Modulation of human glutathione S-transferases by botanically defined vegetable diets.

Glutathione S-transferases (GSTs) conjugate activated xenobiotics with glutathione; thus, GST induction may improve detoxification and excretion of potentially harmful compounds. Using a randomized cross-over design, we tested the hypothesis that, in humans, serum GST-alpha concentration (GST-alpha) and GST activity increase with vegetable consumption and that this effect is GSTM1 genotype dependent. Twenty-one men (10 GSTM1-null and 11 GSTM1+) and 22 women (15 GSTM1-null and 7 GSTM1+), nonsmokers, 20-40 years of age and not on medications, ate four 6-day controlled diets: basal (vegetable-free), and basal supplemented with three botanically defined groups of vegetables (i.e., brassica, allium, and apiaceous). Fasting blood samples, collected on the last 2 days of each feeding period, were analyzed for GST-alpha, serum GST activity [against 1-chloro-2,4-dinitrobenzene (CDNB) and 7-chloro-4-nitrobenzo-2-oxa-1,3-diazole (NBD-Cl)] and peripheral-lymphocyte GST-mu activity (against trans-stilbene oxide). The brassica, but not allium or apiaceous, vegetable diets (relative to the basal diet) increased GST-alpha by 26% (P = 0.005) and GST (NBD-Cl) activity by 7% (P = 0.02) in the GSTM1-null individuals, particularly the women. Apiaceous vegetable supplementation decreased GST-alpha in the GSTM1+ men (P = 0.03). Among the GSTM1+ women, both brassica and the allium diets increased GST-mu activity by 18% (P = 0.02) and 26% (P = 0.001), respectively. The vegetable diets had no effect on GST (CDNB) activity, irrespective of GSTM1 genotype or sex. These results demonstrate that GSTM1 genotype has a significant effect on GST responses to diet and that brassica vegetables are most effective at inducing GST-alpha, whereas both brassica and allium vegetables induce GST-mu. GST responses were more pronounced in women than men, but it is not clear from this study whether this is a dose-per-body-weight or a sex-specific effect.

Brassica vegetables increase and apiaceous vegetables decrease cytochrome P450 1A2 activity in humans: changes in caffeine metabolite ratios in response to controlled vegetable diets.

Induction or inhibition of biotransformation enzymes, enzymes that activate or detoxify numerous xenobiotics, is one mechanism by which vegetables may alter cancer risk. Using a randomized crossover design, we examined the effect of various vegetable diets on cytochrome P450 (CYP) 1A2, N-acetyltransferase 2 (NAT2) and xanthine oxidase activity in humans. Men and women, non-smokers, on no medication and 20-40 years of age ate four 6-day controlled diets: basal (vegetable-free) and basal with three botanically defined vegetable groups. Enzyme activities were determined by measuring urinary caffeine metabolite ratios after a 200 mg caffeine dose on the last day of each feeding period. Mean CYP1A2 activity for 19 men and 17 women (least squares means adjusted for sex, GSTM1 genotype, urine volume and feeding period) with basal, brassica, allium and apiaceous vegetable diets differed significantly (P

Sex differences in nitrogen balance following marrow grafting for leukemia.

A sex difference in nitrogen balance was investigated in 40 adults, 21 men and 19 women, undergoing chemoradiotherapy and marrow transplantation for leukemia and receiving total parenteral nutrition. Twenty-four hour collections of urine and mixed urine-stool were analyzed for total nitrogen daily through day 14 posttransplant. Nitrogen balance, corrected for changes in blood urea nitrogen, decreased significantly over time (p less than 0.005) in both men and women, but men experienced a greater negative nitrogen balance during the time period (p less than 0.001). Mean daily nitrogen balance in men was -6.0 g for week 1 and -9.2 g for week 2, corresponding to -3.3 g and -5.6 g in women for week 1 (p less than 0.005) and 2 (p less than 0.01), respectively. The differences remained after controlling for stress level and adjusting for total calorie intakes. There were no differences in age, disease status, or nitrogen intakes per kg ideal body weight, and no effects on nitrogen balance by arm muscle area at admission, cyclosporine use, or the branched-chain amino acid content of the parenteral solution. The average rise in 3-methylhistidine excretion was 23% in men and 11% in women. These results suggest higher per kg nutrient needs in males during stress and may indicate differing metabolic responses to stress. The possibility of gender differences should be considered in research evaluating nitrogen metabolism during severe stress.

Intravenous branched chain amino acid trial in marrow transplant recipients.

Branched chain amino acids (BCAA) improve nitrogen balance and end-organ function in surgical patients, but are untested in marrow transplant recipients. We compared nitrogen balance, urinary 3-methylhistidine-to-creatinine ratio, upper arm anthropometry, serum prealbumin, and day to peripheral engraftment in a randomized, double-blinded trial between 45% (high-leucine) and 23% BCAA intravenous solutions in 40 adult leukemia patients for 1 month following allogeneic marrow transplantation. Nutritional support, provided at approximately 30 nonprotein calories/kg and 0.21 g nitrogen/kg ideal weight, did not differ between groups. Despite greater nitrogen loss and muscle breakdown evidenced by increased 3-methylhistidine-to-creatinine ratio and loss of arm muscle area by study end in the 45% BCAA, no statistical differences were observed when nitrogen balance was compared by week and within stress level as defined by organ and infectious complications. It is likely the patients in the 45% BCAA experienced greater metabolic stress by study end. Serum prealbumin and day posttransplant to peripheral engraftment also did not differ between groups. The chances (power) of this study exceeded 85% in detecting a difference in nitrogen balance of 2.5 g during study week 1 and 4.0 g during week 2. The power during week 3 was 77% for detecting a difference of 4.0 g, and it is unlikely that the true difference exceeds this magnitude. Thus, we did not find any evidence that intravenous BCAA-enriched solutions improved nitrogen balance during the first month after marrow transplantation.

Primary taste thresholds in children with leukemia undergoing marrow transplantation.

Taste threshold for the four basic tastes were determined to assess taste impairments in 11 children with acute leukemia undergoing marrow transplantation and in 20 normal children. Thresholds were measured on admission, 2 days, and 45 days after transplant using the Up-Down Staircase method. No significant difference was noted between patients at admission and the control group for sweet, bitter, or salt. There was a significant difference between patients and controls for the sour threshold (p = 0.006). Patient threshold values on day 2 and day 45 (posttransplant were compared with admission values. No significant differences were seen, except for the salt threshold which was increased at day 2 posttransplant when compared with the admission values. We conclude that only minor changes in taste thresholds were demonstrated in this study. These changes probably do not account for abnormal food tastes reported by patients.

Nutritional management of patients with intestinal graft-versus-host disease.

Gastrointestinal Graft-Versus-Host Disease (GI GVHD) may occur following bone marrow transplantation for the treatment of acute leukemia or aplastic anemia. The resulting GI damage leads to symptoms including altered intestinal mobility, malabsorption, and protein losing enteropathy. A five-phase nutritinal regimen has been developed to supply adequate nutrient support, promote intestinal healing, reduce GI symptoms, and satisfy individual dietary preferences. The patient and family are integrally involved in the dietary planning and care. Dietary compliance is promoted through the use of nutrition education materials which explain GI GVHD and provide nutritional guidelines and their rationale.

Anthropometric measurement in a protective environment.

Although specifically designed for intensive chemotherapy, the LAF room is in use in other related treatment areas, including organ transplantation, burn therapy, and hematologic conditions in which the ability to ward off infections is impaired. With the increased use of protective environments in a variety of clinical conditions, the dietitian must be able to identify and develop proper sterile techniques for anthropometry to provide the health care team with ongoing nutritional assessment for this patient population.