Vitamin and herbal supplements' use among patients with advanced gastrointestinal cancers included in eight clinical trials.

OBJECTIVE: To evaluate the patterns of vitamin and herbal supplement use among patients with advanced gastrointestinal (GI) cancers and the association of such behavior with the efficacy and toxicity of systemic anticancer treatment. METHODS: Project data sphere (PDS) was used to access de-identified datasets of eight clinical trials of advanced GI cancers. Multivariable logistic regression analysis was used to identify factors predicting the use of supplements. Kaplan-Meier survival estimates were used to evaluate the association of supplement use with overall and progression-free survival. Results were stratified according to the site of the primary tumor [pancreatic, gastric, colorectal or hepatocellular carcinoma (HCC)] The association between supplement use and selected chemotherapy side effects was evaluated through Chi-squared testing and subsequent logistic regression. RESULTS: A total of 3441 patients were included in the analysis. Of these, 775 patients reported use of supplements and 2666 patients reported no use of supplements. Higher ECOG performance score (Odds ratio: OR for ECOG 1 versus 0: 1.629; 95% CI 1.363-1.947; P < 0.001) and pancreatic primary site (OR for gastric cancer versus pancreatic cancer: 0.538; 95% CI 0.408-0.709; P < 0.001) was associated with greater use of these supplements. Supplement use was associated with a better overall survival among patients with pancreatic cancer (P = 0.002) but not other GI malignancies. Supplement use was associated with a higher probability of anemia and diarrhea among patients with pancreatic cancer (P < 0.001 for both), gastric cancer (P = 0.016; P = 0.036, respectively) and colorectal cancer (P < 0.001 for both). CONCLUSIONS: There is an association between the use of vitamin and herbal supplements and a higher probability of hematologic and gastrointestinal toxicities. There is a need for more studies to confirm the association between such behavior and better overall survival among patients with pancreatic cancer.

Fish oil-enriched nutrition combined with systemic chemotherapy for gastrointestinal cancer patients with cancer cachexia.

Despite recent advances in chemotherapy for gastrointestinal cancer, a crucial factor related to poor prognosis is reduced tolerance to chemotherapy induced by cancer cachexia. Fish oil (FO)-derived eicosapentaenoic acid (EPA) modulates inflammation in patients with various malignancies; however, the impact of FO-enriched nutrition as a combined modality therapy on clinical outcomes remains controversial. We systemically analysed chronological changes in biochemical and physiological status using bioelectrical impedance analysis in 128 gastrointestinal cancer patients provided with or without FO-enriched nutrition during chemotherapy. Furthermore, we evaluated the clinical significance of FO-enriched nutrition and clarified appropriate patient groups that receive prognostic benefits from FO-enriched nutrition during treatment of gastrointestinal cancer. The control group showed significant up-regulation of serum CRP) levels and no significant difference in both skeletal muscle mass and lean body mass. In contrast, the FO-enriched nutrition group showed no changes in serum CRP concentration and significantly increased skeletal muscle mass and lean body mass over time. Furthermore, high CRP levels significantly correlated with reduced tolerance to chemotherapy, and FO-enriched nutrition improved chemotherapy tolerance and prognosis, particularly in gastrointestinal cancer patients with a modified Glasgow prognostic score (mGPS) of 1 or 2. We conclude that FO-enriched nutrition may improve the prognosis of patients with cancer cachexia and systemic inflammation (i.e., those with a mGPS of 1 or 2).

Effects of omega-3 fatty acids on patients undergoing surgery for gastrointestinal malignancy: a systematic review and meta-analysis.

BACKGROUND: Surgical resection remains the primary treatment for gastrointestinal (GI) malignancy including early-stage cancer. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been reported to have beneficial clinical and immune-modulating effects in the prognosis of GI cancer patients undergoing surgery. METHODS: We searched PubMed, Embase, EBSCO-Medline, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI and Wanfang to identify primary research reporting the effects of n-3 PUFAs compared with isocaloric nutrition on GI cancer patients who underwent surgery up to the end of June 30, 2016. Two authors independently reviewed and selected eligible randomized controlled trials (RCTs). RESULTS: A total of 9 RCTs (623 participants) were included. The n-3 PUFAs regime resulted in lower levels of C-reactive protein (CRP) (P < 0.05), interleukin-6 (IL-6) (P < 0.01), and higher levels of albumin (ALB), CD3+ T cells, CD4+ T cells and CD4+/CD8+ ratio (P < 0.05) compared with the isocaloric nutrition regime. However, there was no significant difference in the level of tumor necrosis factor-α (TNF-α) between the n-3 PUFAs regime and the isocaloric nutrition regime (P = 0.17). And the level of CD8 + T cells decreased compared with the isocaloric nutrition regime (P < 0.0001). CONCLUSIONS: Our meta-analysis revealed that n-3 PUFAs are effective in improving the nutritional status and immune function of GI cancer patients undergoing surgery as they effectively enhance immunity and attenuate the inflammatory response.

Nutrition care in patients with cancer: A retrospective multicenter analysis of current practice - Indications for further studies?

BACKGROUND & AIMS: Weight loss and malnutrition are frequent problems in oncology patients. The aim of this study was to get a perspective of the current practice of parenteral nutrition (PN) care in an outpatient setting and to improve patient-centered nutritional care. METHODS: Fifty-three outpatient oncology centers participated in this observational study performed between July 2010 and March 2011. All participating centers entered data online into a web-based documentation form, containing a number of oncology patients, diagnoses, and detailed data about oncology patients receiving PN. RESULTS: Two cohorts were analyzed. First cohort consisted of all oncology patients in quarter 04/2010. Second cohort consisted of patients with PN during the whole studying period. In the first cohort 2.46% (n = 626) of 25,424 oncology patients received PN. Most frequent diagnoses of patients receiving PN were gastric cancer (n = 119) and colorectal cancer (n = 104), however most stated diagnosis was "other" (n = 163). In the second cohort (n = 1137), a common indication for PN was impaired gastrointestinal passage (n = 177), although here again most stated reason was "other" (n = 924). In the course of the PN treatment, patients (n = 1137) showed a stable or slowly increasing body mass index (from 21.6 ± 3.8 kg/m(2) to 21.8 ± 3.5 kg/m(2)). CONCLUSION: This is the largest study outlining the characteristics of oncology patients in the context of PN in German ambulatory centers. They confirm the important role of PN in the care of gastrointestinal cancer. Further studies have to be performed to identify if other indications than those mentioned in relevant guidelines can trigger initiation of PN.

Dietary therapy of qi-yin-reinforcing porridge for the alleviation of chemotherapy related symptoms of gastrointestinal tumors: a single-case randomized controlled study.

OBJECTIVE: To investigate the efficacy of dietary therapy of qi-yin-reinforcing porridge for the alleviation of clinical symptoms during FOLFOX chemotherapy. METHODS: A single-case randomized controlled study was carried out. Fourteen patients with gastrointestinal tumors accepting FOLFOX chemotherapy were enrolled using self-crossover control design. On days 1-7 of chemotherapy, the dietary therapy experimental group and the placebo control group were given dietary therapy of qi-yin-reinforcing porridge and dextrin-prepared porridge which had the same appearance, smell, color and taste as the qi-yin-reinforcing porridge, respectively. Fourteen clinical symptoms, including debility, vomiting and nausea, etc. were observed. RESULTS: Ten patients completed the study and were estimable. The qi-yin-reinforcing porridge demonstrated certain efficacy in alleviating clinical symptoms of patients with gastrointestinal tumors during the period of chemotherapy. Better effect of alleviating debility was found in the dietary therapy experimental group than in the placebo control group, and the difference was statistically significant (Z=2.27, P=0.02). No statistically significant difference was found between the experimental group and the control group with respect to the effect of alleviating the other 13 clinical symptoms including anorexia, nausea, vomiting, dry stool, loose stool, etc. and body weight (P>0.05). CONCLUSION: Dietary therapy of qi-yin-reinforcing porridge shows an additional benefit in alleviating debility of patients during chemotherapy and deserves clinical use and popularization.

Mushroom Ganoderma lucidum prevents colitis-associated carcinogenesis in mice.

BACKGROUND: Epidemiological studies suggest that mushroom intake is inversely correlated with gastric, gastrointestinal and breast cancers. We have recently demonstrated anticancer and anti-inflammatory activity of triterpene extract isolated from mushroom Ganoderma lucidum (GLT). The aim of the present study was to evaluate whether GLT prevents colitis-associated carcinogenesis in mice. METHODS/PRINCIPAL FINDINGS: Colon carcinogenesis was induced by the food-borne carcinogen (2-Amino-1-methyl-6-phenylimidazol[4,5-b]pyridine [PhIP]) and inflammation (dextran sodium sulfate [DSS]) in mice. Mice were treated with 0, 100, 300 and 500 mg GLT/kg of body weight 3 times per week for 4 months. Cell proliferation, expression of cyclin D1 and COX-2 and macrophage infiltration was assessed by immunohistochemistry. The effect of GLT on XRE/AhR, PXR and rPXR was evaluated by the reporter gene assays. Expression of metabolizing enzymes CYP1A2, CYP3A1 and CYP3A4 in colon tissue was determined by immunohistochemistry. GLT treatment significantly suppressed focal hyperplasia, aberrant crypt foci (ACF) formation and tumor formation in mice exposed to PhIP/DSS. The anti-proliferative effects of GLT were further confirmed by the decreased staining with Ki-67 in colon tissues. PhIP/DSS-induced colon inflammation was demonstrated by the significant shortening of the large intestine and macrophage infiltrations, whereas GLT treatment prevented the shortening of colon lengths, and reduced infiltration of macrophages in colon tissue. GLT treatment also significantly down-regulated PhIP/DSS-dependent expression of cyclin D1, COX-2, CYP1A2 and CYP3A4 in colon tissue. CONCLUSIONS: Our data suggest that GLT could be considered as an alternative dietary approach for the prevention of colitis-associated cancer.

Evaluación de la terapia nutricional perioperatoria en pacientes con neoplasia del tracto gastrointestinal superior / Evaluation of perioperative nutritional therapy in patients with gastrointestinal tract neoplasms

Objetivos: La enfermedad oncológica se acompaña de un grado importante de desnutrición que se asocia con elevadas tasas de morbi-mortalidad postoperatoria. El propósito de este estudio fue evaluar la efectividad de un programa de apoyo nutricional perioperatorio de cara a reducir complicaciones postoperatorias, estancias hospitalarias y mortalidad entre pacientes sometidos a cirugía oncológica del tracto digestivo superior. Métodos: Estudio prospectivo aleatorizado sobre una muestra de pacientes intervenidos por cáncer gastrointestinal alto (esófago, estómago, cardias y duodeno/páncreas) durante un periodo de 4 años. Se realizó una valoración nutricional y se administró de forma perioperatoria una formula enteral inmunomoduladora a un grupo de pacientes malnutridos (DS), mientras que otro grupo de pacientes malnutridos (DNS) y los normonutridos (NN) recibieron consejo dietético antes de la cirugía y después de esta sueros por vía intravenosa hasta la reintroducción de la dieta normal. Las variables estudiadas fueron edad, sexo, estadio tumoral, tipo de neoplasia y estancia hospitalaria. También se recogieron la situación nutricional, mortalidad, complicaciones postoperatorias y alteraciones gastrointestinales. Para el análisis estadístico realizamos un estudio de frecuencias y aplicamos el test de Chi-cuadrado en las variables cualitativas. Para las cuantitativas usamos la ANOVA y el test Post-hoc de Tukey. Se consideraron significativos aquellos valores de p < 0,05. Resultados: Estudio sobre 50 pacientes divididos en 3 grupos. Se encontraron diferencias estadísticamente significativas en la incidencia de complicaciones gastrointestinales e infecciosas con mejores avances en el grupo DS. Se obtuvo una reducción de la duración de la estancia hospitalaria de 12,29 días en el grupo de DS en contraste con el grupo DNS (P = 0,224). Conclusiones: Se ha demostrado un beneficio significativo del apoyo nutricional perioperatorio en los pacientes severamente desnutridos sometidos a cirugía que recibieron suplementación. Se observaron en estos pacientes una menor incidencia de complicaciones gastrointestinales e infecciosas así como acortamiento de la estancia hospitalaria con respecto a los pacientes desnutridos que no recibieron suplementación perioperatoria (AU)

Objectives: Cancer is usually associated to an important level of desnutrition together with a postoperative morbidity and mortality increase. The purpose of this study was evaluating its efficacy perioperative nutritional support to reduce surgical complications, stances and mortality significantly in patients undergoing higher digestive tract procedures. Method: A prospective, randomized trial was done among a sample of neoplasic patients undergoing higher intestinal tract resective surgery during a period of 4 years. After a nutritional assessment, a perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received pre-surgical dietetic guidance and intravenous fluids after surgery until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi(2) for qualitative variables, ANOVA and the Turkey post-hoc tests for the quantitative ones, with a significance of 95%. Results: Sample conformed by 50 patients in 3 groups that were compared for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal and infectius complications with better progress in DS group. It was obtained a reduction in the length of hospital stay in 12.29 days in DS group in contrast to DNS group (P = 0,224). Conclusions: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity occurred on the group that received perioperative nutrition(AU)

Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial.

BACKGROUND: Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma. METHODS: Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. RESULTS: In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal (n = 277) and lung (n = 81) cancers were recruited. Median (range) follow-up was 6 (0-49) months. One-year survival was 38.6% (95% confidence interval 33.3-43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. CONCLUSIONS: Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention.

Treatment with growth hormone, somatostatin, and insulin in combination with hypocaloric parenteral nutrition in gastrointestinal cancer patients after surgery.

OBJECTIVE: The metabolic response to gastrointestinal cancer in patients undergoing surgery is associated with hypermetabolism and insulin resistance. The potential use of synergetic anabolic hormones in conjunction with hypocaloric parenteral nutrition (HPN) has become a significant area of investigation. The presented study was performed to determine the clinical efficiency and safety of hormone therapy combined with HPN in patients with gastrointestinal cancer. METHODS: One hundred patients with a Nutrition Risk Screening score of 3 or 4 undergoing surgery for gastrointestinal cancer were randomized into two groups. The patients in the control group received standard total parenteral nutrition and systemic insulin. The patients in the study group received HPN and systemic insulin in addition to pretreatment with recombinant human growth hormone and octreotide. Clinical efficiency and safety were evaluated by the measurement of hormones and protein metabolites, immune function, clinical outcome, and adverse events. Follow-ups were performed to determine the influence on prognosis. RESULTS: Treatment with recombinant human growth hormone, octreotide, and insulin in combination with HPN significantly increased protein synthesis, immune function, and metabolic tolerance, decreased infectious complications, and shortened postoperative hospital stays, but did not increase the risk of tumor development and recurrence in the study group compared with the control group. CONCLUSION: The proper short-term perioperative administration of growth hormone, somatostatin, and insulin in combination with HPN can overcome the postoperative stress response through the increase of protein synthesis to improve immune function in patients with gastrointestinal cancer after surgery.

[The significance of Onodera's prognostic nutritional index for the treatment of gastrointestinal cancer].

BACKGROUND: We evaluated the role of the prognostic nutritional index reported by Onodera (Onodera's PNI) in patients with gastrointestinal cancer regarding the occurrence of postoperative complications. METHOD: Subjects were 324 patients (42 with esophageal cancer, 107 with gastric cancer, and 175 with colon cancer). We classified them into the high risk group (< or = 40) and the non-high risk group (> 40) according to Onodera's PNI. We evaluated the rate of the occurrence of postoperative complications between the high risk group and the non-high risk group. RESULT: The rate of postoperative complications occurring in the high risk group was higher than that of the non-high risk group (p=0.04). CONCLUSION: Onodera's PNI is useful for patients with gastrointestinal cancer regarding the occurrence of postoperative complications.

Nutritional support during oncologic treatment of patients with gastrointestinal cancer: who could benefit?

INTRODUCTION: In patients with gastrointestinal (GI) cancer, severe malnutrition is associated with increased morbidity and mortality, reduction of treatment efficacy, and increased length of hospital stay. Therefore, systematic screening and care of malnutrition is mandatory. MATERIALS AND METHODS: Data for this review were identified by searches of Medline with and without MeSH database and Cancerlit. Studies were selected only if they were randomised clinical trials or historical reports. References were also identified from reference lists in relevant previously published articles. Recent guidelines and meta-analyses were included. Only articles published in English were taken into consideration. RESULTS: For surgical patients, practical information such as weight loss or subjective global assessment would provide a better basis for deciding whether or not to delay surgery. At least 10 days of nutritional support is recommended in severely malnourished patients before major digestive surgery. In non-severely malnourished patients, preoperative oral immunonutrition is associated with a 50% decrease in postoperative complications. The benefit of immune-enhancing diets in severely malnourished patients remains to be proven. For patients undergoing radiochemotherapy, dietary counselling should be proposed to all patients. In cases of severely malnourished patients or if dietary counselling suffers a setback, enteral nutrition should be recommended. Parenteral nutrition should be reserved for patients with severe digestive intolerance when enteral nutrition is not possible. CONCLUSION: Propose an adaptive nutritional support at each step of a multimodal GI oncological treatment is essential. These recommendations should be used in daily practice but should also be included in all clinical research protocols.

[Dietary fibre: more than a matter of dietetics. II. Preventative and therapeutic uses]. / Ballaststoffe: Mehr als ein Diätmittel. II. Präventive und therapeutische Anwendungen.

A nutrition rich in fibre has a preventive effect against constipation, colon diverticulosis, carcinoma of the large bowel and stomach, type 2-diabetes, metabolic syndrome and cardiovascular disease. In case of constipation, diverticulosis and diabetes this effect solely depends on dietary fibre. Regarding carcinomas and cardiovascular diseases, so far unknown factors integrated in or associated with fibre-rich food may also contribute to the preventive effect. Therapy with dietary fibre is indicated for constipation, colon diverticulosis, diarrhea, diabetes, and hypercholesterinemia. The individual dietary fibres differ substance-specifically. Food-integrated dietary fibre such as whole-grain bread, vegetables and fruit have their place in prevention. Dietary fibre preparations such as wheat bran, flax seed or sugar-beet fibre are useful in the treatment of constipation, colon diverticulosis and adiposity. Oat bran is preferentially used in hypercholesterinemia. Purified dietary fibres such as cellulose, guar, psyllium, and beta-glucan have an anti-diabetic, all viscous fibres an anti-lipaemic effect. The therapeutic dosages of dietary fibre preparations are 20-40 g/day and of purified fibres substances 10-20 g/day respectively.

Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients.

AIM: To evaluate if the administration of an enteral diet supplemented with glutamine, arginine and omega-3-fatty acids modulates inflammatory and immune responses after surgery. METHODS: A prospective randomized double-blind, clinical trial was performed. Forty-eight patients with gastrointestinal cancer were randomized into two groups, one group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and omega-3-fatty acids. Feedings were started within 48 hours after operation, and continued until day 8. All variables were measured before operation and on postoperative day 1 and 8. Immune responses were determined by phagocytosis ability, respiratory burst of polymorphonuclear cells, total lymphocytes lymphocyte subsets, nitric oxide, cytokines concentration, and inflammatory responses by plasma levels of C-reactive protein, prostaglandin E2 level. RESULTS: Tolerance of both formula diets was excellent. There were significant differences in the immunological and inflammatory responses between the two groups. In supplemented group, phagocytosis and respiratory burst after surgery was higher and C-reactive protein level was lower (P<0.01) than in the standard group. The supplemented group had higher levels of nitric oxide, total lymphocytes, T lymphocytes, T-helper cells, and NK cells. Postoperative levels of IL-6 and TNF-alpha were lower in the supplemented group (P <0.05). CONCLUSION: It was clearly established in this trial that early postoperative enteral feeding is safe in patients who have undergone major operations for gastrointestinal cancer. Supplementation of enteral nutrition with glutamine, arginine, and omega-3-fatty acids positively modulated postsurgical immunosuppressive and inflammatory responses.