No food for thought-How important is breakfast to the health, educational attainment and wellbeing of school-aged children and young people?

There have been reports from teachers of pupils in the United Kingdom arriving at school hungry. Poor nutritional intake during childhood can increase the risk of developing both short- and long-term health problems. Breakfast consumption has been associated with several outcomes including better diet quality and healthier weight status. Nevertheless, skipping breakfast is a frequent behaviour in young people, particularly adolescents, and those from lower socio-economic groups, who are less likely to meet dietary recommendations and nutritional targets. The aim of this narrative review is to explore the contribution of breakfast consumption at home or at school and the impact of breakfast skipping on nutrient intakes in school-aged children (aged 4-18 years), and their effect on weight and cardiometabolic health. We will also summarise evidence for a link with cognitive function and educational attainment. A broadly positive effect of breakfast intake on diet quality, weight status and school-related outcomes was found in the literature, although inconsistencies in findings and methodological limitations within the evidence base are notable. Further research is warranted to better understand impact of breakfast intake and school breakfast provision on longer-term learning, educational attainment and health outcomes. This also needs to consider the cost benefit, type of breakfast and any unintended consequences such as encouraging multiple breakfasts. Breakfast consumption could improve the nutritional intakes of the most vulnerable young people and may help to address inequalities in educational outcomes at least in the short term.

How do we differentiate not demonise - Is there a role for healthier processed foods in an age of food insecurity? Proceedings of a roundtable event

The 'ultra-processed food' (UPF) concept, with classification of foods by 'level of processing' rather than nutrient profiles, and its relationship with health outcomes, is currently a topic of debate among academics and increasingly referred to in the media. The British Nutrition Foundation convened a virtual roundtable on 6th July 2022 to gather views on the use of the term (and current definitions of) UPF for public health messaging, seeking to establish areas of consensus and disagreement and identify topics for further research. A small group of invited expert stakeholders attended, including representatives from academia, policy, behavioural science, communications, health, food science, retail and consumer interests. Participants' discussions clustered into cogent themes which included: problems with the use of definitions for UPF, the lack of causal evidence and defined mechanisms linking processing per se with poor health outcomes, and advice that may result in consumer confusion. There was agreement that many foods classified as UPF are high in fat, sugars and/or salt and public health messages should continue to focus on reducing these in the diet since it is unclear whether reported associations between high intakes of UPF and poor health reflect poorer dietary patterns (defined by nutrient intakes), and nutrient-health relationships are well established. Examples of misalignment were also highlighted (i.e. some foods are classified as UPF yet recommended in food-based dietary guidelines [featuring in healthy dietary patterns]). This raises challenges for consumer communication around UPF. Concern was also expressed about potential unintended consequences, particularly for vulnerable groups, where advice to avoid UPF could create stigma and guilt due to lack of time or facilities to prepare and cook meals from scratch. It could also impact on nutrient intakes, as some foods classified as UPF represent more affordable sources of important nutrients (e.g. packaged wholemeal bread). Discordance between the concept of UPF and current strategies to improve public health, such as reformulation, was also discussed. The group concluded that the use of the concept of UPF in UK policy (e.g. dietary guidelines) would be unhelpful at present. Overall, participants felt that it was more important to focus on providing practical advice around selection of healthier processed foods and making healthier foods more accessible rather than promoting the avoidance of UPF. The latter may act to demonise all foods classified as UPF by current definitions, including some affordable nutrient-dense foods.

Cooking at home to retain nutritional quality and minimise nutrient losses: A focus on vegetables, potatoes and pulses

Cooking at home has experienced a decline in many countries since the mid-20th century. As rates of obesity have increased, there has been an emphasis on more frequent home cooking, including its incorporation into several food-based dietary guidelines around the world as a strategy to improve dietary quality. With the recent trend towards the adoption of diets richer in plant-based foods, many consumers cooking at home may now be cooking plant foods such as vegetables, potatoes and pulses more often. It is, therefore, timely to explore the impact that different home cooking methods have on the range of nutrients (e.g. vitamin C and folate) and bioactive phytochemicals (e.g. carotenoids and polyphenols) that such plant foods provide, and this paper will explore this and whether advice can be tailored to minimise such losses. The impact of cooking on nutritional quality can be both desirable and/or undesirable and can vary according to the cooking method and the nutrient or phytochemical of interest. Cooking methods that expose plant foods to high temperatures and/or water for long periods of time (e.g. boiling) may be the most detrimental to nutrient content, whereas other cooking methods such as steaming or microwaving may help to retain nutrients, particularly those that are water-soluble. Dishes that use cooking liquids may retain nutrients that would have been lost through leaching. It may be helpful to provide the public with more information about better methods to prepare and cook plant foods to minimise any nutrient losses. However, for some nutrients/phytochemicals the insufficient and inconsistent research findings make clear messages around the optimal cooking method difficult, and factors such as bioaccessibility rather than just quantity may also be important to consider.

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council (GMC) Outcome for Graduates.As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training. With this imperative, the Association for Nutrition established the Inter-Professional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service, royal colleges, medical schools and universities, government public health departments, learned societies, medical students and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors. Through an iterative and transparent consultative process, 13 key nutritional competencies, to be achieved through mastery of 11 graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skills acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council Outcomes for Graduates. As nutrition is an integrative science, the AfN IPG recommends the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden to teaching staff. The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip front-line staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered nutritionist (RNutr)/registered associate nutritionist (ANutr) or a registered dietitian (RD) where this is likely to be beneficial.

Walnut consumption and health outcomes with public health relevance-a systematic review of cohort studies and randomized controlled trials published from 2017 to present

CONTEXT

Considering the accumulation of recent studies investigating the health effects of walnut consumption, both including and beyond cardiovascular health effects, a systematic review of this literature to investigate the strength of the evidence is warranted.

OBJECTIVE

To investigate associations between walnut consumption and outcomes with public health relevance (specifically all-cause mortality, type 2 diabetes, CVD, metabolic syndrome, obesity, cancer, neurological and mental health, musculoskeletal, gastrointestinal, and maternal disorders) and the effect on associated disease risk markers, reported in studies published from 2017 to present.

DATA SOURCES

MEDLINE, FSTA, CENTRAL, and Scopus were searched from 1 January 2017 to 5 May 2021.

DATA EXTRACTION

Human studies (cohort studies and RCTs) ≥3 weeks in duration comparing consumption of walnuts (whole, pieces, or 100% butter) to a control and measuring associations with relevant public health outcomes and disease risk markers were assessed. Key study characteristics were extracted independently by 2 investigators using a standardized table. The quality of the studies was assessed using the Cochrane Risk-of-Bias tool 2.0 and the Newcastle-Ottawa Scale.

DATA ANALYSIS

Only 1 RCT was considered to be at low risk of bias for any of its outcomes. The cohort studies were considered to be of moderate or high quality. The results were synthesized using vote counting, based on the direction of effect. Thirty-three articles, 23 describing RCTs (walnut dose ∼10-99 g/day, 1,948 subjects) and 10 describing cohort studies (∼675,928 subjects), were included. Vote counting could be performed for the blood lipids, cardiovascular function, inflammation- and hemostatic-related factors, markers of glucose metabolism, and body weight and composition outcome groupings. The results are presented in effect direction plots. With respect to blood lipids, results from 8/8 RCTs favoured walnuts, in accordance with associations with a reduced risk of CVD suggested by cohort studies; results from 6/6 RCTs favoured control with respect to body weight and composition, although most of these effects were small. This was contrary to cohort study results suggesting small benefits of walnut consumption on body weight. There was no overall consistent direction of effect for cardiovascular function, markers of glucose metabolism, or inflammation- and hemostatic-related factors.

CONCLUSIONS

Evidence published since 2017 is consistent with previous research suggesting that walnut consumption improves lipid profiles and is associated with reduced CVD risk. Evidence is accumulating in other areas, such as cognitive health, although more research is needed to draw firm conclusions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD4202122.

Temporary screw epiphyseodesis of the first metatarsal for correction of juvenile hallux valgus

PURPOSE

Juvenile hallux valgus deformity (JHVD) is rare but may be associated with symptoms or deformities that require surgical treatment. Literature recommends waiting to perform surgical treatment until maturity. However, if conservative treatment is not sufficient and the children's psychological or physical suffering is particularly severe, earlier surgical treatment should be considered. The aim of this study was to evaluate the safety and efficiency of temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal as a new treatment option for JHVD during growth age.

METHODS

Between June 2011 and November 2017, 33 patients (24 girls, nine boys; 59 feet) with a JHVD were treated by temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal. At the time of surgery mean age was 11.1 years SD 1.4 (8 to 15). Patients were followed clinically and with standing, weight-bearing radiographs of the feet in two planes.

RESULTS

In all, 22 patients (39 feet) were included into this study. Mean follow-up was 27.8 months SD 9.9 (12 to 58). The hallux valgus angle changed from 26.5° SD 6.6° preoperatively to 20.2° SD 6.2° (p < 0.001) at time of follow-up. The intermetatarsal angle changed from 14.1° SD 5.4° to 10.5° SD 2.9° during this time (p < 0.01). In two patients (three feet) the screws were removed before the JHVD was fully corrected due to local tenderness over the screw head. In two patients screw migration away from the growth plate was observed, resulting in no further deformity correction in one patient and increasing deformity in the other patient. No other complications were seen.

CONCLUSION

Temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal seems to be an effective, safe, technically easy and minimally invasive early treatment option to correct JHVD in children with particularly severe suffering. Due to the individual correction rate, frequent follow-up visits are recommended until skeletal maturity.

LEVEL OF EVIDENCE

IV.

Vitamin D: An overview of vitamin D status and intake in Europe

In recent years, there have been reports suggesting a high prevalence of low vitamin D intakes and vitamin D deficiency or inadequate vitamin D status in Europe. Coupled with growing concern about the health risks associated with low vitamin D status, this has resulted in increased interest in the topic of vitamin D from healthcare professionals, the media and the public. Adequate vitamin D status has a key role in skeletal health. Prevention of the well-described vitamin D deficiency disorders of rickets and osteomalacia are clearly important, but there may also be an implication of low vitamin D status in bone loss, muscle weakness and falls and fragility fractures in older people, and these are highly significant public health issues in terms of morbidity, quality of life and costs to health services in Europe. Although there is no agreement on optimal plasma levels of vitamin D, it is apparent that blood 25-hydroxyvitamin D [25(OH)D] levels are often below recommended ranges for the general population and are particularly low in some subgroups of the population, such as those in institutions or who are housebound and non-Western immigrants. Reported estimates of vitamin D status within different European countries show large variation. However, comparison of studies across Europe is limited by their use of different methodologies. The prevalence of vitamin D deficiency [often defined as plasma 25(OH)D <25 nmol/l] may be more common in populations with a higher proportion of at-risk groups, and/or that have low consumption of foods rich in vitamin D (naturally rich or fortified) and low use of vitamin D supplements. The definition of an adequate or optimal vitamin D status is key in determining recommendations for a vitamin D intake that will enable satisfactory status to be maintained all year round, including the winter months. In most European countries, there seems to be a shortfall in achieving current vitamin D recommendations. An exception is Finland, where dietary survey data indicate that recent national policies that include fortification and supplementation, coupled with a high habitual intake of oil-rich fish, have resulted in an increase in vitamin D intakes, but this may not be a suitable strategy for all European populations. The ongoing standardisation of measurements in vitamin D research will facilitate a stronger evidence base on which policies can be determined. These policies may include promotion of dietary recommendations, food fortification, vitamin D supplementation and judicious sun exposure, but should take into account national, cultural and dietary habits. For European nations with supplementation policies, it is important that relevant parties ensure satisfactory uptake of these particularly in the most vulnerable groups of the population.

Circulating irisin levels and coronary heart disease: association with future acute coronary syndrome and major adverse cardiovascular events

INTRODUCTION

Irisin is a newly discovered myokine, associated with 'browning' of the white adipose tissue, obesity, insulin resistance and metabolic syndrome. The purpose of this study is to evaluate circulating irisin as a predictor of acute coronary syndromes (ACSs) and major adverse cardiovascular events (MACE).

METHODS

Sub-study 1: a case-control study, nested within the Veteran's Affairs Normative Ageing Study, evaluating circulating irisin levels in 88 ACS cases and 158 age- and sampling year-matched controls, as a predictor of ACS. Sub-study 2: a prospective cohort study, where 103 participants with established coronary artery disease were stratified by circulating irisin levels at the time they received percutaneous coronary interventions (PCIs) and were followed for the development of MACE.

RESULTS

Study 1: there was no association between irisin levels and ACS in otherwise healthy individuals (odds ratio: 1.00 95% confidence interval: (0.99-1.00)). Study 2: the incidence of MACE was significantly lower in the first irisin tertile compared with the second and third (incidence rate 0 vs 0.92 (0.51-1.61) vs 0.57 (0.28-1.14) events per 1000 person-days; P < 0.01). This was primarily driven by the lower incidence of unstable angina (incidence rate 0 vs 0.61 (0.31-1.22) vs 0.43 (0.19-0.96) per 1000 person-days; P = 0.01).

CONCLUSION

This is the first study to date that demonstrates that, although circulating irisin levels do not predict the development of ACS in healthy individuals, increased irisin levels are associated with the development of MACE in patients with established coronary artery disease after PCI.

Calcium homeostasis influences radiological fracture healing in postmenopausal women

INTRODUCTION

Recent studies suggest that calcium and 25-[OH]-cholecalciferol represent substantial co-factors in fracture healing. However, there still seems to be no sustainable consensus regarding the influence on fracture healing patterns. In this study, the influence of calcium and vitamin D levels on fracture callus formation was prospectively analysed using pQCT scan.

METHODS

94 postmenopausal females with distal radius fractures and consecutive surgery were included. Calcium, 25-[OH]-cholecalciferol, parathyroid hormone and bone-specific alkaline phosphatase levels were obtained prior surgical treatment and after 6 weeks. A pQCT scan was performed on both sites. Bone mineral density and fracture callus area were determined after detecting the outer border contour at a threshold of 280 mg/ccm. Patients received daily supplements of 1000 mg calcium and 880 IU 25-[OH]-cholecalciferol.

RESULTS

Mean 25-[OH]-cholecalciferol level was 19.61 ± 21.87 ng/ml, mean parathyroid hormone level was 52.6 ± 58.9 ng/l and mean Ca level was 2.23 ± 0.35 mmol/l. After 6 weeks of supplementation a significant increase of calcium (p < 0.001) and 25-[OH]-cholecalciferol (p < 0.001), and a significant decrease of parathyroid hormone (p < 0.001) levels were observed. Sixth week follow-up fracture callus area correlated significantly with postoperative normal range calcium levels on the fractured site (p = 0.006). Bone mineral density correlated with age (p < 0.001), but not with calcium and 25-[OH]-cholecalciferol levels after 6 weeks. All fractures presented timely adequate callus formation.

CONCLUSION

Calcium and parathyroid hormone serum levels influence fracture callus area interpreted as fracture callus formation patterns. Calcium levels within physiological range accounted for highest fracture callus area. Therefore, a balanced calcium homeostasis is required for appropriate callus formation.

Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial

BACKGROUND

Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma.

METHODS

Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed.

RESULTS

In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal (n = 277) and lung (n = 81) cancers were recruited. Median (range) follow-up was 6 (0-49) months. One-year survival was 38.6% (95% confidence interval 33.3-43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention.

CONCLUSIONS

Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention.

A genome screen of successful aging without cognitive decline identifies LRP1B by haplotype analysis

Successful aging without cognitive decline (SA) is apparent in those who escape age-related illnesses, such as cardiovascular disease and dementia. To determine whether there are protective genotypes that increase the probability of successful cognitive aging, a genome-wide screen was conducted on subjects who were 85 years of older, had MMSE scores >26, and had no major illnesses. SNP 500K microarrays were used. The data from the microarrays was analyzed versus that from Alzheimer's patients. Three SNPs in the gene for the low density lipoprotein receptor-related protein 1B (LRP1B) had significant P values, after Bonferroni correction. Additional SNPs were analyzed in this very large gene. Haplotypes in intron 18 were significant for successful aging versus Alzheimer's patients; those haplotypes were not significant when Alzheimer's patients versus CEPH controls were analyzed. These results suggest that haplotypes in the gene LRP1B are significant/protective for successful aging without cognitive decline.

Pediatric oral health-related quality of life improvement after treatment of early childhood caries: a prospective multisite study

PURPOSE

This study's purpose was to compare changes in parent-reported pediatric oral health-related quality of life between children with early childhood caries (ECC) and children who were caries-free; the ECC children received surgical dental intervention between baseline and follow-up.

METHODS

A newly developed self-report instrument, the POQL, was administered to 501 parents of 2- to 8-year-old children (caries-free=315; ECC=186) in hospital dental clinics in Columbus, Ohio, and Washington, D.C.

RESULTS

At baseline, ECC children were more likely to have fair or poor oral health and were rated as having more pain and trouble with physical, mental, and social functioning due to their teeth or mouth vs caries-free children (P<.001). At 6 and 12 months following dental treatment for ECC, there were significant improvements in parental ratings of their children's oral health status and a significant reduction in problems reported with physical, mental, and social functioning (all P<.001).

CONCLUSIONS

Compared with caries-free children, early childhood caries children were more likely to have worse questionnaire response scores and to experience greater negative impacts on physical, mental, and social functioning. Dental interventions in ECC children had a significant positive impact on parental ratings of their overall oral health and physical, mental, and social functioning.

A review of the evidence for the impact of improving nutritional care on nutritional and clinical outcomes and cost

BACKGROUND

The association between malnutrition and poor clinical outcome is well-established, yet most research has focussed on the role of artificial nutritional support in its management. More recently, emphasis has been placed on the provision of adequate nutritional care, including nutritional screening and the routine provision of food and drink. The aim of this literature review is to establish the evidence for the efficacy of interventions that might result in improvements in nutritional and clinical outcomes and costs.

METHODS

A structured literature review was conducted investigating the role of nutritional care interventions in adults, and their effects on nutritional and clinical outcomes and costs, in all healthcare settings. Ten databases were searched electronically using keywords relating to nutritional care, patient outcomes and healthcare costs. High quality trials were included where available.

RESULTS

Two hundred and ninety-seven papers were identified and reviewed. Of these, only two randomised, controlled trials and six other trials were identified that addressed the major issues. A further 99 addressed some aspects of the provision of nutritional care, although very few formally evaluated nutritional or clinical outcomes and costs.

CONCLUSIONS

This review reveals a serious lack of evidence to support interventions designed to improve nutritional care, in particular with reference to their effects on nutritional and clinical outcomes and costs. The review suggests that screening alone may be insufficient to achieve beneficial effects and thus more research is required to determine the most cost-effective interventions in each part of the nutritional care pathway, in a variety of healthcare settings and across all age ranges, to impact upon nutritional and clinical outcomes.

Perseveration in Alzheimer's disease

BACKGROUND/AIMS AND METHODS

Perseveration is common in Alzheimer's disease (AD). We document the type and quantitative burden of perseveration as cognitive decline progresses from normal aging (n = 30) through mild AD (n = 20) to moderate AD (n = 20) by administering a semantic verbal fluency task.

RESULTS

We found perseveration to increase significantly with increasing severity of AD and different types of perseveration that distinguish the subject groups in a statistically significant manner. Recurrent and continuous perseverations appear early in AD. As the disease progresses in severity into moderate stage, the number of recurrent and continuous perseverations increases, and stuck-in-set perseverations emerge.

CONCLUSION

The different types of perseveration are likely to reflect the progressive deterioration of different brain regions in AD.

6450 nm wavelength tissue ablation using a nanosecond laser based on difference frequency mixing and stimulated Raman scattering

A four-stage laser system was developed, emitting at a wavelength of 6450 nm with a 3-5 ns pulse duration, < or = 2 mJ pulse energy, and 1/2 Hz pulse repetition rate. The laser system successfully ablated rat brain tissue, where both the collateral damage and the ablation rate compare favorably with that previously observed with a Mark-III Free-Electron Laser.

The views and practice of oncologists towards nutritional support in patients receiving chemotherapy

Malnutrition in patients with cancer is common and an adverse prognostic indicator. A questionnaire answered by 357 (72%) UK specialist oncological trainees suggests that they lack the ability to identify factors that place patients at risk from malnutrition. Major barriers to effective nutritional practice included lack of guidelines, knowledge and time.

Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation

INTRODUCTION

Weight loss is an independent prognostic factor for decreased survival in cancer patients. The effectiveness of treatment is impaired in patients with weight loss. The aetiology of this weight loss is complex and poorly characterised. Decreased calorie intake may be important. The reasons for decreased intake are unknown.

AIMS AND METHODS

To determine in adult patients with cancer, who had not started chemotherapy or radiotherapy, the prevalence of symptoms which carry a risk to nutritional status and how these relate to weight loss, tumour burden and primary tumour site. New patients referred for treatment of any form of gastrointestinal (GI) cancer, non-small cell lung cancer or lung mesothelioma completed a validated questionnaire recording symptoms contributing to weight loss (Patient-generated Subjective Global Assessment--PG-SGA). In a subset of patients without metastatic disease, computed tomography scans were assessed to determine tumour burden.

RESULTS

Between August and October 2004, 122 patients with GI and 29 with lung cancers were recruited. There were 48% of GI and 28% of lung cancer patients who had lost weight. Sixty-two percent of the patients had one or more symptoms at presentation. The frequency of symptoms varied according to the site of disease. The most common symptom at all tumour sites was loss of appetite (38%). There was a weak but significant correlation between the number of symptoms and amount of weight loss (r=0.347). Patients reporting a reduced food intake had more symptoms than patients who had not lost weight. Tumour burden did not correlate with weight loss.

CONCLUSION

The symptoms in cancer patients occur across different types of primary tumours, may affect food intake and have a part in causing weight loss. More information on the role of symptom management in improving nutritional status is needed.