THE EFFECTS OF PERSONALIZED NUTRITION INTERVENTION IN BREAST CANCER PATIENTS: A SYSTEMATIC REVIEW

Breast cancer is a common cancer in women worldwide. Personalized nutrition interventions have gained attention as a promising approach in the treatment of breast cancer. This systematic review aimed to evaluate their effectiveness. A comprehensive search of ScienceDirect and PubMed databases was conducted from 2018 to 2023 using the keyword "Personalized nutrition interventions for breast cancer." Six studies met the inclusion criteria. Results showed that dietary interventions led to improvements in body weight, metabolic parameters, and quality of life in breast cancer patients. The Mediterranean diet was associated with significant improvements in body weight, BMI, waist circumference, glycemia, and triglyceride levels, as well as a greater reduction in metabolic syndrome markers. The ketogenic diet resulted in significant weight loss due to fat mass reduction, while personalized and balanced diet interventions reduced the frequency of leukopenia and abdominal pain. A triple intervention program involving nutrition, exercise, and mindfulness positively impacted the quality of life in breast cancer survivors. Individualized diet therapy based on nutritional needs also significantly reduced barriers and improved nutritional status and quality of life in breast cancer patients undergoing chemotherapy. This review employed a systematic approach, including a comprehensive literature search, clear inclusion criteria, and thorough study quality assessment. In conclusion, personalized nutrition interventions can be effective for improving outcomes in breast cancer patients.


INTRODUCTION
Breast cancer is a common cancer in women worldwide, Personalized nutrition interventions have gained attention as a promising approach in the treatment of breast cancer (Swaminathan, 2020).Proper nutrition plays a major role in preventing diseases, and nutritional interventions constitute crucial strategies in the field of public health (Sellami et al, 2020).Nutrigenomics and nutriproteomics are specialties that focus on the interaction between nutrients and the human genome and proteome, respectively, providing insights into the role of diet in carcinogenesis (Sellami et al, 2020).Nutrigenomics and lifestyle factors play a vital role in health management and represent an exceptional prospect for the improvement of personalized diets to the individual at risk of developing diseases like cancer (Ray et al, 2022).Breast cancer patients are at high risk of developing malnutrition from the underlying disease as well as from various drug regimens, chemotherapy, and/or radiotherapy interventions (Swaminathan, 2020).An effective personalized nutritional therapy during and after cancer treatment leads to a better quality of life for breast cancer patients (Swaminathan, 2020).Clinical trials are pivotal for any recommendations to be used at the commercial level upon approval of the Food & Drug Administration (Swaminathan, 2020).Several clinical trials have been carried out, and many are now undertaken to come up with a significant upshot conclusion based on primary and secondary outcomes to show the after-effects of particular nutrient supplements by increasing the overall survival or any other physiological upregulated/downregulated manifestation leading to diseasefree survival (Swaminathan, 2020).Understanding metabolic and immune regulation inherent to patient populations is key to improving the radiation response for breast cancer patients (Shastri et al, 2021).

RESEARCH METHODS
A comprehensive search of the ScienceDirect and PubMed databases was conducted, covering the period from 2018 to 2023 with the keyword "Personalized nutrition interventions for breast cancer".The inclusion criteria for the review were studies published between 2018 and 2023 that focused on personalized nutrition interventions in precision medicine for breast cancer patients.

DISCUSSION
The findings from this study provide valuable insights into the potential benefits of various dietary interventions for breast cancer patients.However, it is important to discuss some considerations and recommendations based on these findings.
Firstly, the study highlighted the effectiveness of a dietary intervention based on the Mediterranean diet and macrobiotic principles in improving body weight and metabolic parameters in women with breast cancer.The positive outcomes were associated with adherence to the dietary recommendations.These findings suggest that implementing this dietary intervention may be beneficial for managing breast cancer risk and improving overall health in breast cancer patients.It is recommended that healthcare professionals consider incorporating such interventions into the treatment plans for breast cancer patients, providing them with guidance and support to adhere to these dietary recommendations.
Furthermore, based on the results demonstrating the positive effects on quality of life among breast cancer survivors, it is recommended that these individuals consider adopting a healthy lifestyle program.This program should include a Mediterranean diet, regular physical activity, and vitamin D supplementation.Implementing such a program may help improve their overall well-being and enhance their quality of life.
Regarding the potential benefits of a ketogenic diet during radiotherapy, further research is needed to fully understand its impact on quality of life and to establish standardized protocols.While the study showed improvements in body composition, it is crucial to consider the potential risks and long-term effects of this diet.Therefore, caution should be exercised, and healthcare professionals should closely monitor patients who choose to follow a ketogenic diet during radiotherapy.
Based on the findings supporting the triple intervention program consisting of nutrition, physical exercise, and mindfulness, it is recommended to implement this program for breast cancer patients who have completed their cancer treatment more than 12 months earlier.This program has demonstrated positive effects on their quality of life, symptoms, complications, weight control, and healthy lifestyle habits.By incorporating these interventions into comprehensive care plans, healthcare providers can potentially improve the overall well-being and outcomes of these patients.
Additionally, individualized dietary interventions based on patients' nutritional needs should be implemented during chemotherapy treatment for breast cancer.This approach has been shown to improve nutritional status and quality of life.By tailoring dietary recommendations to each patient's specific needs, healthcare professionals can address nutritional barriers and optimize outcomes during chemotherapy.
Finally, the study highlights the need for further research to explore additional nonpharmacological strategies that can effectively reduce adverse effects of cancer treatments and improve quality of life in breast cancer patients.Understanding and implementing such strategies can provide holistic support for patients throughout their cancer journey, promoting overall wellbeing and enhancing treatment outcomes.

CONCLUSION
In conclusion, the collective findings from these studies suggest that personalized nutrition interventions can have a positive impact on the outcomes and quality of life of breast cancer patients.Specifically, adopting a dietary intervention based on Mediterranean diet principles and recipes, along with incorporating fermented foods from the Macrobiotic tradition, can lead to improved adherence to dietary recommendations, weight loss, and improvements in metabolic parameters.This comprehensive qualitative dietary change appears to be beneficial for breast cancer survivors.
Additionally, a lifestyle program combining a low glycemic index traditional Mediterranean diet, daily brisk walking, and vitamin D supplementation has shown positive effects on health-related quality of life (HRQoL) in breast cancer survivors.This program has been associated with improvements in physical functioning, emotional well-being, and breast cancer-related symptoms.
The use of a ketogenic diet during radiotherapy has shown improvements in body composition, with reductions in body weight due to fat loss and water loss.It also induced some favorable hormonal changes.However, the impact on quality of life was not statistically significant.
Furthermore, a triple intervention program consisting of nutrition, physical exercise, and mindfulness has demonstrated positive effects on the quality of life, symptoms, complications, weight control, and healthy lifestyle habits of breast cancer patients.This intervention has improved adherence to the Mediterranean Diet, reduced symptoms such as fatigue and dyspnea, and promoted a healthy lifestyle.
Individualized diet therapy based on nutritional needs has been shown to significantly reduce nutritional barriers, improve nutritional status, and enhance the quality of life in breast cancer patients undergoing chemotherapy.

Figure 1 .
Figure 1.Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the literature search and filtering results.

Table 2 .
A table including the research question posed by each study, the conclusions derived from the research, and the recommendations stated in each included study.