Living in interesting times - Challenging protein metabolism in the era of the epidemiological shift

The recently released results of the Global Burden of Disease, Injuries, and Risk Factor study 2013 reveal that during the past 23 years, metabolic and behavioral risk factors, including high BMI, increased their impact on global mortality and disability-adjusted life-years [1]. These data highlight the importance of the investigation of the metabolic impact of specific nutrients and different eating behaviors on preserving and restoring the health of individuals and also populations

Reply - Letter to the Editor - Malnutrition: The kiss of grim reaper

Conducting a large, multicenter, prospective, randomized clinical trial poses a number of challenges. In particular, the successful completion of the trial is based on devising a protocol which could yield to clinically relevant answers yet no becoming so complex and sophisticated to prevent centers' participation and patients' enrollment. Consequently, the methodology of any trial reflects the clinical questions it tries to address

Nutrition: New challenges for a venerable vision

Nutrition: New challenges for a venerable visio

ACT-ONE - ACTION at last on cancer cachexia by adapting a novel action beta-blocker

Novel action beta-blockers combine many different pharmacological effects. The espindolol exhibits effects through β and central 5-HT1α receptors to demonstrate pro-anabolic, anti-catabolic, and appetite-stimulating actions. In the ACT-ONE trial, espindolol reversed weight loss and improved handgrip strength in patients with cachexia due to non-small cell lung cancer or colorectal cancer. With this trial, another frontier of cachexia management is in sight. Nonetheless, more efficacy and safety data is needed before new therapeutic indications for novel action beta-blockers can be endorsed

A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting

Background & aims: There is limited information about the economic impact of nutritional support despite its known clinical benefits. This systematic review examined the cost and cost effectiveness of using standard (non-disease specific) oral nutritional supplements (ONS) administered in the hospital setting only. Methods: A systematic literature search of multiple databases, data synthesis and analysis were undertaken according to recommended procedures. Results: Nine publications comprising four full text papers, two abstracts and three reports, one of which contained 11 cost analyses of controlled cohort studies, were identified. Most of these were based on retrospective analyses of randomised controlled trials designed to assess clinically relevant outcomes. The sample sizes of patients with surgical, orthopaedic and medical problems and combinations of these varied from 40 to 1.16 million. Of 14 cost analyses comparing ONS with no ONS (or routine care), 12 favoured the ONS group, and among those with quantitative data (12 studies) the mean cost saving was 12.2%. In a meta-analysis of five abdominal surgical studies in the UK, the mean net cost saving was $746 per patient (se$338; P = 0.027). Cost savings were typically associated with significantly improved outcomes, demonstrated through the following meta-analyses: reduced mortality (Risk ratio 0.650, P < 0.05; N = 5 studies), reduced complications (by 35% of the total; P < 0.001, N = 7 studies) and reduced length of hospital stay (by ~2 days, P < 0.05; N = 5 surgical studies) corresponding to ~13.0% reduction in hospital stay. Two studies also found ONS to be cost effective, one by avoiding development of pressure ulcers and releasing hospital beds, and the other by gaining quality adjusted life years. Conclusion: This review suggests that standard ONS in the hospital setting produce a cost saving and are cost effective. The evidence base could be further strengthened by prospective studies in which the primary outcome measures are economic

A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings

Background & aims: Despite the clinical benefits of using standard (non-disease specific) oral nutritional supplements (ONS) in the community and care homes, there is uncertainty about their economic consequences. Methods: A systematic review was undertaken according to recommended procedures to assess whether ONS can produce cost savings and cost-effective outcomes. Results: 19 publications with and without a hospital component were identified: 9 full text papers, 9 abstracts, and 1 report with retrospective analyses of 6 randomised controlled trials. From these publications a total of 31 cost and 4 cost-effectiveness analyses were identified. Most were retrospective analyses based on clinical data from randomised controlled trials (RCTs). In 9 studies/economic models involving ONS use for 0.05; 5 studies). In RCTs, ONS accounted for less than 5% of the total costs and the investment in the community produced a cost saving in hospital. Meta-analysis indicated that ONS reduced hospitalisation significantly (16.5%; P < 0.001; 9 comparisons) and mortality non-significantly (Relative risk 0.86 (95% CI, 0.61, 1.22); 8 comparisons). Many clinically relevant outcomes favouring ONS were reported: improved quality of life, reduced infections, reduced minor post-operative complications, reduced falls, and functional limitations. Of the cost-effectiveness analyses involving quality adjusted life years or functional limitations, most favoured the ONS group. The care home studies (4 cost analyses; 2 cost-effectiveness analyses) had differing aims, designs and conclusions. Conclusions: Overall, the reviewed studies, mostly based on retrospective cost analyses, indicate that ONS use in the community produce an overall cost advantage or near neutral balance, often in association with clinically relevant outcomes, suggesting cost effectiveness. There is a need for prospective studies designed to examine primary economic outcomes

Practical Management of Cancer Cachexia

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Glazed sgraffito ware from Torre Alemanna (Foggia, fifteenth to sixteenth century A.D.): technological aspects of a local production

The archaeometric investigation of 46 potsherds of “Torre Alemanna type” pottery aimed to define a compositional refer- ence group and to understand the technological characteristics of its production. Principal component analysis applied to bulk chemical data (XRF) of the ceramic body showed a strong compositional homogeneity. Their comparison with local clays and 6 fragments of bricks sampled from the ceramic kiln, on the one hand, revealed the use of alluvial clays as raw material and, on the other hand, proved their fractionation for the production of pottery. The mineralogical assemblages detected by X-ray powder diffraction analysis inferred maximum firing temperatures between 750 and 1000 °C for the ceramic body. Polarising optical microscopy and scanning electron microscopy with energy dispersive spectroscopy (SEM–EDS) investigations on coating revealed the presence of quartz-rich white engobe covered with a high lead transparent glaze. The polychromatic decoration was analysed by colorimetry and EDS to compare the colour characteristics through all the pot- sherds. A temperature range between 780 and 950 °C of liquidus temperatures was inferred from the ternary phase diagram of PbO-Al2O3-SiO2 system. Overlap of temperature ranges for sintering of the ceramic body and maturing glaze points to a single firing of the Torre Alemanna type ware. The results obtained define the reference compositional group and technol- ogy of the Torre Alemanna type ware, already attested in several archaeological contexts of southern Italy, and showed a technological continuity with the past about the use of local carbonate-rich clays to produce fine pottery