Nutrition and Cancer-An International Journal最新文献

Radiotherapy is a common cancer treatment, and concurrent nutritional interventions can maintain nutritional status and improve clinical and supportive care outcomes. However, optimal nutritional interventions during radiotherapy are not firmly established. Herein, we assessed the feasibility, safety, and efficacy of dietary counseling interventions without oral nutrition supplements on health outcomes in adults receiving radiotherapy for cancer in a systematic review. Prospective clinical trials that implemented nutritional counseling interventions during radiotherapy were identified from four databases from inception through December 2023. Feasibility, safety, and efficacy were extracted from 32 articles that described 23 randomized and 4 non-randomized clinical trials. The interventions included individualized nutritional counseling (n = 14 articles), nutritional counseling plus exercise (n = 4), and nutritional counseling focused on increasing or reducing intake of specific nutrients (n = 9). Trials targeted head and neck (n = 12), pelvic cancers (n = 14), and/or breast (n = 5) cancers. Control groups had variable designs and included general nutrition education and intervention as needed. Studies recruited 120 ± 104 participants (range 26-468). Interventions tended to be feasible regarding retention and attendance at sessions, though feasibility metrics varied among different interventions. Most interventions were safe with no studies reporting adverse events attributable to dietary intervention. Individualized dietary counseling interventions tended to lead to between-group differences favoring the intervention group in regard to improved nutritional status, maintenance or attenuation of loss of body mass, improved quality of life, and reduced radiation-induced toxicities. Diets that encouraged/discouraged specific nutrients tended to recruit patients receiving radiation to the pelvic area and resulted in positive or neutral effects on gastrointestinal symptoms. In conclusion, nutritional interventions appear to be feasible, safe, and effective during radiotherapy for various symptom outcomes.

This study investigates the impact of neoadjuvant therapy (NT) on body composition and its correlation with long-term survival and other clinical outcomes in patients with advanced gastric cancer. We utilized Computed Tomography (CT) scans to measure body composition before and after NT, including Subcutaneous Adipose Tissue Index (SATI), Visceral Adipose Tissue Index (VATI), Skeletal Muscle Index (SMI), and Muscle Density (MA). We then analyzed the decrease in body composition in relation to tumor regression, inflammatory markers, nutritional scores, and long-term survival. Our findings reveal a negative correlation between the decrease in SATI and VATI after NT, and both tumor regression and nutritional score. Notably, patients who experienced a significant loss in SATI or VATI post-NT had shorter Recurrence-Free Survival (RFS) and Overall Survival (OS). Additionally, significant loss in SATI and VATI emerged as an independent risk factor for both RFS and OS. In conclusion, our study convincingly demonstrates that in patients with advanced gastric cancer, SATI and VATI decreases after NT and is negatively associated with tumor regression and nutritional score. A significant loss in SATI and VATI is a risk factor for shorter RFS and OS, thereby underscoring the importance of maintaining body composition during NT.

Currently, the combination of atezolizumab and bevacizumab (Atez/Bev) is recommended as the first-line therapy for patients with advanced hepatocellular carcinoma (HCC). However, there is a lack of research on the levels of nutrient elements in advanced HCC patients receiving Atez/Bev treatment. In this study, data from 35 patients with advanced HCC and 37 healthy individuals of similar age and sex were included. The levels of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase were significantly increased in patients with HCC. These levels returned to the reference range after three rounds of Atez/Bev treatment. Additionally, the levels of blood urea nitrogen and creatinine (Cr) increased after Atez/Bev treatment. In HCC patients, the levels of calcium (Ca), iron (Fe), and copper (Cu) were significantly higher, while the levels of sodium (Na), magnesium (Mg), and zinc (Zn) were significantly lower compared to healthy individuals. These changes were reversed after Atez/Bev treatment. In conclusion, our findings indicate that treatment with Atez/Bev influences the levels of Ca, Fe, Cu, Na, Mg, and Zn in patients with HCC. The alterations in these elements caused by Atez/Bev treatment require mechanistic research in the future.

Sarcopenia is common in patients with head and neck cancer and is suggested to be associated with decreased survival. This study aimed to investigate the relationship between changes in skeletal muscle mass during alternating chemoradiotherapy (CRT) and the prognosis of patients with nasopharyngeal carcinoma (NPC). This retrospective study included 64 patients with NPC who had undergone alternating CRT at our institution between 2005 and 2022. The skeletal muscle mass index (SMI) was measured using pre- and post-treatment computed tomography. SMI decreased in 58 patients (90.6%), with a mean change of -6.1%. Using a cutoff value of -6.0% for SMI change, 32 patients (50.0%) were categorized into the SMI loss group. The SMI loss group had a significantly lower mean overall survival (OS) than the SMI maintenance group (122.6 vs. 153.0 months; p = 0.021). Multivariate analysis identified SMI loss and prognostic nutritional index (PNI) as independent predictors of poor OS (p < 0.05). They were used to construct the nomogram of OS. In conclusion, SMI loss during alternating CRT was identified as a poor prognostic factor. These findings suggest that preserving skeletal muscle mass during alternating CRT may improve the prognosis and merits further investigation.

Creatine has demosntrated protective effects against muscle dysfunction, but its potential protection against doxorubicin-induced cardio and skeletal muscle toxicity remains poorly understood. We aimed to investigate the protective effects of creatine supplementation against doxorubicin-induced cardio and skeletal muscle myotoxicity. This study analyzed twenty male C57BL/6J mice, divided into three groups: Control (C; n = 6), Dox (n = 7) which received weekly doxorubicin injections (16 mg/kg i.p. in 20 days) and DoxCr (n = 7) with both doxorubicin and creatine supplementation (4%). Doxorubicin administration induced skeletal muscle atrophy in extensor digitorum longus (EDL) (-28%) and soleus muscles (-17%), accompanied by a decline in muscle strength. This atrophic response was concomitant with increased oxidative stress and elevated levels of IL-6. Cardiotoxic effects of doxorubicin were marked by a 15% reduction in cardiac mass and a significant 21% decrease in cardiomyocyte diameter, alongside a substantial 58% rise in IL-6 levels. On the opposite creatine supplementation mitigated doxorubicin-induced oxidative stress (elevated MDA and IL-6, and reduced GSH/GSSG ratio) and prevented skeletal muscle atrophy in both the EDL and soleus muscles, while also enhancing muscle strength. However, protective effects were not observed in cardiac muscle. Creatine protects skeletal, but not cardiac muscle against doxorubicin-induced toxicity, atrophy and strength loss.

Background: Patients with esophageal cancer are prone to poor nutrition. Concurrent chemoradiation therapy (CCRT) may further influences body compositions including skeletal muscle (SM) and adipose tissue which are key indicators of nutritional status. This study aimed to evaluate whether body compositional change during CCRT could be a predictor of prognosis in esophageal cancer patients.

Methods: From 2006 to 2018, esophageal cancer patients who received CCRT as initial treatment were consecutively enrolled. We assessed body compositions, including subcutaneous fat (SCF), intramuscular fat (IMF), and SM mass by measuring the cross-sectional area (CSA) of the fourth thoracic vertebral body on computed tomography (CT) scan. The body compositional change was assessed by comparing baseline and post-CCRT CSA. The association of body compositions and their changes during CCRT with patient prognosis was analyzed.

Results: A total of 178 patients were enrolled with a mean baseline body mass index (BMI) of 22. After CCRT, there was a significant decrease in bodyweight (BW), SCF, IMF, and SM (P < 0.001). BMI and body compositions at baseline or post-CCRT were not significantly associated with patient prognosis. Patients with SCF loss during CCRT had significantly poorer CCRT response (OR 3.7, P < 0.001), shorter time to tumor progression (8.5 vs. 23.7 months, P = 0.011), and overall survival (13.7 vs. 25.9 months, P < 0.001) than patients with SCF gain/stable. IMF, SM, and BW change during CCRT did not correlate with CCRT response or survival. In multivariate Cox regression analysis, SCF change (HR 1.49, 95% CI: 1.03-2.14, P = 0.033) during CCRT was an independent predictor of survival after adjusting baseline BMI, cancer stage, treatment modality, and CCRT response.

Conclusions: During the course of CCRT, SCF change is more sensitive than weight in assessing the nutritional status of esophageal cancer patients. SCF loss during CCRT is associated with worse CCRT response and survival in esophageal cancer patients.

Malnutrition is common in adults with cancer and is associated with lower quality of life and higher risk of mortality. A comprehensive picture of dietitian efficacy in cancer care is needed to inform payers and policymakers about effective care options. The objective of this umbrella review of systematic reviews (SRs) is to examine the impact of dietitian interventions, compared to no intervention or usual care, on nutrition-related outcomes in adults with all types and stages of cancer. MEDLINE, CINAHL, Cochrane Database of SRs, Food Science Source, and SPORTSDiscus databases were searched for SRs and meta-analyses published from 2018 to September 2024. The GRADE method was used to rate evidence certainty. There were 2,087 articles identified in the search, 125 full texts were examined for eligibility, and seven SRs were included in this umbrella review, representing 25 randomized controlled trials and six observational studies. Interventions provided by dietitians may improve nutrition status, protein and energy intake, length of stay, and quality of life, but evidence certainty was low, primarily due to the risk of bias in primary studies, heterogeneity, and lack of precise effect size. Providing dietitian-led interventions for adults with cancer may improve a wide range of nutrition-related outcomes.

This multicenter, randomized, non-inferiority phase III trial (NCT03792100) aimed to evaluate the efficacy and safety of SmofKabiven^®, a three-chamber parenteral nutrition (PN) emulsion in adult patients undergoing gastrointestinal surgery. Eligible participants were randomized to either SmofKabiven^® group (SEG) (n = 135) or hospital-compounded PN group (HCG) (n = 134) for five consecutive postoperative days. The primary endpoint was the change in serum prealbumin levels from baseline to day 6, with a non-inferiority margin of -2.75 mg/dL. By day 6, change of serum prealbumin levels from baseline was 3.22 mg/dl in the SEG and 2.74 mg/dl in the HCG, with a difference of 0.48 mg/dl (95% confidence interval: -0.80 to 1.77), indicating comparable improvement in nutritional status. Linoleic acid decreased more with SEG than that with HCG (between-group difference: -7.84 mg/l, P = 0.0128), while arachidonic acid decreased more with HCG (between-group difference: 0.38 mg/l, P = 0.0025). Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were significantly higher with SEG (between-group difference: EPA, 0.48 mg/l, P < 0.0001; DHA, 0.64 mg/l, P < 0.0001, respectively), and taurine levels also increased significantly (between-group difference: 14.77 µM, P = 0.0217). Treatment-related adverse events were comparable in the two groups. SmofKabiven^® was comparable to hospital-compounded PN in improving postoperative nutritional status and safety profile and its enrichment with omega-3 fatty acids and taurine may provide additional benefits.

Background: The role of early oral feeding (EOF) following esophagectomy remains debated. This study evaluates whether postoperative EOF improves patients' quality of life.

Methods: A comprehensive search was performed across eight databases to identify relevant studies. The effects of continuous variables were assessed using the mean difference (MD). The effects of dichotomous variables were assessed using the relative risk (RR).

Results: Seven studies were included in the analysis. EOF significantly improved postoperative overall quality of life [MD = 9.64, 95% CI (6.11, 13.16), p < 0.001], dysphagia [MD = -7.37, 95% CI (-14.32, -0.42), p = 0.040], and eating difficulty [MD = -6.72, 95% CI (-10.62, -2.82), p < 0.001]. However, no significant differences were observed in postoperative reflux [MD = -5.90, 95% CI (-12.52, 0.73), p = 0.080], esophageal pain [MD = -1.86, 95% CI (-5.51, 1.78), p = 0.320], anastomotic leakage [RR = 0.70, 95% CI (0.37, 1.35), p = 0.290], and pulmonary infection [RR = 0.44, 95% CI (0.15, 1.35), p = 0.150].

Conclusion: EOF after esophagectomy appears to improve patients' quality of life; however, these findings are constrained by the limited number and quality of studies. Further research is needed to validate these results.

Objective: This study investigated the safe indocyanine green retention rate at the 15-minute (ICG-R15) threshold for hepatectomy and the effect of nutritional management on ICG-R15 and posthepatectomy liver failure (PHLF).

Methods: A retrospective cohort study was conducted on 70 hepatectomy patients with chronic liver disease, divided into routine care and nutrition intervention groups. ICG-R15 was measured pre- and postoperatively, along with PHLF occurrence and other health metrics.

Results: Seventy patients with chronic liver disease were divided into two groups: one received routine care, while the other followed a nutrition plan based on Omaha theory. The intervention group showed a significantly lower incidence of PHLF (15.8% vs 41.2%, p = 0.009) and clinically relevant PHLF (5.3% vs 19.6%, p = 0.031), along with shorter hospital stays (11.3 ± 6.4 days vs 21.5 ± 15.5 days, p = 0.012) and fewer complications (26.3% vs 47.1%, p = 0.020). The optimal ICG-R15 threshold for predicting PHLF was 4.5%, with 8.5% being critical.

Conclusion: ICG-R15 is a reliable predictor of PHLF, with 4.5% being safe and 8.5% critical. Nutritional management based on Omaha theory improves outcomes and quality of life. Further validation is needed.