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Survivorship in immune therapy: Assessing toxicities, body composition and health-related quality of life among long-term survivors treated with antibodies to programmed death-1 receptor and its ligand.
Patrinely JR, Young AC, Quach H, Williams GR, Ye F, Fan R, Horn L, Beckermann KE, Gillaspie EA, Sosman JA, Friedman DL, Moslehi JJ, Johnson DB
(2020) Eur J Cancer 135: 211-220
MeSH Terms: Aged, Antineoplastic Agents, Immunological, B7-H1 Antigen, Body Composition, Female, Functional Status, Humans, Immune Checkpoint Inhibitors, Male, Middle Aged, Neoplasms, Nutritional Status, Programmed Cell Death 1 Receptor, Progression-Free Survival, Quality of Life, Retrospective Studies, Survivors, Time Factors
Show Abstract · Added September 29, 2020
AIM - Antibodies to programmed death-1 receptor and its ligand (anti-PD-1/PD-L1) produce durable responses in many cancers. However, the long-term effects of anti-PD-1/PD-L1 blockade are not well defined. We identified the toxicities, health outcomes and health-related quality of life (HRQoL) amongst long-term survivors treated with anti-PD-1/PD-L1.
METHODS - We assessed 217 patients who received anti-PD-1/PD-L1 for melanoma, renal cell carcinoma or non-small-cell lung carcinoma between 2009 and 2017, with survival greater than two years after treatment. Patient and tumour characteristics, immune-related adverse events (irAEs), cardiometabolic parameters (glucose, blood pressure, body mass index [BMI]), body composition (using automated body composition analyser, computed tomography and Slice-o-matic software) and HRQoL outcomes were tracked.
RESULTS - Among the included patients, most were men (70.3%) and at anti-PD-1/PD-L1 initiation had an average age of 61.0 years and median BMI of 28.5. Median overall survival was not reached; 33 (15.2%) died during the follow-up primarily from progressive cancer (n = 28). At the last follow-up, most patients' Eastern Cooperative Oncology Group performance status was 0 (38%) or 1 (41%). There was no difference in blood pressure, glucose or BMI from baseline to two years after treatment initiation. Body composition showed increased adiposity (p = 0.05), skeletal muscle mass (p = 0.03) and skeletal muscle gauge (p = 0.04). We observed chronic irAEs at the last follow-up including hypothyroidism (10.6%), arthritis (3.2%), adrenal insufficiency (3.2%) and neuropathy (2.8%). New diagnoses of type 2 diabetes (6.5%) and hypertension (6.0%) were observed, with uncertain relationship to anti-PD-1/PD-L1. Patient-reported outcomes compared favourably with cancer and general populations, although younger age (p = 0.003) and need for subsequent therapy (p = 0.03) were associated with worse HRQoL outcomes.
CONCLUSION - Durable responses to anti-PD-1/PD-L1 therapy and favourable HRQoL outcomes are encouraging. Chronic events may be more common than previously thought although no clear chronic adverse cardiometabolic effects were observed.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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18 MeSH Terms
Associations between calcium and magnesium intake and the risk of incident gastric cancer: A prospective cohort analysis of the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study.
Shah SC, Dai Q, Zhu X, Peek RM, Smalley W, Roumie C, Shrubsole MJ
(2020) Int J Cancer 146: 2999-3010
MeSH Terms: Adenocarcinoma, Calcium, Dietary, Cardia, Cohort Studies, Diet, Dietary Supplements, Female, Humans, Magnesium, Male, Middle Aged, Nutritional Status, Prospective Studies, Stomach Neoplasms, Surveys and Questionnaires, United States
Show Abstract · Added March 3, 2020
Gastric cancer remains a leading cause of cancer-related mortality. Identifying dietary and other modifiable disease determinants has important implications for risk attenuation in susceptible individuals. Our primary aim was to estimate the association between dietary and supplemental intakes of calcium and magnesium and the risk of incident gastric cancer. We conducted a prospective cohort analysis of the National Institutes of Health-American Association of Retired Persons Diet and Health Study. We used Cox proportional hazard modeling to estimate the association between calcium and magnesium intakes with risk of incident gastric adenocarcinoma (GA) overall and by anatomic location, noncardia GA (NCGA) and cardia GA (CGA). A total of 536,403 respondents (59% males, 41% females) were included for analysis, among whom 1,518 incident GAs (797 NCGA and 721 CGA) occurred. Increasing calcium intake was associated with lower risk of GA overall (p-trend = 0.05), driven primarily by the association with NCGA, where the above median calcium intakes were associated with a 23% reduction in risk compared to the lowest quartile (p-trend = 0.05). This magnitude of NCGA risk reduction was greater among nonwhite ethnic group and Hispanics (hazard ratio [HR] 0.51, 95% confidence interval [CI]: 0.24-1.07, p-trend = 0.04), current/former smokers (HR 0.58, 95% CI: 0.41-0.81), obese individuals (HR 0.54, 95% CI: 0.31-0.96) and those with high NCGA risk scores (HR 0.50, 95% CI: 0.31-0.80). Among men only, increasing magnesium intake was associated with 22-27% reduced risk of NCGA (p-trend = 0.05), while for the cohort, dietary magnesium intake in the highest vs. lowest quartile was associated with a 34% reduced risk of NCGA (HR 0.66, 95% CI: 0.48-0.90). These findings have important implications for risk factor modification. Future investigations are needed not only to confirm our results, but to define mechanisms underlying these associations.
© 2019 UICC.
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16 MeSH Terms
Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association.
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
(2019) Circulation 139: e56-e528
MeSH Terms: American Heart Association, Cholesterol, Heart Diseases, Humans, Hypertension, Metabolic Diseases, Nutritional Status, Obesity, Quality of Health Care, Risk Factors, Smoking, Stroke, United States, Venous Thromboembolism
Added April 2, 2019
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14 MeSH Terms
Nutrigenomics, the Microbiome, and Gene-Environment Interactions: New Directions in Cardiovascular Disease Research, Prevention, and Treatment: A Scientific Statement From the American Heart Association.
Ferguson JF, Allayee H, Gerszten RE, Ideraabdullah F, Kris-Etherton PM, Ordovás JM, Rimm EB, Wang TJ, Bennett BJ, American Heart Association Council on Functional Genomics and Translational Biology, Council on Epidemiology and Prevention, and Stroke Council
(2016) Circ Cardiovasc Genet 9: 291-313
MeSH Terms: American Heart Association, Animals, Biomedical Research, Cardiovascular Diseases, Diet, Diffusion of Innovation, Epigenesis, Genetic, Forecasting, Gastrointestinal Microbiome, Gastrointestinal Tract, Gene-Environment Interaction, Genetic Predisposition to Disease, Genetic Variation, Host-Pathogen Interactions, Humans, Metagenomics, Nutrigenomics, Nutrition Assessment, Nutritional Status, Phenotype, Preventive Health Services, Risk Assessment, Risk Factors, United States
Show Abstract · Added June 14, 2016
Cardiometabolic diseases are the leading cause of death worldwide and are strongly linked to both genetic and nutritional factors. The field of nutrigenomics encompasses multiple approaches aimed at understanding the effects of diet on health or disease development, including nutrigenetic studies investigating the relationship between genetic variants and diet in modulating cardiometabolic risk, as well as the effects of dietary components on multiple "omic" measures, including transcriptomics, metabolomics, proteomics, lipidomics, epigenetic modifications, and the microbiome. Here, we describe the current state of the field of nutrigenomics with respect to cardiometabolic disease research and outline a direction for the integration of multiple omics techniques in future nutrigenomic studies aimed at understanding mechanisms and developing new therapeutic options for cardiometabolic disease treatment and prevention.
© 2016 American Heart Association, Inc.
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24 MeSH Terms
Predictors of major amputation despite patent bypass grafts.
Smith AD, Hawkins AT, Schaumeier MJ, de Vos MS, Conte MS, Nguyen LL
(2016) J Vasc Surg 63: 1279-88
MeSH Terms: Aged, Aged, 80 and over, Amputation, Chi-Square Distribution, Comorbidity, Critical Illness, Disease Progression, Double-Blind Method, Female, Humans, Ischemia, Limb Salvage, Lower Extremity, Male, Middle Aged, Multivariate Analysis, Nutritional Status, Peripheral Arterial Disease, Proportional Hazards Models, Prospective Studies, Quality of Life, Reoperation, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vascular Grafting, Vascular Patency, Veins
Show Abstract · Added September 27, 2016
OBJECTIVE - Despite patent vein bypass grafts, some patients with critical limb ischemia (CLI) receive major amputations. We analyzed the predictive factors leading to major amputation in the presence of patent lower extremity bypass (LEB) grafts.
METHODS - Data from the Project of Ex-Vivo vein graft Engineering via Transfection III (PREVENT III), a large prospective randomized trial of 1404 patients who underwent LEB with vein graft for CLI, were queried for outcomes. The primary outcome was major amputation with patent (PMA) LEB compared with patients with patent LEB who achieved limb salvage (PLS). The population excluded those who received amputation for occluded grafts. A Cox proportional hazard model identified independent predictors.
RESULTS - Of 1404 LEB patients, 162 (11.5%) had major amputation: 89 (6.3%) with patent and 73 (5.2%) with occluded LEB. For PMA, 21 of 89 (23.6%) developed critical stenosis and 11 of 21 (52.4%) were revised. For PLS, 460 of 1242 (37.0%) developed critical stenosis and 351 of 460 (76.3%) were revised. Predictive patient factors included having preoperative gangrene (vs rest pain; hazard ratio [HR], 3.504; 95% confidence interval [CI], 1.533-8.007; P = .0029), diabetes (HR, 1.800; 95% CI, 1.006-3.219; P = .0477), black (vs white) race (HR, 1.779; 95% CI, 1.051-3.011; P = .0321), baseline creatinine clearance <25 mL/min (vs >65 mL/min; HR, 1.759; 95% CI, 1.016-3.048; P = .0439), prior history of coronary artery bypass grafting (HR, 1.702; 95% CI, 1.080-2.683; P = .0221), and lower baseline activity quality of life score (HR, 1.401; 95% CI, 1.105-1.778; P = .0054). Postoperative wound factors included gangrenous changes (HR, 5.830; 95% CI, 1.647-20.635; P = .0063), surgical wound necrosis (HR, 5.319; 95% CI, 1.478-19.146; P = .0105), deep (vs superficial) wound infection (HR, 3.815; 95% CI, 1.220-11.927; P = .0213), and wound healing abnormally (HR, 3.754; 95% CI, 1.061-13.278; P = .0402). Associated postoperative consequences leading to PMA included having recurrent CLI symptoms (HR, 2.915; 95% CI, 1.816-4.681; P < .0001), a severe (vs mild) adverse event (HR, 2.751; 95% CI, 1.391-5.443; P = .0036), fewer percutaneous revisions (HR, 2.425; 95% CI, 1.573-3.740; P < .0001), discharge on low-molecular-weight heparin (HR, 2.087; 95% CI, 1.309-3.326; P = .0020), and decreasing days to critical stenosis/occlusion/revision/amputation (HR, 1.010; 95% CI, 1.007-1.012; P < .0001).
CONCLUSIONS - Whereas a patent vein graft is important to all vascular surgeons, additional factors should be considered in trying to attain limb salvage for patients with CLI. These factors include intervening surgically before CLI has progressed to a state of gangrene or limited activity and optimizing nutrition, diabetes control, cardiac conditions, and activity level. Revision offers hope for clinical improvement but may be delayed when there is no graft lesion identified. The absence of a graft lesion to revise may also portend amputation despite a patent graft because of nongraft-related factors such as infection. Finally, the experience of a severe (vs mild) adverse event may also result in limb loss despite a patent graft. Systematic efforts to reduce severe adverse events among patients may also lead to increased limb salvage.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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29 MeSH Terms
Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Status Interact with Vitamin D and/or Calcium Status?
Rosanoff A, Dai Q, Shapses SA
(2016) Adv Nutr 7: 25-43
MeSH Terms: Calcium, Chronic Disease, Energy Intake, Female, Humans, Magnesium, Magnesium Deficiency, Male, Nutritional Status, Vitamin D, Vitamin D Deficiency
Show Abstract · Added May 6, 2016
Although much is known about magnesium, its interactions with calcium and vitamin D are less well studied. Magnesium intake is low in populations who consume modern processed-food diets. Low magnesium intake is associated with chronic diseases of global concern [e.g., cardiovascular disease (CVD), type 2 diabetes, metabolic syndrome, and skeletal disorders], as is low vitamin D status. No simple, reliable biomarker for whole-body magnesium status is currently available, which makes clinical assessment and interpretation of human magnesium research difficult. Between 1977 and 2012, US calcium intakes increased at a rate 2-2.5 times that of magnesium intakes, resulting in a dietary calcium to magnesium intake ratio of >3.0. Calcium to magnesium ratios <1.7 and >2.8 can be detrimental, and optimal ratios may be ∼2.0. Background calcium to magnesium ratios can affect studies of either mineral alone. For example, US studies (background Ca:Mg >3.0) showed benefits of high dietary or supplemental magnesium for CVD, whereas similar Chinese studies (background Ca:Mg <1.7) showed increased risks of CVD. Oral vitamin D is widely recommended in US age-sex groups with low dietary magnesium. Magnesium is a cofactor for vitamin D biosynthesis, transport, and activation; and vitamin D and magnesium studies both showed associations with several of the same chronic diseases. Research on possible magnesium and vitamin D interactions in these human diseases is currently rare. Increasing calcium to magnesium intake ratios, coupled with calcium and vitamin D supplementation coincident with suboptimal magnesium intakes, may have unknown health implications. Interactions of low magnesium status with calcium and vitamin D, especially during supplementation, require further study.
© 2016 American Society for Nutrition.
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11 MeSH Terms
Rethinking the restriction on nutrition during hemodialysis treatment.
Kistler BM, Fitschen PJ, Ikizler TA, Wilund KR
(2015) J Ren Nutr 25: 81-7
MeSH Terms: Eating, Humans, Kidney Failure, Chronic, Nutritional Status, Practice Guidelines as Topic, Renal Dialysis, United States
Show Abstract · Added August 5, 2015
The annual mortality rate for patients undergoing maintenance hemodialysis (MHD) treatment in the United States is 20%, a rate higher than most other countries in the world. Poor nutrition status in MHD patients contributes to this adverse outcome as well as poor quality of life. Providing oral nutrition to MHD patients, especially during hemodialysis (HD) treatment has many potential benefits including improvements in nutrition status and attenuating HD-related muscle wasting. However, this practice is generally restricted in the United States presumably because of concerns that include worsening hemodynamic instability, reductions in treatment efficiency, and increased gastrointestinal symptoms. Despite widespread restrictions, few studies have adequately examined the effect of eating during HD on these outcomes, leaving many questions unanswered. This review outlines the current evidence regarding the effects of feeding during HD and provides potential future directions to outline the best practices in this controversial area.
Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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7 MeSH Terms
Using and interpreting serum albumin and prealbumin as nutritional markers in patients on chronic dialysis.
Ikizler TA
(2014) Semin Dial 27: 590-2
MeSH Terms: Biomarkers, Humans, Kidney Failure, Chronic, Nutritional Status, Prealbumin, Renal Dialysis, Serum Albumin
Added September 29, 2014
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7 MeSH Terms
Comparison of new modeling methods for postnatal weight in ELBW infants using prenatal and postnatal data.
Porcelli PJ, Rosenbloom ST
(2014) J Pediatr Gastroenterol Nutr 59: e2-8
MeSH Terms: Algorithms, Birth Weight, Body Weight, Electronic Health Records, Enteral Nutrition, Female, Fluid Therapy, Forecasting, Gestational Age, Growth Charts, Humans, Infant, Extremely Low Birth Weight, Infant, Extremely Premature, Infant, Newborn, Linear Models, Male, Neural Networks, Computer, Nutritional Status, Parenteral Nutrition
Show Abstract · Added January 26, 2016
OBJECTIVES - Postnatal infant weight curves are used to assess fluid management and evaluate postnatal nutrition and growth. Traditionally, postnatal weight curves are based on birth weight and do not incorporate postnatal clinical information. The aim of the present study was to compare the accuracy of birth weight-based weight curves with weight curves created from individual patient records, including electronic records, using 2 predictive modeling methods, linear regression (LR) and an artificial neural network (NN), which apply mathematical relations between predictor and outcome variables.
METHODS - Perinatal demographic and postnatal nutrition data were collected for extremely-low-birth-weight (ELBW; birth weight <1000 g) infants. Static weight curves were generated using published algorithms. The postnatal predictive models were created using the demographic and nutrition dataset.
RESULTS - Birth weight (861 ± 83 g, mean ± 1 standard deviation [SD]), gestational age (26.2 ± 1.4 weeks), and the first month of nutrition data were collected from individual health records for 92 ELBW infants. The absolute residual (
measured-predicted
) for weight was 84.8 ± 74.4 g for the static weight curves, 60.9 ± 49.1 g for the LR model, and 12.9 ± 9.2 g for the NN model, analysis of variance: both LR and NN P<0.01 versus static curve. NPO (nothing by mouth) infants had greater weight curve discrepancies.
CONCLUSIONS - Compared with birth weight-based and logistic regression-generated weight curves, NN-generated weight curves more closely approximated ELBW infant weight curves, and, using the present electronic health record systems, may produce weight curves better reflective of the patient's status.
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19 MeSH Terms
Amino acid losses during sustained low efficiency dialysis in critically ill patients with acute kidney injury.
Umber A, Wolley MJ, Golper TA, Shaver MJ, Marshall MR
(2014) Clin Nephrol 81: 93-9
MeSH Terms: Acute Kidney Injury, Aged, Aged, 80 and over, Amino Acids, Chromatography, High Pressure Liquid, Chromatography, Reverse-Phase, Critical Illness, Dialysis Solutions, Humans, Intensive Care Units, Male, Middle Aged, Nutritional Status, Parenteral Nutrition, Prospective Studies, Renal Dialysis, Serum Albumin, Serum Albumin, Human, Treatment Outcome
Show Abstract · Added March 19, 2014
OBJECTIVE - Sustained low efficiency dialysis (SLED) involves the use of standard dialysis machines for prolonged intermittent renal replacement therapy in critically ill patients. In this study we aimed to quantify dialysate amino acid (AA) and albumin losses in 5 patients who underwent successful SLED treatment.
DESIGN - This was a prospective observational study.
SETTING - The study was performed in a general intensive care unit.
SUBJECTS - The study was performed in critically ill patients with acute kidney injury undergoing SLED using low-flux hemodialyzers.
INTERVENTION - We performed total dialysate collection and measured dialysate AA profiles by reverse phase high-pressure liquid chromatography using an automated AA analyser.
MAIN OUTCOME MEASURE - Individual and total amino acid losses.
RESULTS - Albumin was undetectable in dialysate. The median (mean ± SD) total amino acid loss was 15.7 (23.4 ± 19.2) g/treatment, or 122.1 (180.6 ± 148.5) mmol/treatment. Two patients were receiving intravenous nutrition. One patient had severe hepatic failure with encephalopathy, and had high dialysate AA levels with a total loss of 57 g/treatment.
CONCLUSIONS - During SLED with low-flux hemodialyzers, albumin losses are negligible but AA losses to dialysate are comparable to those during continuous renal replacement therapy. Patients' nutritional protein prescriptions should be augmented to account for this.
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19 MeSH Terms