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Table 4 Combined intervention results

From: Dietary restriction during the treatment of cancer: results of a systematic scoping review

Reference (author, year)

Design

Population (No. of participants, age, site/lesion type)

Intervention (DR intervention, corresponding cancer treatment)

Feasibility

Tolerance

Treatment effect

Freedland, 2016, USA [44]

RCT

40 (19 IG, 21 CG)

Age NR

Prostate cancer

Low CHO diet (< 20 g/day) combined with moderate physical activity increased by 30 min/day for 5 days/wk.

Concurrent to ADT

81% retention

Mild headaches main side effect

↓ HOMA by 19% in IG compared to 7% in CG (p = 0.127) at 3 m

↓ weight (kg) of 9.3 in IG compared to ↑ of 1.3 in CG (p < 0.001) at 6 m

↓ FM of 16.2% in IG compared to ↑ of 11.0% in CG (p = 0.002) at 6 m

↑ bone mineral content of 0.1% in IG compared to ↓2.3% in CG (p = 0.025) at 6 m

↓ PSA 99% in both groups (p = 0.37)

Reinwald, 2015 and Branca, [45], Italy [46]

Case report

1

Age 66y

Breast cancer

An isocaloric KD: special amino acid formula combined with probiotic yoghurt containing vitD binding protein macrophage activating factors and injections of vitD, oleic acid and vitD binding protein

3 weeks prior to surgery

NR

NR

Change in gene expression to HER2 -ve.

Increase in progesterone expression (20 vs < 1%)

No invasion of blood or lymph vessels around the tumour

ER and Ki-67 markers were unchanged

Iyikesici, 2017, Turkey [47]

Case report

1

Age 29y

Triple negative breast cancer

Chemotherapy administered after a 12 h fast followed by 5–10 units of insulin. Patient also consumed a KD for duration of treatment

Patient adhered to KD (urinary ketones present at each visit)

NR

Pathological complete response

Zuccoli, 2010, Italy [48]

Case report

1

Age 65y

Brain cancer

Self-administered post-operative fast followed by a calorie restricted KD with chemo-radiotherapy. KD: 600ckal/day using Keto-Cal® 4:1 supplemented with multivitamins. After approx. 2 months on restricted KD, patient switched to a calorie restricted non-KD (600 kcal/day) for 5 months.

NR

Karnofsky performance status: 100% during diet

Hyperuricemia on restricted KD so patient was switched to a non-KD calorie restricted diet.

Hypoproteinemia on restricted diet, resolved by increasing dietary protein to 7 g/day for 1 month.

↓ bodyweight (− 9%) after fast and − 22% after restricted diet

↓ blood glucose: −50% after fast and − 53.3% after restricted diet

↑ ketones: from 0 (baseline) to 2.5 mmol/L after fast and after restricted diet

  1. ↑ = increase
  2. ↓ = reduction
  3. Where absolute figures were provided, %s have been calculated to aid comparison
  4. Abbreviations: ADT Androgen Deprivation Therapy, CG Control Group, CHO Carbohydrate, DR Dietary Restriction, ER Estrogen receptor, FM Fat Mass, HER-2 Human Epidermal Growth Factor Receptor 2, HOMA Homeostatic model assessment, IG Intervention Group, KD Ketogenic Diet, m months, NR Not Reported, PSA Prostate-Specific Antigen, RCT Randomised Controlled Trial, VitD Vitamin D