Prof J Yorke, Dr S Burden, Prof Gordon Jayson
No more applications being accepted
Funded PhD Project (European/UK Students Only)
About the Project
Currently, no specific nutritional guidelines exist for cancer patients regarding the use of ketogenic diets, and dietary recommendations are based on those for the general population.1 However, it has been repeatedly reported that patients with cancer show impaired glucose tolerance and insulin sensitivity.2-4 The general recommendations for carbohydrate is 55% of energy intake, albeit this may be inappropriate, contributing to decreased energy availability. This could lead to complications in patients with cancer including weight loss, muscle wasting, increased symptom burden and toxicity with chemotherapy.5-7 In contrast, fat metabolism is increased in these patients. 8,9 A ketogenic diet, high in fat and low in carbohydrate can provide a dietary alternative, which favours patient’s physiology.10 However, there is no consensus on macronutrient ratios in ketogenic diets for patients with cancer that provides physiological benefits but remains palatable, as adherence to the diet is problematic.
Hence, we would like to test the hypothesis that ketogenic diet with the ratio of 68% fat, 25% of protein and 8% of carbohydrate can provide physiological benefits to patients and improve outcomes. To overcome the current problems with the compliance and tolerability of the diet, this study also aims to utilise ketogenic diet mobile application (https://www.carbmanager.com) to help patients monitor their diet which could potentially improve adherence and outcomes.
This project is a feasibility study based on prospective data collection of 60 women with ovarian cancer (30 per arm) who will be randomised to a ketogenic diet group supported with a mobile application or a control group. The intervention group will receive an individually tailored diet with the ratio of 68% fat, 25% of protein and 8% of carbohydrate based on the individual’s energy requirements and compared to control group receiving standard care. The intervention will be followed for a period of 4 months and data will be collected at baseline and each month of the study. The variables recorded include participant’s characteristics, tumour and treatment characteristics, nutritional status, energy expenditure (to estimate energy requirement at baseline), blood tests, treatment toxicity, adherence, tolerability of diet, anti-cancer therapy and quality of life.
Outcomes will include compliance to the ketogenic diet, recruitment rates, and feasibility of gaining measurements for a full trial (nutritional status measurements, body composition, insulin, glucose, triglycerides, insulin growth factor 1, inflammatory markers, ketones) and some qualitative interviews with participants on the use of the app and barriers and facilitators to following the diet.
Funding Notes
This project is to be funded under the MRC Doctoral Training Partnership. If you are interested in this project, please make direct contact with the Principal Supervisor to arrange to discuss the project further as soon as possible. You MUST also submit an online application form - full details on how to apply can be found on our website www.manchester.ac.uk/mrcdtpstudentships
Applications are invited from UK/EU nationals only. Applicants must have obtained, or be about to obtain, at least an upper second class honours degree (or equivalent) in a relevant subject.
References
1. Chen X et al. The Warburg Effect: Evolving interpretations of an established concept. Free Radic Biol Med 2015, 0, 253-263.
2. Lundholm K et al. Insulin resistance in patients with cancer. Cancer Res 1978, 38, 4665-70.
3. Marat, D et al. Insulin resistance and tissue glycogen content in the tumor-bearing state. Hepatogastroenterology 1999, 46, 3159-65.
4. McCall JL et al. Serum tumour necrosis factor alpha and insulin resistance in gastrointestinal cancer. Br J Surg 1992, 79, 1361-3.
5. Ryan AM et al. Cancer associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closest 40 years later. Nutrition Society. 2016; 75:199-211.
6. Dela Vega MCM et al. Sarcopenia and chemotherapy toxicity. Eisnstain. 2016;14(4): 580-4.
7. Prado CM et al. Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact. Nutr, 2016; 75, 188-198.
8. Arcidiacono B et al. Insulin resistance and cancer risk: an overview of the pathogenetic mechanisms. Exp Diabetes Res 2012, 2012, 789174.
9. Gambardella A et al. Different contribution of substrates oxidation to insulin resistance in malnourished elderly patients with cancer. Cancer 1993, 72, 3106-13.
10. Korber J et al. Increased lipid utilization in weight losing and weight stable cancer patients with normal body weight. Eur J Clin Nutr 1999, 53:740-745.
11. Legaspi A, Whole lipid and energy metabolism in the cancer patient. Metabolism 1987, 36:958e63.
12. Selberg O et al. Palmitate turnover and its response to glucose infusion in weight-losing cancer patients. Clin Nutr 1990, 9, 150-6.
13. Waterhouse C et al. Carbohydrate metabolism in subjects with cancer. Cancer Res 1971, 31, 1273-8.
14. Oliveira C et al. A Nutritional Perspective of Ketogenic Diet in Cancer: A Narrative Review 2017, J Acad Nutr Diet. Soc. 2016; 75, 188-198.
Continue with Facebook
