Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Weill Cornell Medical Center, New York, NY 10065, USA.
Nutrients. 2022 Aug 27;14(17):3542. doi: 10.3390/nu14173542.
Hyperinsulinemia is an independent risk factor for cancer mortality. Insulin-lowering dietary strategies such as calorie restriction (CR), low-carbohydrate or ketogenic diets (KD), and intermittent fasting (IF) are aimed at reducing systemic stores of nutrients utilized by cancer cells, attenuating insulin-related growth signaling, and improving obesity-related metabolic parameters. In this narrative review, we searched the published literature for studies that tested various insulin-lowering diets in metastatic cancer in preclinical and clinical settings. A total of 23 studies were identified. Of these, 14 were preclinical studies of dietary strategies that demonstrated improvements in insulin levels, inhibition of metastasis, and/or reduction in metastatic disease burden in animal models. The remaining nine clinical studies tested carbohydrate restriction, KD, or IF strategies which appear to be safe and feasible in patients with metastatic cancer. These approaches have also been shown to improve serum insulin and other metabolic parameters. Though promising, the anti-cancer efficacy of these interventions, such as impact on tumor response, disease-specific-, and overall survival, have not yet been conclusively demonstrated. Studies that are adequately powered to evaluate whether insulin-lowering diets improve cancer outcomes are warranted.
高胰岛素血症是癌症死亡的独立危险因素。降低胰岛素的饮食策略，如热量限制（CR）、低碳水化合物或生酮饮食（KD）和间歇性禁食（IF），旨在减少癌细胞利用的系统营养储存，减弱与胰岛素相关的生长信号，并改善与肥胖相关的代谢参数。在这篇叙述性综述中，我们在临床前和临床环境中搜索了测试各种降低胰岛素饮食的转移性癌症的已发表文献。共确定了 23 项研究。其中，14 项是关于饮食策略的临床前研究，这些研究表明在动物模型中改善了胰岛素水平、抑制了转移、并/或降低了转移性疾病负担。其余 9 项临床研究测试了碳水化合物限制、KD 或 IF 策略，这些策略似乎在转移性癌症患者中是安全且可行的。这些方法还显示出改善血清胰岛素和其他代谢参数的作用。尽管这些干预措施很有前景，如对肿瘤反应、疾病特异性和总体生存率的影响，但它们的抗癌疗效尚未得到明确证实。有必要进行足够有力的研究，以评估降低胰岛素饮食是否能改善癌症结局。
