The Determinants of Nutritional Risk in Paediatric Cancer

The five-year survival rates of paediatric cancer patients have improved considerably in the last 40 years with the implementation of more intensive and progressive treatments. Consequently attention is shifting to the reduction of treatment-related sequelae during and after the completion of therapy. Malnutrition and vitamin D inadequacy are a major concern as they are thought to increase the risk of short- and long-term complications in this population. Furthermore, emerging evidence has found a protective role of antioxidants and docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) against chronic conditions, including cardiovascular disease and cancer, which are common long-term complications in survivors of paediatric cancer. Therefore, this thesis aimed to investigate the nutritional status (NS), vitamin D, antioxidants and oxidative stress levels, as well as DHA and EPA levels of paediatric cancer patients. Potential factors that may contribute to the development of malnutrition in this population were also investigated. A prospective cohort-study of SE Scottish children aged 95th). Vitamin D status was defined by the Endocrine Society Clinical Practice Guidelines (2011); inadequacy (<50nmol/L). Eighty-two patients [median(IQR) age 3.9(1.9-8.8) years; 56% males)] were recruited. At diagnosis, the prevalence of undernutrition was 13%, overweight 7% and obesity 15%. TSF identified the highest prevalence of undernutrition (15%) and the lowest of obesity (1%). BMI [p<0.001; 95% CI (1.31-3.47)] and FM (BIA) [p<0.05; 95% CI (0.006-0.08)] significantly increased after 3 months of treatment, whilst FFM (BIA) [p<0.05; 95% CI (-0.78-(-0.01)] significantly decreased during the first three months and these patterns remained until the end of the study. High-treatment risk significantly contributed to undernutrition during the first three months of treatment [p=0.04; 95% CI (-16.8-(-0.4)] and solid tumours had the highest prevalence of undernutrition [BMI (17%)]. Vitamin D inadequacy was highly prevalent (64%; 42/65) at both baseline and during treatment (33-50%) and those children who were not supplemented had the lowest vitamin D levels at every stage with median(IQR) levels ranging from 32.0(21.0-46.5)nmol/L to 45.0(28.0-64.5)nmol/L. Paediatric cancer patients had high levels of oxidative stress and low levels of DHA and EPA, especially at baseline. Antioxidant status remained steady at 6 months, however antioxidant capacity increased slightly. Finally, antioxidant levels, antioxidant capacity, oxidative stress and EPA and DHA did not statistically differ between children receiving nutritional support and those who were not. Arm anthropometry (or BIA) alongside appropriate nutritional supplementation should be implemented in clinical practice due to the high risk of malnutrition (undernutrition and obesity), the changes in body composition (increase in fat mass and reduction in lean mass) and vitamin D inadequacy, as well as the low levels of EPA and DHA seen in this paediatric cancer cohort.sub_dnbsunpub2078_ethesesunpu

Consumption of Green Coffee Reduces Blood Pressure and Body Composition by Influencing 11_-HSD1 Enzyme Activity in Healthy Individuals: A Pilot Crossover Study Using Green and Black Coffee

Dietary polyphenols may have a protective role against the development of CVD. Thus, we aimed to investigate the effects of green coffee (GC), rich in chlorogenic acid, and black coffee (BC) on cardiovascular markers. A randomised pilot crossover study was performed on healthy subjects who consumed both coffees for 2 weeks. We measured anthropometry, blood pressure, and arterial elasticity after each intervention and collected urine samples to monitor antioxidant capacity. Free cortisol and cortisone levels were obtained from urine and analysed by specific ELISA methods. Systolic blood pressure (P = 0.018) and arterial elasticity (P = 0.001) were significantly reduced after GC. BMI (P = 0.04 for BC; P = 0.01 for GC) and abdominal fat (P = 0.01 for BC; P = 0.009 for GC) were also significantly reduced with no changes in energy intake. Urinary free cortisol was significantly reduced from 125.6 85.9 nmol/day to 76.0 54.9 nmol/day following GC and increased to 132.1 89.1 nmol/day after BC. Urinary free cortisone increased by 18% following BC and 9% following GC (nonsignificant). Cortisol/cortisone ratio (indicating 11_-HSD1 activity) was reduced after GC (from 3.5 1.9 to 1.7 1.04, P = 0.002). This suggests that GC can play a role in reducing cardiovascular risk factors. Further research including hypertensive and overweight individuals will now be justified to clarify whether GC could have a therapeutic role in CVD. 2014 R. Revuelta-Iniesta and E. A. S. Al-Dujaili.sch_die2014pub3995pub48270

A systematic review of N-3 and N-6 polyunsaturated fatty acid concentration in childhood cancer patients and associated clinical outcomes

Background: This systematic review evaluated primary research to establish blood omega-3 polyunsaturated fatty acids (n-3 PUFA); eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and omega-6 polyunsaturated fatty acids (n-6 PUFA); arachidonic acid (AA) concentration. The effectiveness of their supplementation on clinical and nutritional outcomes and associations between their concentration and clinical and nutritional outcomes were also evaluated.Methods: Electronic databases were searched (no restriction-Dec 2018) with no language restrictions. We included studies of cancer patients aged < 18 years and reporting supplementation and/or concentration of EPA, DHA and AA. Evidence was critically appraised employing the CASP tool.Findings: Three studies (n = 84) met the inclusion criteria, mainly of weak quality and heterogeneous in both study designs and outcomes measured. The overall median(range) n-3 and n-6 PUFA concentration were; EPA: 0.4 (0.24 - 0.4%), DHA: 1.66 (1.3 - 1.68%), AA: 7.01 (6.5 - 7.3%) and AA/EPA: 18.7 (171 - 29.2%). EPA%, DHA% and AA% were all lower than the references 0.45 - 0.77%, 2.22 - 3.76% and 7.91 - 10.46% respectively, whilst AA/EPA% was higher than the reference (< 14.59%). Both higher intake and blood concentration of EPA and DHA may reduce weight loss during initial treatment, whilst a high ratio of AA/EPA may be associated with lower BMI centiles.Interpretation: EPA and DHA may be beneficial in children with cancer. High-quality population-based longitudinal cohort studies and clinical trials are urgently warranted.This study received financial support from four sources: the Fergus Maclay Leukaemia Trust, GI-Nutrition Research Fund (Child Life and Health, University of Edinburgh) and Queen Margaret University.https://www.ecronicon.com/ecnu/pdf/ECNU-14-00646.pdfhttps://www.ecronicon.com/ecnu/volume14-issue9.php14pubpub

Knowledge, attitudes and perceptions towards Vitamin D in a UK adult population: A cross-sectional study

This article belongs to the Special Issue Vitamin D and Public Health - https://www.mdpi.com/journal/ijerph/special_issues/vitaminSupplementary Materials: The following are available online at http://www.mdpi.com/1660-4601/15/11/2387/ s1, Figure S1: title, Table S1: title, Video S1: title.The prevalence of vitamin D deficiency in the United Kingdom is high, despite updated Scientific Advisory Committee on Nutrition (SACN) guidelines. Therefore, our aims were to identify population knowledge, attitudes and perceptions of vitamin D supplementation and factors contributing to supplement use in a UK adult population. A cross-sectional study was performed between April–June 2018 using a newly designed piloted questionnaire. Scores for knowledge were calculated as a percentage (Boland et al. 2015). Logistic regression analysis was used to predict supplement use. 209 participants (82% female), mean (±SD) age 34.9 (±12.3) completed the questionnaire. The mean (±SD) vitamin D knowledge score was 56.6% (±19.9%); only 48% were concerned about their vitamin D concentration and 57% did not take vitamin D. Most participants (86%) wished to learn more about vitamin D. Knowledge score (OR 2.5; p = 0.01; 95% CI 1.2–5.3), concern (OR 2.1; p = 0.03; 95% CI 1.0–4.2) and location (OR 0.3; p = 0.006; 95% CI 0.1–0.7) predicted supplemented use. Individuals living in England had 2.9 (95% CI 1.4–6.3) lower odds of taking vitamin D than those living in Scotland. As a result of these findings, this study suggests that vitamin D supplementation and fortification, alongside education strategies, may be an effective method for improving UK vitamin D health; however, more research is warranted.15pubpub11, [2387

Effect of Vitamin D supplementation on aerobic exercise performance in healthy adults; a randomised single blinded placebo controlled pilot study

Background: 1,25-dihydroxyvitamin D (1,25(OH)D), the biologically active form of vitamin D, is thought to be directly related to exercise induced inflammation and skeletal muscle performance and deficiency has catabolic effects on muscle tissue, causes muscle weakness and impairs cross-bridge formation. 1,25(OH)D may also affect cardiovascular risk factors such as blood pressure (BP), which in turn may have an effect on aerobic exercise; however, at present evidence investigating this association are lacking. Therefore,the aim of this study was to investigate the effect of vitamin D supplementation on aerobic exercise following two weeks of intervention. Methods: A randomised placebo controlled single-blinded pilot study aimed to investigate the short term effects of vitamin D supplementation on aerobic exercise performance in a group of healthy adults. Eleven healthy adults were allocated to receive either 2000IU (50_g/day) of vitamin D or a placebo (sucrose) for 14 days. Physical activity and diet diaries were completed throughout the study. Aerobic exercise performance was assessed at baseline and day 14 following a 15-minute run on a treadmill set at a gradient of 1.5%. Height, weight, systolic/diastolic BP and heart rate (HR) were recorded at baseline and day 14 before running. Parameters of aerobic exercise exertion (BP, %HR and difference in blood lactate) were recorded before and after each run. The rate of perceived exertion (RPE) was recorded after each run. Results: HR reduced significantly by 2.5% (p = 0.002) from 91.5 4.5% to 89.0 3.7% in the intervention group, but not in the placebo group (1.2%; 87.8 4.5% to 86.6 5.1%. p = 0.4). The difference in blood lactate between pre and post run was smaller in the intervention group [(3.9 3.7 mmol/L; p = 0.2 SEM (1.5)] than in the placebo group [(5.5 3.8 mmol/L; p = 0.1; SEM (5.9)]; however,this did not statistically differ between [p = 0.5; SEM (2.2)] and within the groups. Finally, a statistically significant reduction [(p = 0.001; SEM (0.7)] in RPE was found in the intervention group only (15.8 1.9 to 14.7 2.2). Conclusion: The significant reduction in both percentage heart rate and rate of perceived exertion found in this study over a two week period suggest that short term vitamin D supplementation may improve aerobic exercise performance. However, larger scale studies are now warranted to verify these findings.sch_die5pub4592pub

The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review

This is the final version. Available on open access from Wiley via the DOI in this recordData availability statement: Data sharing is not applicable to this article as no new data were created or analysed in this study.Background: Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high‐income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition‐related challenges during treatment. Methods: This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice. Results: The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high‐energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high‐risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status. Conclusions: With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary

Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results)

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordBackground: The department of Haematology and Oncology at the Royal Hospital for Sick Children (RHSC) in Edinburgh have developed their own nutritional standards specific to paediatric cancer. We aimed to audit the current nutritional practice in anthropometry, nutritional biochemistry and malnutrition screening for paediatric cancer patients against nutritional standards to identify areas for nutritional-practice improvement and progress nutrition-related clinical outcomes. Methods: A Clinical audit was conducted >20 weeks between 2015 and 2017 in three data collection locations (inpatient (IP), day-care (DC), or outpatient (OP)) at RHSC. We included patients aged 0–18 years and undergoing treatment for diagnosed malignant childhood cancer (ICCC-3 or Langerhans Cell Histiocytosis). Data were collected by analysing documentation and observing clinical practice for frequency and mode of administration of anthropometry, malnutrition screening, nutritional biochemistry and resulting documentation completion. Results were presented as descriptive statistics and stratified by percentage of standard met (100%, 99-70%, <70%). Results: 185 audited patient records (22 IP, 54 DC and 109 OP) were analysed. The areas which were <70% of the standard were: height and weight documentation for DC; head-circumference for IP; arm anthropometry assessment for all locations; initial PYMS screening and re-screening in IP; malnutrition screening in DC and OP; and initial assessment and re-assessment for serum vitamins D, A, E, B12 and parathyroid hormone levels. Conclusion: Baseline nutritional practice was successfully established, identifying areas for practice improvement in the RHSC Paediatric Oncology and Haematology Department; this will be implemented in the next step of the audit to optimise patient care

The Role of Diet in the Cardiovascular Health of Childhood Cancer Survivors - A Systematic Review

This is the final version. Available on open access from MDPI via the DOI in this recordBackground: Childhood cancer survivors (CCSs) face an increased risk of cardiovascular disease (CVD). This systematic review aims to provide the first synthesis of observational and interventional studies on the relationship between diet and cardiovascular health in CCSs. Methods: A comprehensive search was conducted for studies published between 1990 and July 2023 in PubMed, MEDLINE, CINAHL, Child Development & Adolescent Studies, and Cochrane Library. Eligible studies included observational and interventional studies examining the associations or effects of dietary factors on CVD incidence, cardiac dysfunction, or CVD risk factors in CCSs diagnosed before age 25 years. Results: Ten studies met the inclusion criteria (nine observational and one interventional). Collectively, they comprised 3485 CCSs (male, 1734; female, 1751). The outcomes examined across observational studies included characteristics of obesity, diabetes biomarkers, hypertension indicators, dyslipidaemia biomarkers, and metabolic syndrome. The evidence suggested that greater adherence to healthy diets was associated with lower body mass index, blood pressure, glucose, and triglycerides and higher high-density lipoprotein cholesterol. The 12-week lifestyle intervention study in childhood leukaemia survivors found no impact on obesity indicators. Conclusion: The review results indicate the potentially protective effects of healthy diets. However, the available research remains preliminary and limited, underscoring the need for more rigorous, adequately powered studies.China Scholarship CouncilStiftung für krebskranke Kinder, Regio BasiliensisUniversity of Basel Research Fund for Excellent Junior Researcher

5-Hydroxyvitamin D concentration in paediatric cancer patients from Scotland:a prospective cohort study

Children with cancer are potentially at high risk of plasma 25-hydroxyvitamin D [25(OH)D] inadequacy and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged <18 years, diagnosed with and treated for cancer (patients) between Aug 2010-Jan 2014 was performed, with control data from Scottish healthy children (controls). Clinical and nutritional data were collected at defined periods up to 24 months. 25(OH)D status was defined by the Royal College of Paediatrics and Child Health (2013); inadequacy [<50 nmol/L: deficiency (<25 nmol/L), insufficiency (25-50 nmol/L)], sufficiency (51-75 nmol/L), optimal (>75 nmol/L). Eighty-two patients [median(IQR) age 3.9(1.9-8.8); 56% males)] and 35 controls [median(IQR) age (6.2(4.8-9.1); 49% males] were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63%; 22/35), and in the patients (64%; 42/65) at both baseline and during treatment (33-50%). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median(IQR) ranging from 32.0 (21.0-46.5) nmol/L to 45.0(28.0-64.5) nmol/L. Older age at baseline [R=-0.46; p<0.001], overnutrition (BMI ≥85th centile) at 3 months [p=0.005; RR=3.1] and not being supplemented at 6 months (p=0.04; RR=4.3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented

Assessment of Plasma Antioxidants, Oxidative Stress and Polyunsaturated Fatty Acids in Paediatric Cancer Patients: A Prospective Cohort Pilot Study

Background: Paediatric cancer patients may have a limited dietary intake, particularly nutrients high in antioxidants, docosahexanoic acid (DHA) and eicosapentanoic acid (EPA). Objective: To investigate the antioxidant status (TAS), antioxidant capacity (TAC), oxidative stress, DHA and EPA of paediatric cancer patients during treatment. Methods: A prospective cohort study of Scottish children aged &lt;18 years, diagnosed with and treated for cancer between April-2013 to Jan-2014 was performed. Clinical data and blood samples were collected at baseline and 6 months. Data were stratified by treatment risk (low, medium and high) and nutritional support. We used Oxygen Radical Absorbance Capacity (ORAC) Antioxidant Assay to measure TAC, thiobarbituric acid reactive substances (TBARS) for lipid peroxidation and high performance liquid chromatography and Inductively Coupled Plasma Mass Spectrometry for TAS. The analyses of DHA and EPA were performed by analysing fatty acidmethyl esters (FAME) using gas-liquid chromatography. The reference ranges used were: Yagi 1998 (1.86-3.94) _mol for lipid peroxidation and Damsgaard.,et al. 2014 for EPA (0.45-0.77) % and DHA (2.22-3.76) %. Results: 20 patients (median (IQR) age 4.2 (1.5-8.5) years; 50% males) were recruited. There were no significant changes in plasma TAS, TAC and EPA, but lipid peroxidation significantly decreased from 7.4 (6.2-9.0) at baseline to 5.3 (4.5-6.4) _mol/MDA at 6 months(p = 0.003). The median (IQR) blood percentage of DHA significantly increased from 1.3 (0.9-1.9) to 1.8 (1.3-2.1) (p = 0.001). Lipid peroxidation was high in 95% (19/20) of patients at baseline and 94% (15/16) at 6 months; whilst DHA and EPA were low in 95%(19/20) and 70% (14/20) at baseline and 87.5% (14/16) and 60% (12/16) at 6 months. Children on high-treatment risk exhibited the highest oxidative stress levels. No statitically significant differences were found between non-supplemented and supplemented children in any of the following parameters (TAS, TAC, oxidative stress, EPA and DHA). Conclusion: There was a high prevalence of oxidative stress, especially in children treated with high-risk protocols and during the initial phases of treatment. Nutritional support does not appear to provide enough TAS, EPA and DHA in this cohort; however, larger high-quality population based studies are warranted to confirm these findings. Keywords: Paediatric cancer; Antioxidants; Oxidative stress; Docosahexanoic acid; Eicosapentanoic acidsch_dieThe Determinants of Nutritional Risk in Paediatric Cancer2pub4313pub