Nutrition as prevention for improved cancer health outcomes: a systematic literature review

Abstract

Background Among adults with cancer, malnutrition is associated with decreased treatment completion, more treatment harms and use of healthcare, and worse short-term survival. To inform the National Institutes of Health Pathways to Prevention (P2P) workshop, Nutrition as Prevention for Improved Cancer Health Outcomes, this systematic review examined the evidence for the effectiveness of providing nutritional interventions before or during cancer therapy to improve outcomes of cancer treatment. Methods We identified randomized controlled trials (RCT) enrolling ≥50 participants published from 2000 through July 2022. We provide a detailed evidence map for included studies and grouped studies by broad intervention and cancer types. We conducted risk of bias and qualitative descriptions of outcomes for intervention and cancer types with a larger volume of literature. Results From 9,798 unique references, 206 RCT from 219 publications met inclusion criteria. Studies primarily focused on non-vitamin/mineral dietary supplements, nutrition support, and route or timing of inpatient nutrition interventions for gastrointestinal or head and neck cancers. Most studies evaluated changes in body weight/composition, adverse events from cancer treatment, length of hospital stay, or quality of life. Few studies were conducted within the U.S. Among intervention and cancer types with a high volume of literature (n = 114), 49% (n = 56) were assessed as high risk of bias. Higher quality studies (low- or medium risk-of-bias) reported mixed results on the effect of nutritional interventions across cancer and treatment-related outcomes. Conclusions Methodological limitations of nutritional intervention studies surrounding cancer treatment impair translation of findings into clinical practice or guidelines.

A Scoping Review to Explore the Potential Benefits of Nutrition Interventions for Latino/a Adult Cancer Survivors in the US

“…The current review examined interventions for Latino/a cancer survivors in the U.S. through January 2023 and extends what is known beyond previous reviews, which searched through August 2021, August 2022, and October 2022 [22][23][24]. Based on the authors' knowledge, this scoping review is the first to report on nutrition interventions post-diagnosis, that is, through active treatment and post-treatment survivorship, specifically for Latino/a adults, regardless of cancer type or gender.…”

“…A common issue related to limited efficacy in nutrition interventions studies with Latino/as include lack of power to detect effects due to small sample sizes. Two previous reviews included RCT studies with relatively small samples (n = 18 or n = 20 participants) [22,24], while a different review by Parsons et al restricted eligibility to interventions with samples sizes greater than or equal to 50 participants [23]. The current review was mostly pilot studies (n = 8 of 10 studies).…”

“…There have been three recent and relevant nutrition reviews for Latino/a cancer survivors [22][23][24]. Pichardo et al led a scoping review of diet and physical activity interventions, with randomized study designs only, for Black and Latina women after a diagnosis of breast cancer and included studies through October 2022 [24].…”

“…Pichardo et al led a scoping review of diet and physical activity interventions, with randomized study designs only, for Black and Latina women after a diagnosis of breast cancer and included studies through October 2022 [24]. Parsons et al completed a systematic review of nutrition and dietary interventions for the prevention and treatment of cancer, including dietary supplements, nutrition support (including oral nutrition supplements), and nutrition interventions from 2000 to August 2022 [23]. Importantly, their review was not intended to provide evidence for cancer survivorship and excluded interventions that started after cancer treatment.…”

Synergistic Strategies for Gastrointestinal Cancer Care: Unveiling the Benefits of Immunonutrition and Microbiota Modulation

“…In cases where patients are severely malnourished and actively undergoing treatment, nutritional support should be implemented immediately to address their nutritional needs. GI cancer patients undergoing radiotherapy can benefit from early and intensive nutritional intervention, which will improve their nutritional status and QoL [26,27]. Nutritional therapy in GI patients should, at first, comprise an adequate calorie and protein intake, essential to preserve lean body mass, promote wound healing, and support the body's immune function.…”