High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: Results of a Brazilian multicenter study.

BACKGROUND: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The objective of this study was to evaluate the prevalence of malnutrition across different age groups in patients with cancer in Brazil and to identify associations with nutrition impact symptoms (NIS). METHODS: In this observational, cross-sectional, multicenter study, the authors evaluated 4783 patients with cancer aged ≥20 years who were admitted to 45 public hospitals in Brazil. Nutritional status, nutritional risk, and NIS were evaluated using the Patient-Generated Subjective Global Assessment. RESULTS: More than one-fourth (25.5%) of all participants were aged ≥65 years. In patients aged ≥65 years, the prevalence of moderate/suspected and severe malnutrition was 55%, it was 45.4% in those aged 51 to 64 years, and it was 36.1% in those aged ≤50 years. Among the NIS with a higher risk of occurrence in patients aged ≥65 years were no appetite (odds ratio [OR], 1.90; 95% CI, 1.62-2.22; P < .05) and dry mouth (OR, 1.40; 95% CI, 1.1-1.67; P < .05). In patients between ages 51 and 64 years, compared with those aged ≤50 years, the NIS with a higher risk of occurrence were no appetite (OR, 1.45; 95% CI, 1.23-1.69; P < .05), dry mouth (OR, 1.22; 95% CI, 1.02-1.45; P < .05), and problems with swallowing (OR, 1.56; 95% CI, 1.25-1.96; P < .05). CONCLUSIONS: The prevalence of malnutrition and the occurrence of NIS are high in hospitalized Brazilian patients aged ≥65 years who have cancer. The occurrence of NIS was higher in the population aged >50 years than in those aged ≤50 years. Nutritional screening and assessment should be performed immediately after hospitalization to enable early diagnosis and multidisciplinary or interdisciplinary intervention(s).

Effect of Nutritional Supplementation Enriched with Eicosapentaenoic Acid on Inflammatory Profile of Patients With Oral Cavity Cancer in Antineoplastic Pretreatment: A Controlled and Randomized Clinical Trial.

The objective of the study is to investigate the effect of nutritional supplementation with eicosapentaenoic acid (EPA)-enriched formula on the inflammatory profile of patients with oral cavity cancer. The study was conducted with 53 patients with oral cavity cancer in antineoplastic pretreatment who were randomized into two groups: the control group received a powdered supplement without EPA during 4 wk and the intervention group received a liquid supplement enriched with EPA (2 g/day) during the same period. In the baseline and after 4 wk of supplementation, serum concentrations of albumin, prealbumin, C-reactive protein (CRP), and interleukin-6 (IL-6) were measured. Values of CRP and of CRP/albumin ratio were lower in the intervention group than those in the control group. However, when the two groups were compared to each other after intervention, any significant difference was not observed. There was a significant negative correlation between levels of CRP and albumin, and IL-6 and albumin, both in the control and in the intervention groups. In both groups, a positive correlation between concentrations of IL-6 and CRP was observed. No significant difference was encountered in the assessed parameters between the group that received standard supplement and the group that received EPA-enriched supplement.

The Impact of Body Mass Index and Waist Circumference on Health-related Quality of Life Among Colorectal Cancer Survivors: Results from the PROFILES Registry.

BACKGROUND: We aimed to assess the association of waist circumference (WC) and body mass index (BMI) with health-related quality of life (HRQL) among colorectal cancer (CRC) survivors. METHODS: CRC survivors diagnosed between 2000 and 2009 completed questionnaires in August 2013 (with self-reported weight, height, and self-assessed WC) and January 2014 (with HRQL using the EORTC-QLQ-C30). Clinical characteristics were retrieved from the Netherlands Cancer Registry. In multivariable linear regression analyses associations of BMI only, WC only and both BMI and WC with HRQL outcomes were assessed. RESULTS: 1,111 CRC survivors were included of whom 34% had a normal weight (18.5 ≤ BMI < 25 kg/m2), 49% had overweight (25 ≤ BMI < 30 kg/m2), 17% had obesity (BMI ≥ 30 kg/m2), and 44% had an increased WC (i.e., >102 and >88 cm for men and women, respectively). Both BMI and WC were separately associated with worse global health status, functioning, and more symptoms of fatigue. Increased WC was associated with lower physical, role and emotional functioning, regardless of BMI, with average differences ranging between 3 and 5 points. CONCLUSION: Future research on HRQL among CRC survivors should consider both BMI and WC. Furthermore, weight reduction trials should not only focus on general weight loss but also on the loss of abdominal fat.

Performance of the new nutrition evaluation tool for hospitalized pediatric patients with cancer in Brazil (ANPEDCancer).

BACKGROUND: There is a lack of specific nutrition assessment tools for pediatric patients with cancer. The aim was to evaluate the performance of the ANPEDCancer assessment tool in a pediatric population with cancer, verifying its ability to detect nutrition inadequacy and predict the length of hospital stay (LOS). METHODS: Evaluated 111 pediatric patients hospitalized in the National Cancer Institute (INCA) in 2019 to assess nutrition status. Patients were classified as malnourished and well nourished by the ANPEDCancer. Measures of weight, height, anthropometric indicators, body composition, laboratory parameters, LOS, and death were compared between groups. The ANPEDCancer classification was compared with the complete nutrition assessment, calculating sensitivity, specificity, and predictive values, and with the LOS. RESULTS: The prevalence of malnutrition was 12.6%, nutrition risk was 48.6%, risk of overweight/obesity was 6.3%, and well-nourished status was 32.4%. According to ANPEDCancer, malnourished patients showed a higher frequency of inadequacy for all anthropometric indices, percentage of weight loss, serum albumin level, C-reactive protein (CRP), and longer LOS when compared with well-nourished patients. There was an association between the tool's diagnosis and measures of body composition, CRP, and LOS. ANPEDCancer validation with the complete nutrition assessment showed a sensitivity of 81.6%, specificity of 55%, positive predictive value of 53.4%, and negative of 82.5%. The LOS was almost twice as long among malnourished patients and was statistically significant (P = 0.002). CONCLUSION: ANPEDCancer is a feasible tool to assess nutrition status and identify the presence of nutrition risk, allowing for targeted assistance in hospitalized pediatric patients with cancer.

Lycopene isomerisation and storage in an in vitro model of murine hepatic stellate cells.

BACKGROUND: Lycopene is a carotenoid whose biological activities and protective effect on prostate and breast cancer have been described, but little is known on its extra-intestinal metabolism and storage. While most alimentary lycopene is in all-trans configuration, in animal and human tissues approximately half of the lycopene is in cis isoforms. AIM OF STUDY: Our object was to monitor the capacity of storage, isomerisation, and intracellular localization of all-trans and cis lycopene in hepatic stellate cells, which are the major sites of metabolism and storage of retinoids and carotenoids in the body. METHODS: We used the GRX cell line representative of murine hepatic stellate cells, incubated with 1-30 muM lycopene in culture medium. Analysis was done by high-performance liquid chromatography. RESULTS: Lycopene was able to induce expression of the lipocyte phenotype and it was internalized into GRX cells. Its cellular release only occurred in presence of albumin with a rapid initial decrease of intracellular lycopene. A corresponding increase in the culture medium was observed at 24 h. All-trans, 13-cis and 9-cis lycopene isoforms were identified in all the cell compartments. The membrane fraction contained the major part of lycopene, followed by the cytoplasmic fraction, lipid droplets and nuclei. The ratio between all-trans and cis isomers was approximately 2/1 in the majority parts of cell compartments. CONCLUSIONS: This study identified a novel hepatic cell type able to store and isomerise lycopene. Liver can contribute to the serum and tissue equilibrium of cis/trans isomers of lycopene, and to participate in storage of lycopene under high extracellular concentration such as observed after the alimentary input.

Effects of ω-3 supplementation on the nutritional status, immune, and inflammatory profiles of gastric cancer patients: A randomized controlled trial.

OBJECTIVE: The aim of this study was to study the effect of ω-3 supplementation on the nutritional status and the immune and inflammatory profiles of patients with gastric cancer during antineoplastic pretreatment. METHODS: This was a randomized, open, controlled longitudinal study with intervention in outpatient patients with gastric cancer. Sixty-eight patients were randomized into two groups and received either a formula enriched with ω-3 (intervention group [IG]) or standard formula without ω-3 (control group) for 30 d consecutively. Nutritional status (based on patient-generated subjective global assessment, bioimpedance, and anthropometric measurements) and immune and inflammatory parameters were collected before and after supplementation. Results were expressed as frequency, median, and interquartile intervals and were compared by non-parametric test. P < 0.05 was considered statistically significant. RESULTS: Thirty-four patients were included in each group. Of the patients, 64.7% were men, 44.1% were older than 60 years, and 45.6% had stage III disease. There was an increase in C-reactive protein in the control group before and after supplementation, in addition to the worsening in some anthropometric parameters, such as arm muscle area and arm muscle circumference. There was maintenance of the immune profile in both groups. An increase in weight gain was observed in the IG but not in the control group (1.2 [0.9-9] versus 0.7 kg [0.4-1.3]; P = 0.03), as was a reduction of interleukin-6 (5.7 [4.1-6.4] versus 6.3 pg/mL [5.6-8.6]; P = 0.03) and a maintenance of nutritional status, after supplementation. CONCLUSIONS: Supplementation with ω-3 leads to weight gain, reduction in the inflammatory profile, and maintenance of the nutritional and immune profiles of these patients, but further studies are needed to examine changes in body composition.

Undernutrition as independent predictor of early mortality in elderly cancer patients.

OBJECTIVES: The aim of this study was to evaluate the 1-y survival of elderly patients with cancer and the association between undernutrition and mortality. METHODS: This was a cohort study with elderly patients ages ≥65 y admitted between September and October 2014. A nutritionist performed a Mini Nutritional Assessment-Short Form (MNA-SF) assessment during 48 h of hospital admission and collected data about potential confounding variables (comorbidities, stage of cancer, treatment in the previous 3 mo, and reason for hospitalization). Vital status was determined from the medical records or public records office. Overall survival was estimated using the Kaplan-Meier method. Cox regression was performed to estimate unadjusted hazard ratios. Variables with P < 0.20 by univariate analysis were selected for multivariate analysis. P < 0.05 was considered statistically significant. RESULTS: Of the 136 patients (mean age, 73.1 y; 52.2% men), 29.4%, 41.2%, and 29.4% were classified as normal, at risk for undernutrition, and undernutrition, respectively, according to the MNA-SF. The mortality rate was 31.6% after 12 mo. One-year mortality was higher among the undernourished patients, followed by patients at risk for undernutrition. After adjustment for confounding variables, the multivariate regression Cox model showed that being undernourished according to the MNA-SF increased the risk for death at 1 y (hazard ratio, 5.59; 95% confidence interval, 1.8-17.3; P < 0.001). CONCLUSION: The results showed that the MNA-SF can be a useful tool in identifying elderly patients at higher risk for 1-y mortality.

Hepatic stellate cells uptake of retinol associated with retinol-binding protein or with bovine serum albumin.

Retinol is stored in liver, and the dynamic balance between its accumulation and mobilization is regulated by hepatic stellate cells (HSC). Representing less than 1% total liver protein, HSC can reach a very high intracellular retinoid (vitamin-A and its metabolites) concentration, which elicits their conversion from the myofibroblast to the fat-storing lipocyte phenotype. Circulating retinol is associated with plasma retinol-binding protein (RBP) or bovine serum albumin (BSA). Here we have used the in vitro model of GRX cells to compare incorporation and metabolism of BSA versus RBP associated [(3)H]retinol in HSC. We have found that lipocytes, but not myofibroblasts, expressed a high-affinity membrane receptor for RBP-retinol complex (KD = 4.93 nM), and both cell types expressed a low-affinity one (KD = 234 nM). The RBP-retinol complex, but not the BSA-delivered retinol, could be dislodged from membranes by treatments that specifically disturb protein-protein interactions (high RBP concentrations). Under both conditions, treatments that disturb the membrane lipid layer (detergent, cyclodextrin) released the membrane-bound retinol. RBP-delivered retinol was found in cytosol, microsomal fraction and, as retinyl esters, in lipid droplets, while albumin-delivered retinol was mainly associated with membranes. Disturbing the clathrin-mediated endocytosis did not interfere with retinol uptake. Retinol derived from the holo-RBP complex was differentially incorporated in lipocytes and preferentially reached esterification sites close to lipid droplets through a specific intracellular traffic route. This direct influx pathway facilitates the retinol uptake into HSC against the concentration gradients, and possibly protects cell membranes from undesirable and potentially noxious high retinol concentrations.

Beta-carotene storage, conversion to retinoic acid, and induction of the lipocyte phenotype in hepatic stellate cells.

Hepatic stellate cells (HSCs) are the major site of retinol (ROH) metabolism and storage. GRX is a permanent murine myofibroblastic cell line, derived from HSCs, which can be induced to display the fat-storing phenotype by treatment with retinoids. Little is known about hepatic or serum homeostasis of beta-carotene and retinoic acid (RA), although the direct biogenesis of RA from beta-carotene has been described in enterocytes. The aim of this study was to identify the uptake, metabolism, storage, and release of beta-carotene in HSCs. GRX cells were plated in 25 cm(2) tissue culture flasks, treated during 10 days with 3 micromol/L beta-carotene and subsequently transferred into the standard culture medium. beta-Carotene induced a full cell conversion into the fat-storing phenotype after 10 days. The total cell extracts, cell fractions, and culture medium were analyzed by reverse phase high-performance liquid chromatography for beta-carotene and retinoids. Cells accumulated 27.48 +/- 6.5 pmol/L beta-carotene/10(6) cells, but could not convert it to ROH nor produced retinyl esters (RE). beta-Carotene was directly converted to RA, which was found in total cell extracts and in the nuclear fraction (10.15 +/- 1.23 pmol/L/10(6) cells), promoting the phenotype conversion. After 24-h chase, cells contained 20.15 +/- 1.12 pmol/L beta-carotene/10(6) cells and steadily released beta-carotene into the medium (6.69 +/- 1.75 pmol/ml). We conclude that HSC are the site of the liver beta-carotene storage and release, which can be used for RA production as well as for maintenance of the homeostasis of circulating carotenoids in periods of low dietary uptake.