An individualized food-based nutrition intervention reduces visceral and total body fat while preserving skeletal muscle mass in breast cancer patients under antineoplastic treatment

Lifestyle interventions with dietary strategies after breast cancer diagnosis: a systematic review

PURPOSE

Obesity can increase mortality and morbidity in breast cancer survivors. Healthy lifestyle factors such as diet can help manage weight in this population. This systematic review examined lifestyle interventions with dietary strategies for breast cancer survivors and their effect on diet and/or weight-related outcomes.

METHODS

Searches were conducted in Ovid MEDLINE® ALL (1946-February 14, 2022), Embase (Elsevier), CINAHL Complete (EBSCO), and APA PsycArticles (EBSCO), using keywords for diet, breast cancer, and intervention. The search was limited to human studies, English language, and publication processing date 2016-2023.

RESULTS

The search yielded 3427 articles. After title and abstract review, 225 full-text articles were screened, and 67 articles with 61 distinct samples and interventions met inclusion criteria. Of these 61 lifestyle interventions with dietary strategies, 43 interventions also addressed physical activity. Most studies were randomized controlled trials (n = 41) and conducted post-treatment (n = 45). Mean participant age was 54 years. Of 29 studies that reported race/ethnicity, 20 (69%) reported ≥50% White participants. Of 36 that reported dietary outcomes, 29 (81%) reported significant findings. Of 57 that reported weight-related outcomes, 51 (89%) reported significant findings.

CONCLUSION

This review demonstrated promising evidence for the efficacy of lifestyle interventions with dietary strategies in breast cancer survivors. However, culturally tailored interventions and interventions conducted before and during treatment are lacking.

Biophysical Parameters of Plasma-Derived Extracellular Vesicles as Potential Biomarkers of Bone Disturbances in Breast Cancer Patients Receiving an Individualized Nutrition Intervention

Extracellular vesicles (EVs) are implicated in several biological conditions, including bone metabolism disturbances in breast cancer patients (BCPs). These disorders hinder the adjustment of nutrition interventions due to changes in bone mineral density (BMD). The biophysical properties of EVs (e.g., size or electrostatic repulsion) affect their cellular uptake, however, their clinical relevance is unclear. In this study, we aimed to investigate the association between the biophysical properties of the plasma-derived EVs and BMDs in BCPs who received an individualized nutrition intervention during the first six months of antineoplastic treatment. As part of the nutritional assessment before and after the intervention, body composition including bone densitometry and plasma samples were obtained. In 16 BCPs, EVs were isolated using ExoQuick^® and their biophysical properties were analyzed using light-scattering techniques. We found that the average hydrodynamic diameter of large EVs was associated with femoral neck bone mineral content, lumbar spine BMD, and neoplasms' molecular subtypes. These results provide evidence that EVs play a role in BCPs' bone disorders and suggest that the biophysical properties of EVs may serve as potential nutritional biomarkers. Further studies are needed to evaluate EVs' biophysical properties as potential nutritional biomarkers in a clinical context.

Association between Diet and Adiposity in Adults: Influence of Sedentary Behavior Patterns

This study analyzed the influence of sedentary behavior (SB) on the association between dietary patterns and adiposity in community-dwelling adults. Eight hundred and forty-three adults (age: 56.5 ± 18.3 years) participated in this cross-sectional epidemiological study. Dietary patterns were evaluated using self-report questions regarding the weekly frequency of consumption of certain foods. Adiposity was determined using anthropometric measurements of weight, waist circumference, and height. SB was evaluated according to the time spent on screen devices. The usual physical activity level and socioeconomic status were considered confounding factors. Associations were determined using multivariate linear models with simultaneous adjustments for confounding variables. A statistical analysis indicated that fruit consumption was negatively related to the body mass index, regardless of the adjustment for SB domains. Red meat consumption was positively related to the body mass index, and fried food consumption was positively related to the waist-to-height ratio, regardless of the adjustment for SB domains. The consumption of fried food was positively associated with global and central adiposity after the adjustments for confounding factors and time spent on screen devices. We concluded that dietary habits are related to adiposity in adults. However, SB domains seem to influence the relationship between body adiposity and dietary habits, mainly regarding the consumption of fried foods.

Extracellular Vesicles and Their Zeta Potential as Future Markers Associated with Nutrition and Molecular Biomarkers in Breast Cancer

A nutritional intervention promotes the loss of body and visceral fat while maintaining muscle mass in breast cancer patients. Extracellular vesicles (EVs) and their characteristics can be potential biomarkers of disease. Here, we explore the changes in the Zeta potential of EVs; the content of miRNA-30, miRNA-145, and miRNA-155; and their association with body composition and biomarkers of metabolic risk in breast cancer patients, before and 6 months after a nutritional intervention. Clinicopathological data (HER2neu, estrogen receptor, and Ki67), anthropometric and body composition data, and plasma samples were available from a previous study. Plasma EVs were isolated and characterized in 16 patients. The expression of miRNA-30, miRNA-145, and miRNA-155 was analyzed. The Zeta potential was associated with HER2neu (β = 2.1; p = 0.00), Ki67 (β = -1.39; p = 0.007), estrogen positive (β = 1.57; p = 0.01), weight (β = -0.09; p = 0.00), and visceral fat (β = 0.004; p = 0.00). miRNA-30 was associated with LDL (β = -0.012; p = 0.01) and HDL (β = -0.02; p = 0.05). miRNA-155 was associated with visceral fat (β = -0.0007; p = 0.05) and Ki67 (β = -0.47; p = 0.04). Our results reveal significant associations between the expression of miRNA-30 and miRNA-155 and the Zeta potential of the EVs with biomarkers of metabolic risk and disease prognosis in women with breast cancer; particularly, the Zeta potential of EVs can be a new biomarker sensitive to changes in the nutritional status and breast cancer progression.

Recommending ultra-processed oral nutrition supplements for unintentional weight loss: Are there risks?

Oral nutrition supplements (ONS) are widely recommended for the management of unintentional weight loss in patient populations, long-term care residents, and community-dwelling older adults. Most marketed ONS are ultra-processed, with precision nutrition and aseptic composition, as well as convenience and availability, driving their selection. However, therapeutic effectiveness is mixed and the potential health risks of consuming ultra-processed ONS long-term in lieu of less-processed foods have received little attention. A diverse and balanced microbiota supporting immunity and wellness is maintained by a diet rich in plant-sourced foods. The implications of ultra-processed ONS displacing plant-sourced foods, and specifically the potential for undesirable impacts on the gut microbiota, require consideration. Most ONS are either devoid of fiber or are supplemented with isolated or purified fibers that may contribute to adverse gastrointestinal symptoms and appetite suppression. In contrast, the diversity of microbial-available, nondigestible carbohydrates, together with the array of phytochemicals found in plant-sourced foods, support microbial diversity and its resiliency. This review outlines the clinical dilemma of recommending commercial ultra-processed ONS vs nutritionally adequate (eg, high-energy/high-protein) foods and beverages that contribute to diet quality, maintenance of a diverse and stable gut microbiota composition, and support nutrition status and health. Ultra-processed ONS may fall short of expected health benefits, and overreliance may potentially contribute to the risk for patient and older adult populations because of the displacement of a variety of healthful foods.

The patient generated-subjective global assessment (PG-SGA) and ECOG performance status are associated with mortality in patients hospitalized with breast cancer

AIM

This study evaluated the association between risk of malnutrition and performance status, and mortality in hospitalized breast cancer patients.

METHODS

Prospective cohort study with hospitalized breast cancer patients evaluated at a referral Cancer Center. The Risk of malnutrition was assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) and performance status was determined using the Eastern Cooperative Oncology Group Performance Status Scale (ECOG PS). Logistic regression was used to analyze the factors associated with death, using the odds ratio (OR) with a 95% confidence interval (CI) as an effect measure.

RESULTS

A total of 195 woman were included, with a mean age of 56.3 (±12.6) years. Patients with an overall PG-SGA score ≥18 (OR: 2.11; 95% CI: 1.03-4.62) and ECOG PS ≥ 3 (OR: 3.34; 95% CI: 1.48-7.52) had a higher occurrence of death during hospitalization, regardless of age or disease stage. The concomitant presence of these two factors improved the accuracy of the association (OR: 5.32; 95% CI: 3.11-9.76) and showed good predictive accuracy (C-statistics: 0.77).

CONCLUSION

Nutritional risk and poor performance status were associated with a higher occurrence of death in women with breast cancer. The use of these two indicators improves their predictive accuracy for mortality.

Current research trends, hotspots, and frontiers of medical nutrition therapy on cancer: a bibliometric analysis

Background

There is a high prevalence of malnutrition in cancer patients, which seriously affects the anti-cancer therapy effect and outcomes, causing a huge disease burden worldwide. Appropriate nutritional support is important for cancer prevention and control. The aim of this study was to explore the development trends, hotspots, and frontiers of Medical Nutrition Therapy (MNT) on Cancer from a bibliometric perspective, and provide new insights for future research and clinic practices.

Methods

The global literature of MNT on Cancer published between 1975 and 2022 were searched in the Web of Science Core Collection Database (WOSCC). After refining the data, descriptive analysis and data visualization were performed with bibliometric tools (CiteSpace, VOSviewer, and R package "bibliometrix").

Results

A total of 10,339 documents with a timespan from 1982 to 2022 were included in this study. The number of documents had increased continuously over the past 40 years, especially with a steep rise from 2016 to 2022. The majority of scientific production outputs were from the United States, which had the most core research institutions and authors. The published documents could be clustered into three themes respectively labeled by terms "double-blind", "cancer" and "quality-of-life". "gastric cancer", "outcome", "inflammation", "sarcopenia" and "exercise" were the most prominent keywords in recent years. "breast-cancer", "colorectal-cancer", "expression", "risk", "in-vitro", "quality-of-life", "cancer" and "life" might represent the newly emerged topics.

Conclusions

There were a good research foundation and reasonable disciplinary structure in the field of medical nutrition therapy for cancer at present. The core research team was mainly located in the United States, England, and other developed countries. According to the current trends in publications, more articles shall be published in the future. Nutritional metabolism, malnutrition risk, and the impact of nutritional therapy on prognosis might be research hotspots. In particular, it was important to focus on specific cancer, such as breast cancer, colorectal cancer, and gastric cancer, which might be the frontiers.

Differences by age in the obesity paradox in severe burns

BACKGROUND

Many studies show a "obesity paradox", which seems to protect against death. Whether an obesity paradox space is present in severe burn patients remains a matter of great debate. Most research on the obesity paradox of burn injuries is classified by body mass index (BMI) rather than by age.

OBJECTIVE

To investigate whether the obesity paradox exists in severe burn patients stratified by age.

METHODS

Retrospective analysis was performed on 490 patients with severe burns who were ≥ 18 years of age and were admitted to Fujian Medical University Union Hospital from January 2005 to December 2020. Demographic and clinical characteristics were collected, including age, BMI, total body surface area (TBSA), presence of inhalation injury, abbreviated burn severity index (ABSI) score, diabetes comorbidities, hypertension comorbidities, and in-hospital mortality. The patients were divided into the younger group (18 ≤ age<65 years) and the older group (age ≥ 65 years). The important variables of the two groups were compared. The predictive value of BMI stratified by age on in-hospital mortality was evaluated by binary logistic regression analysis and the Cochran's and Mantel-Haenszel statistics.

RESULTS

A total of 490 patients were selected for this study, and were divided into the younger group (413) and the elderly group (77) according to their ages. In the younger group, logistic regression analyses indicated that high BMI remained significantly and independently associated with decreased in-hospital mortality (P = 0.021). That is, in-hospital mortality decreased by 17.8% when BMI increased by 1 kg/m². In the older group, BMI was not associated with in-hospital mortality (P = 0.808). In the younger group, the results of Pearson's chi-square test was less than 0.05, indicating a correlation between BMI and prognosis. In the older group, the conclusion was contrary with, no correlation between BMI and prognosis. If the confounding factors of age were not considered, this results in no correlation between BMI and prognosis. In the younger group, the survival/death ratio of patients with overweight and obesity was 2.078 times that of patients with normal weight.

CONCLUSION

In this study of patients with severe burns, overweight and obesity had protective effect on burn injury in the younger group (18 ≤ age<65 years), but not in the older group (age ≥ 65 years). Investigating the obesity paradox in burn patients needs to consider age differences. However, multicentre clinical trials are needed to verify the results.

Halophilic Carotenoids and Breast Cancer: From Salt Marshes to Biomedicine

Breast cancer is the leading cause of death among women worldwide. Over the years, oxidative stress has been linked to the onset and progression of cancer. In addition to the classical histological classification, breast carcinomas are classified into phenotypes according to hormone receptors (estrogen receptor-RE-/progesterone receptor-PR) and growth factor receptor (human epidermal growth factor receptor-HER2) expression. Luminal tumors (ER/PR-positive/HER2-negative) are present in older patients with a better outcome. However, patients with HER2-positive or triple-negative breast cancer (TNBC) (ER/PR/HER2-negative) subtypes still represent highly aggressive behavior, metastasis, poor prognosis, and drug resistance. Therefore, new alternative therapies have become an urgent clinical need. In recent years, anticancer agents based on natural products have been receiving huge interest. In particular, carotenoids are natural compounds present in fruits and vegetables, but algae, bacteria, and archaea also produce them. The antioxidant properties of carotenoids have been studied during the last years due to their potential in preventing and treating multiple diseases, including cancer. Although the effect of carotenoids on breast cancer during in vitro and in vivo studies is promising, clinical trials are still inconclusive. The haloarchaeal carotenoid bacterioruberin holds great promise to the future of biomedicine due to its particular structure, and antioxidant activity. However, much work remains to be performed to draw firm conclusions. This review summarizes the current knowledge on pre-clinical and clinical analysis on the use of carotenoids as chemopreventive and chemotherapeutic agents in breast cancer, highlighting the most recent results regarding the use of bacterioruberin from haloarchaea.