The impact of a higher eating frequency on the diet quality and nutritional status of women with breast cancer undergoing chemotherapy

* Corresponding author: Yara Cristina de Paiva Maia, fax [phone], email [email protected]

In women, breast cancer (BC) is the most common type of diagnosed cancer and the leading cause of cancer death in both developed and developing countries⁽¹⁾. Among the treatment modalities, chemotherapy (CT) is recommended for most BC patients^(2,3), a practice that contributes to reduce relapse, metastasis and mortality⁽⁴⁾. However, CT has a non-selective systemic approach, affecting both mutant and healthy cells, which can be toxic and cause a series of adverse effects that directly affect food consumption⁽⁵⁾.

The adverse effects of CT interfere negatively on daily dietary intake and perceptions related to food intake^(6–8). Food that was palatable is often rejected during CT, mainly due to changes in appetite, taste and nausea⁽⁷⁾. In addition, there may be a decrease in the intake of macro- and micronutrients during treatment, as well as of important food groups, such as Total Fruit and Dark Green and Orange Vegetables and Legumes⁽⁶⁾.

Recent evidence also suggests that dietary behaviours related to lower daily eating frequency (EF) may negatively influence the diet quality^(9–11) and the metabolic health of humans⁽¹²⁾, including the risk of developing cancer^(13,14). Specifically for BC, one single study, to our knowledge, found that a lower number of daily eating episodes in healthy women would be related to the increase in biomarkers linked to systemic inflammation and, consequently, to an increased risk of developing the disease, but the study did not evaluate the impact on diet quality⁽¹³⁾. Studies with other population groups involving EF and diet quality, however, did not present significant results^(15,16) and need to be better explored.

In addition to diet quality, inverse associations between the number of eating episodes and anthropometric variables were identified^(10,17,18). Studies show better control of body weight and healthy maintenance of biological markers when eating episodes are lower in energy intake and more frequent^(19–21), but the results are still inconsistent because of variations in methodological factors, especially for the optimal number of meals for anthropometric benefits^(22,23). It is known that negative anthropometric changes in BC patients are already commonly observed...