利用纤维对抗骨髓瘤：植物性饮食带来希望

一项新的临床试验的结果表明，高纤维植物性饮食可能有益于罹患多发性骨髓瘤（第二种最常见的血癌类型）的患者。

　　

一项新的临床试验结果表明，高纤维植物性饮食可能有益于罹患多发性骨髓瘤（第二大常见血癌）风险的患者。研究表明，这种饮食不仅切实可行且广受欢迎，还能改善多种因素，从而延缓可能导致多发性骨髓瘤的癌前病变的进展。  

多发性骨髓瘤通常先于早期非癌性疾病出现，这些疾病涉及异常浆细胞（一种存在于骨髓中的白细胞）。研究表明，高体重、不良饮食和肠道菌群失衡会增加罹患这些疾病并进展为多发性骨髓瘤的风险。

“随着癌症的早期发现和癌前状态的识别率不断提高，我们越来越有机会了解饮食和生活方式等可改变的风险因素如何影响癌症进展，”纪念斯隆凯特琳癌症中心临床研究营养师弗朗西斯卡·卡斯特罗说道。“我们的研究结果强调了在疾病早期改善饮食质量的重要性，并可能为未来的临床试验提供指导。” 

卡斯特罗将于5 月 31 日至 6 月 3 日在奥兰多举行的美国营养学会旗舰年会“营养 2025”上展示这一研究成果。

目前针对多发性骨髓瘤高危患者的研究往往集中于确定导致病情进展的基因组和免疫驱动因素，以及针对患有前体疾病患者的治疗方案。

“由于癌症治疗期间和治疗前患者无法控制一切，研究饮食可以为患者提供一个机会，让他们能够降低患病风险，并提高治疗的成功率，”纪念斯隆凯特琳癌症中心的医师科学家、该研究的首席研究员Urvi A. Shah医学博士说道。“我们的研究展现了营养在预防方面的力量，并展示了它有可能让患者在诊断过程中拥有自主权。”

这项先导研究是NUTRIVENTION试验的一部分，纳入了20名因先兆疾病和体重指数升高而面临罹患多发性骨髓瘤风险的患者。患者接受了12周的高纤维植物性膳食、24周的个性化营养咨询，并进行了52周的随访。

Study participants were encouraged to eat to satiety as long as they consumed whole plant-based foods such as fruits, vegetables, nuts, seeds, whole grains and legumes. They were also asked to avoid refined grains, animal products, added sugar and highly processed foods.

The researchers found that the high-fiber, plant-based diet was feasible and well-received, leading to dietary adherence and weight loss. Before the study began, only 20% of total calories were from high-fiber plant-based foods whereas by the end of the 12-week dietary intervention, that number jumped to 91%. At 12 weeks, the median participants’ BMI of had dropped 7% and this weight loss was sustained at 1 year. In addition, two patients experienced a slowing of disease progression while progression remained stable in the others.

The investigators also observed significant improvements in dietary quality, quality of life, metabolic markers such as insulin resistance and lipid profiles, inflammation, and the diversity and composition of the gut microbiome. These improvements were still observable at the end of the 12-week intervention and sustained through the 52-week follow-up.

“Our study had diverse racial enrollment as well as a comprehensive dietary and biomarker evaluation,” said Shah. “Our comprehensive analysis of improved immune and metabolic response suggests that a high-fiber plant-based diet can also reduce risk for cardiovascular conditions, diabetes and other metabolic conditions.”

When consuming fiber, most Americans fall short of the around 28 grams per day recommended by the US Dietary Guidelines. To boost fiber in the diet, the researchers suggest setting realistic daily goals and focusing on one meal at a time.

“Think about what foods you can add or swap to increase fiber intake,” said Castro. “It can be very simple like adding a piece of fruit at the end of a meal or swapping out a refined grain for a whole grain. Eating more fiber can lower risk for many other conditions and can improve overall health, beyond just reducing cancer risk.”

The investigators are currently enrolling participants in follow-up NUTRIVENTION Trials to evaluate the potential effects of a high-fiber, plant-based diet in larger groups of patients and to investigate the effects of diet versus supplements on the gut microbiome. They also plan to study the effects of the high-fiber plant-based diet on other precursor blood conditions, such as clonal hematopoiesis, which increases risk for other blood cancers, such as leukemia.