Current Evidence on the Impact of Diet, Food, and Supplement Intake on Breast Cancer Health Outcomes in Patients Undergoing Endocrine Therapy

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Please see attachment.

Comments for author File: Comments.pdf

Author Response

Dear Respected Reviewers,

We deeply value your time and efforts in providing the meaningful suggestions to our manuscript. We dutifully addressed each comment point-by-point, as included below. We also corrected the manuscript accordingly and marked all changes in red and/or highlighted in yellow some sections. With those changes, the manuscript looks and reads much better, it is very comprehensive and we hope that you will approve for publication in Nutrients.

Again, thank you for all your efforts and time spent in reviewing our manuscript.

With best regards on behalf of the authors

Jasminka Ilich, PhD, RDN, FACN

Professor of Nutrition

Florida State University

Reviewer 1.

Comments on the Review article titled: “Current evidence on the impact of diet, food, and supplement intake on breast cancer health outcomes in patients undergoing endocrine therapy”

On this review article, the authors synthesize and summarize the main findings of different intervention studies regarding the impact of diet and supplementation over different health outcomes in women with breast cancer receiving endocrine therapy. This topic is particularly interesting since diet and supplementation are modifiable and actionable factors that should be explored further in the field of cancer. They present a total of 26 studies which fit their inclusion and exclusion criteria and include a table with the summary of each study. Although they performed a comprehensive review, they state that it is difficult to select an effective universal combination of diet/supplementation and highlight the limitations of their review.

Thank you for the nice summary of the most important points in our manuscript.

Some additional comments:

Line 12: It should be “the most common type of breast cancer”

Line 13: Instead of the first-conventional treatment, I would suggest using first line treatment or standard of care treatment.

Line 13-16: Maybe rephrase this statement: "Among the side effects produced by this treatment,

aromatase inhibitor arthralgia is the most common, affecting the patients' overall health and quality of life."

Line 19: Please include the complete time frame from beginning to end.

Thank you very much! All the comments above are corrected in the manuscript and marked in red.

Line 125-126: Please include the complete time frame. Verify for consistency with the abstract.

Included and verified, both in Abstract and Methods. The original search in databases were conducted from June to September 2024, with additional manual search for relevant studies until November 2024.

Table 1:

The authors should break down the table into various smaller tables for each type of intervention. It will allow for better readability and could incorporate additional details relevant to each type of intervention. Include an additional column with the parameters evaluated. It is easier to follow the results column since it has a lot of abbreviations. Include the statistical significance for all the results included in the table. It can be inferred that results without the NS are significant, but it should be clear. The significance can be included in a parenthesis after the comparisons, it would be easier to follow. Be consistent in the position of the arrows to show the effect, it is better if it is located before the parameter.

Thank you very much for these excellent suggestions to make the table clearer! The smaller tables for each intervention were constructed and all corrections have been done. Briefly, we separated the original Table 1 into 5 different tables according to the intervention that has been used in the studies. We also included one additional column with “Parameters Evaluated” and the last column is retitled to “Significant Changes” where we listed all significant changes with p values. In some instances, we also inserted p>0.05 for parameters that changed after intervention (baseline vs. intervention) but there were no significant changes among the groups. All arrows indicating the change are inserted in front of parameters. Again, thank you very much, as the tables are much easier to follow now.

Some abbreviations are missing, please verify.

All abbreviations have been verified and checked. Each table has the listed abbreviations. Additionally, we added the table with all abbreviations defined at the end of manuscript and before the Reference List, thank you.

Line 417: Remove “is”

Removed, thank you

Reviewer 2 Report

Comments and Suggestions for Authors

Abstract

 

This section responds well to what is expected of a research work although it should better describe the nature of the subjects to which the biblographic search was limited. It also presents the main findings detected as well as a clear synthesis of the most important conclusions.

 

Introduction

 

The authors make a deep reflection on the object of study of their research and also an interesting biblographic search in which they confirm how little studied previously has been the core of their research (only a few works). That is why this article could potentially be cited in a future new research since the problem they analyze is very useful for the target population through nutrition.

 

2. Materials and Methods 

2.1. Search Strategy

 

The search strategy, the databases used and the keywords are well described. Good work.

 

Eligibility Criteria

This section is generally well explained. However, there is a need to describe precisely what are the criteria for considering an article to be of “relevance” as indicated at the beginning of line 140.

 

 

3. Results

Ok, good figure 1

 

General Characteristics of the Studies

 

Please explain or justify why you have included the papers in which there is some intervention with physical activity as described in lines 162-164.

 

Table 1. Excellent

 

4. Discussion

 

This is undoubtedly the best section of the entire article in which the authors compile the existing literature and make a real effort to summarize and compile all the information with the limitations indicated in this study. L

In addition, they include the conclusions in the sections “Body Composition And Weight As Outcomes”, “Cardiovascular Disease Risk Factors As Outcomes”, “Inflammation As Outcome”, “Quality of life as an outcome” and finally acknowledge the limitations to this study.

It is appreciated that in each section they include at the end the main conclusions of that section although I request that they include practical recommendations for nutritionists, physicians and health personnel.

 

5. Conclusions

 

A true selection of the main findings detected in the articles has been made. Congratulations for your work

Author Response

Dear Respected Reviewers,

We deeply value your time and efforts in providing the meaningful suggestions to our manuscript. We dutifully addressed each comment point-by-point, as included below. We also corrected the manuscript accordingly and marked all changes in red and/or highlighted in yellow some sections. With those changes, the manuscript looks and reads much better, it is very comprehensive and we hope that you will approve for publication in Nutrients.

Again, thank you for all your efforts and time spent in reviewing our manuscript.

 

With best regards on behalf of the authors

Jasminka Ilich, PhD, RDN, FACN

Professor of Nutrition

Florida State University

Reviewer 2

Comments and Suggestions for Authors

Abstract

This section responds well to what is expected of a research work although it should better describe the nature of the subjects to which the biblographic search was limited. It also presents the main findings detected as well as a clear synthesis of the most important conclusions.

We included a brief description of subjects included in the search terms, thank you.

Introduction

The authors make a deep reflection on the object of study of their research and also an interesting biblographic search in which they confirm how little studied previously has been the core of their research (only a few works). That is why this article could potentially be cited in a future new research since the problem they analyze is very useful for the target population through nutrition.

Thank you very much for your positive evaluation of our text and encouraging comments.

2. Materials and Methods 

2.1. Search Strategy

The search strategy, the databases used and the keywords are well described. Good work.

Thank you again!

Eligibility Criteria

This section is generally well explained. However, there is a need to describe precisely what are the criteria for considering an article to be of “relevance” as indicated at the beginning of line 140.

Thank you, yes this was our omission, and we added more text and explanation in the Selection Criteria.

3. Results

Ok, good figure 1

General Characteristics of the Studies

Please explain or justify why you have included the papers in which there is some intervention with physical activity as described in lines 162-164.

Excellent observation, thank you. While our objective was to include diet and/or dietary components in this review, we encountered three studies that, in addition to dietary components, included several types of physical activity. Since the effects of diets were examined together with these types of physical activities (in two out of three studies) and in the third study both diet and physical activity were assessed, we thought that it would be beneficial to include all three of these studies. It was also explained better in the text.

Table 1. Excellent

4. Discussion

This is undoubtedly the best section of the entire article in which the authors compile the existing literature and make a real effort to summarize and compile all the information with the limitations indicated in this study. L

In addition, they include the conclusions in the sections “Body Composition And Weight As Outcomes”, “Cardiovascular Disease Risk Factors As Outcomes”, “Inflammation As Outcome”, “Quality of life as an outcome” and finally acknowledge the limitations to this study.

It is appreciated that in each section they include at the end the main conclusions of that section although I request that they include practical recommendations for nutritionists, physicians and health personnel.

Thank you so much for such encouraging comments. Some of the recommendations were added in each section of the Discussion and then in overall recommendations at the end of the Conclusions, entitled: “Closing the Gaps and Recommendations for Future Research

5. Conclusions

A true selection of the main findings detected in the articles has been made. Congratulations for your work

We are so grateful and appreciative of your comments and suggestions that improved our manuscript. Some of the authors are young and at the beginning of their careers and these comments mean a lot to them.

Submission Date

22 December 2024

Date of this review

10 Jan 2025 01:01:19

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript provides a detailed and systematic review of the impact of diet, food, and supplement intake on breast cancer health outcomes in patients undergoing endocrine therapy. It offers valuable insights into dietary patterns, nutritional interventions, and their effects on body composition, cardiovascular health, inflammation, and quality of life. However, the study would benefit from greater integration of recent and highly relevant literature, more structured discussions, and clearer recommendations for future research and clinical practice.

Suggestions for Revisions:

1. Expand the discussion of novel approaches like the fasting-mimicking diet (see suggested references below: Caffa et al., Vernieri et al.) and their role in enhancing the efficacy of endocrine therapies. Highlight mechanisms, clinical implications, and future research directions.
2. Discuss the comprehensive nutritional strategies reviewed by Garutti et al. (2023) and their practical application in managing oncological symptoms, as they align closely with the manuscript's goals (QoL data).
3. While the review is thorough, it would be beneficial to explicitly outline gaps in knowledge, especially regarding the long-term benefits of combined dietary and pharmacological interventions.
4. Provide more detailed criteria for the selection of studies and clarify any potential biases
5. Conclude the manuscript with clear recommendations based on the findings. For instance:
• Exploration of the cyclic fasting-mimicking diet in diverse patient populations.
• Long-term studies on the combined effects of dietary patterns and pharmacological treatments on inflammation and QoL.
• Evaluation of cereal grain composition and its potential as a preventative strategy against breast cancer recurrence.
6. Incorporating the following references could enhance discussions on the role of specific dietary interventions (e.g., fasting-mimicking diets), comprehensive nutritional management, and estrogen deprivation effects:

 

• Caffa I, et al. (2020). Fasting-mimicking diet and hormone therapy induce breast cancer regression. Nature. 583(7817):620-624.
• Vernieri C, et al. (2024). Cyclic fasting-mimicking diet in cancer treatment: Preclinical and clinical evidence. Cell Metab. 36(8):1644-1667.
• Garutti M, et al. (2023). Nutritional Management of Oncological Symptoms: A Comprehensive Review. Nutrients. 15(24):5068.
• Cucciniello L, et al. (2023). Estrogen deprivation effects of endocrine therapy in breast cancer patients: Incidence, management and outcome. Cancer Treat Rev. 120:102624.

Author Response

Dear Respected Reviewers,

We deeply value your time and efforts in providing the meaningful suggestions to our manuscript. We dutifully addressed each comment point-by-point, as included below. We also corrected the manuscript accordingly and marked all changes in red and/or highlighted in yellow some sections. With those changes, the manuscript looks and reads much better, it is very comprehensive and we hope that you will approve for publication in Nutrients.

Again, thank you for all your efforts and time spent in reviewing our manuscript.

 

With best regards on behalf of the authors

Jasminka Ilich, PhD, RDN, FACN

Professor of Nutrition

Florida State University

Reviewer 3

The manuscript provides a detailed and systematic review of the impact of diet, food, and supplement intake on breast cancer health outcomes in patients undergoing endocrine therapy. It offers valuable insights into dietary patterns, nutritional interventions, and their effects on body composition, cardiovascular health, inflammation, and quality of life. However, the study would benefit from greater integration of recent and highly relevant literature, more structured discussions, and clearer recommendations for future research and clinical practice.

We truly appreciate all your comments and suggestions, as well as the references you provided for us to include in our manuscript. We included and discussed them all. Thank you very much! All the changes in manuscript are in red color or sometimes highlighted in yellow.

Suggestions for Revisions:

1. Expand the discussion of novel approaches like the fasting-mimicking diet (see suggested references below: Caffa et al., Vernieri et al.) and their role in enhancing the efficacy of endocrine therapies. Highlight mechanisms, clinical implications, and future research directions.

These two references were incorporated and elaborated more in the separate section after Discussion, entitled: Additional Possibilities with Diet Interventions. This was a great idea to incorporate these new possible treatments for breast cancer patients, and we are very thankful for your suggestions

1. Discuss the comprehensive nutritional strategies reviewed by Garutti et al. (2023) and their practical application in managing oncological symptoms, as they align closely with the manuscript's goals (QoL data).

The paper from Garutti et al., is another excellent paper. We addressed it immediately in the Introduction, and later in Discussion under QoL. Unfortunately, since our manuscript is already long, we could not elaborate too much on this article as it is very comprehensive and detailed

1. While the review is thorough, it would be beneficial to explicitly outline gaps in knowledge, especially regarding the long-term benefits of combined dietary and pharmacological interventions.

We addressed these to a certain extent, at the end of each section in Discussion, thank you

1. Provide more detailed criteria for the selection of studies and clarify any potential biases

This was addressed under Selection Criteria in Methods

1. Conclude the manuscript with clear recommendations based on the findings. For instance:

Thank you very much for the great suggestions you provided. We included them all with some elaboration at the end of the manuscript, titled: Closing the Gaps and Recommendations for Future Research

 

• Exploration of the cyclic fasting-mimicking diet in diverse patient populations.
• Long-term studies on the combined effects of dietary patterns and pharmacological treatments on inflammation and QoL.
• Evaluation of cereal grain composition and its potential as a preventative strategy against breast cancer recurrence.
1. Incorporating the following references could enhance discussions on the role of specific dietary interventions (e.g., fasting-mimicking diets), comprehensive nutritional management, and estrogen deprivation effects:

Again, thank you so much. All references have been incorporated and discussed

• Caffa I, et al. (2020). Fasting-mimicking diet and hormone therapy induce breast cancer regression. Nature. 583(7817):620-624.
• Vernieri C, et al. (2024). Cyclic fasting-mimicking diet in cancer treatment: Preclinical and clinical evidence. Cell Metab. 36(8):1644-1667.
• Garutti M, et al. (2023). Nutritional Management of Oncological Symptoms: A Comprehensive Review. Nutrients. 15(24):5068.
• Cucciniello L, et al. (2023). Estrogen deprivation effects of endocrine therapy in breast cancer patients: Incidence, management and outcome. Cancer Treat Rev. 120:102624.

 

Submission Date

22 December 2024

Date of this review

02 Jan 2025 14:04:11

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have successfully addresses my suggestions and comments. The manuscript has improved in quality, structure, and readability.