Prospective Analysis of Food Consumption and Nutritional Status and the Impact on the Dietary Inflammatory Index in Women With Breast Cancer During Chemotherapy

Considering the implications of adverse effects of chemotherapy (CT) and the potential impact of diet on patients’ recovery, this study aimed to prospectively evaluate the association between the consumption of food groups, patients’ Dietary Inflammatory Index (DII®) scores, and their nutritional status. Anthropometric and dietary assessments of 55 women with breast cancer (BC) were performed at three time points. T0 is the time point after the first CT cycle, T1 is the time point after the intermediate CT cycle, and T2 is the time point after the last CT cycle. We identified a significant increase in weight, body mass index, and waist circumference during CT. Consumption of poultry and eggs was higher in T1 when compared to T2, while consumption of total fruit and total vegetables was higher at T0 compared to T1 and T2. The diet became more pro-inflammatory over the course of treatment (X2(2) = 61.127), and was related to higher abdominal adiposity. Total fruit (T0: R2 = 0.208, T1: R2 = 0.095, T2: R2 = 0.120) and total vegetable consumption (T0: R2 = 0.284, T1: R2 = 0.365, T2: R2 = 0.580) predicted DII® change at the three-time points. Meanwhile, consumption of total grains was significantly associated only with T1 (R2 = 0.084) and T2 (R2 = 0.118), and consumption of simple sugars was significantly associated only with T0 (R2 = 0.137) and T1 (R2 = 0.126). Changes in food consumption led to an increase in the inflammatory profile of the diet, suggesting the necessity to improve the guidelines during and after CT. These results reinforce the need to promote healthier eating practices in concert with maintaining a healthy nutritional status in women with BC treated with C

Impacto da quimioterapia na alimentação e estado nutricional de mulheres com câncer de mama

Background: 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. However, there are still gaps in knowledge and a need for more information regarding the side effects of chemotherapy associated with nutrition and healthy eating, especially about intake and inadequacy of macro and micronutrientes. Improvements in the quantity and quality of food consumed are modifiable behaviors that contribute to recovery, reducing the recurrence of the disease and survival. Considering the adverse effects of chemotherapy and implications of the dietary pattern adopted, the aim of this study was to evaluate the treatment impact on the diet and nutritional status of women with breast cancer (BC). Methods: 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 during CT. 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. Results: 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). Analysis of the individual behavior of women in relation to BHEI-R during treatment found that the diet quality clusters with more representative percentages were Descending (30.9%, n=17) and Constant (29.1%, n=16). Calcium, saturated fat, niacin and riboflavin were the only nutrients that did not change significantly. Cholesterol, thiamine and vitamin B6 showed a significant increase, while the consumption of energy and the other thirteen nutrients lowered significantly during treatment. There was 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 (WC) increased significantly, indicating a worse nutritional status, and there was a correlation between poor diet quality and higher values for BMI, Waist-Hip Ratio (WHR) and Waist-to-Height Ratio (WHTR). Conclusions: 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.Fundação de Amparo a Pesquisa do Estado de Minas GeraisMestre em Ciências da SaúdeIntrodução: Determinados grupos alimentares costumam ser rejeitados durante a quimioterapia (QT), devido aos efeitos colaterais do tratamento, podendo interferir na adequação da dieta e estado nutricional. Contudo, ainda existem lacunas no conhecimento e necessidade de mais informações referentes aos efeitos colaterais da QT associados à nutrição e alimentação saudável, especialmente quanto à ingestão e inadequação de macro e micronutrientes. Melhorias na quantidade e qualidade dos alimentos consumidos são comportamentos modificáveis que contribuem para a recuperação, redução do risco de recidiva e sobrevivência. Considerando os efeitos adversos da QT e as implicações do padrão alimentar adotado, o principal objetivo deste estudo foi avaliar o impacto do tratamento na alimentação e estado nutricional de mulheres com câncer de mama (CM). Métodos: Neste estudo longitudinal prospectivo, realizado em 2014-2015, 55 mulheres com diagnóstico recente de CM e idade média de 51,5 ± 10,1 anos, foram acompanhadas, tendo sido coletados dados em três momentos da QT. Realizou-se avaliação antropométrica e dietética, sendo esta última por aplicação de nove Recordatórios 24h, utilização do Índice de Qualidade da Dieta Revisado (IQD-R) e cálculo da prevalência de inadequação pelo método de EAR como ponto de corte. Resultados: Quanto à análise do IQD-R, a maioria das mulheres apresentou padrão de dieta necessitando modificações , tanto no início (T0, 58,2%, n= 32) quanto durante o tratamento (T1, 54,5%, n= 30). Contudo, após o término da QT, o maior percentual de pacientes (T2, 49,1%, n= 27) foi classificada como padrão de dieta inadequada , sendo que o consumo de Frutas Totais e de Vegetais Verde-Escuro, Alaranjados e Leguminosas reduziu significativamente durante o tratamento (p = 0,043 e p = 0,026, respectivamente). A análise do comportamento individual das mulheres em relação ao IQD-R, durante o tratamento, identificou que os clusters de qualidade da dieta com percentuais mais representativos foram Decrescente (30,9%, n=17) e Constante (29,1%, n=16). Cálcio, gordura saturada, niacina e riboflavina foram os únicos nutrientes que não apresentaram alteração de consumo significativa. Colesterol, tiamina e vitamina B6 apresentaram aumento significativo, enquanto energia e os demais treze nutrientes reduziram significativamente, durante o tratamento. Foram identificadas, ainda, elevadas prevalências de inadequação, de até 100%, para cálcio, ferro, fósforo, magnésio, niacina, riboflavina, tiamina, vitamina B6, vitamina C e zinco. A avaliação do estado nutricional indicou que 56% (n=31) das pacientes apresentavam excesso de peso nos três tempos avaliados. Peso, IMC e Circunferência da Cintura (CC) aumentaram significativamente, indicando piora do estado nutricional, tendo havido correlação entre pior qualidade da dieta e valores mais elevados de IMC, razão CC pela Circunferência do Quadril (CC/CQ) e Relação CC pela Estatura (RCE). Conclusão: A quimioterapia interfere na dieta das pacientes com impacto negativo na qualidade e no aporte de micro e macronutrientes, além de impactar o estado nutricional, com aumento das medidas antropométricas

Assessment and impact of adverse effects of adjuvant endocrine therapy in postmenopausal breast cancer survivors: a prospective study

Introduction: The adjuvant treatment with Aromatase Inhibitor (AI) is considered standard of care for postmenopausal breast cancer (BC) women with hormone receptor-positive (HR+), however, it often causes adverse effects such as cancer-related fatigue (CRF), depression and musculoskeletal symptoms. Instruments to manage symptoms may improve adherence and persistence of treatment, health-related quality of life (HRQL) and health outcomes. Objective: This thesis had two main objectives: 1) To identify the relationship between serum 25-hydroxyvitamin D [25(OH)D] level and CRF, and to analyze their effects on depression, anxiety, functional disability, muscle/joint aches and HRQL; 2) To perform additional validation of the 31-item Cervantes Scale (CS-31), 16-item Cervantes Short-Form Scale (CS-16) and 10-item Cervantes Scale (CS-10). Material and Methods: This is a prospective study conducted with 89 postmenopausal women diagnosed with HR+ early BC in adjuvant endocrine therapy with AI. The assessments were performed at three time points: T0, baseline; T1, intermediate follow-up period, 12 months after T0; and T2, final follow-up period, 24 months after T0. At each time point, anthropometric and body composition assessments were performed, as well as dietary assessments by application of 24-hour dietary recall (24HR). The women completed the Cervantes Scale (CS), Hospital Anxiety and Depression Scale (HADS) and Health Assessment Questionnaire (HAQ). The CRF was measured using the subscale fatigue (FACIT-Fatigue) of the Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F), and a score below 34 was adopted as an indicator of the presence of this adverse effect. The serum 25(OH)D level was determined by electrochemiluminescence, with a cut-off above 75nmol/L adopted as an indication of sufficiency. Generalized Linear Model (GLzM) and Generalized Mixed Model (GMM) analysis were used to determine, respectively, associations and effects. A Minimum Clinically Important Difference (MCID) of 5% in FACIT-Fatigue score between the three time points was used to classify the women into five clusters of CRF: The same, better, worse, V and Inverted V. In addition, for CS, internal consistency, construct validity, responsiveness and known-group validity were evaluated. Results: Our results showed that slightly more than one-third of the BC survivors had CRF and low serum 25(OH)D levels. The women with CRF had been using AI for a shorter time when compared to the subgroup without CRF. The dietary vitamin D did not differ significantly between the subgroups of 25(OH)D, however none of the women reached the Estimated Average Requirements (EAR) of this nutrient. There were negative associations between the FACIT-Fatigue score and body adiposity. The greater percentage of women was classified as “better”, i.e with improvement in the FACIT-Fatigue score throughout the study. No significance was found regarding the direct and reverse causality between serum 25(OH)D level and CRF. Low serum 25(OH)D level had a negative effect on the scores of anxiety, of Menopause and Health domain and Vasomotor subdomain of the CS-31. In addition, women with CRF presented more anxiety, depression, functional disability, muscle/joint aches, worse HRQL and worse score in the following domains and subdomains of the CS-31 – Menopause and Health, Psychological, Vasomotor, Health, Aging and Couple Relations. These results show the clinical relevance of both serum 25(OH)D and CRF, highlighting the latter. The three CS presented adequate internal consistency and known-group validity, with statistical significance between anxiety and depression and worse HRQL, but only CS-10 and CS-31 presented satisfactory construct validity. Also, we identified a prospective improvement in HRQL, with higher scores at T0 compared to other time points. Conclusion: The clinical relevance of 25(OH)D and CRF is highlighted, especially CRF, considering theirs impact on others important adverse effects reported by these women. In addition, the negative effect of body adiposity on CRF can be confirmed in this study. The analysis of psychometric properties revealed that the CS, highlighting the CS-31, seem to be appropriate instruments for the medical routine with BC survivors during adjuvant endocrine therapy and may help to monitoring adverse effects and HRQL, although larger studies are needed to confirm these results.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorTese (Doutorado)Introdução: O tratamento adjuvante com Inibidor de Aromatase (IA) é considerado padrão de cuidado para mulheres pós-menopausadas com câncer de mama (CM) receptor hormonal positivo (RH+), entretanto, são frequentes efeitos adversos como fadiga relacionada ao câncer (FRC), depressão e sintomas musculoesqueléticos. Instrumentos para manejo desses sintomas podem melhorar adesão e persistência ao tratamento, qualidade de vida relacionada à saúde (QVRS) e resultados em saúde. Objetivo: Essa tese teve dois objetivos principais: 1) Identificar a relação entre níveis séricos de 25-hidroxivitamina D [25(OH)D] e FRC, bem como analisar seus efeitos na depressão, ansiedade, incapacidade funcional, dor e QVRS; 2) Realizar validação adicional da Escala Cervantes 31-itens (CS-31), 16-item Cervantes Short-Form Scale (CS-16) e 10-item Cervantes Scale (CS-10). Material e Métodos: Esse é um estudo prospectivo conduzido com 89 mulheres pós-menopausadas diagnosticadas com CM RH+ inicial, em terapia endócrina adjuvante com IA. As avaliações foram realizadas em três momentos: T0, linha de base; T1, período intermediário do seguimento, 12 meses após T0; e T2, período final do seguimento, 24 meses após T0. Em cada momento, foram realizadas avaliações antropométricas e de composição corporal, bem como avaliações dietéticas por aplicação de recordatórios alimentares de 24 horas (R24h). As mulheres completaram as Cervantes Scale (CS), Hospital Anxiety and Depression Scale (HADS) e Health Assessment Questionnaire (HAQ). A FRC foi determinada a partir da subescala fadiga (FACIT-Fatigue) da Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F), tendo sido adotado escore abaixo de 34 como indicador de presença desse efeito adverso. O nível sérico da 25(OH)D foi determinado por eletroquimioluminescência, com ponto de corte acima de 75nmol/L adotado como indicativo de suficiência. Generalized Linear Model (GLzM) e Generalized Mixed Model (GMM) foram utilizados para determinar, respectivamente, associações e efeitos. Diferença Mínima Clinicamente Importante (DMCI) de 5% no escore FACIT-Fatigue entre os três tempos foi adotada para classificar as mulheres em cinco clusters da FRC: The same, better, worse, V e Inverted V. Além disso, para as CS, foram avaliadas consistência interna, validade de construto, responsividade e validade de grupos conhecidos. Resultados: Nossos resultados mostraram que um pouco mais de um terço das sobreviventes de CM tinham FRC e baixos níveis séricos de 25(OH)D. As mulheres com FRC estavam em uso de IA há menos tempo quando comparadas ao subgrupo sem FRC. A vitamina D dietética não diferiu significativamente entre os subgrupos da 25(OH)D, entretanto, nenhuma das mulheres atingiu o Estimated Average Requirements (EAR) desse nutriente. Houve associações negativas entre o escore FACIT-Fatigue e adiposidade corporal. O maior percentual de mulheres foi classificado como “better”, ou seja, com melhoria no escore FACIT-Fatigue ao longo do estudo. Nenhuma significância foi encontrada em relação à causalidade direta e reversa entre 25(OH)D sérica e FRC. Baixo nível sérico de 25(OH)D teve efeito negativo nos escores de ansiedade, do domínio Menopausa e Saúde e subdomínio Sintomatologia Vasomotora da CS-31. Além disso, mulheres com FRC apresentaram maiores níveis de ansiedade, depressão, incapacidade funcional, dor nos músculos/articulações, pior QVRS e pior escore nos seguintes domínios e subdomínios da CS-31 – Menopausa e Saúde, Psicológico, Sintomatologia Vasomotora, Saúde, Envelhecimento e Relação de Casal. Esses resultados mostram a relevância clínica tanto da 25(OH)D sérica quanto da FRC, especialmente dessa última. As três CS apresentaram consistência interna adequada e validade de grupos conhecidos, com significância estatística entre ansiedade e depressão e pior QVRS, mas somente CS-10 e CS-31 apresentaram validade de construto satisfatória. Além disso, identificamos melhora prospectiva na QVRS, com maiores escores em T0 em relação aos outros tempos. Conclusão: Destaca-se a relevância clínica da 25(OH)D e da FRC, principalmente desta última, considerando seu impacto sobre outros importantes efeitos adversos reportados por essas mulheres. Ainda, o efeito negativo da adiposidade corporal na FRC pôde ser confirmado nesse estudo. A análise das propriedades psicométricas revelou que as CS, especialmente a CS-31, parecem ser instrumentos apropriados para uso na rotina médica com sobreviventes de CM durante terapia endócrina adjuvante, podendo auxiliar no monitoramento de efeitos adversos e da QVRS, embora estudos maiores sejam necessários para confirmar esses resultados.2023-09-2

Relationship between food perceptions and health-related quality of life in a prospective study with breast cancer patients undergoing chemotherapy

OBJECTIVE: To correlate the perceptions related to dietary intake with the domains and subscales of health-related quality of life (HRQL) in women with breast neoplasms receiving chemotherapy. METHODS: In this prospective study, 55 women with breast cancer were followed up during chemotherapy at three different times (T0, T1, T2). Before chemotherapy, perceptions related to food consumption were evaluated. HRQL was analyzed with the EORTC QLQ-C30 and Br23 instruments 21 days after each investigated cycle. The differences (T2-T0) in the subscales and HRQL domains were correlated with the differences (T2-T0) in the appetite scores. Spearman’s correlation was used to verify a possible correlation between differences in functional and overall HRQL domains (T2-T0) and differences in appetite scores for certain foods and between the differences in some subscales of EORTC QLQ-C30 and Br23 (T2-T0) and differences in appetite scores for certain food groups (T2-T0). RESULTS: Correlations between pain and appetite for bitter taste and between an increased appetite for juices and pain intensification or fatigue were identified, and pain was correlated with an appetite for starchy foods. An appetite for vegetables, legumes and meat/eggs was correlated with physical function. The only significant correlation with social functions occurred between the appetite for sweet foods and these functions. We found a correlation between overall health, emotional function, social function and physical function and the appetite for juices. CONCLUSION: Chemotherapy alters the individual’s relationship with food and, consequently, the individual’s HRQL

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

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

Impact of chemotherapy on perceptions related to food intake in women with breast cancer: A prospective study

<div><p>Breast cancer (BC) treatment includes mostly chemotherapy (CT), which can cause side effects like nausea, taste changes, early satiety, slow gastric emptying and xerostomia. In this way, the individual’s relationship with food may change during the treatment. The aim of this study was to evaluate the impact of chemotherapy on perceptions related to food intake of women with BC. Fifty-five women with BC were followed, and data were collected at three periods during first-line CT: beginning (T0), intermediate (T1) and end (T2). A visual analogue scale (VAS) (0 to 10 cm) for hunger, appetite for various food categories and meal enjoyment was investigated. The frequency and intensity of side effects were evaluated using a 4 cm scale. The results showed a higher prevalence of taste changes in T1 (p = 0.044) and more nausea in T1 and T2 (p = 0.018). Furthermore, the intensity of nausea was higher in T2 (p = 0.01) than in the other periods. We observed moderate hunger in T0, T1 and T2 (p = 0.113), but the overall appetite increased between T0 and T2 (p = 0.003). Meal enjoyment was reduced from T0 to T1and returned back to the initial value in T2 (p = 0.021). The appetite for salty (p = 0.004) and spicy (p = 0.03) foods was increased in T1. There was an increase of body weight (p = 0.008), body mass index (BMI) (p = 0.009) and waist circumference (WC) (p = 0.03) during CT. CT changes food hedonism, increasing the overall appetite and the appetite for salty and spicy foods. Moreover, we observed the negative impact of CT on meal enjoyment and an increase in side effects and anthropometric parameters.</p></div

Clinical, anthropometric and therapeutic characteristics of women with breast cancer in chemotherapy (n = 55).

<p>Clinical, anthropometric and therapeutic characteristics of women with breast cancer in chemotherapy (n = 55).</p

Diagram reporting the numbers of individuals at each stage of the study.

<p>Diagram reporting numbers of women with breast cancer screened, approached and recruited (n = 55).</p

Frequencies of determinants of food choice, reasons to eat or not to eat, state after the meal and median (p25–p75) of hunger and food satisfaction scales of women with breast cancer (BC) in chemotherapy (CT) (n = 23).

<p>Frequencies of determinants of food choice, reasons to eat or not to eat, state after the meal and median (p25–p75) of hunger and food satisfaction scales of women with breast cancer (BC) in chemotherapy (CT) (n = 23).</p