Abstract
Colorectal cancer has the second highest cancer-related mortality rate, with an estimated 881,000 deaths worldwide in 2018. The urgent need to reduce the incidence and mortality rate requires innovative strategies to improve prevention, early diagnosis, prognostic biomarkers, and treatment effectiveness. Caloric restriction (CR) is known as the most robust nutritional intervention that extends lifespan and delays the progression of age-related diseases, with remarkable results for cancer protection. Other forms of energy restriction, such as periodic fasting, intermittent fasting, or fasting-mimicking diets, with or without reduction of total calorie intake, recapitulate the effects of chronic CR and confer a wide range of beneficial effects towards health and survival, including anti-cancer properties. In this review, the known molecular, cellular, and organismal effects of energy restriction in oncology will be discussed. Energy-restriction-based strategies implemented in colorectal models and clinical trials will be also revised. While energy restriction constitutes a promising intervention for the prevention and treatment of several malignant neoplasms, further investigations are essential to dissect the interplay between fundamental aspects of energy intake, such as feeding patterns, fasting length, or diet composition, with all of them influencing health and disease or cancer effects. Currently, effectiveness, safety, and practicability of different forms of fasting to fight cancer, particularly colorectal cancer, should still be contemplated with caution.
Highlights
Bioactive Products and Metabolic Syndrome Group-BIOPROMET, Precision Nutrition and Aging Program, Institute IMDEA Food (CEI UAM+CSIC), Crta. de Canto Blanco no 8, E-28049 Madrid, Spain; Molecular Oncology and Nutritional Genomics of Cancer Group, Precision Nutrition and Cancer Program, Institute IMDEA Food (CEI, UAM/CSIC), Crta. de Canto Blanco no 8, E-28049 Madrid, Spain; Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224, USA
In this scenario, screening colonoscopies aimed at early diagnosis are recommended to start at the age of 45–50 years, a strategy that has contributed to the overall reduction of colorectal cancer (CRC) incidence and mortality
In the context of CRC, Rubio-Patiño and colleagues showed in different mouse cancers models of CRC that mice fed a low-protein diet prompted the induction of IRE1α and RIG1 signaling downstream of endoplasmic reticulum stress (ERS), resulting in increased levels of cytokines, effective assembly of the immune response, and reduced colorectal tumor growth [146]
Summary
An estimated 18.1 million new cancer cases and 9.6 million cancer deaths occurred worldwide in 2018. Colorectal cancer (CRC) ranked third for incidence (10.2%, with 1.8 million new cases) and second for mortality (9.2%, with 881,000 deaths) [1,2]. Evidence from epidemiological studies reveal that protective nutrition may reduce CRC incidence (reviewed in [8]) These nutritional practices include diets rich in fruits and vegetables, fiber, folate, calcium, garlic, dairy products, vitamin D and B6, magnesium, and fish [8]. Later stages are concomitant with dissemination of cancer cells to the lymph system or other organs in the body In this scenario, screening colonoscopies aimed at early diagnosis are recommended to start at the age of 45–50 years, a strategy that has contributed to the overall reduction of CRC incidence and mortality.
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