Background: Obesity has been associated with decreased disease free survival and overall survival in postmenopausal breast cancer survivors. Proposed mechanisms for this finding include elevated estradiol levels, hyperinsulinemia, and increased inflammatory mediators. This feasibility study evaluated whether a low carbohydrate, calorie restricted dietary intervention could achieve weight loss and measurable metabolic changes in a group of obese postmenopausal breast cancer survivors. Methods: Twenty-three early stage estrogen receptor positive breast cancer survivors were enrolled on a low carbohydrate, calorie-restricted dietary intervention. At time of enrollment the patient had to be deemed postmenopausal and have a BMI >28. Patients were not allowed to have an underlying inflammatory condition or be receiving treatment for diabetes. The mean age was 57 years old (42-68) with a mean weight of 220 lbs (171-300) and mean BMI of 37 (28-48.5). All subjects had completed surgery and adjuvant chemotherapy. The majority of patients were on endocrine therapy with 61% on an AI and 35% on tamoxifen. The dietary intervention utilized 0.5g protein/pound (actual body weight), less than 40 grams of carbohydrates and 800-1200 calories per day. The program provided weekly coaching, meal replacement protein products and nutritional supplements. Subjects were medically monitored with brief physical exams and labs done every 2 weeks for the first 12 weeks, then monthly thereafter. Subjects were seen by a health coach every week. The average weight loss period spanned 23 weeks (7-59 weeks) due to the variance in weight loss goals aimed at a BMI ≤28. Results: The mean weight loss was 19.9% of total body weight, the equivalent of 43.7 pounds. Total body fat lost was 6.86%. Weight loss averaged 5.4 pounds in week one and 2.14 pounds per week in weeks 2-19. Statistically significant declines in the total estrogen level (p = 0.0345), estrone (p = 0.0296), and estradiol serum levels (p = 0.0296) were demonstrated. A rapid decline in fasting insulin level was seen with a 23% decline by Week 3 (p = 0.0959), 26% by Week 7 (p = 0.0139), and 42% by Week 19 (p = 0.0071). A statistically significant improvement in the CRP level compared to baseline was also demonstrated with a 40% decrease at Week 19 (p = 0.0272). Conclusions: Our results support that a low carbohydrate dietary intervention can be used to successfully achieve weight loss and improve metabolic parameters. This feasibility study provides additional support for larger trials evaluating the role of carbohydrate restriction in breast cancer survivors. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD2-5.
Background: Obesity and weight gain are associated with higher rates of breast cancer recurrence and increased mortality. Cardiovascular disease is a leading cause of death in breast cancer survivors. Control of body weight and cardiovascular risk factors are key aspects in breast cancer survivorship. The purpose of our study was to see if a low carbohydrate, calorie restricted dietary intervention could be implemented in a group of obese postmenopausal breast cancer survivors to achieve weight loss and improved lipid profiles. Methods: Twenty-four postmenopausal estrogen receptor positive breast cancer patients were enrolled on a low carbohydrate, calorie restricted dietary intervention. The dietary intervention utilizes 0.5g protein/pound (actual body weight), less than 40 grams of carbohydrates, and 800-1200 calories per day. Body weight, body fat percentage, blood triglyceride level, and total cholesterol level were measured and monitored, during the dietary intervention. Results: The average weight loss spanned 23.8 weeks (varying from 5 to 59 weeks). When compared with the mean body weight prior to the dietary intervention, the mean body weight was reduced by 19.9% (equivalent to 43.7 pounds). The mean body fat percentage was reduced by 6.86%. In addition, the dietary intervention significantly decreased the patients’ blood triglyceride level by 33.8% (p = 0.00013). The mean total cholesterol level was decreased by 9.5% with the dietary intervention (p = 0.00498). Conclusion: This study demonstrated that a low carbohydrate, calorie restricted diet resulted in significant weight loss with improved lipid profiles. This study suggests that this dietary intervention is feasible in postmenopausal breast cancer survivors and a potential strategy for cardiovascular risk reduction. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-09-04.
Background: It is well known that obesity and weight gain are significant issues in breast cancer survivorship. Weight gain frequently occurs after a breast cancer diagnosis, often attributed to adjuvant chemotherapy and the onset of menopause. Weight loss in the general population has been widely studied and shown to improve overall quality of life. The effect of weight loss on functional health and well being in breast cancer survivors is not well studied. The purpose of our study was to evaluate quality of life measures in overweight breast cancer survivors on a low carbohydrate, calorie restricted dietary intervention. Methods: Overweight estrogen-receptor positive postmenopausal breast cancer survivors who completed radiation and chemotherapy were eligible for the dietary intervention. There were 23 women enrolled on the study, 14 completed the dietary intervention and were used for analysis. The dietary intervention utilizes 0.5g protein/pound (actual body weight), less than 40 grams of carbohydrates, and 800-1200 calories per day. Patients stayed on the dietary intervention for an average of 23 weeks (7-59) depending on their weight loss goal. Quality of life was measured by a short-form health survey, SF-36, measuring functional status, wellbeing and overall evaluation of health (Brazier, 1992). Patients completed the quality of life questionnaire at baseline and every two months until the end of year 2. The student's t-test was used to analyze mental and physical health scores at baseline and intervals thereafter, p-value ≤0.05 was considered statistically significant. Results: The average total body weight reduction after dietary intervention was 19.9% equivalent to 43.7 pounds. Changes in the physical health scores from baseline were significant when compared to 2-months after diet start (p = 0.001) and diet termination (p = 0.00001). These changes remained significant at the 2-month follow-up visit (p = 0.0001). The changes to mental health scores were not statistically significant when compared to baseline. Conclusion: Overall physical health quality of life scores were improved as a result of the low carbohydrate, calorie restricted dietary intervention in estrogen-receptor positive postmenopausal breast cancer survivors. Over half of the patients started with mental health scores above the general population norm, which could have contributed to the lack of statistical significance. Additional research with a larger sample size may confirm the positive influence of weight loss through a low carbohydrate dietary intervention. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-16.
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