Biomarcadores de pronóstico modificables nutricionalmente en el paciente con cáncer colorrectal tras el diagnóstico de la enfermedad

Colorectal cancer (CRC) is the second most common cancer in the Western world. About one million of new CRC cases are diagnosed per year. The survival rate of patients with CRC changes widely, even among patients with the same tumor histology. This is possibly due to the impact of environmental factors on tumor development. The diet is the most important among these factors. It is known that nutrition can modify the risk of CRC. However, the role that nutrition plays in the risk of recurrence or survival in patients with CRC is not known with accuracy. The objective of this review was to try to clarify this fact. Material and Methods: Collecting the data obtained as of today in the epidemiological studies of association among recurrence, survival or mortality risk of CRC; and vitamins and the body mass index (BMI), to develop a series of nutritional advices to patients. Thanks to the studies discussed in this work, we could conclude that: BMI, retinol and vitamin D, and in some cases folic acid, at the time of disease diagnosis, operate like recurrence and survival prognosis markers in CRC.El cáncer colorrectal (CCR) es el segundo cáncer más frecuente en el mundo occidental, de tal manera que se diagnostican cerca de un millón de casos nuevos por año. La tasa de supervivencia de pacientes con CCR varía ampliamente, aún entre pacientes con el mismo tumor histológico. Esto posiblemente es debido al impacto de los factores ambientales sobre el desarrollo tumoral. Dentro de estos factores, destaca la dieta. Se conoce que la nutrición puede modificar el riesgo de padecer CCR. Sin embargo, no se conoce con precisión el papel que desempeña la nutrición en el riesgo de recurrencia o supervivencia en pacientes con CCR. El objetivo de esta revisión fue tratar de esclarecer el papel que desempeña la nutrición en el riesgo de recurrencia o supervivencia en pacientes con CCR. Material y métodos: recopilación de los datos obtenidos hasta el momento en los estudios epidemiológicos más recientes, de la asociación entre recurrencia, supervivencia o riesgo de mortalidad en el CCR; y las vitaminas y el índice de masa corporal (IMC), con el fin de elaborar una serie de consejos nutricionales a estos pacientes. Gracias a los estudios comentados se puede concluir que el IMC y el nivel de vitamina D, retinol y en algunos casos el del ácido fólico, en el momento del diagnóstico de la enfermedad, funcionan como marcadores de pronóstico de recurrencia y supervivencia al CCR.El càncer colorectal (CCR) és el segon càncer més freqüent en el món occidental, de tal manera que es diagnostiquen prop d'un milió de casos nous per any. La taxa de supervivència de pacients amb CCR varia àmpliament, fins i tot entre pacients amb el mateix tumor histològic. Això possiblement és degut a l'impacte dels factors ambientals sobre el desenvolupament tumoral. Dins d'aquests factors destaca la dieta. Es coneix que la nutrició pot modificar el risc de patir CCR. No obstant això, no es coneix amb precisió el paper que exerceix la nutrició en el risc de recurrència o supervivència en pacients amb CCR. L'objectiu d'aquesta revisió va ser intentar aclarir el paper que exerceix la nutrició en el risc de recurrència o supervivència en pacients amb CCR. Material i mètodes: recopilació de les dades obtingudes fins al moment en els estudis epidemiològics més recents, de l'associació entre recurrència, supervivència o risc de mortalitat en el CCR; i les vitamines i l'índex de massa corporal (IMC), per tal d'elaborar una sèrie de consells nutricionals a aquests pacients. Gràcies als estudis comentats es pot concloure que l'IMC i el nivell de vitamina D, retinol i en alguns casos el de l'àcid fòlic, en el moment del diagnòstic de la malaltia, funcionen com a marcadors de pronòstic de recurrència i supervivència al CCR

A Review of Current Evidence with Continuous Glucose Monitoring in Patients with Diabetes

Devices that measure glucose on a near-continuous basis may provide a better insight into glycemic profiles, allowing patients with diabetes to make therapeutic adjustments to improve metabolic control, thereby reducing the risk of diabetic complications. Motivated and technologically adept patients with brittle diabetes, hypoglycemia unawareness, diabetic pregnancy, or who use pumps might benefit

Influencia del peso corporal en el pronóstico de las supervivientes de cáncer de mama: abordaje nutricional tras el diagnóstico

La obesidad combinada con el cáncer de mama constituye un problema de salud pública dada la gran incidencia y prevalencia de ambas enfermedades. El objetivo de esta revisión es conocer el estado actual de las investigaciones sobre la relación entre el peso de las pacientes con cáncer de mama y su pronóstico. El sobrepeso y la obesidad en el momento del diagnóstico se asocian con un peor pronóstico en las mujeres supervivientes de cáncer de mama. Estudios observacionales muestran un aumento del 33% de la mortalidad entre las supervivientes obesas en comparación con las no obesas. Además, el aumento de peso en estas pacientes es común tras del diagnóstico y es mayor aún en las que reciben quimioterapia. Se observan ganancias de 2-8 kg de peso en el 68% de las pacientes a los tres años del diagnóstico. Cada aumento de 5 kg de peso se relaciona con un aumento del 13% en la mortalidad por cáncer de mama. Se desconocen los mecanismos que producen este aumento de peso, pero sí se observa que cuanto mayor es éste, mayor es el riesgo de padecer enfermedades cardio-metabólicas asociadas lo que conduce a una peor calidad de vida y menor supervivencia global. Por otro lado, el exceso de tejido adiposo actúa como promotor indirecto de la proliferación celular tumoral y del aumento de los estrógenos circulantes. De ahí la importancia de prevenir un exceso de peso en estas pacientes. Ante las limitaciones que supone la poca cantidad de estudios controlados aleatorios que estudien específicamente la dieta a aplicar en casos de cáncer de mama, los estudios actuales señalan que una dieta saludable, baja en grasa y azúcares simples, con alta proporción de frutas, vegetales y productos integrales tiene el potencial de reducir significativamente la morbilidad y el riesgo de recurrencia, mejorando por tanto, el pronóstico y la calidad de vida a largo plazo

BMC Public Health

Background Elevated ferritin levels have been associated with single cardiovascular risk factors but the relationship to the presence of metabolic syndrome is inconclusive. The aim of this systematic review and meta-analysis of published observational studies was to estimate the association between serum ferritin levels and metabolic syndrome in adults. Methods The Pubmed, SCOPUS and the Cochrane Library databases were searched for epidemiological studies that assessed the association between ferritin levels and metabolic syndrome and were published before September 2013. There were no language restrictions. Two investigators independently selected eligible studies. Measures of association were pooled by using an inverse-variance weighted random-effects model. The heterogeneity among studies was examined using the I2 index. Publication bias was evaluated using the funnel plot. Results Twelve cross-sectional, one case–control and two prospective studies met our inclusion criteria including data from a total of 56,053 participants. The pooled odds ratio (OR) for the metabolic syndrome comparing the highest and lowest category of ferritin levels was 1.73 (95% CI: 1.54, 1.95; I2 = 75,4%). Subgroup analyses indicate that pooled OR was 1.92 (95% CI: 1.61, 2.30; I2 = 78%) for studies adjusting for C-reactive protein (CRP), and 1.52 (95% CI:1. 36, 1.69; I2 = 41%) for studies that did not adjust for CRP (P = 0.044). This finding was remarkably robust in the sensitivity analysis. We did not find publication bias. Conclusions The meta-analysis suggests that increased ferritin levels are independently and positively associated with the presence of the metabolic syndrome with an odds ratio higher than 1.73.Cuencavolumen 1

Food and Nutrition Bulletin

Background. The high prevalence of childhood overweight and obesity is a health problem worldwide. In developing countries, we lack information on the extent of the problem and the risk factors involved. Objective. To determine the prevalence rates of overweight and obesity and of abdominal obesity, and their relationship with physical activity, poverty, and eating habits in schoolchildren in Cuenca, Ecuador. Methods. A cross-sectional survey in a representative sample (n = 743) schoolchildren aged 6 to 9 years was conducted. Overweight and obesity were detected using the International Obesity Task Force cutoffs according to body mass index (BMI), and abdominal obesity was detected according to waist circumference. Poverty, physical activity, and eating habits were assessed with validated questionnaires. Results. The prevalence rates of overweight and obesity and of abdominal obesity were 26.0% and 10.6%, respectively. There were no differences between the sexes, but the prevalence of overweight and obesity was 1.5- to 2-fold higher in 9-year-old than in 6-year-old children (p < .05). Multivariate models demonstrated that higher BMI and waist circumference were significantly related to low physical activity and nonpoverty. Insufficient physical activity (in 75% of children) was associated with a 13% to 18% increased risk of overweight and obesity and abdominal obesity. Eating breakfast and eating more than three meals per day (in 96.7% and 85.9% of children, respectively) were not related to the prevalence of overweight and obesity. Eating fruits during school break was associated with a lower BMI. Conclusions. The high prevalence of overweight and obesity observed in schoolchildren increased from the ages of 6 to 9 years and was associated with insufficient physical activity and nonpoverty. Promoting physical activity and fruit consumption in school snacks should be explored as intervention measures to prevent and reduce overweight and obesity in Cuenca schoolchildren.Cuencavolumen 34; número

Adverse effects of low occuptional cadmium exposure on renal and oxidative stress biomarkers in solderers.

Objectives Recent studies suggest adverse health effects after low exposure to cadmium (Cd). Brazing with Cd-containing solder exposes workers to Cd. The purpose of this study was to assess: (1) indicators of Cd exposure in blood (Cd-B)/ urine (Cd-U); (2) the association between Cd-B, Cd-U and renal and oxidative stress biomarkers. Methods In this cross-sectional study Cd-B, Cd-U, renal (ie, N-acetyl-β-D-glucosaminidase/urinary intestinal alkaline phosphatase (IAP)/microalbumin/beta-2-microglobulin/retinol binding protein and oxidative stress markers (ie, derivatives of reactive oxygen metabolites/glutathione peroxidase/superoxide dismutase (SOD)/ advanced oxidation protein products/8-hydroxy-2′-deoxyguanosin/8-isoprostanes) were determined in 36 solderers. Results Multiple linear regression analysis adjusting for age and pack-years of smoking show that IAP is statistically significantly associated with Cd-B (B=0.24; SE=0.11) and Cd-U (B=0.15; SE=0.07). Also SOD is statistically significantly associated with Cd-B (B=62.96; SE=29.62). The association between SOD and Cd-U is of borderline statistical significance (B=37.69; SE=19.59). Conclusions While there is still some debate as whether the Cd-induced tubular effects are reversible or not, IAP and SOD appear as sensitive and potentially useful early biomarkers for the health surveillance of workers exposed to low levels of Cd

Prevalence and socioeconomic differences of risk factors of cardiovascular disease in Ecuadorian adolescents

Purpose: The aim of this paper is to report the prevalence of cardiovascular risk factors and socioeconomic differences in school-going Ecuadorian adolescents. Methods: A cross-sectional study was performed from January 2008 until April 2009 in 770 adolescents aged 10 to 16 years old, who attend secondary schools in an urban (Cuenca), and rural area (Nabón) in Ecuador. Data collected for the overall sample included anthropometric variables (weight, height and waist circumference), blood pressure and socio-demographic characteristics. Fasting blood glucose and lipid profile determinations were collected in a subsample of 334 adolescents. Results: The most prevalent cardiovascular risk factors were dyslipidemia (34.2%), abdominal obesity (19.7%) and overweight (18.0%). The prevalence of the remaining cardiovascular risk factors were high levels of blood pressure (6.2%) and obesity (2.1%). Boys were 3.3 times (P < 0.001) more likely to have risk levels of blood pressure. Compared to their peers from lower socioeconomic groups, children from better off socioeconomic strata were 1.5 times (P = 0.048) more likely to be overweight/obese and 1.5 times (P = 0.046) more likely to have abdominal obesity. Overweight and obese children were 4.4 times more likely to have dyslipidemia (P < 0.001). Children living in the rural area were 2.8 times (P = 0.002) more likely to have dyslipidemia than those from the urban area. Conclusions: Our results demonstrate the advanced levels of the nutrition transition in this Ecuadorian adolescent population. Primary health care should monitor and take actions to address this public health problem in adolescents

Impact of Oxidative Stress on the Endothelial Dysfunction of Children and Adolescents With Type 1 Diabetes Mellitus: Protection by Superoxide Dismutase?

A

Iron-induced oxidative stress in haemodialysis patients: a pilot study on the impact of diabetes

Background: Administration of intravenous iron preparations in haemodialysis patients may lead to the appearance of non-transferrin bound iron which can catalyse oxidative damage. We investigated this hypothesis by monitoring the oxidative stress of haemodialysis patients and the impact of iron and diabetes mellitus herein.\ud \ud Materials and methods: Baseline values of serum iron and related proteins, transferrin glycation, non-transferrin bound iron, antioxidant capacity and lipid peroxidation (malondialdehyde) of 11 haemodialysis patients (six non-diabetic and five type 2 diabetes) were compared to those of non-haemodialysis control subjects (non-diabetic and type 2 diabetes). Changes in these parameters were monitored during haemodialysis before and after iron administration.\ud \ud Results: Baseline values of malondialdehyde correlated with ferritin concentration (r = 0.664, P = 0.036) and were elevated to the same extent in non-diabetic and diabetic haemodialysis patients (median of 1.09 compared to 0.60 μmol/l in control persons, P < 0.02). After iron infusion, transferrin saturation increased more markedly in non-diabetic subjects from 28% to 185% vs. from 33% to 101% in diabetic patients (P = 0.008). This increase was accompanied by the appearance of non-transferrin bound iron (5.91 ± 1.33 μmol/l), a loss in plasma iron-binding antioxidant capacity and a further increase in malondialdehyde which was more pronounced in diabetic patients (from 0.93 ± 0.30 μmol/l to 2.21 ± 0.69 μmol/l vs. from 1.21 ± 0.42 μmol/l to 1.86 ± 0.56 μmol/l in the non-diabetic subjects, P = 0.046).\ud \ud Conclusions: In haemodialysis patients, higher lipid peroxidation is determined by higher body iron stores. The increase induced by iron infusion is accompanied by a loss in iron-binding antioxidant capacity and is more pronounced in diabetes mellitus