Predictors of elevated C-reactive protein among pre-treatment, newly diagnosed breast cancer patients: A cross-sectional study.

BACKGROUND & AIMS: Accumulating evidence showed that inflammation contributes markedly to cancer progression, with C-reactive protein (CRP) being one of the lengthily studied inflammation marker. For breast cancer (BCa), pre-treatment elevated CRP upon diagnosis was linked with increased mortality. This study aimed to identify factors predictive of elevated CRP in pre-treatment BCa population that can serve as potential therapeutic targets to reduce inflammation. METHODS: This is a cross-sectional study using multiple logistic regression to identify predictors of elevated CRP among pre-treatment, newly diagnosed BCa patients. Studied variables were socio-demographic and medical characteristics, anthropometric measurements [body weight, Body Mass Index, body fat percentage, fat mass/fat free mass ratio, muscle mass, visceral fat], biochemical parameters [albumin, hemoglobin, white blood cell (WBC), neutrophil, lymphocyte], energy-adjusted Dietary Inflammatory Index, handgrip strength (HGS), scored Patient Generated-Subjective Global Assessment, physical activity level and perceived stress scale (PSS). RESULTS: A total of 105 participants took part in this study. Significant predictors of elevated CRP were body fat percentage (OR 1.222; 95 % CI 1.099-1.358; p < 0.001), PSS (OR 1.120; 95 % CI 1.026-1.223; p = 0.011), low vs normal HGS (OR 41.928; 95 % CI 2.155-815.728; p = 0.014), albumin (OR 0.779; 95 % CI 0.632-0.960; p = 0.019), and WBC (OR 1.418; 95% CI 1.024-1.963; p = 0.036). CONCLUSION: Overall, predictors of elevated CRP in pre-treatment, newly diagnosed BCa population were body fat percentage, PSS, HGS category, albumin and WBC.

Association between dietary inflammatory index and body fat percentage among newly diagnosed breast cancer patients.

BACKGROUND: Obesity, particularly excessive body fat, is an established risk factor and substantial prognostic determinant in breast cancer. Recent studies suggested that diet-related inflammation plays a key role in obesity. This study aimed to determine the association between energy-adjusted dietary inflammatory index (E-DII) and body composition, particularly body fat percentage, among patients with newly diagnosed breast cancer. MATERIALS AND METHODS: This cross-sectional study was conducted on 124 breast cancer outpatients within the first year of diagnosis and yet to commence oncological treatment. Body composition parameters [body weight, body mass index (BMI), body fat percentage, fat mass over fat-free mass ratio (FM/FFM), muscle mass, and visceral fat] were obtained using a bioelectrical impedance analyzer. Body fat percentage was categorized into two groups which were normal (<35%) and high (≥35%). The E-DII was calculated from the validated 165-items Food Frequency Questionnaire (FFQ) and categorized into three groups or tertiles. Multiple logistic regression analysis was used to determine the association between the E-DII and body fat percentage. RESULTS: Mean body weight, body fat percentage, FM/FFM, and visceral fat increased as E-DII increased from the lowest tertile (T1) to the most pro-inflammatory tertile (T3) (p for trend <0.05). E-DII was positively associated with body fat percentage (OR 2.952; 95% CI 1.154-7.556; p = 0.024) and remained significant after adjustment for cancer stage, age, physical activity, ethnicity, smoking history, and presence of comorbidities. Compared to T1, participants in T3 had a significantly lower consumption of fiber, vitamin A, beta-carotene, vitamin C, iron, thiamine, riboflavin, niacin, vitamin B6, folic acid, zinc, magnesium, and selenium, but a higher intake of total fat, saturated fat, and monounsaturated fatty acids. CONCLUSIONS: A higher E-DII was associated with increased body fat percentage, suggesting the potential of advocating anti-inflammatory diet to combat obesity among newly diagnosed breast cancer patients.

E-DII was significantly and positively associated with high body fat percentage, particularly among pre-menopausal breast cancer patients.Participants in the highest E-DII tertile group had significantly higher body weight, body fat percentage, FM/FFM, and visceral fat than those in the lowest E-DII tertile group.Those in the highest E-DII tertile group were more likely to consume a higher intake of total fat, saturated fat, and monounsaturated fatty acids, but lower fiber, vitamin A, beta-carotene, vitamin C, iron, thiamine, riboflavin, niacin, vitamin B6, folic acid, zinc, magnesium, and selenium compared to the lowest E-DII tertile group.

Factors associated with malnutrition among head and neck cancer in-patients before radiotherapy in National Cancer Institute, Putrajaya

@#Introduction: Head and neck cancer (HNC) patients are often malnourished during diagnosis and before treatment. This study determined the prevalence of malnutrition and factors associated with malnutrition among HNC patients. Methods: A crosssectional study among HNC in-patients before radiotherapy was conducted. Malnutrition status of the patients was determined using scored Patient GeneratedSubjective Global Assessment (PG-SGA). Nutritional parameters of muscle mass, fat mass, albumin, energy and protein intakes were collected. Nutrition impact symptoms (NIS) of the patients were assessed using a validated Head and Neck Symptoms Checklist© (HNSC©). Results: Fifty HNC patients were recruited in this study and the age range of patients was 21 to 78 years old, with gender distribution of 78% males and 22% females. More than half of the patients were malnourished, with 20% severely malnourished before radiotherapy. The lack of dietitian referral before treatment was found to significantly affect nutritional status (p=0.027). There was a significant negative relationship between energy intake (r=0.342, p=0.015) and protein intake (r=0.386, p=0.006) with PG-SGA, indicating lower energy and protein intakes related with poor nutritional status. The result showed a significant positive relationship between NIS score (r=0.731, p<0.001) and PG-SGA, indicating the lower the NIS, the better the nutritional status among HNC patients. More than half of the HNC patients had difficulty chewing. Conclusion: A strong association between nutritional status and NIS showed the importance of dietary management in HNC patients. Early identification of the nutritional status of HNC patients can ensure optimal nutritional status to improve treatment outcomes.

Clinical audit on adherence to using Malnutrition Screening Tool and dietitian referral in the Oncology Outpatient Clinic, National Cancer Institute, Malaysia

@# Introduction: Malnutrition is a frequent complication in cancer patients and can negatively affect treatment outcome. Preliminary audit conducted at the Oncology Clinic, National Cancer Institute (NCI), found that only 5.8% of outpatients underwent nutrition screening using the Malnutrition Screening Tool (MST), and only 2.6% of dietitian referrals were recorded. This audit aims to determine the rate of adherence to nutritional screening, and to implement remedial measures for improved patient care. Methods: This was a cross-sectional audit comprising three phases, namely initial audit, remedial measures and re-audit. Criteria audited include screening rate using MST and dietitian referral based on MST scores. Standards were set at 100% for both criteria. Data collected for initial audit were patients’ MST scores records and total dietitian referral forms retrieved from Electronic Medical Records. After initial audit, self-administered questionnaires for nurses and physicians were developed to identify barriers. Measures implemented for change included patientadministered MST to shorten screening time, and procedure flowchart to facilitate referral. After 6 months, a re-audit was conducted. Results: Total subjects for initial audit and re-audit were 349 and 390, respectively. Initial audit and re-audit showed screening rate using MST increased significantly from 6.3% to 79.5%, but there was no significant change for the dietitian referral rate. Conclusion: This clinical audit has led to a change in the policy in NCI outpatient clinics whereby nurses directly schedule dietitian referrals without going through physicians for patients with MST scores ≥2. Continuous audit and monitoring are necessary to facilitate improvement in MST implementation for better outpatient care.