Intermittent Fasting in Breast Cancer: A Systematic Review and Critical Update of Available Studies

Abstract

Breast cancer (BC) is the most-frequent malignancy amongst women, whereas obesity and excess caloric consumption increase the risk for developing the disease. The objective of this systematic review was to examine the impact of intermittent fasting (IF) on previously diagnosed BC patients, regarding quality of life (QoL) scores during chemotherapy, chemotherapy-induced toxicity, radiological response and BC recurrence, endocrine-related outcomes, as well as IF-induced adverse effects in these populations. A comprehensive search was conducted between 31 December 2010 and 31 October 2022, using the PubMed, CINAHL, Cochrane, Web of Science, and Scopus databases. Two investigators independently performed abstract screenings, full-text screenings, and data extraction, and the Mixed Method Appraisal Tool (MMAT) was used to evaluate the quality of the selected studies. We screened 468 papers, 10 of which were selected for data synthesis. All patients were female adults whose age ranged between 27 and 78 years. Participants in all studies were women diagnosed with BC of one of the following stages: I, II (HER2−/+), III (HER2−/+), IV, LUMINAL-A, LUMINAL-B (HER2−/+). Notably, IF during chemotherapy was found to be feasible, safe and able to relieve chemotherapy-induced adverse effects and cytotoxicity. IF seemed to improve QoL during chemotherapy, through the reduction of fatigue, nausea and headaches, however data were characterized as low quality. IF was found to reduce chemotherapy-induced DNA damage and augmented optimal glycemic regulation, improving serum glucose, insulin, and IGF-1 concentrations. A remarkable heterogeneity of duration of dietary patterns was observed among available studies. In conclusion, we failed to identify any IF-related beneficial effects on the QoL, response after chemotherapy or related symptoms, as well as measures of tumor recurrence in BC patients. We identified a potential beneficial effect of IF on chemotherapy-induced toxicity, based on markers of DNA and leukocyte damage; however, these results were derived from three studies and require further validation. Further studies with appropriate design and larger sample sizes are warranted to elucidate its potential standard incorporation in daily clinical practice.

Decanoylcarnitine Inhibits Triple-Negative Breast Cancer Progression via Mmp9 in an Intermittent Fasting Obesity Mouse

“…Despite encouraging preclinical data, the lack of extensive clinical trials assessing the impact of IF on breast cancer across diverse populations poses a significant challenge. 9 , 30 Since robust clinical evidence is essential to form conclusive insights. Further clinical trials are crucial to substantiate and expand upon these preliminary findings.…”

“… 5 IF has garnered attention for its potential benefits in metabolic health, weight management, and its impact on chronic diseases. 6 – 8 Recent investigations have explored the influence of IF on breast cancer, especially the aggressive TNBC subtype, 9 , 10 revealing promising outcomes in restraining cancer growth and improving treatment effectiveness. 11 , 12 However, this field remains dynamic, with ongoing research necessary to comprehensively understand the intricate relationship between IF and TNBC.…”

Breast Cancer Exposomics

“…The female breast is rich in adipose tissue [ 121 ], so that, in postmenopausal women, the adipose tissue becomes a significant source of estrogen, this obesity-associated estrogen likely playing an essential role in BC growth, mainly in ER+ BC tumors [ 120 ]. Conversely, caloric restriction or intermittent fasting, a period of voluntary abstention from all food or specific food products [ 122 ], can negatively impact BC development, reduce the treatment-induced adverse effects, cytotoxicity, and DNA damage, and increase optimal glycemic regulation, improving serum glucose, insulin, and insulin-like growth factor 1 (IGF-1) levels [ 123 ]. Insulin and the IGF-1 pathway regulate lifespan and longevity [ 124 ].…”

“…Food components may act as mutagens, such as N-nitroso-derivatives, polycyclic aromatic hydrocarbons (PAHs), and heterocyclic aromatic amines [ 43 ], which can be involved in nutritional regulation of the mammary tumor microenvironment (TME) [ 44 ], and impact the growth and proliferation of cancer cells [ 45 ]. Nutritional stimuli modulate interactions between different cell populations within the TME, such as immune cells, adipocytes, vascular cells, and mammary epithelial and BC stem cells, so that both obesity, a chronic over-nutritional condition, as well as excess caloric consumption, disrupt mammary gland homeostasis and increase BCR [ 44 , 123 ]. EDCs has been reported in aquatic macroinvertebrates, mussels and seawater or freshwater fish [ 126 ], pork, beef, and chicken meat [ 127 ], vegetables [ 128 ], as well as in milk and dairy products [ 129 ].…”

Calorie Restriction and Time-Restricted Feeding: Effective Interventions in Overweight or Obese Patients Undergoing Radiotherapy Treatment with Curative Intent for Cancer

“…A systematic review on the impact of IF on breast cancer from January 2023 by Anemoulis et al [ 40 ], which included studies from 2009 to 2021, failed to conclude if there were beneficial effects from IF on quality of life (QoL), response after chemotherapy or an improvement in symptoms. They did, however, find that there could be a beneficial effect on chemotherapy-related adverse effects based on markers of DNA and leukocyte damage but required further validation.…”