Nutritional Biomarkers Research Articles

Calcium, Phosphate, and Vitamin D in Children and Adolescents with Chronic Diseases: A Cross-Sectional Study.

Chronic diseases may affect the nutritional status of children and adolescents. Calcium (Ca), phosphorus (P), and vitamin D (Vit-D) are crucial nutrients for their growth and development. Proper diagnosis and treatment are critical components of personalized and precision medicine. Hence, we conducted a cross-sectional and comparative study to evaluate Ca, P, and Vit-D levels in their non-skeletal functions and their association with health and nutritional biomarkers in children and adolescents with diverse chronic conditions. We performed anthropometric, body composition, clinical evaluation, biochemical analysis, and dietary survey methods. A total of 78 patients (1-19 years, 43 females, 42 children) took part in this study. Overall, 24, 30, and 24 participants were obese, undernourished, and eutrophic, respectively. Results found that 74% and 35% of individuals had deficient Vit-D and Ca intake, respectively. Most cases were normocalcemic. Results also found that 47% of the subjects had Vit-D deficiency (VDD), 37% were insufficient, and 37% had hypophosphatemia. Of the 46% and 31% of patients with VDD and insufficient levels, 19% and 11% were hypophosphatemic, respectively. Calcium, P, and Vit-D levels were associated with anthropometric parameters, body mass index, body composition, physical activity, diet, growth hormones, and the immune, liver, and kidney systems. These results show the coincident risk of altered Ca, P, and Vit-D metabolism in children and adolescents with chronic diseases.

Abstract 2171: Nutritional mediators of inflammation: A cause for increased surveillance

Abstract Background: Nutritional and inflammatory factors collected in routine cancer labs, neutrophil percentage to albumin ratio (NPAR), neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet lymphocyte ratio (PLR), have been shown feasible in identification of patients at risk of increased treatment complications, decreased cognition, anxiety and depression, and increased mortality. These have proven sensitive to multiple cancer types and stages, though little is known about causal pathways. The Vitamin/Mineral and Inflammatory Correlations To Understand Chronic Stress in the U.S. (The VICTUS Study) sought to elucidate a relationship between diet and food insecurity within these panels. Methods: Using NHANES 2017/2018 surveys, adults > 18 years without renal or hepatic disorders, pregnancy, alcohol, or supplement use were included. NPAR, NLR, MLR, and PLR were categorized as quartiles and compared to demographic, food security, plasma micronutrient statuses [vitamins A, B9, C, D, E, calcium (Ca), ferritin (Fe), phosphorus (P), potassium (K), sodium (Na)], and smoking, activity level, and sun exposure, using chi-square and ANOVA. ANOVA models compared food security and poverty to NPAR, NLR, MLR, and PLR means. Results: From 3,317 participants, 50.2% were male, 54.3% non-Hispanic White, 33.7%, food insecure, 51.1% food stamp recipients, 27.7% smokers, with a mean age of 42.5 (SD 0.44), poverty to income ratio 2.79 (SD 0.08), CRP 3.90 (SD 0.18), NPAR 14.1 (SD 0.14), NLR 2.07 (SD 0.04), MLR 0.28 (SD 0.003), and PLR 118.7 (SD 1.61). CRP was found to be statistically significantly associated with all biomarker ratios (p < 0.018). Significant micronutrient biomarker-inflammatory biomarker associations were identified in Fe [NPAR, MLR, PLR (p < 0.001)], P [NPAR, NLR, MLR, PLR (p < 0.033)], C [NPAR, NLR (p < 0.008)], E [MLR, PLR (p < 0.016)], K [NPAR, NLR, MLR, PLR (p < 0.015)], Ca [NPAR, PLR (p < 0.04)], A [NPAR (p < 0.023)] and D [NLR (p < 0.035)]. Significant micronutrient intake-inflammatory biomarker associations were detected in vitamin A [NPAR, PLR (p < 0.013)], lycopene [NLR, PLR (p < 0.035)], and B12 [NLR, PLR (p < 0.031)]. Age [NPAR, NLR, MLR, PLR (p < 0.001)], gender [NPAR, MLR, PLR (p < 0.001)], ethnicity [NPAR, NLR, MLR (p < 0.006)], and sedentariness [MLR, PLR (p < 0.039)] were also associated with inflammatory markers. Poverty was significantly associated with NPAR, NLR, MLR, and CRP (p < 0.018). Food insecurity was significantly associated with NPAR (p < 0.001) and CRP (p < 0.001). Discussion: Food insecurity and poverty were significantly associated with NPAR, a ratio implicated in overall poorer cancer health outcomes. Multiple inadequate micronutrient intakes and plasma biomarkers were associated with inflammatory panels, though neither nutritional biomarker nor food insecurity statuses and their contributions to inflammatory processes are routinely surveilled within cancer disease and treatment. Citation Format: Jennifer Crook, Eunkyung Lee, Rui Xie, Opeyemi Bolajoko, Victoria Loerzel. Nutritional mediators of inflammation: A cause for increased surveillance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2171.

Abstract 3680: Prognostic value of serum biomarkers in pancreatic adenocarcinoma: Results from a Swiss single center cohort analysis

Abstract Introduction: Inflammatory and nutritional biomarkers, such as neutrophil to lymphocyte ratio (NLR), C-Reactive Protein (CRP), lactate dehydrogenase (LDH) and albumin, are valuable prognostic indicators, refining stratification strategies in oncological patients. This study aims to delineate the impact of these markers on overall survival in patients with pancreatic adenocarcinoma, in order to aid in clinical risk stratification. Methods: We conducted a retrospective analysis on patients with adenocarcinoma of the pancreas, treated at the Cantonal Hospital Baselland (January 2018 - February 2022). Clinical data, including diagnosis, treatment, and blood markers, were extracted from electronic records. The analysis incorporated the computation of median values for each blood marker, followed by survival analysis and determination of Cox proportional hazard ratios with a 95% confidence interval. Results: Our cohort included 43 patients, 53% women, 44% men, median age 73 years (IQR 14.75) with adenocarcinoma of the pancreas. Most patients (56%) had advanced distant disease and 25% of these did not receive any oncological therapy. At least one cycle of chemotherapy was administered in 85% of patients. NLR<4 was reported in 63% of cases, normal albumin levels in 72%, normal LDH levels in 79%, and normal CRP levels in 47%. In the multivariate Cox regression analysis, there was a significant higher risk for death with metastatic disease (HR 6.216 CI 2.00-19.28, p=0.002), age ≥75 (HR 4.88, CI 1.65-14.39, p=0.004) and CRP>10 (HR 3.38, CI 1.18-9.66, p=0.023) and lower risk with addition of chemotherapy (HR 0.076, CI 0.02-0.29, p<0.001). NLR, LDH and albumin levels did not significantly correlate with higher HR for death. At a median follow-up period of 8.5 months (IQR 14), the median overall survival was 9 months (IQR 14.5) with a worsening prognostic for increased CRP (p=0.00027), NLR>4 (p=0.051), albumin <35g/l (p=0.0024), LDH >250 U/l (p=0.037). Better survival rates were seen in patients receiving chemotherapy 75% vs 20 for those without chemotherapy (p<0.0001) and in those with local disease 80% vs 60% for metastatic disease p=0.034). Age ≥75 years carried a significant poorer prognostic (p=0.0017), while gender was not relevant. However, due to small sample size, age adjusted survival was not carried out and age was considered not relevant for the survival analysis. Conclusion: Beyond the expected factors like stage of disease and therapy, an increased CRP appears to carry significant correlation with hazard ratio for death among patients with adenocarcinoma of the pancreas. In our cohort, abnormal CRP, NLR, albumin and LDH levels demonstrated significant association with shorter survival period, underscoring the potential utility of these biomarkers in prognostic stratification and their incorporation into routine oncological assessments. Citation Format: Elena D. Chiru, Marie Knufike, Martina Sonderegger-Stalder, Raphael Mosimann, Antonia Sgries, Robert Rosenberg, Emanuel Burri, Sandra Mitrovic, Michèle Voegeli, Kristen Mertz, Alessandra Angelini, Marcus Vetter. Prognostic value of serum biomarkers in pancreatic adenocarcinoma: Results from a Swiss single center cohort analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3680.

Abstract 2516: Influence of pre-treatment nutrition and inflammation on immunotherapy response in non-small cell lung cancer

Abstract Purpose: Immune checkpoint inhibitor therapy (ICI) is effective in non-small-cell lung cancer (NSCLC) but only a minority respond, likely due in part to the gut microbiome. Given the coupling of host nutritional status and gut microbiota composition, we investigated the pre-treatment associations of nutritional status and biomarkers with ICI treatment response and survivals. Methods: We recruited stage III-IV NSCLC patients. Pre-ICI treatment clinical information and blood samples were obtained. Clinician assessed ICI response and survival data were recorded. The nutritional/inflammatory indicators were compared based on treatment response and survivals. ICI Clinical Benefit was defined as 12-month progression free survival. Pearson Chi-square or Fisher’s Exact test was used to compare categorical metrics; non-parametric analysis compared continuous metrics by treatment response. Overall survivals were assessed using multivariable Cox proportional hazards models to estimate associations. Results: Of the 76 patients recruited, all were ECOG performance status 0 (14.5%) or 1 (85.5%). 36 (47%) had Clinical Benefit with median survival 21.3 mo. vs. 6.6 mo. among the No Clinical Benefit patients (p<0.01). Non-responders had significantly more often weight loss, lower serum albumin, elevated red cell distribution index (RDW) and worse scores for Frailty Index, Geriatric Nutritional Risk Index and Mini-Nutritional Assessment (MNA). Non-responders had significantly more inflammation with a higher Systemic Immune Response Index (SIRI) and RDW. Overall survival was negatively correlated with: 1. weight loss; 2. low serum albumin; 3. low serum sodium; 4. high RDW; 5. elevated total neutrophils, total white blood cells, total monocytes, neutrophil to lymphocyte ratio, and monocyte to lymphocyte ratio; 6. adverse MNA and Geriatric Nutritional Risk Index; 7. elevated SIRI and Systemic Immune Inflammation Index (SII). ICI response prediction accuracy using a solely MNA-based model was significantly high in terms of AUROC of 0.85 [95% CI= (0.76, 0.93); p<0.05]. In multivariable analysis, the predictor of immunotherapy response and survival was the 6-measure MNA which strongly correlates with weight loss, low serum albumin and depressed Frailty Index. Conclusions: An adverse nutritional status with accompanying chronic inflammation is strong predictor of non-response to ICI. Since lung cancer patients with depressed pre-treatment nutrition have a low likelihood of an ICI response, they should be promptly referred for dietician consultation for intensive nutritional therapy which may improve their clinical outlook. Considering the negative association of malnutrition/inflammation with response to ICI treatment in NSCLC patients who still qualify as ECOG performance status 0-1 patients, prospective clinical trials should also stratify their results by nutritional status. Citation Format: Lary A. Robinson, Youngchul Kim, Acadia Buro, Stephanie R. Hogue, Alexis Bailey, Gina M. DeNicola, Christine Pierce, Mark Umbarger, Doratha A. Byrd. Influence of pre-treatment nutrition and inflammation on immunotherapy response in non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2516.

Abstract 2198: Poverty, food insecurity, and nutritional inflammatory mediators of allostatic load

Abstract Background: Though widely recognized in cancer pathogenesis, inflammatory pathways of allostatic load remain vaguely understood. A partial explanation may be found within the realm of food insecurity and micronutrient inadequacies, defined as nutrient intake less than the estimated average requirement. Many micronutrient deficiencies contribute to pro-inflammatory and immunocompromised milieus. Inadequacies, however, which may present without overt symptoms, are not currently well studied. The purpose of this study was to examine relationships between known inflammation-associated nutritional biomarkers of micronutrients and biomarker variables of allostatic load. Methods: Using NHANES 2017/2018 surveys, adults > 18 years without renal or hepatic disorders, pregnancy, alcohol, or supplement use were included. Plasma levels of vitamins A, B9, C, D, E, calcium (Ca), ferritin (Fe), phosphorus (P), potassium (K) and sodium (Na) were grouped into deficiency, inadequate and adequate groups based on clinically recognized standards. Micronutrient prevalence was assessed and variables of allostatic load [blood pressure, glucose, albumin, creatinine, red cell distribution width (RDW), high density lipoprotein (HDL), low density lipoprotein (LDL), cholesterol and triglycerides] were analyzed for mean differences among micronutrient groups, food security and poverty. Results: From 3,317 unique participants, inadequacy prevalence percentages were quantified as: vitamins A (0.4%), B9 (12.2%), C (58.3%), D (39.6%), E (21.0%), P (11.4%), K (3.4%), Na (24.2%), Ca (59.5%), and Fe (37.4%) [p < 0.001]. Statistically significant differences were identified in age [C, D, E, Ca, Fe, P, Na (p < 0.004)], race/ethnicity [B9, C, D (p < 0.006)], gender [C, E, Ca, Fe, P, K, Na (p < 0.018)], poverty [A, B9, C, D, E, Fe, K (p < 0.025)], and food security [B9, C, D, E, P (p < 0.032)]. Associations to allostatic load were discovered in: albumin [A, C, D, Ca, Fe, P, Na (p < 0.025)], glucose [C, E, Fe, P, Na (p < 0.009)], HDL [C, D, E, Fe, P, K (p<0.045)], LDL [E, Ca, Fe, Na (p<0.028)], creatinine [C, D, Ca, Fe (p<0.001)], triglycerides [B9, D, E, Fe (p<0.033)], cholesterol [C, D, E, Ca, Fe, Na (p<0.006)], B/P [C, E, Fe, P, Na (p < 0.035)], and RDW [C, D, Ca, Fe (p < 0.001)]. Poverty was significantly associated with all variables of allostatic load (F = 2.85, p = 0.002). Food security was significantly correlated with albumin (p < 0.001), glucose (p = 0.005) and HDL (p < 0.001). Conclusion: Allostatic load, poverty, and food security were significantly associated with subclinical micronutrient statuses, which may not present with signs of deficiency and are not currently well assessed. Similarly, poverty was significantly associated with all variables of allostatic load, though food security was only identified to be associated with albumin, glucose, and HDL, suggesting that food security may not be currently adequately defined for surveillance. Citation Format: Jennifer M. Crook, Eunkyung Lee, Opeyemi Bolajoko, Rui Xie. Poverty, food insecurity, and nutritional inflammatory mediators of allostatic load [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2198.

Cachexia-Affected Survival Based on Inflammatory Parameters Compared to Complex Conventional Nutritional Assessments in Patients with Pancreatic Cancer and Other Gastrointestinal Tumors-The CONKO 020 Investigation.

Pancreatic adenocarcinoma (PDAC) is still a complex, devastating disease. Cachexia symptoms frequently impair patient survival. This accompanying syndrome is commonly diagnosed late, when clinical signs become evident. Early diagnosis using conventional measurement methods is often difficult, and the discrimination of this disease from cancer progression is challenging and often overlaps. The aim of this study was to analyze whether conventional nutritional assessments or laboratory biomarkers are better predictive tools for the early detection of patients at risk of reduced survival. We analyzed a prospective predefined cohort of 182 patients with gastrointestinal cancer, 120 patients with PDAC and-as controls-62 patients with other gastrointestinal adenocarcinoma (oAC), from whom we have sufficient data of protocol-defined conventional nutritional assessments, clinical data, and specific laboratory parameters. at the time of tumor diagnosis, high inflammatory biomarkers (c-reactive protein (CRP), interleukin-6 (IL-6)) and albumin serum levels were associated with impaired OS in PDAC patients, but not in patients with oAC. Hemoglobin, body mass index (BMI), and bioelectrical assessments alone did not have a prognostic impact at the time of diagnosis. In a multivariate analysis, only CRP (HR 1.91 (1.25-2.92), p = 0.003) was found to be an independent prognostic factor in PDAC patients. Over the course of the disease in PDAC patients, inflammatory biomarkers, albumin, hemoglobin, and bioelectrical assessments were associated with impaired OS. In multivariate testing, CRP (HR 2.21 (1.38-3.55), p < 0.001) and albumin (HR 1.71 (1.05-2.77), p = 0.030) were found to be independent prognostic factors in PDAC patients. Specifically for PDAC patients, high inflammatory index and albumin serum levels potentially represent a sufficient early surrogate marker to detect patients at high risk of impaired OS better than complex conventional methods. These findings could help to identify patients who may benefit from early therapeutic interventions.

Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer.

Malnutrition, characterized by altered body composition and impaired function, is particularly prevalent among gastric cancer patients, affecting up to 60% of them. Malnutrition in these patients can manifest both before and after surgery, due to factors such as gastric outlet obstruction, cancer cachexia, and anatomical changes. Notably, total gastrectomy (TG) presents the most significant nutritional challenges. However, function-preserving gastrectomy, such as pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG), have shown promise in improving nutritional outcomes. Effective nutritional risk screening and assessment are vital for identifying patients at risk. Nutritional support not only improves nutritional parameters but also reduces complications, enhances quality of life (QoL) and survival rates. Those unable to maintain more than 50% of the recommended intake for over 7 days are recommended for nutritional support. Common methods of nutritional support include oral nutrition supplements (ONS), enteral nutrition (EN), or parenteral nutrition (PN) depending on the patient's status. Effect of perioperative nutritional support remains controversial. Preoperative interventions including ONS and PN have shown mixed results, with selective benefits in patients with sarcopenia or hypoalbuminaemia, while impact of EN in gastric outlet obstruction patients have been positive. In contrast postoperative support appears to be consistent. Tube feeding after TG has shown improvements, and ONS have been effective in reducing weight loss and improving nutritional biomarkers. PN was also associated with benefits such as weight maintenance and QoL. This review explores the mechanisms, assessment, and clinical impact of malnutrition, emphasizing the importance of nutritional support in gastric cancer patients undergoing gastrectomy.

Inflammatory and Nutritional Biomarkers in Patients With Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Chemotherapy and Radiation Therapy.

To investigate the relationship between pretreatment inflammatory and nutritional biomarkers in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemotherapy and radiation therapy (nCRT). 213 patients with newly diagnosed stage II-III ESCC who received nCRT at an academic hospital in Taiwan. Electronic health record data were used. Records on inflammatory and nutritional biomarkers and clinical outcomes were extracted. Logistic regression analysis was used to predict treatment-related adverse events, Cox regression was used for survival outcomes, and receiver operating characteristic curve analysis was used to determine optimal cutoff values. There was a significant association between low prognostic nutritional index (PNI) and nCRT toxicities and survival. Advanced cancer stage, high platelet-to-lymphocyte ratio, and occurrence of pneumonia/infection were linked to survival outcomes. PNI shows promise in predicting prognosis, helps identify high-risk patients, and enables nurses to apply tailored interventions.

Effect of eight-week controlled dietary modification trial on nutritional biomarkers in young Indian athletes

Objective: Present study was intended to examine the effects of dietary modification on nutritional biomarkers in young Indian male athletes. Methods: Eighty-eight footballers and hockey players were randomly segregated into ad-libitum group (ALG) and nutrition counselling group (NCG). Eight weeks of dietary modification trial was implemented on NCG, resulting in 9.5, 2.6, and 2.1 g/kgbw/day of carbohydrate, protein, and fat respectively. Rate of changes in daily nutrient intake and nutrition biomarkers were captured. Results: NCG revealed significant increases in total serum protein (5.6%, p&lt;0.001), haemoglobin (3.9%, p&lt;0.001) and vitamin E (2.9%, p&lt;0.001). They also exhibited rises in serum vitamin C (6%, p=0.004), folate (4.5%, p=0.004), ferritin (4.8%, p=0.003), calcium (4.2%, p=0.009), serum vitamins B12 (3.9%, p=0.012) and D (12.3%, p&lt;0.001). Haemoglobin levels were positively correlated with daily protein (p&lt;0.01), iron (p&lt;0.05), vitamins B12 and vitamin C (p&lt;0.05 both) intakes. Serum calcium positively correlated with daily calcium (p&lt;0.01), phosphorus and protein (p&lt;0.05 both) intakes. Serum zinc was positively correlated with daily protein, calcium, vitamin B9 and vitamin D intake, while serum ferritin and vitamin B12 were positively correlated with protein and iron intake. Post-intervention, NCG reported optimal blood levels of calcium, zinc, protein, Hb, ferritin, vitamins B12, C and E, whereas the folate and vitamin D values were suboptimal. On the other hand, the ALG revealed marginal levels of zinc and total protein as well as noticeably low levels of calcium, folate, and vitamin D. Conclusion: Enhanced blood levels of nutritional biomarkers noted after eight-weeks of controlled dietary modification was supported by positive correlations observed with the daily nutrient intakes.

Mollusc and crustacean consumption in the first 1000 days: a scoping review.

Mollusc and crustacean consumption in the first 1000 d may improve maternal and child health by providing essential nutrients. However, in some contexts, molluscs and crustaceans have been associated with allergies and environmental contamination, potentially leading to adverse health and development outcomes. It is unclear whether the health benefits of consuming molluscs and crustaceans, collectively classified as shellfish in nutrition, are outweighed by the potential risks to pregnant women and children. We conducted a scoping review (PROSPERO: CRD42022320454) in PubMed, Scopus and EBSCO Global Health of articles published between January 2000 and March 2022 that assessed shellfish consumption during pregnancy, lactation or childhood (0-2 years) in relation to maternal health, child health or child development. A total of forty-six articles were included in this review. Overall, shellfish consumption was associated with higher biomarkers of environmental contaminants, with mercury being the most studied and having the strongest evidence base. The limited research on nutritional biomarker status shows an association between shellfish consumption and iodine status. Preterm birth was not associated with shellfish consumption, but newborn anthropometry showed mixed results, with several studies reporting lower birth weight with higher shellfish consumption. The few studies that examined child development and maternal health outcomes reported no significant associations. This review revealed trade-off health risks and benefits with inclusion of molluscs and crustaceans in the dietary patterns of mothers and young children. More research is needed to understand how these aquatic animal-source foods may be safely consumed and leveraged for improving human nutrition.

Baseline immune status and the effectiveness of response to enteral nutrition among ICU patients with COVID-19: An observational, retrospective study

ObjectivesThis study aimed to compare how immunocompromised and immunocompetent patients responded differently to enteral nutrition (EN) support in intensive care units (ICUs) during the COVID-19 pandemic, including serum nutritional biomarkers, inflammatory biomarkers, gastrointestinal (GI) intolerance symptoms, and clinical outcomes. MethodsAn observational, retrospective study was conducted in the ICUs of a teaching hospital in southwest China. We recruited a convenience sample of 154 patients between December 2022 and February 2023. We defined immunocompromise as primary immunodeficiency diseases, active malignancy, receiving cancer chemotherapy, HIV infection, solid organ transplantation, hematopoietic stem cell transplantation, receiving corticosteroid therapy with a target dose, receiving biological immune modulators, or receiving disease-modifying antirheumatic drugs or other immunosuppressive drugs. We conducted a Mann–Whitney U test, χ2 test, or generalized estimation equation model to explore the differences between immunocompromised and immunocompetent patients. ResultsAmong the 154 study participants, 41 (27%) were defined as immunocompromised. The immunocompromised patients were younger than the immunocompetent patients. There were no statistically significant differences between the two groups with respect to serum nutritional biomarkers, inflammatory biomarkers, incidence of GI intolerance symptoms, and in-hospital mortality. However, the immunocompromised patients exhibited a longer hospitalization duration than the immunocompetent patients. ConclusionWe found that the immunocompromised patients spent more time in the hospital. These findings may help us to standardize the participants before EN interventional studies better and better individualize EN supports based on patients’ immunity status.

Prognostic Value of the Geriatric Nutritional Risk Index in Previously Untreated Patients with Advanced Non-Small Cell Lung Cancer Treated with a Combination Therapy of Anti-PD-1/-PD-L1 Antibodies and Platinum-Based Chemotherapy: A Multicenter Retrospective Study

Introduction: Combination therapy of anti-programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) antibodies and platinum-based chemotherapy has been widely used as a first-line treatment for patients with unresectable advanced non-small cell lung cancer (NSCLC) in clinical settings; however, prognostic biomarkers associated with survival outcomes have not been sufficiently investigated. Methods: We enrolled 147 previously untreated patients with advanced NSCLC who were treated with a combination therapy of anti-PD-1/-PD-L1 antibodies and platinum-based chemotherapy at eight institutions in Nagano Prefecture between December 2018 and April 2023. We evaluated the prognostic value of the geriatric nutritional risk index (GNRI), a systemic inflammatory nutritional biomarker calculated from body weight and serum albumin level, for patients with NSCLC treated with a combination therapy of anti-PD-1/-PD-L1 antibodies and platinum-based chemotherapy. Results: The cutoff value of the GNRI was set at 92. The high GNRI and low GNRI groups included 88 and 59 patients, respectively. The median follow-up period was 15.9 months. The overall survival (OS) in the high GNRI group was significantly longer than that in the low GNRI group (27.9 vs. 15.6 months, p = 0.015). Multivariate analysis revealed that a high GNRI was an independently favorable prognostic predictor for OS (hazard ratio, 1.73; 95% confidence interval, 1.06–2.86; p = 0.031). Conclusion: The present study demonstrates that the GNRI is a useful prognostic predictor in patients with NSCLC treated with a combination therapy of anti-PD-1/-PD-L1 antibodies and platinum-based chemotherapy in clinical settings.

Anthropometric, biochemical, dietary, morbidity and well-being assessments in women and children in Indonesia, India and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper

IntroductionChild stunting has a complex aetiology, especially in the first 1000 days of life. Nutrition interventions alone have not produced expected impacts in reducing/preventing child stunting, indicating the importance of...

Effect of Egg-White Protein Alone or Combined With Niacin on Nutritional Status, and Phosphorus Control in Maintenance Hemodialysis Patients: A Randomized Controlled Trial

BackgroundNiacin is reported to decrease phosphorus concentration in Maintenance Hemodialysis (MHD) patients. Egg white is one of the main substitutable proteins in MHD patients due to its low phosphorus content. Therefore, we aimed to evaluate the effects of combined egg white and niacin supplementation on dialysis patients' serum phosphorus and nutritional biomarkers. MethodsIn this randomized controlled clinical trial, 98 patients on MHD were randomly allocated to four groups for eight weeks: 24 g egg white (n=25), 600 g niacin daily (n=24), egg white combined with niacin (n=24), and control (n=24). Calcium, phosphorus, fibroblast growth factor-23, and other nutritional markers were assessed. ResultsThere was a significant difference among the groups only in phosphorus at the end of the trial, which was significantly lower in the niacin group (4.38+0.812 mg/dl) than in both the egg white (5.07+0.49 mg/dl) and egg white with niacin supplementation (5.41+0.662 mg/dl) groups. In this regard, albumin increased in egg white and egg white with niacin supplementation, while albumin did not change significantly in the niacin group. Urea reduction ratio and Kt/V rose only in the egg-white group, while aspartate aminotransferase increased only in the niacin and control groups. ConclusionNiacin decreases serum phosphorus concentration more than egg-white protein or a combined intervention. Egg white protein supplementation has beneficial effects on some nutritional statuses other than phosphorus control without the side effects of niacin.

Pretransplantation Inflammatory and Nutritional Status in Elderly Allogeneic Hematopoietic Stem Cell Transplantation: Prognostic Value of C-Reactive Protein-to-Albumin Ratio

There are no clear criteria for selecting elderly patients with hematologic malignancies eligible for allogeneic hematopoietic stem cell transplantation (HSCT). This study aimed to evaluate inflammatory and nutritional status biomarkers as prognostic indicators of allogeneic HSCT in elderly patients. We compared the prognostic effects of 4 representative pretransplantation biomarkers: C-reactive protein-to-albumin ratio (CAR), Glasgow Prognostic Score (GPS), prognostic nutritional index (PNI), and albumin-to-globulin ratio (AGR). A total of 143 patients age ≥60 years who underwent their first allogeneic HSCT for a hematologic malignancy were enrolled between 2010 and 2020 in our single-center cohort. The median patient age was 65 years (range, 60 to 72 years). Pretransplantation high CAR, high GPS, and low PNI scores were associated with poor overall survival (OS), but the AGR was not associated with OS. Among the 4 biomarkers, CAR stratified OS most significantly (P < .001). Multivariate analyses identified only high CAR as an independent prognostic factor associated with OS (hazard ratio [HR], 1.98; P = .031) and showed that a Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥3 also was associated with OS (HR, 2.04; P = .012). High CAR was correlated with poor performance status, male sex, and high Disease Risk Index, but not with high HCT-CI score. When the patients were stratified into 3 groups according to a composite risk assessment using CAR and HCT-CI, the 3-year OS decreased significantly with increasing scores (82.8%, 50.3%, and 27.0%, respectively; P < .0001). In conclusion, CAR is the most useful prognostic indicator among the inflammatory and nutritional status biomarkers for allogeneic HSCT in elderly patients. Inflammatory and nutritional status in the elderly may be important prognostic factors for allogeneic HSCT independent of HCT-CI score.

Anti-Obesity Effect of Combining White Kidney Bean Extract, Propolis Ethanolic Extract and CrPi3 on Sprague-Dawley Rats Fed a High-Fat Diet.

Obesity has been associated with the occurrence and prevalence of various chronic metabolic diseases. The management of obesity has evolved to focus not only on reducing weight, but also on preventing obesity-related complications. Studies have shown that bioactive components in natural products like white kidney bean extract (WKBE), propolis ethanolic extract (PEE), and chromium picolinate (CrPi3) showed anti-obesity properties. However, no studies have examined the outcomes of combining any of these nutraceutical supplements. We compared the effects of HFD supplemented with WKBE, WKBE+PEE, or WKBE+PEE+CrPi3 against control and obese groups using Sprague-Dawley rats fed a 45% high-fat diet as an in vivo model. Nutritional parameters, biochemical parameters, and biomarkers of cardiovascular disease, liver function, kidney function, and gut health were among the comparable effects. Our findings showed that combining the three nutraceutical supplements had a synergetic effect on reducing weight gain, food utilization rate, abdominal fat, serum lipids, arterial and hepatic lipids, risk of cardiovascular disease, and blood glucose level, in addition to improving renal function and gut microbiota. We attributed these effects to the α-amylase inhibitor action of WKBE, flavonoids, and polyphenol content of PEE, which were potentiated with CrPi3 resulting in a further reduction or normalization of certain parameters.

Using a new human milk fortifier to optimize human milk feeding among very preterm and/or very low birth weight infants: a multicenter study in China

BackgroundHuman milk fortifier (HMF) composition has been optimized recently. But clinical evidence of its safety and efficacy is limited in Chinese population. The aim of this study was to evaluate effects of a new HMF in growth, nutritional status, feeding intolerance, and major morbidities among very preterm (VPT) or very low birth weight (VLBW) infants in China.MethodsVPT/VLBW infants admitted from March 2020 to April 2021 were prospectively included in the experimental (new HMF, nHMF) group, who received a new powdered HMF as a breast milk feeding supplement during hospitalization. Infants in the control group (cHMF) admitted from January 2018 to December 2019, were retrospective included, and matched with nHMF group infants for gestational age and birth weight. They received other kinds of commercially available HMFs. Weight gain velocity, concentrations of nutritional biomarkers, incidence of major morbidities, and measures of feeding intolerance were compared between the two groups.ResultsDemographic and clinical characteristics of infants in nHMF and cHMF groups were comparable. Weight gain velocity had no significant difference between the nHMF (14.0 ± 3.5 g/kg/d) and the cHMF group (14.2 ± 3.8 g/kg/d; P = 0.46). Incidence of morbidities, including necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, culture-confirmed sepsis, and feeding intolerance during hospitalization between nHMF and cHMF, were similar (all P-values > 0.05). The time to achieve full enteral feeding [13.5 (10, 21) days] in the nHMF group was significantly shorter than that in the cHMF group [17 (12, 23) days, HR = 0.67, 95%CI: 0.49, 0.92; P = 0.01]. Compared with cHMF group, the decrease of blood urea nitrogen level over time in nHMF group was smaller (β = 0.6, 95%CI:0.1, 1.0; P = 0.01).ConclusionsThe new HMF can promote growth of preterm infants effectively without increasing the incidence of major morbidity and feeding intolerance. It can be used feasible in Chinese VPT/VLBW infants.Trial registrationThis study was registered on ClinicalTrials.gov (NCT04283799).

Red blood cell distribution width (RDW) – A new nutritional biomarker to assess nutritional risk and response to nutritional therapy?

Red cell distribution width (RDW) has been proposed as a surrogate marker for acute and chronic diseases and may be influenced by nutritional deficits. We assessed the prognostic value of RDW regarding clinical outcomes and nutritional treatment response among medical inpatients at nutritional risk. This is a secondary analysis of EFFORT, a randomized, controlled, prospective, multicenter trial investigating the effects of nutritional support in patients at nutritional risk in eight Swiss hospitals. We examined the association between RDW and mortality in regression analysis. Among 1,244 included patients (median age 75 years, 46.6% female), high RDW (≥15%) levels were found in 38% of patients (n=473) with a significant association of higher malnutrition risk [OR 1.48 (95%CI 1.1 to 1.98); p=0.009]. Patients with high RDW had a more than doubling in short-term (30 days) mortality risk [adjusted HR 2.12 (95%CI 1.44 to 3.12); p<0.001] and a signficant increase in long-term (5 years) mortality risk [adjusted HR 1.73 (95%CI 1.49 to 2.01); p<0.001]. Among patients with high RDW, nutritional support reduced morality within 30 days [adjusted OR 0.56 (95%CI 0.33 to 0.96); p=0.035], while the effect of the nutritional intervention in patients with low RDW was markedly smaller. Among medical patients at nutritional risk, RDW correlated with several nutritional parameters and was a strong prognostic marker for adverse clinical outcomes at short- and long-term, respectively. Patients with high baseline RDW levels also showed a strong benefit from the nutritional intervention. Further research is needed to understand whether monitoring of RDW over time severs as a nutritional biomarker to assess effectiveness of nutritional treatment in the long run. ClinicalTrials.gov Identifier: NCT02517476.

Diagnostic Value of Nutritional Risk Index and Other Indices for Predicting Sarcopenia in the Middle-Aged and Elderly Population of China Without Cancer: A ROC Curve Analysis.

Emerging evidence suggests that systemic inflammatory and nutritional biomarkers, along with derived indices, could serve as predictors for sarcopenia in cancer population. This study aimed to compare these predictors, focusing on the nutritional risk index (NRI) and evaluate its diagnostic value, for sarcopenic patients without cancer. This cross-sectional retrospective study included 1674 participants. Sarcopenia is defined by skeletal muscle mass index (SMI). Laboratory data reflected the values of systemic inflammatory and nutritional biomarkers, from which the derived indices were calculated. Multiple logistic regression analysis, ROC curve analysis, and the Youden index were utilized to assess the association between these markers and sarcopenia and determine the cutoff value for predicting sarcopenia. Among all participants (1110 men and 564 women, mean age 61.97 ± 9.83 years), 398 individuals were diagnosed with sarcopenia, indicating a prevalence of 23.78% in China's middle-aged and elderly population without cancer. Logistic regression analysis revealed significant associations between all biomarkers and derived indices with sarcopenia. Following adjustment for potential confounders, lower NRI values were significantly associated with a higher incidence of sarcopenia. For sarcopenia diagnosis, the area under the curve (AUC) for NRI was 0.769 ([95% CI, 0.742, 0.796], P < 0.001), with a cutoff value of 106.016, sensitivity of 75.6% and specificity of 66.1%. NRI demonstrated greater predictive advantage for sarcopenia incidence in men compared to women. A lower NRI value was associated with a higher prevalence of sarcopenia. NRI shows promise for early, rapid, and effective sarcopenia screening, particularly in China's middle-aged and elderly male population without cancer.

Influence of sea ice concentration, sex and chick age on foraging flexibility and success in an Arctic seabird.

Declining sea ice and increased variability in sea ice dynamics are altering Arctic marine food webs. Changes in sea ice dynamics and prey availability are likely to impact pagophilic (ice-dependent and ice-associated) species, such as thick-billed murres (Uria lomvia), through changes in foraging behaviour and foraging success. At the same time, extrinsic factors, such as chick demand, and intrinsic factors, such as sex, are also likely to influence foraging behaviour and foraging success of adult murres. Here, we use 3 years of data (2017-2019) to examine the impacts of environmental conditions (sea ice concentration and sea surface temperature), sex and chick age (as a proxy for chick demand) on foraging and diving behaviour (measured via biologgers), energy expenditure (estimated from activity budgets) and foraging success (measured via nutritional biomarkers) of thick-billed murres during the incubation and chick-rearing stages at Coats Island, Nunavut. Murres only exhibited foraging flexibility to environmental conditions during incubation, which is also the only stage when ice was present. When more ice was present, foraging effort increased, murres foraged farther and made deeper dives, where murres making deeper dives had higher foraging success (greater relative change in mass). During incubation, murre behaviour was also influenced by sex of the individual, where males made more and shorter trips and more dives. During chick-rearing, murre behaviour was influenced primarily by the sex of the individual and chick age. Males made shallower dives and fewer dive bouts per day, and more dives. Birds made longer, deeper dives as chicks aged, likely representing increased intra-specific competition for prey throughout the season. Our results suggest variation in sea ice concentration does impact foraging success of murres; however, sex-specific foraging strategies may help buffer colony breeding success from variability in sea ice concentration.