ESPEN guidelines on nutrition in cancer patients

Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.

Nutritional risk and status of surgical patients; the relevance of nutrition training of medical students.

BACKGROUND: The prevalence of undernutrition among surgical patients is thought to be high, and negatively influencing outcomes. However, recent evidence shows the increase of overweight/obesity in hospitalised patients. AIMS: A pilot cross-sectional study was conducted in 50 patients of a Surgical Department of the University Hospital of Santa Maria (CHLN) that aimed: 1) to assess nutritional risk and status through validated methods; 2) to explore the presence of overweight/obesity; 3) to evaluate the prevalence of metabolic risk associated with obesity. METHODS: Nutritional risk was assessed by Malnutrition Universal Screening Tool (MUST), nutritional status by Body Mass Index (BMI), waist circumference (WC), & Subjective Global Assessment (SGA). Statistical significance was set for p < 0.05. RESULTS: 58% of patients were overweight/obese and 54% had high cardio-metabolic risk, according to waist circumference; 30% of patients had significantly lost weight (≥ 5%), whereas 28% gained weight. By MUST, 46% of patients were at low risk and 34% at high risk. By SGA, 58% patients were well nourished and 40% had moderate/severe undernutrition. A longer length of stay was associated with moderate/high risk by MUST, and undernutrition by SGA (p = 0.01). CONCLUSIONS: Undernutrition or obesity pose surgical risks. The lack of nutrition discipline in the medical curricula, limits the multiprofessional management and a better understanding of the more adequate approaches to these patients. Further, the change in the clinical scenario argues for more studies to clarify the prevalence and consequences of sarcopenic obesity in surgical patients.

Nutritional risk and status of surgical patients; the relevance of nutrition training of medical students / Riesgo y estado nutricionales en pacientes quirúrgicos; la relevancia del entrenamiento nutricional en estudiantes de medicina

Background: The prevalence of undernutrition among surgical patients is thought to be high, and negatively influencing outcomes. However, recent evidence shows the increase of overweight/obesity in hospitalised patients. Aims: A pilot cross-sectional study was conducted in 50 patients of a Surgical Department of the University Hospital of Santa Maria (CHLN) that aimed: 1) to assess nutritional risk and status through validated methods; 2) to explore the presence of overweight/obesity; 3) to evaluate the prevalence of metabolic risk associated with obesity. Methods: Nutritional risk was assessed by Malnutrition Universal Screening Tool (MUST), nutritional status by Body Mass Index (BMI), waist circumference (WC), & Subjective Global Assessment (SGA). Statistical significance was set for p < 0.05. Results: 58% of patients were overweight/obese and 54% had high cardio-metabolic risk, according to waist circumference; 30% of patients had significantly lost weight (> 5%), whereas 28% gained weight. By MUST, 46% of patients were at low risk and 34% at high risk. By SGA, 58% patients were well nourished and 40% had moderate/severe undernutrition. A longer length of stay was associated with moderate/high risk by MUST, and undernutrition by SGA (p = 0.01). Conclusions: Undernutrition or obesity pose surgical risks. The lack of nutrition discipline in the medical curricula, limits the multiprofessional management and a better understanding of the more adequate approaches to these patients. Further, the change in the clinical scenario argues for more studies to clarify the prevalence and consequences of sarcopenic obesity in surgical patients (AU)

Antecedentes: Se piensa que la prevalencia de la hipo-nutrición en los pacientes quirúrgicos es alta y afecta de forma negativa los resultados. Sin embargo, las pruebas recientes muestran el aumento del sobrepeso/obesidad en los pacientes hospitalizados. Objetivos: Se realizó un estudio transversal piloto en 50 pacientes de un Departamento de Cirugía del Hospital Universitario de Santa María (CHLN) enfocado a: 1) evaluar el riesgo y el estado nutricionales a través de métodos validados; explorar la presencia de sobrepeso/obesidad; 3) evaluar la prevalencia del riesgo metabólico asociado con la obesidad. Métodos: Se evaluó el riesgo nutricional mediante la Malnutrition Universal Screening Tool (MUST), el estado nutricional mediante el índice de masa corporal (IMC), la circunferencia de la cintura (CC), y la Subjective Global Assessment (SGA). Se fijó la significación estadística en p < 0,05. Resultados: El 58% de los pacientes tenía sobrepeso/ obesidad y el 54% tenía un riesgo cardiometabólico elevado, de acuerdo con la circunferencia de la cintura; el 30% de los pacientes tuvo una pérdida significativa de peso (> 5%), mientras que el 28% ganó peso. Mediante MUST, el 46% de los pacientes tenía un riesgo bajo y el 34% un riesgo elevado. Mediante el SGA, el 58% de los pacientes estaban bien nutridos y el 40% tenía hiponutrición moderada/grave. Una mayor estancia hospitalaria se asoció con un riesgo moderado/alto por MUST, e hiponutrición por SGA (p = 0,01). Conclusiones: La hiponutrición o la obesidad plantean riesgos quirúrgicos. La falta de la disciplina de nutrición en los currículos médicos limita el manejo multiprofesional y una mejor compresión de los abordajes más adecuados de estos pacientes. Además, el cambio en el escenario clínico es un argumento para la necesidad de más estudios que aclaren la prevalencia y las consecuencias de la obesidad sarcopénica en los pacientes quirúrgicos (AU)

Métodos de valoración del estado nutricional / Methods of valuation of the nutritional condition

Este artículo de revisión pretende abordar una descripción detallada de los aspectos más importantes para realizar el diagnóstico nutricional de un individuo sano o enfermo a nivel individual o colectivo; mediante la aplicación de métodos validados, que permiten la clasificación de la malnutrición tanto desde el punto de vista cuantitativo como cualitativo en sus diferentes grados de severidad, a través del uso e interpretación de sus indicadores antropométricos, bioquímicos, dietéticos, clínicos y la dimensión funcional del estado nutricional de acuerdo a las características propias de los diferentes ciclos de la vida que incluyen desde el neonato hasta el anciano. La evaluación nutricional de individuos o grupos de población constituye un área fundamental en la cual deben estar capacitados los profesionales que trabajen en el campo de la nutrición. Una apropiada utilización de los métodos y técnicas de evaluación del estado nutricional, requiere tanto del conocimiento científico, como del desarrollo de una actitud crítica para su selección, aplicación e interrelación ante una situación específica. Es también importante realizar estudios en los diferentes países de Iberoamérica para adaptar las guías de incremento de peso durante el embarazo donde se incluyan el estado nutricional preconcepcional al inicio del embarazo y la talla materna (AU)

This review article aims to describe and detail the fundamental aspects necessary to perform an adequate nutritional diagnosis in health and disease, at the individual or population level. This can only be achieved with the application of validated methods allowing the classification of malnutrition, both in a quantitative or qualitative point of view. It also allows the categorization of its severity by the use and interpretation of indicators, e.g. anthropometric, biochemical, dietetic, clinical and functional dimension of the nutritional status, all valued in the context of the distinct characteristics throughout the life cycle, from the new-born to the elderly. Nutritional evaluation of individuals or groups of individuals is a key area in health care, thus the integration of differentiated and trained nutrition professionals is mandatory. An appropriate utilization of nutritional assessment methods and techniques requires both scientific knowledge and development of a critical mindset for their selection, application and inter-relation in specific situations. It is also of utmost importance to develop studies in the different countries of Iberoamerica, in order to adapt guidelines of weight gain during pregnancy, including nutritional status before conception, to the begging of the pregnancy until the end of the gestation period (AU)

International exchange program between medical schools: the relevance of a clinical research training in nutrition / Programa de intercambio internacional entre estudiantes de medicina: la relevancia de la formación en investigación clínica en nutrición

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Nutritional status and eating pattern in prostate cancer patients.

BACKGROUND: Prostate cancer is the second most common cancer in men worldwide. Differences in prostate cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among men diagnosed with prostate cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. PATIENTS & METHODS: Throughout 2006, 87 men with prostate cancer were included. EVALUATIONS: weight & height to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bioimpedance analysis (BF-306), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. RESULTS: Mean age was 69+/-7 (46-85) years; 74 (84.1%) patients were in stage II, 5 (5.7%) in stage I & 9 (10.2%) in stage III; 39(45%) patients had a Gleason score>or=7. Regarding nutritional status, 78 (89%) patients were overweight/obese, 84 (97%) had a body fat above the maximum limit (>25%) and 43 (49%) had a waist circumference>102 cm (prevalence analysis: p<0.05). Univariate analysis did not show any association between Gleason Score, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat and aggressive Gleason scores (p<0.002), such variables worsened with age. Food frequency analysis showed a low consumption of n-3 fatty acids sources as well as vegetables and whole grain cereals and a correlation between low yogurt and vegetables intake with more aggressive Gleason scores was found (p<0.05). CONCLUSION: Our findings show a high prevalence of obesity, excessive body and abdominal fat and diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase!

Body fat and poor diet in breast cancer women.

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Differences in breast cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity, excess body fat and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among women diagnosed with breast cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. PATIENTS AND METHODS: Throughout 2006, 71 consecutive women with breast cancer were included. EVALUATIONS: weight (kg) & height (m), determined with a SECA(R) floor scale+stadiometer to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bio-impedance analysis (BF-306), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. RESULTS: Mean age was 60+/-12 (36-90) years. Invasive ductal carcinoma was the most frequent histology (68%), p<0.05. Most patients were in stage I (30%) or stage IIA (25%) of disease vs IIB (10%), IIIB (4%), IV (4%) or others (21%), p<0.05. Regarding nutritional status, 82% were overweight/obese; 89% of patients had a %body fat mass above the maximum limit of 30% vs only 8 (11%) with %body fat within normal range (p<0.002); 62% pts had a waist circumference>88 cm (prevalence analysis: p<0.04), and 61% of pts had gained weight after diagnosis. Univariate analysis did not show any association between histology, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat & aggressive histologies (p<0.005). Food frequency analysis showed a low intake of vegetables and whole grain cereals rich in complex carbohydrates (sources of fibre and phytochemicals), of fatty fish & nuts, primary sources of n-3 PUFA's and a high intake of saturated fat; more aggressive histologies were correlated with low intake of green leafy vegetables (p=0.05) and n-3 fatty acids food sources (p=0.01). CONCLUSIONS: Our findings show a vast prevalence & homogeneous pattern of overweight/obesity, excessive body and abdominal fat, as well as weight gain after diagnosis, combined with diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase.

Nutritional status and eating pattern in prostate cancer patients / Estado nutricional y tipo de alimentación en pacientes con cáncer de próstata

Background: Prostate cancer is the second most common cancer in men worldwide. Differences in prostate cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among men diagnosed with prostate cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. Patients & methods: Throughout 2006, 87 men with prostate cancer were included. Evaluations: weight & height to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bioimpedance analysis (BF-306®), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. Results: Mean age was 69 ± 7 (46-85) years; 74 (84.1%) patients were in stage II, 5 (5.7%) in stage I & 9 (10.2%) in stage III; 39(45%) patients had a Gleason score ≥ 7. Regarding nutritional status, 78 (89%) patients were overweight/obese, 84 (97%) had a body fat above the maximum limit (> 25%) and 43 (49%) had a waist circumference > 102 cm (prevalence analysis: p < 0.05). Univariate analysis did not show any association between Gleason Score, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat and aggressive Gleason scores (p < 0.002), such variables worsened with age. Food frequency analysis showed a low consumption of n-3 fatty acids sources as well as vegetables and whole grain cereals and a correlation between low yogurt and vegetables intake with more aggressive Gleason scores was found (p < 0.05). Conclusion: Our findings show a high prevalence of obesity, excessive body and abdominal fat and diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase! (AU)

Introducción: el cáncer de próstata es el segundo en frecuencia en hombres en el mundo. Las diferencias en la incidencia del cáncer de próstata sugieren un papel significativo de los factores ambientales en su etiología: se ha sugerido la obesidad, adiposidad central y algunos factores dietéticos como factores de riesgo. Objetivos: este estudio piloto se proponía analizar el patrón del estado nutricional, la grasa corporal y el consumo dietético habitual en hombres diagnosticados de cáncer de próstata y remitidos de forma consecutiva al Servicio de Radioterapia del Hospital Universitario de Santa María. Pacientes y métodos: a lo largo de 2.006, se incluyeron 87 hombres con cáncer de próstata. Evaluaciones: peso y talla para calcular el índice de masa corporal (IMC), la circunferencia de la cintura, el % de grasa corporal mediante análisis bipolar manual de bioimpedancia (BF-306®), el cuestionario Food Frequency Questionnaire validado en su versión portuguesa para valorar el consumo dietético habitual. Se emplearon los análisis de frecuencia y la prueba U de Mann-Whitney para evaluar la prevalencia y las asociaciones. Resultados y discusión: la edad media fue de 69 ± 7 (46-85) años; 74 (84,1%) pacientes estaban en estadio II, 5 (5,7%), en estadio I y 9 (10,2%) en estadio III; 39 (45%) pacientes tenían una puntuación de Gleason ≥ 7. Con respecto al estado nutricional, 78 (89%) pacientes eran obesos o tenían sobrepeso, 84 (97%) tenían grasa corporal por encima del límite máximo (>25%) y en 43 (49%) la circunferencia de la cintura era > 102 cm (análisis de prevalencia: p < 0,05). El análisis univariable no mostró ninguna asociación entre la puntuación de Gleason, el IMC, el % de grasa corporal ni la circunferencia de la cintura; el análisis multivariado mostró una asociación entre un mayor IMC, el % de grasa corporal y puntuaciones de Gleason malas (p < 0,002); estas variables empeoraban con al edad. El análisis de frecuencia de alimentos mostró un consumo bajo de fuentes de ácidos grasos n-3 así como de vegetales y de cereales integrales, y se encontró una correlación entre un consumo bajo de yogur y vegetales y unas peores puntuaciones de Gleason (p < 0,05). Conclusión: nuestros hallazgos muestran un prevalencia elevada de obesidad, exceso de grasa corporal y abdominal y las dietas deficientes en nutrientes protectores. ¡Se requieren investigaciones adicionales puesto que las tasas de cáncer en Portugal siguen aumentando! (AU)

Body fat and poor diet in breast cancer women / Grasa corporal y mala alimentación en mujeres con cáncer de mama

Background: Breast cancer is the most common cancer in women worldwide. Differences in breast cancer incidence suggest a significant role of environmental factors in the aetiology: obesity, central adiposity, excess body fat and some dietary factors have been suggested as risk factors. This pilot study aimed to analyse the pattern of nutritional status, body fat, and the usual dietary intake among women diagnosed with breast cancer, consecutively referred to the Radiotherapy Department of the University Hospital Santa Maria. Patients and methods: Throughout 2006, 71 consecutive women with breast cancer were included. Evaluations: weight (kg) & height (m), determined with a SECA® floor scale + stadiometer to calculate body mass index (BMI), waist circumference, percentage body fat with bipolar hand-held bio-impedance analysis (BF-306®), Food Frequency Questionnaire validated for the Portuguese population to assess the usual dietary intake. Frequency analysis and Mann-Whitney U test were used to evaluate prevalence and associations. Results: Mean age was 60 ± 12 (36-90) years. Invasive ductal carcinoma was the most frequent histology (68%), p < 0.05. Most patients were in stage I (30%) or stage IIA (25%) of disease vs IIB (10%), IIIB (4%), IV (4%) or others (21%), p < 0.05. Regarding nutritional status, 82% were overweight/obese; 89% of patients had a %body fat mass above the maximum limit of 30% vs only 8 (11%) with %body fat within normal range (p < 0.002); 62% pts had a waist circumference > 88 cm (prevalence analysis: p < 0.04), and 61% of pts had gained weight after diagnosis. Univariate analysis did not show any association between histology, BMI, %body fat and waist circumference; by multivariate analysis there was an association between higher BMI, %body fat & aggressive histologies (p < 0.005). Food frequency analysis showed a low intake of vegetables and wholegrain cereals rich in complex carbohydrates (sources of fibre and phytochemicals), of fatty fish & nuts, primary sources of n-3 PUFA's and a high intake of saturated fat; more aggressive histologies were correlated with low intake of green leafy vegetables (p =0.05) and n-3 fatty acids food sources (p = 0.01). Conclusions: Our findings show a vast prevalence & homogeneous pattern of overweight/obesity, excessive body and abdominal fat, as well as weight gain after diagnosis, combined with diets deficient in protective nutrients. Further investigation is warranted as cancer rates in Portugal continue to increase (AU)

Antecedentes: el cáncer de mama es el cáncer más frecuente en mujeres en todo el mundo. Las diferencias en la incidencia de cáncer de mama sugieren un papel significativo de los factores ambientales en su etiología: se han propuesto la obesidad, la adiposidad central, el exceso de grasa corporal y algunos factores dietéticos como factores de riesgo. El propósito de este estudio piloto fue analizar el patrón del estado nutricional, la grasa corporal y consumo dietético habitual en mujeres diagnosticadas de cáncer de mama y remitidas de forma consecutiva al Servicio de Radioterapia del Hospital Universitario de Santa María. Pacientes y métodos: A lo largo de 2.006, se incluyeron 71 mujeres consecutivas con cáncer de mama. Evaluaciones: peso (kg) & talla (m), determinados mediante una báscula + estadiómetro SECA® para calcular el índice de masa corporal (IMC), la circunferencia de la cintura, el porcentaje de grasa corporal con el análisis bipolar manual de bioimpedancia (BF-306®), el cuestionario Food Frequency Questionnaire validado en versión portuguesa para evaluar el consumo dietético habitual. Se emplearon el análisis de frecuencia y la prueba U de Mann-Whitney para evaluar la prevalencia y las asociaciones. Resultados: la edad media fue 60 ± 12 (36-90) años. La histología más frecuente fue el carcinoma ductal invasivo (68%), p < 0,05. La mayoría de las pacientes estaba en estadio I (30%) o estadio IIA (25%) de la enfermedad frente a los estadios IIB (10%), IIIB (4%), IV (4%) y otros (21%), p < 0,05. Con respecto al estado nutricional, el 82% tenía sobrepeso / obesidad; el 89% de las pacientes tenía un % de grasa corporal por encima del límite máximo de 30% frente a sólo (11%) con un % de grasa corporal dentro del rango normal (p < 0,002); 62% pacientes tenían una circunferencia de la cintura > 88 cm (análisis de prevalencia: p < 0,04) y 61% de ellas había ganado peso tras el diagnóstico. El análisis univariado no mostró asociación alguna entre la histología, el IMC, el % de grasa corporal ni la circunferencia de la cintura; mediante el análisis multivariado se mostró una asociación entre un mayor IMC, el % de grasa corporal e histologías agresivas (p < 0,005). El análisis de frecuencia de alimentos mostró un consumo bajo de vegetales y cereales integrales ricos en complejos carbohidratados (fuentes de fibra o histoquímicos) o de ácidos grasos de pescados o frutos secos, fuentes primarias de ácidos grasos poliinsaturados n-3 y un consumo elevado de grasas saturadas; las histologías más agresivas se correlacionaban con un consumo bajo de verduras (p = 0,05) y de fuentes de ácidos grasos n-3 (p = 0,01). Conclusiones: nuestros hallazgos muestran una amplia prevalencia y un patrón homogéneo de sobrepeso/obesidad, y una cantidad excesiva de grasa corporal y abdominal, así como de ganancia de peso tras el diagnóstico, junto con deficiencias dietéticas en nutrientes protectores. ¡Se requiere investigación adicional puesto que las tasas de cáncer siguen aumentando en Portugal! (AU)

Weight concerns and weight reduction practices of Portuguese adolescents / Preocupaciones por el peso y prácticas de reducción del peso en adolescentes portugueses

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A longitudinal study of hospital undernutrition in the elderly: comparison of four validated methods.

BACKGROUND: Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use. DESIGN: Within 48 hrs of admission and 24 hrs before discharge: the following data were collected: clinical data, nutritional status (BMI, %weight loss) and risk (MNA, MUST), energy requirements (Owen et al), diet. RESULTS: Significant changes from admission to discharge in risk/undernutrition prevalence, were not shown by BMI (approximately 17% vs 22%), > or = 5%weight loss (approximately 53% vs approximately 56%) or MNA 83% vs approximately 81%; at admission, 93% patients were MUST high risk declining to approximately 47% (p=0.001) at discharge, alongside eating resumption. By multivariate analysis comparing all methods and differences between patient groups during hospitalization, only %weight loss clarified nutritional progression: more surgical patients had > or = 10%weight loss vs medicine, p < 0.01. Only admission > or = 5%weight loss was predictive of longer hospitalizations (OR:1.57; 95%CI 1.02-2.40; p < 0.003), though MNA and MUST undernourished/high risk had significantly longer stays. MNA and MUST were the most concordant methods, p < 0.001. Eating compromising symptoms were prevalent in surgery/medicine with > or = 5%weight loss, MNA risk/undernutrition, and MUST high risk, p < 0.005. Overall, mean energy requirements/diet were not significantly different between admission/discharge: requirements approximately 1400 kcal were always lower than on offer approximately 2128 kcal, p=0.0001. CONCLUSIONS: Rigid diets create costly waste which do not counteract nutritional deterioration. Different nutritional risk/status prevalences were unveiled at admission and discharge: > 50% patients were at risk/undernourished by significant weight loss, MNA or MUST, all associated with longer stays. Recent weight loss is unarguably essential, comprehensive MNA and MUST similarly reliable; in this study dynamic MUST seemed easier to practise. Quality nutritional care before/during/after hospitalization is mandatory in the elderly.

NF-kappaB and apoptosis in colorectal tumourigenesis.

BACKGROUND: Nuclear factor-kappaB (NF-kappaB) may play an important role in colorectal tumourigenesis, controlling cell cycle and apoptosis gene expression. In addition, imbalances between cell proliferation and cell death are thought to underlie neoplastic development. The aims of this study were to investigate apoptosis and expression of several apoptosis-related proteins, and to determine correlations with colorectal tumour progression. MATERIALS AND METHODS: Apoptosis was evaluated by the TUNEL assay in 48 patient samples, including adenomas, adenocarcinomas and adjacent normal mucosas. Immunohistochemistry was performed for Bcl-2 and NF-kappaB. Expression levels of p53, Bax and IkappaB proteins were determined by immunoblotting. Cultured human colon cancer cells were used to evaluate NF-kappaB expression and nuclear translocation by immunocytochemistry and immunoblotting. RESULTS: Apoptosis and NF-kappaB immunoreactivity were significantly higher in tumour tissue compared with normal mucosa (P < 0.01), increasing in association with histological tumour progression (P < 0.01). Bcl-2 was consistently higher in normal mucosa (P < 0.01) and inversely correlated with the percentage of apoptosis (P < 0.01). Phosphorylated p53 and Bax levels were similar in tumour tissue and normal mucosa; however, the NF-kappaB inhibitor, IkappaB, tended to decrease in tumours. In vitro, nuclear translocation of NF-kappaB was greater in proliferative than in resting phases of colon cancer cells. CONCLUSIONS: NF-kappaB expression and apoptosis are increased from adenoma to poorly differentiated adenocarcinoma tissues. Apoptosis is correlated with suppression of Bcl-2 expression, but appears to proceed through a p53- and Bax-independent pathway. Activation of NF-kappaB may play an important role in colorectal tumour progression.

Does nutrition play a role in the quality of life of patients under chronic haemodialysis?

BACKGROUND: In patients with chronic renal failure under haemodialysis, we investigated the inter-relationships and relative contributions of disease, haemodialysis and of nutrition related factors on the patients' Quality of Life. METHODS: Collected data in 60 adult patients comprised: co-morbidities (multiple medicines, other chronic diseases), duration of renal failure and of haemodialysis (in months), % weight loss since haemodialysis, nutrient intake derived from diet history analysis (DIETPLAN5 2003, UK). The EuroQoL instrument that includes 5 dimensions, mobility, self-care, activities, pain/discomfort, anxiety/depression, and an overall health visual analogue scale evaluated QoL. RESULTS: Estimates of effect size attributed to each variable included in the general linear model revealed that 47% of patients' mobility/self-care scores were worsened by deficient protein/energy intake and 30% by weight loss =10%. Poor performance of usual activities was attributed in 45% to duration of haemodialysis and of disease, 70% to protein/energy/vitamin B12/zinc/iron deficits, and 20% to weight loss =10%. Pain/discomfort were worsened in 45% by the duration of haemodialysis and of disease, and in 15% by co-morbidities. Higher anxiety/depression were related in 43% to protein/energy/selenium & vitamin C deficits, in 40% to the duration of haemodialysis and of disease, in 10% to weight loss =10%, and in 3% to co-morbidities. Likewise, 47% of poor overall health was determined by protein/energy/vitamin B12/ zinc/selenium & vitamin C deficits, 25% by weight loss =10%, 10% by disease duration, and 7% by co-morbidities. CONCLUSION: Protein, antioxidants and key micronutrients involved in protein metabolism, did exert a major effect on patients' Quality of Life. Given the prevalence of nutrient deficits, the ensuing impaired functional capacity is likely to compromise QoL, timely nutrition is thus warranted.

Trends of food intake in Portugal, 1987-1999: results from the National Health Surveys.

OBJECTIVE: To assess trends of food intake in Portugal. DESIGN: Analysis of three cross-sectional studies: 1987, 1995-1996 and 1998-1999. SETTING: Representative samples of free-living individuals. SUBJECTS: 64 734 men and 71 282 women. INTERVENTIONS: Food intake was assessed by questionnaires inquiring the number of meals and which foodstuffs (fish, meat, milk, rice/pasta/potatoes, soup, vegetables and fruit) had been consumed the day before. RESULTS: Age-adjusted average number of meals decreased from 3.3+/-0.1 in 1987 to 2.9+/-0.1 in 1998-1999 in both genders (P<0.001). In men, the percentage of subjects consuming meat, milk and potatoes/rice/pasta increased from 73, 66 and 91% in 1987 to 83, 74 and 95% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 56% in 1987 to 62 and 53% in 1998-1999, respectively. In women, the percentage of subjects consuming meat, milk, potatoes/rice/pasta and vegetable increased from 70, 66, 89 and 71% in 1987 to 78, 77, 93 and 83% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 55% in 1987 to 64 and 53% in 1998-1999, respectively. These trends were more pronounced in the younger age, which also displayed a higher frequency of snacking. Multivariate analysis adjusting for age group, region and educational level showed that the consumption of meat, milk and vegetables increased and the consumption of soup, fish and fruit decreased in 1998-1999 relative to 1995-1996. CONCLUSIONS: Within a decade, the Portuguese dietary pattern has changed considerably, shifting from a traditional, south European to a more Westernized, protein-rich diet. SPONSORSHIP: The Unidade de Nutrição e Metabolismo of the Instituto de Medicina Molecular is partially funded by a grant from the FCT (Fundação para a Ciência e a Tecnologia) ref. RUN 437.

Does nutrition play a role in the quality of life of patients under chronic haemodialysis? / ¿Desempeña la nutrición un papel en la calidad de vida de los pacientes con hemodiálisis crónica?

Background: In patients with chronic renal failure under haemodialysis, we investigated the inter-relationships and relative contributions of disease, haemodialysis and of nutrition related factors on the patients' Quality of Life. Methods: Collected data in 60 adult patients comprised: co-morbidities (multiple medicines, other chronic diseases), duration of renal failure and of haemodialysis (in months), % weight loss since haemodialysis, nutrient intake derived from diet history analysis (DIETPLAN5 2003, UK). The EuroQoL instrument that includes 5 dimensions, mobility, self-care, activities, pain/discomfort, anxiety/depression, and an overall health visual analogue scale evaluated QoL. Results: Estimates of effect size attributed to each variable included in the general linear model revealed that 47% of patients' mobility/self-care scores were worsened by deficient protein/energy intake and 30% by weight loss=10%. Poor performance of usual activities was attributed in 45% to duration of haemodialysis and of disease, 70% to protein/energy/vitamin B12/zinc/iron deficits, and 20% to weight loss =10%. Pain/discomfort were worsened in 45% by the duration of haemodialysis and of disease,and in 15% by co-morbidities. Higher anxiety/depression were related in 43% to protein/energy/selenium & vitamin C deficits, in 40% to the duration of haemodialysis and of disease, in 10% to weight loss =10%, and in 3% to co-morbidities. Likewise, 47% of poor overall health was determined by protein/energy/vitamin B12/zinc/selenium & vitamin C deficits, 25% by weight loss=10%, 10% by disease duration, and 7% by co-morbidities. Conclusion: Protein, antioxidants and key micronutrients involved in protein metabolism, did exert a major effect on patients' Quality of Life. Given the prevalence of nutrient deficits, the ensuing impaired functional capacity is likely to compromise QoL, timely nutrition is thus warranted (AU)

Antecedentes: en pacientes con insuficiencia renal crónica y en hemodiálisis, investigamos las relaciones y contribuciones relativas de la enfermedad, hemodiálisis y factores nutricionales del paciente sobre la calidad de vida (QOL). Métodos: los datos recogidos de 60 pacientes adultos incluían: comorbilidades (múltiples fármacos, otras enfermedades crónicas), duración de la insuficiencia renal y hemodiálisis (en meses), % pérdida de peso desde la hemodiálisis, ingestión de nutrientes derivada del análisis de la historia dietética (DIETPLAN5, 2003, RU). La escala EuroQOL que incluye 5 dimensiones de movilidad, autocuidado, actividades, dolor / malestar, ansiedad/depresión, y una escala analógica visual sobre salud global, evaluó la QOL. Resultados: las estimaciones del efecto del tamaño atribuido a cada variable incluida en el modelo linear general mostraron que el 47% de las puntuaciones de los pacientes sobre movilidad/pérdida de peso empeoraban con una ingestión de deficiente de proteínas / energía y el 30% por una pérdida de peso ≥ 10%. El bajo rendimiento en las actividades habituales se atribuyó en un 45% a la duración de la hemodiálisis y de la enfermedad, el 70% a deficiencias de proteínas/energía/vitamina B12/cinc/hierro, y el 20% a una pérdida de peso ≥ 10%. El dolor/ansiedad empeoraban en un 45% por la duración de la hemodialysis y de la enfermedad, y en un 15% por comorbilidades. La mayor ansiedad/depresión se relacionó en un 43% con deficiencias de proteínas / energía/selenio y vitamina C, en un 40% por la duración de la hemodialysis y la enfermedad, en un 10% por una pérdida de peso ≥ 10%, y en un 3% a las comorbilidades. Asimismo, el 47% de la salud global mala vino determinado por deficiencias de proteína/energía/vitamina B12/cinc/selenio y vitamina C, 25% por pérdida de peso ≥ 10%, el 10% por la duración de la enfermedad, y el 7% por las comorbilidades. Conclusiones: las proteínas, los antioxidantes y los micronutrientes clave implicados en el metabolismo proteico ejercieron un efecto principal sobre la calidad de vida de los pacientes. Dada la prevalencia de las deficiencias nutricionales, la alteración resultante de la capacidad funcional probablemente comprometa la calidad de vida, por lo que se debe garantizar una nutrición adecuada (AU)

Nutritional risks and colorectal cancer in a Portuguese population.

BACKGROUND: Food and nutrition as major causes of colorectal cancer (CRC) are still debatable. AIM OF THE STUDY: This cross-sectional study in a Portuguese population aimed to characterize and identify "high-risk" diets/life-styles and explore their associations with colorectal cancer. METHODS: In 70 colorectal cancer patients and 70 sex, age-matched subjects without cancer history, we evaluated: diet history and detailed nutrient intake (DIET-PLAN5 2002, UK), alcohol (amount, type, years), smoking (number packages/year, years), physical activity, co-morbidities and body mass index. Age-adjusted Relative Risks were calculated, Proportional Hazards models adjusted the analysis for multiple risk factors. RESULTS: Smoking was a risk factor (1.90). Increased colorectal cancer risk regarding the lowest vs the highest intake quartile emerged for: vitamin B12 (3.41), cholesterol (3.15), total fat (2.87), saturated fat (1.98), animal protein (1.95), energy (1.85), alcohol (1.70), iron (1.49), refined carbohydrates (1.39). Reduced colorectal cancer risk for the highest vs the lowest intake quartile was found for: n-3 fatty acids (0.10), insoluble fiber/folate (0.15), flavonoids/vitamin E (0.25), isoflavones/beta-carotene (0.30), selenium (0.36), copper (0.41), vitamin B6 (0.46). CONCLUSION: Our results corroborated well-established risk factors and identified emergent nutrients. Prolonged excessive intake of macronutrients and some micronutrients concurrent with marked deficits of fiber and protective compounds were dominant in colorectal cancer and more significant than alcohol and smoking. The interaction diet-colorectal cancer is consistent and the relevance of new nutrients is emerging.

Nutritional risks and colorectal cancer in a portuguese population / Riesgos nutricionales y cáncer colorrectal en una población portuguesa

Background: Food and nutrition as major causes of colorectal cancer (CRC) are still debatable. Aim of the Study: This cross-sectional study in a Portuguese population aimed to characterize and identify “high-risk” diets/life-styles and explore their associations with colorectal cancer. Methods: In 70 colorectal cancer patients and 70 sex, age-matched subjects without cancer history, we evaluated: diet history and detailed nutrient intake (DIETPLAN52002, UK), alcohol (amount, type, years), smoking(number packages/year, years), physical activity, co-morbidities and body mass index. Age-adjusted Relative Risks were calculated, Proportional Hazards models adjusted the analysis for multiple risk factors. Results: Smoking was a risk factor (1.90). Increased colorectal cancer risk regarding the lowest vs the highest intake quartile emerged for: vitamin B12 (3.41), cholesterol (3.15), total fat (2.87), saturated fat (1.98), animal protein (1.95), energy (1.85), alcohol (1.70), iron (1.49), refined carbohydrates (1.39). Reduced colorectal cancer risk for the highest vs the lowest intake quartile was found for: n-3 fatty acids (0.10), insoluble fiber/folate (0.15), flavonoids/vitamin E (0.25), isoflavones/beta-carotene(0.30), selenium (0.36), copper (0.41), vitamin B6(0.46). Conclusion: Our results corroborated well-established risk factors and identified emergent nutrients. Prolonged excessive intake of macronutrients and some micronutrients concurrent with marked deficits of fiber and protective compounds were dominant in colorectal cancer and more significant than alcohol and smoking. The interaction diet- colorectal cancer is consistent and the relevance of new nutrients is emerging

Antecedentes: Se sigue debatiendo el que los alimentos y la nutrición sean causas principales en el cáncer colorrectal (CCR). Objetivo del estudio: Este estudio transversal en una población portuguesa tenía como objetivo caracterizare identificar las dietas/estilos de vida de “riesgo elevado” y explorar sus asociaciones con el cáncer colorrectal. Métodos: En 70 pacientes con cáncer colorrectal y en70 individuos sin antecedentes de cáncer, emparejados por edad y sexo, evaluamos: los antecedentes dietéticos y la ingestión detallada de nutrientes (DIETPLAN5 2002,RU), alcohol (cantidad, tipo, años), tabaquismo (número de paquetes/año, años), la actividad física, las enfermedades concomitantes, y el índice de masa corporal. Se calcularon los riesgos relativos ajustados por edad, y los modelos de riesgos proporcionales ajustaron el análisis para múltiples factores de riesgo. Resultados: El tabaquismo fue un factor de riesgo (1,90). Destacaba un riesgo aumentado para cáncer colorrectal con respecto a los cuartiles de ingestión inferior frente al superior para: vitamina B12 (3,41), colesterol (3,15), grasa total (2,87), grasa saturada (1,98), proteína animal (1,95), energía (1,85), alcohol (1,70), hierro (1,49), carbohidratos refinados (1,39). Se halló un riesgo disminuido para cáncer colorrectal con respecto al cuartil de ingestión superior frente al inferior para: ácidos grasosn-3 (0,10), fibra insoluble/folatos (0,15), flavonoides/vitamina E (0,25), isoflavonas/beta-caroteno (0,30), selenio(0,36), cobre (0,41), vitamina B6 (0,46).Conclusiones: Nuestros resultados corroboraban los factores de riesgo bien establecidos e identificaron nuevos nutrientes. La ingestión excesiva prolongada de macronutrientes y algunos micronutrientes concomitantemente con deficiencias marcadas de fibra y componentes protectores eran dominantes en el cáncer colorrectal y más significativos que el alcohol y el tabaquismo. La interacción dieta-cáncer colorrectal es coherente y emerge la relevancia de nuevos nutrientes