RezumatScop: Multe paciente cu cancer mamar prezintă creştere ponderală pe parcursul administrării chimioterapiei sau al tratamentului antiestrogenic, ceea ce creşte riscurile de limfedem, metastază, recurenţă şi mortalitate de cauză general şi specific oncologică. Studiul de faţă îşi propune să evalueze eficienţa unei intervenţii nutriţionale şi kinetice în contracarearea obezităţii pacientelor cu cancer mamar. Pacienţi şi metodă: 165 paciente cu cancer mamar ER+/PR±/ HER2-aflate în tratament antiestrogenic au fost randomizate pentru a urma timp de 1 an, la domiciliu, fie o dietă bazată pe alimente natural bogate în proteine, calciu, probiotice şi prebiotice (D), fie dieta şi 4 minute de exerciţii fizice izometrice (D+Ex). Am măsurat greutatea (G), adipozitatea subcutanată (AS) şi adipozitatea viscerală (AV) cu un cântar cu impedanţă bioelectrică cu multifrecvenţe la 6 şi 12 luni şi am corelat rezultatele cu tipul de chimioterapie, intervenţie chirurgicală şi tratament antiestrogenic.
After diagnosis, many breast cancer patients start consuming high quantities of beetroot and carrot juice, in the hope of improving the outcome of their treatment. However, these foods are very high in nitrate, which can competitively inhibit the uptake of iodine by the thyroid, potentially leading to hypothyroidism or thyroid nodules. We applied a nitrate and iodine food frequency questionnare (asking about dairy, fish, seafood and iodized salt for iodine intake and spinach, carrots, beetroot, lettuce and arugula for nitrate intake) to 353 ER+/PR±/HER2-luminal A and B breast cancer patients during antiestrogenic treatment. We excluded patients with a thyroid disease diagnosis prior to the cancer diagnosis, smokers, ex-smokers and those with renal disease or bipolar disorder. The only correlations found between dietary intake of iodine and nitrate and the incidence of de novo thyroid nodules were: decreased risk for a daily intake of minimum 250ml dairy; and increased risk for daily intakes of over 200g spinach, 250g carrots or 250g beetroot. The correlations between dietary intake of nitrate and the incidence of de novo hypothyroidism were: decreased risk for a daily intake of iodized salt 2.5g and minimum of 100g fish or 250ml dairy; and increased risk for daily intakes of over 250g carrots or 250g beetroot. The results of this study support the hypothesis that the increased intake of nitrate-rich foods – particularly beetroot and carrot juice – is a risk factor for de novo hypothyroidism or thyroid nodules, after a breast cancer diagnosis.
Sleep disturbances overthrow breast cancer patients' eating behavior, aggravating fat gain through hedonic hunger, insulin and leptin resistance, thus increasing recurrence and mortality risks (1). Seeking behavioral fat loss solutions for overweight and obese ER + breast cancer patients with sleep disturbances, we randomized 50-of which 16 had a depression diagnosis-to follow a high protein diet based on foods naturally high in protein, calcium, omega-3, pre-and probiotics (2) (D), or the diet and sleep journal (D + SJ) interventions for 8 weeks. No supplements were used. Patients were asked to keep a daily food journal where to write the time they took each meal, exactly what it contained, in what quantity, and if they were hungry or not when they ate. To improve eating behaviour, we explained the metabolic differences between eating when not hungry and eating when physically hungry, we asked patients to learn to recognize gastric hunger, to respect it by not eating when not hungry and also by eating within a maximum of 1 hour after feeling it even if they stopped feeling it (3). Half of the patients were asked to write a 7-day Kalionska sleep diary: the time it took them to fall asleep, number of awakenings during the night, how much they slept, how much they stayed in bed, and self-perceived sleep quality. Then they were asked to follow set sleeping and wake up hours calculated based on their SJ-using the Kalionska Institute's behavioral medicine method for increasing sleep quality-and to not sleep during the day. (4) 8 patients from the D + SJ group left the study, 5 being depressive. We measured weight and body compositionheight, total body weight (W), body fat percentage (%BF), skeletal muscle percentage (%SkM) and visceral fat percentage (% VF)with a BIA scale. After the 8 week intervention patients kept the 7-day sleep log again, and we compared the self-perceived sleep quality. D group improved body composition on all measured parameters; with no differences regarding fat loss between patients with or without depression. Non-depressive patients in D + SJ group also improved body composition on all measured parameters and they obtained an increased sleep continuity; whereas depressive patients in D + SJ group did not obtain neither statistically significant results on any measured parameters nor the improved sleep qualitymaybe because of the tiring effect of the SJ intervention. So, both D and D + SJ interventions improve breast cancer patients' body composition despite sleep disturbances. But D + SJ intervention improves sleep quality only in patients without depression, decreasing fat regain risk.
Sleep disturbances overthrow breast cancer patients’ eating behavior, aggravating sarcopenic obesity causes like insulin, leptin and dopamine resistance, thus increasing recurrence and mortality risks. Seeking fat loss solutions for sarcopenic obesity in ER+ breast cancer patients with sleep disturbances, we randomized 50 – of which 16 were depressive – to follow a high protein diet (D) or the diet and sleep journal interventions (D+SJ). Patients ate only when hungry foods naturally high in protein, calcium, omega-3, pre- and probiotics, and were asked to write a daily food journal. Half of the patients were asked to write a 7-day Kalionka Institute type sleep journal – containing questions about the time it took them to fall asleep, number of awakenings during the night, how much they slept, how much they stayed in bed, and self-perceived sleep quality. After writing the sleep journal, we asked patients to follow set sleeping and wake up hours calculated based on their SJ answers, and to not sleep during the day. After 8 weeks we remeasured body composition with a multi-frequency bioelectrical impedance scale. 8 patients from the D+SJ group asked to leave the study, 5 being depressive. D group lost 2.31±2.86% body fat (p=0.001), and 0.76±1.16% visceral fat (p=0.001); with no fat loss difference between patients with or without depression. Depressive patients did not obtain statistically significance for weight loss. D+SJ group improved sleep quality and lost 2.16±2.35% body fat (p=0.002), and 0.86±1.24% visceral fat (p=0.005). Depressive patients didn’t obtain statistically significant results neither for fat, nor for weight loss – maybe because of the overtiring effect of the SJ intervention. So, both D and D+SJ interventions improve breast cancer patients’ body composition despite sleep disturbances, but only non-depressive patients also lose weight. And SJ intervention improves sleep quality in patients without depression, decreasing weight regain risk.
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