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Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy

Wedlake, Linda, Shaw, Clare, McNair, Helen, Lalji, Amyn, Mohammed, Kabir, Klopper, Tanya, Allan, Lindsey, Tait, Diana, Hawkins, Maria, Somaiah, Navita , Lalondrelle, Susan, Taylor, Alexandra, VanAs, Nicholas, Stewart, Alexandra, Essapen, Sharadah, Gage, Heather, Whelan, Kevin and Andreyev, H Jervoise N (2017) Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy The American Journal of Clinical Nutrition, 106 (3). pp. 849-857.

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Abstract

Background: Therapeutic radiotherapy is an important treatment of pelvic cancers. Historically, low-fiber diets have been recommended despite a lack of evidence and potentially beneficial mechanisms of fiber. Objective: This randomized controlled trial compared low-, habitual-, and high-fiber diets for the prevention of gastrointestinal toxicity in patients undergoing pelvic radiotherapy. Design: Patients were randomly assigned to low-fiber [≤10 g nonstarch polysaccharide (NSP)/d], habitual-fiber (control), or high-fiber (≥18 g NSP/d) diets and received individualized counseling at the start of radiotherapy to achieve these targets. The primary endpoint was the difference between groups in the change in the Inflammatory Bowel Disease Questionnaire–Bowel Subset (IBDQ-B) score between the starting and nadir (worst) score during treatment. Other measures included macronutrient intake, stool diaries, and fecal short-chain fatty acid concentrations. Results: Patients were randomly assigned to low-fiber (n = 55), habitual-fiber (n = 55), or high-fiber (n = 56) dietary advice. Fiber intakes were significantly different between groups (P < 0.001). The difference between groups in the change in IBDQ-B scores between the start and nadir was not significant (P = 0.093). However, the change in score between the start and end of radiotherapy was smaller in the high-fiber group (mean ± SD: −3.7 ± 12.8) than in the habitual-fiber group (−10.8 ± 13.5; P = 0.011). At 1-y postradiotherapy (n = 126) the difference in IBDQ-B scores between the high-fiber (+0.1 ± 14.5) and the habitual-fiber (−8.4 ± 13.3) groups was significant (P = 0.004). No significant differences were observed in stool frequency or form or in short-chain fatty acid concentrations. Significant reductions in energy, protein, and fat intake occurred in the low- and habitual-fiber groups only. <p>Conclusions: Dietary advice to follow a high-fiber diet during pelvic radiotherapy resulted in reduced gastrointestinal toxicity both acutely and at 1 y compared with habitual-fiber intake. Restrictive, non–evidence-based advice to reduce fiber intake in this setting should be abandoned. This trial was registered at clinicaltrials.gov as NCT 01170299.</p>

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > School of Economics
Authors :
NameEmailORCID
Wedlake, LindaUNSPECIFIEDUNSPECIFIED
Shaw, ClareUNSPECIFIEDUNSPECIFIED
McNair, HelenUNSPECIFIEDUNSPECIFIED
Lalji, AmynUNSPECIFIEDUNSPECIFIED
Mohammed, KabirUNSPECIFIEDUNSPECIFIED
Klopper, TanyaT.Klopper@surrey.ac.ukUNSPECIFIED
Allan, LindseyUNSPECIFIEDUNSPECIFIED
Tait, DianaUNSPECIFIEDUNSPECIFIED
Hawkins, MariaUNSPECIFIEDUNSPECIFIED
Somaiah, NavitaUNSPECIFIEDUNSPECIFIED
Lalondrelle, SusanUNSPECIFIEDUNSPECIFIED
Taylor, AlexandraUNSPECIFIEDUNSPECIFIED
VanAs, NicholasUNSPECIFIEDUNSPECIFIED
Stewart, AlexandraUNSPECIFIEDUNSPECIFIED
Essapen, SharadahUNSPECIFIEDUNSPECIFIED
Gage, HeatherH.Gage@surrey.ac.ukUNSPECIFIED
Whelan, KevinUNSPECIFIEDUNSPECIFIED
Andreyev, H Jervoise NUNSPECIFIEDUNSPECIFIED
Date : 5 July 2017
Identification Number : 10.3945/ajcn.116.150565
Copyright Disclaimer : © American Society for Nutrition
Uncontrolled Keywords : Gastrointestinal; Toxicity; Radiotherapy; Pelvic; Cancer; Pelvic radiation disease; Fiber; Nonstarch polysaccharide; Short-chain fatty acid; Inflammatory Bowel Disease Questionnaire
Depositing User : Clive Harris
Date Deposited : 28 Sep 2017 15:10
Last Modified : 28 Sep 2017 15:10
URI: http://epubs.surrey.ac.uk/id/eprint/842425

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