Ketogenic diet: a tool for the management of neuroendocrine neoplasms?

Abstract

Neuroendocrine neoplasms (NENs) are a heterogeneous group of neoplasms, whose incidence has rapidly increased in the last years. Nutrition plays an important role in their management; indeed, malnutrition negatively impacts on rates of complications, hospitalization, hospital stay, costs and mortality. Furthermore, it has been reported that a poor nutritional status could influence the outcome of patients with pancreatic NENs. Moreover, obesity, predisposing to insulin resistance and compensatory hyperinsulinemia, could stimulate the growth of these neoplasms. Ketogenic diet (KD), a high-fat, low-carbohydrate diet with adequate amounts of protein, has been reported to be a promising approach for the management of several types of cancer, mostly gynecological and neurological ones. Indeed, it appears to sensitize most cancers to standard treatment by exploiting the reprogramed metabolism of cancer cells and thus resulting in a promising candidate as an adjuvant cancer therapy. Thus, the aim of this review is to provide an overview on the importance of nutrition in cancer management and in particular in NENs’ setting. Furthermore, we reported the current evidence on the efficacy of KD in the management of cancer and based on molecular mechanisms; we also hypothesize the potential use of this nutritional pattern in the management of NENs.

Keywords:

• Cancer
• ketogenic diet
• neuroendocrine neoplasms
• nutrition
• obesity

Acknowledgments

This review is part of the “Neuroendocrine Tumors Innovation Knowledge and Education” project led by Prof. Annamaria Colao and Prof. Antongiulio Faggiano, which aims at increasing the knowledge on NET. We would like to acknowledge all the Collaborators of the “NIKE” project: Manuela Albertelli – Genova; Barbara Altieri – Wurzburg; Severo Campione – Napoli; Roberta Centello – Roma; Alessia Cozzolino – Roma; Federica De Cicco – Napoli; Sergio Di Molfetta – Bari; Valentina Di Vito – Roma; Alessandra Dicitore – Milano; Andrea Dotto – Genova; Giuseppe Fanciulli – Sassari; Tiziana Feola – Roma; Diego Ferone – Genova; Francesco Ferraù – Messina; Marco Gallo – Torino; Elisa Giannetta – Roma; Federica Grillo – Genova; Erika Maria Grossrubatscher – Milano; Elia Guadagno – Napoli; Valentina Guarnotta – Palermo; Andrea M. Isidori – Roma; Andrea Lania – Milano; Andrea Lenzi – Roma; Fabio Lo Calzo – Avellino; Pasqualino Malandrino – Catania; Erika Messina – Messina; Roberto Minotta – Napoli; Roberta Modica – Napoli; Riccardo Pofi – Roma; Giulia Puliani – Roma; Alberto Ragni – Torino; Paola Razzore – Torino; Laura Rizza – Roma; Manila Rubino – Milano; Rosa Maria Ruggieri – Messina; Davide Saronni – Milano; Francesca Sciarra – Roma; Franz Sesti – Roma; Mary Anna Venneri – Roma; Giovanni Vitale – Milano; Isabella Zanata – Ferrara.

Declaration of interest

The authors have no conficts of interest.

Additional information

Funding

This work was supported by the Italian Ministry of Education, University and Research (MIUR): PRIN 2017Z3N3YC