Weight Gain and Loss In Cancer Patients Undergoing Chemotherapy: Importance of Dose Adjustment

Introduction: The established dose of chemotherapy is based on the values of the patient's body weight, where variations during treatment can increase the toxicity of chemotherapy, with the development of nephrotoxicity, among other toxicity profiles, as well as in cases of weight gain, patients may receive low doses and compromise the therapeutic response to the tumor. Objective: to evaluate weight gain and loss in cancer patients undergoing chemotherapy. Methods: Longitudinal analytical study with patients at the end of chemotherapy treatment of both genders. The type, location of the tumor and the antineoplastic agent used were collected from the medical records, as well as height and weight at the beginning of treatment. At the time of collection, anthropometric assessment was performed using body mass index, arm circumference, arm muscle circumference, triceps skinfold thickness and percentage of weight loss. Results: Among the patients included in the study, 47.5% had a weight gain of around 2.5 kg, while the remaining patients (52.5%) had a weight loss of around 2.8 kg. Of the patients who had GFR, 55.5% had severe PP, 33.4% had no significant loss and 11.1 had significant loss. In the current study, only 22% had a GFR <60ml/min/1.73m², but they would already need to readjust the medication calculation. Conclusion: It is important to evaluate body surface variations and also the GFR to adjust the dose of the antineoplastic agent and to prevent or minimize nephrotoxicity, as well as to reduce the risk of underdosing and inefficiency of the therapy.

Pregnancy’s Relationship With Diabetes and Induced Hypertension: A Mini-Review

It is pointed out in many articles that induced hypertension and gestational diabetes are well linked to pregnancy, but this relationship is not well determined. The report focuses on the pregnancy’s relationship with diabetes and induced hypertension. It is found herein that mean pregnancy is directly related with glucose levels (GLUC) (P=0.07), age (P<0.01), BMI (P=0.07), Diabetic Women (DW) status (P=0.01), interaction effect of Triceps SkinFold Thickness (TSFT) and age (TSFT × Age) (P<0.01), while it is inversely related with GLUC × Age (P=0.02), TSFT × BMI (P<0.01), Insulin (INSU) (P=0.06) and Diabetes Pedigree Function (DPDF) (P=0.03). Variance of pregnancy is directly related with GLUC (P=0.07), Diastolic Blood Pressure (DBP) (P=0.04), GLUC × TSFT (P<0.01), DBP × TSFT (P<0.01), DPDF (P=0.01), INSU × BMI (P=0.15), while it is inversely related with GLUC × DBP (P=0.01), TSFT (P<0.01), TSFT × DPDF (P=0.03), INSU (P=0.07). It is easily interpreted that pregnancy’s mean is well connected to diabetic parameters such as INSU and GLUC levels, history of DW, DPDF, BMI, GLUC × Age, while its variance is connected to diabetic and hypertension parameters such as GLUC, DPDF, DBP, GLUC × TSFT, DBP × TSFT, INSU × BMI, GLUC × DBP, TSFT × DPDF, INSU. Moreover, it is derived that a diabetic female has a higher chance to be pregnant than a normal woman.

Fat mass assessment using the triceps skinfold thickness enhances the prognostic value of the GLIM criteria in patients with lung cancer

The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the GLIM framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients at two institutions in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HRs). Malnutrition was identified in 808 (30.2%) patients, and the best TSF thresholds were 9.5 mm in men and 12 mm in women. Accordingly, 496 (18.6%) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54% (HR = 1.54, 95%CI = 1.25 to 1.88) greater death hazard compared with well-nourished individuals, which was also greater compared to malnourished patients with a normal TSF (HR = 1.23, 95%CI = 1.06 to 1.43) or malnourished patients without TSF assessment (HR = 1.31, 95%CI = 1.14 to 1.50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimize the long-term outcomes in patients with LC.

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥ 70 years. Individual activities of daily living were documented by the Barthel index (BI, 0-100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1 - t2, t2 - t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2 - t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.

Percutaneous Endoscopic Gastrostomy Feeding in Children with Cerebral Palsy

Aim The prevalence of congenital cerebral palsy (CP) worldwide ranges from 0.15 to 0.4%. CP causes several gastrointestinal complications that inhibit normal eating behavior. This single-center observational study aimed to determine the tolerability and benefits of percutaneous endoscopic gastrostomy (PEG) in pediatric CP patients with malnutrition. Materials and Methods The study included 41 pediatric CP patients with malnutrition. All patient data were retrospectively obtained from Bakırköy Dr. Sadi Konuk Research and Training Hospital, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Istanbul, Turkey. In addition to baseline measurements of weight, height, triceps skinfold thickness, 1,25-hydroxyvitamin D3, folate, iron, zinc, vitamin B12, hemoglobin, and mean corpuscular volume, data analyzed included follow-up measurements recorded at 3 and 6 months of PEG (standard polymeric enteral supplementation as 1.0 kcal mL–1). Results There was significant improvement in both height, weight, and triceps skinfold thickness in all patients at 3 and 6 months of PEG (p < 0.05). In terms of blood parameters, there was not significant improvement, except that the number of patients with a low hemoglobin count significantly decreased at 3 and 6 months of (p = 0.022). Moreover, the number of patients with vomiting after PEG also significantly decreased at 3 and 6 months of (p = 0.004). Conclusion PEG significantly improves malnutrition in pediatric CP patients and does not cause any major complications. Based on these findings, we think PEG is a beneficial and cost-effective intervention with a high rate of tolerability in pediatric CP patients with malnutrition.

NUTRITIONAL STATUS IN CHILDREN WITH CANCER: COMPARISON OF DEUTERIUM OXIDE DILUTION WITH BIOELECTRIC IMPEDANCE ANALYSIS AND ANTHROPOMETRY

ABSTRACT Objective: To explore changes in the nutritional status of pediatric cancer patients before and after chemotherapy and evaluate the correlation between deuterium oxide dilution, bioelectric impedance analysis, and anthropometry for assessment of body composition. Methods: This study included 14 children (aged 5.6 to 13.6 years) and classified them as having hematologic or solid tumors. They had their body composition analyzed according to deuterium oxide, bioelectric impedance, and anthropometric measurements before the first chemotherapy cycle and after three and six months of therapy. Results: The patients in the hematologic tumor group had an increase in weight, height, body mass index, waist, hip, and arm circumference, subscapular skinfold thickness, and fat mass with the isotope dilution technique during chemotherapy. In the solid tumor group, the children showed a reduction in fat-free mass when assessed by bioimpedance analysis. We found a positive correlation between the triceps skinfold thickness and fat mass determined by bioimpedance analysis and deuterium oxide. The arm muscle circumference correlated with the fat-free mass estimated by bioimpedance analysis and deuterium oxide. Conclusions: Patients with hematologic tumors had an increase in body weight, height, and fat mass, which was not identified in the solid tumor group. The positive correlation between anthropometry (triceps skinfold thickness and arm muscle circumference), deuterium oxide dilution, and bioelectric impedance analysis shows the applicability of anthropometry in clinical practice.

Hyperglycaemia in Pregnancy and Anthropometric Parameters in the Offspring at 10 Years: A Community-Based Retrospective Cohort Study in Sri Lanka

Background. Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring. There is limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero. Objective. The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and anthropometric parameters in the offspring at 10-11 years of age. Methods. A community-based retrospective cohort study was conducted in Colombo district, Sri Lanka. In the first stage, children born in 2005 were identified, and the availability of antenatal records was assessed. In the second stage, the exposure status of participants was ascertained based on antenatal records and predefined criteria. In the third stage, height, weight, waist circumference, and triceps skinfold thickness (TSFT) of eligible participants were measured to ascertain the outcome status. Background characteristics were collected by interviewing mothers. A 24-hour dietary recall and a 3-day diet diary were recorded. Results. 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (nonexposed) participated. Mean ages (SD) of exposed and unexposed groups were 10.9 (0.3) and 10.8 (0.3) years, respectively. The median BMI (17.6 vs 16.1, p<0.001), waist circumference (63 cm vs 59.3 cm, p<0.001), and triceps skinfold thickness (13.7 mm vs 11.2 mm, p<0.001) were significantly higher in the exposed group. Offspring of women with HIP were more likely to be overweight (aOR = 2.6, 95% CI 1.4–4.9) and have abdominal obesity (aOR = 2.7, 95% CI 1.1–6.5) and high TSFT (aOR = 2.2, 95% CI 1.06–4.7) at 10-11 years than children who were not exposed after adjusting for maternal BMI, maternal age at delivery, and birth order. Conclusions. Intrauterine exposure to HIP is a significant determinant of overweight, high TSFT, and abdominal obesity in the offspring.

Anthropometric Measurements and Frailty in Patients with Liver Diseases

There have been scarce data regarding the relationship between frailty and anthropometry measurements (AMs) in patients with chronic liver diseases (CLDs). We aimed to elucidate the influence of AMs on frailty in CLDs (median age = 66 years, 183 men and 192 women). AMs included arm circumference, triceps skinfold thickness, calf circumference (CC), waist circumference, and body mass index. Frailty assessment was done by using five phenotypes (body weight loss, exhaustion, decreased muscle strength, slow walking speed, and low physical activity). Robust (frailty point 0), prefrail (frailty point 1 or 2), and frailty (frailty point 3 or more) were observed in 63 (34.4%), 98 (53.6%), and 22 (12.0%) of males, respectively, and 63 (32.8%), 101 (52.6%), and 28 (14.6%) of females, respectively. In receiver operating characteristics (ROC) curve analyses for the presence of frailty, CC had the highest area under the ROC (AUC) both in male (AUC = 0.693, cutoff point = 33.7 cm) and female (AUC = 0.734, cutoff point = 33.4 cm) participants. In the multivariate analysis associated with frailty, for the male participants, only the presence of liver cirrhosis (p = 0.0433) was identified to be significant, while among the female participants, serum albumin (p = 0.0444) and CC (p = 0.0010) were identified to be significant. In conclusion, CC can be helpful for predicting frailty, especially in female CLD patients.

Functional Dentition and 12-Month Changes in Body Measurements among Thai Older Adults

This study evaluated the association of functional dentition with 12-month changes in body measurements and nutrient intake among older adults. Data from 651 community dwellers, aged 60 years and over, in Phetchaburi, Thailand, were analysed (retention rate: 83%). Data were collected via interviews (including a semi-structured food frequency questionnaire), anthropometric measurements and dental examinations. Associations were tested in linear regression models adjusted for baseline sociodemographic factors, behaviours, chronic conditions and medications. On average, participants experienced a significant increase in body mass index (BMI) and significant decreases in waist circumference (WC) and triceps skinfold thickness (TSF). A negative, albeit not significant, association between functional dentition and change in BMI was observed after adjusting for confounders. Whilst participants who had non-functional dentition without dentures experienced increases in BMI (predicted mean change: 0.25; 95% Confidence Interval: 0.09, 0.41), those who had non-functional dentition with dentures (0.21; 95%CI: −0.08, 0.50) and functional dentition (−0.07; 95%CI: −0.42, 0.28) remained stable. No similar trends were noted for WC or TSF. Functional dentition was not associated with changes in nutrient intake either. The findings provide little evidence on the association of functional dentition with short-term changes in nutrient intake or nutritional status.