Judith M. Ashley

Clinical detection of sarcopenic obesity by bioelectrical impedance analysis

To assess whether bioelectrical impedance analysis (BIA) provides clinically useful information on body composition beyond that obtained from measuring height and weight, we clinically classified 306 obese patients (233 females and 73 males) into tertiles of increasing fat-free mass estimated by BIA. Because fat-free mass by BIA is an estimate of lean body mass, the lowest tertile was clinically defined as sarcopenic obesity (reduced lean body mass), as contrasted with proportionate or muscular obesity in the next two tertiles. Fat mass in patients in each of the above tertiles based on BIA was then compared with fat mass estimated by using the equations of Garrow and Webster with body mass index (weight/height2). BIA-estimated fat mass was 4.3 kg greater in the sarcopenic group (n = 102) than predicted from body mass index. Fat mass predicted by BIA in the proportionate (n = 102) and muscular (n = 102) groups differed by less than the SEE of fat mass predicted by BMI. In premenopausal women at increased risk of breast cancer BIA showed a high prevalence of sarcopenic obesity (28/30) in these women at normal body mass indexes. Thus, BIA may be clinically useful for demonstrating sarcopenic obesity, but additional studies are needed to determine the metabolic and clinical significance of sarcopenic obesity.

Effects of a very low fat, high fiber diet on serum hormones and menstrual function implications for breast cancer prevention

Background. Low fat, high fiber dietary interventions that decrease blood estrogen levels may reduce breast cancer risk. Asian women consuming their traditional low fat, high fiber diets have lower blood estrogen levels before and after menopause and lower rates of breast cancer compared with Western women. The current controlled feeding study of premenopausal women was designed to determine the effects of a very low fat (10% of calories) and high fiber (35–45g/day) diet on blood estrogen levels and menstrual function.

Nutrition in Advanced Cancer: Anorexia as an Outcome Variable and Target of Therapy

The endpoints used as outcome variables in clinical cancer treatment trials, including nutrition intervention studies, should contain items that are meaningful to the patient. Variables to consider are appetite, food intake, physical performance, psychological and social functioning, response to cancer therapies, survival time, nutrition status, associated morbidity, and costs. Ideally, the design and conduct of nutrition trials should be carried out by a multidisciplinary team comprising medical oncologists, physician specialists in nutrition, dietitians, and social scientists. Anorexia has not been a focus of nutrition support trials in the past partly because of the lack of effective strategies to reverse it. Anorexia is one important cause of cancer starvation, and it also causes patient discomfort. This paper describes outcome variables that include patient derived subjective factors such as anorexia, and outlines new strategies to reverse anorexia. Pharmacologic strategies tested to reverse anorexia include corticosteroids, anabolic steroids, cyproheptadine, hydrazine sulfate, cannabinoids, and megestrol acetate. Of these, only the latter has been consistently well tolerated and effective, with significant improvements in appetite and food intake demonstrated in large-scale, randomized, controlled trials involving more than 600 cancer patients. Dose-response studies have demonstrated increasing efficacy with increasing doses of megestrol acetate from 160 to 800 mg/day. Doses in excess of 800 mg/day are not currently recommended. The mechanisms of action of megestrol acetate involve both behavioral and metabolic effects, and its impact on energy expenditure, appetite, body composition, endocrine function, and lipid metabolism is the subject of ongoing research.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of adherence to a low-fat diet for breast cancer prevention☆☆☆

BACKGROUND The relationships between self-reported adherence to a low-fat diet in healthy women between the ages of 44 and 69 and a number of correlates of this self-reported behavior were examined in an attempt to improve monitoring of adherence to nutritional intervention trials for breast cancer prevention. METHODS Dietary fat intake in 87 women who completed 6 months of nutritional intervention was reduced from 38.2 +/- 5.9% to 21.7 +/- 7.8% of total energy intake (P less than 0.005). Reported total calorie intake was reduced by approximately 20%. RESULTS Body weight decreased by 2.7% from 68.1 +/- 11.2 kg to 66.3 +/- 11.9 kg (P less than 0.05). Fasting total plasma cholesterol levels decreased from 205 +/- 31 mg/dl to 184 +/- 29 mg/dl (P less than 0.05). Fasting plasma triglyceride levels did not change significantly (97 +/- 44 mg/dl vs 101 +/- 55 mg/dl). Relative percentage changes in body weight correlated with percentage changes in dietary fat intake (r = 0.23, P less than 0.05). CONCLUSION Self-reported changes in dietary behavior correlated significantly with objective changes in body weight and fasting cholesterol in these healthy women encouraged to consume a low-fat diet for prevention of breast cancer.

Position of the American Dietetic Association: food and nutrition misinformation.

Food and nutrition experts, including ADA members, need to take an active role in helping consumers recognize misinformation. The challenge of dealing with food and nutrition misinformation is long-standing and persistent. However, qualified dietetics professionals, in partnership with other members of the health-care team, educators, and representatives of the food industry, can be a forceful voice against food and nutrition misinformation. Qualified dietetics professionals can positively shape the food choices of Americans by collaborating with the media to communicate balanced nutrition information to consumers and to counter misinformation; writing letters to the editors of newspapers and magazines to counter inaccurate and biased articles; calling television and radio shows that interview nutrition extremists and purveyors of misinformation to express their professional concerns; directing the news media and consumers to responsible sources of nutrition information; encouraging researchers to present their results with a balanced perspective; collaborating with the food industry to provide reliable nutrition information; and cooperating with other practitioners to expose emerging misinformation, misbeliefs, frauds, and quackery before they are widely accepted.

The effects of a palm-oil enriched diet on plasma lipids and lipoproteins in healthy young men

Abstract In order to compare the effects of feeding a diet enriched in palm oil, coconut oil, or hydrogenated soybean oil on plasma lipids and lipoproteins in normocholesterolemic subjects, 13 healthy males ages 22 to 43 were randomized to receive a diet in which 35% of energy was derived from fat and in which 50% of the fat in the diet was derived from the test oil incorporated into muffins or cookies. Each diet was fed for three 3-week test periods to the same individuals with two week washouts between diets. There were no significant changes following three weeks of eating a palm oil-enriched diet in mean cholesterol, LDL cholesterol, apoprotein A or apoprotein B among 9 individuals who completed all three diet periods based on non-parametric statistical analysis. We conclude that palm oil enrichment of the diet in normal individuals does not lead to an increase in plasma cholesterol or LDL cholesterol when fed for a three week period in over twenty times the relative amounts usually found in the American diet. Studies in larger numbers of individuals over longer periods of time must be done to establish the effects of palm oil on cholesterol metabolism in humans.

Stromal-epithelial cell interactions in breast cancer.

The vast majority of breast cancers originate from breast ductal epithelial cells and are either infiltrating ductal or intraductal breast cancers (1). These cells exist in a local microenvironment in which both stromal cell products and blood-borne factors may influence both transformation and tumor growth. Breast ductal epithelial cells and stromal cells have a number of things in common. Both cell types produce protein growth factors and active steroids. At the same time both cell types respond to stimulation by peptides and steroids. This chapter will explore the hypothesis that these two cell types interact in both paracrine and endocrine fashion to affect breast epithelial growth, tumor development, and breast tumor metastasis.

Lipid Biomarkers of Adherence to Low Fat Diets

The need to lower fat intake in the U.S. has been emphasized in at least fifteen major national dietary recommendations issued since the 1970’s. These include the first Senate Select Committees Dietary Goals in 1977, the Surgeon General’s reports in 1979 and 1988, which laid the groundwork for the concept that changes in food intake could make a significant impact on chronic diseases, the USDA updated guidelines in 1990, and the National Academy of Sciences recommendations, as well as guidelines from the American Cancer Society and the American Institute for Cancer Research1–6. Although the latest periodic study of the U. S. diet, HANES III (National Health and Nutrition Examination Study, 1988–91), shows a downward trend toward an average fat intake of 34%, this still falls short of the recommended 30% or less energy from fat7.

Adipose tissue and the effects of fat and calories on breast tumorigenesis in rats

A high fat diet fed ad libitum will promote breast tumorigenesis in rats while caloric restriction of the same high fat diet counteracts this promotional effect. The present study examined the effects of dietary fat and calorie intake on adipose tissue weight and fatty acid composition and on tumor incidence and development. The sites of adipose tissue chosen were the mammary fat pad, representing adipose tissue in the immediate location of the studied tumor, and the abdominal fat depot which in humans has been associated with an increased risk of breast cancer. High (20% corn oil) and low (5% corn oil) fat test diets were offered ad libitum and at 40% restriction levels. In agreement with prior studies, caloric restriction of both high and low fat diets led to marked decreases in tumor incidence (63 to 68% versus 21%), tumor burden (1.84 to 2.05 versus 0.37 to 0.43 tumors/rat), and tumor weight (7.1 to 11.9 versus 1.4 to 2.2 g) at the time of sacrifice (133 days post-DMBA). While final body weights were reduced in proportion to the level of caloric restriction (290 to 291 g versus 184 to 201 g), abdominal fat (8.8 to 9.2 versus 0.9 to 1.6 g), and mammary fat weights (3.1 to 4.1 versus 0.7 to 2.0 g) were reduced markedly in association with the decrease in tumorigenesis. While both tumor and mammary fat were enriched with linoleate reflecting the fatty acid composition of dietary fat, the ratio of arachidonic acid to linoleic acid was higher in tumor tissue than in surrounding normal mammary tissue in both the phospholipid (0.78 versus 0.18) and neutral lipid fractions (0.22 versus 0.03). These observations are consistent with the concept that increases in fat tissue mass in abdominal and mammary fat depots may mediate some of the promotional effects of high fat and high calorie diets. Restriction of dietary fat and calories to reduce body fat and strategies to modify the composition of stored lipids in fat depots may offer nutritional approaches to breast cancer prevention and treatment.