Fasting Intervention for Children With Unilateral Renal Tumors to Reduce Toxicity

Abstract

Childhood renal tumors account for around 6% of all childhood cancers and 90% of these cases are Wilms tumor. In Europe, the SIOP-RTSG approach is considered standard of care and has resulted in five-year survival rates of over 90%. Efforts to decrease toxicity are now being pursued. Short-term fasting (STF), a short but strong reduction in calorie-intake, is associated with improved fitness, enhanced coping with acute physical stress and a lower risk of age-associated diseases. STF temporarily reduces growth to boost resilience, maintenance, and defense-mechanisms, by which toxic side-effects of (oxidative) damage and inflammation are largely prevented. Renal surgery for Wilms tumor carries a risk of acute kidney injury (AKI) and pediatric patients that had an episode of AKI are at increased risk for developing chronic renal disease. STF could mitigate surgery-induced stress and could further improve outcomes. We aim to investigate the effect of STF on renal function recovery after renal tumor surgery by conducting a single-center, prospective, randomized, non-blinded, intervention study. Children diagnosed with a unilateral renal tumor and opting for curative treatment are eligible for inclusion. The main study objective is to investigate the potential decrease in occurrence of AKI due to STF. Secondary objectives include renal function recovery, child's wellbeing, physical functioning, and feasibility of and adherence to STF in children with cancer.

Do treats facilitate the interpretation of findings on caloric restriction?

“…This was not as expected, given that on average, women tend to crave sweet treats more than men 37 38. Lastly, study personnel were found to significantly rate lower, influenced by their involvement in the active trials,29–31 possibly setting higher standards for the coordinating investigator or they were just sad to see a familiar batch of brownies distributed to others. The consistent findings in the subscores support the absence of the ‘Brownie-Effect’.…”

“…We selected 200 email addresses of healthcare professionals from departments associated with the active clinical trials 29–31. The survey was sent twice, on 26 April 2023 and 10 May 2023, and people were given a response window of 6 weeks from 26 April 2023.…”

“…Contents and protocol on this investigational product have been published earlier 6. At the start of the presentation, colleagues were informed about the content of the presentation; an update on the active clinical trials investigating STF 29–31. After this brief introduction, they received information about the current randomised study.…”

“…We hypothesise that providing a treat positively influences the score given by participants who are not familiar with fasting, while not or negatively influencing the participants who are familiar with it. By combining two studies we hope to shed light on the factors that shape the attitudes of medical professionals toward research into fasting, to facilitate successful implementation of potential findings of current research,29–31 and ultimately contribute to evidence-based strategies. In summary, our study explores the effect of treats offered as a treat during presentations about IF and STF, while accounting for the irony of the situation: a calorie-rich brownie versus the information on the potential health benefits of restricting calories.…”

Chocolate brownies and calorie restriction: the sweetest paradox?

“…Preliminary results indicate that brownies did not influence their views—but many saw value in short term fasting to improve wellbeing. While we complete the analysis and interpretation of our findings, we offer (in the spirit of open science) the potential intervention for BMJ readers to implement: a tried-and-tested brownie recipe meticulously honed by the coordinating investigator (box) 1011…”