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Dietary restriction during active cancer therapy is associated with improved treatment response: a systematic review and meta-analysis

Kajal Agrawal, Dominic Shao Yong Goh, Ee Chern Ng, Shyn Yi Tan, Carlos Cifuentes-González, Jason Xing Kang, William K. K. Wu, Rashid N. S. Lui, Rupesh Agrawal, Yusuf Ali and Sunny H. Wong
Cancer Biology & Medicine July 2026, 20250841; DOI: https://doi.org/10.20892/j.issn.2095-3941.2025.0841

Article Figures & Data

Figures

  • Effect of dietary restriction on clinical outcomes: Forest plots comparing the effect of DR vs. control across included studies. Fixed-effects model (Mantel–Haenszel method): The pooled OR demonstrated a significant association favouring dietary restriction (OR = 4.80, 95% CI: 1.74, 13.25; P = 0.002). There was no evidence of heterogeneity among studies (χ2 = 0.29, df = 2, P = 0.87; I2 = 0%). Random-effects model: Using a random-effects model, the overall effect remained significant (OR = 4.55, 95% CI: 1.64, 12.58; P = 0.004), with similarly low heterogeneity (τ2 = 0.00; χ2 = 0.29, df = 2, P = 0.87; I2 = 0%). Each square represents the effect estimate for an individual study with size proportional to study weight and horizontal lines indicating 95% confidence intervals. The diamond represents the pooled effect estimate. Values to the right of the line of no effect (OR = 1) favour dietary restriction. CI, confidence interval; DR, dietary restriction; OR, odds ratio.
    Figure 1

    Effect of dietary restriction on clinical outcomes: Forest plots comparing the effect of DR vs. control across included studies. Fixed-effects model (Mantel–Haenszel method): The pooled OR demonstrated a significant association favouring dietary restriction (OR = 4.80, 95% CI: 1.74, 13.25; P = 0.002). There was no evidence of heterogeneity among studies (χ2 = 0.29, df = 2, P = 0.87; I2 = 0%). Random-effects model: Using a random-effects model, the overall effect remained significant (OR = 4.55, 95% CI: 1.64, 12.58; P = 0.004), with similarly low heterogeneity (τ2 = 0.00; χ2 = 0.29, df = 2, P = 0.87; I2 = 0%). Each square represents the effect estimate for an individual study with size proportional to study weight and horizontal lines indicating 95% confidence intervals. The diamond represents the pooled effect estimate. Values to the right of the line of no effect (OR = 1) favour dietary restriction. CI, confidence interval; DR, dietary restriction; OR, odds ratio.

Tables

  • Table 1

    Outcomes of included studies

    Study IDChange in QoL scoresNumber of adverse effectsTreatment outcomes (Radiological response)
    ControlInterventionPControlInterventionPControlInterventionP
    Bahrami et al. (2024)3Grade I: 47
    Grade II: 57
    Grade III: 50    		Grade I: 59
    Grade II: 71
    Grade II: 24    		CR/PR: 8
    SD/PD: 14    		CR/PR: 15
    SD/PD: 7    		P 0.03
    Demark-Wahnefried et al. (2017)4+1.1−0.040.68
    Demark-Wahnefried et al. (2020)2+0.9+0.30.58
    de Groot et al. (2015)536
    de Groot et al. (2020)636 (out of 64)11 (out of 22)0.54CR/PR: 38*
    SD/PD: 14*    		CR/PR: 47*
    SD/PD: 6*    		0.039*
    Lugtenberg et al. (2021)7−4.7−0.80.30
    Riedinger et al. (2020)8+0.22+5.10.01200.49CR/PR: 8
    SD/PD: 2
    		CR/PR: 10
    SD/PD: 0    		0.47**
    Zuccoli et al. (2010)9No adverse side effectsNo clear evidence of disease recurrence
    Study IDAverage QoL scores
    Li et al. (2015)10M: 55.6M: 67.8<0.05

    CR, complete response; PR, partial response; PD, progressive disease; SD, stable disease. *intention to treat, **calculated using the Fisher’s exact test. Quality of life scoring: (Demark-Wahnefried et al. (2017)4: RAND-36, Demark-Wahnefried et al. (2020)2: FACT B, Lugtenberg et al. (2021)7: EORTC-QLQ-C30, Riedinger et al. (2020)8: NCCN FACT FOSI-18, Li et al. (2015)10: SF-36).

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