The Effects of a Mediterranean Diet Intervention on Cancer-Related Fatigue for Patients Undergoing Chemotherapy: A Pilot Randomized Controlled Trial

Abstract

Cancer-related fatigue is a common, burdensome symptom of cancer and a side-effect of chemotherapy. While a Mediterranean Diet (MedDiet) promotes energy metabolism and overall health, its effects on cancer-related fatigue remain unknown. In a randomized controlled trial, we evaluated a rigorous MedDiet intervention for feasibility and safety as well as preliminary effects on cancer-related fatigue and metabolism compared to usual care. Participants had stage I–III cancer and at least six weeks of chemotherapy scheduled. After baseline assessments, randomization occurred 2:1, MedDiet:usual care. Measures were collected at baseline, week 4, and week 8 including MedDiet adherence (score 0–14), dietary intake, and blood-based metabolic measures. Mitochondrial respiration from freshly isolated T cells was measured at baseline and four weeks. Participants (n = 33) were 51.0 ± 14.6 years old, 94% were female, and 91% were being treated for breast cancer. The study was feasible, with 100% completing the study and >70% increasing their MedDiet adherence at four and eight weeks compared to baseline. Overall, the MedDiet intervention vs. usual care had a small-moderate effect on change in fatigue at weeks 4 and 8 (ES = 0.31, 0.25, respectively). For those with a baseline MedDiet score <5 (n = 21), the MedDiet intervention had a moderate-large effect of 0.67 and 0.48 at weeks 4 and 8, respectively. The MedDiet did not affect blood-based lipids, though it had a beneficial effect on fructosamine (ES = −0.55). Fatigue was associated with mitochondrial dysfunction including lower basal respiration, maximal respiration, and spare capacity (p < 0.05 for FACIT-F fatigue subscale and BFI, usual fatigue). In conclusion, the MedDiet was feasible and attenuated cancer-related fatigue among patients undergoing chemotherapy, especially those with lower MedDiet scores at baseline.

The Effect of Melatonin Supplementation on Cancer-Related Fatigue during Chemotherapy Treatment of Breast Cancer Patients: A Double-Blind, Randomized Controlled Study

“…This effect was more profound for those patients having lower MedDietScores at baseline [40]. The favorable effects of the MD on CRF have been linked with substantial improvements in mitochondrial function including basal respiration, maximal respiration, and spare capacity [40]. It has been documented that obesity in BC is directly linked with CRF, and this association is probably attributed to the high levels of circulating inflammatory cytokines, i.e., tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), as well as blood fatty acid imbalance [41].…”

“…According to the results of a recent randomized trial, cancer patients following the MD for 8 weeks showed a significant amelioration in fatigue, as indicated by FACIT-F scores. This effect was more profound for those patients having lower MedDietScores at baseline [40]. The favorable effects of the MD on CRF have been linked with substantial improvements in mitochondrial function including basal respiration, maximal respiration, and spare capacity [40].…”

Mediterranean-style dietary interventions in adults with cancer: a systematic review of the methodological approaches, feasibility, and preliminary efficacy

“… Primary outcome: Nutrition status Intent: Weight maintenance to meet EER. Kleckner et al 2022 [ 30 ] (United States) 33 (2-M, 31-F), Breast cancer, other cancers (23-int, 10-con) Treatment: Chemotherapy Intervention timing in relation to treatment: Undergoing chemotherapy. Details of other treatment NR.…”

Preventing Functional Decline with Age: Biomarkers and Best Practices

“…In the case of cancer related fatigue, adoption of the Mediterranean diet was associated with a small-moderate decrease in fatigue levels [44]. High protein [45], carnitine [46,47], Omega-3 [48], American Ginseng [49], Wisconsin Ginseng [50] and Astralagus membranacus [51] reduced fatigue [52].…”