Abstract
BackgroundObesity and low muscle mass are associated with worse outcomes of breast cancer patients. We conducted a controlled trial to study the impact of a ketogenic diet (KD) based on natural foods versus an unspecified standard diet (SD) on body composition in breast cancer patients undergoing radiotherapy.MethodsPatients with non-metastasized breast cancer were allocated to either the KD (N = 32) or the SD (N = 31) during radiotherapy. Body composition was measured weekly by bioimpedance analysis. Blood parameters and quality of life were assessed before, during, and at the end of radiotherapy.ResultsA total of 29 KD and 30 SD patients completed the study. During radiotherapy, mean and median fasting BHB concentrations in the KD group were 0.72 and 0.49 mmol/l (range 0.06–4.9) which was significantly higher than those in the SD group (p < 2.2 × 10−16). There was a very small and insignificant increase in body weight and fat mass in the SD group, as well as a decrease of fat free mass. In contrast, patients in the KD group lost body weight and fat free and skeletal muscle mass quickly after diet onset, which for the most part was related to water losses. The KD did not cause further substantial changes in fat free or skeletal muscle mass, but was associated with a gradual decrease of 0.4 kg body weight and fat mass per week (p < 0.0001). The KD significantly decreased free T3 levels by 0.06 pg/ml/week (p = 6.3 × 10−5). Global quality of life remained stable in the SD group but increased in the KD group from a score of 66.7 to 75.0 (p = 0.20).ConclusionsIn breast cancer patients undergoing curative radiotherapy, a KD based on natural foods is feasible. After initial water losses, the KD tends to reduce body weight and fat mass while preserving fat free and skeletal muscle mass.Trial registrationClinicalTrials.gov identifier: NCT02516501, registered on August 06, 2015.
Highlights
Obesity and low muscle mass are associated with worse outcomes of breast cancer patients
General results We had separated the three waves of recruitment by longer breaks, so that the first patient was enrolled into the study in August 2016, and the last patient in March 2020
The recruitment process resulted in an approximately balanced distribution of patient characteristics with the exception of a higher, yet clinically insignificant, β-OHB concentration in the ketogenic diet (KD) group (Table 1). The latter difference was likely due to a number of patients in the KD group having already reduced carbohydrate consumption after being asked to participate in the study, despite our request to maintain their normal diet until the day of baseline measurements
Summary
Obesity and low muscle mass are associated with worse outcomes of breast cancer patients. There is burgeoning interest in researching modifiable factors that causally impact the treatment outcome and prognosis of breast cancer patients. A large proportion of newly diagnosed breast cancer patients exhibit high fasting blood glucose levels [16], obesity, and low muscle mass [5, 6]. These phenomena may be exacerbated during radio- and chemotherapy, worsening the health and fitness of patients. Lifestyle modifications are of particular interest since they allow patients to take self-responsibility during their treatment
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