Intestinal failure-associated liver disease in patients with short bowel syndrome: Evaluation by transient elastography.

OBJECTIVE: Patients with short bowel syndrome (SBS) receiving long-term parenteral nutrition (PN) are at risk for intestinal failure-associated liver disease (IFALD). The aim of the present study was to evaluate dynamic changes of liver fibrosis and steatosis within 12 mo by transient elastography (TE), including controlled attenuation parameter (CAP) in a cohort of patients with SBS receiving long-term PN. METHODS: Twenty-five adult patients with SBS and PN requirement for ≥3 mo consecutively were included and prospectively followed. Liver stiffness by FibroScan (Echosens, Paris, France) and CAP measurement were done at study entry and after 12 mo. Clinical parameters, as well as data on underlying bowel disease and nutrition composition, were collected. Bioelectrical impedance analysis was performed in all patients. RESULTS: FibroScan and CAP did not show any significant differences after 12 mo (5.2 kPa [2.8-16.2 kPa]; 223dB/m [101-366 dB/m]) compared with study entry (5.3 kPa [2.7-12.3 kPa]; 237dB/m [100-344 dB/m]). There was no significant correlation between FibroScan and CAP and elevated transaminase levels. CAP significantly correlated with triacylglyceride levels (r = 0.411; P = 0.042) and body mass index (r = 0.468; P = 0.016). Patients with a remnant small bowel <100cm showed a significantly higher stiffness value by FibroScan than those having a remnant length ≥100cm (6.1 versus 4.7 kPa; P = 0.028). CONCLUSION: In the present study cohort, prevalence of advanced fibrosis or cirrhosis was low (<10%) without significant dynamic within the 12-mo follow-up. Short intestinal remnant length <100cm appeared to be a risk factor for development of fibrosis.

Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice.

BACKGROUND: Many cancer patients use cancer diets. MATERIALS AND METHODS: We listed 13 cancer diets simulating an internet search for which we systematically reviewed clinical data. In the next step we derived recommendations on counseling patients using a Delphi process. RESULTS: We evaluated the following diets: raw vegetables and fruits, alkaline diet, macrobiotics, Gerson's regime, Budwig's and low carbohydrate or ketogenic diet. We did not find clinical evidence supporting any of the diets. Furthermore, case reports and pre-clinical data point to the potential harm of some of these diets. From published recommendations on counseling on complementary and alternative medicine, we were able to derive 14 recommendations for counseling on cancer diets. CONCLUSION: Considering the lack of evidence of benefits from cancer diets and potential harm by malnutrition, oncologists should engage more in counseling cancer patients on such diets. Our recommendations could be helpful in this process.

Predictors of postpartum diabetes in women with gestational diabetes mellitus.

The aim of this study was to stratify risk for postpartum diabetes in women who have gestational diabetes. Women with gestational diabetes were recruited between 1989 and 1999, and 302 were followed with oral glucose tolerance tests at 9 months and 2, 5, 8, and 11 years postpregnancy. The 8-year postpartum diabetes risk was 52.7% (130 diabetic cases). Risk was increased in women with autoantibodies to GAD and/or insulinoma antigen-2 (adjusted hazard ratio 4.1; P < 0.0001), women who required insulin during pregnancy (4.7; P < 0.0001), women with BMI >30 kg/m2 (1.5; P = 0.04), and women with more than two prior pregnancies (2.5; P = 0.02). Women without these risk factors had a postpartum diabetes risk of 14% by 8 years, and risk rose incrementally to 96% by 8 years in autoantibody-positive women. Parity status, C-reactive protein concentration, a diabetes family history, maternal age, weeks of gestation, and the child's birth weight did not significantly affect risk in multivariate analysis. Prospective diabetes assessment is indicated and intervention should be considered in women with gestational diabetes who are autoantibody positive, require insulin treatment during pregnancy, or are obese.