Energy and caloric restriction, and fasting and cancer: a narrative review
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REVIEW ARTICLE
Energy and caloric restriction, and fasting and cancer: a narrative review Ezzeldin M. Ibrahim 1 & Meteb H. Al-Foheidi 2,3 & Mubarak M. Al-Mansour 2,3,4 Received: 2 September 2020 / Accepted: 5 November 2020 # The Author(s) 2020
Abstract Dietary interventions have a significant impact on body metabolism. The sensitivity of cancer cells to nutrient and energy deficiency is an evolving characteristic of cancer biology. Preclinical studies provided robust evidence that energy and caloric restrictions could hinder both cancer growth and progression, besides enhancing the efficacy of chemotherapy and radiation therapy. Moreover, several, albeit low-powered, clinical trials have demonstrated clinical benefits in cancer patients. Future research will inform and firmly establish the potential efficacy and safety of these dietary interventions. Here, we review the current evidence and ongoing research investigating the relationship between various dietary restriction approaches and cancer outcomes. Keywords Energy restriction . Caloric restriction . Fasting . Cancer
Introduction Diet-related obesity is a known risk factor for numerous aging-related diseases and several types of cancers, including breast cancer, pancreatic cancer, colorectal cancer, hepatic cancer, and prostate cancer [1]. In cancer patients, obesity is associated with an increased risk for disease recurrence and higher disease-specific or overall mortality [2]. Preclinical studies have shown that caloric restriction (CR) can protect animals against the toxic effects of chemotherapy, while also enhancing the efficacy of various chemotherapeutic agents [3].
* Mubarak M. Al-Mansour [email protected] 1
Oncology Center, International Medical Center, Jeddah, Kingdom of Saudi Arabia
2
Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region (MNGHA-WR), Jeddah, Kingdom of Saudi Arabia
3
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
4
Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, PO Box 9515, Jeddah 21423, Kingdom of Saudi Arabia
Thus, this review will examine the current knowledge concerning the mechanisms that explain normal and cancer cells’ responses to CR. Moreover, it summarizes the available preclinical and clinical data that addressed the impact of CR on cancer incidence, and its potential effects on enhancing efficacy and reducing the toxicity of chemotherapy and radiotherapy.
Review Autophagy To understand the relationship between energy restriction (ER) and cancer biology, a thorough insight of the autophagy is required. Autophagy is a catabolic process essential to support cellular homeostasis and survival in response to both physiologic and pathologic stimuli by involving degradation and recycling of cells’ intracellular endogenous and exogenous components through the lysosomal machinery [4, 5]. This
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