Nutrition and Cancer-An International Journal最新文献

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.

Adenosine monophosphate-activated protein kinase (AMPK), a metabolic sensor activated by nutrient starvation, plays a multifaceted role in cancer. Whether AMPK is beneficial or malevolent is controversial. This study aimed to investigate AMPK levels in breast cancer patients receiving chemotherapy and compare the effects of intermittent fasting combined with different diets on these levels. Forty-five breast cancer patients were divided into three groups: a control, a group practicing 23:1-h intermittent fasting (IF) with a routine diet (RD), and another with a ketogenic diet (KD) over 4 weeks. Body mass index (BMI), Carbohydrate Antigen 15-3 (CA 15-3) levels, and serum AMPK levels were measured pre and post-intervention. Results showed a significant increase in AMPK levels in both the fasting groups and no significant difference in the non-fasting group, with the keto diet group showing the most significant growth. CA 15-3 levels were reduced in all the groups but significantly reduced in the KD group as compared to the RD group. This study shows that intermittent fasting with the keto diet improves AMPK levels and may serve as a valuable non-pharmacological complementary strategy for reducing or eliminating the tumor and, simultaneously, preventing the healthy cells from the toxic side effects of chemotherapy.

Objective: This study aims to evaluate the effects of a problem-oriented nursing model combined with early enteral nutrition (EEN) during the perioperative period in patients with stage II/III gastric cancer (GC).

Methods: One hundred patients with stage II/III GC were randomly divided into a control group (conventional perioperative care and routine nutritional support) and an intervention group (problem-oriented nursing model plus EEN). Clinical outcomes, body mass index (BMI), emotional status, nutritional and inflammatory markers, complication rates, and patient satisfaction were compared.

Results: Versus the control group, the intervention group exhibited shorter times to first flatus, hospital stay, ambulation, and defecation (Cohen's d = 1.93, 1.24, 1.49, 1.57), higher postoperative PA, Hb, and ALB levels (Cohen's d = -0.63, -0.78, -0.70), lower CRP, IL-6, and TNF-α levels (Cohen's d = 0.48, 1.07, 0.90), and lower SAS and SDS scores (Cohen's d = 1.80, 0.89). At discharge, the intervention group exhibited a higher BMI (Cohen's d = -2.13), lower overall incidence of complications (OR = 6.00), and higher patient satisfaction (OR = 0.17) (p < 0.05).

Conclusion: The problem-oriented nursing model combined with EEN support improves nutritional status, accelerates recovery, and enhances postoperative rehabilitation in patients with stage II/III GC undergoing surgery.

Objectives: Evidence regarding the association between tea consumption and bladder cancer (BC) risk is inconsistent. This study aimed to increase our knowledge of the association by using international data from the Bladder Cancer Epidemiology and Nutritional Determinants Consortium.

Methods: Individual data on 2,347 cases and 6,871 controls from 15 case-control studies with information on black, green, herbal, or general tea was pooled. The association was estimated using multilevel multivariable logistic regression analysis adjusted for multiple (non-)dietary factors.

Results: Association between tea consumption and BC risk was observed (odds ratio, OR = 0.72, 95% confidence interval, 95% CI = 0.65-0.80) compared to non-tea drinkers. Stratified analyses based on gender and smoking status yielded similar results. Stratified analysis showed no significant association between black or green tea consumption and BC risk across models, while herbal tea consumption was linked to a reduced BC risk (OR = 0.59, 95% CI = 0.36-0.96). As daily tea consumption increased within a suitable range (<5.67 cups/day), BC risk decreased.

Conclusions: Camellia sinensis tea showed no association with BC risk, while herbal tea was inversely linked to BC incidence. Despite some significant findings in the selected strata, further studies are required to clarify the underlying mechanisms.

This study aimed to evaluate the effect of vitamin D (VD) supplementation on the pathological complete response (pCR) rate in women with breast cancer (BC) undergoing neoadjuvant chemotherapy (NCT). A randomized clinical trial was conducted with 80 women aged ≥45years with BC who were eligible for NCT. Women were randomized into two groups: VD group, daily supplementation with 2,000IU of cholecalciferol (n = 40) or placebo (n = 40), for 6 months. The primary outcome measure was the pCR rate. Serum 25-hydroxyvitamin-D [25(OH)D] levels were measured after BC diagnosis and the end of NCT. Of the 80 randomized women, 75 completed the NCT and underwent surgery. Baseline 25(OH)D values indicated hypovitaminosis D in both groups (VD: 19.6 ± 5.8 ng/mL and placebo: 21 ± 7.9 ng/mL, p = 0.33). After 6 months, 25(OH)D levels increased in the VD group compared to the placebo group (28 ± 8.7 vs. 20.2 ± 6.1 ng/mL, p = 0.03). The pCR rate was higher in women supplemented with VD when compared than the placebo (43% vs. 24%, p = 0.04). Adjusted logistic regression showed that women with 25(OH)D levels ≥20ng/mL were more likely to achieve pCR (OR3.65, 95%CI 1.09-12.8, p = 0.04). Women with BC undergoing NCT who received supplementation with 2,000IU of VD were more likely to achieve a pathological complete response than women in the placebo group.

Trial registration: Ensaiosclinicos.gov.br, identifier RBR-10k4gqdg.

The aim of the present study was to determine the effectiveness of combined exercise and nutrition interventions on physical function and quality of life (QOL) in patients with acute leukemia or malignant lymphoma (ML) during inpatient chemotherapy. The study was a randomized controlled trial where patients with acute leukemia or ML who were receiving inpatient chemotherapy and exercise therapy were divided into an intervention group (IG) and a control group (CG). Both groups underwent resistance training and aerobic exercise. The patients in the IG were instructed to take nutritional supplements twice a day. Assessment items were muscle strength (handgrip strength and knee extension strength), 6-min walking test, skeletal muscle mass, QOL, nutritional status, and fatigue. Two-way analysis of variance showed a significant interaction for bilateral handgrip strength and knee extension strength. No significant interactions were found for the other items. The results of the present study showed improved muscle strength in the IG compared to the CG, indicating the effectiveness of combined exercise and nutrition interventions during inpatient chemotherapy in patients with acute leukemia or ML.