Cancer Prevention and Therapy With Nutritional Science: Addressing the Gap in Medical Education and Practice

Abstract

Cancer is a leading cause of morbidity and mortality worldwide. There exists a correlation between certain cancers and dietary factors. Several known carcinogens are present in the standard American diet, also known as the Western Diet. Additionally, food preparation methods can initiate carcinogenesis. Various dietary components, particularly plant-based foods, contain bioactive phytochemicals, have demonstrated potential anticancer effects through various molecular mechanisms. Consuming a wide variety of these so-called “cancer-fighting” foods may lead to synergism in preventing and slowing cancer progression. The nutritional intervention is also beneficial in cancer therapy, including avoiding malnutrition and cachexia and alleviating cancer therapy-induced symptoms as well as the use of specific diets that may augment concomitant therapies. This review aims to explore these concepts and highlight the need for their integration into medical school curriculum, particularly osteopathic medical education, as nutrition is closely interrelated to the whole-person patient care approach. These are fundamental concepts that do not gain the recognition they deserve in the typical medical school curriculum, and this may be reflected in clinical outcomes if not appropriately addressed. Addressing this gap in clinical medicine may reduce the risk of cancer, improve patient outcomes, build trust, and decrease the burden of cancer-related healthcare costs.

Keywords

cancer / carcinogens / diet / nutrition / osteopathic medicine / prevention

References

[1] F. Bray, M. Laversanne, H. Sung, et al., “Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries, ” CA: A Cancer Journal for Clinicians 74, no. 3 (2024): 229-263.

[2] R. L. Siegel, T. B. Kratzer, A. N. Giaquinto, H. Sung, and A. Jemal, “Cancer Statistics, 2025, ” CA: A Cancer Journal for Clinicians 75, no. 1 (2025): 10-45.

[3] D. Hanahan and R. A. Weinberg, “Hallmarks of Cancer: The next Generation, ” Cell 144, no. 5 (2011): 646-674.

[4] D. Hanahan, “Hallmarks of Cancer: New Dimensions, ” Cancer Discovery 12, no. 1 (2022): 31-46.

[5] American Society of Clinical Oncology (ASCO). “Genes and Cancer.” American Society of Clinical Oncology, Accessed 14 January 2024, https://www.cancer.net/navigating-cancer-care/cancer-basics/genetics/genes-and-cancer.

[6] Centers for Disease Control and Prevention (CDC). (2023). Screening test. Retrieved from, https://www.cdc.gov/cancer/dcpc/prevention/screening.htm.

[7] (ASCO). “Cancer Screening.” American Society of Clinical Oncology, Accessed 14 January 2024, https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/cancer-screening#head-neck-cancers.

[8] C. Vidoni, A. Ferraresi, A. Esposito, et al., “Calorie Restriction for Cancer Prevention and Therapy: Mechanisms, Expectations, and Efficacy, ” Journal of Cancer Prevention 26, no. 4 (2021): 224-236.

[9] M. Mirahmadi, S. Azimi-Hashemi, E. Saburi, H. Kamali, M. Pishbin, and F. Hadizadeh, “Potential Inhibitory Effect of Lycopene on Prostate Cancer, ” Biomedicine & Pharmacotherapy 129 (2020): 110459.

[10] J. Lane, N. I. Brown, S. Williams, E. P. Plaisance, and K. R. Fontaine, “Ketogenic Diet for Cancer: Critical Assessment and Research Recommendations, ” Nutrients 13, no. 10 (2021): 3562.

[11] B. D. Mercier, E. Tizpa, E. J. Philip, et al., “Dietary Interventions in Cancer Treatment and Response: A Comprehensive Review, ” Cancers 14, no. 20 (2022): 5149.

[12] K. Clifton, C. Ma, L. Fontana, and L. L. Peterson, “Intermittent Fasting in the Prevention and Treatment of Cancer, ” CA: A Cancer Journal for Clinicians 71 (2021): 527-546.

[13] A. Monllor-Tormos, A. G. Vigara, O. Morgan, N. Mendoza, J. J. Tarin, and A. Cano, “Mediterranean Diet for Cancer Prevention and Survivorship, ” Maturitas 178 (2023): 107841.

[14] L. Barrea, M. Caprio, D. Tuccinardi, E. Moriconi, L. Di Renzo, and G. Muscogiuri, “Could Ketogenic Diet “Starve” Cancer? Emerging Evidence, ” Critical Reviews in Food Science and Nutrition 62, no. 7 (2020): 1800-1821.

[15] K. J. Gu and G. Li, “An Overview of Cancer Prevention: Chemoprevention and Immunoprevention, ” Journal of Cancer Prevention 25, no. 3 (2020): 127-135.

[16] A. Khalifa, A. Guijarro, and A. Nencioni, “Advances in Diet and Physical Activity in Breast Cancer Prevention and Treatment, ” Nutrients 16, no. 14 (2024): 2262.

[17] M. U. Adamek, L. Bergmann, and H. E. Adamek, “Exercise and Diet in Colorectal Cancer Prevention and Therapy, ” Zeitschrift Fur Gastroenterologie 61, no. 07 (2023): 818-826.

[18] S. Pati, W. Irfan, A. Jameel, S. Ahmed, and R. Shahid, “Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management, ” Cancers 15, no. 2 (2023): 485.

[19] X. Shi, G. Deng, H. Wen, et al., “Role of Body Mass Index and Weight Change in the Risk of Cancer: A Systematic Review and Meta-analysis of 66 Cohort Studies, ” Journal of Global Health 14 (2024): 04067.

[20] F. M. Kristensson, J. C. Andersson-Assarsson, and M. Peltonen, “Breast Cancer Risk After Bariatric Surgery and Influence on Insulin Levels, ” JAMA Surgery 159, no. 8 (2024): 856-863.

[21] R. Kolb, F. Sutterwala, and W. Zhang, “Obesity and Cancer: Inflammation Bridges the Two, ” Current Opinion in Pharmacology 29 (2016): 77-89.

[22] T. Sugimura, K. Wakabayashi, H. Nakagama, and M. Nagao, “Heterocyclic Amines: Mutagens/Carcinogens Produced During Cooking of Meat and Fish, ” Cancer Science 95, no. 4 (2004): 290-299.

[23] W. Zheng and S. Lee, “Well-done Meat Intake, Heterocyclic Amine Exposure, and Cancer Risk, ” Nutrition and Cancer 61, no. 4 (2009): 437-446.

[24] K. Kim, S. Jahan, E. Kabir, and R. Brown, “A Review of Airborne Polycyclic Aromatic Hydrocarbons (PAHs) and Their human Health Effects, ” Environment International 60 (2013): 71-80.

[25] G. Sampaio, G. Guizellini, S. Silva, et al., “Polycyclic Aromatic Hydrocarbons in Food: Biological Effects, Legislation, Occurrence, Analytical Methods, and Strategies to Reduce Their Formation, ” International Journal of Molecular Sciences 22, no. 11 (2021): 6010.

[26] J. Lunn, G. Kuhnle, V. Mai, et al., “The Effect of Haem in Red and Processed Meat on the Endogenous Formation of N-nitroso Compounds in the Upper Gastrointestinal Tract, ” Carcinogenesis 28, no. 3 (2007): 685-690.

[27] S. Breda, K. Mathijs, H. J. Pieters, et al., “Replacement of Nitrite in Meat Products by Natural Bioactive Compounds Results in Reduced Exposure to N-nitroso Compounds: The PHYTOME Project, ” Molecular Nutrition & Food Research 65, no. 20 (2021): 2001214.

[28] A. Abid, A. Cross, and R. Sinha, “Meat, Dairy, and Cancer, ” American Journal of Clinical Nutrition 100, no. 1 (2014): 386S-393S.

[29] World Health Organization. IARC Monographs Evaluate Consumption of Red Meat and Processed Meat. (2015). Accessed 3 July 2024, Retrieved from, https://www.iarc.who.int/wp-content/uploads/2018/07/pr240_E.pdf.

[30] D. M. Klurfeld, “What Is the Role of Meat in a Healthy Diet?, ” Animal Frontiers 8 (2018): 5-10.

[31] D. Mottram, B. Wedzicha, and A. Dodson, “Acrylamide Is Formed in the Maillard Reaction, ” Nature 419, no. 6909 (2002): 448-449.

[32] L. Mucci and K. Wilson, “Acrylamide Intake Through Diet and human Cancer Risk, ” Journal of Agricultural and Food Chemistry 56, no. 15 (2008): 6013-6019.

[33] L. Lipworth, J. Sonderman, R. Tarone, and J. McLaughlin, “Review of Epidemiologic Studies of Dietary Acrylamide Intake and the Risk of Cancer, ” European Journal of Cancer Prevention 21, no. 4 (2012): 375-386.

[34] M. Virk-Baker, T. Nagy, S. Barnes, and J. Groopman, “Dietary Acrylamide and human Cancer: A Systematic Review of Literature, ” Nutrition and Cancer 66, no. 5 (2014): 774-790.

[35] P. Mirmiran, Z. Bahadoran, and Z. Gaeini, “Common Limitations and Challenges of Dietary Clinical Trials for Translation Into Clinical Practices, ” International Journal of Endocrinology and Metabolism 19, no. 3 (2021): e108170.

[36] A. Gray, B. Dang, T. Moore, R. Clemens, and P. Pressman, “A Review of Nutrition and Dietary Interventions in Oncology, ” SAGE Open Medicine 8 (2020): 1-16.

[37] A. Agaj, Ž. Peršurić, and S. K. Pavelić, “Mediterranean Food Industry By-Products as a Novel Source of Phytochemicals With a Promising Role in Cancer Prevention, ” Molecules (Basel, Switzerland) 27, no. 24 (2022): 8655.

[38] T. L. Wong, K. R. Strandberg, C. R. Croley, et al., “Pomegranate Bioactive Constituents Target Multiple Oncogenic and Oncosuppressive Signaling for Cancer Prevention and Intervention, ” Seminars in Cancer Biology 73 (2021): 265-293.

[39] B. Mirza, C. R. Croley, M. Ahmad, et al., “Mango (Mangifera indica L.): A Magnificent Plant With Cancer Preventive and Anticancer Therapeutic Potential, ” Critical Reviews in Food Science and Nutrition 61, no. 13 (2021): 2125-2151.

[40] A. Mondal, S. Banerjee, S. Bose, et al., “Cancer Preventive and Therapeutic Potential of Banana and Its Bioactive Constituents: A Systematic, Comprehensive, and Mechanistic Review, ” Frontiers in Oncology 11 (2021): 697143.

[41] R. A. Haber, R. D. Garcia, J. N. Hernandez, S. Jamieson, A. Mondal, and A. Bishayee, “Papaya (Carica papaya L.) for Cancer Prevention: Progress and Promise, ” Critical Reviews in Food Science and Nutrition 63, no. 30 (2023): 10499-10519.

[42] S. Jamieson, C. E. Wallace, N. Das, P. Bhattacharyya, and A. Bishayee, “Guava (Psidium guajava L.): A Glorious Plant With Cancer Preventive and Therapeutic Potential, ” Critical Reviews in Food Science and Nutrition 63, no. 2 (2023): 192-223.

[43] T. E. Collignon, K. Webber, J. Piasecki, et al., “Avocado (Persea americana Mill) and Its Phytoconstituents: Potential for Cancer Prevention and Intervention, ” Critical Reviews in Food Science and Nutrition (2023): 1-21.

[44] L. S. Kalick, H. A. Khan, E. Maung, et al., “Mangosteen for Malignancy Prevention and Intervention: Current Evidence, Molecular Mechanisms, and Future Perspectives, ” Pharmacological Research 188 (2023): 106630.

[45] D. De Greef, E. M. Barton, E. N. Sandberg, et al., “Anticancer Potential of Garlic and Its Bioactive Constituents: A Systematic and Comprehensive Review, ” Seminars in Cancer Biology 73 (2021): 219-264.

[46] M. Zadorozhna and D. Mangieri, “Mechanisms of Chemopreventive and Therapeutic Proprieties of Ginger Extracts in Cancer, ” International Journal of Molecular Sciences 22, no. 12 (2021): 6599.

[47] Y. Asemani, N. Zamani, M. Bayat, and Z. Amirghofran, “Allium Vegetables for Possible Future of Cancer Treatment, ” Phytotherapy Research 33, no. 12 (2019): 3019-3039.

[48] V. Mossine, T. P. Mawhinney, and E. L. Giovannucci, “Dried Fruit Intake and Cancer: A Systematic Review of Observational Studies, ” Advances in Nutrition 11, no. 2 (2020): 237-250.

[49] A. Bishayee, J. Kavalakatt, C. Sunkara, et al., “Litchi (Litchi chinensis Sonn.): A Comprehensive and Critical Review on Cancer Prevention and Intervention, ” Food Chemistry 457 (2024): 140142.

[50] B. W. Bolling, D. Aune, H. Noh, K. S. Petersen, and H. Freisling, “Dried Fruits, Nuts, and Cancer Risk and Survival: A Review of the Evidence and Future Research Directions, ” Nutrients 15, no. 6 (2023): 1443.

[51] K. I. Block, C. Gyllenhaal, L. Lowe, et al., “Designing a Broad-spectrum Integrative Approach for Cancer Prevention and Treatment, ” Seminars in Cancer Biology 35S (2015): S276-S304.

[52] G. Mohan Shankar, M. Swetha, C. K. Keerthana, T. P. Rayginia, and R. J. Anto, “Cancer Chemoprevention: A Strategic Approach Using Phytochemicals, ” Frontiers in Pharmacology 12 (2022): 809308.

[53] A. Rudzinka, P. Juchaniuk, J. Wisniewska, W. Wojdan, K. Szklener, and S. Mandziuk, “Phytochemicals in Cancer Treatment and Cancer Prevention—review on Epidemiological Data and Clinical Trials, ” Nutrients 15, no. 8 (2023): 1896.

[54] M. H. Cháirez-Ramírez, K. G. de la Cruz-López, and A. García-Carrancá, “Polyphenols as Antitumor Agents Targeting Key Players in Cancer-driving Signaling Pathways, ” Frontiers in Pharmacology 12 (2021): 710304.

[55] A. Haque, D. Brazeau, and A. R. Amin, “Perspectives on Natural Compounds in Chemoprevention and Treatment of Cancer: An Update With New Promising Compounds, ” European Journal of Cancer 149 (2021): 165-183.

[56] R. Kotecha, A. Takami, and J. L. Espinoza, “Dietary Phytochemicals and Cancer Chemoprevention: A Review of the Clinical Evidence, ” Oncotarget 7, no. 32 (2016): 52517-52529.

[57] A. Ranjan, S. Ramachandran, N. Gupta, et al., “Role of Phytochemicals in Cancer Prevention, ” International Journal of Molecular Sciences 20, no. 20 (2019): 4981.

[58] M. Abotaleb, A. Liskova, P. Kubatka, and D. Büsselberg, “Therapeutic Potential of Plant Phenolic Acids in the Treatment of Cancer, ” Biomolecules 10, no. 2 (2020): 221.

[59] P. Manogaran, N. M. Beeraka, R. S. Paulraj, P. Sathiyachandran, and M. Thammaiappa, “Impediment of Cancer by Dietary Plant-derived Alkaloids Through Oxidative Stress: Implications of PI3K/AKT Pathway in Apoptosis, Autophagy, and Ferroptosis, ” Current Topics in Medicinal Chemistry 23, no. 10 (2023): 860-877.

[60] L. F. Zheng, F. Dai, B. Zhou, L. Yang, and Z. L. Liu, “Prooxidant Activity of Hydroxycinnamic Acids on DNA Damage in the Presence of Cu(II) Ions: Mechanism and Structure-activity Relationship, ” Food and Chemical Toxicology 46 (2008): 149-156.

[61] T. C. Hsieh, C. Y. Lin, H. Y. Lin, and J. M. Wu, “AKT/MTOR as Novel Targets of Polyphenol Piceatannol Possibly Contributing to Inhibition of Proliferation of Cultured Prostate Cancer Cells, ” ISRN Urology 2012 (2012): 272697.

[62] J. A. Sirerol, M. L. Rodríguez, S. Mena, M. A. Asensi, J. M. Estrela, and A. L. Ortega, “Role of Natural Stilbenes in the Prevention of Cancer, ” Oxidative Medicine and Cellular Longevity 2016 (2016): 3128951.

[63] K. Brusselmans, R. Vrolix, G. Verhoeven, and J. V. Swinnen, “Induction of Cancer Cell Apoptosis by Flavonoids Is Associated With Their Ability to Inhibit Fatty Acid Synthase Activity, ” Journal of Biological Chemistry 280 (2005): 5636-5645.

[64] S. Damasceno, B. Dantas, J. Ribeiro-Filho, et al., “Chemical Properties of Caffeic and Ferulic Acids in Biological System: Implications in Cancer Therapy. A Review, ” Current Pharmaceutical Design 23 (2017): 3015-3023.

[65] N. Koolaji, B. Shammugasamy, A. Schindeler, Q. Dong, F. Dehghani, and P. Valtchev, “Citrus Peel Flavonoids as Potential Cancer Prevention Agents, ” Current Developments in Nutrition 4 (2020): 4005008.

[66] L. G. S. Ponte, I. C. B. Pavan, M. C. S. Mancini, et al., “The Hallmarks of Flavonoids in Cancer, ” Molecules (Basel, Switzerland) 26 (2021): 2029.

[67] R. Niranjana, R. Gayathri, S. Nimish Mol, et al., “Carotenoids Modulate the Hallmarks of Cancer Cells, ” Journal of Functional Foods 18 (2015): 968-985.

[68] N. Shahzad, W. Khan, S. MD, et al., “Phytosterols as a Natural Anticancer Agent: Current Status and Future Perspective, ” Biomedicine & Pharmacotherapy 88 (2017): 786-794.

[69] A. S. Choudhari, P. C. Mandave, M. Deshpande, P. Ranjekar, and O. Prakash, “Phytochemicals in Cancer Treatment: From Preclinical Studies to Clinical Practice, ” Frontiers in Pharmacology 10 (2020): 1614.

[70] X. Su, X. Jiang, L. Meng, X. Dong, Y. Shen, and Y. Xin, “Anticancer Activity of Sulforaphane: The Epigenetic Mechanisms and the Nrf2 Signaling Pathway, ” Oxidative Medicine and Cellular Longevity 2018 (2018): 5438179.

[71] A. E. Kaiser, M. Baniasadi, D. Giansiracusa, et al., “Sulforaphane: A Broccoli Bioactive Phytocompound With Cancer Preventive Potential, ” Cancers 13, no. 19 (2021): 4796.

[72] D. Aune, D. S. Chan, R. Lau, et al., “Dietary Fibre, Whole Grains, and Risk of Colorectal Cancer: Systematic Review and Dose-response Meta-analysis of Prospective Studies, ” Bmj 343 (2011): d6617.

[73] V. Aggarwal, H. S. Tuli, M. Tania, et al., “Molecular Mechanisms of Action of Epigallocatechin Gallate in Cancer: Recent Trends and Advancement, ” Seminars in Cancer Biology 80 (2022): 256-275.

[74] T. Tanaka, R. Aoki, and M. Terasaki, “Potential Chemopreventive Effects of Dietary Combination of Phytochemicals Against Cancer Development, ” Pharmaceuticals 16, no. 11 (2023): 1591.

[75] A. Mondal, S. Banerjee, W. Terang, et al., “Capsaicin: A Chili Pepper Bioactive Phytocompound With a Potential Role in Suppressing Cancer Development and Progression, ” Phytotherapy Research 38, no. 3 (2024): 1191-1223.

[76] S. D. Mittelman, “The Role of Diet in Cancer Prevention and Chemotherapy Efficacy, ” Annual Review of Nutrition 40 (2020): 273-297.

[77] H. M. Parsons, M. L. Forte, H. Abdi, et al., “Nutrition as Prevention for Improved Cancer Health Outcomes: A Systematic Literature Review, ” JNCI Cancer Spectrum 7, no. 3 (2023): pkad035.

[78] B. N. Ames, M. Profet, and L. S. Gold, “Dietary Pesticides (99.99% all natural), ” PNAS 87, no. 19 (1990): 7777-7781.

[79] J. C. Lachance, S. Radhakrishnan, G. Madiwale, S. Guerrier, and J. K. P. Vanamala, “Targeting Hallmarks of Cancer With Food-system-based Approach, ” Nutrition (Burbank Los Angeles County Calif) 69 (2020): 110563.

[80] V. DeClercq, J. T. Nearing, and E. Sweeney, “Plant-based Diets and Cancer Risk: What Is the Evidence?, ” Current Nutrition Reports 11, no. 2 (2022): 354-369.

[81] L. Hardt, Y. Mahamat-Saleh, D. Aune, and S. Schlesinger, “Plant-based Diets and Cancer Prognosis: A Review of Recent Research, ” Current Nutrition Reports 11, no. 4 (2022): 695-716.

[82] E. D. Giles, S. A. Purcell, J. Olsen, et al., “Trends in Diet and Cancer Research: A Bibliometric and Visualization Analysis, ” Cancers 15, no. 15 (2023): 3761.

[83] V. Liu, E. L. Blarigan, L. Zhang, et al., “Plant-based Diets and Disease Progression in Men With Prostate Cancer, ” JAMA Network Open 7, no. 5 (2024): e249053.

[84] Council for Responsible Nutrition (CRN). Three-quarters of Americans take dietary supplements; Most users agree they are essential to maintaining health, CRN consumer survey finds. (2023). Retrieved from, https://www.crnusa.org/newsroom/three-quarters-americans-take-dietary-supplements-most-users-agree-they-are-essential#:~:text=Topline%20data%20from%20the%202023,qualifying%20as%20%E2%80%9Cregular%20users.%E2%80%9D.

[85] M. Martinez, E. Jacobs, J. Baron, J. Marshall, and T. Byers, “Dietary Supplements and Cancer Prevention: Balancing Potential Benefits Against Proven Harms, ” JNCI: Journal of the National Cancer Institute 104, no. 10 (2012): 732-739.

[86] J. W. Erdman, “Health and Nutrition Beyond Essential Nutrients: The Evolution of the Bioactives Concept for human Health, ” Molecular Aspects of Medicine 89 (2022): 101116.

[87] J. I. Ottaviani, H. Schroeter, and G. Kuhnle, “Measuring the Intake of Dietary Bioactives: Pitfalls and How to Avoid Them, ” Molecular Aspects of Medicine 89 (2023): 101139.

[88] G. Fraser, “Vegetarian Diets: What Do We Know of Their Effects on Common Chronic Diseases?, ” American Journal of Clinical Nutrition 89, no. 5 (2009): 1607S-1612S.

[89] A. Lanou and B. Svenson, “Reduced Cancer Risk in Vegetarians: An Analysis of Recent Reports, ” Cancer Management and Research 3 (2011): 1-8.

[90] M. Dinu, R. Abbate, G. F. Gensini, A. Casini, and S. F. Vegetarian, “Vegan Diets and Multiple Health Outcomes: A Systematic Review With Meta-analysis of Observational Studies, ” Critical Reviews in Food Science and Nutrition 57, no. 17 (2017): 3640-3649.

[91] D. Weber, S. Aminzadeh-Gohari, J. Tulipan, L. Catalano, R. G. Feichtinger, and B. Kofler, “Ketogenic Diet in the Treatment of Cancer - Where Do We Stand?, ” Molecular Metabolism 33 (2020): 102-121.

[92] M. Heiden, L. Cantley, and C. Thompson, “Understanding the Warburg Effect: The Metabolic Requirements of Cell Proliferation, ” Science 324, no. 5930 (2009): 1029-1033.

[93] R. J. Morscher, S. Aminzadeh-Gohari, R. Feichtinger, et al., “Inhibition of Neuroblastoma Tumor Growth by Ketogenic Diet and/or Calorie Restriction in a CD1-nu Mouse Model, ” PLoS ONE 10, no. 6 (2015): e0129802.

[94] S. Khodadadi, N. Sobhani, S. Mirshekar, et al., “Tumor Cells Growth and Survival Time With the Ketogenic Diet in Animal Models: A Systematic Review, ” International Journal of Preventive Medicine 8 (2017): 35.

[95] K. Nakamura, H. Tonouchi, A. Sasayama, and K. Ashida, “A Ketogenic Formula Prevents Tumor Progression and Cancer Cachexia by Attenuating Systemic Inflammation in Colon 26 Tumor-bearing Mice, ” Nutrients 10, no. 2 (2018): E206.

[96] N. Erickson, V. Sulosaari, E. Sullivan, et al., “Nutrition in Cancer Care: An Overlooked Part of Patient-centered Care, ” Seminars in Oncology Nursing 41 (2025): 151799.

[97] K. Tanaka, S. Nakamura, and H. Narimatsu, “Nutritional Approach to Cancer Cachexia: A Proposal for Dietitians, ” Nutrients 14, no. 2 (2022): 345.

[98] K. Fearon, F. Strasser, S. Anker, et al., “Definition and Classification of Cancer Cachexia: An International Consensus, ” The Lancet Oncology 12, no. 5 (2011): P489-495.

[99] J. Arends, “Malnutrition in Cancer Patients: Causes, Consequences, and Treatment Options, ” European Journal of Surgical Oncology 50, no. 5 (2024): 107074.

[100] B. Ren, J. Shen, Y. Qian, and T. Zhou, “Sarcopenia as a Determinant of the Efficacy of Immune Checkpoint Inhibitors in Non-small Cell Lung Cancer: A Meta-analysis, ” Nutrition and Cancer 75, no. 2 (2022): 685-695.

[101] T. Ispoglou, D. McCullough, A. Windle, et al., “Addressing Cancer Anorexia-cachexia in Older Patients: Potential Therapeutic Strategies and Molecular Pathways, ” Clinical Nutrition 43, no. 2 (2024): P552-566.

[102] B. Baguley, H. Arnold, A. Bence, et al., “Systematic Review of Nutrition Interventions in Older Patients With Cancer: A Synthesis of Evidence and a Future Research Priority, ” Journal of Geriatric Oncology 16, no. 2 (2025): 102181.

[103] A. Makitie, R. Alabi, H. Orell, et al., “Managing Cachexia in Head and Neck Cancer: A Systematic Scoping Review, ” Advances in Therapy 39 (2022): 1502-1523.

[104] G. Pasquale, S. Mancin, S. Matteucci, et al., “Nutritional Prehabilitation in Head and Neck Cancer: A Systematic Review of the Literature, ” Clinical Nutrition Espen 58 (2023): P326-334.

[105] J. Zeidler, S. Kutschan, J. Dörfler, J. Buntzel, and J. Huebner, “Impact of Nutrition Counseling on Nutrition Status in Patients With Head and Neck Cancer Undergoing Radio- or Radiochemotherapy: A Systematic Review, ” European Archives of Oto-Rhino-Laryngology 281 (2024): 2195-2209.

[106] T. Cederholm, G. Jensen, M. Correia, et al., “GLIM Criteria for the Diagnosis of Malnutrition - A Consensus Report From the Global Clinical Nutrition Community, ” Clinical Nutrition 38, no. 1 (2019): 1-9.

[107] J. Lovey, A. Molnar, and B. Banky, “Long-term Nutrition in Patients Candidate to Neoadjuvant and Adjuvant Treatments, ” European Journal of Surgical Oncology 50, no. 5 (2024): 106850.

[108] C. Orsso, A. Caretero, T. Poltronieri, et al., “Effects of High-protein Supplementation During Cancer Therapy: A Systematic Review and Meta-analysis, ” American Journal of Clinical Nutrition 120, no. 6 (2024): 1311-1324.

[109] M. Garutti, C. Noto, B. Pastò, et al., “Nutritional Management of Oncological Symptoms: A Comprehensive Review, ” Nutrients 15, no. 24 (2023): 5068.

[110] L. Agate, E. Minaldi, A. Basolo, et al., “Nutrition in Advanced Thyroid Cancer Patients, ” Nutrients 14, no. 6 (2022): 1298.

[111] A. Carrato, L. Cerezo, J. Feliu, et al., “Clinical Nutrition as Part of the Treatment Pathway of Pancreatic Cancer Patients: An Expert Consensus, ” Clinical and Translational Oncology 24 (2022): 112-126.

[112] K. B. Swamy, S. A. Hadi, M. Sekaran, and M. R. Pichika, “The Clinical Effects of Synsepalum Dulcificum: A Review, ” Journal of Medicinal Food 17, no. 11 (2014): 1165-1169.

[113] J. H. Maselli-Schoueri, P. N. Aguiar Junior, and A. D. Giglio, “Natural Supplementation to Effectively Treat Cancer-induced Fatigue: Evidence of a Meta-analysis on the Use of guaraná, ” Revista Da Associacao Medica Brasileira 70, no. 10 (2024): e20240528.

[114] C. G. Palma, A. T. Lera, T. Lerner, et al., “Guarana (Paullinia cupana) Improves Anorexia in Patients With Advanced Cancer, ” Journal of Dietary Supplements 13, no. 2 (2016): 221-231.

[115] A. B. del Giglio, I. Cubero Dde, T. G. Lerner, et al., “Purified Dry Extract of Paullinia cupana (guaraná) (PC-18) for Chemotherapy-related Fatigue in Patients With Solid Tumors: An Early Discontinuation Study, ” Journal of Dietary Supplements 10, no. 4 (2013): 325-334.

[116] M. P. de Oliveira Campos, R. Riechelmann, L. C. Martins, B. J. Hassan, F. B. Casa, and A. Del Giglio, “Guarana (Paullinia cupana) Improves Fatigue in Breast Cancer Patients Undergoing Systemic Chemotherapy, ” Journal of Alternative and Complementary Medicine 17, no. 6 (2011): 505-512.

[117] L. C. de Paula, F. Fonseca, F. Perazzo, et al., “Uncaria tomentosa (cat's claw) Improves Quality of Life in Patients With Advanced Solid Tumors, ” Journal of Alternative and Complementary Medicine 21, no. 1 (2015): 22-30.

[118] C. Santos Araújo Mdo, I. L. Farias, and J. Gutierres, “Uncaria Tomentosa-Adjuvant Treatment for Breast Cancer: Clinical Trial, ” Evid Based Complement Alternat Med 2012 (2012): 676984.

[119] A. C. Akinmoladn, A. R. Adetuyi, K. Komolafe, and O. O. Oguntibeju, “Nutritional Benefits, Phytochemical Constituents, Ethnomedicinal Uses and Biological Properties of Miracle Fruit Plant (Synsepalum dulcificum Shumach. & Thonn. Daniell), ” Heliyon 6, no. 12 (2020): e05837.

[120] R. Mahdavi, E. Faramarzi, Z. Nikniaz, and F. FarshiRadvar, “Role of Probiotics and Synbiotics in Preventing Chemoradiotherapy-associated Toxicity in Colorectal Cancer Patients: A Systematic Review, ” Iran Journal of Medical Science 48, no. 2 (2023): 110-117.

[121] C. Lee, L. Raffaghello, S. Brandhorst, et al., “Fasting Cycles Retard Growth of Tumors and Sensitize a Range of Cancer Cell Types to Chemotherapy, ” Science Translational Medicine 4, no. 124 (2012): 124ra27.

[122] M. M. Mihaylova and R. J. Shaw, “The AMPK Signaling Pathway Coordinates Cell Growth, Autophagy and Metabolism, ” Nature Cell Biology 13, no. 9 (2011): 1016-1023.

[123] P. C. Henning, D. E. Scofield, K. R. Rarick, et al., “Effects of Acute Caloric Restriction Compared to Caloric Balance on the Temporal Response of the IGF-I System, ” Metabolism 62, no. 2 (2013): 179187.

[124] F. Pietrocola, J. Pol, E. Vacchelli, et al., “Caloric Restriction Mimetics Enhance Anticancer Immunosurveillance, ” Cancer Cell 30, no. 1 (2016): 147-160.

[125] F. M. Safdie, T. Dorff, D. Quinn, et al., “Fasting and Cancer Treatment in Humans: A Case Series Report, ” Aging (Albany NY) 1, no. 12 (2009): 988-1007.

[126] C. Vernieri, G. Fucà, F. Ligorio, et al., “Fasting-mimicking Diet Is Safe and Reshapes Metabolism and Antitumor Immunity in Patients With Cancer, ” Cancer Discovery 12, no. 1 (2022): 90-107.

[127] J. Polański, N. Światoniowska-Long, S. KIolaczyńska, and M. Chabowski, “Diet as a Factor Supporting Lung Cancer Treatment-A Systematic Review, ” Nutrients 15 (2023): 1477.

[128] S. Massironi, F. Panzuto, A. Zilli, et al., “Nutritional Aspects in Neuroendocrine Neoplasms. Bridging the Gap Between Dietary Interventions and Cancer Care Strategies: A Scoping Review, ” Journal of Endocrinological Investigation 48 (2025): 269-281.

[129] H. O. Santos, R. Genario, G. M. Tinsley, et al., “A Scoping Review of Intermittent Fasting, Chronobiology, and Metabolism, ” American Journal of Clinical Nutrition 115, no. 4 (2022): 991-1004.

[130] P. F. Innominato, V. P. Roche, O. G. Palesh, A. Ulusakarya, D. Spiegel, and F. A. Lévi, “The Circadian Timing System in Clinical Oncology, ” Annals of Medicine 46, no. 4 (2014): 191-207.

[131] D. Masi, M. E. Spoltore, R. Rossetti, et al., “The Influence of Ketone Bodies on Circadian Processes Regarding Appetite, Sleep and Hormone Release: A Systematic Review of the Literature, ” Nutrients 14, no. 7 (2022): 1410.

[132] S. Li, S. Zhu, and J. Yu, “The Role of the Gut Microbiota and Metabolites in Cancer Chemotherapy, ” Journal of Advanced Research 64 (2024): 223-235.

[133] A. Amaro-da-Cruz, T. Rubio-Tomás, and A. I. Álvarez-Mercado, “Specific Microbiome Patterns and Their Association With Breast Cancer: The Intestinal Microbiota as a Potential Biomarker and Therapeutic Strategy, ” Clinical & Translational Oncology 21 (2025): 15-41.

[134] A. I. Martin-Quesada, M. A. Hennessy, and A. C. Gutiérrez, “Charting Cancer's Course: Revealing the Role of Diet, Exercise, and the Microbiome in Cancer Evolution and Immunotherapy Response, ” Clinical & Translational Oncology 27 (2025): 473-485.

[135] S. E. Kapsetaki, G. Marquez Alcaraz, C. C. Maley, C. M. Whisner, and A. Aktipis, “Diet, Microbes, and Cancer across the Tree of Life: A Systematic Review, ” Current Nutrition Reports 11 (2022): 508-525.

[136] A. Jotshi, K. K. Sukla, M. M. Haque, et al., “Exploring the human Microbiome - A Step Forward for Precision Medicine in Breast Cancer, ” Cancer Reports 6, no. 11 (2023): e1877.

[137] B. Routy, T. Jackson, L. Mählmann, et al., “Melanoma and Microbiota: Current Understanding and Future Directions, ” Cancer Cell 42, no. 1 (2024): 16-34.

[138] P. Raoul, V. D. Gaetano, G. Sciaraffia, et al., “Gastric Cancer, Immunotherapy, and Nutrition: The Role of the Microbiota, ” Pathogens 13 (2024): 357.

[139] K. L. Greathouse, M. Wyatt, A. J. Johnson, et al., “Diet-microbiome Interactions in Cancer Treatment: Opportunities and Challenges for Precision Nutrition in Cancer, ” Neoplasia 29 (2022): 100800.

[140] J. Crowley, L. Ball, and G. J. Hiddink, “Nutrition in Medical Education: Systematic Review, ” The Lancet 3, no. 9 (2019): E379-389.

[141] National Research Council Committee on Nutrition in Medical Education. Nutrition Education in U.S. Medical Schools. Washington, DC: National Academy Press; 1985.

[142] K. M. Adams, M. Kohlmeier, and S. H. Zeisel, “Nutrition Education in U.S. medical Schools: Latest Update of a National Survey, ” Academic Medicine 85, no. 9 (2010): 1537-1542.

[143] S. C. Tuscano, J. Haxton, A. Ciardo, L. Ciullo, and R. Zegarra-Parodi, “The Revisions of the First Autobiography of AT Still, the Founder of Osteopathy, as a Step towards Integration in the American Healthcare System: A Comparative and Historiographic Review, ” Healthcare (Basel) 12, no. 2 (2024): 130.

[144] S. Paulus, “The Core Principles of Osteopathic Philosophy, ” International Journal of Osteopathic Medicine 16, no. 1 (2013): 11-16.

[145] Foundations of Osteopathic Medicine. 3rd edition. Chila. Lippincott Williams & Wilkins, 2011.

[146] P. Giosia, C. A. Stamerra, P. Giorgini, T. Jamialahamdi, A. E. Butler, and A. Sahebkar, “The Role of Nutrition in Inflammaging, ” Ageing Research Reviews 77 (2022): 101596.

[147] S. E. Berry, A. Valdes, D. Drew, et al., “Human Postprandial Responses to Food and Potential for Precision Nutrition, ” Nature Medicine 26, no. 6 (2020): 964-973.

[148] M. M. Mihaylova, A. Chaix, M. Delibegovic, et al., “When a Calorie Is Not Just a Calorie: Diet Quality and Timing as Mediators of Metabolism and Healthy Aging, ” Cell Metabolism 35, no. 7 (2023): 1114-1131.

[149] C. Niedzwiedz, L. Knifton, K. Robb, S. V. Katikireddi, and D. J. Smith, “Depression and Anxiety Among People Living With and Beyond Cancer: A Growing Clinical and Research Priority, ” BMC cancer 19, no. 1 (2019): 943.

[150] C. Low, S. Loke, G. Pang, B. Sim, and V. Yang, “Psychological Outcomes in Patients With Rare Cancers: A Systematic Review and Meta-analysis, ” Eclinical Medicine 72 (2024): 102631.

[151] M. Grajek, K. Krupa-Kotara, A. Białek-Dratwa, et al., “Nutrition and Mental Health: A Review of Current Knowledge About the Impact of Diet on Mental Health, ” Frontiers in Nutrition 9 (2022): 943998.

[152] N. Xu and Q. An, “Correlation Between Dietary Score and Depression in Cancer Patients: Data From the 2005-2018 National Health and Nutrition Examination Surveys, ” Frontiers in Psychology 13 (2022): 978913.

[153] American Society for Nutrition. How to Boost Mental Health through Better Nutrition. American Psychiatric Association, April 2023.

[154] American Association of Colleges of Osteopathic Medicine (AACOM). “AACOM Releases Historic Statement After ‘’Food As Medicine” Special Session, Accessed 3 July 2024, https://www.aacom.org/news-reports/news/2024/04/19/aacom-releases-historic-statement-after-food-as-medicine-special-session.

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