Impact of Chemotherapy on Diet and Nutritional Status of Women with Breast Cancer: A Prospective Study

Abstract

Certain food groups are often rejected during chemotherapy (CT) due to the side effects of treatment, which may interfere with adequate diet and nutritional status. The aim of this study was to evaluate the treatment impact on the diet and nutritional status of women with breast cancer (BC). In this prospective longitudinal study, conducted in 2014–2015, 55 women diagnosed with BC, with a mean age 51.5±10.1 years, were followed and data were collected at three different times. Anthropometric and dietary assessments were performed, the latter by applying nine 24h dietary recalls, by using the Brazilian Healthy Eating Index Revised (BHEI-R), and calculating the prevalence of inadequacy by the EAR cut-off point method. Regarding the BHEI-R analysis, the majority of women had a “diet requires modification’, both at the beginning (T0, 58.2%, n = 32) and during treatment (T1, 54.5%, n = 30). However, after the end of the CT, the greater percentage of patients (T2, 49.1%, n = 27) were classified as having an "inadequate diet", since the Total Fruit consumption as well as the Dark Green and Orange Vegetable and Legume consumption decreased significantly during treatment (p = 0.043 and p = 0.026, respectively). There was a significant reduction in the intake of macro and micronutrients, with a high prevalence of inadequacy, of up to 100%, for calcium, iron, phosphorus, magnesium, niacin, riboflavin, thiamin, vitamin B6, vitamin C and zinc. Assessment of the nutritional status indicated that 56% (n = 31) of patients were overweight at these three different times. Weight, BMI and Waist Circumference increased significantly, indicating a worse nutritional status, and there was a correlation between poor diet quality and higher values for BMI, Waist-Hip Ratio and Waist-to-Height Ratio. Chemotherapy interferes in the patients’ diet generating a negative impact on the quality and intake of micro and macronutrients, as well as an impact on their nutritional status, with an increase in anthropometric measurements.

Diet quality and its relationship with overweight and laboratory parameters in breast cancer patients undergoing treatment

“…In this study, the consumption of whole grains, dairy, fatty acids and refined grains were low. This finding was consistent with earlier studies 23,24 . Avoidance and abstinence of certain foods are common among cancer patients, owing to belief that animal products are the causes of cancer development 19,20 or treatment-related side effects that alter the taste perception 25 .…”

“…As poor diet is commonly perceived to be linked with cancer developement 19,20 , cancer patients are likely to consume low fat, high fiber diet upon diagnosis 21,22 . Nonetheless, few studies highlighted the reduced diet quality during treatment among breast cancer patients, which resulted from the poor adherence to dietary guidelines for the components of fruits and vegetables 23,24 , grains, solid fats, alcohol and added sugars 23 . This could be explained by the altered taste or increased eating pleasure for "heavy taste" food during treatment 25 .…”

Effect of chemotherapy and aromatase inhibitors in the adjuvant treatment of breast cancer on glucose and insulin metabolism—A systematic review

“…This is mainly evident by a small increase in weight and/or change in body composition, but the underlying mechanism has not yet been thoroughly described. Earlier explanations like overeating, seem unlikely on its own, due to the loss of lean body mass and development of sarcopenic obesity . A combination of fatigue, physical inactivity, altered appetite and sarcopenic obesity having a negative impact on especially the insulin and glucose metabolism appear to be the most likely explanation.…”

Longer Times of Receipt of Adjuvant Endocrine Therapy Correspond to Improved Functional Capacity and Lower Adiposity in Women Receiving Adjuvant Therapy

“…BC survivors are significantly more likely to report difficulty performing heavy housework, walking half a mile, and walking up and down stairs compared to their cancer-free peers. 33 The significant weight gain observed during BC treatment 13,34 may be one of the influencing factors. Furthermore, Brazilian public health sources suggest that women with BC often deviate (temporarily or permanently) from their work activities after being diagnosed with neoplasia, which probably decreases energy expenditure and facilitates weight gain.…”

“…10 In addition to being an independent factor for developing distant metastases and death, 11 obesity may affect physical functions in BC survivors. 12 Because it is common for women to gain weight after being diagnosed with BC, especially after chemotherapy, 13,14 the impact of body composition on FC for different duration of AI receipts is of interest, given the importance of its adverse effects and adherence to long-term endocrine treatment. 3 On this basis, we hypothesized that longer duration of AI receipts in women are positively correlated with adiposity parameters and impaired FC.…”