Table 2.
Summary of studies that assessed shared mechanisms between cancer and cardiovascular diseases [70,115,125,127,130,140,141,142,143].
| First Author, Year, Country | Population | Study Design | Follow Up | Intervention | Comparator | Outcomes |
|---|---|---|---|---|---|---|
| Wolver S, 2021, United States | 85 T2DM who initially presented on insulin the age 56.1 ± 9.9 years 70% Female |
One arm intervention | 1 year | LCKD (20 g of total carbohydrates per day from non-starchy vegetables) | - | ↓ insulin dose, HbA1c, and weight |
| Li S, 2022, China | 60 overweight or obese patients newly diagnosed with T2DM | RCT | 12 weeks | KD (the main foods for the diet were olive oil, butter, fried eggs, double-fried pork, pan-fried salmon, pacific saury, sardines, broccoli, avocado, etc.; daily limits for ingredients were as follows: carbohydrate 30–50 g, protein 60 g, fat 130 g, and total calories 1500 kcal + 2000 mL water/day | Routine diet for diabetes (carbohydrate 250–280 g, protein 60 g, fat 20 g), total calories (1500 kcal, without no limitation on foods) + 2000 mL water/day | Greater ↓ in weight, BMI, waist, TG, TC, LDL-C, HDL-C, FBG, FIN, and HbA1c in the KD group compared with the control group |
| Dashti HM, 2006, Kuwait | 66 healthy obese patients (BMI ≥ 30 kg/m2) with a high cholesterol level (group I; n = 35) and normal cholesterol level (group II; n = 31) | Non-randomized clinical trial | 56 weeks | KD (less than 20 g of carbohydrates in the form of green vegetables and salad, and 80–100 g of proteins in the form of meat, fish, fowl, eggs, shellfish, and cheese. PUFA and MUFA (5 tablespoons olive oil) were included in the diet. | KD (less than 20 g of carbohydrates in the form of green vegetables and salad and 80–100 g of proteins in the form of meat, fish, fowl, eggs, shellfish, and cheese. PUFA and MUFA (5 tablespoons olive oil) were included in the diet. | ↓ weight, BMI, TC, LDL-C, TG, FBG, and ↑ HDL-C in both groups. KD was safe and beneficial in both groups. |
| Volek JS, 2009, USA | 40 subjects with atherogenic dyslipidemia | RCT | 12 weeks | Low carbohydrate diet % carbohydrate: fat: protein = 12:59:28 | Low-fat diet (56:24:20) | Greater ↓ in glucose and insulin levels, insulin sensitivity, weight, adiposity, and more favorable TG, HDL-C, and TC/HDL-C ratio in the low carbohydrate diet group compared with the low-fat diet group |
| Zhang Y, 2018, China | 20 patients (14 males, 6 females) | Single arm trial | 6 months | KD non-fasting diet with a classic 4:1 ratio KD fat:protein plus carbohydrates. Fat from pork, oils such as olive oil, coconut oil, and other sources. Plant fat accounted for about 70% of the amount of fat. At least 1 g of protein per kg body weight from animal sources (e.g., eggs, meat, poultry, and fish). Carbohydrate-containing foods such as fruits and vegetables were added. |
- | ↓ alpha diversity in fecal microbiota ↓ abundance of Firmicutes ↑ levels of Bacteroidetes |
| Gutiérrez-Repiso C, 2019, Spain | 33 obese patients | RCT | 2 months | VLCKD + synbiotics | Low-calorie diet | ↔ microbial diversity ↑ short-chain fatty acid-producing bacteria ↑ Odoribacter and Lachnospira |
| Basciani S, 2020, Italy | 48 patients with obesity (19 males and 29 females, HOMA index ≥ 2.5, aged 56.2 ± 6.1 years, BMI 35.9 ± 4.1 kg/m2 | RCT | 45 days | VLCKD regimens (≤800 kcal/day) containing whey, plant, or animal protein | Greater ↓ in relative abundance of Firmicutes and greater ↑ in Bacteroidetes in whey and plant protein compared with animal protein group. | |
| Rosenbaum M, 2019, USA | 17 men (BMI: 25–35 kg/m2) | Single arm trial | 4 weeks | Isocaloric KD (15% protein, 5% carbohydrate, 80% fat) | Baseline diet (15% protein, 50% carbohydrate, 35% fat) | ↑ free fatty acids, TC, LDL-C, and CRP ↓ Fasting insulin, C-peptides, TG, and fibroblast growth factor 21 |
| Cohen CW, 2018, Birmingham | women with ovarian or endometrial cancer (age: ≥19 years; BMI ≥ 18.5 kg/m2) | RCT | 12 weeks | KD (70:25:5 energy from fat, protein, and carbohydrate) | The American Cancer Society diet (high-fiber, low-fat) | Greater ↓ in total and android fat mass, visceral fat, and fasting serum insulin in KD compared with control ↔ lean mass |
T2DM: diabetes mellitus type II; LCKD: low-carbohydrate ketogenic diet; HbA1c: hemoglobin A1c; RCT: randomized clinical trial; KD: ketogenic diet; BMI: body mass index; TG: triglyceride; TC: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; FBG: fasting blood glucose; FIN: fasting insulin; PUFA: polyunsaturated fatty acid; MUFA: mono-unsaturated fatty acid; VLCKD: very-low-calorie ketogenic diet; HOMA: homeostatic model assessment; CRP: C-reactive protein; ↓: decrease; ↑: increase; ↔: no change.