The Effect of Adherence to Mediterranean Diet on Inflammation and Recurrence in Cancer Patients

Yıl 2023, Cilt: 45 Sayı: 4, 504 - 513, 20.07.2023

Arif Hakan Onder , Nilgün Seremet Kürklü

https://doi.org/10.20515/otd.1283977

Öz

Systemic inflammation and oxidative stress are known to have an effect on the development and progression of cancer. Although there are some studies showing that the effect of the Mediterranean diet on cancer is through these parameters, this relationship has still not been clearly determined. Therefore, the aim of this study was to reveal the relationship between adherence to the Mediterranean diet and systemic inflammation markers in cancer patients and to examine its effect on relapse or progression in these patients. For this purpose, 102 cancer patients who applied to University of Health Sciences Antalya Education and Resarch Hospital Medical Oncology Department outpatient clinic for follow-up and treatment between March 2021 and May 2021 were evaluated. Patients were divided according to whether they received active oncological treatment or not. Adaptation to the Mediterranean diet; Evaluated by the Mediterranean diet adherence scale ([Mediterranean Diet Adherence Screener (MEDAS)] questionnaire. Systemic inflammation index and HALP score were used to evaluate the inflammation status of the patients. In addition, Charlson Comorbidity index, which may affect the results of inflammation and recurrence, was also evaluated in patients. It was detected that the mean MEDAS score (7.4±2.41) of the individuals in the untreated group was significantly higher than the MEDAS score average (6.3±1.78) of the individuals in the treated group (p<0.05). In the analysis on inflammation markers, it was detected that individuals who did not adharence to the Mediterranean diet had higher CRP levels and SII scores, and lower HALP scores than those who did adharence to the Mediterranean diet (p<0.05). As a result of univariate and multivariate analyzes, CRP (OR 0.97, 95% CI 0.95-0.99, p=0.006) and presence of relapse (OR 0.07, 95% CI 0.01-0.45, p=0.005) were found to be associated with the Mediterranean diet, independent of other factors. In conclusion, our study showed that adherence to the Mediterranean diet was inversely related to CRP, an inflammation marker, and ultimately to the recurrence or progression of the disease. As a result of univariate and multivariate analyzes, CRP (OR 0.97, 95% CI 0.95-0.99, p=0.006) and presence of recurrence or progression (OR 0.07, 95% CI 0.01-0.45, p=0.005) were associated with adherence to the Mediterranean diet, regardless of other factors. found to be related. In conclusion, our study showed that adherence to the Mediterranean diet was inversely related to CRP, an inflammation marker, and ultimately to the recurrence or progression of the disease.

Anahtar Kelimeler

Mediterranean diet, inflammation, cancer, recurrence

Kanser Hastalarında Akdeniz Diyetine Uyumun İnflamasyon ve Nüks Üzerine Olan Etkisi

Öz

Sistemik inflamasyon ve oksidatif stresin kanserin gelişimi ve ilerlemesi üzerine etkisi olduğu bilinmektedir. Akdeniz diyetinin kanser üzerine olan etkisinin bu parametreler üzerinden olduğunu gösteren bazı çalışmışalar bulunsa da bu ilişki hale net olarak belirlenememiştir. Bu nedenle bu çalışmanın amacı, kanser hastalarında Akdeniz diyetine uyum ile sistemik İnflamasyon belirteçleriyle olan ilişkiyi ortaya koymak ve bu hastalardaki nüks veya progresyon üzerine olan etkisini incelemekti. Bu amaçla Mart 2021 ile Mayıs 2021 tarihleri arasında takip ve tedavi Sağlık Bilimleri Üniversitesi Antalya Eğitim Araştırma Hastanesi Tıbbi Onkoloji Bilim Dalı polikliniğine başvuran 102 kanser hastası değerlendirilmiştir. Hastalar aktif onkolojik tedavi alıp almamasına göre ayrılmıştır. Akdeniz diyetine uyum; Akdeniz diyeti bağlılık ölçeği ([Mediterranean Diet Adherence Screener (MEDAS)] anketi ile değerlendirilmiştir. Hastaların inflamasyon durumlarının değerlendirilmesinde ise sistemik inflamasyon indeksi ve HALP skoru kullanılmıştır. Ayrıca inflamasyon ve nüks sonuçlarına etki edebilecek Charlson Komorbidite indeksi de hastalarda değerlendirilmiştir. Hastalarda tedavi almayan gruptaki bireylerin MEDAS skor ortalamasının (7.4±2.41) tedavi alan gruptaki bireylerin MEDAS skor ortalamasına (6.3±1.78) göre anlamlı düzeyde yüksek olduğu saptanmıştır (p<0.05). İnflamasyon belirteçler üzerine yapılan analizde ise Akdeniz diyetine uyum sağlamayan bireylerin Akdeniz diyetine uyum sağlayan bireylere göre C-reaktif protein (CRP) düzeyleri ve Sİİ skorları daha yüksek, HALP skorlarının ise daha düşük olduğu saptanmıştır (p<0.05). Yapılan univariate ve multivariate analizler sonucunca CRP (OR 0.97, %95 CI 0.95-0.99, p=0.006) ve nüks varlığı (OR 0.07, %95 CI 0.01-0.45, p=0.005) diğer faktörlerden bağımsız olarak Akdeniz diyetiyle ilişkili olarak saptanmıştır. Sonuç olarak çalışmamızda Akdeniz diyetine uyumun bir inflamasyon belirteci olan CRP ile ve nihayetinde hastalığın nüks veya progresyonu ile ters ilişki olduğu gösterilmiştir.

Anahtar Kelimeler

Akdeniz diyeti, İnflamasyon, Kanser, Nüks

Kaynakça

• 1. World Health Organization. Cancer. https://www.who.int/health-topics/cancer#tab=tab_1 Erişim 12.04.2023.
• 2. World Cancer Research Fund. Worldwide cancer data. https://www.wcrf.org/cancer-trends/worldwide-cancer-data/ Erişim 01.04.2023.
• 3. Schwingshackl L, Schwedhelm C, Galbete C, et al. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients 2017;9:1063.
• 4. Morze J, Danielewicz A, Przybyłowicz K, Zeng H, Hoffmann G, Schwingshackl L. An updated systematic review and meta-analysis on adherence to mediterranean diet and risk of cancer. Eur J Nutr. 2021;60: 1561-86.
• 5. Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, bMiggiano GAD. Cancer and Mediterranean diet: a review. Nutrients 2019;11:2059.
• 6. Guasch‐Ferré M, Willett WC. The Mediterranean diet and health: A comprehensive overview. J Intern Med. 2021;290:549-66.
• 7. Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72:30-43.
• 8. Barrea L, Muscogiuri G, Frias-Toral E, Laudisio D, Pugliese G, Castellucci B, et al. Nutrition and immune system: From the Mediterranean diet to dietary supplementary through the microbiota. Crit Rev Food Sci Nutr. 2021;61:3066-90.
• 9. Hernáez Á, Estruch R. The Mediterranean diet and cancer: What do human and molecular studies have to say about it? Nutrients 2019;11:2155.
• 10. Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets. 2014;14:245-54.
• 11. Farràs M, Almanza-Aguilera E, Hernáez Á, Agustí N, Julve J, Fitó M, et al. Beneficial effects of olive oil and Mediterranean diet on cancer physio-pathology and incidence. Semin Cancer Biol. 2021;73: 178-95.
• 12. Karadağ İ, Karakaya S. Can systemic inflammatory index (sıı) and meld score predict survival in liver metastatic colorectal cancer? Turk Clin Lab. 2022;13:59-63.
• 13. Huang H, Liu Q, Zhu L, Zhang Y, Lu X, Wu Y, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep. 2019;9:1-9.
• 14. Bindea G, Mlecnik B, Fridman WH, Pagès F, Galon J. Natural immunity to cancer in humans. Curr Opin Immunol. 2010;22:215–22.
• 15. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212–22.
• 16. Passardi A, Scarpi E, Cavanna L, Dall'Agata M, Tassinari D, Leo S, et al. Inflammatory indexes as predictors of prognosis and bevacizumab efficacy in patients with metastatic colorectal cancer. Oncotarget 2016;7: 33210–9.
• 17. Hong X, Cui B, Wang M, Yang Z, Wang L, Xu Q. Systemic ımmune-inflammation ındex, based on platelet counts and neutrophil-lymphocyte ratio ıs useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med. 2015;236:297–304.
• 18. Guo Y, Shi D, Zhang J, Mao S, Wang L, Zhang W, et al. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel significant prognostic factor for patients with metastatic prostate cancer undergoing cytoreductive radical prostatectomy. J Cancer. 2019:10:81.
• 19. Peng D, Zhang C, Tang Q, Zhang L, Yang KW, Yu X, et al. Prognostic significance of the combination of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with renal cell carcinoma after nephrectomy. BMC Urology 2018;18:20.
• 20. Peng D, Zhang C, Gong YQ, Hao H, Guan B, Li XS, et al. Prognostic significance of HALP (hemoglobin, albumin, lymphocyte and platelet) in patients with bladder cancer after radical cystectomy. Sci Rep. 2018;8:794.
• 21. Xu H, Zheng X, Ai J, Yang L. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13,110 patients. Int Immunopharmacol. 2023;114:109496.
• 22. Charlson Comorbidity Index (CCI). MDCalc. https://www.mdcalc.com/charlson-comorbidity-index-cci Erişim 10.01.2023.
• 23. World Health Organization. Physical status: The use and interpretation of anthropometry. https://www.who.int/publications/i/item/9241208546 Erişim: 10.01.2023.
• 24. Martínez-González MÁ, Corella D, Salas-Salvadó J, Ros E, Covas MI, Fiol M, et al. Cohort profile: design and methods of the PREDIMED study. Int J Epidemiol. 2012;41:377-85.
• 25. Pehlivanoglu Ozkan EF, Balcioglu H, Unluoglu I. Turkish validation and reliability of mediterranean diet adherence screener. Osmangazi Journal of Medicine 2020;42:160-4.
• 26. Fowler H, Belot A, Ellis L, Maringe C, Luque-Fernandez MA, Njagi EN, et al. Comorbidity prevalence among cancer patients: a population-based cohort study of four cancers. BMC Cancer 2020;20:1-15.
• 27. Minas TZ, Kiely M, Ajao A, Ambs S. An overview of cancer health disparities: new approaches and insights and why they matter. Carcinogenesis 2021;42:2-13.
• 28. Karakoç MD. Kanser hastalarında polifarmasi ve ilaç etkileşimleri. Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2022:6:31-42.
• 29. Çaparlar MA, Dokcu Ş, Demirci S. Cerrahi onkoloji kliniğimize acil servisten plansız yapılan yatışların özellikleri ve yönetimi: Tek merkez deneyimi. Gevher Nesıbe Journal of Medıcal and Health Scıences 2022;7:1-4.
• 30. Urhan M, Akbulut G. Obezite ve kanser ilişkisi: Leptin kanserojen bir adipokin midir?. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2017;2:35-43.
• 31. D’Alessandro A, de Pergola G, Silvestris F. Mediterranean diet and cancer risk: an open issue. Int J Food Sci Nutr. 2016;67:593-605.
• 32. Benito AS, Zanuy MÁV, Cano MA, Alonso AR, Bravo IA, Blanco ER, et al. Adherence to Mediterranean diet: A comparison of patients with head and neck cancer and healthy population. Endocrinología, Diabetes y Nutrición 2019;66:417-24.
• 33. Acevedo-León D, Gómez-Abril SÁ, Monzó-Beltrán L, Estañ-Capell N, Arroyo-Montañés R, Bañuls C, et al. Adherence to the Mediterranean diet has a protective role against metabolic and DNA damage markers in colorectal cancer patients. Antioxidants 2022;11:499.
• 34. Muhsiroglu Ö. Kanser hastalarında tıbbı̇ beslenme tedavı̇si. Gülhane Medical Journal 2017;59:79-88.
• 35. Harvey BI, Youngblood SM, Kleckner AS. Barriers and facilitators to adherence to a mediterranean diet ıntervention during chemotherapy treatment: A qualitative analysis. Nutr Cancer 2023:1-12. 36. Ostan R, Lanzarini C, Pini E, Scurti M, Vianello D, Bertarelli C, et al. Inflammaging and cancer: a challenge for the Mediterranean diet. Nutrients 2015;7:2589-621.
• 37. Sureda A, Bibiloni MDM, Julibert A, Bouzas C, Argelich E, Llompart I, et al. Adherence to the mediterranean diet and inflammatory markers. Nutrients 2018;10:62.
• 38. Bédard A, Lamarche B, Corneau L, L., Dodin S, Lemieux S. Sex differences in the impact of the Mediterranean diet on systemic inflammation. Nutr J. 2015;14:1-6.
• 39. Neale EP, Batterham MJ, Tapsell LC. Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: A meta-analysis. Nutr Res. 2016;36:391–401.
• 40. Panagiotakos DB, Dimakopoulou K, Katsouyanni K, Bellander T, Grau M, Koenig W, et al. Mediterranean diet and inflammatory response in myocardial infarction survivors. Int J Epidemiol. 2009;38:856–66.
• 41. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults. J Am Coll Cardiol. 2004;44:152–8.
• 42. Fung TT, McCullough ML, Newby PK, Manson JE, Meigs JB, Rifai N, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005;82:163–73.
• 43. Arouca A, Michels N, Moreno LA, González-Gil EM, Marcos A, Gómez S, et al. Associations between a Mediterranean diet pattern and inflammatory biomarkers in European adolescents. Eur J Nutr. 2017:1–14.
• 44. Lahoz C, Castillo E, Mostaza JM, De Dios O, Salinero-Fort MA, González-Alegre T, et al. Relationship of the Adherence to a Mediterranean diet and ıts main components with CRP levels in the Spanish population. Nutrients 2018;10:379.
• 45. Bonaccio M, Di Castelnuovo A, De Curtis A, Costanzo S, Persichillo M, Donati MB, et al. Adherence to the Mediterranean diet is associated with lower platelet and leukocyte counts: results from the Moli-sani study. Blood 2014;123:3037-44.
• 46. Piccirillo F, Miano N, Goffredo C, Nusca A, Mangiacapra F, Khazrai YM, et al. Impact of Mediterranean diet on metabolic and inflammatory status of patients with polyvascular atherosclerotic disease. Nutr Metab Cardiovasc Dis. 2022;32:117-24.
• 47. Eleftheriou D, Benetou V, Trichopoulou A, La Vecchia C, Bamia C. Mediterranean diet and its components in relation to all-cause mortality: Meta-analysis. Br J Nutr. 2018;120:1081–97.
• 48. Di Maso M, Augustin LS, Toffolutti F, Stocco C, Dal Maso L, Jenkins DJ, et al. Adherence to mediterranean diet, physical activity and survival after prostate cancer diagnosis. Nutrients, 2021;13:243.
• 49. Kenfield SA, DuPre N, Richman EL, Stampfer MJ, Chan JM, Giovannucci EL. Mediterranean diet and prostate cancer risk and mortality in the Health Professionals Follow-up Study. Eur Urol. 2014;65:887–94.
• 50. Ratjen I, Schafmayer C. , di Giuseppe R, Waniek S, Plachta-Danielzik S, Koch M, et al. Postdiagnostic Mediterranean and healthy Nordic dietary pattern are inversely associated with all-cause mortality in long-term colorectal cancer survivors. J Nutr. 2017;147:636–44.
• 51. Di Maso M, Maso LD, Augustin LS, Puppo A, Falcini F, Stocco C, et al. Adherence to the Mediterranean diet and mortality after breast cancer. Nutrients 2020;12:3649.