Sposób żywienia a rak jajnika

Ocena sposobu żywienia pacjentów onkologicznych stanowi nadal niewielki wycinek prac publikowanych w zakresie onkologii. Występujące w trakcie leczenia chemioterapią zmiany w zakresie odczuwania smaku, zapalenie błony śluzowej jamy ustnej, awersja do wybranych produktów żywnościowych, nudności i wymioty, biegunki czy zaparcia wraz z towarzyszącym osłabieniem oraz bólem wpływają niekorzystnie na stan odżywienia pacjentek. Prowadzenie badań naukowych w zakresie oceny sposobu żywienia pacjentów w trakcie chemioterapii wymaga ujęcia w metodyce choćby czasu wykonywania takiej oceny względem podawania cytostatyków. Sugeruje się, że występujące zmiany masy ciała w zaawansowanym raku jajnika jako istotny czynnik prognostyczny, natomiast otwartym pytaniem pozostaje czy zmiany masy ciała w trakcie chemioterapii powinny być ujmowane wyłącznie jako wykładnik metaboliczny nowotworu i czy wprowadzenie interwencji żywieniowej zapobiegającej utracie masy ciała wpłynęłoby na wydłużenie przeżyć

Wybrane determinanty sposobu żywienia a regulacja masy ciała

Badania prowadzone w zakresie zrozumienia i poszukiwania nowych determinant sposobu żywienia wydają się szczególnie istotne w praktyce w odniesieniu do pacjentów określanych jako tak zwani „maintainers”, utrzymujących początkową masę ciała przez co najmniej rok i przybierających nie więcej niż 15% w stosunku do masy ciała po zakończonej interwencji oraz u pacjentów z grupy tak zwanych „regainers”, czyli osób przybierających przynajmniej 33% masy ciała w porównaniu z końcem zastosowanej interwencji żywieniowej. Wykorzystanie sezonowo występującej żywności w dietach pacjentów wraz z regulacją gęstości energetycznej pożywienia może przynieść wymierne efekty dla uzyskania pozytywnego, długofalowego efektu redukcji masy ciała. Z kolei pełniejsze zrozumienie terminu „chrononutrition” związanego z dobową regulacją przyjmowania pokarmów wraz z aplikacją tej wiedzy w codziennej praktyce może przyczynić się do tworzenia nowych strategii terapeutycznych w bezpośredniej pracy z pacjentem otyłym

Home parenteral nutrition a life-saving therapy in a primary intestinal lymphangiectasia patient affecting the entire GI tract - 3 year follow-up case report

Introduction and Importance: Primary intestinal lymphangiectasia (PIL) is a rare protein-losing gastroenteropathy of unknown etiology, characterized by impaired lymphatic vessels drainage. The pathological changes in PIL result in usually localized or diffuse dilatation of intestinal lacteals, leading to leakage of lymphatic fluid rich of proteins, lymphocytes, and immunoglobulins into the intestinal lumen. PIL may be asymptomatic or mildly symptomatic in moderate forms of the disease. In some patients, though, the outcome may be poor or even life-threatening. This case report demonstrates the severity of protein malnutrition, in some cases, and the extent of GI tract affected, requiring to start PN early and the need for its continuation as home parenteral nutrition (HPN). Case presentation: We present a case of 39-year-old male with Factor V Leiden deficiency, who presented initially with symptoms of malnutrition and anasarca. The diagnosis was confirmed by histopathological findings pathognomonic for PIL from biopsies of the stomach, small intestine and colon. Clinical discussion: The patient was started on low fat, high protein parenteral nutrition from the beginning of the treatment and required a long-term HPN for 3 years, because trials of tapering off and discontinuation of PN led to worsening of the biochemical results and recurrence of symptoms. Patient gradually improved and stabilized with persistent nutritional support. Conclusions: The presented case report shows the magnitude of nutritional support (HPN) needed for severe PIL patients. HPN offers PIL patients with poor outcome and life-threatening complications a chance to improve and lead a normal life

Link between diet and chemotherapy related gastrointestinal side effects

Aim of the study : To evaluate an association between food products consumption, dietary intake and the incidence of selected gastrointestinal symptoms (nausea, vomiting, diarrhea and constipation) in cancer patients undergoing chemotherapy. Material and methods : Fifty six women receiving chemotherapy for ovarian cancer were eligible for the study. Anthropometrical measurements were assessed. The dietary intake was evaluated by 24-hours food records. The association between the consumption of selected food products and gastrointestinal symptoms incidences was assessed by modified semi-quantitative food frequency questionnaire including 77-different food items that was developed and applied in cancer patients undergoing chemotherapy. Results : BMI values indicated 9%, 45%, 30% and 16% of patients as underweight, normal weight, overweight and obese respectively. Only 23% and 32% of patients never experienced nausea and constipation when 43% and 45% never experienced vomiting and diarrhea. Nausea was promoted by oils, constipation by chocolate and chocolate products and diarrhea by dairy products, stone fruit and apple. Significant inverse correlations were found between vomiting and the intake of energy, fat, protein, carbohydrates, B groups vitamins, vitamin D, phosphorus and zinc. The difference in energy intake between marginal values of vomiting incidence exceeded 400 kcal. Conclusions : Dietary intake as well as specific food products influence on gastrointestinal side effect of chemotherapy in cancer patients. The dietary approach based on either exclusion or limited intake of selected food products and improvement of diet could reduce and prevent chemotherapy induced gastrointestinal symptoms therefore should be taken under consideration in clinical practice

Microbiome Composition in Microscopic Colitis: A Systematic Review

Believed to be a rare cause of chronic diarrhoea, microscopic colitis (MC) is a condition with rising incidence. Many prevalent risk factors and the unknown pathogenesis of MC rationalise the need for studies on microbiota composition. PubMed, Scopus, Web of Science and Embase were searched. Eight case-control studies were included. The risk of bias was assessed with the Newcastle–Ottawa Scale. Clinical details on the study population and MC were poor. The most consistent result among the studies was a decreased Akkermansia genus in faecal samples. Other results were inconsistent due to the different taxonomic levels of the outcomes. Possible changes in different taxa were observed in patients who suffered from MC compared to healthy controls. The alpha diversity compared between MC and the diarrhoea control may suggest potential similarities. The beta diversity in MC compared to healthy and diarrhoeal populations showed no significant outcomes. The microbiome composition in MC possibly differed from the healthy control, but no agreement regarding taxa was made. It might be relevant to focus on possible factors influencing the microbiome composition and its relationship with other diarrhoeal diseases

Sex cord stromal tumors of the ovary: principles of management

Sex cord stromal tumors of the ovary are rare neoplasms that account for only 7% of all ovarian malignancies. They are derived from the sex cords and the ovarian stroma or mesenchyme. Most common in this group is granulosa cell tumor that accounts for approximately 70% of malignant sex cord stromal tumors and divides into adult and juvenile type. Surgery remains the mainstay of initial management and is necessary to establish a definitive tissue diagnosis. In patients wishing to preserve their fertility unilateral salphingo-oophorectomy seems to be reasonable. In patients with advanced disease and in postmenopausal women total abdominal hysterectomy with bilateral salphingo-oophorectomy and complete surgical staging should be performed. Most of these tumors are classified as stage I at the time of diagnosis. Patients with stage I disease have a very good prognosis (5-years survival 84-95%) and do not require adjuvant treatment. Only long-term, careful follow-up is recommended. In advanced stages adjuvant chemotherapy with BEP is usually considered standard first line. Serum tumor markers are very useful in follow-up, especially inhibins and estradiol. Other sex cord stromal tumors include tumors from thecoma-fibroma group, Sertoli-Leydig cell tumors and very rare gynandroblastoma and sex cord tumors with annular tubules.Guzy gonadalne jajnika są rzadko występującymi nowotworami, które stanowią około 7% nowotworów złośliwych jajnika. Rozwijają się one zarówno z elementów gonady żeńskiej, jak i męskiej oraz z komórek podścieliska i fibroblastów. W tej grupie guzów najczęściej występują ziarniszczaki, które są odpowiedzialne za występowanie prawie 70% złośliwych guzów gonadalnych. Dzieli się je na postać dojrzałą, stanowiącą 95% ziarniszczaków, i młodzieńczą, która stanowi jedynie 5% przypadków w tej grupie. Podstawę leczenia stanowi zabieg operacyjny, który jest niezbędny do ostatecznego rozpoznania histopatologicznego. U pacjentek z niskim stopniem zaawansowania, chcących zachować płodność, zasadne jest leczenie oszczędzające z jednostronnym usunięciem przydatków. Z kolei u kobiet z zaawansowaną chorobą i po menopauzie wskazane jest przeprowadzenie zabiegu radykalnego: wycięcie macicy z przydatkami i maksymalna redukcja guza. Większość guzów rozpoznaje się w stadium I według FIGO. Pacjentki w I stopniu zaawansowania mają bardzo dobre rokowanie (5-letnie przeżycia: 84-95%) i nie wymagają dalszego leczenia. Zaleca się wyłącznie długoletnią, dokładną obserwację. W zaawansowanych przypadkach (FIGO >II) niezbędne jest leczenie uzupełniające. Najczęściej rozpatrywane postępowanie pierwszego rzutu to chemioterapia według schematu BEP (bleomycyna + etopozyd + cisplatyna). Pomocne w monitorowaniu przebiegu choroby są markery nowotworowe, szczególnie inhibina i estradiol. Do guzów gonadalnych zalicza się również guzy z grupy otoczkowiakowłókniaków, grupę guzów z komórek Leydiga i Sertoliego, jak również niezwykle rzadkie: gynandroblastoma oraz guzy sznurów płciowych i zrębu z obrączkowatymi cewkami

An analysis of the meal pattern at the nutrient level in Polish women

BACKGROUND: Before the 1990's, access to a variety of foods in Eastern Europe was limited, which could have influenced the currently analyzed dietary behaviors pertaining to overweight and obesity development. The aim of this study was to describe the daily profile of meal patterns in Polish women aged 50-70 at the nutrient level. METHODS: The anthropometrical parameters of four-hundred and fifty Polish women aged 50-70 were assessed. Three 24-hour dietary recalls and validated questionnaires regarding socio-demographic-economic status and meal frequency were applied. Timing in food intake was considered as follow: 6:00-8:59 CET - breakfast, 9:00-11:59 CET - morning snacks, 12:00-14:59 CET - lunch, 15:00-17:59 CET - afternoon snacks, 18:00-21:00 CET - dinner. Statistical analyses were conducted using Tukey's multiple comparison tests and discriminant analysis. RESULTS: No statistically significant differences were found in socio-demographic-economic and anthropometrical characteristics between women categorized to differentiated meal frequency intakes. However, the subjects from the 5-meal-per-day group were characterized by higher anthropometrical parameters, the statistically lowest percentage of regularity in meal consumption and skipping meals related to shortest breaks between meals. At the nutrient level, potassium, niacin, vitamin E and vitamin D were selected in the discriminant analysis as the nutrients most strongly related to different dietary behaviors. CONCLUSIONS: Our findings did not provide sufficient evidence that diverse nutrient intake could lead to the development of a specific nutritional profile in Polish women

Role of Probiotics in Modulating Human Gut Microbiota Populations and Activities in Patients with Colorectal Cancer—A Systematic Review of Clinical Trials

Background: Growing attention has been given to the role of nutrition and alterations of microbial diversity of the gut microbiota in colorectal cancer (CRC) pathogenesis. It has been suggested that probiotics and synbiotics modulate enteric microbiota and therefore may be used as an intervention to reduce the risk of CRC. The aim of this study was to evaluate the influence of probiotics/synbiotics administration on gut microbiota in patients with CRC. Methods: PubMed, Scopus, and Web of Science were searched between December 2020 and January 2021. Randomized controlled trials (RCTs) recruiting adults with CRC, who have taken probiotics/synbiotics for at least 6 days were included. Changes in gut microbiota and selected biochemical and inflammatory parameters (i.e., hsCRP, IL-2, hemoglobin) were retrieved. Results: The search resulted in 198 original research articles and a final 6 were selected as being eligible, including 457 subjects. The median age of patients was 65.4 years old and they were characterized by the median BMI value: 23.8 kg/m2. The literature search revealed that probiotic/synbiotic administration improved enteric microbiota by increasing the abundance of beneficial bacteria such as Lactobacillus, Eubacterium, Peptostreptococcus, Bacillus and Bifidobacterium, and decreased the abundance of potentially harmful bacteria such as Fusobacterium, Porhyromonas, Pseudomonas and Enterococcus. Additionally, probiotic/synbiotic intervention improved release of antimicrobials, intestinal permeability, tight junction function in CRC patients. Conclusions: The use of probiotics/synbiotics positively modulates enteric microbiota, improves postoperative outcomes, gut barrier function and reduces inflammatory parameters in patients suffering from CRC

Dietary and cardio-metabolic risk factors in patients with Obstructive Sleep Apnea: cross-sectional study

Background Little is known about the role of dietary intake in obstructive sleep apnea (OSA), which could prove important in improving clinical outcomes for people with obesity and/or cardiovascular disease within these populations. Reduction in energy intake typically results in weight loss, markedly improving metabolic parameters and ameliorating OSA severity. The aim of this study was to evaluate the association of dietary and cardio-metabolic risk factors with OSA severity. Methods This was a cross-sectional study. A total of 75 volunteers at risk of OSA were recruited from 153 patients suffering from sleep disturbance at the Department of Pulmonology, Allergology and Respiratory Oncology at the Poznan University of Medical Sciences. Polysomnography was used for OSA diagnosis. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Blood pressure, parameters of glucose (fasting glucose, glucose tolerance test) and lipid metabolism (TC, LDL-C, HDL-C, TG) were assessed using routine enzymatic methods. Dietary intake was evaluated by 24-hr dietary recalls and Food Frequency Questionnaire. Ordinal logistic regression models were used for association of background characteristics and dietary intake with OSA severity. All analyses were adjusted for age, sex, BMI, smoking and alcohol intake. Results A higher percentage of smokers were observed in patients with mild OSA, while alcohol intake was the highest in severe OSA patients. Approximately 60% of the studied patients were self-reported poor sleepers. Results from ordinal logistic regression models showed that higher intakes of alcohol intake were associated with increased odds of severe OSA; whereas higher HDL-C levels were associated with lower odds (OR 0.01; 95% CI [0.0003–0.55]). Significantly higher odds of high OSA severity were observed in patients with disturbed sleep stages and obstructive sleep apnea. Moreover, the investigation of nutrient intake in relation to OSA severity showed that a higher intake of dietary fiber was associated with decreased OSA severity (OR 0.84; 95% CI [0.71–0.98]). Conclusions The severity of OSA is related to higher alcohol consumption and disturbed sleep. The significantly lower dietary fiber intake in patients with severe OSA is of particular importance for dietary consulting in clinical practice, which may positively influence cardiometabolic outcomes

Androgen Deprivation Therapy for Prostate Cancer Influences Body Composition Increasing Risk of Sarcopenia

Computed tomography (CT) scans used in treatment response assessment in prostate cancer (PCa) patients are a useful tool for nutritional status evaluation. The aim of this study was to assess the nutritional status, including sarcopenia development based on CT scans, in PCa patients and its association with progression-free survival (PFS). Sixty-four PCa patients were included (group 1: 34 patients undergoing androgen deprivation therapy (ADT) with docetaxel due to newly diagnosed, hormone-sensitive, metastatic PCa and group 2: 30 patients with castration-resistant metastatic PCa continuing ADT therapy with enzalutamide or abiraterone acetate). Nutritional status was evaluated with anthropometrical parameters, Nutritional Risk Score (NRS), and CT scans at the L3 vertebrae. Survival analyses were performed. According to NRS, nutritional status was significantly related to PFS. In both groups, there was a significant reduction in muscle tissue (total muscle tissue and skeletal muscle index). A significant increase in the distribution of adipose tissue (subcutaneous fat, visceral fat, subcutaneous adipose tissue index, and visceral adipose tissue index) in group one was observed. Sarcopenia was diagnosed in patients but with no influence on PFS. Significant reduction in muscle mass and increase in fat mass was observed in patients treated for PCa with no impact on PFS. The NRS was related to PFS in PCa patients and associated with body composition, assessed by CT after the castration therapy. Long-term castration combined with abiraterone therapy with prednisone or enzalutamide significantly influenced muscle tissue and may lead to sarcopenia development