Bioimpedance-derived body composition parameters predict mortality and dose-limiting toxicity: the multicenter ONCO-BIVA study.

BACKGROUND: In patients with cancer, lean body mass loss is frequent and associated with worse outcomes, including reduced treatment tolerance and survival. Bioelectrical impedance analysis (BIA) is a popular method for body composition assessment. We evaluated the value of BIA-derived body composition parameters in predicting mortality and, for the first time, dose-limiting toxicity (DLT). PATIENTS AND METHODS: We conducted a prospective multicenter (n = 12) observational study in adult patients with solid neoplastic disease and receiving primary systemic treatment. We collected information on BIA-derived parameters: phase angle (PhA) <5th percentile of age and gender-specific normative values; standardized PhA (SPA) <-1.65; Nutrigram® <660 mg/24 h/m and <510 mg/24 h/m for males and females, respectively. The primary outcome and the key secondary were 1-year mortality and DLT (any-type severe toxicity requiring a delay in systemic treatment administration or a reduction of its dosage), respectively. RESULTS: In total, 640 patients were included. At 12 months, death occurred in 286 patients (47.6%). All BIA-derived body composition parameters were independently associated with death: SPA, hazard ratio (HR) = 1.59 [95% confidence interval (CI) 1.30-1.95] (P < 0.001); PhA, HR = 1.38 (95% CI 1.13-1.69) (P = 0.002); Nutrigram®, HR = 1.71 (95% CI 1.42-2.04) (P < 0.001). DLT occurred in 208 patients (32.5%) and body composition parameters were associated with this outcome, particularly SPA: odds ratio = 6.37 (95% CI 2.33-17.44) (P < 0.001). CONCLUSIONS: The study confirmed that BIA-derived body composition parameters are independently associated not only with survival but also with DLT. Although our findings were limited to patients receiving first-line systemic treatment, the evidence reported may have important practice implications for the improvement of the clinical work-up of cancer patients.

Tumour necrosis factor alpha and oxidative stress as maintaining factors in the evolution of anorexia nervosa.

OBJECTIVE: Aim of the study was to evaluate tumour necrosis factor α (TNF-α) axis and oxidative status in patients with anorexia nervosa (AN) seeking a possible correlation with both nutritional status and evolution of the disease. SUBJECTS AND METHODS: Thirty-nine consecutive women with AN and an age-matched healthy control group were studied. Patients were 26±9 yr, with a body mass index (BMI) of 13.9±2 kg/m(2). TNF-α, its receptors TNF-R55 and TNF-R75, and oxidative status markers (selenium, ascorbic/ dehydroascorbic acid, retinol, α-tocopherol, selenium-dependent gluthatione peroxidase, reduced/oxidated gluthatione) were measured. A correlation with both nutritional indexes (body weight, BMI, albumin, prealbumin, transferrin, lymphocyte count) and disease duration was investigated. Pearson's correlation and unpaired Student's t-test were used to compare patients and controls. RESULTS: TNF-α and oxidative status markers were significantly higher in patients than controls and TNF-α was directly related to dehydroascorbic acid (p<0.05). Both TNF-R55 and TNF-R75 were higher in patients with duration of disease longer than one year as compared to controls and patients with shorter duration. Receptors inversely correlated with BMI (p<0.05 and p<0.01) and directly with disease duration (p<0.05). Inverse correlation between disease duration and BMI was present (p<0.01). CONCLUSIONS: The study showed activation of TNF-α axis and oxidative stress in AN patients, as well as correlation between the two systems. Due to the correlation between TNF receptors and both BMI and disease duration, a possible role of pro-inflammatory cytokines in the evolution of the eating disorder is suggested.

Chronic anorexia nervosa: enteral nutrition via percutaneous endoscopic gastrostomy and liaison psychiatry.

Anorexia nervosa is a complex mental disorder characterized by altered eating behaviour often resulting in life-threatening weight loss (<85% of expected body weight) associated with amenorrhea and a disturbance of body image. Although classified as mental health disorders, they may lead to serious medical consequences and have the highest rate of premature death of any mental health diagnosis. We report our experience with the use of enteral feeding via percutaneous endoscopic gastrostomy in a 39-year-old woman with chronic restricter anorexia nervosa treated in liaison psychiatry and psychotherapy. On admission to psychiatry unit, the patient presented seriously deteriorated general condition and a body mass index (BMI) of 10 (BMI = weight kg/height m(2)). She refused oral feeding, but eventually accepted nasogastric feeding. In preparation for her continuing long-term (>1 month) enteral feeding at home, a percutaneous endoscopic gastrostomy was performed and a home nutrition support regimen that met her energy-protein intake requirements was prescribed. During the follow-up period, an overall improvement in nutritional status, general condition, mood and cognitive functioning was observed. Patient compliance with refeeding is notoriously problematic; however, enteral feeding interventions may be feasible in the long-term treatment of selected anorexia nervosa patients when closely followed-up by a multidisciplinary medical team.

[The efficacy of dietetic intervention in multiple sclerosis]. / Utilità dell'intervento dietetico nella sclerosi multipla.

The involvement of nutritional factors in the etiopathogenesis of multiple sclerosis is currently being investigated. Notwithstanding the huge amount of data present in the literature, the possible etiological or protective role of nutrients with regard to the disease remain debatable. The epidemiological data suggest an association between multiple sclerosis and nutrition; the populations that take in a higher quantity of foods of animal origin (meat p<0.0001 and dairy products p<0.01) seem to be the most affected. A role of saturated fatty acids in the etiopathogenesis of myelinic damage has been hypothesised. Case control studies have identified certain foods that act as risk factors and others as protection in the onset of the disease. Some case control studies point to a time-cause relationship between the intake of total calories (O.R. 2.03) and saturated fats (O.R. 1.88) and the incidence of multiple sclerosis; other prospective studies failed to confirm this hypothesis, negating the protective effect of a diet rich in anti-oxidant vitamins and polyunsaturated fatty acids. Intervention studies are discordant with respect to the effects of polyunsaturated fatty acid supplements on the course of the disease. In patients with a progressive chronic form of the disease, polyunsaturated fatty acids did not demonstrate any effect on the progression of the invalidating lesions. Interventions on patients suffering from an acute and remittent form have pointed to the significant effect of treatment with polyunsaturated fatty acids in slowing down the progression of lesions only in cases with a slight initial degree of disability or no disability (p=0.001) at all. They do, however, seem to confirm the hypothesis of an association between the gravity of the disease and consumption of saturated fats (p<0.05) and show an improvement trend in patients treated with polyunsaturated fatty acids, although the data are not statistically significant.

[Nutrition in acute pancreatitis]. / Pancreatite acuta: ruolo del nutrizionista.

Nutritional management during acute pancreatitis has the purpose to avoid a negative influence on the outcome and to preserve the morphofunctional integrity of the gut, preventing bacterial translocation. When the patient would start again normal nutrition after a period shorter than a week, thanks to the resolution of the clinical picture, and when the initial nutritional state of the patient is satisfactory, a particular nutritional support is not necessary. When the course of the disease is longer and the severity is higher, an early artificial nutritional support is advisable. Caloric needs thought to be useful are 25-30 kcal/kg/die; 40-60% of nutrient mixture should consist of carbohydrates and 20-30% of lipids. Proteins should be approximately 1.0-1.5 g/kg/die. On the basis of recent randomised, prospective clinical trials, enteral jejunal feeding is indicated as a first choice nutritional way, because of its ability to maintain the integrity of the intestinal barrier and its minimal effect on pancreatic secretion, acting significantly on inflammatory parameters and on prognostic markers. This procedure is not indicated when ileum is present and when it causes nausea, vomiting, abdominal pain and an increase of hepatic enzymes. In this case, parenteral feeding is an alternative. Hydroly-sated formulas, containing short peptides and a low percentage of long chain fat acids, are recommended.