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Pradeep Yarra   Citation: Prado CM, Purcell SA, Laviano A. Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle. 2020;11(2):366-380. doi:10.1002/jcsm.12525 Question 1:   Why is this study important? Nutritional status is an important determinant of patients of cancer in relation to their prognosis, treatment options and improve health across the cancer continuum. Poor nutritional status leads to Cachexia, which in turn impacts on quality of life, health outcomes and prognosis in cancer. Studies exploring nutrition interventions and anorexia in cancer patients have largely focused on those receiving palliative care. This systematic review aimed to synthesize nutrition interventions that improve appetite and nutrition-related outcomes of adults with cancer undergoing chemotherapy, immunotherapy and radiotherapy treatments, and to identify appetite assessment tools used in research and practice in the oncology setting. Identify one key finding of this study and describe how it relates to nutritional sciences          Primary outcomes of the study are1)	Dietary counselling improved appetite rather than the use of just oral nutritional supplements (ONS). Flavors, taste preferences, tastes changes and altered perception of food in cancer patients during treatment can be ever changing and can impact on appetite and compliance to ONS. Dietary counselling was also demonstrated to be more effective for improving the appetite of participants who underwent combined chemotherapy and radiotherapy, whereas ONS was found to improve appetite in all studies with chemotherapy treatments in long term basis. 2)	The use of fish oil capsules found that anti-inflammatory eicosapentaenoic acid plasma markers improved which correlated positively with improvements in appetite. 3)	Secondary outcomes were energy and protein intake, weight change and muscle mass had positive trend.                      Link for the standardized and validated appetite assessment tool among oncology patients:Ozorio GA, de Almeida M, Faria SO, Cardenas TC, Waitzberg DL (2019) Appetite assessment of hospitalized cancer patients in Brazil - a validation study. Clinics (Sao Paulo) 74:e1257. https://doi.org/ 10.6061/clinics/2019/e1257What are the clinical implications of this study? The use of oral nutrition supplements and dietary counselling and increases in EPA from fish oil supplementation improved the appetite and nutrition outcomes of patients with cancer undergoing cancer treatments. Nutrition interventions led to appetite improvements, there were corresponding increases in energy and protein intake or meal portions, and associated improvements or stabilization in weight. Validated assessment tools in the oncology setting are needed to determine which nutrition interventions positively influence appetite outcomes.  

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Pradeep Yarra   Citation: Prado CM, Purcell SA, Laviano A. Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle. 2020;11(2):366-380. doi:10.1002/jcsm.12525 Question 1:   Why is this study important? Nutritional status is an important determinant of patients of cancer in relation to their prognosis, treatment options and improve health across the cancer continuum. Poor nutritional status leads to Cachexia, which in turn impacts on quality of life, health outcomes and prognosis in cancer. Studies exploring nutrition interventions and anorexia in cancer patients have largely focused on those receiving palliative care. This systematic review aimed to synthesize nutrition interventions that improve appetite and nutrition-related outcomes of adults with cancer undergoing chemotherapy, immunotherapy and radiotherapy treatments, and to identify appetite assessment tools used in research and practice in the oncology setting. Identify one key finding of this study and describe how it relates to nutritional sciences          Primary outcomes of the study are1)	Dietary counselling improved appetite rather than the use of just oral nutritional supplements (ONS). Flavors, taste preferences, tastes changes and altered perception of food in cancer patients during treatment can be ever changing and can impact on appetite and compliance to ONS. Dietary counselling was also demonstrated to be more effective for improving the appetite of participants who underwent combined chemotherapy and radiotherapy, whereas ONS was found to improve appetite in all studies with chemotherapy treatments in long term basis. 2)	The use of fish oil capsules found that anti-inflammatory eicosapentaenoic acid plasma markers improved which correlated positively with improvements in appetite. 3)	Secondary outcomes were energy and protein intake, weight change and muscle mass had positive trend.                      Link for the standardized and validated appetite assessment tool among oncology patients:Ozorio GA, de Almeida M, Faria SO, Cardenas TC, Waitzberg DL (2019) Appetite assessment of hospitalized cancer patients in Brazil - a validation study. Clinics (Sao Paulo) 74:e1257. https://doi.org/ 10.6061/clinics/2019/e1257What are the clinical implications of this study? The use of oral nutrition supplements and dietary counselling and increases in EPA from fish oil supplementation improved the appetite and nutrition outcomes of patients with cancer undergoing cancer treatments. Nutrition interventions led to appetite improvements, there were corresponding increases in energy and protein intake or meal portions, and associated improvements or stabilization in weight. Validated assessment tools in the oncology setting are needed to determine which nutrition interventions positively influence appetite outcomes.  

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Yoshida, S., Kaibara, A., Ishibashi, N., &amp; Shirouzu, K. (2001, August 23). Glutamine supplementation in cancer patients. Retrieved April 21, 2021, from https://www.sciencedirect.com/science/article/pii/S0899900701006293

This study is important because it highlights the potential importance of glutamine ingestion for cancers such as esophageal cancer. In this 2 part animal and human model study, 13 murine control subjects were observed for their of glutamine  deficiency status, if deficiency was more prevalent in cancer patients, and whether glutamine supplementation changes protein metabolism throughout radiochemotherapy treatments. Tumor formation was induced as a control, while measurements proteolysis and glutamine levels were measured in order to compare the murine groups. In this 4 week study, results showed that glutamine was depleted in rodents with tumor formation and was ameliorated by glutamine supplementation supposed aid in protein metabolism restoration. Further, this study revealed promising evidence of glutamine as a protective agent against tumor progression. This study combined these results and analyzed them in conjunction with human cancer patients’ response to glutamine supplementation. The patients had advanced esophageal cancer and were instructed to orally administer glutamine in conjunction with radiochemotherapy treatments. Results from blood sample and weekly lymphocyte functional analysis showed an expected depletion of glutamine levels in the weeks following treatment, while the patients who were supplemented with oral glutamine was important in maintaining the integrity of the gut and systemic lymphocytic function. While the exact mechanism of glutamine’s role is not fully understood, what is important is that oral administration of glutamine has been correlated with beneficial outcomes in cancer treatments. This information could be usable in creating new avenues of research and finding better ways to enhance treatment modalities. Glutamine is a somewhat accessible micronutrient, as well. Therefore, encouraging patients to consume foods high in glutamine could be beneficial to use in conjunction with some cancer treatments modalities.

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Hi Jerika,

Thank you for sharing your findings from this study. We have heard a lot of positives from the Mediterranean diet so I am not surprised that information about this specific diet would also have benefits to help prevent cancer. Perhaps modulating inflammation is a key factor in the anti-cancer properties. I found this article and I think I would like to do some more research about the topic. I welcome your thoughts about it.  https://hunter.cuny.edu/news/hunter-study-shows-that-certain-olive-oils-kill-cancer-cells/

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Citation: Wang S, Maxwell CA, Akella NM. Diet as a Potential Moderator for Genome Stability and Immune Response in Pediatric Leukemia. Cancers (Basel). 2021 Jan 22;13(3):413. doi: 10.3390/cancers13030413. PMID: 33499176; PMCID: PMC7865408.                                                 This study is important because it investigates the most prevalent cancer affecting children in developed societies. Immunologic modulation of this form of cancer occurs in utero and this means that infants depend upon the nutritional choices of the mother in terms of cancer progression. They also shown that breastfeeding was associated with lower occurrence of acute lymphoblastic leukemia and that those born with this cancer can modulate the progression via nutritional decisions early in life.

One key finding from the study was that the mother’s nutritional status had an impact on the severity of the infants acute lymphoblastic leukemia. This information suggests that some cancer mutations begin to develop in utero and that nutrition had an impact on fetal genome and immune development. For example, heavy weight infants were also at a higher risk of developing lymphoblastic leukemia, perhaps through epigenetic modifications that occurred during fetal development.

I think the clinical implication from this study was that having an understanding of the extent of how early in life should we really be concerned about cancer development and what can be done to help modulate its progression. This speaks most clearly to mother’s nutrition but also the importance of other factors such as physical activity, stress, and other life style choices. Groups that are genetically predisposed to blood cancers should be aware of strategies that they can implement to help modulate cancer risk in their future offspring.

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Foster, K. L., Kern, K. D., Chambers, T. M., Lupo, P. J., Kamdar, K. Y., Scheurer, M. E., & Brown, A. L. (2019). Weight trends in a multiethnic cohort of pediatric acute lymphoblastic leukemia survivors: A longitudinal analysis. PloS one, 14(5), e0217932. https://doi.org/10.1371/journal.pone.0217932

Background:

•       Acute lymphoblastic leukemia (ALL) is curable in more than 90% of cases; research focus has shifted to long-term health outcomes of ALL survivors.

•       With 95.5% of cancer survivors experiencing at least one chronic disease by 45 years of age.
This is an important study because it aimed to characterize BMI trends in a multi-ethnic cohort of childhood ALL patients during therapy and determine whether early changes in BMI in treatment were associated with post-treatment weight status.

The key finding of this study is that at diagnosis, 60% of patients were normal weight and 11% underweight. By 5 years post-diagnosis, most patients were either overweight (22%) or obese (35%). Moreover, at the diagnosis, overweight and obese children: Hispanic 37% and 20% non-Hispanic whites. By 5-years post-diagnosis, the overweight and obesity rate increased to 60% of Hispanics and 52% of non-Hispanic whites.

The clinical implication of this study is that the one-year time point is an appropriate time to screen for significant BMI changes.

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Paolo Boffetta, Elisabeth Couto, Janine Wichmann, Pietro Ferrari, Dimitrios Trichopoulos, et. al., Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC), JNCI: Journal of the National Cancer Institute, Volume 102, Issue 8, 21 April 2010, Pages 529–537, https://doi.org/10.1093/jnci/djq072

This was an European study done to look at impacts of fruits and vegetable intakes on cancer risks. It is said that most believe diets high in vegetables and fruits help reduce the ricks but data is inconsistent and still fully unknown. This study seems very important to me, because addition of fruits and vegetables can be a simple change in diets that can impact and better health overall, and if it lead to decreases in cancer risks as well, maybe more individuals would add them into their diet. It did find that there was a modest inverse association between these is causal, and this information directs directly to nutritional sciences. For clinical implications since a lot of information seems explanatory, remember to explain the importance of getting these foods in your diet. Also keep in mind that not every patient will have the funding/time/availability to certain foods, so to be aware of that.

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Kawamori T, Lubet R, Steele VE, et al. Chemopreventive Effect of Curcumin, a Naturally Occurring Anti-Inflammatory Agent, during the Promotion/Progression Stages of Colon Cancer. Cancer Research. 1999;59(3):597-601. Accessed April 21, 2021. https://cancerres.aacrjournals.org/content/59/3/597

This trial studies the action of Curcumin (active compound in Turmeric) on colon carcinogenesis. Finding any, and all food ingredients that may prevent cancer progression is important in developing nutrition guidelines to include safe and effective chemopreventive nutrients.

A key finding was the curcumin enriched diet fed to mice that had introduction of a tumor-inducing chemical, inhibited colon tumor development. Curcumin included in the diet before, during and after chemical AOM administration, significantly inhibited noninvasive adenocarcinomas, invasive adenocarcinomas, and total adenocarcinomas of the colon. Initiating the curcumin diet 14 weeks after chemical AOM administration also significantly inhibited the incidence of invasive adenocarcinomas. Administration of a higher curcumin diet 14 weeks after the tumor induction noninvasive, invasive, and total adenocarcinomas. The curcumin was found to inhibit tumor development and progression by its action to increase apoptosis in the colon tumors.

By including turmeric in the diet, incidence of colon tumor development and progression was decreased in mice. Turmeric has been shown to have multiple benefits including anti-inflammatory and antioxidant properties. This study also shows support for including turmeric as a chemopreventive nutrient.

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14 – 81% of patients undergoing chemotherapy, depending on dosage, suffer from oral mucositis.

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Citation: Edwards, A, Santos, C, Chen, A‐Y, Bauer, J. Nutritional interventions for oral mucositis: a systematic literature review. Nutrition & Dietetics. 2021; 78: 101– 114.

This literature review is important because anywhere from 14 – 81% of patients undergoing chemotherapy, depending on dosage, suffer from oral mucositis. Despite the high frequency, and often debilitating occurrence, strategies to support optimal nutrition in these patients is lacking. The evidence supporting current recommendations, bland food and avoiding tart/acidic/spicy food, has proven inconsistent.

The article found nine nutrition interventions for oral mucositis that included oral cryotherapy, consumption of various supplements/vitamins and glutamine. They found that oral cryotherapy had a moderate certainty of being beneficial. It is thought that vasoconstriction of cells caused by cooling of the mouth prevents delivery of cytotoxic drugs to oral tissues which reduces the risk of oral mucositis development.

This is clinically important because this suggests that oral cryotherapy can be used to maintain optimal nutrition status in individuals suffering from this condition. Reducing the occurrence of this condition will allow patients to eat appropriate foods and not limit their diet.

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Citation: Tasevska N, Jiao L, Cross AJ, et al. Sugars in diet and risk of cancer in the NIH-AARP Diet and Health Study. Int J Cancer. 2012;130(1):159-169. doi:10.1002/ijc.25990

Key study question:

To investigate the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 malignancies

Key clinical finding:

Added sugars were positively associated with risk of esophageal adenocarcinoma (95% CI: 1.07–2.45; Ptrend = 0.01); added fructose was associated with risk of small intestine cancer (95% CI: 1.16–4.16; Ptrend = 0.009); and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer.

Study importance:

Added sugars had a strong positive association with oesophageal cancer, even after eliminating BMI from the model analysis. This suggests an independent association between added sugars and esophageal cancer. The strong association between malignancies and added sugars was explained by few mechanisms; synthesis of insulin and IGF-I induced by the glycemic effect of diets high in added sugars may enhance tumour development through promoting cell proliferation and inhibiting apoptosis. The association is intriguing and may point towards a broader adverse effect added sugars may exert play than just in metabolic syndrome and obesity.

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Toledo, E., Salas-Salvadó, J., Donat-Vargas, C., Buil-Cosiales, P., Estruch, R., Ros, E., Corella, D., Fitó, M., Hu, F. B., Arós, F., Gómez-Gracia, E., Romaguera, D., Ortega-Calvo, M., Serra-Majem, L., Pintó, X., Schröder, H., Basora, J., Sorlí, J. V., Bulló, M., Serra-Mir, M., … Martínez-González, M. A. (2015). Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial. JAMA internal medicine, 175(11), 1752–1760. https://doi.org/10.1001/jamainternmed.2015.4838

This study is important because it looks at how the Mediterranean diet impacts breast cancer risk in a population of women who are at high cardiovascular risk. The researchers did a randomized clinical trial to look at how the Mediterranean diet influences breast cancer risk from 2003 to 2009. Over four thousand women were recruited for the study and were assigned one of three diets. The first diet was a Mediterranean diet with extra-virgin olive oil. The next diet was a Mediterranean diet with mixed nuts. The last diet was a control diet, but participants in this diet were asked to decrease dietary fat intake.

One key finding in this study is that the breast cancer incidence rate (new cases) was 1.1 in the Mediterranean diet with extra-virgin olive oil. The breast cancer incidence rate for the Mediterranean diet with mixed nuts was 1.8. Lastly, the breast cancer incidence rate was 2.9 for the control group.

This study is important clinically because it suggests that consuming a Mediterranean diet might decrease breast cancer risk for female patients with high cardiovascular risk. The patients who consumed the Mediterranean diet with extra-virgin olive oil had the lowest rates of breast cancer. The women who consumed the control diet had a higher breast cancer rate.

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Citation: Fang Fang Zhang, Frederick Cudhea, Zhilei Shan, Dominique S Michaud, Fumiaki Imamura, Heesun Eom, Mengyuan Ruan, Colin D Rehm, Junxiu Liu, Mengxi Du, David Kim, Lauren Lizewski, Parke Wilde, Dariush Mozaffarian, Preventable Cancer Burden Associated With Poor Diet in the United States, JNCI Cancer Spectrum, Volume 3, Issue 2, June 2019, pkz034, https://doi.org/10.1093/jncics/pkz034

Diet is an important factor for cancer. Cancer is the second largest cause of death in the US accounting for 1 in 4 deaths. Poor dietary habits have long been recognized to be associated with cancer risk. This study estimated the preventable cancer burden associated with suboptimal intake of 7 dietary factors, individually and combined, among US adults for 15 cancers. The study separately estimated the cancer burden attributable to direct associations and accounting for demographic differences, study further analyzed diet-associated cancer burden among age, sex, and race/ethnicity subgroups.

More than 80000 new cancer cases in 2015 were associated with suboptimal intake of seven dietary factors among US adults, with middle-aged men and racial/ethic minorities experiencing the largest proportion of diet-associated burden in the US. Among dietary factors evaluated, low consumption of whole grains and excess processed meats. Middle-aged men and racial/ethic minorities experienced the largest proportion of diet-associated cancer burden. Suboptimal diet was associated with the most cases for colorectal cancer among all cancers. It’s suggested that compared to estimated cancer burden with other modifiable risk factors, diet associated burden was comparable to that with alcohol intake, slightly lower than excessive body weight, and higher than physical inactivity.

The findings underscore the need for reducing cancer burden and disparity in the US by improving the intake of key food groups and nutrients of Americans. These results reinforce the important of addressing unhealthy diet at the population level and evaluating the cost-effectiveness of broad nutrition policies on reducing cancer burden and disparities in the US.

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Melnik, B.C., John, S.M., Carrera-Bastos, P. et al. The impact of cow's milk-mediated mTORC1-signaling in the initiation and progression of prostate cancer. Nutr Metab (Lond) 9, 74 (2012).

Prostate cancer (PCa) is common in North America and Europe, 80-100/100,000, while 10-20/100,000 in Asia and Africa. It is men’s second highest mortality rate among cancer, and Western diet is known to increase the risk of PCa, especially cow milk. Japan after WWII saw a drastic increase in the death from PCa as much as 25-fold, which correlates to  increased consumption of milk (20-fold). Calcium lowers serum concentrations and may increase prostate carcinogenesis: When a man intake dairy proteins 35g/day more, the risk of PCa increases by 32%. Interestingly, the risk factor from calcium is only from dairy products like milk and cheese, not from other foods.

This study is to find evidence that dairy protein-derived amino acids’ impact as the cancer promoting effect through mTORC1-signaling system.

Cow’s milk overstimulates mTORC1 activity from increased insulin/IGF-1 signaling and substantial leucine, stimuli of amino acid-mediated mTORC1 activation.  The leucine consists 3.3 g/L in cow´s milk and 0.9 g/L in human’s, which shows a large difference between breast-feeding and cow´s milk-based infant formula. Also, recent studies report that PCa is promoted by estrogens which are contained in commercialized milk.

This study concludes with suggestion of plant-based diet over animal products consumption: Plant-based diets, for example, more cruciferous vegetables and tomatoes, are important for preventing PCa by decreasing mTORC1 activation and by providing natural plant-derived inhibitors of mTORC1.

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Mark J. Messina, Charles L. Loprinzi, Soy for Breast Cancer Survivors: A Critical Review of the Literature, The Journal of Nutrition, Volume 131, Issue 11, November 2001, Pages 3095S–3108S, https://doi.org/10.1093/jn/131.11.3095S

This study was interesting to me, because I have an office mate and a sister in law who are in the recent post-breast cancer stage, and this topic has come up multiple times in conversation. This study is a review of current literature and found, as anticipated that there are mixed findings on the effects of soy intake post-breast cancer. One key finding of this review was that multiple studies found that there was a decrease in tumor bulk and multiplicity in rats fed a strictly soy protein diet as opposed to a more standard diet. This is contrary to the commonly belief, as both my colleague and sister in law were told to avoid soy in the diet. There are several landmark studies referenced that have been the foundation of the soy avoidance, however there is still controversial data being discovered daily. It was interesting that rats break down soy into a certain isoflavonoid that only 1/3 of humans produce with the same diet.  There is certainly more work and research that needs to be done in this area, as breast cancer is extremely common and encountered frequently in both inpatient and primary medicine.

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Kapelner, Adam, and Matthew Vorsanger. “Starvation of Cancer via Induced Ketogenesis and Severe Hypoglycemia.” Medical Hypotheses, vol. 84, no. 3, 2015, pp. 162–168., doi:10.1016/j.mehy.2014.11.002.

This article explores the role of the keto-diet and the potential that following a keto-diet and inducing ketogenesis may starve cancer cells. Glucose is the main substrate for energy consumption in cancer cells and rely heavily on glucose uptake for fuel. This article is important because it introduces the idea that depriving cancer cells of glucose as its major energy and fuel source in order to induce apoptosis. While it is a good thought, there are many of the body’s systems that also rely on glucose as the major fuel source, so depriving the body of glucose is not an advantageous venture. There is little research done on this topic, but this article suggests this is a potential future therapeutic and dietary intervention for cancer patients. Nutritionally, if people were to follow this keto-diet as a cancer therapy the diet would need to shift from carbohydrate laden diets to most calories from fats and protein.  hypoglycemia would be a main concern in this situation, but this group suggests that depressing gluconeogenesis and administering glucose directly to the brain will decrease the effects. This will require intensive future research but I thought the concept was interesting and could promote future research on this topic.

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Citation: Banikazemi, Z, Haji, HA, Mohammadi, M, et al.  Diet and cancer prevention: Dietary compounds, dietary MicroRNAs, and dietary exosomes. J Cell Biochem. 2018; 119: 185– 196. https://doi-org.ezproxy.uky.edu/10.1002/jcb.26244

Importance:

The study of how nutrition affects cancer risk has been ongoing for some time. The review states that multiple studies indicate that dietary microRNAs and exosomes may have a role in cancer prevention. I one thing they stated was that there was no evidence for recommending supplements of vitamins A, C, E, selenium for the prevention of lung cancer. This lined up with what we learned in the lecture and our readings this week, in which supplements have not been shown to affect cancer risk/prevention.

Key findings:

They conclude that dietary compounds including curcumin, green tea components, carotenoids, and micronutrients could affect a variety of cellular and molecular targets which are involved in cancer initiation and progression. However, they associated milk with an increased level of IL-6 and IL-6's association with cancer. This claim is up for debate since other studies show that milk has anti-inflammatory properties (Bordoni et al., 2017).

Clinical Relevance:

Food compounds have a large impact on our body's processes. If we can understand how different food compounds affect our disease risk we can come up with better treatments.

Additional reference:
Bordoni A, Danesi F, Dardevet D, Dupont D, Fernandez AS, Gille D, Nunes Dos Santos C, Pinto P, Re R, Rémond D, Shahar DR, Vergères G. Dairy products and inflammation: A review of the clinical evidence. Crit Rev Food Sci Nutr. 2017 Aug 13;57(12):2497-2525. doi: 10.1080/10408398.2014.967385. PMID: 26287637.

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Citation :Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Allès B, Méjean C, Deschasaux M, Fassier P, Latino-Martel P, Beslay M, Hercberg S, Lavalette C, Monteiro CA, Julia C, Touvier M. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018 Feb 14;360:k322. doi: 10.1136/bmj.k322. PMID: 29444771; PMCID: PMC5811844.

Importance:
This study  provides insight and objective information about a topic on which very little has been documented.   This is a randomized controlled trial looking at dietary trends and associated incidence of cancer.   During the past decades, diets in many countries have shifted towards a dramatic increase in consumption of ultra-processed foods. After undergoing multiple physical, biological, and/or chemical processes, these food products are conceived to be microbiologically safe.

Key Findings:
104,980 participants were evaluated with  validated dietary intake diaries and food was  categorized using NOVA, a food classification system based on the extent and purpose of industrial food processing.   Mean follow up time was 5 years.
In this large prospective cohort, a 10% increase in the proportion of ultra-processed foods in the diet was associated with significant increases of 12% in the risk of overall cancer and 11% in the risk of breast cancer.

Clinical Implications:
A few studies have previously suggested that ultra-processed foods contribute to increasing the risk of cardiometabolic disorders—such as obesity, hypertension, and dyslipidemia—but no previous prospective epidemiological study has evaluated the association between food processing and risk cancer. This is an area where more objective data is needed . Cancer incidence continues to increase , particularly in our state which ranks highest in the country, and prevention must be at the forefront of reducing these numbers.

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Brown, J., Byers, T., Thompson, K., Eldridge, B., Doyle, C., & Williams, A. M. (2001). Nutrition during and after cancer treatment: A guide* for informed choices by cancer survivors. CA: A Cancer Journal for Clinicians, 51(3), 153-181.

1. Importance
I went a different direction this week. This is a guide by providers and cancer survivors on nutritional guidelines that are recommended to follow. This article was written with cancer patients and survivors in mind since the only well-known nutritional guidelines are for cancer prevention. This article follows nutritional issues, deficits, and recommendations through treatment, treatment recovery, and into prevention of recurrence.

2. One Key Finding
This article was written in an obvious blindspot of literature - nutrition for individuals undergoing cancer treatment, individuals recovering from treatment, and individuals who are preventing recurrence. This article discusses in-depth a lot of topics that I feel are left out of literature: changes in one's body during and post-cancer including dietary supplements, diets, alcohol, recommended foods, and a host of other recommendations to help others deal with food after a cancer diagnosis.

3. Clinical Implications
While this was primarily written to help individuals with cancer deal with nutrition, this holds a lot of valuable information that those of us interested in nutrition and current/future providers could use professionally. This article discussed really difficult issues like how nutrient absorption and needs change and how to deal with that. I think this is the perfect, easy-to-read tool that providers could utilize to help discuss nutritional plans during cancer treatment. I really recommend this as a read.

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Citation: Erin S. Sullivan, Niamh Rice, Elaine Kingston, Aoife Kelly, John V. Reynolds, Jennifer Feighan, Derek G. Power, Aoife M. Ryan, A national survey of oncology survivors examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey, Clinical Nutrition ESPEN, Volume 41, 2021, Pages 331-339, ISSN 2405-4577, https://doi.org/10.1016/j.clnesp.2020.10.023.

Why is this study important?

The goal of this research was to provide perspective on a cancer patient’s experience in the context of nutritional advice and care, during and after their treatment journey.  The research is important to providing a better understanding of the desired nutritional support needs of a cancer patient, along with the support they actually receive, to determine if there are gaps in acute care treatment and how these might be filled, to provide better nutritional support to cancer patients when needed.

Key findings and nutritional science: Overall findings concluded that although many cancer patients feel that nutrition is important, they are not being given appropriate access to a dietitian and nutrition counseling during the time of cancer treatment or in survivorship, even though they may be experiencing “serious diet-related problems including weight and muscle loss”.  Many patients are confused regarding proper nutritional advice and have tried alternative dietary strategies or supplementation.

Clinical implications: This study was conducted in Ireland, where the authors noted that oncology dietetic services are “severely under-resourced”. Perhaps this has some impact on the results of the study; however, a family member of mine in the US experienced a similar lack of support when diagnosed with cancer and commencing treatment, therefore I feel the conclusions may be applicable here in the US as well.

According to this article, malnutrition and muscle loss are common in and have a negative impact on clinical outcome for cancer patients.  Even post treatment, metabolic changes can prompt insulin resistance and weight gain, both associated with risks of cancer recurrence.  If there are low rates of nutritional screening in the clinical setting, there are lost opportunities to impact the overall survival or quality of life of some patients, either by managing an acute dietary related issue such as muscle loss, or by providing evidence based strategies for nutritional management and thereby minimizing dietary confusion for many patients.

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Schulpen, M., & Van den Brandt, P. A. (2021). Adherence to the Mediterranean diet and overall Cancer Incidence: The Netherlands cohort study. Journal of the Academy of Nutrition and Dietetics, 121(2), 242-252. doi:10.1016/j.jand.2020.07.025

I was very pleased to receive my February edition of the Journal of Academy of Nutrition and Dietetics because listed on the front page were several articles pertaining to the topic of cancer.  So I set my journal aside and flagged the article titled Adherence to the Mediterranean Diet and Overall Cancer Incidence.  Jackpot! CVD risk reduction and cancer risk reduction all with the same eating pattern! With all the positive coverage that the Mediterranean Diet has been receiving regarding CVD risk reduction it seemed plausible that the Mediterranean Diet would also play a role in overall cancer risk reduction as the plant-based foods linked to CVD risk reduction: whole grains, fruits and vegetables have also been recommended by the AICR to reduce cancer risk reduction.  This study is important because it attempts to determine if Mediterranean Diet adherence is associated with overall cancer risk reduction in men and women.   Since alcohol consumption has been linked to cancer risk the researchers an alternate Mediterranean diet score without alcohol.

The key finding from this study was that middle compared with low adherence to the Med Diet was significantly associated with a reduced overall cancer risk in women but not for men.  The authors of the research speculate that sex-specific hormones may influence the rate of tumor development and that sex-related differences regarding exposure to risk factors and carcinogen metabolism may also influence the association of dietary factors with cancer risk.  The authors also note that other studies have not identified a difference in association between males and females.  More research is recommended.