Colorectal cancer therapy and nutrition: From ultra-processed consumption to metabolic reprogramming

Table 2 Clinical evidence: Fasting and caloric restriction in colorectal cancer

Ref	Intervention	Population/Protocol	Metabolic effects	Clinical or therapeutic impact
Bensalem et al[59], 2025 and Teong et al[72], 2023	Intermittent fasting/TRE (iTRE)	Clinical trials in cancer patients	Blood glucose reduction, insulin reduction, ketone bodies increase, autophagy increase	Metabolic environment less favorable to tumor proliferation, with potential response to therapies increase
Tsuda et al[77], 2020; Khodabakhshi et al[78], 2021; and Mindikoglu et al[79], 2020	Prolonged overnight fasting (> 13 hours)	CRC patient cohorts	Insulin sensitivity, systemic inflammation reduction increase	Risk of tumor recurrence reduction
Vernieri et al[19], 2022; Zhong et al[83], 2023; Ligorio et al[84], 2022; and Ligorio et al[85], 2025	Fasting mimicking diet	Clinical trials in CRC	Glucose reduction, insulin reduction, IGF-1 reduction, ketone bodies increase; L-arginine in tumor tissues increase	Favorable safety profile; response to chemotherapy increase; CD8+ infiltration increase; microbiota remodeling; abundance of B. pseudolongum increase; improved patient prognosis
Bustamante-Marin et al[70], 2023 and Vidoni et al[88], 2021	Moderate caloric restriction (20%-40%)	Clinical trials in cancer patients	Glucose reduction, insulin reduction, IGF-1 reduction, insulin sensitivity increase, autophagy increase	Potential for therapeutic response and tumor progression reduction increase

TRE: Time-restricted eating; iTRE: Intermittent time restricted eating; CRC: Colorectal cancer; B. pseudolongum: Bifidobacterium pseudolongum.