Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content.

OBJECTIVE: To investigate the effect of including seafood and fish oils, as part of an energy-restricted diet, on weight loss in young overweight adults. DESIGN: Randomized controlled trial of energy-restricted diet varying in fish and fish oil content was followed for 8 weeks. Subjects were randomized to one of four groups: (1) control (sunflower oil capsules, no seafood); (2) lean fish (3 x 150 g portions of cod/week); (3) fatty fish (3 x 150 g portions of salmon/week); (4) fish oil (DHA/EPA capsules, no seafood). The macronutrient composition of the diets was similar between the groups and the capsule groups, were single-blinded. SUBJECTS: A total of 324 men and women aged 20-40 years, BMI 27.5-32.5 kg/m(2) from Iceland, Spain and Ireland. MEASUREMENTS: Anthropometric data were collected at baseline, midpoint and endpoint. Confounding factors were accounted for, with linear models, for repeated measures with two-way interactions. The most important interactions for weight loss were (diet x energy intake), (gender x diet) and (gender x initial-weight). RESULTS: An average man in the study (95 kg at baseline receiving 1600 kcal/day) was estimated to lose 3.55 kg (95% CI, 3.14-3.97) (1); 4.35 kg (95% CI, 3.94-4.75) (2); 4.50 kg (95% CI, 4.13-4.87) (3) and 4.96 kg (95% CI, 4.53-5.40) on diet (4) in 4 weeks, from baseline to midpoint. The weight-loss from midpoint to endpoint was 0.45 (0.41-0.49) times the observed weight loss from baseline to midpoint. The diets did not differ in their effect on weight loss in women. Changes in measures of body composition were in line with changes in body weight. CONCLUSION: In young, overweight men, the inclusion of either lean or fatty fish, or fish oil as part of an energy-restricted diet resulted in approximately 1 kg more weight loss after 4 weeks, than did a similar diet without seafood or supplement of marine origin. The addition of seafood to a nutritionally balanced energy-restricted diet may boost weight loss.

Inflammation and conjugated linoleic acid: mechanisms of action and implications for human health.

Data from a number of studies and trials have shown that different conjugated linoleic acids (CLA's) may produce beneficial effects on cancer, atherosclerosis, hypertension, diabetes and changes in body composition. Despite the increasing knowledge about CLA's implications on health, the mechanism of action of these fatty acids is not completely understood. Moreover, human studies indicate that some of these beneficial effects are considerably less evident than anticipated from mice studies, while the efficacy and safety of dietary supplements containing CLA have been questioned in some intervention trials. Recently, it has been suggested that the anti-carcinogenic and anti-atherosclerosis effects of CLA's stem from its anti-inflammatory properties. Because inflammatory responses are associated with the pathophysiology of many diseases, including obesity and the metabolic syndrome, the investigation in this area is of growing interest in recent years.

Relationship between degree of cellular differentiation in colorectal cancer and topographical distribution.

OBJECTIVES: To demonstrate the relationship between degree of cellular differentiation in colorectal cancer and topographical distribution in 215 patients diagnosed with colorectal cancer from 1997 to 2000. MATERIAL AND METHODS: 215 patients (129 men and 86 women) were studied prospectively with a mean age of 64 years (range: 23-84 years). In all patients we performed a full colonoscopy with several biopsies (in patients with colon stenosis we used barium enema), radiographic studies (CT, abdominal ultrasounds), and laboratory tests for serum tumour markers (CEA, Ca 19-9, alpha-fetoprotein). The topographic location of colorectal cancer was: rectum 35%, sigmoid colon 31%, descending colon 10%, transverse colon 6%, ascending colon 9%, caecum 5%, and we included anorectal cancer 4%. RESULTS: According to histological differentiation we found: A) well-differentiated tumours 101/215 (47%); B) moderately-differentiated tumours 98/215 (45.5%), and C) poorly-differentiated tumours 16/215 (7.5%). We found no significant association among histological differentiation, topographic location, stage according to the Astler-Coller classification, sex or age (p = ns). The prevalence of well-differentiated tumours in men was 49% and 43% in women; of moderately-differentiated cancers in men was 43%, and 49% in women; for poorly-differentiated tumours in men was 7.5%, and 7.2% in women. Regarding tumour location, 165 cancers were found in the left colon: 80 were well differentiated, 77 moderately differentiated and 8 poorly differentiated. In the transverse colon we found 12 tumours: 7 well differentiated, 3 moderately differentiated and 2 poorly differentiated. 30 cancers were localized in the right colon: 11 well differentiated, 15 moderately differentiated and 4 poorly differentiated. In the anorectum 8 tumours were found: 3 well differentiated, 3 moderately differentiated and 2 poorly differentiated. According to staging classification, well differentiated tumours (101/215) were more common in Dukes' C2 (20.7%) and B1 (32.6%), moderately differentiated cancers (98/215) were in B1 (28.5%) and C2 (20.4%), and poorly differentiated tumours (16) were more common in Dukes' C2 (25%), without differences among other stages (p = ns). CONCLUSIONS: According to our results we have found that histological differentiation of colorectal cancer has no association with topographic location, and it is independent of sex or age. We have not found any relationship either between histological differentiation and stage in the Astler-Coller classification, but well differentiated cancers were more common at any location, age or sex.

Relationship between degree of cellular differentation in colorectal cancer and topographical distribution / Relationship between degree of cellular differentiation in colorectal cancer and topographical distribution

Objetivos: intentar establecer la relación existente entre el grado de diferenciación celular del cáncer de colon y su distribución topográfica, en 215 pacientes diagnosticados de cáncer colorrectal entre los años 1997 y 2000.Material y métodos: se estudiaron de forma prospectiva 215 pacientes (129 hombres y 86 mujeres) de edades comprendidas entre 23 y 84 años, con edad media de 64 años. En todos se realizó colonoscopia completa con varias tomas de biopsia. En los casos de estenosis tumoral con imposibilidad para sobrepasar la lesión se realizó enema opaco. Los estudios de extensión incluyeron TAC y ecografía abdominal, hemograma, perfil bioquímico completo y marcadores tumorales (CEA, Ca 19-9 y alfafetoproteina). La distribución topográfica de los cánceres colorrectales fue la siguiente: recto 78 (35 por ciento), sigma 66 (31 por ciento), descendente 21 (10 por ciento), transverso 12 (6 por ciento), ascendente 19 (9 por ciento), ciego 11 (5 por ciento), y anorrectal 8 (4 por ciento).Resultados: siendo el objetivo de nuestro estudio el establecer la relación entre el asentamiento tumoral en el colon y su grado de diferenciación celular encontramos: a) bien diferenciados 101/215 (47 por ciento); b) moderadamente diferenciados 98/215 (45,5 por ciento); y c) pobremente diferenciados 16/215 (7,5 por ciento). El cáncer bien diferenciado lo encontramos en el 49 por ciento de los hombres y en el 43 por ciento de las mujeres, el moderadamente diferenciado fue del 43 por ciento entre los hombres y del 49 por ciento entre las mujeres, el pobremente diferenciado fue del 7,5 por ciento entre los hombres y del 7,2 por ciento entre las mujeres. Según su distribución: en el colon izquierdo , 80 adenocarcinomas eran bien diferenciados, 77 moderadamente diferenciados y 8 pobremente diferenciados; en el colon transverso ; 7 adenocarcinomas eran bien diferenciados, 3 moderadamente diferenciados y 2 pobremente diferenciados, en el colon derecho 11 adenocarcinomas eran bien diferenciados, 15 moderadamente diferenciados y 4 pobremente diferenciados. De los 8 cánceres recto-anales , 3 eran bien diferenciados, 3 moderadamente diferenciados y 2 pobremente diferenciados, habiendo observado que dicho grado de diferenciación no tiene un significado estadístico de relación con la distribución topográfica del tumor. Según la clasificación por estadios, los bien diferenciados (101/215) fueron más frecuentes en los estadios B1 (32,6 por ciento) y C2 (20,7 por ciento); los moderadamente diferenciados (98/215) lo fueron en los estadios B1 (28,5 por ciento) y C2 (20,4 por ciento); el 25 por ciento de los estadios C2 fueron tumores pobremente diferenciados . No apreciamos diferencias estadísticamente significativas en la distribución de los grados de diferenciación por estadios (p=ns).Conclusiones: según nuestros resultados, no hemos observado que el grado de diferenciación celular del cáncer colorrectal se relacione con su localización inicial en el colon y es, igualmente, independiente del sexo y de la edad. En cuanto a su posible relación con la clasificación por estadios de Dukes y Astler-Coller tampoco hemos podido demostrarla (AU)

Tratamiento de las hepatitis virales crónicas B y C según la medicina basada en la evidencia / Evidence-based medicine treatment of chronic viral hepatitis B and C

En todo el mundo, la hepatitis viral es la principal causa de ictericia, enfermedad hepática crónica, cirrosis y hepatocarcinoma. Aunque se han realizado importantes avances en el tratamiento y en la prevención , no existe un tratamiento totalmente satisfactorio para cada una de estas dos enfermedades. Ambas representan un porcentaje elevado de la etiología de las hepatitis virales y tienen una alta tendencia a la cronicidad y al desarrollo de cirrosis, conllevando gran consumo de recursos sanitarios. Por otra parte los tratamientos son prolongados y con fármacos de precio elevado. Por ello es necesario aplicar la medicina basada en la evidencia en este tipo particular de patología para alcanzar la mejor relación coste/beneficio. En la presente revisión, analizamos los diferentes fármacos y regímenes de tratamiento empleados en las hepatitis crónicas virales B y C, así como las respuestas obtenidas (AU)