A Nutritional Approach for the Management of Chemotherapy-Induced Diarrhea in Patients with Colorectal Cancer

Abstract

This study aimed to determine if dietary modifications using a nutritional regimen could prevent or reduce the incidence of cancer therapy-induced diarrhea in patients with metastatic colorectal cancer and to evaluate the relationship of Vitamin D blood levels with diarrhea severity. Patients with metastatic colorectal cancer were enrolled. A Mediterranean diet, containing some special limitations aiming to reduce the risk of diarrhea, was administered before and during the entire chemotherapy program. Enrolled patients numbering 60/137 (44%) had diarrhea during chemotherapy. Adherence to the diet was high in 36 (26.3%) patients, medium in 94 (68.6%), and low in 7 (5.1%). Mean adherence to the diet was significantly lower in patients who experienced diarrhea with maximum grade 2–3 compared to those who had no diarrhea or grade 1 diarrhea (score = 5.4 ± 1.9 vs. 7.1 ± 1.5, p < 0.001). Patients with higher adherence to the diet had a lower risk of grade 2–3 diarrhea (odds ratio: 0.5 (95% CI: 0.3–0.7, p < 0.001)). In addition, patients who completed a higher number of chemotherapy cycles had an increased risk of grade 2–3 diarrhea (odds ratio: 1.2 (95% CI: 1.0–1.5, p = 0.02)). Of note, a lower level of Vitamin D correlated with an increased risk of G2-G3 diarrhea (p = 0.03). A diet based on vegetables with a controlled fiber content, Mediterranean Modified Healthy Diet (MMHD), is useful to control the incidence of cancer therapy-induced diarrhea.

Falls prechemotherapy and toxicity‐related hospitalization during adjuvant chemotherapy for breast cancer in older women: Results from the prospective multicenter HOPE trial

“…For instance, early referral to physical therapy and occupational therapy to improve physical function before or during treatment has been shown to improve outcomes and reduce morbidity. [49][50][51][52] Additional evidence-based strategies may include careful medication reconciliation to prevent polypharmacy, 53,54 home-based care, 55,56 or nutritional interventions, [57][58][59] among others. Future studies are warranted to test the efficacy of using such strategies to improve the care of older adults most vulnerable to therapy-related toxicity.…”

Relationship between dietary fiber intake and chronic diarrhea in adults

“…Instead, it passes into the large intestine, where it is fermented by the intestinal flora. The gut microbiota and microbial metabolic processes can be impacted by the fermentation process[ 1 ]…”

Mediterranean Diet as a Supportive Intervention in Cancer Patients: Current Evidence and Future Directions

“…Cancer currently represents a leading cause of morbidity and mortality, and it can be held responsible for about one in six deaths worldwide [ 1 ]. Nutrition represents a rather novel, promising, highly cost-effective intervention paradigm in oncology, not only because 30–50% of all cancer cases can be prevented with proper diet and lifestyle modifications [ 2 ], but also because diet may affect the risk of cancer recurrence [ 3 ] and even influence the course of clinically relevant, cancer-related [ 4 ] and treatment-related adverse events [ 5 ]. Among several nutritional approaches [ 6 ] with potential benefits in cancer patients, which include the use of hypocaloric, fasting-mimicking, ketogenic, low-fat diets, the adoption of the Mediterranean Diet (MedDiet) represents one of the most promising, easily applicable and widely investigated nutritional interventions [ 7 ].…”