F.N. Belle

Dietary Fiber, Carbohydrates, Glycemic Index and Glycemic Load in Relation to Breast Cancer Prognosis in the HEAL Cohort

Background: Dietary intake of fiber, carbohydrate, glycemic index (GI), and glycemic load (GL) may influence breast cancer survival, but consistent and convincing evidence is lacking. Methods: We investigated associations of dietary fiber, carbohydrates, GI, and GL with breast cancer prognosis among n = 688 stage 0 to IIIA breast cancer survivors in the Health, Eating, Activity, and Lifestyle (HEAL) study. Premenopausal and postmenopausal women from Western Washington State, Los Angeles County, and New Mexico participated. Usual diet was assessed with a food frequency questionnaire. Total mortality, breast cancer mortality, nonfatal recurrence, and second occurrence data were obtained from SEER (Surveillance, Epidemiology, and End Results) registries and medical records. Cox proportional hazards regression estimated multivariate-adjusted hazard ratios and 95% confidence intervals (CI). Results: During a median of 6.7 years follow-up after diagnosis, n = 106 total deaths, n = 83 breast cancer-specific deaths, and n = 82 nonfatal recurrences were confirmed. We observed an inverse association between fiber intake and mortality. Multivariate-adjusted hazard rate ratios (HRR) comparing high to low intake were 0.53 (95% CI 0.23–1.23) and 0.75 (95% CI 0.43–1.31). A threshold effect was observed whereby no additional benefit was observed for intakes of 9 g/d or more. Fiber intake was suggestively inversely associated with breast cancer-specific mortality (HRR = 0.68, 95% CI 0.27–1.70) and risk of nonfatal recurrence or second occurrence (HRR = 0.68, 95% CI 0.27–1.70), but results were not statistically significant. Conclusion: Dietary fiber was associated with a nonsignificant inverse association with breast cancer events and total mortality. Further studies to assess and confirm this relationship are needed in order to offer effective dietary strategies for breast cancer patients. Impact: Increasing dietary fiber may an effective lifestyle modification strategy for breast cancer survivors. Cancer Epidemiol Biomarkers Prev; 20(5); 890–9. ©2011 AACR.

A potential role for regulatory T-cells in the amelioration of DSS induced colitis by dietary non-digestible polysaccharides

Inflammatory bowel diseases (IBD) including ulcerative colitis (UC) and Crohns disease (CD) are chronic relapsing inflammatory disorders of the gastrointestinal tract. The interaction between a disturbed microbial composition, the intestinal mucosal barrier and the mucosal immune system plays an important role in IBD and its chronicity. It has been indicated that due to the altered microbial composition the balance between T regulatory cells (Treg) and T helper cells (Th) 17 is disturbed, leading to an inflammatory state. The present study shows that oral intake of a specific multi fibre mix (MF), designed to match the fibre content of a healthy diet, counteracts IBD-like intestinal inflammation and weight loss in dextran sodium sulphate treated mice. This reduction in inflammation might be brought about, at least in part, by the MF-induced decrease in inflammatory cytokines, increase in IL-10 and the relative increase in Treg cells in the mesenteric lymph nodes (MLN). Moreover, the Treg percentage in the MLN correlates with the percentage of tolerogenic lamina propria derived CD103+RALDH+dendritic cells in the MLN, suggesting that these play a role in the observed effects. In children with CD exclusive enteral nutrition (EEN) is a widely used safe and effective therapy. Optimizing enteral nutritional concepts with the tested fibre mix, know to modulate the gut microbiota composition, SCFA production and inflammatory status (as indicated by the present study) could possibly further improve efficacy in inducing remission.

Childhood cancer survival in Switzerland (1976-2013): Time-trends and predictors.

Population‐based studies on childhood cancer survival are key to monitor progress against cancer and to detect potential differences between regions and other subgroups in the population. We investigated time trends and factors associated with childhood cancer survival on a national level in Switzerland, from 1976 to 2013. We extracted data from the population‐based Swiss Childhood Cancer Registry of 5,776 children (age 0–14 years) diagnosed with cancer from 1985 to 2014 in Switzerland. We calculated age‐adjusted 5‐year survival, defined the annual reduction in risk of death (ARR), and explored associations of survival with clinical and demographic factors. Overall, 5‐year survival improved significantly, from 64% in 1976–1983 to 88% in 2004–2013. ARR over the whole period was 4% for all diagnostic groups, greatest for Hodgkin lymphomas (8%), ependymomas (6%), Burkitts lymphomas (6%) and germ cell tumours (6%). Children treated in hospitals without specialised paediatric cancer centre for leukaemia (HR 12.9), lymphoma (HR 5.0) and neuroblastoma (HR 3.7) were at higher risk of death. In French‐speaking Switzerland, risk of death was lower for lymphoma (HR 0.6), CNS tumours (HR 0.7) and neuroblastoma (HR 0.5). Children with migration background had a higher risk of death from all tumours except bone tumours. Childhood cancer survival significantly improved from 1976 to 2013, but there is room for further improvement. Survival rates varied by type of clinical treatment, language region and nationality. All paediatric cancer patients should be referred to a specialised paediatric cancer centre. Further research is needed to intervene and completely eliminate inequalities in survival.

Growth and nutritional status, and their association with lung function: a study from the international Primary Ciliary Dyskinesia Cohort

Chronic respiratory disease can affect growth and nutrition, which can influence lung function. We investigated height, body mass index (BMI), and lung function in patients with primary ciliary dyskinesia (PCD). In this study, based on the international PCD (iPCD) Cohort, we calculated z-scores for height and BMI using World Health Organization (WHO) and national growth references, and assessed associations with age, sex, country, diagnostic certainty, age at diagnosis, organ laterality and lung function in multilevel regression models that accounted for repeated measurements. We analysed 6402 measurements from 1609 iPCD Cohort patients. Height was reduced compared to WHO (z-score −0.12, 95% CI −0.17 to −0.06) and national references (z-score −0.27, 95% CI −0.33 to −0.21) in male and female patients in all age groups, with variation between countries. Height and BMI were higher in patients diagnosed earlier in life (p=0.026 and p<0.001, respectively) and closely associated with forced expiratory volume in 1 s and forced vital capacity z-scores (p<0.001). Our study indicates that both growth and nutrition are affected adversely in PCD patients from early life and are both strongly associated with lung function. If supported by longitudinal studies, these findings suggest that early diagnosis with multidisciplinary management and nutritional advice could improve growth and delay disease progression and lung function impairment in PCD. Multidisciplinary management and nutritional advice could improve growth and delay lung function impairment in PCD http://ow.ly/5iQz30gB4Mo

Low adherence to dietary recommendations in adult childhood cancer survivors

BACKGROUND & AIMS Poor diet may increase the risk that childhood cancer survivors (CCS) will suffer from chronic disease. We compared adherence to national dietary recommendations between CCS, their siblings and the Swiss population, identified determinants of adherence, and assessed the association of adherence with cardiovascular disease (CVD) risk profiles. METHODS As part of the Swiss Childhood Cancer Survivor Study (SCCSS), a questionnaire was sent to all Swiss resident CCS aged <21 years at diagnosis, who survived ≥5 years and were 16-45 years old at the time of the survey. We compared dietary adherence between CCS, their siblings and participants in the Swiss Health Survey (SHS), a representative survey of the general population. A multivariable logistic regression was used to assess characteristics associated with dietary adherence. We sorted CCS into four kinds of CVD risk groups based on type of treatment (anthracyclines, chest irradiation, a combination, or neither). RESULTS We included 1864 CCS, 698 siblings and 8258 participants of the general population. Only 43% of the CCS met the recommended dietary intakes for meat, 34% for fruit, 30% for fish, 18% for dairy products, 11% for vegetables, and 7% for combined fruit and vegetables. Results were similar for both control groups. In all groups, dietary adherence was associated with gender, parental education, migration background, language region in Switzerland, smoking, alcohol consumption and sport participation. CCS with a higher CVD risk profile because of cardiotoxic treatment had no better adherence. CONCLUSIONS CCS have similar food patterns as their siblings and the general population, and poorly adhere to current recommendations. Awareness of the importance of a healthy diet should be raised among CCS, to prevent chronic diseases like CVD.

Prevalence and reasons for smoking in adolescent Swiss childhood cancer survivors.

Smoking harms health, particularly that of childhood cancer survivors, who face risk of pulmonary and cardiovascular diseases because of chemotherapy and radiotherapy to the chest. This nationwide study assessed smoking habits and reasons for smoking in adolescent survivors and healthy peers.

Risk Factors and the Prevention of Weight Gain During Induction Chemotherapy in Children With Acute Lymphoblastic Leukemia.

In a recent issue of the Journal of Pediatric Hematology/Oncology, Seki and colleagues reported on risk factors for weight gain during induction chemotherapy in 96 childhood acute lymphoblastic leukemia (ALL) patients. In a retrospective study of medical records, they found that non–high-risk treatment for childhood ALL and treatment start date before daily weight measurement were risk factors for weight gain during induction therapy. They concluded that daily body weight measurements might prevent weight gain during induction therapy and can result in maintaining a healthy weight after aLL treatment. We agree that early weight management should be emphasized, but question the study’s conclusions because of its methodological weaknesses. The retrospective design could have introduced surveillance bias and confounding. During the second half of the study period (after 2005), more focus was put on weight management as daily body weight measurements were initiated in an attempt to control weight. Patients who experienced weight gain in the second half of the study (after 2005) may have been more closely monitored than patients in the first half of the study (before 2005). The closer surveillance could potentially have led to difference in management, for example, diet control and water retention. Reverse causation may have occurred: overall differences in weight management, not the daily weight measurements, caused a weight reduction. More details on how weight gain found during induction was handled in the 2 periods would have helped the reader interpret this study.2 In the future, an intervention study with weight monitoring procedures in addition to normal clinical practice of daily weight measurements would assist gaining insight into good management of weight reduction.

SUN-P215: Overweight and Obesity in Swiss Childhood Leukaemia Survivors

CLS who received high dosage CRT (≥20 Gy) were more than two times more likely to be overweight at survey than those who received no CRT, p-value<0.001 (Figure 1). a Institute of Social and Preventive Medicine (ISPM), University of Bern; b Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital; c Nursing Science (INS), Department Public Health, Faculty of Medicine, University of Basel; d University Children’s Hospital Zurich; e Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern