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1.
Plasma Vitamin C Levels: Risk Factors for Deficiency and Association with Self-Reported Functional Health in the European Prospective Investigation into Cancer-Norfolk.
McCall, SJ, Clark, AB, Luben, RN, Wareham, NJ, Khaw, KT, Myint, PK
Nutrients. 2019;(7)
Abstract
BACKGROUND To investigate the demographic and lifestyles factors associated with vitamin C deficiency and to examine the association between plasma vitamin C level and self-reported physical functional health. METHODS A population-based cross-sectional study using the European Prospective Investigation into Cancer-Norfolk study. Plasma vitamin C level < 11 µmol/L indicated vitamin C deficiency. Unconditional logistic regression models assessed the association between vitamin C deficiency and potential risk factors. Associations between quartiles of vitamin C and self-reported functional health measured by the 36-item short-form questionnaire (SF-36) were assessed. RESULTS After adjustment, vitamin C deficiency was associated with older age, being male, lower physical activity, smoking, more socially deprived area (Townsend index) and a lower educational attainment. Compared to the highest, those in the lowest quartile of vitamin C were more likely to score in the lowest decile of physical function (adjusted odds ratio (aOR): 1.43 (95%CI: 1.21-1.70)), bodily pain (aOR: 1.29 (95% CI: 1.07-1.56)), general health (aOR: 1.4 (95%CI: 1.18-1.66)), and vitality (aOR: 1.23 (95%CI: 1.04-1.45)) SF-36 scores. CONCLUSIONS Simple public health interventions should be aimed at populations with risk factors for vitamin C deficiency. Poor self-reported functional health was associated with lower plasma vitamin C levels, which may reflect symptoms of latent scurvy.
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2.
Obesity survival paradox in cancer patients: Results from the Physical Frailty in older adult cancer patients (PF-EC) study.
Pamoukdjian, F, Aparicio, T, Canoui-Poitrine, F, Duchemann, B, Lévy, V, Wind, P, Ganne, N, Sebbane, G, Zelek, L, Paillaud, E
Clinical nutrition (Edinburgh, Scotland). 2019;(6):2806-2812
Abstract
BACKGROUND & AIMS the obesity survival paradox is an emergent issue in oncology, but its existence remains unclear particularly in older cancer patients. We aimed to assess the obesity survival paradox in older cancer patients. METHODS all consecutive cancer outpatients 65 years and older referred for geriatric assessment (GA) before a decision on cancer treatment between November 2013 and September 2016 were enrolled in the PF-EC cohort study. The main outcome was 6-month mortality. A Cox univariate and multivariate proportional hazard regression models were performed with baseline GA, oncological variables (cancer site, extension and treatment modalities) and C-reactive protein (CRP). We assessed the prognostic value of body mass index categories (i.e. malnutrition <21, 21 ≤ normal weight ≤24.9, 25 ≤ overweight ≤29.9 and obesity ≥30 kg/m2) in the whole study population and according to the metastatic status. RESULTS 433 patients with a mean age of 81.2 ± 6.0 years were included, 51% were women, 44.3% had digestive cancers, 18% breast cancer and 14.5% lung cancer and 45% metastatic cancers. Eighty-eight of these patients (20.3%) were obese at baseline. Mortality rate was 17% during the 6-month follow-up period. After adjustment for sex, gait speed, Mini-Mental State Examination, cancer site and exclusive supportive care, obesity (compared to normal weight) was independently and negatively associated with 6-month mortality only in metastatic patients (aHR 0.17, 95% CI [0.03-0.92], P = 0.04). CONCLUSION our study confirms the obesity survival paradox in older cancer patients only in the metastatic group.
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3.
Amino acid kinetics and the response to nutrition in patients with cancer.
van der Meij, BS, Teleni, L, Engelen, MPKJ, Deutz, NEP
International journal of radiation biology. 2019;(4):480-492
Abstract
PURPOSE Amino acids are involved in many physiological processes in the body and serve as building blocks of proteins which are the main component of muscle mass. Often patients with cancer experience muscle wasting, which is associated with poor outcomes. The purpose of this paper is to discuss amino acid kinetics in cancer, review the evidence on the response to nutrition in patients with cancer, and to give recommendations on the appropriate level of amino acid or protein intake in cancer. Current evidence shows that amino acid kinetics in patients with cancer are disturbed, as reflected by increased and decreased levels of plasma amino acids, an increased whole body turnover of protein and muscle protein breakdown. A few studies show beneficial effects of acute and short-term supplementation of high protein meals or essential amino acid mixtures on muscle protein synthesis. CONCLUSIONS Cancer is associated with disturbances in amino acid kinetics. A high protein intake or supplementation of amino acids may improve muscle protein synthesis. Future research needs to identify the optimal level and amino acid mixtures for patients with cancer, in particular for those who are malnourished.
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4.
Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines.
Hong, CHL, Gueiros, LA, Fulton, JS, Cheng, KKF, Kandwal, A, Galiti, D, Fall-Dickson, JM, Johansen, J, Ameringer, S, Kataoka, T, et al
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2019;(10):3949-3967
Abstract
PURPOSE The aim of this study was to update the clinical practice guidelines for the use of basic oral care (BOC) interventions for the prevention and/or treatment of oral mucositis (OM). METHODS A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention in each cancer treatment setting was assigned an evidence level. The findings were added to the database used to develop the 2013 MASCC/ISOO clinical practice guidelines. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible. RESULTS A total of 17 new papers across six interventions were examined and merged with a previous database. Based on the literature, the following guidelines were possible. The panel suggests that the implementation of multi-agent combination oral care protocols is beneficial for the prevention of OM during chemotherapy, head and neck (H&N) radiation therapy (RT), and hematopoietic stem cell transplantation (Level of Evidence III). The panel suggests that chlorhexidine not be used to prevent OM in patients undergoing H&N RT (Level of Evidence III). No guideline was possible for professional oral care, patient education, saline, and sodium bicarbonate, and expert opinion complemented these guidelines. CONCLUSIONS The evidence supports the use of multi-agent combination oral care protocols in the specific populations listed above. Additional well-designed research is needed on the other BOC interventions prior to guideline formulation.
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5.
Switching from Conventional to Nano-natural Phytochemicals to Prevent and Treat Cancers: Special Emphasis on Resveratrol.
Salman Ul Islam, , Ahmed, MB, Mazhar Ul-Islam, , Shehzad, A, Lee, YS
Current pharmaceutical design. 2019;(34):3620-3632
Abstract
BACKGROUND Natural phytochemicals and their derivatives have been used in medicine since prehistoric times. Natural phytochemicals have potential uses against various disorders, including cancers. However, due to low bioavailability, their success in clinical trials has not been reproduced. Nanotechnology has played a vital role in providing new directions for diagnosis, prevention, and treatment of different disorders, and of cancer in particular. Nanotechnology has demonstrated the capability to deliver conventional natural products with poor solubility or a short half-life to target specific sites in the body and regulate the release of drugs. Among the natural products, the phytoalexin resveratrol has demonstrated therapeutic effects, including antioxidant, antiinflammatory, and anti-proliferative effects, as well as the potential to inhibit the initiation and promotion of cancer. However, low water solubility and extensive first-pass metabolism lead to poor bioavailability of resveratrol, hindering its potential. Conventional dosage forms of resveratrol, such as tablets, capsules, dry powder, and injections, have met with limited success. Nanoformulations are now being investigated to improve the pharmacokinetic characteristics, as well as to enhance the bioavailability and targetability of resveratrol. OBJECTIVES This review details the therapeutic effectiveness, mode of action, and pharmacokinetic limitations of resveratrol, as well as discusses the successes and challenges of resveratrol nanoformulations. Modern nanotechnology techniques to enhance the encapsulation of resveratrol within nanoparticles and thereby enhance its therapeutic effects are emphasized. CONCLUSION To date, no resveratrol-based nanosystems are in clinical use, and this review would provide a new direction for further investigations on innovative nanodevices that could consolidate the anticancer potential of resveratrol.
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6.
Parenteral nutrition.
Bozzetti, F
Nutrition (Burbank, Los Angeles County, Calif.). 2019;:101-107
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7.
Dietary total antioxidant capacity and mortality from all causes, cardiovascular disease and cancer: a systematic review and dose-response meta-analysis of prospective cohort studies.
Parohan, M, Anjom-Shoae, J, Nasiri, M, Khodadost, M, Khatibi, SR, Sadeghi, O
European journal of nutrition. 2019;(6):2175-2189
Abstract
PURPOSE No conclusive information is available about the association between dietary total antioxidant capacity (DTAC) and risk of mortality. Current meta-analysis of prospective cohort studies was done to summarize available findings on the association between DTAC and risk of death from all-cause, cancer and cardiovascular diseases (CVDs). METHODS Online databases were searched to detect relevant publications up to January 2018, using relevant keywords. To pool data, either fixed-effects or random-effects model was used. Furthermore, linear and non-linear dose-response analyses were also done. RESULTS In total, five prospective studies were included in the current systematic review and meta-analysis. In a follow-up period of 4.3-16.5 years, there were 38,449 deaths from all-cause, 4470 from cancer and 2841 from CVDs among 226,297 individuals. A significant inverse association was found between DTAC and all-cause mortality (combined effect size: 0.62, 95% CI 0.60-0.64). Such finding was also seen for cancer (combined effect size: 0.81, 95% CI 0.75-0.88) and CVD (combined effect size: 0.71, 95% CI 0.63-0.82) mortality. Findings from linear dose-response meta-analysis revealed that a 5 mmol/day increment in DTAC based on ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) was associated with 7% and 15% lower risk of all-cause mortality, respectively. Based on findings from non-linear dose-response meta-analysis, a significant reduction in risk of all-cause mortality was seen when increasing FRAP from 2 to 12 mmol/day (P-nonlinearity = 0.002) and ORAC from 5 to 11 mmol/day (P-nonlinearity < 0.001). CONCLUSIONS Adherence to diet with high total antioxidant capacity was associated with decreased risk of death from all-cause, cancer and CVDs.
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8.
Association Between Standardized Phase Angle, Nutrition Status, and Clinical Outcomes in Surgical Cancer Patients.
Pena, NF, Mauricio, SF, Rodrigues, AMS, Carmo, AS, Coury, NC, Correia, MITD, Generoso, SV
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2019;(3):381-386
Abstract
BACKGROUND Different nutrition assessment tools in surgical cancer patients are used in clinical practice, which results in different prevalence rates of malnutrition. This may impact the interpretation of the association between nutrition status and clinical outcomes. Reduced standardized phase angle (SPA) values are associated with adverse outcomes in patients with cancer. Thus, it is important to assess the association of SPA with nutrition status and relate it to postoperative clinical outcomes. METHODS This prospective observational study included 121 surgical cancer patients. Bioelectrical impedance analysis, subjective global assessment (SGA), anthropometric measurements, and assessment of muscle strength were used to provide nutrition diagnosis 1 day before surgery. The patients were followed for infectious and noninfectious postoperative complications from the first day after the operation until discharge or death. RESULTS The prevalence of malnutrition was higher according to SGA (63.6%). Patients with an SPA < -1.65 had a greater chance of being diagnosed as malnourished according to the SGA (3.66 [1.35-9.90]), midarm circumference (OR 4.24; CI95%; 1.72-10.43), midarm muscle area (OR 4.38; CI95%; 1.68-11.42), and low handgrip strength (3.84 [1.31-11.25]). Patients with an SPA < -1.65 presented with more infectious complications (OR 4.19; CI95%; 1.52-11.53), but there was no association between SPA and other outcomes or death. SPA was the only significant predictor of infectious complications (AUC, 0.61; 95% CI, 0.51-0.71). CONCLUSION SPA was associated with different nutrition status parameters, and it was able to predict postoperative infectious complications.
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9.
Programmed cell death protein 1 inhibitor treatment is associated with acute kidney injury and hypocalcemia: meta-analysis.
Manohar, S, Kompotiatis, P, Thongprayoon, C, Cheungpasitporn, W, Herrmann, J, Herrmann, SM
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2019;(1):108-117
Abstract
BACKGROUND The aim of this meta-analysis was to assess the risks and incidence of nephrotoxicity and electrolyte abnormalities in patients receiving programmed cell death protein 1 (PD-1) inhibitors. METHODS We conducted a meta-analysis of clinical trials that monitored electrolyte levels and kidney functions during treatment with nivolumab or pembrolizumab by searching MEDLINE, EMBASE and the Cochrane Database from inception through April 2017. Our protocol is registered with International Prospective Register of Systematic Reviews; no.CRD42017060579. RESULTS A total of 48 clinical trials with a total of 11 482 patients were included. The overall pooled risk ratios (RR) of all acute kidney injury (AKI) and all electrolyte abnormalities in patients treated with PD-1 inhibitors were 1.86 [95% confidence interval (CI) 0.95-3.64] and 1.67 (95% CI 0.89-3.12), respectively. Compared with non-nephrotoxic controls, the pooled RR of AKI in patients treated with PD-1 inhibitors was 4.19 (95% CI 1.57-11.18). Prespecified subgroup analyses demonstrated a significant association between PD-1 inhibitors and hypocalcemia with a pooled RR of 10.87 (95% CI 1.40-84.16). The pooled estimated incidence rates of AKI and hypocalcemia in patients treated with PD-1 inhibitors were 2.2% (95% CI 1.5-3.0%) and 1.0% (95% CI 0.6-1.8%), respectively. Among patients who developed AKI with PD-1 inhibitors, the pooled estimated rate of interstitial nephritis was 16.6% (95% CI 10.2-26.0%). CONCLUSIONS Treatment with PD-1 inhibitors is associated with a higher risk of AKI compared with non-nephrotoxic agents. It will be important to characterize the AKI patients to better understand the etiology behind the event. In addition, treatment with PD-1 inhibitors is associated with an increased risk of hypocalcemia. This study highlights a rare but serious adverse event of anti-PD-1 antibodies and we recommend, in addition to electrolytes panel, routine calcium monitoring.
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10.
18F-FDG PET-CT in paediatric oncology: established and emerging applications.
Chambers, G, Frood, R, Patel, C, Scarsbrook, A
The British journal of radiology. 2019;(1094):20180584
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Abstract
Accurate staging and response assessment is vital in the management of childhood malignancies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET-CT) provides complimentary anatomical and functional information. Oncological applications of FDG PET-CT are not as well-established within the paediatric population compared to adults. This article will comprehensively review established oncological PET-CT applications in paediatric oncology and provide an overview of emerging and future developments in this domain.