Role of Mediterranean diet in preventing platinum based gastrointestinal toxicity in gynecolocological malignancies: A single Institution experience

Table 1 Clinical and nutritional characteristics of the sample at baseline

Characteristics	n = 22
Age (yr, mean value)	61
Weight (kg, mean value ± SD)	64 ± 14.2
BMI (mean value ± SD)	25 ± 5.2
Allergies, n (%)
Yes	15 (68.2)
No	7 (31.8)
Smoke, n (%)
Yes	5 (22.7)
No	17 (77.3)
Alcohol, n (%)
Yes	8 (36.4)
No	14 (63.6)
Type of gynecological cancer, n (%)
Cervical cancer	5 (22.7)
Endometrial cancer	2 (9.1)
Ovarian cancer	15 (68.2)
Chemotherapy treatment, n (%)
Carboplatin	2 (9.2)
Carboplatin - Bevacizumab	1 (4.5)
Carboplatin - Caelyx	3 (13.6)
Carboplatin - Gemcitabine	2 (9.2)
Carboplatin - Taxol	9 (40.9)
Carboplatin - Gemcitabine - Bevacizumab	1 (4.5)
Cisplatin	3 (13.6)
Cisplatin – Bevacizumab	1 (4.5)
Number of lines, n (%)
I	14 (63.6)
II	7 (31.8)
III	1 (4.6)
Nutritional requirements
BEE in kcal (Average value ± SD)	1262.5 ± 146.6
TEE in kcal (Average value ± SD)	1678.9 ± 177.1
Mediterranean diet adherence
MDSS (mean value ± SD)	12.5 ± 3.4
MDSS ≥ 13, n (%)	12 (54.5)
MDSS < 13	10 (45.5)

SD: Standard deviation; MDSS: Mediterranean diet serving score; BMI: Body mass index; TEE: Total energy expenditure; BEE: Basal energy expenditure.

Table 2 Anthropometric and nutritional characteristics of the two groups at the baseline according to the Mediterranean diet adherence score

	MDSS ≥ 13	MDSS < 13	Total
	(n = 12)	(n = 10)	(n = 22)
Age (yr, mean value ± SD)	64.9 ± 11.6	56.4 ± 11.9	61 ± 12.2
Weight (kg, mean value ± SD)	61.3 ± 11.4	67.2 ± 17	64 ± 14.2
BMI (mean value ± SD)	24.5 ± 4.3	25.7 ± 6.3	25 ± 5.2
MDSS (mean value ± SD)	15.1 ± 2.1	9.5 ± 1.7	12.5 ± 3.4
Average daily intake
Proteins (g, mean value ± SD)	67.8 ± 15.6	83.5 ± 32	74.9 ± 25.1
Fats (g, mean value ± SD)	73.7 ± 21.9	91.6 ± 41.2	81.8 ± 32.6
Saturated fats (g, mean value ± SD)	25.8 ± 7.4	33.1 ± 19.9	29.1 ± 14.6
Carbohydrates (g, mean value ± SD)	227.5 ± 37.7	208.3 ± 80	218.8 ± 59.8
Sugars (g, mean value ± SD)	91 ± 15	85,9 ± 29	88,7 ± 22
Fibers (g, mean value ± SD)	22 ± 4.5	17.3 ± 6	19.9 ± 5.6
Energy intake (kcal, mean value ± SD)	1893.3 ± 376.3	2038.7 ± 724.8	1959.4 ± 552.1
Fluid intake (mL, mean value ± SD)	1320.8 ± 491.5	1365 ± 704	1340.9 ± 582.6
Coverage of the TEE (mean % ± SD)	115.8 ± 20.2	117.7 ± 41.6	116.7 ± 30.9
Coverage of the TEE > 100%, n (%)	10 (83.3)	5 (50)	15 (68.2)

SD: Standard deviation; MDSS: Mediterranean diet serving score; BMI: Body mass index; TEE: Total energy expenditure.

Table 3 Nutritional-anthropometric features derived from the analysis of the second food frequency questionnaire

	MDSS ≥ 13	MDSS < 13	Total
	(n = 12)	( n = 10)	( n = 22)
Weight (kg, mean value ± SD)	61 ± 11.3	67.2 ± 17.3	63.8 ± 14.3
BMI (mean value ± SD)	24.4 ± 4.3	25.7 ± 6.3	25 ± 5.2
MDSS (mean value ± SD)	13.3 ± 0.8	8.9 ± 2.6	11.3 ± 2.9
Average daily intake
Proteins (g, mean value ± SD)	56.1 ± 15.5	70.6 ± 34.2	62.7 ± 26.1
Fats (g, mean value ± SD)	60.6 ± 17.8	83 ± 29	70.8 ± 25.6
Saturated fats (g, mean value ± SD)	21.3 ± 6.6	27.5 ± 12	24.1 ± 9.7
Carbohydrates (g, mean value ± SD)	212.5 ± 55.9	215 ± 95.6	213.6 ± 74.5
Sugars (g, mean value ± SD)	87.9 ± 20.6	99 ± 37.9	93 ± 29.5
Fibers (g, mean value ± SD)	18.3 ± 5.5	18.7 ± 8.3	18.5 ± 6.8
Energy intake (kcal, mean value ± SD)	1633.8 ± 406.8	1921.7 ± 687.7	1764.6 ± 557.5
Fluid intake (mL, mean value ± SD)	1400 ± 495.5	1388.9 ± 416.7	1394.7 ± 427.5
Coverage of the TEE (%, mean value ± SD)	100.2 ± 24.5	110.4 ± 36.4	104.8 ± 30.1
Coverage of the TEE > 100%, n (%)	7 (58.3)	5 (50)	12 (54.5)

SD: Standard deviation; MDSS: Mediterranean diet serving score; BMI: Body mass index; TEE: Total energy expenditure.

Table 4 Gastrointestinal toxicities’ score after first chemotherapy cycle in the whole study population and in the two study’s groups according to the Mediterranean diet serving score

	MDSS ≥ 13	MDSS < 13	Total	P value
Dry mouth (G)	1 ± 1.3	1.1 ± 1.3	1 ± 1.3	0.85
Dysphagia (G)	0.3 ± 0.5	0.4 ± 0.7	0.3 ± 0.6	0.70
Oral sores (A)	0.2 ± 0.4	0.5 ± 1.3	0.3 ± 0.9	0.45
Oral sores (G)	0.1 ± 0.3	0.4 ± 1.3	0.2 ± 0.9	0.44
Mouth’s cracks (G)	0.1 ± 0.3	0.4 ± 1.3	0.2 ± 0.9	0.44
Dysgeusia (G)	0.9 ± 1.2	1 ± 1.2	1 ± 1.2	0.84
Loss of appetite (I.A)	1.1 ± 1.1	1.4 ± 1.5	1.2 ± 1.3	0.59
Loss of appetite (G)	1 ± 1	1.3 ± 1.7	1.1 ± 1.3	0.61
Nausea (F)	1.5 ± 1.1	1.4 ± 1.6	1.5 ± 1.3	0.86
Nausea (G)	1 ± 0.9	1.5 ± 1.7	1.2 ±1.3	0.38
Vomiting (F)	0.6 ± 0.8	0.6 ± 1.3	0.6 ± 1	1
Vomiting (G)	0.3 ± 0.5	0.6 ± 1.3	0.5 ± 1	0.46
Stomachache (F)	0.2 ± 0.6	0.7 ± 0.9	0.4 ± 0.8	0.13
Stomachache (G)	0.1 ± 0.3	0.5 ± 0.7	0.3 ± 0.6	0.08
Intestinal gas (yes/no)	0.4 ± 0.5	0.3 ± 0.5	0.4 ± 0.5	0.64
Bloating (F)	0.7 ± 0.9	0.5 ± 1	0.6 ± 0.9	0.62
Bloating (G)	0.3 ± 0.5	0.4 ± 0.7	0.4 ± 0.6	0.70
Constipation (G)	0.5 ± 0.5	0.7 ± 0.7	0.6 ± 0.6	0.44
Diarrhea (F)	0.7 ± 0.9	0.7 ± 1.3	0.7 ± 1.1	1
Abdomen ache (F)	1.1 ± 1	0.3 ± 0.7	0.7 ± 0.9	0.04
Abdomen ache (G)	0.8 ± 0.8	0.2 ± 0.4	0.5 ± 0.7	0.04
Abdomen ache (I.A)	0.7 ± 0.8	0.2 ± 0.6	0.5 ± 0.7	0.11
Toxicity (TOT)	13.4 ± 6.6	15.1 ± 14.5	14.2 ± 10.7	0.7

I.A: Interference with daily activities; MDSS: Mediterranean diet serving score; G: Gravity; F: Frequency; TOT: Time of treatment.

Table 5 Gastrointestinal toxicities’ score after last chemotherapy cycle in the whole study population and in the two study’s groups according to the Mediterranean diet serving score

	MDSS ≥ 13	MDSS < 13	Total	P value
Dry mouth (G)	1.5 ± 1.8	0.8 ± 1.8	1.2 ± 1.7	0.53
Dysphagia (G)	0 ± 0	0.2 ± 0.4	0.1 ± 0.3	0.24
Oral sores (G)	0 ± 0	0 ± 0	0 ± 0	1
Oral sores (A)	0 ± 0	0 ± 0	0 ± 0	1
Mouth’s cracks (G)	0 ± 0	0.2 ± 0.4	0.1 ± 0.3	0.24
Dysgeusia (G)	1.3 ± 1.5	2.6 ± 1.9	1.9 ± 1.8	0.23
Loss of appetite (G)	1.3 ± 1.5	2.4 ± 1.7	1.8 ± 1.6	0.28
Loss of appetite (I.A)	1.3 ± 1.5	2 ± 1.4	1.6 ± 1.4	0.44
Nausea (F)	0.7 ± 1.6	3.6 ± 0.9	2 ± 2	< 0.01
Nausea (G)	0.7 ± 1.6	3.4 ± 0.9	1.9 ± 1.9	< 0.01
Vomiting (F)	0.3 ± 0.8	0.8 ± 1.3	0.5 ± 1	0.45
Vomiting (G)	0.2 ± 0.4	1 ± 1.7	0.5 ± 1.2	0.28
Stomach ache (F)	0 ± 0	1 ± 1	0.5 ± 0.8	0.03
Stomach ache (G)	0 ± 0	1.2 ± 1.3	0.5 ± 1	0.04
Gas (yes/no)	0.3 ± 0.5	0.4 ± 0.5	0.4 ± 0.5	0.74
Bloating (F)	0 ± 0	1.4 ± 1.3	0.6 ± 1.1	0.02
Bloating (G)	0 ± 0	1 ± 1	0.5 ± 0.8	0.03
Constipation (G)	0.8 ± 0.4	2.4 ± 1.8	1.5 ± 1.4	0.06
Diarrhea (F)	0.5 ± 0.8	1.2 ± 1.1	0.8 ± 1	0.25
Abdomen ache (F)	0.2 ± 0.4	1.4 ± 0.9	0.7 ± 0.9	0.01
Abdomen ache (G)	0.2 ± 0.4	1.2 ± 0.8	0.6 ± 0.8	0.02
Abdomen ache (I.A)	0.2 ± 0.4	1.2 ± 0.8	0.6 ± 0.8	0.02
GI toxicity (TOT)	9.5 ± 10.9	29.4 ± 10.4	18.5 ± 14.5	0.01

I.A: Interference with daily activities; MDSS: Mediterranean diet serving score; G: Gravity; F: Frequency; TOT: Time of treatment; GI: Gastrointestinal.