Diet Choices and Supplement Use May Affect MPN Symptom Burden

Some studies have indicated that diets and supplements have demonstrated antioxidant and anti-inflammatory pharmacologic properties, such as decreased inflammatory markers and reactive oxygen species. Researchers conducted a study to examine nutritional and supplemental needs in this patient population. Robyn M. Scherber, MD, at Oregon Health and Science University in Portland, discussed the findings at the ASH Annual Meeting (https://ash.confex.com/ash/2017/webprogram/Paper106221.html).

The researchers conducted an internet-based survey that was hosted by the Mayo Clinic Survey Research Center and promoted on multiple MPN-focused websites and communities during February 2017. The survey included data on demographics, MPN characteristics, nutritional habits, supplement use, and symptom burden (using the MPN-10 symptom assessment).

A total of 1,329 international patients from 37 countries responded to the online survey; they were diagnosed with myelofibrosis (24%), essential thrombocytopenia (38%), or polycythemia vera (37%). Of these respondents, 1,131 consented to the survey, completed more than 10 multiple choice questions, and were aged 18 years or older. The average MPN Symptom Assessment Form Total Symptom Score (TSS) was 31 (standard deviation = 17).

Thirty-four percent of respondents said that they used specific dietary measures to help control symptoms or disease. Twenty-three percent reported food allergies or intolerances, and 31% followed a specific diet or had dietary restrictions. Almost all respondents said they were willing to eat only certain foods if it helped to control symptom burden (96%) or could help their MPN to stabilize or reduce the risk of their MPN getting worse (98%).

Many patients (72%) reported using over-the-counter supplements, the most common of which were vitamin C (28.1%), multivitamin or mineral (22.5%), magnesium (18.7%), calcium (16.5%), and vitamin B₁₂ (13.4%). Supplement use was significantly more common among woman than men (74% versus 66%; p = 0.01), and supplement users were significantly more likely to be older (mean age = 59 versus 56 years old; p < 0.001), with lower self-reported body mass index (mean = 25.7 versus 26.6 kg/m²; p = 0.02) and higher frequency of engaging in at least 30 minutes of physical activity (mean = 4 versus 3 days per week; p = 0.04).

TSS was significantly lower in those who ingested (analyzed as a continuous variable based on frequency of intake over an average week):

• Alcohol (p < 0.0001)
• Baked foods (p = 0.02)
• Dairy (p = 0.02)
• Pasta (p = 0.02)

The following were also associated with worsened symptom score:

• Fast food (p = 0.0007)
• Premade snacks (p = 0.03)
• Soda (p < 0.0001)
• Refined sugar (p = 0.01)
• Tacos (p = 0.03)

Supplement intake also impact symptom burden: it was significantly lower among those taking amino acid supplements (2.8 versus 3.4; p = 0.02) and N-acetylcysteine (2.4 versus 3.4; p = 0.02), and significantly higher in individuals taking Bach flowers (5.2 versus 3.4; p = 0.008).

“Supplement use and nutritional alteration have the potential to be paired with standard therapy to allow [patients with] patients to self-manage symptom burden and possibly reduce disease-related inflammation,” the researchers concluded.