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.
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.
Conclusions and Relevance
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.
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Accepted for Publication: March 29, 2022.
Published Online: July 7, 2022. doi:10.1001/jamaoncol.2022.1769
Corresponding Author: Urvi A. Shah, MD, Myeloma Service, Memorial Sloan Kettering Cancer Center, 530 E 74th St, New York, NY 10021 (firstname.lastname@example.org).
Author Contributions: Drs Shah and Iyengar had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Obtained funding: All authors.
Administrative, technical, or material support: All authors.
Conflict of Interest Disclosures: Dr Shah reported grants from Celgene/BMS and Janssen to her institution and personal fees from MJH Life Sciences, Association of Community Cancer Centers, MashUp MD, and Janssen Biotech outside the submitted work. Dr Iyengar reported grants from Novartis to his institution and personal fees from Novartis and Seattle Genetics outside the submitted work.
Funding/Support: Drs Shah and Iyengar are supported by the National Institutes of Health/National Cancer Institute Memorial Sloan Kettering Cancer Center Support grant P30 CA008748 and participated in the TREC Training Workshop (grant R25CA203650). Dr Shah is supported by research grants from International Myeloma Society Career Development Award, Paula and Rodger Riney Foundation, the Allen Foundation Inc, the HealthTree Foundation, the Parker Institute of Cancer Immunotherapy, and the National Cancer Institute MSK Paul Calabresi Career Development Award for Clinical Oncology (grant K12CA184746) to her institution. Dr Iyengar is supported by research grants from National Institutes of Health/National Cancer Institute (R01 CA235711, R01 CA241409), the American Cancer Society (Research Scholar Grant), the Breast Cancer Research Foundation, Novartis, and Kat’s Ribbon of Hope to his institution.
Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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