Feasibility Outcomes of a Pilot Randomized Clinical Trial to Increase Cruciferous and Green Leafy Vegetable Intake in Posttreatment Head and Neck Cancer Survivors

Crowder, Sylvia L.; Frugé, Andrew D.; Douglas, Katherine G.; Chen, Yi Tang; Moody, Laura; Delk-Licata, Ashley; Erdman, John W.; Black, Michael; Carroll, William R.; Spencer, Sharon A.; Locher, Julie L.; Demark‐Wahnefried, Wendy; Rogers, Laura Q.; Arthur, Anna E.

doi:10.1016/j.jand.2018.11.005

Cited by 6 publications

(9 citation statements)

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“…Originally, 24 participants were recruited, but only 23 are included in this analysis due to missing serum cytokine and carotenoid data for one participant. A detailed description of the pilot study methods and population have been detailed elsewhere [26]. The study was approved by the Institutional Review Board at UAB and University of Illinois Urbana-Champaign (UIUC) and all participants provided written informed consent before initiating study activities.…”

Section: Study Population and Proceduresmentioning

confidence: 99%

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Epigenetic stratification of head and neck cancer survivors reveals differences in lycopene levels, alcohol consumption, and methylation of immune regulatory genes

et al. 2020

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Background Inflammation has been associated with higher rates of recurrence and mortality in head and neck cancer (HNC). While the biological mechanisms predisposing patients to heightened inflammatory states remain largely unknown, DNA methylation has been proposed to reflect systemic inflammation. In this analysis, we attempt to identify meaningful epigenetic patterns in HNC survivors by stratifying individuals based on DNA methylation profiles in leukocytes. Results We used hierarchical clustering to uncover three distinct methylation patterns among HNC survivors. Each group displayed a unique methylation signature in inflammatory pathways including cytokine and B-cell receptor signaling. Additionally, we examined physiological, clinical, and lifestyle parameters related to inflammation, such as circulating carotenoid and cytokine levels, cancer treatment type, and alcohol consumption. Specifically, we identified one group of survivors who had significant differential methylation of transcriptional and translational regulators as well as genes in the T-cell receptor signaling pathway, including hypermethylation of CD40 ligand (CD40LG) and Tec protein tyrosine kinase (TEC) and hypomethylation of CD8A. This group also displayed high circulating lycopene levels. We identified another group that had distinctive methylation in the toll-like receptor (TLR) signaling pathway, including hypomethylation of TLR5, a component of the inhibitor of nuclear factor-kappa B kinase complex (CHUK), and two mitogen-activated protein kinases (MAP3K8 and MAP2K3). This group also had hypermethylation of mitochondrial ribosomal genes along with higher rates of alcohol consumption. Conclusion The correlation between lycopene, alcohol consumption, DNA methylation, and inflammation warrants further investigation and may have implications in future recommendations and interventions to impact health outcomes in HNC survivors.

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Section: Study Population and Proceduresmentioning

confidence: 99%

“…Herein, we report an analysis of data collected as part of a pilot clinical trial in HNC survivors [26]. We investigate blood samples with the objective of characterizing survivors according to DNA methylation signatures in leukocytes.…”

Section: Introductionmentioning

confidence: 99%

Epigenetic stratification of head and neck cancer survivors reveals differences in lycopene levels, alcohol consumption, and methylation of immune regulatory genes

et al. 2020

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“…Most recently, Crowder et al reported that head and neck cancer survivors were receptive to and adherent of a 12-week intervention including weekly correspondence and counseling from a Registered Dietitian. In this pilot study, the intervention group displayed an mean increase in GLV intake by 5.5 cups and cruciferous vegetables by 3.5 cups per week [36]. Pierce et al investigated the feasibility of a high vegetable diet in breast cancer survivors to prevent recurrence.…”

Section: Discussionmentioning

confidence: 99%

Primary Outcomes of a Randomized Controlled Crossover Trial to Explore the Effects of a High Chlorophyll Dietary Intervention to Reduce Colon Cancer Risk in Adults: The Meat and Three Greens (M3G) Feasibility Trial

et al. 2019

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Preclinical and observational research suggests green leafy vegetables (GLVs) may reduce the risk of red meat (RM)-induced colonic DNA damage and colon cancer (CC). We sought to determine the feasibility of a high GLV dietary intervention in adults with an increased risk of CC (NCT03582306) via a 12-week randomized controlled crossover trial. Participants were randomized to immediate or delayed (post-4-week washout) intervention groups. During the 4-week intervention period, participants were given frozen GLVs and counseled to consume one cooked cup equivalent daily. The primary outcomes were: accrual—recruiting 50 adults in 9 months; retention—retaining 80% of participants at completion; and adherence—meeting GLV intake goals on 90% of days. Adherence data were collected twice weekly and 24-h dietary recalls at each time point provided nutrient and food group measures. The Food Acceptability Questionnaire (FAQ) was completed to determine acceptability. On each of the four study visits, anthropometrics, stool, saliva, and blood were obtained. Fifty adults were recruited in 44 days. Participants were 48 ± 13 years of age, 62% female, and 80% Caucasian, with an average BMI at screening of 35.9 ± 5.1. Forty-eight (96%) participants were retained and completed the study. During the intervention phase, participants consumed GLVs on 88.8% of days; the adherence goal of one cup was met on 73.2% of days. Dietary recall-derived Vitamin K and GLVs significantly increased for all participants during the intervention periods. Overall satisfaction did not differ between intervention and control periods (p = 0.214). This feasibility trial achieved accrual, retention and acceptability goals, but fell slightly short of the benchmark for adherence. The analysis of biological specimens will determine the effects of GLVs on gut microbiota, oxidative DNA damage, and inflammatory cytokines.

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“…Participants were randomized to two groups: (1) an attention control group ( n = 12) that received weekly telephone counseling from a registered dietitian nutritionist (RDN) focusing on general healthy eating for cancer survivors while addressing chronic side effects of treatment that might interfere with the ability or desire to eat; or (2) an experimental group ( n = 12) who received the same weekly dietary counseling plus additional goals for consuming 2.5 and 3.5 cups of cruciferous (CV) and green leafy vegetables (GLV) per week, respectively. A detailed description of the study population and intervention methods have been described elsewhere [15]. Briefly, stage I–IV oral, pharyngeal, or laryngeal cancer patients who were > 6 months post-treatment and able to consume at least soft foods orally were recruited via the institutional cancer registry.…”

Section: Methodsmentioning

confidence: 99%

“…However, dietary intervention preferences in HNC survivors are understudied [8, 14]. As such, the objective of this study was to determine dietary intervention preferences and a study program evaluation as reported by post-cancer treatment HNC survivors who previously participated in a pilot dietary intervention trial [15]. Results can inform future frameworks for successful dietary interventions within this patient population and determine acceptability of research testing dietary interventions.…”

Section: Main Textmentioning

confidence: 99%

Head and neck cancer survivors’ preferences for and evaluations of a post-treatment dietary intervention

Crowder

Douglas

Frugé

et al. 2019

Nutr J

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Background Dietary preferences vary depending on cancer type. The purpose of this study was to report dietary intervention preferences and a study program evaluation from post-treatment head and neck cancer survivors participating in a dietary intervention. Methods Between January 2015 and August 2016, 24 head and neck cancer survivors participated in a 12-week randomized clinical dietary intervention trial that promoted weekly consumption of 2.5 cups of cruciferous vegetables and 3.5 cups of green leafy vegetables. At study completion, survivors completed a preferences survey and a study program evaluation to probe interests and improvement aspects for planning future dietary intervention trials. Descriptive statistics (means and frequencies) were generated for multiple choice question responses. Responses to open-ended questions were recorded and grouped based on themes, and verified by quality assurance checks by a second study team member. Results Twenty-three survivors completed the preferences and evaluation surveys (response rate 96%). Overall, most participants reported a preference for one-on-one telephone counseling from a registered dietitian nutritionist before beginning treatment. Ninety-six percent of participants ranked the overall study program as “very good” to “excellent,” and all agreed the objectives of the study were clear, the study staff was helpful and easy to contact, and the registered dietitian nutritionist was knowledgeable. Conclusions Future research and dietary intervention planning for head and neck cancer survivors should focus on strategies to promote one-on-one telephone or other distance-based counseling combined with face-to-face visits, according to survivor preference.

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Feasibility Outcomes of a Pilot Randomized Clinical Trial to Increase Cruciferous and Green Leafy Vegetable Intake in Posttreatment Head and Neck Cancer Survivors

Cited by 6 publications

References 59 publications

Epigenetic stratification of head and neck cancer survivors reveals differences in lycopene levels, alcohol consumption, and methylation of immune regulatory genes

Epigenetic stratification of head and neck cancer survivors reveals differences in lycopene levels, alcohol consumption, and methylation of immune regulatory genes

Primary Outcomes of a Randomized Controlled Crossover Trial to Explore the Effects of a High Chlorophyll Dietary Intervention to Reduce Colon Cancer Risk in Adults: The Meat and Three Greens (M3G) Feasibility Trial

Head and neck cancer survivors’ preferences for and evaluations of a post-treatment dietary intervention

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