Caloric restriction in clinical practice: Tailor-made preconditioning before surgery and chemotherapy

We conclude that long-term CR and STF holds potential for clinical application and could
benefit a myriad of populations. Obviously, it is of utmost importance to first improve
insight in the mechanisms of dietary modifications, so that objective primary endpoints
can be defined. Prior research has mostly been done to investigate feasibility, not added
clinical benefit, or was not adequately designed to account for confounding factors. Studies
postulated in this thesis show its potential in long-term weight loss and its beneficial effect
on liver adenomas, its short-term effect on recovery after living donor surgery, its potential
to reduce the postoperative burden on transplanted patients, and the potential to unlock the
same biological response in paediatric patients. Additional well-designed trials, with well
defined objective primary outcomes, in larger and more diverse populations and diseases,
are needed to fully quantify and clarify its clinical impact.
In summary, we recommend to further expand research into CR and STF in the clinical
field focusing on the mechanism and pathways involved, carefully accounting for patient
characteristics and potential epidemiological pitfalls, at both the trial- and individual level.
Studies presented in this thesis support the potential it has for improving relevant clinical
outcomes, from long-term significant weight loss, to improved (kidney function) recovery
after surgery, to reduced burden of disease in children. When performed and investigated
correctly, we can unlock the full clinical potential of CR and STF in medical and surgical care.