Impact of Caloric Restriction in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: A Prospective Case Control Study
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design and Patients
2.2. Nutritional Assessment and Blood Sampling
2.3. Statistical Analysis
3. Results
3.1. Impact of CR in Response to NACT
3.2. Nutritional Efficacy and Safety of CR in NACT Patients
3.2.1. IC and BIA
3.2.2. Anthropometric Parameters
3.2.3. Biochemical Analysis
3.2.4. Compliance with CR
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BC | Breast Cancer |
BCM | Body Cell Mass |
BIA | Bioimpedentiometry |
BMI | Body Mass Index |
CHO | Carbohydrates |
CI | Confidence Intervals |
CR | Caloric Restriction |
CT | Chemotherapy |
ER | Estrogen Receptor |
FFM | Free Fat Mass |
FM | Fat Mass |
HDL | High-density Lipoprotein |
HOMA | Homeostatic Model Assessment |
IC | Indirect Calorimetry |
LDL | Low-density Lipoprotein |
NACT | Neoadjuvant Chemotherapy |
OR | Odd Ratio |
PA | Phase Angle |
pCR | Pathological Complete Response |
PR | Progesterone Receptor |
REE | Resting Energy Expenditure |
RQ | Respiratory Quotient |
RR | Relative Risk |
TEE | Total Energy Expenditure |
TBW | Total Body Water |
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Diet Group (39) | Control Group (60) | Chi-Square | p-Value | |
---|---|---|---|---|
Age years (median) | 46 | 52 | ||
Size (mm) | ||||
≤20 | 11 | 3 | 11.586 | 0.003 |
20–50 | 21 | 36 | ||
>50 | 7 | 21 | ||
Lymph node tatus | ||||
Positive | 23 | 45 | 2.822 | ns |
Negative | 16 | 15 | ||
Histotype | ||||
Non-special type | 39 | 55 | 3.423 | ns |
Others | 0 | 5 | ||
Histological grade | ||||
1 | 2 | 1 | 1.22 | ns |
2 | 17 | 24 | ||
3 | 20 | 35 | ||
ER (%) | ||||
0 | 17 | 12 | 6.35 | 0.01 |
>1 | 22 | 48 | ||
PR (%) | ||||
0 | 26 | 26 | 5.161 | 0.02 |
>1 | 13 | 34 | ||
HER2 | ||||
Negative | 21 | 33 | 0.013 | ns |
Positive | 18 | 27 | ||
Ki67 (%) | ||||
≤20 | 2 | 8 | 1.752 | ns |
>20 | 37 | 52 |
Diet Group (39) | Control Group (60) | Chi-Square | p-Value | |
---|---|---|---|---|
Surgery | ||||
Conservative | 32 | 24 | 6.915 | 0.008 |
Mastectomy | 7 | 36 | ||
Size (mm) | ||||
Not determined | 11 | 7 | 11.505 | 0.009 |
≤20 | 19 | 23 | ||
20–50 | 9 | 20 | ||
>50 | 0 | 10 | ||
Residual tumor | ||||
No | 20 | 17 | 0.015 | |
Yes | 19 | 43 | ||
Lymph node status | ||||
Positive | 9 | 29 | 6.375 | 0.01 |
Negative | 30 | 31 | ||
ypT | ||||
Is | 1 | 7 | 22.324 | <0.001 |
0 | 19 | 10 | ||
1 | 17 | 24 | ||
2 | 1 | 13 | ||
3 | 0 | 6 | ||
4 | 1 | 0 | ||
ypN | ||||
0 | 30 | 29 | 9.431 | 0.008 |
1 | 7 | 29 | ||
2 | 2 | 2 | ||
Pinder tumor stage | ||||
1 | 20 | 17 | 10.767 | 0.004 |
2 | 18 | 32 | ||
3 | 0 | 11 | ||
Pinder lymph node stage | ||||
1 | 24 | 17 | 15.081 | 0.001 |
2 | 6 | 14 | ||
3 | 9 | 17 | ||
4 | 0 | 12 | ||
ER (%) | ||||
0 | 9 | 8 | 5.478 | 0.01 |
>1 | 10 | 35 | ||
PR (%) | ||||
0 | 14 | 22 | 4.938 | 0.02 |
>1 | 3 | 21 | ||
Not performed | 2 | 0 | ||
HER2 | ||||
Negative | 13 | 33 | 0.477 | ns |
Positive | 6 | 10 | ||
Ki67 (%) | ||||
≤20 | 9 | 25 | 0.166 | ns |
>20 | 5 | 18 | ||
Not performed | 5 | 0 |
Lymph Nodes Status Post Nact | Total | ||||
---|---|---|---|---|---|
yN0 | yN1–2 | ||||
Control Group | Lymph Nodes Status Pre Nact | Negative | 13 | 2 | 15 |
Positive | 16 | 29 | 45 | ||
Total | 29 | 31 | 60 | ||
Diet Group | Negative | 16 | 0 | 16 | |
Positive | 14 | 9 | 23 | ||
Total | 30 | 9 | 39 |
pCR vs. Residual Cancer | ||||||
---|---|---|---|---|---|---|
Breast Cancer | Lymph Nodes | |||||
OR (Crude) | 95% Confidence Interval | OR (Crude) | 95% Confidence Interval | |||
Inf | Sup | Inf | Sup | |||
Diet group vs. control group | 2.66 | 1.15 | 6.18 | 4.05 | 1.72 | 9.52 |
OR (adj) | Inf | Sup | OR (adj) | Inf | Sup | |
Diet group vs. control group | 2.94 | 1.07 | 8.10 | 3.22 | 1.22 | 8.56 |
Size in mm (T0) | 0.94 | 0.44 | 2.01 | 0.77 | 0.36 | 1.63 |
ER (T0) | 1.09 | 0.32 | 3.69 | 0.54 | 0.16 | 1.83 |
PGR (T0) | 0.45 | 0.14 | 1.42 | 0.38 | 0.12 | 1.19 |
Ki67 (T0) | 1.02 | 0.84 | 15.34 | 5.17 | 0.47 | 56.30 |
HER2 (T0) | 1.66 | 1.05 | 2.63 | 1.09 | 0.69 | 1.73 |
Parameter | Time | Median (Range) | p |
---|---|---|---|
Resistance (Ohm) | T0 | 598 (416–700) | |
T2 | 565 (426–727) | ns | |
Reactance (Ohm) | T0 | 57 (40–75) | |
T2 | 50 (37–66) | 0.0009 | |
PA (°) Reference values: 5.2–7.2° | T0 | 5.6 (4.3–6.6) | |
T2 | 5.0 (4.2–6.5) | 0.003 | |
FFM (kg) | T0 | 44.2 (36.2–53.5) | |
T2 | 45 (38.6–55.2) | ns | |
FM (kg) | T0 | 22.4 (17.1–29.6) | |
T2 | 12.1 (2.3–32) | 0.0001 | |
TBW (L) | T0 | 32.4 (26.5–39.2) | |
T2 | 32.5 (25.7–38.6) | ns |
Median | T0 | T2 | p | Δ% T0–T2 |
---|---|---|---|---|
Body Weight (kg) | 63 | 59 | 0.001 | −6.35 |
BMI (kg/m2) | 24.22 | 22.49 | 0.02 | −7.14 |
Waist Circumference (cm) | 81 | 74 | 0.0001 | −9.46 |
Hip Circumference (cm) | 97.5 | 91.5 | 0.0001 | −6.56 |
Time | CR Diet 50% TEE | CR Diet 70% TEE | ||
---|---|---|---|---|
Prescription | Value | Prescription | ||
Energy (kcal/die) Median (range) | T0 | 900 (704–1097) | 918 (450–1160) | 1300 (1012–1660) |
T1 | 980 (532–1400) | |||
T2 | 945 (550–1126) | |||
CHO (g/die) Median (range) | T0 | 47 (37–53) | 56 (20–117) | 117 (85–145) |
T1 | 60 (20–126) | |||
T2 | 58 (30–110) | |||
Protein (g/die) Median (range) | T0 | 75 (45–98) | 68 (31–83) | 65 (55–80) |
T1 | 67 (34–100) | |||
T2 | 67 (33–82) | |||
Lipid (g/die) Median (range) | T0 | 50 (37–59) | 49 (20–77) | 65 (44–92) |
T1 | 52 (30–80) | |||
T2 | 50 (25–75) |
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Castellano, I.; Gallo, F.; Durelli, P.; Monge, T.; Fadda, M.; Metovic, J.; Cassoni, P.; Borella, F.; Raucci, C.; Menischetti, M.; et al. Impact of Caloric Restriction in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: A Prospective Case Control Study. Nutrients 2023, 15, 4677. https://doi.org/10.3390/nu15214677
Castellano I, Gallo F, Durelli P, Monge T, Fadda M, Metovic J, Cassoni P, Borella F, Raucci C, Menischetti M, et al. Impact of Caloric Restriction in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: A Prospective Case Control Study. Nutrients. 2023; 15(21):4677. https://doi.org/10.3390/nu15214677
Chicago/Turabian StyleCastellano, Isabella, Francesco Gallo, Paola Durelli, Taira Monge, Maurizio Fadda, Jasna Metovic, Paola Cassoni, Fulvio Borella, Carlo Raucci, Monica Menischetti, and et al. 2023. "Impact of Caloric Restriction in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: A Prospective Case Control Study" Nutrients 15, no. 21: 4677. https://doi.org/10.3390/nu15214677
APA StyleCastellano, I., Gallo, F., Durelli, P., Monge, T., Fadda, M., Metovic, J., Cassoni, P., Borella, F., Raucci, C., Menischetti, M., Beano, A., Migliaretti, G., & Finocchiaro, C. (2023). Impact of Caloric Restriction in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: A Prospective Case Control Study. Nutrients, 15(21), 4677. https://doi.org/10.3390/nu15214677