Effects of an elemental diet, Elental®, may differ between healthy oral cells and oral cancer cells.

The effectiveness of an elemental diet (ED), Elental®, against radiotherapy­ or chemoradiotherapy­induced oral mucositis was previously reported. However, the administration of additional nutrition or an ED in patients with oral cancer may also provide extra nutrition for cancer cells, which could result in cancer development. At present, it remains unclear whether the beneficial effects of an ED are likely to surpass its potential harmful effects on oral cancer treatment. In the present study, we aimed to clarify whether Elental® has different effects on a healthy human oral keratinocyte (HOK) cell line compared with its effects on oral squamous cell carcinoma (OSCC) cell lines (HSC2, HSC3, HSC4). The efficacy of Elental® was compared in relation to the growth and migration ability of HOK and OSCC cell lines using MTT assay and migration assay, respectively. In addition, whole transcriptome analysis and network analysis were performed to determine the difference in the mechanism of action of Elental® between HOK and HSC2 cells. In addition, Elental® promoted growth and migration ability of­malnourished and 5­fluorouracil (5­FU)­treated damaged HOK cells cultured in low nutrition medium (0% growth supplement). However, Elental® did not affect the growth ability of 5­FU­treated damaged HSC2 cell line in low nutrition medium (0 or 1% fetal bovine serum (FBS), as well as the growth ability of HSC3 and HSC4 cell lines in medium containing 0% FBS. Elental® pre­treatment also enhanced the apoptosis­inducing effect of anticancer agents against OSCC cells. In addition, whole transcriptome analysis and Ingenuity Pathways Analysis (IPA) data suggested that Elental® may help in the proliferation and survival of HOK through the induction of ERK. Moreover, Elental® added stress to HSC2 cells through the induction of the endoplasmic reticulum stress response marker, BiP and GRP 94. The results showed that Elental® may add stress to HSC2 cells and provide growth stimulation to HOK. These findings suggest that the effects of Elental® on healthy oral cells and oral cancer cells may differ.

"Eat to Live"-Piloting a Culinary Medicine Program for Head & Neck Radiotherapy Patients.

BACKGROUND: Head and neck radiotherapy (H&N RT) patients are at risk for malnutrition following treatment due to dysphagia and alterations in taste quality. This project studied feasibility of a food skills intervention strategy support food preparation, cooking confidence, and individualized dietary choices to support nutritional status in this patient population. METHODS: We piloted a monthly cooking class (called "Eat to Live") from November 2018 to January 2019. Every class included cooking and nutrition domains, organized around a specific meal of the day (i.e., breakfast, lunch, or dinner). Seven participants (4 patients, 3 caregivers) attended at least one class, with four participants (3 patients, 1 caregiver) completing all three classes. Pre- and post-study measures (self-administered questionnaires) assessed changes in cooking behavior, dietary choices, and taste sensation before and after the intervention. RESULTS: Healthful eating scores increased modestly from start to finish of the class (1.5 to 1.7 on a 3-point scale), with averaged patient preference scores for healthy foods increasing incrementally. This took place despite physical taste scores declining across the 3-month study. After completing the class, participants were more likely to select fresh fruits and vegetables, grains, lean cuts of meat, and dairy products. Patients also adopted positive behavioral modifications to their diets, such as eating out at restaurants less often and baking/grilling foods instead of frying. CONCLUSIONS: To our knowledge, this is the first published report on feasibility and patient acceptance of an evidence-based culinary medicine intervention in H&N RT patients. We observed objective improvements in dietary choices and cooking confidence in a small cohort of patient/caregiver dyads. This pilot work justifies follow-on development of a more comprehensive intervention optimized for patient convenience and longitudinal support.

Does the low FODMAP diet improve symptoms of radiation-induced enteropathy? A pilot study.

RATIONALE: Patients with radiation-induced enteropathy (RE) after cancer treatment show similar symptoms as patients with irritable bowel syndrome (IBS). The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (LFD) is a widespread management strategy for IBS. We aimed to investigate if there may be a positive effect of LFD on symptoms and health-related quality of life (HRQOL) in patients with RE. METHODS: In an open non-controlled pilot study, 11 patients (all female) with RE-related IBS symptoms were recruited largely based on own initiative. All followed LFD for four weeks. IBS Severity Scoring System (IBS-SSS) and IBS Symptom Questionnaire (IBS-SQ) were used to assess symptoms. Short Form Nepean Dyspepsia Index (SF-NDI) and 12-item Short Form Health Survey (SF-12) evaluated HRQOL. A three day food record was used to estimate baseline intake of FODMAPs and to reveal dietary changes. RESULTS: FODMAP intake was successfully reduced, although LFD was found a burdensome intervention. IBS symptoms improved significantly based on mean total score of IBS-SSS and IBS-SQ, which changed from 310.2 ± 60.7 to 171.4 ± 107.2 (p = .001) and 27.4 ± 4.1 to 15.7 ± 10.1 (p = .002). HRQOL improved based on SF-NDI total score (30.5 ± 9.4 to 18.3 ± 8.2, p = .001) and based on mental (p = .047) and physical (p = .134) score of SF-12. Main additional dietary changes were reduced intake of energy, carbohydrates, and fiber. CONCLUSION: Our findings from this small-scaled pilot study indicate that the LFD may alleviate symptoms and improve HRQOL in patients with RE. Further controlled studies with larger sample size should be conducted to verify our results and hopefully enable implementation of LFD as a future part of the management strategy for RE.

Predictors of radiation-induced gastrointestinal morbidity: A prospective, longitudinal study following radiotherapy for carcinoma of the prostate.

Background Chronic gastrointestinal (GI) morbidity occurs in ≥50% of patients after external beam radiotherapy (EBRT) for carcinoma of prostate (CaP). This prospective, longitudinal study examines which baseline measurements of: 1) homocysteine and micronutrients in plasma; 2) chromosome damage/misrepair biomarkers; and 3) anal and rectal dose volume metrics predict GI morbidity after EBRT. Patients and methods In total, 106 patients with CaP had evaluations of GI symptoms (modified LENT-SOMA questionnaires) before EBRT and at one month, one, two and three years after its completion. Other variables measured before EBRT were: 1) plasma concentrations of homocysteine and micronutrients including caroteinoids and selenium; 2) chromosome damage/DNA misrepair (micronuclei/nucleoplasmic bridge) indices; and 3) mean anal and rectal wall doses and volumes of anal and rectal walls receiving ≥40 Gy and ≥60 Gy. Univariate and multivariate analyzes examined the relationships among: 1) plasma levels of homocysteine and micronutrients; 2) indices of chromosome damage/DNA misrepair; and 3) mean anal and rectal wall doses and volumes of anal and rectal walls receiving ≥40 Gy and ≥60 Gy and total GI symptom scores from one month to three years after EBRT. Results Increased frequency and urgency of defecation, rectal mucous discharge and bleeding after EBRT resulted in sustained rises in total GI symptom scores above baseline at three years. On univariate analysis, total GI symptom scores were significantly associated with: 1) plasma selenium and α tocopherol; 2) micronuclei indices of DNA damage; 3) mean anal and rectal wall doses; and 4) volumes of anal and rectal wall receiving ≥40 Gy and ≥60 Gy (p = 0.08-<0.001). On multivariate analysis, only volume of anal wall receiving ≥40 Gy was significant for increased GI symptoms after EBRT (p < 0.001). Conclusion The volume of anal wall receiving ≥40 Gy predicts chronic GI morbidity after EBRT for CaP.

Dietary intake of cancer patients on radiotherapy / La ingesta dietética de los pacientes con cáncer en radioterapia

The dietary intake of cancer patients can affect their nutritional status. Objectives: To assess the dietary intake and nutritional status of head and neck cancer patients on radiotherapy. Methods: 24-hour recalls and anthropometric measures were taken during the first and third weeks of radiotherapy. Results: Of the 62 patients, significant reductions were found in arm muscle area (p = 0.001) and arm muscle circumference (p < 0.001), and 69% of patients had an average weight loss of 5.7% in three weeks. With regards to their dietary intake, reductions were found in energy (26.5 kcal/kg/d-21.3 kcal/kg/d, p < 0.001), carbohydrate (196.9 g/d - 180.5 g/d, p = 0.020), protein (1.19 g/kg/d-0.93 g/kg/d, p = 0.009) and fat (44.4 g/d-33.1 g/d, p < 0.001) intakes during the study period. Discussion: The changes that result from cancer radiotherapy led to reductions in dietary intake and negatively affected body composition measures (AU)

La ingesta dietética de los pacientes con cáncer pueden afectar su estado nutricional. Objetivos: Evaluar la ingesta alimentaria y el estado nutricional de los pacientes con cáncer de la cabeza y cuello de la radioterapia. Métodos: Recuerdo de ingesta de 24 horas y valoración del status nutricional por antropometría fueron tomadas durante la primera semana y la tercera de la radioterapia. Resultados: De los 62 pacientes, las reducciones significativas en el área muscular del brazo (p = 0,001) y la circunferencia muscular del brazo (p < 0,001), y el 69% de los pacientes tenían una pérdida de peso promedio de 5,7% en tres semanas. Con respecto a su ingesta, las reducciones fueron encontrados en la energía (26,5 kcal/ kg/día-21,3 kcal/kg/día, p < 0,001), carbohidratos (196,9 g/día-180,5 g/día, p = 0,020), la proteína (1,19 g/kg/día-0,93 g/kg/día, p = 0,009) y grasas (44,4 g/día-33,1 g/día, p < 0,001) la ingesta durante el período de estudio. Discusión: Los cambios resultan en reducción de la ingesta alimentaria y las medidas del cuerpo afectado negativamente a su composición (AU)

Protective effects of dietary antioxidants on proton total-body irradiation-mediated hematopoietic cell and animal survival.

Abstract Dietary antioxidants have radioprotective effects after gamma-radiation exposure that limit hematopoietic cell depletion and improve animal survival. The purpose of this study was to determine whether a dietary supplement consisting of l-selenomethionine, vitamin C, vitamin E succinate, alpha-lipoic acid and N-acetyl cysteine could improve survival of mice after proton total-body irradiation (TBI). Antioxidants significantly increased 30-day survival of mice only when given after irradiation at a dose less than the calculated LD(50/30); for these data, the dose-modifying factor (DMF) was 1.6. Pretreatment of animals with antioxidants resulted in significantly higher serum total white blood cell, polymorphonuclear cell and lymphocyte cell counts at 4 h after 1 Gy but not 7.2 Gy proton TBI. Antioxidants significantly modulated plasma levels of the hematopoietic cytokines Flt-3L and TGFbeta1 and increased bone marrow cell counts and spleen mass after TBI. Maintenance of the antioxidant diet resulted in improved recovery of peripheral leukocytes and platelets after sublethal and potentially lethal TBI. Taken together, oral supplementation with antioxidants appears to be an effective approach for radioprotection of hematopoietic cells and improvement of animal survival after proton TBI.

Surgical experience with small bowel damage secondary to pelvic radiotherapy.

BACKGROUND: Patients undergoing pelvic radiotherapy are at risk of developing radiation enteritis. This study reviewed patients with radiation enteritis referred to a specialist colorectal unit. METHODS: Patients referred with radiation enteritis secondary to pelvic radiotherapy (July 2001 to July 2005) were analysed regarding: indication, duration, dosage/fractionation of radiotherapy, nutritional/biochemical assessment, investigation, surgery, histopathology, and hospital stay. RESULTS: Eleven patients underwent pelvic radiotherapy. The median interval between radiotherapy and referral was 17 months. The majority were nutritionally deficient at presentation (haemoglobin < 12 g/l: 91%; magnesium < 0.75 mmol/l: 64%; albumin < 35 g/l: 91%). Eight (73%) patients had either a BMI < 20 or weight loss of >10% within 3 months prior to referral. Radiation enteritis was diagnosed by preoperative radiology, laparotomy and at histopathology. All patients underwent surgery (resection/ilesotomy/bypass) and median post-operative stay was 24 days. CONCLUSIONS: Radiation enteritis is associated with prolonged symptoms. Majority of patients are undernourished and despite nutritional support a high morbidity is noted.

Soporte nutricional en un paciente con síndrome de intestino corto secundario a enteritis rádica / Nutritional support in a patient with a short bowel syndrome by radiation enteritis

El síndrome de intestino corto se caracteriza por un cuadro clínico que describe las consecuencias metabólicas y nutricionales que ocurren tras una resección masiva de intestino delgado. El pronóstico depende de la longitud y segmento intestinal resecado, presencia o ausencia de la válvula ileocecal y colon, existencia de enfermedad intestinal subyacente y capacidad de adaptación del intestino remanente. Resecciones de intestino delgado superiores al 75 por ciento provocan un cuadro de malabsorción grave con compromiso nutricional que a menudo requiere el uso de nutrición parenteral a largo plazo. La exposición de la mucosa intestinal a los nutrientes intraluminales es uno de los principales mecanismos implicados en la respuesta adaptativa del intestino remanente. Presentamos el caso de un síndrome de intestino corto con un remanente intestinal afectado por enteritis rádica y con una longitud de 100 cm de yeyuno proximal y 30 cm de colon transverso/descendente. Tras un período 18 meses, en los que el paciente precisó nutrición parenteral domiciliaria para mantener su estado nutricional, se consiguió la adaptación del intestino remanente y en la actualidad sus requerimientos nutricionales se hallan cubiertos con un soporte nutricional por vía oral (AU)

[Methodological principles for using agents for the mass prevention of the sequelae of human irradiation]. / Metodologicheskie printsipy primeneniia sredstv massovoi profilaktiki posledstvii oblucheniia cheloveka.

The means of mass prevention of radiation consequences are biologically active additives to food, usual diet components, etc., micronutrients, as well as some sorbents and radio protective agents, which show various actions: 1) those reducing absorption; 2) those accelerating radionuclide excretion; 3) those enhancing the body's resistance to radiation; 4) those contributing to the prevention (less risk) of late radiation-induced cancer. The paper formulates basic requirements for means of mass prevention and guidelines for their use in terms of benefits and risk.

Quality of life during pelvic radiotherapy.

BACKGROUND: A randomized clinical trial was carried out to evaluate the effect of a diet low in fat and lactose to prevent acute radiation-induced diarrhea. The effect of the diet treatment on the patients' health related quality of life was studied. METHODS: 143 women with gynecological malignancies were included. The daily number and consistency of stools, use of antidiarrheal agents and quality of life measured by using the EORTC Core Quality of life Questionnaire 36 item version, were recorded before therapy, in the last week of treatment, six weeks after end of radiotherapy and every eight weeks during one year's follow up. RESULTS: Fourteen patients (23%) in the intervention group reported diarrhea during radiotherapy, compared to 32 (48%) in the control group (p < 0.01). This difference was not seen with the EORTC questionnaire. The diet intervention did not interfere with emotional and social well-being. Within the control group diarrhea was associated with higher scores on the physical functioning scale (p < 0.01), and fatigue and malaise scale (p < 0.01) indicating more pronounced dysfunction of symptoms. CONCLUSION: When measuring specific phenomena such as diarrhea in a clinical trial, the EORTC questionnaire does not seem to be as sensitive as specific trial-related instruments. Diet intervention during radiotherapy might influence the patients' ability to cope with diarrhea by giving them more control over their own situation.

Effects of active addition of bacterial cultures in fermented milk to patients with chronic bowel discomfort following irradiation.

Radiotherapy is a cornerstone in the treatment of malignancies in the pelvis. Consequently, there is usually exposure of the intestine and especially the lower colon and rectum, with ensuing disturbances in bowel habits at different times following radiotherapy. The main problem is diarrhoea associated with lactose intolerance, bile salt absorption and fat malabsorption. Bacterial contamination has also been described. In the present study we have evaluated the influence of the active administration of specific bacterial cultures in fermented milk, which inhibit the growth of potentially pathogenic micro-organisms, to 40 consecutive patients with chronic alteration in their bowel habits caused by previous radiotherapy of pelvic malignancies. The results suggest that intake of fermented milk products could be of value in decreasing chronic bowel discomfort following radiotherapy of pelvic malignancies. However, a more extensive study is warranted in order to very the significance of the results and to find the optimal product.

[Pectin-containing products in the dietary nutrition of subjects exposed to ionizing radiation as a result of the accident at the Chernobyl Atomic Electric Power Station]. / Pektinsoderzhashchie produkty v dieticheskom pitanii lits, podvergshikhsia vozdeistviiu ioniziruiushchego izlucheniia v rezul'tate avarii na Chernobyl'skoi AES.

Effect of natural and enriched with pectin tanned fruits on radiation-induced metabolic disorders was studied in persons subjected to radiation due to Chernobyl accident. It was shown that products in question beneficially influenced blood antioxidant system as well as brought to the norm contents of triglicerides and albumins in patients with IIa and IV types of hyperlipoproteinaemia.

Malnutrition and the role of nutritional support for radiation therapy patients.

The nutritional status of a tumor patient can be negatively influenced by the local and systemic effects of the malignant tumor (tumor cachexia, anorexia, difficult oral food intake), by the effects of the various antitumoral therapy modalities (surgery, radiotherapy, chemotherapy), and by the complications associated with such modalities (anorexia, nausea, vomiting, mucositis, xerostomia, alterations of the smell and taste sensations, odynophagia, dysphagia, maldigestion, malabsorption, diarrhea, steatorrhea, conditioned aversions, radiogenic late effects), as well as by the psychological reactions of the patient to the real or feared existence of his tumor. The radiation-induced nutritional disorders depend on the tumor localization, the region irradiated, the dose and length of radiotherapy, the fractionation, the volume irradiated, and the combination with other therapeutic modalities ("combined modality therapy"). The acute radiation-induced reactions are usually of limited duration and for this reason tend to interfere with the nutritional status to a lesser extent than the permanent chronic consequences of irradiation. Weight loss and malnutrition tend to develop particularly in patients in whom segments of the gastrointestinal tract are subjected to irradiation. The incidence and severity of deficient nutrition depend not only on the region irradiated (head-neck region, thorax, abdomen, pelvis) but also, and most particularly, on the volume of the digestive tract irradiated. Chemotherapy and radiotherapy combined act very strongly on rapidly proliferating cell populations (skin, mucosa, epithelium of the gastrointestinal tract). In this context, actinomycin D and adriamycin act like real sensitizers, whereas the majority of the other drugs are likely to produce only an additive effect. The first named cytostatics give rise to the so-called recall phenomenon, i.e., the reactivation of latent radiation effects in response to the subsequent administration of the drug. Malnutrition impairs organ function and ultimately results in increased morbidity and mortality. For this reason it has proven mandatory and reasonable that the organism of all tumor patients suffering from malnutrition is provided with the missing essential nutrients (especially amino acids for protein synthesis). This tends to clearly improve the Karnofsky performance status, with a positive effect on response rates, toxicity, and survival rates in retrospective studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical observations on the effects of elemental diet supplementation during irradiation.

A study has been conducted to assess the effects of adding an elemental diet as a supplement to a standard low-roughage diet recommended to a group of patients receiving a fractionated course of abdominal irradiation. The supplement was not found to modify patient experience of radiotherapy-induced complications.

The metabolic effects of abdominal irradiation in man with and without dietary therapy with an elemental diet.

The metabolic effects of abdominal radiotherapy were assessed in patients with pelvic neoplasms, and the effects of supplementation of the diet with an 'elemental' diet assessed. Therapeutic irradiation led to significant mean weight losses of 1.4 kg in control patients and 1.0 kg in patients receiving 'elemental' diet supplements. Irradiation was associated with small falls in plasma potassium and calcium concentrations in both groups. In the 'elemental' group there was a small increase in circulating alanine and insulin concentrations and a fall in glycerol and ketone body concentrations, but all variables remained within or close to normal basal reference ranges. Plasma albumin fell slightly but significantly in the 'elemental' diet group from 44 +/- 1 to 42 +/- 1 g/litre during treatment. Is is concluded that modern radiotherapy is no more than a modest catabolic stimulus. Long-term dietary supplementation with 'elemental' diets in ill subjects did not produce adverse effects.