Effects of Health Risk Assessment and Counselling on Fruit and Vegetable Intake in Older People: A Pragmatic Randomised Controlled Trial.

OBJECTIVES: Interventions to increase fruit and vegetable intake among community-dwelling older people have shown mixed effects. We investigated whether an intervention based on an initial multidimensional health risk assessment and subsequent physician-lead nutrition counselling has favourable effects on dietary intake among community-dwelling older people. DESIGN: Randomised controlled trial comparing the intervention versus usual care. SETTING AND PARTICIPANTS: Non-disabled persons aged 65 years or older at an ambulatory geriatric clinic in Bucharest, Romania, allocated to intervention (n=100) and control (n=100) groups. INTERVENTION: Participants received a computer-generated health profile report based on answers to a health risk assessment questionnaire, followed by monthly individual counselling sessions with a geriatrician on topics related to health promotion and disease prevention, with a special focus on adequate fruit and vegetable consumption. MEASUREMENTS: Fruit and vegetable intake at baseline and at 6-month follow-up. RESULTS: At baseline, fruit and vegetable intake was below the recommended five portions per day in most study participants (85% in the intervention group, and 86% among controls, respectively). At six months, intake increased in the intervention group from a median of 3.8 to 4.6 portions per day, and decreased in the control group due to a seasonal effect from a median of 3.8 to 3.1 portions per day. At six months, fruit and vegetable consumption was significantly higher among persons in the intervention group as compared to controls (median difference 1.4 portions per day, 95% confidence interval 1.1-1.7, p<0.001). CONCLUSION: Personalised food-based dietary guidance, delivered as part of multidimensional preventive health counselling during geriatric clinic visits, results in relevant improvement of fruit and vegetable intake in community-dwelling older adults.

Correlation between erythropoietin serum levels and erythrocyte susceptibility to lipid peroxidation in elderly with type 2 diabetes.

Erythropoietin (EPO), a key hormone involved in red blood cell formation has been recently acknowledged for its pleiotropic actions and protective role in ageing and various pathological conditions concurrent with oxidative stress, vascular diseases and metabolic abnormalities such as diabetes mellitus. The aim of the study was to evaluate the relationship between circulating erythropoietin levels and oxidative stress biomarkers, in elderly with type 2 diabetes (T2DM). The study was carried out in 67 subjects with T2DM (69 ± 5 years; n = 37) without anemia, and aged-matched controls (70 ± 6 years; n = 30). EPO serum levels, erythrocyte susceptibility to lipid peroxidation (ESP) and total antioxidant capacity (TAC) were evaluated. Lower EPO levels (p < 0.01) and higher ESP values (p < 0.001) were found in T2DM group, compared to healthy subjects. EPO levels showed significant negative associations with ESP, both in T2DM subjects (r = -0.565; p < 0.001) and in all study population (r = -0,600; p < 0,001; n = 67). In conclusion, we provide new data regarding the cytoprotective effect of EPO exerted at systemic level on erythrocyte membrane, in the particular state of impaired glucose metabolism associated with oxidative stress, in the elderly.

Patrones de consumo alimentario y exceso de peso infantil; encuesta de la situación nutricional en Colombia, 2010 / Food consumption patterns and excess childhood weight; a survey of the nutritional situation in Colombia, 2010

The prevalence of overweight and its relation to food consumption patterns in 10 187 Colombian children between 5-17 years was assessed by factor analysis: Three consumption patterns were identified: Protein/Fiber, Snack and Traditional/Starch. By calculating Prevalence Ratios (RP), associations between food consumption patterns and overweight were established. The prevalence of overweight and obesity was 12.7% and obesity 2.8%. After adjusting for age, sex and level of wealth, Protein/ Fiber and Traditional/Starch patterns are associated with excess weight (test for linear trend for quartiles of adherence, p = 0.018 and p <0.0001 respectively). The excess weight is more prevalent than the delay for height. The dietary transition that experiences Colombia has negative effects on nutritional status.

En 10 187 niños colombianos entre 5 a 17 años se estableció la prevalencia de exceso de peso y se identificó su patrón de consumo y la relación con el exceso de peso. Con base en análisis de factores se establecieron tres patrones de consumo; Proteico/Fibra, Bocadillo o Snack y Tradicional/ Almidón. Mediante el cálculo de razones de prevalencia (RP), se establecieron asociaciones entre los alimentos, los patrones de consumo y el exceso de peso. La prevalencia de exceso de peso fue 12,7% y la de obesidad 2,8%. Al ajustar por la edad, el sexo y el nivel de riqueza, los patrones Proteico/Fibra y Tradicional/Almidón están asociados al exceso de peso (Test de tendencia lineal para cuartiles de adherencia, p=0,018 y p<0,0001 respectivamente). El exceso de peso es más prevalente que el retraso para la talla. La transición alimentaria que experimenta Colombia, tiene efectos negativos sobre el estado de nutrición.

Escalas para medir la seguridad alimentaria en Colombia: ¿son válidas?? / Scales for measuring food security in Colombia: are they valid?

The aim of this study was to assess reproducibility in four Colombian cities of the results obtained on food insecurity (INSA) comparing it with the factorial and criterion validity of the Food Security Perceptions scale (EPSA) and the Latin American and Caribbean (ELCSA) methods in homes from urban and rural area based on the usual consumption of energy for all household members. The reproducibility was 051 for EPSA and 056for ELCSA . The sensitivity of the EPSA was between 39.6% and 40.5% and for the ELCSA between 62.6% and 622%. The agreement against the reference for the EPSA was between 0.10 and 018for ELCSA was between 0.09 and 0.13. The efficiency of the two tests as a global measure of reliability is just greater than the probability in a coin toss. The results of these scales should be used conservatively.

El objetivo de este estudio fue establecer en cuatro ciudades colombianas la reproducibilidad de los resultados sobre inseguridad alimentaria (INSA), la validez factorial y de criterio de la escala de Percepción de Seguridad Alimentaria (EPSA) y la Latinoamericana y Caribeña (ELCSA) en hogares urbanos y rurales, frente a tres métodos referentes usados para declarar INSA basados en el consumo usual de energía de todos los miembros del hogar. La reproducibilidad para EPSA fue de 0,51 y para ELCSA de 0,56. La sensibilidad de la EPSA estuvo entre 39,6% y 40,5%, de la ELCSA entre 62,2% y 62,6%. El acuerdo frente al referente para la EPSA estuvo entre 0,10 y 0,18, y para la ELCSA entre 0. 09 y 0,13. La eficiencia de las dos pruebas como medida resumen de confiabilidad es apenas mayor que la probabilidad en el lanzamiento de una moneda. Los resultados de estas escalas deben usarse de manera conservadora.

Impacto de estrategias para aumentar el consumo de frutas y verduras en Colombia / Impact of strategies to increase the consumption of fruits and vegetables in Colombia

During the years 2007-2008, a study was carried out in Lebrija (Colombia) to evaluate the impact of two strategies implemented in families with school-age children to increase the consumption of fruits and vegetables at home. Sixteen homes were intervened with the A strategy while twenty-three homes were intervened with a B strategy. Thirty-four homes served like controls. These strategies included, among others, informative shops, preparation of recipes, activities in-group and evaluation of tasks. At the initiation, 3.0 percent of the intervened homes consumed five or more portions increasing to 26.3 percent at the end of the intervention, an increment of8.8 times. In the control group, the consumption of five or more daily portions was of 2.0 percent at the beginning and 0.0 percent at the end. There was no difference between strategy A and B in the increase in consumption (0 percent to 23.5 percent and 4.3 percent to 28.6 percent, respectively. The two evaluated strategies had positive impact, the A on the consumption of fruits and vegetables, the B on the consumption of fruits.

Durante los años 2007-2008 se realizó en Lebrija, Colombia, un estudio para evaluar el impacto de dos estrategias implementadas en familias de niños escolarizados, que tuvieron como objetivo incrementar el consumo de frutas y verduras en el hogar. Dieciséis hogares fueron intervenidos con la estrategia A. Veintitrés hogares fueron intervenidos con la estrategia B. Treinta y cuatro hogares sirvieron como controles. Las estrategias incluyeron entre otros, talleres informativos, preparación de recetas, actividades grupales y evaluación de tareas. En los hogares intervenidos el 3,0 por ciento en la línea de base consumían cinco o más porciones, al finalizar las estrategias aumentaron al 26,3 por ciento, un incremento de 8,8 veces. En el grupo control al inicio este consumo recomendado de cinco o más porciones/día fue de 2,0 por ciento, al final de 0,0 por ciento. El aumento no fue diferencial dada la estrategia de intervención, en la estrategia A paso del 0 por ciento de hogares en la línea de base al 23,5 por ciento, en la B del 4,3 al 28,6 por ciento. Las dos estrategias evaluadas tuvieron impacto positivo, la A sobre el consumo de frutas y verduras, la B sobre el consumo de frutas.

Nosocomial outbreak of Enteroccocus gallinarum: untaming of rare species of enterococci.

An unusual increase in infections caused by vancomycin-resistant Enterococcus gallinarum (VREG) was identified in May 2004, in a Colombian tertiary care teaching hospital. A case-control study was subsequently designed to identify risk factors associated with the development of infections due to these organisms. All VREG isolates were subjected to antimicrobial susceptibility testing, vancomycin resistance gene detection and pulsed-field gel electrophoresis (PFGE) typing. Additionally, the presence of genes associated with an acquired pathogenicity island of E. faecalis and a hyl-like gene of E. faecium was assessed by hybridisation assays. Eleven cases of VREG were identified between May through June 2004. VREG was isolated from blood (N=4), surgical secretions (N=4), paranasal sinus secretion (N=1), lung abscess (N=1) and urine (N=1). Infections with VREG were associated with mucositis, hospitalisation in the haematology ward and surgical unit, length of hospital stay prior to culture and invasive procedures within 30 days prior to the culture. Logistic regression found that female sex and hospitalisation in the surgical unit were independent factors for VREG infection. All isolates were identified as E. gallinarum, harboured the vanC1 gene and exhibited indistinguishable restriction patterns by PFGE. Virulence-associated genes were not detected. This is the first documented hospital-wide outbreak of VREG and highlights the fact that uncommon species of enterococci are capable of nosocomial dissemination.

Conocimientos, actitudes y prácticas relacionados con lactancia materna en mujeres en edad fértil en una población vulnerable / Knowledge, attitudes and practices related to breast-feeding in women in reproductive age in a vulnerable population

Objective: To identify the knowledge, attitudes and practices related with breast feeding (BF) in women in reproductive age residents in the settlement Marías of the Municipality of Girón in the year 2005. Subjects and method: A survey of Knowledge, Attitudes, Practices (CAP) was applied to 96 women in fertile age from the Marías settlement. The data were entered and validated in Epi-Info 6.04 and analyzed in Stata 8.2. Central tendency measures were used to analyze the continuous variables; the categorical variables were expressed as proportions. Results: 78.1% of the participants had children. Only 13% had knowledge on the correct form of breastfeeding, 49% did not know the methods for maternal milk conservation, and 69.8% of the participants had a support attitude to breast feeding. The average nursing time was 5.7 months. Complementary feeding was frequently initiated with broth (88%). Conclusions: A considerable proportion of women of the study gave BF less than six months, they initiated complementary feeding before the 6 months and BF was suspended when the infant suffered some illness.

Objetivo: Identificar los conocimientos, actitudes, prácticas relacionados con la Lactancia Materna (LM) en mujeres en edad fértil residentes del asentamiento las Marías del Municipio de Girón en el año 2005. Sujetos y métodos: Se realizó un corte transversal descriptivo con 96 mujeres en edad fértil del asentamiento las Marías, Girón, 2005. Se aplicó una encuesta tipo Conocimientos, Actitudes y Prácticas (CAP). Los datos fueron digitados y validados en Epi- Info 6,04 y analizados en Stata 8,2. Para analizar las variables continuas, se utilizaron medidas de tendencia central y de variabilidad; las variables categóricas fueron expresadas como proporciones. Resultados: El 78,1% de las participantes había tenido hijos. Sólo el 13% tenía conocimientos sobre la forma correcta de amamantar. Un 49% no conocía los métodos de conservación de la leche materna. El 69,8% de las participantes tiene actitud de apoyo cuando ve a una familiar lactando. El tiempo promedio de lactancia materna fue 5,7 meses. El alimento con el que más inician la alimentación complementaria es el caldo (88%). Conclusiones: se presentaron proporciones considerables de mujeres que dieron LM durante menos de seis meses, que iniciaron la alimentación complementaria antes de los 6 meses y que suspendieron la LM cuando el hijo lactante sufrió alguna enfermedad.

Hybrid (intravenous and oral) administration of vinorelbine plus cisplatinum followed by oral vinorelbine as first-line therapy of advanced non-small cell lung cancer: a phase II study.

BACKGROUND: The combination of alternate i.v./oral (hybrid) administration of vinorelbine (VNR) plus cisplatin (CDDP), followed by oral VNR, could result in a more suitable first-line regimen for patients (pts) with advanced non-small cell lung cancer (aNSCLC) in the outpatient setting. METHODS: The induction treatment consisted of CDDP 80 mg/m(2) i.v. and VNR 25 mg/m(2) i.v. day 1 and VNR 60 mg/m(2) oral day 8, every 3 weeks for 4 courses. A dose escalation of VNR to 80 mg/m(2) oral from day 8 of the second course and to 30 mg/m(2) i.v. from day 1 of the third course was planned in the absence of G3-4 toxicity. Pts with disease control after 4 courses underwent consolidation treatment with oral VNR 80 mg/m(2) days 1 and 8 every 3 weeks up to intolerance or progression. RESULTS: Fifty-three pts entered the study: 80% males; median age 63 years (range 43-71); median ECOG PS 0 (range 0-1); histotype: adenocarcinoma 59%, epidermoid 31%, undifferentiated 10%; disease stage: IIIB 22%, IV 70%, recurrent disease 8%. The objective response was as follows: 1 (2%) CR, 20 (38%) PR, 16 (30%) SD, 11 (21%) PD and 5 (9%) pts were not assessable. Median TTP and OS were 6 and 10 months, respectively. G3-4 neutropenia was observed in 23 and 24% of pts in the induction and in the consolidation phases, respectively, with febrile neutropenia in 6 pts (11%) and 2 (8%), respectively. G3-4 non-haematological toxicity was rare, being represented by nausea-vomiting and neurotoxicity in 3 pts (6%) in the induction phase. CONCLUSIONS: This combination regimen including hybrid administration of VNR plus CDDP is feasible, tolerable and effective as a first-line treatment in pts with aNSCLC.

Ingesta usual de macronutrientes y energía en Bucaramanga, Colombia: análisis de registros de consumo 1998-2003 / Usual intake of nutrients and energy in Bucaramanga, Colombia: analysis of intake records 1998-2003

The measurement of dietary intake is complex. The analysis methods, when used incorrectly, can distort reality generating a waste of resources and opportunities to intervene appropriately at the individual and population level. The intake records of seven consecutive days of 167 subjects were analyzed using the methods proposed by the University of Iowa and compared with the values of reference of dietary intake (DRI's). The variation in energy consumption compared with recommendations was 15%. Ninety two % of the men and 80% of the women's consumed protein above the recommendation (RDA). The average consumption of total fiber was half of the recommendation and all the people had intakes below the RDA. Seventeen % consumed total fats above the RDA regardless of differences in body mass index (BMI). The intake of saturated fat was twice that of polyunsaturated fat. The consumption of monounsaturated, polyunsaturated and saturated fat also did not change for different BMI. The socioeconomic level was associated to the intake of proteins and fats. It is evident that the diet is not healthy and represents a risk factor for cancer development, cardiovascular events and other chronic illnesses.

La medición del consumo dietario es compleja. Además los métodos de análisis utilizados incorrectamente pueden distorsionar la realidad generando una pérdida de recursos y de oportunidades para intervenir adecuadamente a nivel individual y poblacional. Se analizaron los registros de consumo dietario de siete días consecutivos de 167 personas adultas, utilizando los métodos propuestos por la Universidad de Iowa y los valores de referencia de ingesta dietaria (DRI`s). La variación del consumo de energía alrededor de la recomendación, es de 15%. El 92% de los hombres y 80% de las mujeres consume proteínas por encima de la recomendación (RDA). El consumo de fibra total es la mitad de la recomendación y el 100% esta por debajo de la RDA. El 17% consume grasas totales por encima de la RDA sin diferencia por el índice de masa corporal (IMC). El consumo de grasa saturada es dos veces el de grasa poli insaturada. El consumo de grasas mono insaturadas, poli insaturadas y saturadas, no es diferencial por IMC. El nivel socioeconómico está asociado al consumo de proteínas y grasas. Es evidente que la dieta no es saludable y un factor de riesgo para el desarrollo de cáncer, eventos cardiovasculares y otras enfermedades crónicas.

Ingesta usual de vitaminas y minerales en Bucaramanga, Colombia / Usual intake of vitamins and minerals in Bucaramanga, Colombia

The usual intake represents the dietary intake of medium and long term; its estimate being preferable to that of the current intake. The usual intake allows comparison with values of dietary reference intake (DRI's) to establish the deficiency or excess. One hundred and sixty seven subjects between 20 and 60 years old, selected at random, completed a record of intake of foods during seven serial days. The inadequate intake was evident for folic acid (30% in men and 50% in women, p < 0.001), zinc (16% for men and 28% for women, p < 0.001) and magnesium (47% for men and 48% for women, p < 0.001). Women had a higher risk of inadequacy than men in consumption of vitamins. Except for folic acid, all studied vitamins were consumed in smaller quantities in the socioeconomic level one, showing a lineal trend (p < 0.001). Deficit in the intakes existed for some vitamins and minerals which may favour the development of chronic diseases and cardiovascular events. It is necessary to continue developing charts of composition of foods that allow a translation of the diet to nutrition, in a way more appropriate and more coherent with the type of epidemic profile and the conditions of dietary intake.

El consumo usual representa la ingesta dietética de mediano y largo plazo, su estimación es preferible a la del consumo actual. El consumo usual permite con base a los valores de referencia de ingesta dietaria (DRI`s) establecer las prevalencias de déficit o exceso. Para tal fin, encuestamos un grupo de 167 personas entre 20 y 60 años, seleccionadas al azar, quienes completaron un registro de consumo de alimentos con medidas de peso y volumen durante siete días consecutivos. La ingesta inadecuada es evidente para el ácido fólico; 30% en hombres y 50% en mujeres (p<0.001), el cinc; 16% para hombres y 28% para mujeres (p<0,001) y el magnesio; 47% para hombres y 48% para mujeres (p<0,001). Las mujeres tienen mayor riesgo de inadecuación en el consumo de vitaminas. Con excepción del ácido fólico todas las vitaminas estudiadas son consumidas en menor cantidad en el nivel socioeconómico uno; existiendo una tendencia lineal (p<0,001). Existen consumos deficitarios para algunas vitaminas y minerales que favorecen el desarrollo de eventos crónicos y cardiovasculares. Es necesario seguir desarrollando tablas de composición de alimentos que permitan una traducción de la dieta a nutrientes, más adecuada y coherente con el tipo de perfil epidemiológico y las condiciones de consumo dietario.

Diseño y eficacia de pruebas para determinar la deficiencia de hierro / Design and efficacy of tests to determine iron deficiency

Objective:. To design and evaluate the efficacy of tests to determine iron deficiency (serum ferritin <=11 µg/L). Material and methods. We applied two food serum deficiency frequency questionnaires of iron intake to 114 adults based on population records. The questionnaires were incorporated into two of three mathematical models. A study of efficacy was carried out for the questionnaires and models using as gold standard the levels of serum ferritin. Results: The sensibility was between 23 percent and 74 percent, the specificity between 81 percent and 99 percent. False positive and negative results were in the range of 2 percent to 14 percent. The predictive value of positive test varied between 33.3 percent and 96.3 percent, and the predictive value of negative test between 74.5 percent and 95.3 percent. One of the models obtained a kappa and similar efficacy to the test of serum ferritin at 1/50 o the cost. Conclusions: An alternating, quick, non invasive, easy to apply test was developed with a high efficacy and cost- effectiveness that allows to diagnose the serum deficiency of iron in adults.

Objetivo: Diseñar pruebas y evaluar su eficacia para determinar deficiencia de hierro (Ferritina <=11 µg/L). Material y métodos. A 114 adultos les fueron aplicados dos cuestionarios de frecuencia de consumo de hierro que fueron desarrollados con base en registros poblacionales. Los cuestionarios fueron incorporados a dos de tres modelos matemáticos. Para los cuestionarios y modelos se realizó un estudio de eficacia, teniendo como referente la prueba de Ferritina sérica. Resultados. La sensibilidad estuvo entre 0.23 y 0.74, la especificidad entre 0.81 y 0.99. La clasificación falso positivo y falso negativo entre 2 por ciento y 14 por ciento. El Valor Predictivo Positivo varió entre 33.3 por ciento y 96.3 por ciento y el Valor Predictivo Negativo entre 74.5 por ciento y 95.3 por ciento. Un modelo al clasificar el déficit sérico obtuvo una kappa y eficacia similares a la prueba de Ferritina, con un costo cincuenta veces menor. Conclusiones. Fue desarrollada una prueba alterna, rápida y no invasiva, fácil de aplicar, con alta eficacia y costo-efectiva, que permite diagnosticar la deficiencia de hierro en adultos.

Métodos para la derivación de listas de chequeo en estudios de consumo dietario / Methods for the derivation of a checklist in studies of dietary intake

Given the relationships between diet and illness it is necessary to develop methods to measure food intake correctly. An incorrect measurement translates in an attenuation of epidemiological measurements. The food frequency questionnaire is the simplified method mostly used in the measurements of long term diet. The election of the checklist is the first step in the construction of the questionnaire. A list of twenty foods was derived of a dietary record of 1603 days carried out by 167 adults, to study iron consumption. Four methods were used; experts consent, an orderly list for the relative contribution to the intake, a lineal regression and the one denominated Max_r. Different statistical approaches were used to evaluate the performance of each method. In total, 51 foods were chosen. Max_r reach the best performance (R2w 94 percent; R2 86 percent), Pearson coefficient was 0.94 and Spearman 0.77. Contrary to a previously published suggestion, the linear regression performed poorly. The relative contribution to the intake and the experts consent can be more useful than the linear regression in the design of a checklist of foods.

Dadas las relaciones entre dieta y enfermedad es necesario desarrollar métodos para medir correctamente esta exposición. La incorrecta medición se traduce en atenuación de las medidas epidemiológicas. Los cuestionarios de frecuencia de consumo, son el método simplificado más utilizado en la medición de la exposición dietaria de largo término. La elección de la lista de chequeo de alimentos es el primer paso en la construcción del cuestionario. Una lista de veinte alimentos fue derivada de un registro dietario de 1603 días realizado por 167 adultos, para estudiar el consumo de hierro. Cuatro métodos fueron utilizados; un consenso de expertos, una lista ordenada por el aporte relativo a la ingesta, una regresión lineal y el denominado Max_r. Diferentes criterios estadísticos fueron calculados para evaluar el desempeño de cada método. En total, fueron elegidos cincuenta y un alimentos. Max_r, alcanzó el mejor desempeño; R2w 94 por ciento; R2 86 por ciento; coeficiente de Pearson 0,94; de Spearman 0,77. En contra de lo sugerido ampliamente, la regresión lineal presentó un pobre desempeño. El aporte relativo a la ingesta y el consenso de expertos, pueden ser más útiles que la regresión lineal en el diseño de una lista de chequeo de alimentos.

Calidad de la dieta en mujeres con condición de desplazamiento forzado en Colombia en el año 2004 / Diet quality of displaced Colombian women in 2004

El conflicto armado en Colombia, produce desplazamiento de familias marginadas del estado, constituyéndose en tragedia humanitaria. Las mujeres en estas familias son muy vulnerables y su dieta es una expresión de miseria. Se analizó el consumo dietario en 102 madres con tres años de desplazamiento forzado, a través de un recordatorio del consumo de las últimas 24 horas. La energía disponible es deficitaria para todas, y hay imbalance en la dieta; el 71 por ciento de la energía/día proviene de carbohidratos, 12 por ciento de proteínas y 20 por ciento de grasa. La adecuación (por ciento) entre lo consumido y lo requerido para todos los macro y micronutrientes, esta por debajo de niveles considerados como aceptables; el mínimo para el calcio (mg) 30,8 por ciento IC (27,4 a 34,7); el máximo para el ácido ascórbico 81,5 por ciento IC (71,1 a 93,4). Las cifras de déficit según el índice de masa corporal son tres veces mayores que en la población pobre. Intervenciones por mejorar la dieta son deseables, pero es necesario además involucrar soluciones de tipo estructural, para evitar que esta tragedia se haga cada vez más crónica y endémica, violentando el derecho básico a la alimentación.

The armed conflict in Colombia produced a displacement of excluded families from the country, constituting a humanitarian tragedy. The women in these families are very vulnerable and their diet is an expression of their misery. Dietary intake was analyzed in 102 mothers displaced for 3 years by means of a 24-hour dietary recall.. Energy availability was deficient for all subjects, with 71 percent of the energy/day coming from carbohydrates, 12 percent from proteins and 20 percent from fats. Intake of all micro and macronutrients was deficient compared to recommendations. The deficit in Body Mass Index was three times higher than in the poor population. Interventions to improve the diet are desirable but it is also necessary to improve infrastructure to avoid an increase in the prevalence of undernutrition.

Cardiac toxicity of trastuzumab in metastatic breast cancer patients previously treated with high-dose chemotherapy: a retrospective study.

HER-2 overexpression is associated to a poor prognosis in high-risk and metastatic breast cancer (MBC) patients treated with high-dose chemotherapy (HDC). HER-2 status is also a predictive factor and when trastuzumab is administered in combination with or sequentially to chemotherapy, a significant disease-free and/or overall survival improvement has been observed in HER-2+ early and MBC. Unfortunately, in both settings, trastuzumab is associated with an increased risk of cardiac dysfunction (CD). We have reviewed the clinical charts of HER-2-overexpressing MBC patients treated with trastuzumab after HDC. Age, baseline left ventricular ejection fraction (LVEF), radiation therapy on cardiac area, exposure to anthracycline, single or multiple transplant, high-dose agents, trastuzumab treatment duration were recorded as potential risk factors. In total, 53 patients have been included in the analysis. Median LVEF at baseline was 60.5%; at the end of trastuzumab (data available for 28 patients only), it was 55% (P = 0.01). Five out of the 28 (17.9%) patients experienced CD. Two out of 53 (3.8%) patients developed a congestive heart failure. Age > or = 50 years and multiple transplant procedure were potential risk factors for CD. The overall incidence of CD observed in this population of HER-2+ MBC patients treated with trastuzumab after HDC is not superior to that reported with concomitant trastuzumab and anthracyclines. However, patients with age > or = 50 years or receiving multiple course of HDC should be considered at risk for CD.

Incidence of human cytomegalovirus infection in patients with refractory solid tumors receiving nonmyeloablative allogeneic stem cell transplants versus recipients of standard SCT for hematologic malignancies.

Human cytomegalovirus (HCMV) infection is the most frequent infectious complication after conventional allogeneic stem cell transplantation (alloSCT). From December 1998 to December 2002, we prospectively monitored HCMV reactivation in 59 patients affected by solid tumors and undergoing nonmyeloablative alloSCT (NST). Patients were allografted from HLA-identical sibling donors after fludarabine/cyclophosphamide-based conditioning regimens. Seventeen (28.8%) of 59 patients presented with HCMV antigenemia, and 14 received ganciclovir, with successful HCMV clearance in all cases. No patient developed HCMV viremia or disease. The median time to HCMV reactivation was 54 days (range, 16-245 days) after NST. These patients were compared with a cohort of hematologic patients who were treated with conventional myeloablative alloSCT. Matching criteria included HCMV risk group, stem cell source, donor type, and age. In the myeloablative group, HCMV active infection was observed in 47 (85.4%) of 55 patients at a median time of 30 days (range, 13-64 days) after alloSCT, and HCMV infection occurred more frequently ( P < .001) and earlier ( P = .001) than in NST patients. Patients affected with solid tumors undergoing NST had a reduced and delayed incidence of HCMV active infection.

Randomized, controlled, multicenter phase III trial of standard-dose fluorouracil-epirubicin-cyclophosphamide (FEC), compared with time-intensive FEC (FEC-G) and mitoxantrone-methotrexate-mitomycin C (MMM-G) in metastatic breast carcinoma.

The purpose of this multicenter phase III trial was to assess the impact of a time-intensification of FEC (fluorouracil, epirubicin, cyclophosphamide) and MMM (mitoxantrone, methotrexate, mitomycin C) regimens, supported by lenograstim (G-CSF) on the objective response rate, time to progression and survival of patients with chemotherapy-naive metastatic breast cancer (mbc). Women with mbc were randomized to receive as first-line chemotherapy either standard-dose FEC (all doses in mg/m2): arm A (500, 75, 500 every 21 days), or time-intensified FEC-G: arm B (500, 75, 500 every 14 days), or time-intensified MMM-G: arm C (mitoxantrone 10, methotrexate 35 every 14 days and mitomycin C 10 every 28 days), both with support of lenograstim (G-CSF 150 microg/m2/day s.c. for 10 days). All study treatments were administered for six cycles. Eligible female patients were in the 31-70 year range with histologically proven mbc, and measurable or evaluable disease. An intent-to-treat analysis was performed. The overall response rate (CR + PR, intent-to-treat analysis) was significantly improved in the time-intensified FEC-G regimen (69%) in comparison with standard-dose FEC (41%), p=0.002. Time-intensified MMM-G (51%) did not lead to a significant improvement in the response rate. The percentage of complete responses was significantly higher in the FEC-G arm as compared to standard-dose FEC (17% vs. 4.7%; p=0.002). The median duration was longer in the intensified-dose arms without, however, achieving a statistically significant improvement. The median time to progression (TTP), and the median survival time did not differ between the three treatment arms. Grade 3-4 leukopenia was significantly higher (p<0.001) in the standard FEC regimen-treated patients. Thrombocytopenia was significantly higher (p<0.001) in both intensified regimens. Alopecia and mucositis were significantly more frequent in both anthracycline-containing regimens (p=0.003). Other hematological and non hematological toxicities were similar in the 3 treatment arms. The increase of dose-intensity of both FEC and MMM regimens improved activity, but not efficacy as compared to standard FEC regimen in our group of chemotherapy-naive, metastatic breast cancer patients.

Low incidence of secondary myelodysplasia and acute myeloid leukemia after high-dose chemotherapy as adjuvant therapy for breast cancer patients: a study by the Solid Tumors Working Party of the European Group for Blood and Marrow Transplantation.

BACKGROUND: To determine the incidence of secondary myelodysplasia (sMDS) or acute myeloid leukemia (AML) in node-positive breast cancer patients who received high-dose chemotherapy (HDCT) followed by autologous stem-cell support as adjuvant therapy. PATIENTS AND METHODS: The incidence of sMDS/AML was retrospectively assessed in 364 node-positive breast cancer patients who received HDCT followed by autologous stem-cell support as adjuvant therapy between November 1989 and December 1997 and were reported to the European Group for Blood and Marrow Transplantation registry. RESULTS: The median age of the patients was 45 years (range 22-62 years). Two hundred and ninety-one patients received peripheral blood stem cells and 55 patients received autologous bone marrow as stem-cell support. The most frequently used conditioning regimen was the STAMP-V regimen (32%), followed by melphalan-thiotepa (22%) and melphalan-mitoxantrone-cyclophosphamide (21%). The 5-year probability of overall survival is 71% (95% CI 65% to 77%). After a median follow-up of 48 months (range 1-108 months) only one case of AML was observed, resulting in a crude incidence of 0.27%. This case of AML was observed 18 months after HDCT consisting of three cycles of epirubicin and cyclophosphamide with a cumulative dose of epirubicin 960 mg and cyclophosphamide 19 g. The French-American-British type of AML was M4, and the cytogenetic analysis showed a translocation t(9;11)(p22;q23). After complete remission following high-dose cytarabine and idarubicin the patient relapsed and died. CONCLUSIONS: In contrast to patients with malignant lymphoma there seems to be no increased risk of sMDS/AML after HDCT in breast cancer. Continued monitoring is required to confirm this low incidence after a longer follow-up period.

Cytotoxic chemotherapy preceding apheresis of peripheral blood progenitor cells can affect the early reconstitution phase of naive T cells after autologous transplantation.

Transient T cell immunodeficiency is a common complication following hematopoietic stem cell transplantation. In breast cancer patients transplanted with autologous peripheral blood progenitor cells (PBPC) harvested after cytotoxic treatment with either cyclophosphamide or epirubicin plus paclitaxel, we evaluated T cells infused in grafts and in peripheral blood during the early reconstitution phase. We found that PBPC grafts harvested after treatment with epirubicin plus paclitaxel contained substantially larger numbers of T cells with less altered composition than after cyclophosphamide. Three months after high-dose cytotoxic chemotherapy, the numbers and the kinetics of circulating naive T cells, but not of memory and CD28- T cells, correlated positively with the number of naive T cells infused PBPC grafts. Finally, retrospective analysis of two cohorts of patients transplanted in different clinical settings with PBPC grafts harvested following cyclophosphamide or epirubicin plus paclitaxel showed apparently different susceptibilities to develop endogenous varicella zoster virus reactivation in the first year after high-dose cytotoxic chemotherapy. On the whole, these data indicate that number and composition of T cells in PBPC grafts vary according to the former cytotoxic therapy, and suggest that autologous transfer of T cells may accelerate the early T cell reconstitution phase and possibly ameliorate immune competence in patients rendered lymphopenic by high-dose chemotherapy.