Randomised controlled trial of intermittent vs continuous energy restriction during chemotherapy for early breast cancer

Abstract

Background Excess adiposity at diagnosis and weight gain during chemotherapy is associated with tumour recurrence and chemotherapy toxicity. We assessed the efficacy of intermittent energy restriction (IER) vs continuous energy restriction (CER) for weight control and toxicity reduction during chemotherapy. Methods One hundred and seventy-two women were randomised to follow IER or CER throughout adjuvant/neoadjuvant chemotherapy. Primary endpoints were weight and body fat change. Secondary endpoints included chemotherapy toxicity, cardiovascular risk markers, and correlative markers of metabolism, inflammation and oxidative stress. Results Primary analyses showed non-significant reductions in weight (−1.1 (−2.4 to +0.2) kg, p = 0.11) and body fat (−1.0 (−2.1 to +0.1) kg, p = 0.086) in IER compared with CER. Predefined secondary analyses adjusted for body water showed significantly greater reductions in weight (−1.4 (−2.5 to −0.2) kg, p = 0.024) and body fat (−1.1 (−2.1 to −0.2) kg, p = 0.046) in IER compared with CER. Incidence of grade 3/4 toxicities were comparable overall (IER 31.0 vs CER 36.5%, p = 0.45) with a trend to fewer grade 3/4 toxicities with IER (18%) vs CER (31%) during cycles 4–6 of primarily taxane therapy (p = 0.063). Conclusions IER is feasible during chemotherapy. The potential efficacy for weight control and reducing toxicity needs to be tested in future larger trials. Clinical trial registration ISRCTN04156504.

Calorie Restriction and Time-Restricted Feeding: Effective Interventions in Overweight or Obese Patients Undergoing Radiotherapy Treatment with Curative Intent for Cancer

“…Our results are consistent with the available literature. TRF showed similar results to the work of Kalam et al [ 39 ], with a high degree of adherence and decrease in weight, and Harvie et al [ 41 ], where IF had a bigger drop in weight compared with CR. However, differences in the mean changes may be explained by the fact that they used another approach of IF which focuses on the amount of calories consumed.…”

“…A large RCT with 187 patients from 2022 [ 41 ] compared intermittent and continous energy restriction during chemotherapy for early breast cancer cases. This study concluded that an intermittent restriction approach had a bigger weight reduction than a continuous restriction when adjusted for total body water.…”

Impact of Caloric Restriction in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: A Prospective Case Control Study

“…We know that CT is associated with a loss of lean mass and an increase in fat mass, independent of weight change [43]. At the same time, the reduction in lean mass is strongly associated with the important decrease in FM in our study (p = 0.0001).…”

Caloric restriction and fasting-mimicking diets in the treatment of cancer patients

“…In a controlled trial, 172 women with early breast cancer were randomized to consume either a diet tailored to their energy requirement for weight loss or maintenance or 2-day cycles of a fasting-mimicking diet repeated every 7 days [37]. The co-primary endpoints of changes in weight, fat mass and fat free mass did not differ between groups nor did chemotherapy toxicity differ.…”