Post-Diagnosis Adherence to the Mediterranean Diet and Cancer Recurrence and Fatigue Outcomes in Cancer Survivors, with Emphasis on Colorectal Cancer: A Systematic Review and Meta-Analysis
Abstract
Background: Cancer survivors face heightened risks of recurrence and persistent cancer-related fatigue (CRF), both of which impair quality of life. The Mediterranean Diet (MD), characterized by its antioxidant and anti-inflammatory profile, has been proposed as a potentially beneficial dietary pattern. This systematic review and meta-analysis evaluated the association between post-diagnosis MD adherence and outcomes of cancer recurrence and CRF among adult survivors, with particular attention to colorectal cancer.
Methods: Systematic searches of PubMed, CINAHL, and the Cochrane Library (January 1995-May 2024) identified prospective cohort studies and randomized controlled trials (RCTs) reporting post-diagnosis MD adherence. Primary outcomes were cancer recurrence and CRF. Random-effects models were applied for recurrence analyses due to anticipated heterogeneity, while a fixed-effects model was used for CRF given the limited number of trials. Heterogeneity was assessed using the I2 statistic. Risk of bias was evaluated using the Cochrane RoB 2 tool (RCTs) and ROBINS-I (cohort studies). This review was registered in PROSPERO (CRD420251248086).
Results: Eight studies met inclusion criteria: six prospective cohort studies assessed recurrence (n = 6697), and two RCTs assessed CRF (n = 76). For recurrence, higher post-diagnosis MD adherence was associated with a lower hazard of recurrence or cancer-specific mortality (HR = 0.83; 95% CI: 0.70-0.99; I2 = 49%). For CRF, the pooled…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 6,697 participants or records.
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