Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients.

BACKGROUND AND AIMS: Vitamin D inadequacy is now an internationally recognized health problem and pediatric cancer patients may be at even higher risk than healthy children. We aimed to evaluate primary research to establish the prevalence of vitamin D inadequacy and to explore its possible causes in pediatric cancer patients. METHODS: Electronic databases were searched (no restriction-Aug 2013) with no language restrictions and keywords related to cancer and vitamin D. We included studies of patients aged <18 years, diagnosed with and treated for cancer and reporting plasma vitamin D status. Evidence was critically appraised employing the CASP tool. Meta-analysis was performed when appropriate. RESULTS: We included 19 studies, which were mainly of moderate-quality and heterogeneous in the definitions of vitamin D deficiency and insufficiency. The median (range) prevalence of vitamin D deficiency was 14% (0-61.5%) and insufficiency 23% (0-83%). Finally, a significant effect of younger age with vitamin D inadequacy was shown (effect size: -0.132; 95%CI -0.203, -0.060). CONCLUSION: There is a possibility of a high prevalence of vitamin D inadequacy in pediatric cancer patients, especially older children, urging the need for high-quality population-based longitudinal studies using standard definitions.

Consumption of green coffee reduces blood pressure and body composition by influencing 11ß-HSD1 enzyme activity in healthy individuals: a pilot crossover study using green and black coffee.

Dietary polyphenols may have a protective role against the development of CVD. Thus, we aimed to investigate the effects of green coffee (GC), rich in chlorogenic acid, and black coffee (BC) on cardiovascular markers. A randomised pilot crossover study was performed on healthy subjects who consumed both coffees for 2 weeks. We measured anthropometry, blood pressure, and arterial elasticity after each intervention and collected urine samples to monitor antioxidant capacity. Free cortisol and cortisone levels were obtained from urine and analysed by specific ELISA methods. Systolic blood pressure (P = 0.018) and arterial elasticity (P = 0.001) were significantly reduced after GC. BMI (P = 0.04 for BC; P = 0.01 for GC) and abdominal fat (P = 0.01 for BC; P = 0.009 for GC) were also significantly reduced with no changes in energy intake. Urinary free cortisol was significantly reduced from 125.6 ± 85.9 nmol/day to 76.0 ± 54.9 nmol/day following GC and increased to 132.1 ± 89.1 nmol/day after BC. Urinary free cortisone increased by 18% following BC and 9% following GC (nonsignificant). Cortisol/cortisone ratio (indicating 11ß-HSD1 activity) was reduced after GC (from 3.5 ± 1.9 to 1.7 ± 1.04, P = 0.002). This suggests that GC can play a role in reducing cardiovascular risk factors. Further research including hypertensive and overweight individuals will now be justified to clarify whether GC could have a therapeutic role in CVD.

Complementary and alternative medicine usage in Scottish children and adolescents during cancer treatment.

AIM: To determine the prevalence of the use of CAM and spiritual practices in the paediatric oncology population of SE Scotland and to establish both the reasons for their use and the perceived benefits. METHODS: A retrospective survey was performed using previously piloted questionnaires. These were distributed to families whose children were <18 years and diagnosed with cancer. Demographic and clinical data were collected, descriptive statistics were used to establish frequencies and univariate associations were established by χ(2) test. RESULTS: Of 169 families approached, 74 (44%) returned completed questionnaires. 41 (55%) families used CAM and 42 (57%) sought spiritual remedies whilst receiving conventional treatment. Higher socioeconomic status was the only factor associated with CAM usage and the most popular therapies were vitamins and minerals (n = 22; 53%), followed by massage (n = 12; 29%) and fish oils (n = 12; 29%). Most families used CAM to reduce stress and, overall, CAM was perceived to be beneficial. CONCLUSION: The high prevalence of CAM usage in this population highlights the need for physicians to enquire routinely about CAM use and warrants high-quality interventional studies to assess safety and efficacy. SUMMARY: The use of Complementary and Alternative Medicine (CAM) among paediatric patients during cancer treatment is popular worldwide, yet data from the UK are scarce. This study showed that more than half of this Scottish cohort used CAM and that there was an overall positive perception of the effect that these therapies had on the patients. Also, socio-economically advantaged families might be more likely to use CAM in Scotland.