Nutrition and Cancer-An International Journal最新文献

Background and objective: This study examined the associations of fat mass index (FMI) and fat free mass index (FFMI) with metabolic syndrome (MetS), cachexia, and all-cause mortality in cancer patients, given the limited existing evidence on these relationships.

Materials and methods: This analysis included 3,247 subjects enrolled in a cohort study. Cox regression analyses calculated hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs). Logistic models generated odds ratios (ORs) and 95% CIs. Mediation effects of FMI and FFMI on the cachexia-mortality association were evaluated.

Results: FMI and FFMI were significantly associated with MetS and cachexia, respectively. FMI (HR [95% CI] = 0.96 (0.94, 0.99), p = 0.003), FFMI (HR [95% CI] = 0.94 (0.91, 0.97), p < 0.001) were significantly associated with mortality. FMI (proportion mediated%=10.21, p = 0.03) and FFMI (proportion mediated%=13.16, p = 0.016) mediate the correlation between cachexia and mortality. Subgroup analysis showed that FMI had a significant mediating effect in gastrointestinal cancer, while FFMI had a significant mediating effect in lung cancer.

Conclusion: FMI and FFMI were positively correlated with MetS, negatively correlated with cachexia and mortality. FMI and FFMI mediate the association between cachexia and mortality, with FFMI having a higher mediating effect than FMI, however, the mediating effect was differentiated by tumor types.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is often diagnosed at advanced stages, limiting therapeutic options. Therefore, preventive strategies are crucial for its control. Among these, the use of nutrients and bioactive food compounds, such as omega-3 polyunsaturated fatty acids (n-3 PUFAs), has gained attention. Alpha-linolenic acid (ALA), a plant-derived n-3 PUFA abundant in flaxseed oil (FSO), has shown chemopreventive effects in various cancer models. This study investigated the chemopreventive potential of FSO in rats subjected to the resistant hepatocyte (RH) model of hepatocarcinogenesis, which generates preneoplastic lesions that may either progress to HCC (pPNL) or revert to a normal phenotype (rPNL). FSO treatment led to a reduction in the number of liver nodules and decreased both the number and size of pPNL. These effects were associated with increased hepatic ALA levels. FSO did not affect cell proliferation or apoptosis; however, it reduced DNA damage and inhibited γ-H2AX expression in preneoplastic livers, particularly in pPNL. Given that pPNL shares molecular alterations with HCC, the inhibition of γ-H2AX suggests a relevant mechanism by which FSO contributes to the chemoprevention of hepatocarcinogenesis.

Malnutrition and nutrition impact symptoms are common during and after anticancer treatment. This systematic review aimed to identify nutrition screening and assessment tools validated in patients with cancer and/or survivors, and to provide an overview. Comprehensive searches were conducted. Covidence was used for reference screening, data extraction, and quality assessment by two reviewers independently. Studies were included if they tested concurrent validity of a tool reporting: sensitivity, specificity, area under the curve (AUC), Pearson's/Spearman's correlation coefficient, or kappa. Data were summarized in tables and described narratively. Of 6,332 screened records, 486 were full-text reviewed, and 98 articles covering 161 validation studies of 47 tools were included. Most articles included mixed cancer diagnoses, followed by head and neck and gastrointestinal cancer; few included survivors. The most frequently validated tools were Nutritional Risk Screening 2002 (NRS 2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), and the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Several reference standards were used. Sensitivity ranged from 6% to 100%, specificity from 11% to 100%, and validity from 'Poor' to 'Good'. The absence of a universal gold standard complicates identification of a superior tool. Nonetheless, rather than ranking tools, this review provides an overview of their validity across different reference standards, offering guidance for clinicians. PROSPERO: CRD42018096678.

Weight and muscle loss in head and neck cancer (HNC) patients are common. While adequate calorie and protein intake may support maintenance, macronutrient composition remains understudied. The primary aim of this pilot randomized controlled trial was to assess the feasibility and acceptability of home-delivered, medically-tailored meals (MTMs) of a carbohydrate-restricted, high-fat (CRHF) diet versus a standard diet (SD) in newly diagnosed HNC patients undergoing radiotherapy (RT). Thirteen patients were randomized to CRHF (n = 6) or SD (n = 7). Participants received isocaloric MTMs daily for two weeks pre-RT and during RT. CRHF meals contained ∼30%-carbohydrate, 45%-fat, and 25%-protein, compared with ∼50/30/20% in SD meals. Feasibility outcomes were recruitment, retention, adherence, acceptability, and adverse events. Exploratory outcomes included descriptive changes in weight and body composition to inform future trial design. Recruitment and retention rates were 65% and 69%, respectively. MTM adherence averaged 92% in CRHF and 96% in SD. Participants reported high MTM satisfaction. CRHF participants exhibited descriptive patterns suggesting greater muscle preservation and fat loss. Higher adherence to either diet was observed with less weight loss during RT. Feasibility data suggest that a "Food is Medicine" approach may warrant further investigation in a larger trial design to assess efficacy.

Aim: To develop a predictive model for nutritional risk in patients with nasopharyngeal carcinoma (NPC) and identify clinically meaningful ranges for key risk factors to guide early intervention.

Methods: This study enrolled 520 patients with nasopharyngeal carcinoma (NPC) who underwent radiotherapy at Guangzhou Nanfang Hospital from 2021 to 2024. Thirty-two baseline variables were collected, including body measurements, lab tests, treatment details, and lifestyle factors. Seven machine learning models were developed. Key predictors were selected using LASSO regression, and their importance was assessed using SHAP values.

Results: The XGBoost model performed best, with an AUC of 0.775 on the validation set. Four main predictors of nutritional risk were identified: body mass index (BMI), alanine transaminase (ALT), clinical stage, and smoking status. Patients with a BMI between 21.5 and 24.9 kg/m² and ALT values in the higher range of normal had a lower risk of malnutrition. These findings provide more specific guidance than existing tools.

Conclusion: This study highlights the added value of combining clinical data and machine learning to identify both key predictors and their optimal ranges for nutritional risk.

Adipose tissue radiodensity has emerged as a prognostic biomarker in oncology. This study aimed to assess its prognostic value in colorectal cancer (CRC) patients receiving adjuvant therapy. Body composition was quantified by computed tomography, with visceral (VAT_d) and subcutaneous (SAT_d) adipose tissue radiodensity measured in Hounsfield units and categorized into tertiles, where higher tertiles indicated lower fat proportion, whereas lower tertiles higher fat proportion. The primary endpoint was 5-year overall survival. Stage III disease (HR 5.54, 95% CI: 1.64-18.70), recurrence or metastasis (HR 4.16, 95% CI: 2.39-7.24), and elevated systemic inflammation response index (HR 2.42, 95% CI: 1.55-3.76) were associated with reduced survival. Conversely, the second VAT_d tertile (HR 0.56, 95% CI: 0.33-0.94), adjuvant chemotherapy (HR 0.43, 95% CI: 0.22-0.84), and chemoradiotherapy (HR:0.45, 95% CI: 0.21-0.93) independently predicted improved outcomes. Higher tertiles of SAT_d and VAT_d negatively impacted the beneficial prognosis of adjuvant therapy. However, patients with intermediate SAT_d experienced better protective effects from chemotherapy or chemoradiotherapy (HR 0.17, 95% CI: 0.06-0.49; HR 0.26, 95% CI: 0.08-0.85, respectively). These findings indicate that intermediate VAT_d confers survival advantage, while elevated SAT_d may attenuate treatment efficacy, reinforcing adipose radiodensity as a clinically relevant prognostic marker in CRC.

Obesity is a significant lifestyle factor that affects the development and outcomes of endometrial tumors. Excess body weight can disrupt hormonal balance and promote cellular mutations, increasing the risk of endometrial cancer. We developed a three-step stochastic model that incorporates clonal proliferation at each stage to investigate how obesity affects cancer progression. The model was tested on two datasets: non-obesity-related cases from the SEER registry (2010-2020) and obesity-related cases in women from the CDC (2017-2021). Our results show that obesity mainly impacts the development of endometrial tumors by causing genetic mutations in women. The stochastic model indicates that fat increases the rates of both initial and later mutations. Body weight can affect the rate at which early intermediate cells multiply, especially in women who are still premenopausal. Understanding how these cellular changes happen is important for estimating an individual's risk of developing endometrial cancer.

We read with great interest the prospective multicenter study by Teng et al., which evaluated whether ultrasound-derived skeletal muscle indices could predict severe chemotherapy-related toxicity in patients with non-small cell lung cancer (NSCLC). We sincerely commend the authors for their innovative focus on a pragmatic, radiation-free tool that can be incorporated conveniently into routine oncology workflows. Their results-demonstrating that quadriceps cross-sectional area and muscle thickness independently predict grade 3-4 toxicities-offer clinically meaningful implications for early risk identification.

Breast cancer survivors (BCS) undergoing adjuvant endocrine therapy have increased risk of obesity. Estrogen and exercise suppress appetite in non-BCS populations, but their combined effects in BCS are unknown. This secondary analysis compared the impact of acute resistance exercise (REx) on appetite and energy intake in estrogen-suppressed BCS versus females without cancer ('non-BCS'). Premenopausal inactive BCS (stage 0-III estrogen receptor-positive breast cancer, <5 years post-diagnosis, undergoing estrogen-targeted therapy) and non-BCS completed REx or sedentary (SED) conditions 35 min after a standardized breakfast. Appetite visual analog scales and hormones (ghrelin and peptide-YY [PYY]) were measured before and after breakfast and REx/SED; energy intake was assessed 3 h post-breakfast (1.5 h post-REx or SED). Fifteen BCS (age: 46 ± 7; BMI: 25.0 ± 3.8 kg/m²) and 12 non-BCS (age: 37 ± 8; BMI: 29.0 ± 5.1 kg/m²) were included. BCS showed greater PYY 90 and 120 min post-breakfast compared to non-BCS, particularly after REx (group x time x condition: p = 0.009, p = 0.005, respectively). No group effects were observed for ghrelin. BCS had lower body mass-adjusted energy intake compared to non-BCS (p = 0.036), despite similar appetite ratings. Estrogen-suppressed BCS exhibit heightened PYY and lower energy intake after REx, revealing novel effects of exercise on appetite in a state of low estrogen.

This study aimed to investigate whether there is an association between the health literacy of breast and prostate cancer survivors and their feeding, considering the planetary diet recommendation. This cross-sectional study utilized secondary data from 201 women with breast cancer and 106 men with prostate cancer. Health literacy was evaluated using the Brazilian version of the Health Literacy Questionnaire. The EAT-Lancet diet adherence was assessed using the Planetary Health Diet Index (PHDI). The mean PHDI score was 45.3 (9.0) points, without differences in consumption between men and women. The health literacy status and PHDI score were unassociated among cancer survivors. Adherence to a healthy and sustainable diet and health literacy were low among the studied population. Further studies should evaluate these conditions in other populations.