SCI

13 July 2022

Plant-Based and Ketogenic Diets As Diverging Paths to Address Cancer: A Review

 (JAMA Oncol, IF: 33.006)

Shah Urvi A,Iyengar Neil M,Plant-Based and Ketogenic Diets As Diverging Paths to Address Cancer: A Review.[J] .JAMA Oncol, 2022, undefined: undefined.

Importance 重要性

As the incidence of cancer and metabolic disorders, such as obesity, concurrently rise, there has been increasing awareness of the pervasive effect of nutrition. The whole foods plant-based diet (WFPBD) and ketogenic diet (KD) have gained popularity in oncology, and this topic is increasingly permeating clinical dialogue.

隨著癌癥和代謝紊亂(如肥胖)的發(fā)病率同時(shí)上升，人們?cè)絹碓揭庾R(shí)到營(yíng)養(yǎng)的普遍影響。全食物植物性飲食(WFPBD)和生酮飲食(KD)在腫瘤學(xué)領(lǐng)域越來越受歡迎，并日益滲透到臨床對(duì)話中。

Observations 觀察

Dietary intake is associated with multiple pathways involved in carcinogenesis and tumor progression. Consumption of a plant-enriched diet is associated with reduced cancer incidence and is recommended by dietary guidelines for cancer prevention. Despite a starkly different nutrient composition, a WFPBD and KD can be associated with weight loss, decreased inflammation, and decreased insulin levels. In addition, a WFPBD is associated with increased fiber, phytochemicals, and butyrate levels and decreased insulin-like growth factor 1 levels, whereas a KD exerts potential anticancer effects by increasing β hydroxybutyrate levels. A KD may be of interest in select, less common settings, such as tumors treated with phosphatidylinositol 3-kinase inhibitors, which induce hyperinsulinemia and hyperglycemia. Completed interventional trials have focused on increasing fruit and vegetable intake or reducing fat intake but have not specifically tested WFPBD or KD for cancer prevention or treatment. Currently available data support plant-based diets as opposed to KD as part of a lifestyle associated with reduced cancer risk. In the postdiagnosis setting, there are currently no rigorously tested approaches that support the recommendation of any diet to treat cancer.

飲食攝入與多種途徑有關(guān)，涉及癌變和腫瘤進(jìn)展。食用富含植物的飲食與降低癌癥發(fā)病率有關(guān)，這是預(yù)防癌癥的膳食指南所推薦的。盡管營(yíng)養(yǎng)成分截然不同，但WFPBD和KD可與體重減輕、炎癥減輕和胰島素水平下降有關(guān)。此外，WFPBD與纖維、植物化學(xué)物質(zhì)和丁酸水平的增加以及胰島素樣生長(zhǎng)因子1水平的降低有關(guān)，而KD通過增加β羥基丁酸水平發(fā)揮潛在的抗癌作用。KD可能對(duì)某些不太常見的情況有興趣，比如用磷脂酰肌醇3激酶抑制劑治療的腫瘤，可誘導(dǎo)高胰島素血癥和高血糖。已完成的干預(yù)臨床試驗(yàn)中注重在增加水果和蔬菜攝入或減少脂肪攝入，但沒有專門測(cè)試WFPBD或KD的癌癥預(yù)防或治療。目前可用的數(shù)據(jù)支持以植物為基礎(chǔ)的飲食作為生活方式的一部分與降低癌癥風(fēng)險(xiǎn)有關(guān)，而不是KD。在診斷后的設(shè)置中，目前還沒有嚴(yán)格的測(cè)試方法支持任何治療癌癥的飲食建議。

Conclusions and Relevance 結(jié)論與相關(guān)性 

The results of this review suggest that the collective evidence supports plant-enriched diets vs KD for the reduction of cancer risk and the improvement of metabolic disorders in survivors. Additional prospective randomized clinical trials are needed to encourage use of dietary modification across the cancer continuum. Rigorous trial designs that adapt classical oncologic end points may identify populations that are likely to benefit from starkly contrasting diets. Current data support prioritization of plant-based diets, and future data could further personalize dietary recommendations in cancer populations.

這一綜述的結(jié)果表明，集體證據(jù)支持植物豐富的飲食與KD相比，在減少癌癥風(fēng)險(xiǎn)和改善幸存者的代謝紊亂。需要額外的前瞻性隨機(jī)臨床試驗(yàn)來鼓勵(lì)在癌癥連續(xù)體中使用飲食改變。采用經(jīng)典腫瘤學(xué)終點(diǎn)的嚴(yán)格試驗(yàn)設(shè)計(jì)可能會(huì)確定哪些人群可能從截然不同的飲食中受益。目前的數(shù)據(jù)支持植物性飲食的優(yōu)先排序，未來的數(shù)據(jù)可以進(jìn)一步個(gè)性化癌癥人群的飲食建議。

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