Current and future strategies for the nutritional management of cardiometabolic complications of androgen deprivation therapy for prostate cancer

Abstract

Androgen deprivation therapy (ADT) is used widely as part of a combined modality for the treatment of prostate cancer. However, ADT has also been associated with the development of cardiometabolic complications that can increase mortality from cardiovascular events. There is emerging evidence to suggest that ADT-related cardiometabolic risk can be mitigated by diet and lifestyle modification. While the clinical focus for a nutritional approach for achieving this effect is unclear, it may depend upon the timely assessment and targeting of dietary changes to the specific risk phenotype of the patient. The present review aims to address the metabolic origins of ADT-related cardiometabolic risk, existing evidence for the effects of dietary intervention in modifying this risk, and the priorities for future dietary strategies.

Obesity and low levels of physical activity impact on cardiopulmonary fitness in older men after treatment for prostate cancer

“…Many of the men in our study had central adiposity, as measured by waist-to-hip ratio, and with levels of HbA1c indicative of pre-diabetes, all of which could have contributed to metabolic health risks associated with their PCa (Shlomai et al, 2016). While ADTrelated cardiometabolic risk shares several of the components of metabolic syndrome (Di Sebastiano et al, 2018), ADT adverse effects are distinct in that it develops more rapidly and is characterised by an accumulation of subcutaneous adipose tissue and sarcopenia (Turner et al, 2017). This impacts on men's body composition which is characterised by a loss of skeletal muscle and accumulation of body fat (Morote et al, 2015).…”

“…Studies have shown an association between all-cause mortality and ADT in men with PCa (Davis et al, 2015;Keating et al, 2013;O'Farrell et al, 2015). While ADT is highly effective as a component of combined modality therapy, its use, and specifically, the use of gonadotrophin-releasing hormone (GnRH) agonists, has been associated with the development of sarcopenic obesity and cardiometabolic risk factors, including dyslipidaemia, insulin resistance and elements of metabolic syndrome (Collier et al, 2011;Morote et al, 2015;Turner et al, 2017). An association between ADT and increased risk of CVD and mortality has been recognised in multiple studies (Bosco et al, 2014;Nguyen et al, 2011;Weaver et al, 2013;Zhao et al, 2014) but CVD and links with increased mortality remain contentious in clinical practice.…”

Examining the effects of creatine supplementation in augmenting adaptations to resistance training in patients with prostate cancer undergoing androgen deprivation therapy: a randomised, double-blind, placebo-controlled trial

“…As a result, men with PCa are at a heightened risk of frailty, falls and fractures, and early mortality 3 5 6. Further, the decline in body composition is also associated with sarcopenic obesity, leading to increases in cardiometabolic risk factors 45 46. Consequently, investigations into strategies that may improve musculoskeletal health is of critical importance in this population.…”

The Effects of Androgens on Cardiometabolic Syndrome: Current Therapeutic Concepts

“…It was suggested that cardiometabolic risk due to ADT can be decreased by diet and lifestyle modification. 59 However, further research is required to comprehend the impact of TRT on cardiometabolic health and to determine the beneficial or harmless dose, route, and duration time of T administration in clinical conditions. Late-onset hypogonadism is linked to hyperglycemia, increased waist circumference, hypertriglyceridemia, hyperlipidemia, as well as diabetes mellitus.…”