The impact of fibre and prebiotic interventions on outcomes in cancer and haematopoietic stem cell transplantation: A systematic review

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-01-01 DOI:10.1016/j.clnu.2024.11.022

Breeana Gardiner , Hannah R. Wardill , Graeme O'Connor , Darren Hargrave , Aaron M. Lett

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引用次数: 0

Abstract

Background & aims

Cancer therapy is associated with a range of toxicities that severely impact patient well-being and a range of clinical outcomes. Dietary fibre/prebiotics characteristically improve the gastrointestinal microenvironment, which consequently elicits beneficial downstream effects that could be relevant to the prevention and management of treatment-related toxicities. Despite the compelling theoretical scientific rationale there has been limited effort to synthesise the available evidence to conclude such scientific underpinning to the clinical use of fibre/prebiotics in cancer patients. Therefore, this systematic review aimed to evaluate the clinical impact of fibre/prebiotic-based interventions on gastrointestinal-side effects; gastrointestinal-microbiome; clinical outcomes; nutrition status and body composition; and quality-of-life in children and adults being treated for cancer or undergoing a haematopoietic stem cell transplant (HSCT).

Methods

This study was conducted in adherence to PRISMA guidelines, and the protocol was published prospectively with PROSPERO (CRD42022299428). Three databases (MEDLINE (Ovid), CINHAL, EMBASE) were searched from inception to December 2023. All articles were assessed for bias using the Cochrane risk-of-bias tool RoB 2.0 (for RCTs) and ROBINS-I (for non-RCTs).

Results

A total of 9989 de-duplicated records were identified, of these, 14 (paediatrics [n = 1], adults [n = 13]) met the inclusion criteria (randomised controlled trials (RCT) [n = 11], observational or non-RCTs [n = 3]). The risk-of-bias was graded to be serious/high (n = 6); moderate/some concerns (n = 7); low (n = 1). Interventions included prebiotic supplement (n = 8), nutrition supplement/formula with added fibre/prebiotic (n = 3) and dietary modification (n = 3). The dose of fibre intervention ranged from 2.4g to 30g per day. Substantial heterogeneity of target parameters was identified across a range all outcome categories, precluding definitive conclusions.

Conclusion

The scientific rationale for fibre/prebiotics-based interventions for the prevention or management of cancer treatment-related toxicities is compelling. However, it is clear that the scientific and clinical field remains disconnected in how to effectively translate this approach to improve cancer outcomes. High-quality intervention studies translatable to clinical practice are now evidently crucial to determine if and how fibre/prebiotics should be used to support people undergoing cancer or HSCT therapy.

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纤维和益生元干预对癌症和造血干细胞移植结果的影响：系统综述。

背景与目的：癌症治疗与一系列严重影响患者健康和一系列临床结果的毒性有关。膳食纤维/益生元具有改善胃肠道微环境的特点，从而引发有益的下游效应，可能与预防和管理治疗相关的毒性有关。尽管有令人信服的理论科学依据，但在综合现有证据以总结纤维/益生元在癌症患者临床应用的科学基础方面所做的努力有限。因此，本系统综述旨在评估基于纤维/益生元的干预措施对胃肠道副作用的临床影响；gastrointestinal-microbiome;临床结果;营养状况及身体成分；改善儿童和成人癌症治疗或接受造血干细胞移植（HSCT）的生活质量。方法：本研究遵循PRISMA指南进行，该方案在PROSPERO上发表（CRD42022299428）。检索自成立至2023年12月的三个数据库（MEDLINE （Ovid）、CINHAL、EMBASE）。使用Cochrane风险偏倚工具RoB 2.0（用于随机对照试验）和ROBINS-I（用于非随机对照试验）评估所有文章的偏倚。结果：共发现9989份去重复记录，其中14份（儿科[n = 1]，成人[n = 13]）符合纳入标准（随机对照试验（RCT） [n = 11]，观察性或非RCT [n = 3]）。偏倚风险分为严重/高（n = 6）；中度/部分担忧（n = 7）；干预措施包括益生元补充剂（n = 8），添加纤维/益生元的营养补充剂/配方（n = 3）和饮食调整（n = 3）。纤维干预剂量为每天2.4g至30g。所有结果类别的目标参数均存在显著异质性，因此无法得出明确结论。结论：以纤维/益生元为基础的干预措施预防或管理癌症治疗相关毒性的科学依据是令人信服的。然而，很明显，在如何有效地将这种方法转化为改善癌症预后方面，科学和临床领域仍然存在脱节。可转化为临床实践的高质量干预研究现在显然对确定纤维/益生元是否以及如何用于支持接受癌症或造血干细胞移植治疗的人至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.