title: Fatigue reduction diet in breast cancer survivors: a pilot randomized clinical trial.
abstract: Fatigue is a prevalent and burdensome effect of breast cancer. Fatigue has been linked to chronic inflammation, and diets high in antioxidant nutrients have been associated with lesser prevalence and severity of fatigue. Studies are needed, however, to test if antioxidant-rich diets could improve fatigue.
  
  
  
  Pilot, randomized, trial conducted between January 2014 and April 2015, to investigate if a 3-month diet rich in fruit, vegetables, whole grains, and omega-3 fatty acid-rich foods, named the fatigue reduction diet (FRD), improved fatigue and sleep compared to an attention control, named the general health curriculum (GHC). 30 stage 0 to III breast cancer survivors, who had completed cancer treatments, were randomized: 15 receiving the FRD and 15 the GHC. Primary outcome was change in fatigue, as measured by the brief fatigue Inventory, from baseline to 3 months analyzed using linear mixed models. Secondary analyses were changes in sleep quality, serum carotenoids, and fatty acids.
  
  
  
  From baseline to 3-month fatigue improved by 44 ± 39% in FRD compared to 8 ± 34% in GHC (p = 0.01); sleep quality improved by 2.5 ± 3.3 points in FRD, and diminished by 0.9 ± 2.3 in GHC (p = 0.03); serum total carotenoids (p < 0.01), β-cryptoxanthin (p = 0.02), lutein (p = 0.05), zeaxanthin (p = 0.01), lycopene (p = 0.05), omega-3 fatty acids (p < 0.01), and ratio of omega-3:omega-6 fatty acids (p = 0.02) were significantly increased, and percent saturated fatty acids were decreased (p = 0.04) in FRD; γ-tocopherol was significantly increased in GHC (p = 0.03), and there was a significant visit by group difference for α-carotene between the study groups (p = 0.05).
  
  
  
  The FRD intervention improved fatigue and sleep in breast cancer survivors compared to the GHC. FRD diet could provide a non-toxic treatment strategy for persistent fatigue.
authors.affiliation: Department Family Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48105, USA. szick@umich.edu.|Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, 6651 SPH I, Ann Arbor, MI, 48109-2029, USA. szick@umich.edu.
authors.forename: Suzanna Maria
authors.initials: SM
authors.lastname: Zick
authors.affiliation: Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, 6651 SPH I, Ann Arbor, MI, 48109-2029, USA.|Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, 6651 SPH I, Ann Arbor, MI, 48109-2029, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Colacino
authors.affiliation: Department Family Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48105, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Cornellier
authors.affiliation: Department Family Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48105, USA.
authors.forename: Tohfa
authors.initials: T
authors.lastname: Khabir
authors.affiliation: Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109-2029, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Surnow
authors.affiliation: Department Family Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48105, USA.|Department of Nutritional Sciences, University of Michigan School of Public Health, Cancer Center room 4306, Ann Arbor, MI, 48109-5936, USA.
authors.forename: Zora
authors.initials: Z
authors.lastname: Djuric
mesh_terms: D000368:Aged; D000975:Antioxidants; D015415:Biomarkers; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy* / Q000628:therapy; D003131:Combined Modality Therapy; D004032:Diet; D002149:Energy Intake; D005221:Fatigue / Q000178:diet therapy* / Q000209:etiology; D015525:Fatty Acids, Omega-3; D005260:Female; D005638:Fruit; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D012307:Risk Factors; D017741:Survivors; D016896:Treatment Outcome; D014675:Vegetables
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D015525:Fatty Acids, Omega-3
keywords: Breast cancer survivor; Cancer-related fatigue; Carotenoids; Diet, omega-3 fatty acids; Fruits; Sleep quality; Vegetables; Whole grains