Myeloproliferative neoplasm (MPN) represents a gaggle of inflammatory diseases, including polycythemia vera (PV), essential thrombocythemia (ET), and first myelofibrosis (PMF). MPNs are linked to hematologic malignancies and are characterised by clonal outgrowth of hematopoietic cells with an acquired mutation in JAK2. 

Multiple studies have shown that the Mediterranean food regimen positively impacts diseases related to chronic subclinical inflammation. Along with the Mediterranean food regimen, the gut microbiome also plays an important role in improving hematologic disorders.

A brand new study published to the medRxiv* preprint server assesses the feasibility of an education-focused Mediterranean food regimen intervention amongst MPN patients.

Study: The NUTRIENT Trial (NUTRitional Intervention amongst myEloproliferative Neoplasms): Feasibility Phase. Image Credit: Antonina Vlasova / Shutterstock.com

*Vital notice: medRxiv publishes preliminary scientific reports that usually are not peer-reviewed and, due to this fact, shouldn’t be thought to be conclusive, guide clinical practice/health-related behavior, or treated as established information.

Background

Clinical manifestations of MPN include abnormal blood counts, thrombosis, and transformation to acute leukemia. One in all the important thing characteristic features of MPN is increased plasma cytokines.

Chronic inflammation results in abnormal blood count. Although JAK inhibitors alleviate MPN symptoms, these drugs are related to certain risks, akin to immunosuppression, skin cancer, and weight gain.

The recent National Comprehensive Cancer Network (NCCN) guidelines for MPN proposed several interventions to cut back symptom burden, no matter the prognosis scoring category.

Since many MPN patients don’t meet the factors for a cytoreductive agent, their symptoms are maintained without specific interventions. Consequently, the standard of lifetime of these patients is adversely affected attributable to the shortcoming to limit disease progression.

Lifestyle modification, mainly through food regimen, can reduce inflammation. For instance, a healthy food regimen high in anti-inflammatory agents can improve symptom burden amongst MPN patients. Adherence to the sort of food regimen can decrease inflammation and significantly delay or prevent disease progression.

The Mediterranean food regimen is a primarily plant-based food regimen, which is related to the consumption of nuts, extra virgin olive oil (EVOO), vegetables, fish, fruits, legumes, and whole grain products. Controlling inflammation through nutrition is a low-risk therapeutic approach to mitigate the burden of symptoms for MPN patients. 

Concerning the study

The first aim of the present study was to find out the willingness of MPN patients to interact in dietary education to administer symptom burden. Participants were randomly assigned to either a regular U.S. Dietary Guidelines for Americans (USDA) group or Mediterranean food regimen group. Each groups received separate but equal education through written dietary resources and registered dietician counseling. 

Patients were followed for adherence, feasibility, and symptom burden assessments. To explore changes within the gut microbiome and inflammatory biomarkers, biological samples were collected at 4 distinct time points throughout the 15-week study period.

NUTRIENT study design.

Study findings

MPN patients found the Mediterranean food regimen program equally easy to follow as a program based on the U.S. Guidelines for Americans. Over 80% of participants within the Mediterranean food regimen group could maintain good adherence throughout the intervention period as in comparison with lower than 50% within the USDA group. This serves as evidence that, with proper dietician counseling and written curriculum, MPN patients can feasibly adopt a Mediterranean food regimen.

MPN patients can adopt a Mediterranean eating pattern with dietician counseling and education. (A) Percentage of participant with MEDAS scores ≥8 at every time point with orange shaded area depicting the energetic intervention period (B) Participant responses to feasibility query during energetic intervention period (C) HEI-2015 was calculated from each 24 hour food regimen recall, and scores for every participant were averaged for the pre-intervention (weeks 1-2), energetic intervention (weeks 3-12), and post-intervention (weeks 13-15) period. Data shown represents median with interquartile range.

In MPN, a vital goal is to focus on symptoms, as symptoms can significantly affect the patient’s’ quality of life. Within the USDA group, 31% of the cohort exhibited greater than a 50% reduction within the MPN-Total Symptom Rating (TSS) at 15 weeks, whereas 53% of the Mediterranean food regimen group exhibited greater than a 50% reduction within the MPN-TSS.

As in comparison with the USDA food regimen, the Mediterranean food regimen had a greater effect on alleviating MPN symptoms. The length of the food regimen intervention and intensity are necessary aspects in alleviating MPN symptoms. 

Changes in symptom burden during study. (A) waterfall plots of percentage change in MPN-SAF (MPN-TSS) at each week in comparison with baseline (baseline defined as average MPN-TSS of weeks 1 and a couple of) (B) Raw change in specific symptoms at each week in comparison with baseline (mean±SD).

Future outlook

Each diets investigated in the present study led to a discount in MPN symptom burden. Thus, these findings reveal that a 10-week intervention is sufficient to detect a change in symptoms.

In the long run, an extended intervention period is required to evaluate whether improvements in symptoms proceed. An extended intervention period would also help detect individuals with delayed symptom improvement.

The present evaluation highlights that MPN symptoms may stem from different root causes; due to this fact, some symptoms change quickly in comparison with others. As a consequence of the small sample size, a decrease within the inflammatory cytokines couldn’t be detected. Due to this fact, future studies with a bigger cohort are needed to elucidate how diets impact inflammatory cytokine levels.

*Vital notice: medRxiv publishes preliminary scientific reports that usually are not peer-reviewed and, due to this fact, shouldn’t be thought to be conclusive, guide clinical practice/health-related behavior, or treated as established information.