DEPEND study protocol: early detection of patients with pancreatic cancer - a pilot study to evaluate the utility of faecal elastase-1 and 13C-mixed triglyceride breath test as screening tools in high-risk individuals.

INTRODUCTION: Pancreatic cancer (PC) is the fifth leading cause of cancer-related death in the UK. The incidence of PC is increasing, with little or no improvement in overall survival and the best chance for long-term survival in patients with PC relies on early detection and surgical resection. In this study, we propose the use of a diagnostic algorithm that combines tests of pancreatic exocrine function (faecal elastase-1 (FE-1) test and the 13C-mixed triglyceride (13C-MTG) breath test) to identify patients with PC that urgently needs imaging studies. METHODS AND ANALYSIS: This prospective pilot (proof of concept) study will be carried out on 25 patients with resectable PC, 10 patients with chronic pancreatitis and 25 healthy volunteers. This study will construct a predictive algorithm for PC, using two tests of pancreatic exocrine function, FE-1 test and the 13C-MTG breath test. Continuous flow isotope ratio mass spectrometry in the 13C-MTG breath test will be used to analyse enriched 13CO2 in exhaled breath samples. The additional predictive benefit of other potential biomarkers of PC will also be considered. Potential biomarkers of PC showing abilities to discriminate between patients with PC from healthy subjects or patients with chronic pancreatitis will be selected by metabolomic analysis. ETHICS AND DISSEMINATION: The study was approved by the North of Scotland Research and Ethics Committee on 1 October 2020 (reference: 20/NS/0105, favourable opinion granted). The results will be disseminated in presentations at academic national/international conferences and publication in peer-review journals.

Growth, tolerance and biochemical measures in healthy infants fed a partially hydrolyzed rice protein-based formula: a randomized, blinded, prospective trial.

OBJECTIVE: To evaluate growth, tolerance and plasma biochemistries in infants fed an experimental rice protein-based infant formula. DESIGN: Randomized, blinded, 16 week parallel feeding trial of 65 healthy infants fed either an experimental partially hydrolyzed rice protein-based infant formula fortified with lysine and threonine (RPF, n = 32), or a standard intact cow's milk protein-based formula (CMF, n = 33) as a control. Assessments occurred at enrollment (average 2 days), 2, 4, 8, and 16 weeks of age. RESULTS: Growth as indicated by weight, length, and head circumference was not different between the 2 formula groups. All plasma biochemistries for both groups were within reference normal range. However, RPF group had lower phosphorus and urea nitrogen, lower essential amino acids except threonine, which was higher, and lower ratio of essential (including semi-essential) to non-essential amino acids. Differences in the concentrations and ratios of amino acids became less as feeding progressed with age. Plasma total protein, albumin, prealbumin, calcium, magnesium, and alkaline phosphatase were not different between groups. CONCLUSION: Healthy infants fed an experimental partially hydrolyzed rice protein-based formula had normal growth, tolerance, and plasma biochemistry comparable to those of infants fed a standard intact milk protein-based formula, despite some differences in amino acid profiles.

Body composition of newborn twins: intrapair differences.

OBJECTIVE: To measure body composition in newborn twins and to test the hypothesis that differences in body weights between twins are reflected proportionally by their differences in various components of body composition. METHODS: 48 pairs of newborn twins delivered at a tertiary teaching hospital had dual energy x-ray absorptiometry (DXA) body composition measurement for bone mineral content (BMC), lean and fat mass (LM, FM). Data analyzed with regression and analysis of variance. RESULTS: Body weight, BMC, LM and FM increased with increased gestational age (p < 0.001). The percent difference in BW between each twin pair was significantly correlated with percent difference in BMC, LM, and FM (p < 0.001). However, mean (+/- SD) percent difference in body weight (14.3+/-10.0%) was significantly lower (p < 0.001) than FM (26.0+/-15.0%) but was not significantly different from LM (13.4+/-9.0%) or BMC (15.9+/-11.6%). CONCLUSION: In newborn twins, body weight and body composition varies with gestational age. For any twin pair, a difference in body weight was correlated with but not proportional to differences in individual components of body composition.

Body composition in neonates: relationship between measured and derived anthropometry with dual-energy X-ray absorptiometry measurements.

This study examined the relationship between measured and derived anthropometric measurements with dual-energy X-ray absorptiometry measured lean and fat mass at 3.0 +/- 2.8 (SD) days in 120 neonates with birth weights appropriate (AGA; n=74), large (LGA; n=30); or small (SGA, n=16) for gestational age. Anthropometric measurements, including total body weight and length, and regional measurements, including circumferences of head, chest, abdomen, midarm, and midthigh and dynamic skinfold thickness (15 and 60 s) at tricep, subscapular, suprailiac, and midthigh, were performed. Derived anthropometry included muscle and fat areas, and ratios were calculated from direct measurements. The skinfold thickness measurements between 15 and 60 s were highly correlated (r=0.973-0.996, p <0.001 for all comparisons). Strong correlations existed within the four circumferences of trunk and extremities, the four skinfolds, and the ratios of weight to length and its higher powers. Weight and length accounted for >97% of the variance of lean mass in AGA and SGA infants and 46% of the variance in LGA infants and for 80, 82, and 84% of the variance of fat mass in SGA, AGA, and LGA infants, respectively, whereas midarm:head circumference ratio and arm muscle and fat areas are the most important derived anthropometry in the prediction for body composition. They independently accounted for up to 16.5 and 10.2%, respectively, of the variance in body composition depending on the state of in utero growth. Thus, total body weight and length and some selected regional and derived anthropometry accounted for the vast majority of the variance of body composition.