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BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Study protocol

Low glycemic index diet, exercise and vitamin D to reduce breast cancer recurrence (DEDiCa): design of a clinical trial

Authors: Livia S.A. Augustin, Massimo Libra, Anna Crispo, Maria Grimaldi, Michele De Laurentiis, Massimo Rinaldo, Massimiliano D’Aiuto, Francesca Catalano, Giuseppe Banna, Francesco Ferrau’, Rosalba Rossello, Diego Serraino, Ettore Bidoli, Samuele Massarut, Guglielmo Thomas, Davide Gatti, Ernesta Cavalcanti, Monica Pinto, Gabriele Riccardi, Edward Vidgen, Cyril W.C. Kendall, David J.A. Jenkins, Gennaro Ciliberto, Maurizio Montella

Published in: BMC Cancer | Issue 1/2017

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Abstract

Background

Mechanisms influencing breast cancer (BC) development and recurrence include hyperglycemia, hyperinsulinemia, high insulin-like growth factor-1, high circulating estrogen, inflammation and impaired cellular differentiation/apoptosis. A lifestyle program that targets all the above mechanisms may be warranted. Low glycemic index (GI) foods produce lower post-prandial glucose and insulin responses and have been associated with lower BC risk. Moderate physical activity post-diagnosis reduces BC recurrence and mortality, partly explained by reduced insulin and estrogen levels. Vitamin D increases cell differentiation/apoptosis and high serum vitamin D levels improve BC survival. Yet no trial has evaluated the combined effect of a low GI diet, moderate physical activity and vitamin D supplementation on BC recurrence in the context of a Mediterranean lifestyle setting.

Methods

Women (30-74 yr) who had undergone surgery for primary histologically confirmed BC (stages I-III) within the previous 12 months, in cancer centres in Italy, will be randomized to follow, for a maximum of 33 months, either a high intensity treatment (HIT) composed of low GI diet + exercise + vitamin D (60 ng/mL serum concentration) or a lower intensity treatment (LITE) with general advice to follow a healthy diet and exercise pattern + vitamin D to avoid insufficiency. Both interventions are on a background of a Mediterranean diet. Considering a 20% recurrence rate within 3 years for BC cases and a predicted rate of 10% in the HIT group, with power of 80% and two-sided alpha of 0.05, the subject number required will be 506 (n = 253 in each arm). Clinic visits will be scheduled every 3 months. Dietary and exercise counselling and vitamin D supplements will be given at each clinic visit when blood samples, anthropometric measures and 7-day food records will be collected.

Discussion

DEDiCa study aims to reduce BC recurrence in women with BC using a lifestyle approach with additional vitamin D and to investigate possible cardio-metabolic benefits as well as epigenetic modifications according to lifestyle changes. Given the supporting evidence and safety of the components of our intervention we believe it is feasible and urgent to test it in cancer patients.

Trial registration

May 11, 2016; NCT02786875.

EudraCT Number

2015-005147-14
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Metadata
Title
Low glycemic index diet, exercise and vitamin D to reduce breast cancer recurrence (DEDiCa): design of a clinical trial
Authors
Livia S.A. Augustin
Massimo Libra
Anna Crispo
Maria Grimaldi
Michele De Laurentiis
Massimo Rinaldo
Massimiliano D’Aiuto
Francesca Catalano
Giuseppe Banna
Francesco Ferrau’
Rosalba Rossello
Diego Serraino
Ettore Bidoli
Samuele Massarut
Guglielmo Thomas
Davide Gatti
Ernesta Cavalcanti
Monica Pinto
Gabriele Riccardi
Edward Vidgen
Cyril W.C. Kendall
David J.A. Jenkins
Gennaro Ciliberto
Maurizio Montella
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3064-4

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