Intake of citrus fruits and vegetables and the intensity of defecation urgency syndrome among gynecological cancer survivors

Maria Hedelin, Viktor Skokic, Ulrica Wilderäng, Rebecca Ahlin, Cecilia Bull, Fei Sjöberg, Gail Dunberger, Karin Bergmark, Andrea Stringer, Gunnar Steineck, Maria Hedelin, Viktor Skokic, Ulrica Wilderäng, Rebecca Ahlin, Cecilia Bull, Fei Sjöberg, Gail Dunberger, Karin Bergmark, Andrea Stringer, Gunnar Steineck

Abstract

Background: Despite the experimental evidence that certain dietary compounds lower the risk of radiation-induced damage to the intestine, clinical data are missing and dietary advice to irradiated patients is not evidence-based.

Materials and methods: We have previously identified 28 intestinal health-related symptoms among 623 gynaecological-cancer survivors (three to fifteen years after radiotherapy) and 344 matched population-based controls. The 28 symptoms were grouped into five radiation-induced survivorship syndromes: defecation-urgency syndrome, fecal-leakage syndrome, excessive mucus discharge, excessive gas discharge and blood discharge. The grouping was based on factor scores produced by Exploratory Factor Analysis in combination with the Variable Cutoff Method. Frequency of food intake was measured by a questionnaire. We evaluated the relationship between dietary intake and the intensity of the five syndromes.

Results: With the exception of excessive mucus discharge, the intensity of all syndromes declined with increasing intake of citrus fruits. The intensity of defecation-urgency and fecal-leakage syndrome declined with combined intake of vegetables and citrus fruits. The intensity of excessive mucus discharge was increased with increasing intake of gluten.

Conclusion: In this observational study, we found an association between a high intake of citrus fruits and vegetables and a lower intensity of the studied radiation-induced cancer survivorship syndromes. Our data suggest it may be worthwhile to continue to search for a role of the diet before, during and after radiotherapy to help the cancer survivor restore her or his intestinal health after irradiation.

Conflict of interest statement

Gunnar Steineck is PI for a study of probiotics sponsored by Probi AB. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There exist no other competing interests.

Figures

Fig 1. Relationships between radiation-induced survivorship syndromes…
Fig 1. Relationships between radiation-induced survivorship syndromes and frequency of citrus intake.
The figure depicts the relationships between frequency of citrus intake (x-axis) and intensities (factor scores) of the five radiation induced syndromes (y-axis: defecation-urgency syndrome, fecal-leakage syndrome, excessive gas discharge, excessive mucus discharge and blood discharge) among long-term gynecological cancer survivors and population controls. Red squares and green triangles denote the mean syndrome intensities within certain citrus intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensities and frequency of citrus intake according to: p ≤ 0.001 - ***, 0.001

Fig 2. Relationship between radiation-induced survivorship syndromes…

Fig 2. Relationship between radiation-induced survivorship syndromes and frequency of vegetable and citrus fruit intake.

Fig 2. Relationship between radiation-induced survivorship syndromes and frequency of vegetable and citrus fruit intake.
The figure depicts the relationships between frequency of combined intake of beans and lentils, cabbage and broccoli, onion and garlic, grated vegetables together with citrus fruits (x-axis) and intensities (factor scores) of the two radiation-induced survivorship syndromes (y-axis) defecation-urgency syndrome and fecal-leakage syndrome among long-term gynecological cancer survivors and population controls. Red squares and green triangles denote the mean syndrome intensities within certain vegetable and citrus intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensities and frequency of vegetable and citrus intake according to: p ≤ 0.001 - ***, 0.001

Fig 3. Relationship between intensity of excessive…

Fig 3. Relationship between intensity of excessive mucus discharge and frequency of gluten intake.

The…

Fig 3. Relationship between intensity of excessive mucus discharge and frequency of gluten intake.
The figure depicts the relationship between frequency of gluten intake (x-axis) and the intensity (factor scores) of the radiation induced syndrome (y-axis) excessive mucus discharge among long-term gynecological cancer survivors and population controls. Red squares/green triangles denote the mean syndrome intensity within certain gluten intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensity and frequency of gluten intake according to: p ≤ 0.001 - ***, 0.001

Fig 4. Relationship between radiation-induced defecation-urgency syndrome…

Fig 4. Relationship between radiation-induced defecation-urgency syndrome and frequency of citrus fruit intake, stratified by…

Fig 4. Relationship between radiation-induced defecation-urgency syndrome and frequency of citrus fruit intake, stratified by those who have changed and those who have not changed dietary behavior after radiotherapy.
The figure depicts the relationship between frequency of citrus fruit intake (x-axis) and the intensity (factor scores) the defecation-urgency syndrome (y-axis) among long-term gynecological cancer survivors stratified according to having or not having made dietary changes after receiving radiotherapy (see the Methods section for detailed information). Red squares and green triangles denote the mean intensities of the syndromes within certain citrus intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensity and frequency of citrus intake according to: p ≤ 0.001 - ***, 0.001
Similar articles
Cited by
References
    1. Khalid U, McGough C, Hackett C, Blake P, Harrington KJ, Khoo VS, et al. A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. International journal of radiation oncology, biology, physics. 2006;64(5):1432–41. 10.1016/j.ijrobp.2005.10.007 - DOI - PubMed
    1. Resbeut M, Marteau P, Cowen D, Richaud P, Bourdin S, Dubois JB, et al. A randomized double blind placebo controlled multicenter study of mesalazine for the prevention of acute radiation enteritis. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 1997;44(1):59–63. - PubMed
    1. Steineck G, Skokic V, Sjoberg F, Bull C, Alevronta E, Dunberger G, et al. Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors. PLoS One. 2017;12(2):e0171461 10.1371/journal.pone.0171461 - DOI - PMC - PubMed
    1. Kuku S, Fragkos C, McCormack M, Forbes A. Radiation-induced bowel injury: the impact of radiotherapy on survivorship after treatment for gynaecological cancers. Br J Cancer. 2013;109(6):1504–12. 10.1038/bjc.2013.491 - DOI - PMC - PubMed
    1. Ferreira MR, Muls A, Dearnaley DP, Andreyev HJ. Microbiota and radiation-induced bowel toxicity: lessons from inflammatory bowel disease for the radiation oncologist. Lancet Oncol. 2014;15(3):e139–47. 10.1016/S1470-2045(13)70504-7 - DOI - PubMed
Show all 56 references
Publication types
MeSH terms
Related information
Grant support
This work was supported by the Swedish Cancer Society to GS, the King Gustav V Jubilee Clinic Cancer Foundation in Göteborg, Sweden to GS and the Swedish state under the ALF agreement in Göteborg. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Fig 2. Relationship between radiation-induced survivorship syndromes…
Fig 2. Relationship between radiation-induced survivorship syndromes and frequency of vegetable and citrus fruit intake.
The figure depicts the relationships between frequency of combined intake of beans and lentils, cabbage and broccoli, onion and garlic, grated vegetables together with citrus fruits (x-axis) and intensities (factor scores) of the two radiation-induced survivorship syndromes (y-axis) defecation-urgency syndrome and fecal-leakage syndrome among long-term gynecological cancer survivors and population controls. Red squares and green triangles denote the mean syndrome intensities within certain vegetable and citrus intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensities and frequency of vegetable and citrus intake according to: p ≤ 0.001 - ***, 0.001

Fig 3. Relationship between intensity of excessive…

Fig 3. Relationship between intensity of excessive mucus discharge and frequency of gluten intake.

The…

Fig 3. Relationship between intensity of excessive mucus discharge and frequency of gluten intake.
The figure depicts the relationship between frequency of gluten intake (x-axis) and the intensity (factor scores) of the radiation induced syndrome (y-axis) excessive mucus discharge among long-term gynecological cancer survivors and population controls. Red squares/green triangles denote the mean syndrome intensity within certain gluten intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensity and frequency of gluten intake according to: p ≤ 0.001 - ***, 0.001

Fig 4. Relationship between radiation-induced defecation-urgency syndrome…

Fig 4. Relationship between radiation-induced defecation-urgency syndrome and frequency of citrus fruit intake, stratified by…

Fig 4. Relationship between radiation-induced defecation-urgency syndrome and frequency of citrus fruit intake, stratified by those who have changed and those who have not changed dietary behavior after radiotherapy.
The figure depicts the relationship between frequency of citrus fruit intake (x-axis) and the intensity (factor scores) the defecation-urgency syndrome (y-axis) among long-term gynecological cancer survivors stratified according to having or not having made dietary changes after receiving radiotherapy (see the Methods section for detailed information). Red squares and green triangles denote the mean intensities of the syndromes within certain citrus intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensity and frequency of citrus intake according to: p ≤ 0.001 - ***, 0.001
Similar articles
Cited by
References
    1. Khalid U, McGough C, Hackett C, Blake P, Harrington KJ, Khoo VS, et al. A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. International journal of radiation oncology, biology, physics. 2006;64(5):1432–41. 10.1016/j.ijrobp.2005.10.007 - DOI - PubMed
    1. Resbeut M, Marteau P, Cowen D, Richaud P, Bourdin S, Dubois JB, et al. A randomized double blind placebo controlled multicenter study of mesalazine for the prevention of acute radiation enteritis. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 1997;44(1):59–63. - PubMed
    1. Steineck G, Skokic V, Sjoberg F, Bull C, Alevronta E, Dunberger G, et al. Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors. PLoS One. 2017;12(2):e0171461 10.1371/journal.pone.0171461 - DOI - PMC - PubMed
    1. Kuku S, Fragkos C, McCormack M, Forbes A. Radiation-induced bowel injury: the impact of radiotherapy on survivorship after treatment for gynaecological cancers. Br J Cancer. 2013;109(6):1504–12. 10.1038/bjc.2013.491 - DOI - PMC - PubMed
    1. Ferreira MR, Muls A, Dearnaley DP, Andreyev HJ. Microbiota and radiation-induced bowel toxicity: lessons from inflammatory bowel disease for the radiation oncologist. Lancet Oncol. 2014;15(3):e139–47. 10.1016/S1470-2045(13)70504-7 - DOI - PubMed
Show all 56 references
Publication types
MeSH terms
Related information
Grant support
This work was supported by the Swedish Cancer Society to GS, the King Gustav V Jubilee Clinic Cancer Foundation in Göteborg, Sweden to GS and the Swedish state under the ALF agreement in Göteborg. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Fig 3. Relationship between intensity of excessive…
Fig 3. Relationship between intensity of excessive mucus discharge and frequency of gluten intake.
The figure depicts the relationship between frequency of gluten intake (x-axis) and the intensity (factor scores) of the radiation induced syndrome (y-axis) excessive mucus discharge among long-term gynecological cancer survivors and population controls. Red squares/green triangles denote the mean syndrome intensity within certain gluten intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensity and frequency of gluten intake according to: p ≤ 0.001 - ***, 0.001

Fig 4. Relationship between radiation-induced defecation-urgency syndrome…

Fig 4. Relationship between radiation-induced defecation-urgency syndrome and frequency of citrus fruit intake, stratified by…

Fig 4. Relationship between radiation-induced defecation-urgency syndrome and frequency of citrus fruit intake, stratified by those who have changed and those who have not changed dietary behavior after radiotherapy.
The figure depicts the relationship between frequency of citrus fruit intake (x-axis) and the intensity (factor scores) the defecation-urgency syndrome (y-axis) among long-term gynecological cancer survivors stratified according to having or not having made dietary changes after receiving radiotherapy (see the Methods section for detailed information). Red squares and green triangles denote the mean intensities of the syndromes within certain citrus intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensity and frequency of citrus intake according to: p ≤ 0.001 - ***, 0.001
Similar articles
Cited by
References
    1. Khalid U, McGough C, Hackett C, Blake P, Harrington KJ, Khoo VS, et al. A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. International journal of radiation oncology, biology, physics. 2006;64(5):1432–41. 10.1016/j.ijrobp.2005.10.007 - DOI - PubMed
    1. Resbeut M, Marteau P, Cowen D, Richaud P, Bourdin S, Dubois JB, et al. A randomized double blind placebo controlled multicenter study of mesalazine for the prevention of acute radiation enteritis. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 1997;44(1):59–63. - PubMed
    1. Steineck G, Skokic V, Sjoberg F, Bull C, Alevronta E, Dunberger G, et al. Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors. PLoS One. 2017;12(2):e0171461 10.1371/journal.pone.0171461 - DOI - PMC - PubMed
    1. Kuku S, Fragkos C, McCormack M, Forbes A. Radiation-induced bowel injury: the impact of radiotherapy on survivorship after treatment for gynaecological cancers. Br J Cancer. 2013;109(6):1504–12. 10.1038/bjc.2013.491 - DOI - PMC - PubMed
    1. Ferreira MR, Muls A, Dearnaley DP, Andreyev HJ. Microbiota and radiation-induced bowel toxicity: lessons from inflammatory bowel disease for the radiation oncologist. Lancet Oncol. 2014;15(3):e139–47. 10.1016/S1470-2045(13)70504-7 - DOI - PubMed
Show all 56 references
Publication types
MeSH terms
Related information
Grant support
This work was supported by the Swedish Cancer Society to GS, the King Gustav V Jubilee Clinic Cancer Foundation in Göteborg, Sweden to GS and the Swedish state under the ALF agreement in Göteborg. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Fig 4. Relationship between radiation-induced defecation-urgency syndrome…
Fig 4. Relationship between radiation-induced defecation-urgency syndrome and frequency of citrus fruit intake, stratified by those who have changed and those who have not changed dietary behavior after radiotherapy.
The figure depicts the relationship between frequency of citrus fruit intake (x-axis) and the intensity (factor scores) the defecation-urgency syndrome (y-axis) among long-term gynecological cancer survivors stratified according to having or not having made dietary changes after receiving radiotherapy (see the Methods section for detailed information). Red squares and green triangles denote the mean intensities of the syndromes within certain citrus intake frequency levels. Vertical black lines stretch between plus-minus the standard error of the mean. Asterisks correspond to significance levels of the Spearman correlations between syndrome intensity and frequency of citrus intake according to: p ≤ 0.001 - ***, 0.001

References

    1. Khalid U, McGough C, Hackett C, Blake P, Harrington KJ, Khoo VS, et al. A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. International journal of radiation oncology, biology, physics. 2006;64(5):1432–41. 10.1016/j.ijrobp.2005.10.007
    1. Resbeut M, Marteau P, Cowen D, Richaud P, Bourdin S, Dubois JB, et al. A randomized double blind placebo controlled multicenter study of mesalazine for the prevention of acute radiation enteritis. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 1997;44(1):59–63.
    1. Steineck G, Skokic V, Sjoberg F, Bull C, Alevronta E, Dunberger G, et al. Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors. PLoS One. 2017;12(2):e0171461 10.1371/journal.pone.0171461
    1. Kuku S, Fragkos C, McCormack M, Forbes A. Radiation-induced bowel injury: the impact of radiotherapy on survivorship after treatment for gynaecological cancers. Br J Cancer. 2013;109(6):1504–12. 10.1038/bjc.2013.491
    1. Ferreira MR, Muls A, Dearnaley DP, Andreyev HJ. Microbiota and radiation-induced bowel toxicity: lessons from inflammatory bowel disease for the radiation oncologist. Lancet Oncol. 2014;15(3):e139–47. 10.1016/S1470-2045(13)70504-7
    1. Baker AM, Cereser B, Melton S, Fletcher AG, Rodriguez-Justo M, Tadrous PJ, et al. Quantification of crypt and stem cell evolution in the normal and neoplastic human colon. Cell Rep. 2014;8(4):940–7. 10.1016/j.celrep.2014.07.019
    1. Lawrie TA, Green JT, Beresford M, Wedlake L, Burden S, Davidson SE, et al. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers. Cochrane Database Syst Rev. 2018;1:CD012529 10.1002/14651858.CD012529.pub2
    1. Henson CC, Burden S, Davidson SE, Lal S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev. 2013(11):CD009896 10.1002/14651858.CD009896.pub2
    1. Wedlake LJ, Shaw C, Whelan K, Andreyev HJ. Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther. 2013;37(11):1046–56. 10.1111/apt.12316
    1. Desai MS, Seekatz AM, Koropatkin NM, Kamada N, Hickey CA, Wolter M, et al. A Dietary Fiber-Deprived Gut Microbiota Degrades the Colonic Mucus Barrier and Enhances Pathogen Susceptibility. Cell. 2016;167(5):1339–53 e21. 10.1016/j.cell.2016.10.043
    1. Leclere L, Cutsem PV, Michiels C. Anti-cancer activities of pH- or heat-modified pectin. Front Pharmacol. 2013;4:128 10.3389/fphar.2013.00128
    1. Sureban SM, May R, Qu D, Chandrakesan P, Weygant N, Ali N, et al. Dietary Pectin Increases Intestinal Crypt Stem Cell Survival following Radiation Injury. PloS one. 2015;10(8):e0135561 10.1371/journal.pone.0135561
    1. Yang J, Ding C, Dai X, Lv T, Xie T, Zhang T, et al. Soluble Dietary Fiber Ameliorates Radiation-Induced Intestinal Epithelial-to-Mesenchymal Transition and Fibrosis. JPEN J Parenter Enteral Nutr. 2017. November;41(8):1399–1410 10.1177/0148607116671101
    1. Lupton JR. Microbial degradation products influence colon cancer risk: the butyrate controversy. The Journal of nutrition. 2004;134(2):479–82. 10.1093/jn/134.2.479
    1. Pacheco RG, Esposito CC, Muller LC, Castelo-Branco MT, Quintella LP, Chagas VL, et al. Use of butyrate or glutamine in enema solution reduces inflammation and fibrosis in experimental diversion colitis. World J Gastroenterol. 2012;18(32):4278–87. 10.3748/wjg.v18.i32.4278
    1. Leonel AJ, Alvarez-Leite JI. Butyrate: implications for intestinal function. Curr Opin Clin Nutr Metab Care. 2012;15(5):474–9. 10.1097/MCO.0b013e32835665fa
    1. Pryde SE, Duncan SH, Hold GL, Stewart CS, Flint HJ. The microbiology of butyrate formation in the human colon. FEMS microbiology letters. 2002;217(2):133–9. 10.1111/j.1574-6968.2002.tb11467.x
    1. Henningsson AM, Bjorck IM, Nyman EM. Combinations of indigestible carbohydrates affect short-chain fatty acid formation in the hindgut of rats. J Nutr. 2002;132(10):3098–104. 10.1093/jn/131.10.3098
    1. Dunberger G, Lind H, Steineck G, Waldenstrom AC, Nyberg T, Al-Abany M, et al. Self-reported symptoms of faecal incontinence among long-term gynaecological cancer survivors and population-based controls. European journal of cancer. 2010;46(3):606–15. 10.1016/j.ejca.2009.10.023
    1. Lind H, Waldenstrom AC, Dunberger G, al-Abany M, Alevronta E, Johansson KA, et al. Late symptoms in long-term gynaecological cancer survivors after radiation therapy: a population-based cohort study. Br J Cancer. 2011;105(6):737–45. 10.1038/bjc.2011.315
    1. Buja A, Eyuboglu N. Remarks on Parallel Analysis. Multivariate Behav Res. 1992;27(4):509–40. 10.1207/s15327906mbr2704_2
    1. Zientek LR, Thompson B. Applying the bootstrap to the multivariate case: bootstrap component/factor analysis. Behav Res Methods. 2007;39(2):318–25.
    1. Choi J, Zou H, Oehlert G. A penalized maximum likelihood approach to sparse factor analysis. Stat Interface. 2010;3(4):429–36.
    1. McGough C, Baldwin C, Frost G, Andreyev HJN. Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy. British Journal of Cancer. 2004;90(12):2278–87. 10.1038/sj.bjc.6601868
    1. Touchefeu Y, Montassier E, Nieman K, Gastinne T, Potel G, Bruley des Varannes S, et al. Systematic review: the role of the gut microbiota in chemotherapy- or radiation-induced gastrointestinal mucositis—current evidence and potential clinical applications. Alimentary pharmacology & therapeutics. 2014;40(5):409–21.
    1. Pettersson A, Nygren P, Persson C, Berglund A, Turesson I, Johansson B. Effects of a dietary intervention on gastrointestinal symptoms after prostate cancer radiotherapy: long-term results from a randomized controlled trial. Radiother Oncol. 2014;113(2):240–7. 10.1016/j.radonc.2014.11.025
    1. Xu L, Yu W, Jiang J, Feng X, Li N. [Efficacy of pectin in the treatment of diarrhea predominant irritable bowel syndrome]. Zhonghua Wei Chang Wai Ke Za Zhi. 2015;18(3):267–71.
    1. Wedlake L, Shaw C, McNair H, Lalji A, Mohammed K, Klopper T, et al. Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy. Am J Clin Nutr. 2017;106(3):849–57. 10.3945/ajcn.116.150565
    1. Kerem M, Bedirli A, Karahacioglu E, Pasaoglu H, Sahin O, Bayraktar N, et al. Effects of soluble fiber on matrix metalloproteinase-2 activity and healing of colon anastomosis in rats given radiotherapy. Clinical nutrition (Edinburgh, Scotland). 2006;25(4):661–70.
    1. Oufir LE, Barry JL, Flourie B, Cherbut C, Cloarec D, Bornet F, et al. Relationships between transit time in man and in vitro fermentation of dietary fiber by fecal bacteria. European journal of clinical nutrition. 2000;54(8):603–9.
    1. Roth JA, Frankel WL, Zhang W, Klurfeld DM, Rombeau JL. Pectin improves colonic function in rat short bowel syndrome. The Journal of surgical research. 1995;58(2):240–6. 10.1006/jsre.1995.1037
    1. Ye MB, Lim BO. Dietary pectin regulates the levels of inflammatory cytokines and immunoglobulins in interleukin-10 knockout mice. Journal of agricultural and food chemistry. 2010;58(21):11281–6. 10.1021/jf103262s
    1. Sanaka M, Yamamoto T, Anjiki H, Nagasawa K, Kuyama Y. Effects of agar and pectin on gastric emptying and post-prandial glycaemic profiles in healthy human volunteers. Clinical and experimental pharmacology & physiology. 2007;34(11):1151–5.
    1. Espinal-Ruiz M, Parada-Alfonso F, Restrepo-Sanchez LP, Narvaez-Cuenca CE, McClements DJ. Interaction of a dietary fiber (pectin) with gastrointestinal components (bile salts, calcium, and lipase): a calorimetry, electrophoresis, and turbidity study. Journal of agricultural and food chemistry. 2014;62(52):12620–30. 10.1021/jf504829h
    1. Xiong Y, Chen D, Yu C, Lv B, Peng J, Wang J, et al. Citrus nobiletin ameliorates experimental colitis by reducing inflammation and restoring impaired intestinal barrier function. Molecular nutrition & food research. 2015;59(5):829–42.
    1. Luceri C, Femia AP, Fazi M, Di Martino C, Zolfanelli F, Dolara P, et al. Effect of butyrate enemas on gene expression profiles and endoscopic/histopathological scores of diverted colorectal mucosa: A randomized trial. Dig Liver Dis. 2016;48(1):27–33. 10.1016/j.dld.2015.09.005
    1. Williams JP, Brown SL, Georges GE, Hauer-Jensen M, Hill RP, Huser AK, et al. Animal models for medical countermeasures to radiation exposure. Radiat Res. 2010;173(4):557–78. 10.1667/RR1880.1
    1. Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106(3):508–14; quiz 15. 10.1038/ajg.2010.487
    1. Krigel A, Lebwohl B. Nonceliac Gluten Sensitivity. Adv Nutr. 2016;7(6):1105–10. 10.3945/an.116.012849
    1. Stewart AJ, Southcott BM. Coeliac disease following high-dose chemotherapy. Clin Oncol (R Coll Radiol). 2002;14(6):494–6.
    1. Chassard C, Lacroix C. Carbohydrates and the human gut microbiota. Curr Opin Clin Nutr Metab Care. 2013;16(4):453–60. 10.1097/MCO.0b013e3283619e63
    1. Sonnenburg ED, Sonnenburg JL. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell Metab. 2014;20(5):779–86. 10.1016/j.cmet.2014.07.003
    1. Ghaffarzadegan T, Marungruang N, Fak F, Nyman M. Molecular Properties of Guar Gum and Pectin Modify Cecal Bile Acids, Microbiota, and Plasma Lipopolysaccharide-Binding Protein in Rats. PLoS One. 2016;11(6):e0157427 10.1371/journal.pone.0157427
    1. Wexler HM. Bacteroides: the good, the bad, and the nitty-gritty. Clin Microbiol Rev. 2007;20(4):593–621. 10.1128/CMR.00008-07
    1. Chang PY, Qu YQ, Wang J, Dong LH. The potential of mesenchymal stem cells in the management of radiation enteropathy. Cell Death Dis. 2015;6:e1840 10.1038/cddis.2015.189
    1. Asfaha S, Hayakawa Y, Muley A, Stokes S, Graham TA, Ericksen RE, et al. Krt19(+)/Lgr5(-) Cells Are Radioresistant Cancer-Initiating Stem Cells in the Colon and Intestine. Cell Stem Cell. 2015;16(6):627–38. 10.1016/j.stem.2015.04.013
    1. Mandir N, FitzGerald AJ, Goodlad RA. Differences in the effects of age on intestinal proliferation, crypt fission and apoptosis on the small intestine and the colon of the rat. Int J Exp Pathol. 2005;86(2):125–30. 10.1111/j.0959-9673.2005.00422.x
    1. Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011;91(1):151–75. 10.1152/physrev.00003.2008
    1. Shukla PK, Gangwar R, Manda B, Meena AS, Yadav N, Szabo E, et al. Rapid disruption of intestinal epithelial tight junction and barrier dysfunction by ionizing radiation in mouse colon in vivo: protection by N-acetyl-l-cysteine. Am J Physiol Gastrointest Liver Physiol. 2016;310(9):G705–15. 10.1152/ajpgi.00314.2015
    1. Shim S, Jang HS, Myung HW, Myung JK, Kang JK, Kim MJ, et al. Rebamipide ameliorates radiation-induced intestinal injury in a mouse model. Toxicol Appl Pharmacol. 2017;329:40–7. 10.1016/j.taap.2017.05.012
    1. Bentzen SM. Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology. Nat Rev Cancer. 2006;6(9):702–13. 10.1038/nrc1950
    1. Schroeder BO, Birchenough GMH, Stahlman M, Arike L, Johansson MEV, Hansson GC, et al. Bifidobacteria or Fiber Protects against Diet-Induced Microbiota-Mediated Colonic Mucus Deterioration. Cell Host Microbe. 2018;23(1):27–40 e7. 10.1016/j.chom.2017.11.004
    1. Gami B, Harrington K, Blake P, Dearnaley D, Tait D, Davies J, et al. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Alimentary pharmacology & therapeutics. 2003;18(10):987–94.
    1. Sekhon S. Chronic radiation enteritis: women's food tolerances after radiation treatment for gynecologic cancer. Journal of the American Dietetic Association. 2000;100(8):941–3. 10.1016/S0002-8223(00)00270-4
    1. Winham DM, Hutchins AM. Perceptions of flatulence from bean consumption among adults in 3 feeding studies. Nutr J. 2011;10:128 10.1186/1475-2891-10-128
    1. Steineck G, Bull C, Kalm M, Sjoberg F, Alevronta E, Malipatlolla DK, et al. Radiation physiology—evidence for a higher biological effect of 24 Gy in four fractions as compared to three. Acta Oncol. 2017;56(9):1240–3. 10.1080/0284186X.2017.1309062

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe