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A lifestyle intervention of weight loss via a low-carbohydrate diet plus walking to reduce metabolic disturbances caused by androgen deprivation therapy among prostate cancer patients: carbohydrate and prostate study 1 (CAPS1) randomized controlled trial

Prostate Cancer and Prostatic Diseases volume 22, pages 428–437 (2019)Cite this article

Subjects

Abstract

Purpose

The objective of this study was to test a low-carbohydrate diet (LCD) plus walking to reduce androgen deprivation therapy (ADT)-induced metabolic disturbances.

Materials and methods

This randomized multi-center trial of prostate cancer (PCa) patients initiating ADT was designed to compare an LCD (≤20g carbohydrate/day) plus walking (≥30 min for ≥5 days/week) intervention vs. control advised to maintain usual diet and exercise patterns. Primary outcome was change in insulin resistance by homeostatic model assessment at 6 months. To detect 20% reduction in insulin resistance, 100 men were required. The study was stopped early after randomizing 42 men due to slow accrual. Secondary outcomes included weight, body composition, lipids, and prostate-specific antigen (PSA). Changes from baseline were compared between arms using rank-sum tests.

Results

At 6 months, LCD/walking reduced insulin resistance by 4% vs. 36% increase in control (p = 0.13). At 3 months, vs. control, LCD/walking arm significantly lost weight (7.8kg; p<0.001), improved insulin resistance (↑36%; p = 0.015), hemoglobin A1c (↓3.3%; p = 0.01), high-density lipoprotein (HDL) (↑13%; p = 0.004), and triglyceride (↓37%; p = 0.036). At 6 months, weight loss (10.6kg; p<0.001) and HDL (↑27%; p = 0.003) remained significant. LCD/walking preserved total body bone mineral count (p = 0.025), reduced fat mass (p = 0.002), lean mass (p = 0.036), and percent body fat (p = 0.004). There were no differences in PSA. Limitations include the effect of LCD, weight loss vs. walking instruction are indistinguishable, and small sample size.

Conclusions

In an underpowered study, LCD/walking did not improve insulin sensitivity at 6 months. Given most secondary outcomes were improved at 3 months with some remaining improved at 6 months and a secondary analysis showed that LCD/walking reduced insulin resistance over the study, supporting future larger studies of LCD/walking intervention to reduce ADT-induced disturbances.

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Acknowledgements

This study was funded by the Atkins Foundation, AUA, NIH K24 CA160653.

Author information

Authors and Affiliations

  1. Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute and Department of Surgery, Division of Urology Cedars-Sinai Medical Center, Section of Urology, Los Angeles, CA, USA

    Stephen J. Freedland

  2. Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, USA

    Stephen J. Freedland

  3. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Lauren Howard

  4. Translational Population Health Research, Duke Clinical and Translational Science Institute, Kannapolis, NC, USA

    Jenifer Allen

  5. Department of Medicine, Nephrology Division, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, USA

    Jordan Smith & Pao-Hwa Lin

  6. Division of Urology, Duke University Medical Center, Durham, NC, USA

    Jennifer Stout, Brant A. Inman & Daniel George

  7. Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    William Aronson

  8. Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA

    William Aronson

  9. Department of Medicine, Division of Urology, Duke University Medical Center, Durham, NC, USA

    Andrew J. Armstrong

  10. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Eric Westman

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Correspondence to Stephen J. Freedland.

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Freedland, S.J., Howard, L., Allen, J. et al. A lifestyle intervention of weight loss via a low-carbohydrate diet plus walking to reduce metabolic disturbances caused by androgen deprivation therapy among prostate cancer patients: carbohydrate and prostate study 1 (CAPS1) randomized controlled trial. Prostate Cancer Prostatic Dis 22, 428–437 (2019). https://doi.org/10.1038/s41391-019-0126-5

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