy Lifestyle Modification After Breast Cancer (HLM-ABC) intervention. METHODS A sample of four BC survivors were studied intensively through longitudinal interviews conducted at four time points with each participant: (1) pre-treatment, (2) mid-way treatment, (3) post-treatment, and (4) three-months following their participation in the HLM-ABC. A multiple-case study, narrative analysis was applied to 15 interviews, resulting in individual narratives as well as shared 'thematic intersections' elucidating cross-participant experiences. RESULTS The findings showed that participants offered unique styles of authorship, characterized by diverse struggles, victories, and motivational insights, organized around the following intersecting themes: (1)Weight management prescription as a motivator or deterrent, (2) 'Time for me' is time away from my family, and (3) Patterns of opposition to lifestyle change. These women's rich, storied accounts suggest experiences of personal growth and imply that existential concerns can be both motivating and deterring in relation to health behavior change. CONCLUSION This research provides a comprehensive and nuanced grasp of healthy lifestyle modification in the survivorship stage of BC.
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20
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Kaiser A, Haskins C, Siddiqui MM, Hussain A, D’Adamo C. The evolving role of diet in prostate cancer risk and progression. Curr Opin Oncol 2019; 31:222-229. [PMID: 30893147 PMCID: PMC7379157 DOI: 10.1097/cco.0000000000000519] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This overview examines the rationale for dietary interventions for prostate cancer by summarizing the current evidence base and biological mechanisms for the involvement of diet in disease incidence and progression. RECENT FINDINGS Recent data have further solidified the association between insulin resistance and prostate cancer with the homeostatic model assessment of insulin resistance. Data also show that periprostatic adipocytes promote extracapsular extension of prostate cancer through chemokines, thereby providing a mechanistic explanation for the association observed between obesity and high-grade cancer. Regarding therapeutics, hyperinsulinemia may be the cause of resistance to phosphatidylinositol-3 kinase inhibitors in the treatment of prostate cancer, leading to new investigations combining these drugs with ketogenic diets. SUMMARY Given the recently available data regarding insulin resistance and adipokine influence on prostate cancer, dietary strategies targeting metabolic syndrome, diabetes, and obesity should be further explored. In macronutrient-focused therapies, low carbohydrate/ketogenic diets should be favored in such interventions because of their superior impact on weight loss and metabolic parameters and encouraging clinical data. Micronutrients, including the carotenoid lycopene which is found in highest concentrations in tomatoes, may also play a role in prostate cancer prevention and prognosis through complementary metabolic mechanisms. The interplay between genetics, diet, and prostate cancer is an area of emerging focus that might help optimize therapeutic dietary response in the future through personalization.
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Affiliation(s)
- Adeel Kaiser
- Department of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, MD USA
| | - Christopher Haskins
- Department of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, MD USA
| | - Mohummad M. Siddiqui
- Division of of Urology, Department of Surgery, Univ. of Maryland School of Medicine, Baltimore, MD USA
- Baltimore Veterans Affairs Medical Center, Baltimore, MD USA
| | - Arif Hussain
- Department of Medicine and University of Maryland Greenebaum Comprehensive Cancer Center, Univ. of Maryland School of Medicine, Baltimore, MD USA
- Baltimore Veterans Affairs Medical Center, Baltimore, MD USA
| | - Christopher D’Adamo
- Department of Family and Community Medicine, Univ. of Maryland School of Medicine, Baltimore, MD USA
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21
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Klement RJ, Schäfer G, Sweeney RA. A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: An interim analysis of the KETOCOMP study. J Tradit Complement Med 2019; 10:180-187. [PMID: 32670812 PMCID: PMC7340871 DOI: 10.1016/j.jtcme.2019.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 12/26/2022] Open
Abstract
Background and aim Ketogenic diets (KDs) have gained interest as a complementary treatment for cancer patients. Here we present first results of our ongoing KETOCOMP study (NCT02516501) concerning body composition changes among rectal, breast and head & neck cancer (HNC) patients who consumed a KD during curative radiotherapy (RT). Experimental procedure Sixty-one patients eating a non-ketogenic diet were compared to 20 patients on a KD supplemented with 10 g essential amino acids on RT days. Body composition was measured prior to and weekly during RT using 8-electrode bioimpedance analysis. Longitudinal body composition data were analyzed using linear mixed effects models. Results and conclusion Patients on the KD exhibited nutritional ketosis, defined as serum β-hydroxybutyrate levels ≥0.5 mmol/l, in a median of 69.0% of blood measurements (range 0–100%) performed in our clinic. In rectal and breast cancer patients, KD was significantly associated with a loss of 0.5 and 0.4 kg fat mass per week (p = 0.00089 and 8.49 × 10−5, respectively), with no significant changes in fat free and skeletal muscle mass. In HNC patients, concurrent chemotherapy was the strongest predictor of body weight, fat free and skeletal muscle mass loss during RT, while consuming a KD was significantly associated with a gain in these measures. These preliminary results confirm prior reports indicating that KDs are safe to consume during standard-of-care therapy. They also provide an important first indication that KDs with ample amino acid intake could improve body composition during RT in curative cancer patients. Consumption of a ketogenic diet (KD) during radio(chemo-)therapy is feasible. In rectal and breast cancer patients, the KD significantly reduced fat mass. Fat-free mass and skeletal muscle mass were preserved by the KD. In head and neck cancer patients a KD influenced body composition opposite to chemotherapy.
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Affiliation(s)
- Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital, Schweinfurt, Germany
| | - Gabriele Schäfer
- Department of Radiation Oncology, Leopoldina Hospital, Schweinfurt, Germany
| | - Reinhart A Sweeney
- Department of Radiation Oncology, Leopoldina Hospital, Schweinfurt, Germany
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22
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Trestini I, Carbognin L, Monteverdi S, Zanelli S, De Toma A, Bonaiuto C, Nortilli R, Fiorio E, Pilotto S, Di Maio M, Gasbarrini A, Scambia G, Tortora G, Bria E. Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer. Crit Rev Oncol Hematol 2018; 129:54-66. [DOI: 10.1016/j.critrevonc.2018.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023] Open
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Travier N, Buckland G, Vendrell JJ, Fernandez-Veledo S, Peiró I, Del Barco S, Pernas S, Zamora E, Bellet M, Margeli M, Cirauqui B, Muñoz M, Tusquets I, Arcusa A, Javierre C, Moreno F, Rodriguez A, Agudo A. Changes in metabolic risk, insulin resistance, leptin and adiponectin following a lifestyle intervention in overweight and obese breast cancer survivors. Eur J Cancer Care (Engl) 2018; 27:e12861. [PMID: 29869823 DOI: 10.1111/ecc.12861] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 02/01/2018] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
Abstract
Adiposity and physical activity are modifiable factors that could be important determinants of breast cancer (BC) prognosis through their effects on endogenous reproductive hormones, chronic inflammation and metabolic changes. Therefore, it is necessary to evaluate whether offering lifestyle interventions to BC survivors could affect the levels of certain biomarkers involved in these mechanisms. We designed a pre-post intervention study offering diet and exercise sessions over 12 weeks to 42 overweight/obese BC survivors. Before and after the intervention, we obtained dietary information, anthropometry and cardiorespiratory fitness (CRF) measurements and blood samples to measure metabolic risk, insulin resistance and adipokines biomarkers. Wilcoxon signed-rank tests and Spearman partial correlation coefficients were used to compare pre- and post-measurements and assess the correlations between changes in biomarkers and changes in anthropometry and CRF. Breast cancer survivors showed significant improvements in metabolic risk biomarkers and insulin resistance indicators along with a non-significant leptin decrease and a significant adiponectin decrease. The improvements in metabolic risk biomarkers, insulin resistance indicators and leptin were moderately correlated (0.32 ≤ |r| ≤ 0.55) with the decrease in body mass index and the increase in CRF. Diet and exercise interventions implemented in overweight/obese BC survivors may improve metabolic risk, insulin resistance and leptin biomarkers.
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Affiliation(s)
- Noemie Travier
- Cancer Prevention and Control Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Genevieve Buckland
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Joan J Vendrell
- Diabetes and Metabolic Associated Diseases Research Group, Hospital Joan XXIII, School of Medicine, Rovira i Virgili University, Tarragona, Spain
| | - Sonia Fernandez-Veledo
- Diabetes and Metabolic Associated Diseases Research Group, Hospital Joan XXIII, School of Medicine, Rovira i Virgili University, Tarragona, Spain
| | - Immaculada Peiró
- Clinical Nutrition Unit, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Sonia Del Barco
- Department of Medical Oncology-ICO, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Sonia Pernas
- Breast Cancer Functional Unit, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Esther Zamora
- Vall d'Hebron Institute of Oncology (VHIO), Breast Cancer Unit, Department of Medical Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Meritxell Bellet
- Vall d'Hebron Institute of Oncology (VHIO), Breast Cancer Unit, Department of Medical Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mireia Margeli
- Department of Medical Oncology-ICO, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Beatriz Cirauqui
- Department of Medical Oncology-ICO, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Montserrat Muñoz
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Ignasi Tusquets
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Angels Arcusa
- Department of Medical Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Casimiro Javierre
- Department of Physiological Sciences II, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ferran Moreno
- Breast Cancer Functional Unit, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Ana Rodriguez
- Breast Cancer Functional Unit, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
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Haskins CP, Henderson G, Champ CE. Meat, eggs, full-fat dairy, and nutritional boogeymen: Does the way in which animals are raised affect health differently in humans? Crit Rev Food Sci Nutr 2018; 59:2709-2719. [PMID: 29672133 DOI: 10.1080/10408398.2018.1465888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background: Food recommendations to improve cancer prevention are generally based on epidemiologic data and remain inconsistent. These epidemiologic studies, while controversial, have generally produced results that caution against the consumption of high-fat foods, including eggs, red meat, and full-fat dairy, such as butter and cheese. Yet, limited data exist assessing the quality of individual sources of these foods and the effect each has after its consumption. This study set out to assess the impact sources of food within the same groups from animals raised differently on variables associated with health in human studies. Methods and Materials: A search was conducted through MEDLINE, Embase, and PubMed. In total, twenty-nine studies met inclusion criteria, measuring physiologic changes in humans after consuming animal products following animal diet manipulation. A meta-analysis was attempted to assess the differences between the cohorts in these studies, but was aborted due to poor study quality, vast differences in study design, and a limited number of studies. Results: Studies varied by animal, animal diet manipulation, food product, and overall design. Significant differences were present between groups eating the same food (cheese, beef, eggs, and butter) from animals raised differently, including levels of: conjugated linoleic acid, omega-3 fatty acids (alpha linoleic acid [ALA], docosahexaenoic acid [DHA], and eicosapentaenoic acid [EPA]), and inflammatory factors (triacyl glycerol [TAG], interleukin-6 [IL-6], interleukin-8 [IL-8], tumor necrosis factor [TNF], and C-reactive protein [CRP]). Lipid levels were minimally affected. Conclusions: This work highlights differences in human health markers after consumption of the same foods from animals raised differently. Overall, lipid levels remained relatively neutral, but significant changes in inflammatory and other serum markers and phospholipids were present. Future studies and dietary recommendations should consider how animals are raised, as this can produce different effects on health markers.
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Affiliation(s)
| | - George Henderson
- Human Potential Centre, Auckland University of Technology , Auckland , New Zealand
| | - Colin E Champ
- Department of Radiation Oncology, University of Pittsburgh Medical Center , Pittsburgh , PA , United States
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25
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Seiler A, Chen MA, Brown RL, Fagundes CP. Obesity, Dietary Factors, Nutrition, and Breast Cancer Risk. CURRENT BREAST CANCER REPORTS 2018; 10:14-27. [PMID: 30662586 PMCID: PMC6335046 DOI: 10.1007/s12609-018-0264-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW To synthesize the critical role of obesity-associated inflammation, dietary factors, and nutrition in determining breast cancer risk. RECENT FINDINGS Obesity-associated inflammation is strongly linked to breast cancer risk and progression, largely via two processes: inflammatory pathways and dysregulated metabolism. Cytokine production in excess adipose tissues creates a chronic inflammatory microenvironment, which favors tumor development. Lifestyle factors, including diet, have long been recognized as important determinants of breast cancer risk and mortality. SUMMARY Obesity increases the risk of developing breast cancer in both pre- and postmenopausal women and also negatively affects breast cancer recurrence and survival. Poor dietary habits characterized by the high intake of refined starches, sugar, and both saturated and trans-saturated fats, as well as the low intake of omega-3 fatty acids, natural antioxidants, and fiber, modulate inflammation and, thereby, appear to be linked to increased risk of breast cancer and mortality.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091 Zurich, Switzerland
| | | | - Ryan L Brown
- Department of Psychology, Rice University, Houston, TX, USA
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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26
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Liu LN, Lin YC, Miaskowski C, Chen SC, Chen ML. Association between changes in body fat and disease progression after breast cancer surgery is moderated by menopausal status. BMC Cancer 2017; 17:863. [PMID: 29254480 PMCID: PMC5735658 DOI: 10.1186/s12885-017-3869-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/29/2017] [Indexed: 01/17/2023] Open
Abstract
Background Obesity is linked to poor disease outcomes in breast cancer patients. However, this link was mostly based on body weight or BMI rather than body-fat. The purpose of this study was to evaluate the relationship between body-fat gain and disease progression in Taiwanese women after breast cancer surgery and how this relationship is influenced by menopausal status. Methods Body fat percentage was measured 1 day before and 6 months after surgery in 131 women with stages 0–III breast cancer. Disease outcomes (metastasis and death) were assessed by chart review and telephone contact 7 to 8 years after diagnosis. These data were analyzed by multivariate Cox proportional hazard model analysis. Results The percentage of women with over 5% gain in body-fat was 56% for premenopausal and 42% for postmenopausal. Rates of distant metastasis and all-cause mortality were 17.6 and 9.9%, respectively over the follow-up period. Distant metastases were predicted in postmenopausal but not premenopausal women with breast cancer by increased body fat percentage (HR = 1.3, p = 0.035), after controlling other potential covariates, including disease severity, estrogen receptor expression, progesterone receptors expression, age, and exercise habit before diagnosis. Survival was not significantly associated with body-fat percentage gains. Conclusions Our results suggest that increased body fat percentage 6 months after breast surgery is an important predictor of distant metastasis in postmenopausal Taiwanese women with breast cancer. Clinicians may need to measure patients’ body fat periodically. Our findings should be validated in studies with a longer follow-up time.
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Affiliation(s)
- Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yung-Chang Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, USA
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Mei-Ling Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. .,School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan, Republic of China. .,Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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Champ CE, Ohri N, Klement RJ, Cantor M, Beriwal S, Glaser SM, Smith RP. Assessing Changes in the Activity Levels of Breast Cancer Patients During Radiation Therapy. Clin Breast Cancer 2017; 18:e1-e6. [PMID: 28916400 DOI: 10.1016/j.clbc.2017.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/07/2017] [Accepted: 08/15/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Radiation therapy (RT) is often delivered after lumpectomy for women with breast cancer. A common perceived side effect of RT is fatigue, yet its exact effect on activity levels and sleep is unknown. In this study we analyzed the change in activity levels and sleep using an activity tracking device before, during, and after RT for women with early stage breast cancer and ductal carcinoma in situ who underwent adjuvant RT. PATIENTS AND METHODS After institutional review board approval, activity levels were quantified before, during, and after RT with measurements of steps, miles walked, calories burned, and sleep metrics in 10 women fitted with activity trackers. All data were uploaded and tabulated on a secure database. Multivariable linear regressions were used to evaluate changes in these variables over time during the RT course. RESULTS Median step count was 5047 per day (range, 2741-15,508) and distance traveled was 1.6 miles per day (range, 0.9-5.3). Step count, distance, and calories decreased by an average of 54 steps per day, 0.02 miles per day, and 3 calories per day (median calories 1822; range, 1461-2712) during RT, respectively. These changes were statistically significant (P < .001), but not clinically relevant. There was no significant change in sleep (average 6.8 hours per night; range, 5.5-8.3). CONCLUSION RT has a minimal effect on activity or sleep in women undergoing treatment for breast cancer. Activity levels varied greatly between patients in a population of women undergoing hypofractionated RT. Because increased activity levels correlate with improved outcomes, further studies evaluating attempts to increase physical activity during as well as after treatment with radiation are warranted.
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Affiliation(s)
- Colin E Champ
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital, Schweinfurt, Germany
| | | | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Scott M Glaser
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ryan P Smith
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Klement RJ. Beneficial effects of ketogenic diets for cancer patients: a realist review with focus on evidence and confirmation. Med Oncol 2017; 34:132. [PMID: 28653283 DOI: 10.1007/s12032-017-0991-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/23/2017] [Indexed: 12/16/2022]
Abstract
Ketogenic diets (KDs) have gained popularity among patients and researchers alike due to their putative anti-tumor mechanisms. However, the question remains which conclusions can be drawn from the available human data thus far concerning the safety and efficacy of KDs for cancer patients. A realist review utilizing a matrix analytical approach was conducted according to the RAMESES publication standards. All available human studies were systematically analyzed and supplemented with results from animal studies. Evidence and confirmation were treated as separate concepts. In total, 29 animal and 24 human studies were included in the analysis. The majority of animal studies (72%) yielded evidence for an anti-tumor effect of KDs. Evidential support for such effects in humans was weak and limited to individual cases, but a probabilistic argument shows that the available data strengthen the belief in the anti-tumor effect hypothesis at least for some individuals. Evidence for pro-tumor effects was lacking completely. Feasibility of KDs for cancer patients has been shown in various contexts. The probability of achieving an anti-tumor effect seems greater than that of causing serious side effects when offering KDs to cancer patients. Future controlled trials would provide stronger evidence for or against the anti-tumor effect hypothesis.
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Affiliation(s)
- Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Str. 10, 97422, Schweinfurt, Germany.
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The Effects of Dietary Nutrition Education on Weight and Health Biomarkers in Breast Cancer Survivors. Med Sci (Basel) 2017; 5:medsci5020012. [PMID: 29099027 PMCID: PMC5635781 DOI: 10.3390/medsci5020012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/21/2022] Open
Abstract
Weight gain after breast cancer diagnosis portends a poorer prognosis, and the majority of sufferers appear to gain weight. Metabolic syndrome is a common co-condition with breast cancer. The Mediterranean diet has been used to reduce excess weight, metabolic syndrome, and to improve the inflammatory profile, and therefore may offer the breast cancer survivor specific benefits over and above the currently recommended nutrition guidelines to eat a low fat, healthy diet. The aim of this randomised controlled trial was to investigate whether a Mediterranean (MD) or low-fat diet (LF) reduce weight and general health in survivors of stage 1–3 breast cancer through a six-month, six-session education package to support dietary change. A control dietary arm received no intervention. Outcome measures for weight, body mass index (BMI), waist circumference, blood lipids, blood glucose, dietary adherence, 3-day food diary, and PREDIMED questionnaire and quality of life were assessed. Both dietary intervention arms, on average, lost weight over the course of the intervention, with significant (p < 0.05) decreases seen in BMI and waist circumference measurements. The control arm gained weight and significantly (p < 0.05) increased BMI and waist circumference measurements overall (1.10 ± 3.03 kg, 0.40 ± 1.65 kg/m2, and 1.94 ± 2.94 cm respectively). Positive trends in blood biomarkers were observed for the intervention arms. Dietary adherence was sufficient. Nutritional education and group support appears to exert beneficial effects on health in breast cancer survivors, of lesser importance is the type of diet that forms the basis of the education.
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Oral Administration of Tualang and Manuka Honeys Modulates Breast Cancer Progression in Sprague-Dawley Rats Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:5904361. [PMID: 28479926 PMCID: PMC5396450 DOI: 10.1155/2017/5904361] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/25/2017] [Accepted: 03/02/2017] [Indexed: 12/21/2022]
Abstract
Breast cancer has been recognized as the leading cause of death in women worldwide. Research has shown the importance of complementary and alternative therapies in cancer. In this study, we investigated the antitumoural therapeutic effects of Malaysian Tualang honey (TH) and Australian/New Zealand Manuka honey (MH) against breast cancer in rats. Thirty syngeneic virgin female Sprague-Dawley (SD) rats were induced by the carcinogen 1-methyl-1-nitrosourea (MNU) 80 mg/kg. The treatment started when first palpable tumour reached 10-12 mm in size by dividing rats into following groups: Group 0 (negative control); Group 1 (positive control); and Groups 2 and 3 which received 1.0 g/kg body weight/day of TH and MH, respectively, for 120 days. The data demonstrate that cancer masses in TH and MH treated groups showed a lower median tumour size, weight, and multiplicity compared with the nontreated positive control (p < 0.05). Treatment also showed a dramatic slower growth rate (up to 70.82%) compared with the nontreated control (0%) (p < 0.05). The antitumoural effect was mediated through modulation of tumour growth, tumour grading, estrogenic activity, and haematological parameters. Our findings demonstrate that systemic administration of TH and MH increases the susceptibility of expression of proapoptotic proteins (Apaf-1, Caspase-9, IFN-γ, IFNGR1, and p53) and decreases the expression of antiapoptotic proteins (TNF-α, COX-2, and Bcl-xL 1) in its mechanism of action. This highlights a potential novel role for TH and MH in alleviating breast cancer.
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Fruit and vegetable intake and breast cancer prognosis: a meta-analysis of prospective cohort studies. Br J Nutr 2017; 117:737-749. [DOI: 10.1017/s0007114517000423] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractThe effect of fruit and vegetable intake on breast cancer prognosis is controversial. Thus, a meta-analysis was carried out to explore their associations. A comprehensive search was conducted in PubMed, Web of Science, OVID, ProQuest and Chinese databases from inception to April 2016. The summary hazard ratios (HR) and 95 % CI were estimated using a random effects model if substantial heterogeneity existed and using a fixed effects model if not. Subgroup analyses and sensitivity analyses were also performed. In total, twelve studies comprising 41 185 participants were included in the meta-analysis. Comparing the highest with the lowest, the summary HR for all-cause mortality were 1·01 (95 % CI 0·72, 1·42) for fruits and vegetables combined, 0·96 (95 % CI 0·83, 1·12) for total vegetable intake, 0·99 (95 % CI 0·89, 1·11) for cruciferous vegetable intake and 0·88 (95 % CI 0·74, 1·05) for fruit intake; those for breast cancer-specific mortality were 1·05 (95 % CI 0·77, 1·43) for total vegetable intake and 0·94 (95 % CI 0·69, 1·26) for fruit intake; and those for breast cancer recurrence were 0·89 (95 % CI 0·53, 1·50) for total vegetable intake and 0·98 (95 % CI 0·76, 1·26) for cruciferous vegetable intake. This meta-analysis found no significant associations between fruit and vegetable intake and breast cancer prognosis.
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Fung J, Berger A. Hyperinsulinemia and Insulin Resistance: Scope of the Problem. JOURNAL OF INSULIN RESISTANCE 2016. [DOI: 10.4102/jir.v1i1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
No abstract available.
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Glycemic index, glycemic load and invasive breast cancer incidence in postmenopausal women: The PREDIMED study. Eur J Cancer Prev 2016; 25:524-32. [PMID: 26633163 DOI: 10.1097/cej.0000000000000209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res Notes 2016; 9:143. [PMID: 26946138 PMCID: PMC4779584 DOI: 10.1186/s13104-016-1959-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/25/2016] [Indexed: 12/27/2022] Open
Abstract
Background Based on promising preclinical data, ketogenic diets (KDs) have been proposed as supplementary measures for cancer patients undergoing standard-of-care therapy. However, data is still scarce on the tolerability and effects of KDs on cancer patients undergoing radiotherapy (RT). Here we present six cases of patients who underwent RT and concurrently consumed a self-administered KD in our clinic within a busy community hospital setting. Methods All patients were followed prospectively with measurements of blood parameters, quality of life and body weight and composition using bioelectrical impedance analysis. Results No adverse diet-related side effects occurred. Two patients had no elevated ketone body levels in serum despite self-reporting compliance to the diet. There was consensus that the KD was satiating and weight loss occurred in all patients, although this was only significant in two patients. Our data indicate that weight loss was mainly due to fat mass loss with concurrent preservation of muscle mass. Overall quality of life remained fairly stable, and all subjects reported feeling good on the diet. Tumor regression occurred as expected in five patients with early stage disease; however one subject with metastatic small cell lung cancer experienced slight progression during three cycles of combined chemotherapy + KD and progressed rapidly after ending the KD. Conclusions Our data lend support to the hypothesis that KDs administered as supportive measures during standard therapy are safe and might be helpful in preservation of muscle mass. Further studies with control groups are needed to confirm these findings and address questions regarding any putative anti-tumor effects. Based on the experience with these six cases we implemented further steps to improve issues with KD compliance and initiated a clinical study that is described in a companion paper.
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Affiliation(s)
- Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany.
| | - Reinhart A Sweeney
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany.
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Fortifying the Treatment of Prostate Cancer with Physical Activity. Prostate Cancer 2016; 2016:9462975. [PMID: 26977321 PMCID: PMC4764749 DOI: 10.1155/2016/9462975] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 11/18/2022] Open
Abstract
Over the past decade, significant data have shown that obese men experience a survival detriment after treatment for prostate cancer. While methods to combat obesity are of utmost importance for the prostate cancer patient, newer data reveal the overall metabolic improvements that accompany increased activity levels and intense exercise beyond weight loss. Along these lines, a plethora of data have shown improvement in prostate cancer-specific outcomes after treatment accompanied with these activity levels. This review discusses the metabolic mechanisms in which increased activity levels and exercise can help improve both outcomes for men treated for prostate cancer while lowering the side effects of treatment.
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Atalay C, Küçük Aİ. The impact of weight gain during adjuvant chemotherapy on survival in breast cancer. ULUSAL CERRAHI DERGISI 2015; 31:124-7. [PMID: 26504414 DOI: 10.5152/ucd.2015.3123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Weight gain can be detected during adjuvant chemotherapy in breast cancer patients, leading to administration of lower drug doses than planned and a decrease in long-term survival. In this study, the effect of weight gain on survival in breast cancer patients was investigated. MATERIAL AND METHODS Breast cancer patients treated with adjuvant chemotherapy between May 2002 and May 2003 were prospectively included in the study. Patients treated with neoadjuvant chemotherapy or with chemotherapy for metastatic disease were excluded from the study. Data regarding patients' demographic, clinical and pathologic characteristics and chemotherapy protocols were recorded. Patients were grouped as those with weight gain less than or more than 3 kg, and those with a body mass index of less than or more than 30. The impact of weight gain on patients' disease-free and overall survival was investigated. Log-rank test and Cox regression analyses were utilized for survival analyses. P<0.05 value was accepted as statistically significant. RESULTS Eighty-eight consecutive female patients with a median age of 46 (29-71) were included in the study. Patients received anthracycline based chemotherapy protocols. Weight gain was detected in 79 patients (89.8%), with more than 3 kg weight gain detected in 38 patients (43.2%). In a median follow-up time of 98 months (62-120), distant metastases were detected in 21 patients (23.9%), and 11 patients (12.5%) died. Mean disease-free survival of patients with a weight gain less than and more than 3 kg during chemotherapy was 89.1±3.9 and 84.7±4.2 months (p=0.007), whereas mean overall survival was 95.6±2.2 and 92.5±2.1 months (p=0.01), respectively. Mean disease-free survival of patients with a body mass index less than and more than 30 was 87.3±2.3 and 85.1±3.6 months (p=0.4), whereas mean overall survival was 94.2±2.3 and 92.1±1.1 months (p=0.35), respectively. CONCLUSION Weight gain during adjuvant chemotherapy has a negative effect on both disease-free and overall survival in patients with breast cancer.
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Affiliation(s)
- Can Atalay
- Clinic of General Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali İmran Küçük
- Clinic of General Surgery, Derince Training and Research Hospital, Kocaeli, Turkey
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Tumour Necrosis Factor-α Gene Polymorphism Is Associated with Metastasis in Patients with Triple Negative Breast Cancer. Sci Rep 2015; 5:10244. [PMID: 26165253 PMCID: PMC4499887 DOI: 10.1038/srep10244] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/07/2015] [Indexed: 12/31/2022] Open
Abstract
Tumour necrosis factor-α (TNF-α) is critical in the regulation of inflammation and tumour progression. TNF-α-308G > A is associated with constitutively elevated TNF-α expression. The purpose of this study was to assess the association between TNF-α-308G > A and breast cancer (BC) risk by subtype and the connection between genotypes and clinical features of BC. A total of 768 patients and 565 controls were enrolled in this study, and genotypes were detected using the TaqMan assay. No effect on susceptibility for any BC subtype was found for the TNF-α-308 polymorphism in our study or in the pooled meta-analysis. This polymorphism was shown to be associated with age at menarche in all BC and in progesterone receptor-negative BC. Interestingly, triple negative breast cancer (TNBC) patients with TNF-α-308A had an increased risk of distant tumour metastasis (OR = 3.80, 95% CI: 1.31-11.02, P = 0.009). Multi-regression analysis showed that TNF-α-308A was also a risk factor for distant tumour metastasis after adjustment for tumour size and lymph node metastasis status (OR = 6.26, 95% CI: 1.88-20.87, P = 0.003). These findings indicate that TNF-α might play a distinct role in the progression of TNBC, especially in distant tumour metastasis of TNBC.
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Ow GS, Kuznetsov VA. Multiple signatures of a disease in potential biomarker space: Getting the signatures consensus and identification of novel biomarkers. BMC Genomics 2015; 16 Suppl 7:S2. [PMID: 26100469 PMCID: PMC4474413 DOI: 10.1186/1471-2164-16-s7-s2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The lack of consensus among reported gene signature subsets (GSSs) in multi-gene biomarker discovery studies is often a concern for researchers and clinicians. Subsequently, it discourages larger scale prospective studies, prevents the translation of such knowledge into a practical clinical setting and ultimately hinders the progress of the field of biomarker-based disease classification, prognosis and prediction. Methods We define all "gene identificators" (gIDs) as constituents of the entire potential disease biomarker space. For each gID in a GSS of interest ("tested GSS"/tGSS), our method counts the empirical frequency of gID co-occurrences/overlaps in other reference GSSs (rGSSs) and compares it with the expected frequency generated via implementation of a randomized sampling procedure. Comparison of the empirical frequency distribution (EFD) with the expected background frequency distribution (BFD) allows dichotomization of statistically novel (SN) and common (SC) gIDs within the tGSS. Results We identify SN or SC biomarkers for tGSSs obtained from previous studies of high-grade serous ovarian cancer (HG-SOC) and breast cancer (BC). For each tGSS, the EFD of gID co-occurrences/overlaps with other rGSSs is characterized by scale and context-dependent Pareto-like frequency distribution function. Our results indicate that while independently there is little overlap between our tGSS with individual rGSSs, comparison of the EFD with BFD suggests that beyond a confidence threshold, tested gIDs become more common in rGSSs than expected. This validates the use of our tGSS as individual or combined prognostic factors. Our method identifies SN and SC genes of a 36-gene prognostic signature that stratify HG-SOC patients into subgroups with low, intermediate or high-risk of the disease outcome. Using 70 BC rGSSs, the method also predicted SN and SC BC prognostic genes from the tested obesity and IGF1 pathway GSSs. Conclusions Our method provides a strategy that identify/predict within a tGSS of interest, gID subsets that are either SN or SC when compared to other rGSSs. Practically, our results suggest that there is a stronger association of the IGF1 signature genes with the 70 BC rGSSs, than for the obesity-associated signature. Furthermore, both SC and SN genes, in both signatures could be considered as perspective prognostic biomarkers of BCs that stratify the patients onto low or high risks of cancer development.
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Klement RJ, Champ CE. Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R's through dietary manipulation. Cancer Metastasis Rev 2015; 33:217-29. [PMID: 24436017 PMCID: PMC3988521 DOI: 10.1007/s10555-014-9495-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aggressive tumors typically demonstrate a high glycolytic rate, which results in resistance to radiation therapy and cancer progression via several molecular and physiologic mechanisms. Intriguingly, many of these mechanisms utilize the same molecular pathways that are altered through calorie and/or carbohydrate restriction. Furthermore, poorer prognosis in cancer patients who display a glycolytic phenotype characterized by metabolic alterations, such as obesity and diabetes, is now well established, providing another link between metabolic pathways and cancer progression. We review the possible roles for calorie restriction (CR) and very low carbohydrate ketogenic diets (KDs) in modulating the five R's of radiotherapy to improve the therapeutic window between tumor control and normal tissue complication probability. Important mechanisms we discuss include (1) improved DNA repair in normal, but not tumor cells; (2) inhibition of tumor cell repopulation through modulation of the PI3K-Akt-mTORC1 pathway downstream of insulin and IGF1; (3) redistribution of normal cells into more radioresistant phases of the cell cycle; (4) normalization of the tumor vasculature by targeting hypoxia-inducible factor-1α downstream of the PI3K-Akt-mTOR pathway; (5) increasing the intrinsic radioresistance of normal cells through ketone bodies but decreasing that of tumor cells by targeting glycolysis. These mechanisms are discussed in the framework of animal and human studies, taking into account the commonalities and differences between CR and KDs. We conclude that CR and KDs may act synergistically with radiation therapy for the treatment of cancer patients and provide some guidelines for implementing these dietary interventions into clinical practice.
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Affiliation(s)
- Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Gustav-Adolf-Straße 8, 97422, Schweinfurt, Germany,
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40
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Energy expenditure in women with breast cancer. Nutrition 2015; 31:556-9. [DOI: 10.1016/j.nut.2014.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/27/2014] [Accepted: 05/01/2014] [Indexed: 01/21/2023]
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Abstract
We propose that dietary carbohydrate restriction, particularly ketogenic diets, may provide benefit as a therapeutic or preventive strategy in cancer, alone or as an adjunct to pharmacology. The argument derives from several points of evidence: There is a close association between cancer and both diabetes and obesity. Extensive evidence shows that low carbohydrate diets are the most effective dietary treatment of Type 2 diabetes and dietary adjunct in Type 1. Such diets also target all the markers of metabolic syndrome. Finally, de facto reduction in carbohydrate likely contributes to total dietary restriction, which is effective in the prevention and treatment of cancer. The idea is consistent with recent interest in treating cancer with drugs that target diabetes. To move forward, we must understand obesity and diabetes as response to a hyperglycemic state rather than simply a cause of downstream effects.
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Affiliation(s)
- Eugene J Fine
- a 1 Department of Nuclear Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Bicakli DH, Varol U, Degirmenci M, Tunali D, Cakar B, Durusoy R, Karaca B, Ali Sanli U, Uslu R. Adjuvant chemotherapy may contribute to an increased risk for metabolic syndrome in patients with breast cancer. J Oncol Pharm Pract 2014; 22:46-53. [PMID: 25233884 DOI: 10.1177/1078155214551315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Cytotoxic treatment may cause weight gain and important alterations in the metabolic status of breast cancer (BC) patients. The aim of this study was to investigate the changes in metabolic and anthropometric parameters of patients with BC who received adjuvant chemotherapy. METHODS All consecutive women treated with adjuvant TAC (docetaxel 75 mg/m(2), doxorubicine 50 mg/m(2), cyclophosphamide 500 mg/m(2)) chemotherapy for node-positive breast carcinoma at our Institution between 2008 and 2010 were included. RESULTS Among 104 patients, 84 of them were stage II and 20 of them were stage III. When we compared the measurements between 1(st) and 6(th) adjuvant chemotherapy, we observed statistically significant increases in weight and serum triglyceride levels, and decreases in high density lipoprotein, apolipoprotein A-1, transferrin, albumin and prealbumin levels. An elevation of follicle stimulating hormone, luteinizing hormone together with the decrease of estradiol was detected. Waist-to-hip ratio has also increased significantly. In subgroup analyses, we observed dramatic changes in body mass index in pre-menopausal women whereas no significant change was seen in the post-menopausal group. CONCLUSIONS Adjuvant chemotherapy may contribute to an increased risk for metabolic syndrome in patients with BC and these changes are more profound in pre-menopausal patients.
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Affiliation(s)
- Derya Hopanci Bicakli
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Umut Varol
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Mustafa Degirmenci
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Didem Tunali
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Burcu Cakar
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Raika Durusoy
- Department of Public Health, School of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Burcak Karaca
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Ulus Ali Sanli
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Ruchan Uslu
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
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Jin G, Zhao Y, Sun S, Kang H. Association between the tumor necrosis factor alpha gene -308G> A polymorphism and the risk of breast cancer: a meta-analysis. Tumour Biol 2014; 35:12091-8. [PMID: 25149156 DOI: 10.1007/s13277-014-2510-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022] Open
Abstract
The multifunctional cytokine tumor necrosis factor alpha (TNF-α) plays an important role in cell proliferation, differentiation, apoptosis, lipid metabolism, and endothelial function. To date, many studies have evaluated the association between the TNF-α -308G> A polymorphism and breast cancer risk; however, the results remain ambiguous and inconclusive. To derive a more precise estimation of the association and assess its strength, we carried out a meta-analysis of 20 published case-control studies with 12,360 cases and 15,110 controls using crude odd ratios (ORs) with 95 % confidence intervals (CIs). Overall, no significant associations were found for all genetic models (allele model OR = 1.06, 95 % CI 0.90-1.24, P heterogeneity < 0.001; homozygous model OR = 1.25, 95 % CI 0.85-1.82, P heterogeneity < 0.001; recessive model OR = 1.26, 95 % CI 0.88-1.82, P heterogeneity = 0.001; dominant model OR = 1.00, 95 % CI 0.85-1.18, P heterogeneity < 0.001). Moreover, no significant associations were observed when stratified by ethnicity, control source, genotyping method, or Hardy-Weinberg equilibrium status. However, in the menopausal status subgroup, significantly decreased breast cancer risks were found among postmenopausal women (allele model OR = 0.90, 95 % CI 0.83-0.98; dominant model OR = 0.89, 95 % CI 0.81-0.98), while the TNF-α -308 AA genotype was a breast cancer risk factor in premenopausal women (homozygous model OR = 4.38, 95 % CI 1.44-13.36; recessive model OR = 4.43, 95 % CI 1.47-13.42). This meta-analysis indicated that the TNF-α -308G> A polymorphism is not associated with breast cancer risk in the overall population but that the A allele may be a protective factor for breast cancer in postmenopausal women, and the AA genotype may be a breast cancer risk factor in premenopausal women.
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Affiliation(s)
- Guojiang Jin
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
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Abstract
Unfavorable physiological, biological, and behavioral alterations during and following treatment for cancer may lead to chronic energy imbalance predisposing to a myriad of deleterious health conditions including obesity, dyslipidemia, and the metabolic syndrome. In addition to the cardiovascular and musculoskeletal effects of these conditions, energy imbalance and metabolic changes after cancer treatment can also affect cancer-related morbidity and mortality. To this end, lifestyle interventions such as diet and physical activity are especially relevant to mitigate the deleterious impact of chronic energy imbalance in cancer survivors.
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Affiliation(s)
- Emily S Tonorezos
- Weill Cornell Medical College and Memorial Sloan-Kettering Cancer Center, New York NY.
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Simone BA, Champ CE, Rosenberg AL, Berger AC, Monti DA, Dicker AP, Simone NL. Selectively starving cancer cells through dietary manipulation: methods and clinical implications. Future Oncol 2014; 9:959-76. [PMID: 23837760 DOI: 10.2217/fon.13.31] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
As the link between obesity and metabolic syndrome and cancer becomes clearer, the need to determine the optimal way to incorporate dietary manipulation in the treatment of cancer patients becomes increasingly important. Metabolic-based therapies, such as caloric restriction, intermittent fasting and a ketogenic diet, have the ability to decrease the incidence of spontaneous tumors and slow the growth of primary tumors, and may have an effect on distant metastases in animal models. Despite the abundance of preclinical data demonstrating the benefit of dietary modification for cancer, to date there are few clinical trials targeting diet as an intervention for cancer patients. We hypothesize that this may be due, in part, to the fact that several different types of diet modification exist with no clear recommendations regarding the optimal method. This article will delineate three commonly used methods of dietary manipulation to assess the potential of each as a regimen for cancer therapy.
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Affiliation(s)
- Brittany A Simone
- Department of Radiation Oncology, Kimmel Cancer Center & Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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46
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Ghosh S, Hughes D, Parma DL, Ramirez A, Li R. Association of obesity and circulating adipose stromal cells among breast cancer survivors. Mol Biol Rep 2014; 41:2907-16. [PMID: 24458825 DOI: 10.1007/s11033-014-3146-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/13/2014] [Indexed: 12/26/2022]
Abstract
A positive association of obesity with breast cancer incidence and mortality is well established. Recent reports indicate that adipose stromal cells (ASCs) play an important role in breast cancer development and progression by producing estrogens and tumor-promoting cytokines. Furthermore, circulating ASCs have been uniquely detected in obese individuals, which is likely due to increased tissue remodeling and cell mobilization. The number of circulating ASCs is even more prominent in obese patients with colon and prostate cancers, both of which are exacerbated by obesity. To determine whether a similar association exists for breast cancer, we collected blood samples from a cohort of breast cancer survivors and enumerated circulating ASCs by flow cytometry on the basis of the previously established ASC-associated immunophenotype (CD34+/CD31-/CD45-). We found significantly higher levels of circulating ASCs (p<0.001) in breast cancer survivors with body mass index (BMI)≥30 kg/m2 than their non-obese counterparts (BMI<30). We also compared circulating ASCs before and after exercise of only the obese subjects enrolled in a 6-month individualized exercise program, but found no statistically significant difference, likely due to limited number of subjects in the study. Our findings suggest that circulating ASCs can serve as a potential biomarker for future studies of the impacts of obesity and physical activity on breast cancer recurrence and survival.
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Affiliation(s)
- Sagar Ghosh
- Department of Molecular Medicine, Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
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47
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Champ CE, Palmer JD, Volek JS, Werner-Wasik M, Andrews DW, Evans JJ, Glass J, Kim L, Shi W. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J Neurooncol 2014; 117:125-31. [PMID: 24442482 DOI: 10.1007/s11060-014-1362-0] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023]
Abstract
Retrospective data suggests that low serum glucose levels during the treatment of glioblastoma multiforme (GBM) may improve clinical outcomes. As such, many patients are implementing a ketogenic diet (KD) in order to decrease serum glucose flux while simultaneously elevating circulating ketones during radiation therapy and chemotherapy for the treatment of GBM. With IRB approval, a retrospective review of patients with high-grade glioma treated with concurrent chemoradiotherapy and adjuvant chemotherapy was carried out from August 2010 to April 2013. Serum glucose and ketone levels, dexamethasone dose, and toxicity of patients undergoing a KD during treatment were also assessed. Blood glucose levels were compared between patients on an unspecified/standard diet and a KD. Toxicity was assessed by Common Terminology Criteria for Adverse Events version 4. In total, 53 patients were analyzed. Six underwent a KD during treatment. The diet was well tolerated with no grade III toxicity and one episode of grade II fatigue. No episodes of symptomatic hypoglycemia were experienced. Four patients are alive at a median follow-up of 14 months. The mean blood glucose of patients on a standard diet was 122 versus 84 mg/dl for those on a KD. Based on this retrospective study, a KD appears safe and well tolerated during the standard treatment of GBM. Dietary restriction of carbohydrates through a KD reduces serum glucose levels significantly, even in conjunction with high dose steroids, which may affect the response to standard treatment and prognosis. Larger prospective trials to confirm this relationship are warranted.
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Affiliation(s)
- Colin E Champ
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, UPMC CancerCenter at UPMC St. Margaret, 200 Delafield Road, Pittsburgh, PA, 15215, USA,
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Hilvo M, Gade S, Hyötyläinen T, Nekljudova V, Seppänen-Laakso T, Sysi-Aho M, Untch M, Huober J, von Minckwitz G, Denkert C, Orešič M, Loibl S. Monounsaturated fatty acids in serum triacylglycerols are associated with response to neoadjuvant chemotherapy in breast cancer patients. Int J Cancer 2013; 134:1725-33. [DOI: 10.1002/ijc.28491] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/02/2013] [Indexed: 01/05/2023]
Affiliation(s)
- Mika Hilvo
- Biotechnology for Health and Well-being; VTT Technical Research Centre of Finland; VTT Espoo Finland
| | - Stephan Gade
- German Breast Group, GBG-Forschungs GmbH; Neu-Isenburg Germany
| | - Tuulia Hyötyläinen
- Biotechnology for Health and Well-being; VTT Technical Research Centre of Finland; VTT Espoo Finland
| | | | - Tuulikki Seppänen-Laakso
- Biotechnology for Health and Well-being; VTT Technical Research Centre of Finland; VTT Espoo Finland
| | - Marko Sysi-Aho
- Biotechnology for Health and Well-being; VTT Technical Research Centre of Finland; VTT Espoo Finland
| | - Michael Untch
- Department of Gynecology and Obstetrics; Helios Klinikum Berlin-Buch; Berlin Germany
| | - Jens Huober
- Department of Gynecology; University of Ulm; Ulm Germany
| | | | - Carsten Denkert
- Institute of Pathology; Charité University Hospital; Berlin Germany
| | - Matej Orešič
- Biotechnology for Health and Well-being; VTT Technical Research Centre of Finland; VTT Espoo Finland
| | - Sibylle Loibl
- German Breast Group, GBG-Forschungs GmbH; Neu-Isenburg Germany
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Kim A, Scharf K, Senthil M, Solomon N, Garberoglio C, Lum SS. The prevalence of overweight and obesity in a breast clinic population: consideration for weight loss as a therapeutic intervention. Surg Obes Relat Dis 2013; 10:348-53. [PMID: 24094868 DOI: 10.1016/j.soard.2013.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/01/2013] [Accepted: 07/29/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity is an important risk factor for breast cancer and weight loss may be associated with a decreased risk for breast cancer and its recurrence. We evaluated the prevalence of overweight, obesity, and obesity-related co-morbidities in a breast health clinic population to determine the potential need for weight loss intervention. METHODS A retrospective review was conducted of sequential patients seen at a breast health clinic from July 1 to December 31, 2011. Body mass index (BMI), reason for visit (breast cancer diagnosis, high risk for breast cancer, or benign condition), and presence of obesity-related co-morbidities were recorded. RESULTS The 302 patients who met inclusion criteria had a median age of 52 years (10-91) and median BMI of 26 kg/m(2) (15.4-56.5). Overall, 36.8% of patients had a BMI between 18.5-24.9 kg/m(2); 32.1%, 25-29.9 kg/m(2); 14.2%, 30-34.9 kg/m(2); 8.3%, 35-39.9 kg/m(2); and 4.3%, ≥ 40 kg/m(2). Overweight or obesity (BMI ≥ 25 kg/m(2)) occurred in 64.2% of breast cancer, 65.0% of high-risk, and 57.1% of benign patients (P value not significant). Criteria for bariatric surgery (BMI 35-39.9 kg/m(2) with ≥ 1 obesity-related co-morbidity or BMI ≥ 40 kg/m(2)) were met in 8.2% of breast cancer, 16.7% of high-risk, and 11.5% of benign patients (P value not significant). CONCLUSIONS Regardless of diagnosis, a significant proportion of patients visiting the breast health clinic meet criteria for weight loss intervention, including bariatric surgery. Weight management represents an underutilized therapeutic modality that could potentially decrease the risk of breast cancer and its recurrence, and improve overall prognosis.
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Affiliation(s)
- Angela Kim
- Loma Linda University School of Medicine, Loma Linda, California
| | - Keith Scharf
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Maheswari Senthil
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Naveenraj Solomon
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Carlos Garberoglio
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Sharon S Lum
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California.
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Hsu MC, Lee KT, Hsiao WC, Wu CH, Sun HY, Lin IL, Young KC. The dyslipidemia-associated SNP on the APOA1/C3/A5 gene cluster predicts post-surgery poor outcome in Taiwanese breast cancer patients: a 10-year follow-up study. BMC Cancer 2013; 13:330. [PMID: 23829168 PMCID: PMC3708770 DOI: 10.1186/1471-2407-13-330] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/30/2013] [Indexed: 12/22/2022] Open
Abstract
Background Post-surgery therapies are given to early-stage breast cancer patients due to the possibility of residual micrometastasis, and optimized by clincopathological parameters such as tumor stage, and hormone receptor/lymph node status. However, current efficacy of post-surgery therapies is unsatisfactory, and may be varied according to unidentified patient genetic factors. Increases of breast cancer occurrence and recurrence have been associated with dyslipidemia, which can attribute to other known risk factors of breast cancer including obesity, diabetes and metabolic syndrome. Thus we reasoned that dyslipidemia-associated nucleotide polymorphisms (SNPs) on the APOA1/C3/A5 gene cluster may predict breast cancer risk and tumor progression. Methods We analyzed the distribution of 5 selected APOA1/C3/A5 SNPs in recruited Taiwanese breast cancer patients (n=223) and healthy controls (n=162). The association of SNP (APOA1 rs670) showing correlation with breast cancer with baseline and follow-up parameters was further examined. Results APOA1 rs670 A allele carriage was higher in breast cancer patients than controls (59.64% vs. 48.77%, p=0.038). The rs670 A allele carrying patients showed less favorable baseline phenotype with positive lymph nodes (G/A: OR=3.32, 95% CI=1.77-6.20, p<0.001; A/A: OR=2.58, 95% CI=1.05-6.32, p=0.039) and negative hormone receptor expression (A/A: OR=4.85, 95%CI=1.83-12.83, p=0.001) in comparison to G/G carriers. Moreover, rs670 A/A carrying patients had higher risks in both tumor recurrence (HR=3.12, 95% CI=1.29-7.56, p=0.012) and mortality (HR=4.36, 95% CI=1.52-12.47, p=0.006) than patients with no A alleles after adjustments for associated baseline parameters. Furthermore, the prognostic effect of rs670 A/A carriage was most evident in lymph node-negative patients, conferring to the highest risks of recurrence (HR=4.98, 95% CI=1.40-17.70, p=0.013) and mortality (HR=9.87, 95%CI=1.60-60.81, p=0.014) than patients with no A alleles. Conclusions APOA1 rs670 A/A carriage showed poor post-surgery prognosis in Taiwanese lymph node-negative breast cancer patients, whose prognosis were considered better and adjuvant treatment might be less stringent according to currently available assessment protocols. Our findings suggest that APOA1 rs670 indicate a post-surgery risk of breast cancer disease progression, and that carriers of this SNP may benefit from more advanced disease monitoring and therapy regimens than the current regular standards. Furthermore, control of lipid homeostasis might protect APOA1 rs670 minor allele carriers from breast cancer occurrence and progression.
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Affiliation(s)
- Mei-Chi Hsu
- Research Center for Medical Laboratory Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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