Optimising weight-loss interventions in cancer patients-A systematic review and network meta-analysis.

Nathalie Levasseur,Nadera Ahmadzai,Carol Stober,Pauline Barbeau,Brian Hutton,Dianna Wolfe,Sasha Mazzarello,Mona Hersi,Lee Jones,Risa Shorr,John Hilton,Lisa Vandermeer,Wei Cheng,Mark Clemons,Anil Abraham Joy,Diane K Ehlers

doi:10.1371/journal.pone.0245794

Abstract

BackgroundExcess weight has been associated with increased morbidity and a worse prognosis in adult patients with early-stage cancer. The optimal lifestyle interventions to optimize anthropometric measures amongst cancer patients and survivors remain inconsistent.ObjectiveTo conduct a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the effects of exercise and dietary interventions alone or in combination on anthropometric measures of adult cancer patients and survivors.MethodsA systematic search of Medline, Embase and the Cochrane Trials Registry was performed. Outcomes of interest included changes in weight, body mass index (BMI), and waist circumference. Screening and data collection were performed by two reviewers. Bayesian NMAs were performed.ResultsOverall, 98 RCTs were included; 75 were incorporated in NMAs (n = 12,199). Groups of intervention strategies included: 3 exercise interventions, 8 dietary interventions, 7 combination interventions of diet and exercise and standard care. Median intervention duration was 26 weeks. NMA suggested that diet alone (mean difference [MD] -2.25kg, 95% CrI -3.43 to -0.91kg) and combination strategies (MD -2.52kg, 95% CrI -3.54 to -1.62kg) were associated with more weight loss compared to standard care. All dietary interventions achieved a similar magnitude of weight loss (MD range from -2.03kg to -2.52kg). Both diet alone and combination strategies demonstrated greater BMI reductions versus standard care, and each of diet alone, exercise alone and combination strategies demonstrated greater reductions in waist circumference than standard care.ConclusionDiet and exercise alone or in combination are effective lifestyle interventions to improve anthropometric measures in cancer patients and survivors. All reputable diets appear to be similarly effective to achieve weight loss.

Highlights

Excess weight has been associated with increased morbidity and a worse prognosis in adult patients with early-stage cancer
network meta-analysis (NMA) suggested that diet alone and combination strategies (MD -2.52kg, 95% CrI -3.54 to -1.62kg) were
Our analyses reveal that dietary and combination regimens of diet and exercise during and after cancer treatment achieved greater weight, body mass index (BMI) and waist circumference reduction when compared to standard care in overweight and obese patients with early stage cancer

Summary

Methods

A systematic search of Medline, Embase and the Cochrane Trials Registry was performed. Outcomes of interest included changes in weight, body mass index (BMI), and waist circumference. NMAs of the changes from baseline in body weight, body mass index and waist circumference were performed. The nature of reporting these endpoints varied across included studies, with some reporting changes from baseline while others reported mean values of each endpoint at baseline and follow-up, with standard deviations for each. For the latter, we calculated the mean changes from baseline and imputed the standard errors of the mean changes (for details, see S3 Text). All mean differences (MD) of interventions versus standard care were reported along with corresponding 95% credible

Results

Discussion

Conclusion