Associations between dietary advice on modified fibre and lactose intakes and nutrient intakes in men with prostate cancer undergoing radiotherapy

Keywords: Fibre, lactose, nutrient intake, prostate cancer, radiotherapy

Abstract

Objectives: A variety of non-evidence-based dietary advice on modified fibre and lactose intakes are provided to patients undergoing pelvic radiotherapy to counteract treatment-related bowel symptoms. More knowledge on the nutritional consequences of such advice is needed. This study aimed to explore how advice on modified fibre and lactose intakes during pelvic radiotherapy was associated with nutrient intakes amongst patients with prostate cancer.

Methods: A total of 77 Swedish men who underwent radiotherapy (50/2 Gy + boost 20–30 Gy) in 2009–2014 due to prostate cancer were given dietary advice at radiotherapy onset (baseline) and at 4 and 8 weeks after radiotherapy onset, to modify their fibre and lactose intakes. At baseline, the participants completed a food frequency questionnaire (FFQ) and a 24-h dietary recall. At 4 and 8 weeks, the participants completed the FFQ and a 4-day estimated food record.

Fibre and lactose intakes were measured by intake scores calculated from the FFQs. Multiple linear regression models were used to analyse associations between intake scores and fibre- and lactose-related nutrients.

Results: In adjusted analyses, there were few significant associations between dietary advice on modified fibre and lactose intakes and observed intakes of fibre- and lactose-related nutrients. A more modified lactose intake was thus associated with a lower intake of calcium (P = 0.041), whilst a more modified fibre intake was associated with a higher value for the change in intake of vitamin C (P = 0.016).

Conclusions: Dietary advice on modified fibre and lactose intake was in most cases not significantly associated with altered nutrient intakes, rather the energy and nutrient intakes were mostly stable during the pelvic radiotherapy. More research is needed on the nutritional consequences of dietary advice on modified fibre and lactose intakes to reach consensus on if they should continue to be provided in the clinic.

Downloads

Download data is not yet available.

References


  1. Lodge N, Evans ML, Wilkins M, Blake PR, Fryatt I. A randomized cross-over study of the efficacy of codeine phosphate versus Ispaghulahusk in patients with gynaecological cancer experiencing diarrhoea during pelvic radiotherapy. Eur J Cancer Care. 1995;4:8–10. doi: 10.1111/j.1365-2354.1995.tb00046.x

  2. Murphy J, Stacey D, Crook J, Thompson B, Panetta D. Testing control of radiation-induced diarrhea with a psyllium bulking agent: a pilot study. Can Oncol Nurs J. 2000;10:96–100. doi: 10.5737/1181912x10396100

  3. Stryker JA, Bartholomew M. Failure of lactose-restricted diets to prevent radiation-induced diarrhea in patients undergoing whole pelvis irradiation. Int J Radiat Oncol Biol Phys. 1986;12:789–92. doi: 10.1016/0360-3016(86)90037-4

  4. Bye A, Ose T, Kaasa S. Quality of life during pelvic radiotherapy. Acta Obstet Gynecol Scand. 1995;74:147–52. doi: 10.3109/00016349509008925

  5. Forslund M, Ottenblad A, Ginman C, Johansson S, Nygren P, Johansson B. Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial. Support Care Cancer. 2019;28:3331–42. doi: 10.1007/s00520-019-05182-5

  6. Wedlake L, Shaw C, McNair H, Lalji A, Mohammed K, Klopper T et al. Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy. Am J Clin Nutr. 2017;106:849–57. doi: 10.3945/ajcn.116.150565

  7. Pettersson A, Johansson B, Persson C, Berglund A, Turesson I. Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: a randomized controlled trial in prostate cancer patients undergoing radiotherapy. Radiother Oncol. 2012;103:333–40. doi: 10.1016/j.radonc.2012.04.006

  8. Pettersson A, Nygren P, Persson C, Berglund A, Turesson I, Johansson B. Effects of a dietary intervention on gastrointestinal symptoms after prostate cancer radiotherapy: long-term results from a randomized controlled trial. Radiother Oncol. 2014;113:240–7. doi: 10.1016/j.radonc.2014.11.025

  9. Persson C, Sjoden PO, Glimelius B. The Swedish version of the patient-generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers. Clin Nutr. 1999;18:71–7. doi: 10.1016/S0261-5614(99)80054-5

  10. Henson CC, Burden S, Davidson SE, Lal S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev. 2013;26(11):Cd009896. doi: 10.1002/14651858.CD009896.pub2

  11. Wedlake LJ, Shaw C, Whelan K, Andreyev HJ. Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther. 2013;37:1046–56. doi: 10.1111/apt.12316

  12. Lawrie TA, Green JT, Beresford M, Wedlake L, Burden S, Davidson SE, et al. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers. Cochrane Database Syst Rev. 2018;1:Cd012529. doi: 10.1002/14651858.CD012529.pub2

  13. Ahlin R, Sjoberg F, Bull C, Steineck G, Hedelin M. Stor variation i kostråden vid strålbehandling av lilla bäckenet. Kost har potential att förebygga följdsjukdomar av strålning och ge bättre tarmhälsa – men vetenskaplig evidens saknas [Differing dietary advice are given to gynaecological and prostate cancer patients receiving radiotherapy in Sweden]. Lakartidningen. 2018;115:1–6.

  14. Nordic Council of Ministers. Nordic nutrition recommendations 2012: integrating nutrition and physical activity. 5th edn. Copenhagen: Nordisk Ministerråd; 2014.

  15. Nguyen PL, Alibhai SM, Basaria S, D Amico AV, Kantoff PW, Keating NL, et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol. 2015;67:825–36. doi: 10.1016/j.eururo.2014.07.010

  16. Amcoff E, Enghardt Barbieri H. Portionsguiden [Portion Guide]. Uppsala, Sweden: The National Food Agency; 2009.

  17. The Swedish National Food Agency. Riksmaten – vuxna 2010-11 : Vad äter svenskarna?: Livsmedels- och näringsintag bland vuxna i Sverige [Riksmaten- Adults 2010-11: What do Swedes eat? Food and nutrition intakes among adults in Sweden]. Uppsala: Livsmedelsverket; 2012.

  18. The Swedish National Food Agency. Råd om fullkorn, rapport 10-2012 [Advice on wholegrains, report 10-2012]. Uppsala: Livsmedelsverket; 2009.

  19. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779–85. doi: 10.1038/sj.ejcn.1601412

  20. Agarwal MM, Rana SV, Mandal AK, Malhotra SM, Khandelwal N, Kumar S, et al. Lactose intolerance in prostate cancer patients: incidence and associated factors. Scand J Gastroenterol. 2008;43:270–6. doi: 10.1080/00365520701676831

  21. Hodges JK, Cao S, Cladis DP, Weaver CM. Lactose intolerance and bone health: the challenge of ensuring adequate calcium intake. Nutrients. 2019;11:718. doi: 10.3390/nu11040718

  22. Gami B, Harrington K, Blake P, Dearnaley D, Tait D, Davies J, et al. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther. 2003;18:987–94. doi: 10.1046/j.1365-2036.2003.01760.x

  23. de Oliveira Pedron ÉL, de Cássia de Aquino R, Borin da Silva C. Impact of the antifermentative diet during radiotherapy for prostate cancer in elderly, SÃO Paulo, Brazil. Support Care Cancer. 2020;28(6):2969–2975. doi: 10.1007/s00520-019-05187-0

  24. Forslund M, Nygren P, Ottenblad A, Johansson B. Experiences of a nutrition intervention-A qualitative study within a randomised controlled trial in men undergoing radiotherapy for prostate cancer. Nutr Diet. 2020;77:223–30. doi: 10.1111/1747-0080.12564

  25. Cook SI, Sellin JH. Review article: short chain fatty acids in health and disease. Aliment Pharmacol Ther. 1998;12:499–507. doi: 10.1046/j.1365-2036.1998.00337.x

  26. Vinolo MA, Rodrigues HG, Nachbar RT, Curi R. Regulation of inflammation by short chain fatty acids. Nutrients. 2011;3:858–76. doi: 10.3390/nu3100858

  27. Gibson RS. Principles of nutritional assessment. 2. edn. New York, NY: Oxford University Press; 2005.

Published
2022-06-10
How to Cite
Söderström L., Forslund M., Johansson B., Ottenblad A., & Rosenblad A. (2022). Associations between dietary advice on modified fibre and lactose intakes and nutrient intakes in men with prostate cancer undergoing radiotherapy. Upsala Journal of Medical Sciences, 127(1). https://doi.org/10.48101/ujms.v127.8261
Section
Original Articles