Introduction: Breast cancer is the second most common oncologic disease in the world and the one with the highest prevalence in the female population. Individuals diagnosed with breast cancer, known as breast cancer survivors (BCS), who are overweight or obese are exposed to an increased risk of cancer recurrence, all-cause mortality, and chronic noncommunicable diseases. To ensure an effective tertiary prevention, it is essential to act on the management of excess weight through education on the principles of a healthy diet and the promotion of an active lifestyle. IOV (Istituto Oncologico Veneto) has long been dealing with the problems related to excess weight in breast cancer survivors. Since 2024, nutritional program addressed to these patients has been enhanced with a new nutritional program which provides for the intervention of a dedicated dietitian to complete the activity of the physician nutrition specialist. Aim: The purpose of this study is to outline a clearer picture of breast cancer survivors’ dietary and lifestyle habits and to identify the role of nutritional intervention and dietary counseling on weight loss, on adherence of mediterranean diet, on the increase of physical activity. Finally, it will also be evaluated whether this intensive program, consisted of dietistic and medical-nutrition interventions, is more effective in terms of weight loss than the one previously provided by IOV. Materials and methods: 16 female patients diagnosed with breast cancer, aged 33-70 years and BMI≥ 25kg/m2 participated in the study. Patients were assessed at the first medical-nutrition examination (T0), during dietary visits at 1 month (T1) and 3 months (T2), and finally at the time of the second medical-nutrition assessment after 5 months (T3). At T0, biochemical data of metabolic interest were recorded and questionnaires were given to assess adherence to the Mediterranean diet, levels of physical activity, degree of sleepiness, and to carry-out psychometric assessment. At each visit, anthropometric measurements, dietary history, and physical activity level were collected. At enrollment, patients were given a moderately hypocaloric balanced dietary pattern and the following visits involved nutritional counseling intervention. Patients' anthropometric data were, finally, compared with those of a sample of subjects previously taken in charge to assess any differences between the nutritional interventions in terms of effectiveness on weight loss. Results: In the first evaluation 68.75% of patients was found to be affected by obesity, while the remaining part was overweight. From the comparison of data collected at the first visit and T1, T2, T3, statistically significant (p<0.05) variations of weight, BMI, daily energy intake and saturated fatty acids intake were found. The comparison between sample observed over 2024 and patients of 2021 showed a significant weight loss in both groups, equal to time; however, no significant evidence was found in the amount of weight loss or circumference reduction between the groups, despite weight loss was still more consistent in the 2024 group. Conclusion: This study highlights the importance of nutritional intervention on the promotion of weight loss and on the improvement of dietary pattern, from both a qualitative and quantitative perspective, in breast cancer survivors with excess weight. However, due to the limitations of the study, there is no evidence that a more intensive nutritional program shows best results in terms of efficacy, compared to previous nutritional program. Anyway, it’s important to consider this work as a step that lays the foundations for further investigations on the role of a nutritional intervention focused on counseling, which aims both to weight loss and also to improve the quality of life of breast cancer survivors.
Introduzione: Il tumore della mammella è la seconda neoplasia maligna più diffusa al mondo e quella con la maggior prevalenza nella popolazione femminile. I soggetti con carcinoma mammario, definiti breast cancer survivor, che presentano eccesso ponderale sono esposti ad un aumentato rischio di recidiva tumorale, di mortalità globale e di sviluppo di patologie croniche. Per garantire un’efficace prevenzione terziaria, è fondamentale agire sulla gestione dell’eccesso di peso attraverso l’educazione alla sana alimentazione e la promozione di uno stile di vita attivo. Da tempo lo IOV (Istituto Oncologico Veneto) si occupa delle problematiche legate all’eccesso ponderale nelle donne con carcinoma mammario e da quest’anno il percorso di presa in carico è stato potenziato grazie all’attivazione di un ambulatorio dietistico dedicato che affianca e integra l’attività del medico dietologo. Obiettivo: Lo scopo dello studio è descrivere le abitudini alimentari e lo stile di vita delle breast cancer survivor con eccesso ponderale e valutare il ruolo dell’intervento nutrizionale nella gestione del peso, nel miglioramento dell’aderenza alla dieta mediterranea e nell’aumento dei livelli di attività fisica. Infine, si valuterà se questo percorso intensivo risulta più efficace, in termini di calo ponderale, rispetto alla presa in carico precedentemente prevista dallo IOV. Materiali e metodi: Lo studio ha preso in esame donne con diagnosi di carcinoma alla mammella, di età compresa tra 33 e 70 anni e BMI≥ 25 kg/m2. 16 pazienti sono state valutate in occasione della prima visita dietologica (T0) e durante la visita dietistica a 1 mese (T1); di queste, 10 hanno partecipato alla seconda valutazione dietistica a 3 mesi (T2) e 5 alla seconda valutazione medico-nutrizionale dopo 5 mesi (T3). Alla prima visita dietologica sono stati registrati i valori degli esami bioumorali e consegnati i questionari per la valutazione dell’aderenza alla dieta mediterranea, dei livelli di attività fisica, del rischio OSAS e per la valutazione psicometrica di I livello. Ad ogni visita sono stati rilevati i valori antropometrici, l’anamnesi alimentare e i livelli di attività fisica. All’arruolamento, è stato consegnato uno schema ipocalorico equilibrato e successivamente è stato strutturato un intervento di counselling nutrizionale. I dati antropometrici delle pazienti sono stati, infine, confrontati con quelli di un campione di soggetti presi in carico in precedenza dallo IOV. Risultati: Alla prima valutazione, il 68.75% delle pazienti presenta una condizione di obesità mentre la restante parte del campione risulta in sovrappeso. Dal confronto tra i dati raccolti in prima visita e a T1, T2, T3 è stata rilevata una variazione significativa (p<0.05) del peso, del BMI, dell’introito energetico giornaliero e del consumo di SFA. Il confronto tra campioni del 2024 e del 2021 ha evidenziato che la perdita di peso è stata significativa in entrambi i gruppi. Tuttavia, non sono risultate significative tra i due gruppi le differenze a livello di riduzione percentuale del peso e della circonferenza addominale, nonostante il calo fosse maggiore nel gruppo seguito in modo intensivo. Conclusioni: Il presente progetto evidenza la centralità dell’intervento nutrizionale nel favorire il calo ponderale e un miglioramento qualitativo e quantitativo del pattern alimentare nelle breast cancer survivor con eccesso ponderale. Tuttavia, a causa dei limiti dello studio, non emerge una maggior efficacia del programma nutrizionale più intensivo, rispetto ad un percorso con controlli più distribuiti nel tempo. È comunque importante considerare questo lavoro come un primo riferimento che pone le basi per approfondire l’importanza dell’intervento nutrizionale focalizzato sul counselling per la perdita di peso e per il miglioramento della qualità di vita delle breast cancer survivor.
Il ruolo dell’intervento nutrizionale volto alla gestione del peso nelle breast cancer survivor con eccesso ponderale
DALLA LIBERA, ELISA
2023/2024
Abstract
Introduction: Breast cancer is the second most common oncologic disease in the world and the one with the highest prevalence in the female population. Individuals diagnosed with breast cancer, known as breast cancer survivors (BCS), who are overweight or obese are exposed to an increased risk of cancer recurrence, all-cause mortality, and chronic noncommunicable diseases. To ensure an effective tertiary prevention, it is essential to act on the management of excess weight through education on the principles of a healthy diet and the promotion of an active lifestyle. IOV (Istituto Oncologico Veneto) has long been dealing with the problems related to excess weight in breast cancer survivors. Since 2024, nutritional program addressed to these patients has been enhanced with a new nutritional program which provides for the intervention of a dedicated dietitian to complete the activity of the physician nutrition specialist. Aim: The purpose of this study is to outline a clearer picture of breast cancer survivors’ dietary and lifestyle habits and to identify the role of nutritional intervention and dietary counseling on weight loss, on adherence of mediterranean diet, on the increase of physical activity. Finally, it will also be evaluated whether this intensive program, consisted of dietistic and medical-nutrition interventions, is more effective in terms of weight loss than the one previously provided by IOV. Materials and methods: 16 female patients diagnosed with breast cancer, aged 33-70 years and BMI≥ 25kg/m2 participated in the study. Patients were assessed at the first medical-nutrition examination (T0), during dietary visits at 1 month (T1) and 3 months (T2), and finally at the time of the second medical-nutrition assessment after 5 months (T3). At T0, biochemical data of metabolic interest were recorded and questionnaires were given to assess adherence to the Mediterranean diet, levels of physical activity, degree of sleepiness, and to carry-out psychometric assessment. At each visit, anthropometric measurements, dietary history, and physical activity level were collected. At enrollment, patients were given a moderately hypocaloric balanced dietary pattern and the following visits involved nutritional counseling intervention. Patients' anthropometric data were, finally, compared with those of a sample of subjects previously taken in charge to assess any differences between the nutritional interventions in terms of effectiveness on weight loss. Results: In the first evaluation 68.75% of patients was found to be affected by obesity, while the remaining part was overweight. From the comparison of data collected at the first visit and T1, T2, T3, statistically significant (p<0.05) variations of weight, BMI, daily energy intake and saturated fatty acids intake were found. The comparison between sample observed over 2024 and patients of 2021 showed a significant weight loss in both groups, equal to time; however, no significant evidence was found in the amount of weight loss or circumference reduction between the groups, despite weight loss was still more consistent in the 2024 group. Conclusion: This study highlights the importance of nutritional intervention on the promotion of weight loss and on the improvement of dietary pattern, from both a qualitative and quantitative perspective, in breast cancer survivors with excess weight. However, due to the limitations of the study, there is no evidence that a more intensive nutritional program shows best results in terms of efficacy, compared to previous nutritional program. Anyway, it’s important to consider this work as a step that lays the foundations for further investigations on the role of a nutritional intervention focused on counseling, which aims both to weight loss and also to improve the quality of life of breast cancer survivors.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/77311