An individualized food-based nutrition intervention reduces visceral and total body fat while preserving skeletal muscle mass in breast cancer patients under antineoplastic treatment.

BACKGROUND & AIMS: Breast cancer patients (BCP) during treatment often experience an increase in body weight and fat mass, and a decrease in muscle mass known as sarcopenic obesity, affecting their prognosis and quality of life. We aimed to evaluate the effect of a 6-month individualized food-based nutrition intervention program in nonmetastatic BCP body composition during treatment. METHODS: This is a pre-post study in recently diagnosed women with invasive ductal/lobular breast carcinoma (clinical stage I-III). The individualized nutrition intervention was based on the dynamic macronutrient meal equivalent menu method (MEM). Dietary plans were developed according to WCRF/AICR guidelines, BCP total energy expenditure, 1.2-1.5 g/kgBW/d of protein intake, 5-9 servings/day of fruits and vegetables, and a caloric restriction (500-1000 kcal/d) when applicable (BMI ≥ 25 kg/m2). Follow-up was every 2-weeks and a different diet menu was provided in each session during 6 months. Baseline and final measurements included the assessment of anthropometry, body composition, and physical activity. RESULTS: Twenty-two participants completed the study and at diagnosis 68% were overweighed or obese. After the 6-month nutrition intervention program, BCP lost 3.1 kg (p < 0.01) of body weight, 2.7 kg (p < 0.01) of fat-mass, 400 g (p < 0.01) of abdominal fat, 118 g (p < 0.05) of visceral fat, 1.2 kg/m2 of body mass index and 1.1 kg/m2 of fat mass index (p < 0.01). During the period, no changes were observed in bone mineral density (p = 0.3), fat-free mass (p = 0.1) and appendicular skeletal muscle mass (p = 0.2). Menopausal status in BCP did not modify the effect of the nutrition intervention. CONCLUSIONS: The individualized food-based nutrition intervention program empowered BCP to make informed healthy food choices within their personal preferences, socioeconomic and cultural background. With this type of intervention, nonmetastatic BCP reduced body weight, fat-mass, fat mass index, visceral and abdominal fat, while preserving skeletal muscle mass, during antineoplastic treatment. ClinicalTrials.govNCT03625635.

The "Super-Child" Approach Is Applied To Estimate Retinol Kinetics and Vitamin A Total Body Stores in Mexican Preschoolers.

BACKGROUND: Retinol isotope dilution (RID) and model-based compartmental analysis are recognized techniques for assessing vitamin A (VA) status. Recent studies have shown that RID predictions of VA total body stores (TBS) can be improved by using modeling and that VA kinetics and TBS in children can be effectively studied by applying population modeling ("super-child" approach) to a composite data set. OBJECTIVES: The objectives were to model whole-body retinol kinetics and predict VA TBS in a group of Mexican preschoolers using the super-child approach and to use model predictions of RID coefficients to estimate TBS by RID in individuals. METHODS: Twenty-four healthy Mexican children (aged 3-6 y) received an oral dose (2.96 µmol) of [13C10]retinyl acetate in corn oil. Blood samples were collected from 8 h to 21 d after dosing, with each child sampled at 4 d and at 1 other time. Composite data for plasma labeled retinol compared with time were analyzed using a 6-component model to obtain group retinol kinetic parameters and pool sizes. Model-predicted TBS was compared with mean RID predictions at 4 d; RID estimates at 4 d were compared with those calculated at 7-21 d. RESULTS: Model-predicted TBS was 1097 µmol, equivalent to ∼2.4 y-worth of VA; using model-derived coefficients, group mean RID-predicted TBS was 1096 µmol (IQR: 836-1492 µmol). TBS at 4 d compared with a later time was similar (P = 0.33). The model predicted that retinol spent 1.5 h in plasma during each transit and recycled to plasma 13 times before utilization. CONCLUSIONS: The super-child modeling approach provides information on whole-body VA kinetics and can be used with RID to estimate TBS at any time between 4 and 21 d postdose. The high TBS predicted for these children suggests positive VA balance, likely due to large-dose VA supplements, and warrants further investigation.

Antineoplastic treatment effect on bone mineral density in Mexican breast cancer patients.

BACKGROUND: Breast cancer is the most deadly malignancy in Mexican women. Although treatment has improved, it may significantly affect bone mineral status in those who receive it. The aim of this study was to assess the impact of cancer treatment on bone mineral density (BMD) and bone mineral content (BMC), in patients with breast cancer and explore the interaction of menopausal status and clinical stage with cancer treatment on such changes. METHODS: A quasi-experimental design was applied with measurements before and after a chemotherapy treatment in 40 patients with primary diagnosis of invasive breast cancer. BMD and body composition measurements were taken by dual X-ray absorptiometry (DXA) and changes in these variables due to therapy were analyzed using mixed regression for repeated measurements. RESULTS: Significant loss was found in femoral neck and L2-L4 BMD (p < 0.001). Patients diagnosed with osteopenia or osteoporosis received calcium + vitamin D supplementation (600 mg/200 IU day). It showed a protective effect in the decrease of femoral neck BMD and total BMC. BMD loss in both femoral neck and L2-L4 BMD was higher in premenopausal women: 0.023 g/cm2 in femoral neck and 0.063 g/cm2 in L2-L4 (p < 0.001), while in postmenopausal women BMD loss was 0.015 g/cm2 in femoral neck and 0.035 g/cm2 in L2-L4 (p = 0.021 and p = 0.001 respectively). Change in lumbar spine BMD was prominent in premenopausal women with advanced clinical stage (IIB, IIIA, IIIB): 0.066 g/cm2 (p = 0.003). CONCLUSION: The antineoplastic breast cancer treatment with chemotherapy had a negative impact on BMD, in premenopausal women overall, although a differential effect was found according to clinical stage and calcium supplementation status.

Impacto del tratamiento antineoplásico en el estado nutricional en pacientes con cáncer de mama / Antineoplastic treatment impact on nutritional status in patients with breast cancer

Introducción: El cáncer de mama es la neoplasia más diagnosticada en mujeres en México y también la de mayor mortalidad. Aunque el tratamiento ha mejorado, puede afectar de forma importante el estado nutricio de quienes lo reciben. Objetivo: Evaluar el impacto del tratamiento antineoplásico sobre el estado nutricio en pacientes con cáncer de mama. Pacientes y métodos: Se aplicó un diseño cuasiexperimental, antes y después de seis meses del inicio del tratamiento quimioterapéutico. Participaron 40 pacientes con diagnóstico primario de cáncer de mama invasivo. Se tomaron medidas antropométricas, de composición corporal mediante absorciometría dual de rayos X (DEXA) así como análisis de la dieta mediante recordatorio de 24 horas y cuestionario de frecuencia de consumo. Además, se cuantificaron los biomarcadores séricos, retinol y Beta-caroteno. El efecto del tratamiento se estimó utilizando regresión linear mixta para mediciones repetidas. Resultados: Se registró una pérdida de tejido magro (p=0.03). Además se encontró interacción del climaterio sobre los parámetros de peso, IMC y grasa corporal; solo en las pacientes preclimatéricas aumentaron estas medidas (p=0.005, 0.006 y 0.001 respectivamente). El retinol sérico disminuyó (p=0.049) pese al incremento en el Beta-caroteno (p=0.030). También se incrementó el consumo de vegetales y hubo una reducción en el consumo de alimentos de origen animal. Conclusión: El tratamiento antineoplásico para cáncer de mama afectó negativamente al peso y grasa corporal, principalmente en las mujeres jóvenes. Pese a las modificaciones dietarias, el consumo promedio de vegetales aún es insuficiente, lo cual se reflejó también en los biomarcadores séricos (AU)

Background: Breast cancer is the most commonly diagnosis malignancy in women in Mexico and also has the highest mortality. Although treatment has improved significantly, it can affect the nutritional status of the recipients. Objective: The aim of this study was to assess the impact of the initial phase of antineoplastic therapy on the nutritional status in patients with breast cancer. Methods: Forty subjects with primary diagnosed of invasive breast cancer were study in a before and after intervention (six months apart) using a quasi-experimental design. Basal and six month after intervention measurements included were anthropometry, body composition by dual X-ray absorptiometry (DEXA), diet by 24-hour recall and food frequency questionnaire, as well as serum Beta-carotene and retinol. The therapy effect was analyzed using repeated measurements mixed linear regression. Results: Lean tissue decreased after the studied period (p=0.032).Addicionally, there was an interaction between weight, BMI and body fat parameters with menopausal status, increasing in these variables due to therapy only premenopausal patients (p=0.005, 0.006 and 0.001, respectively). Serum retinol decreased (p=0.049) despite the improvement in Beta-carotene status (p=0.03). In general there was an increase the consumption of vegetables food products whilst a decrease in animal foods products. Conclusion: The breast cancer antineoplasic treatment had a negative effect on weight and body fat, especially in young women. Although there were some positive dietary changes, vegetables consumption remained insufficient, which was also reflected in serum biomarkers (AU)

Vitamin A-fortified milk increases total body vitamin A stores in Mexican preschoolers.

Vitamin A (VA) deficiency (VAD) continues to be a major nutritional problem in developing countries, including Central America. In Mexico, milk is a well-accepted vehicle for the administration of micronutrients, including VA, to preschoolers. Thus, we conducted a randomized, controlled, clinical trial to investigate the efficacy of daily consumption of 250 mL of VA-fortified milk (which provided 196 retinol equivalents/d) for 3 mo on VA stores in mildly to moderately VAD (serum retinol concentration 0.35-0.7 µmol/L) preschoolers who were not enrolled in a food assistance program. Twenty-seven mildly to moderately VAD children were randomly assigned based on screening measurements to either the intervention (n = 14) or control group (n = 13) (children in the control group did not receive placebo). All children in the control group and 79% (n = 11) of the children in the intervention group completed the study. The total body VA (TBVA) pool size was estimated using the deuterated retinol dilution technique before and after the intervention. After 3 mo, median changes in the serum retinol concentration for the intervention and control groups were 0.13 and -0.21 µmol/L, respectively (P = 0.009). Median changes in the TBVA stores were 0.06 and 0.01 mmol, respectively (P = 0.006) and estimated median changes in the liver VA concentration were 0.09 and 0.01 µmol/g, respectively (P = 0.002). The VA-fortified milk was well accepted among preschoolers and significantly increased TBVA stores, liver VA stores, and serum retinol concentration, indicating that it may be an effective means to ameliorate VAD in young Mexican children.

Efecto de la suplementación con una dosis masiva de vitamina A en niños de 6 a 36 meses de edad / Effect of massive vitamin A supplement in children from 6 to 36 months of age

Objetivo. Evaluar el impacto de la suplementación con una dosis masiva de vitamina A en el estado nutricio de dicha vitamina y del hierro, en niños de zonas urbanas marginadas de Hermosillo, Sonora, México. Material y métodos. Se seleccionaron 60 niños (6-36 meses), a los que se les administró una dosis de 100 00 UI (6-12 meses) y 200 000 UI (12-36 meses) de vitamina A en el Día Nacional de Salud de la Secretaría de Salud (junio de 1994). Se midieron niveles séricos de retinol, carotenioide, hierro, transferrina y ferritina, en tres fases: basal, a las dos semanas y después de tres meses. Resultados. En la primera fase, la mediana de retinol fue 0.7 µmol/l; en la segunda aumentó a 0.97 µmol/l (p< 0.001), y en la tercera disminuyó a 0.83 µmol/l (p> 0.05). Un 6.3 por ciento de los niños presentó deficiencia severa de vitamina A al inicio, y no se encontró ningún caso en las fases posteriores a la suplementación. En la fase basal, 42 por ciento de los casos presentaron deficiencia moderada y la mayoría fue normal en las siguientes fases. No hubo diferencias en los niveles de hierro y transferrina (p> 0.05), pero sí en ferritina (p< 0.001), lo que indica un mejoramiento en las reservas de hierro a los tres meses. Conclusiones. Las campañas de distribución de dosis masivas pueden tener un impacto importante en el estado nutricio de vitamina A y hierro