Yves Marc Dupertuis

Body composition interpretation. Contributions of the fat-free mass index and the body fat mass index.

OBJECTIVE Low and high body mass index (BMI) values have been shown to increase health risks and mortality and result in variations in fat-free mass (FFM) and body fat mass (BF). Currently, there are no published ranges for a fat-free mass index (FFMI; kg/m(2)), a body fat mass index (BFMI; kg/m(2)), and percentage of body fat (%BF). The purpose of this population study was to determine predicted FFMI and BFMI values in subjects with low, normal, overweight, and obese BMI. METHODS FFM and BF were determined in 2986 healthy white men and 2649 white women, age 15 to 98 y, by a previously validated 50-kHz bioelectrical impedance analysis equation. FFMI, BFMI, and %BF were calculated. RESULTS FFMI values were 16.7 to 19.8 kg/m(2) for men and 14.6 to 16.8 kg/m(2) for women within the normal BMI ranges. BFMI values were 1.8 to 5.2 kg/m(2) for men and 3.9 to 8.2 kg/m(2) for women within the normal BMI ranges. BFMI values were 8.3 and 11.8 kg/m(2) in men and women, respectively, for obese BMI (>30 kg/m(2)). Normal ranges for %BF were 13.4 to 21.7 and 24.6 to 33.2 for men and women, respectively. CONCLUSION BMI alone cannot provide information about the respective contribution of FFM or fat mass to body weight. This study presents FFMI and BFMI values that correspond to low, normal, overweight, and obese BMIs. FFMI and BFMI provide information about body compartments, regardless of height.

Green tea polyphenol epigallocatechin-3-gallate (EGCG) as adjuvant in cancer therapy.

BACKGROUND & AIMS Green tea catechins, especially epigallocatechin-3-gallate (EGCG), have been associated with cancer prevention and treatment. This has resulted in an increased number of studies evaluating the effects derived from the use of this compound in combination with chemo/radiotherapy. This review aims at compiling latest literature on this subject. METHODS Keywords including EGCG, cancer, chemotherapy, radiotherapy and side effects, were searched using PubMed and ScienceDirect databases to identify, analyze, and summarize the research literature on this topic. Most of the studies on this subject up to date are preclinical. Relevance of the findings, impact factor, and date of publication were critical parameters for the studies to be included in the review. RESULTS Additive and synergistic effects of EGCG when combined with conventional cancer therapies have been proposed, and its anti-inflammatory and antioxidant activities have been related to amelioration of cancer therapy side effects. However, antagonistic interactions with certain anticancer drugs might limit its clinical use. CONCLUSIONS The use of EGCG could enhance the effect of conventional cancer therapies through additive or synergistic effects as well as through amelioration of deleterious side effects. Further research, especially at the clinical level, is needed to ascertain the potential role of EGCG as adjuvant in cancer therapy.

Auger radiation targeted into DNA: a therapy perspective

BackgroundAuger electron emitters that can be targeted into DNA of tumour cells represent an attractive systemic radiation therapy goal. In the situation of DNA-associated decay, the high linear energy transfer (LET) of Auger electrons gives a high relative biological efficacy similar to that of α particles. In contrast to α radiation, however, Auger radiation is of low toxicity when decaying outside the cell nucleus, as in cytoplasm or outside cells during blood transport. The challenge for such therapies is the requirement to target a high percentage of all cancer cells. An overview of Auger radiation therapy approaches of the past decade shows several research directions and various targeting vehicles. The latter include hormones, peptides, halogenated nucleotides, oligonucleotides and internalising antibodies.DiscussionHere, we will discuss the basic principles of Auger electron therapy as compared with vector-guided α and β radiation. We also review some radioprotection issues and briefly present the main advantages and disadvantages of the different targeting modalities that are under investigation.

Colon cancer therapy: new perspectives of nutritional manipulations using polyunsaturated fatty acids

Purpose of reviewRecent advances in the development of new therapeutic strategies combining conventional adjuvant radio/chemotherapy with nutritional manipulations with n-3 polyunsaturated fatty acids (PUFAs) are presented. Recent findingsStudies in cell culture and tumour-bearing animals have reported the ability of long-chain n-3 PUFAs to enhance the cytotoxicity of several anticancer drugs. In colon cancer, combination of n-3 PUFAs with 5-fluorouracil resulted in an additive growth inhibitory effect on different cell lines. Moreover, recent findings suggest that eicosapentaenoic or docosahexaenoic acid may be used to enhance tumour radiosensitivity while reducing mucosal/epidermal radiotoxicity similar to radioprotective agents. The underlying mechanism is probably mediated through lipid peroxidation because the antitumour effect of n-3 PUFAs is shared with the n-6 PUFA, arachidonic acid, and abolished by vitamin E. In vivo, the use of n-3 PUFAs may provide an additional advantage compared with n-6 PUFAs. Downregulation of eicosanoid synthesis from cyclooxygenase II may reduce angiogenesis, inflammation and metastasis induction. SummaryNew insights suggest that n-3 PUFAs may play an important role not only in cancer prevention but also in cancer management. They may act synergistically with radio/chemotherapy to kill tumour cells by increasing oxidative stress while reducing angiogenesis, inflammation and metastasis induction.

Body composition in 995 acutely ill or chronically ill patients at hospital admission: a controlled population study.

OBJECTIVE To determine if fat-free mass and fat mass in acutely ill and chronically ill patients differed from healthy controls at hospital admission and if prevalence of malnutrition differed by body mass index (BMI) or fat-free mass percentile. SUBJECTS/SETTING 995 consecutive patients 15 to 100 years of age admitted to the hospital were measured in the hospital admission center and compared with 995 healthy age- and height-matched subjects DESIGN Cross-sectional study. Fat-free mass, fat mass, and percentage fat mass were determined by 50 kHz bioelectrical impedance analysis. Prevalence of malnutrition was determined by BMI < or = 20 kg/m2 or fat-free mass in the 10th percentile. STATISTICAL ANALYSIS Analysis of variance was used to examine differences between acutely ill and chronically ill patients and controls and between age groups. RESULTS Fat-free mass was significantly lower in patients than controls (P< or = .05), and the difference with age in fat-free mass in patients was greater than the age-related difference in the controls. A higher percentage fat mass was found in spite of lower BMI in chronically ill patients older than 55 years. Among participants, 25% of acutely ill and 37.3% of chronically ill patients fell below fat-free mass in the 10th percentile, compared with 15.6% of acutely ill and 18.9% of chronically ill patients falling below BMI < or = 20 kg/m2. APPLICATIONS/CONCLUSION Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass.

Advancing from immunonutrition to a pharmaconutrition: a gigantic challenge

Purpose of reviewThis review presents some difficulties encountered to develop and translate immunonutrition into clinical practice, and suggests moving forward to a pharmaconutrition approach. Recent findingsImmunonutrition suffers from inconclusive and contradictory data due to the design of many of experiments and clinical studies conducted so far. The concept of a single immunonutrient formula applicable to various types of patients has also contributed to leave the medical world in a state of uncertainty. We propose to move forward to the concept of pharmaconutrition where a disease-dedicated nutrition therapy is developed following a rigorous step-by-step procedure. Nutrients are selected according to their pharmacological properties and after an in-depth evaluation of their biological interactions when mixed together. The optimum administration schedule (i.e. dose, route, timing and duration) of the new formulae is then determined in well conducted projective clinical trials where it is administered apart from the standard nutrition to ensure full delivery of the expected doses. SummaryThis review suggests moving forward to a pharmaconutrition approach where a rigorous step-by-step procedure would allow overcoming of the difficulties encountered to translate immunonutrition into clinical practice.

Role of polyunsaturated fatty acids and lipid peroxidation on colorectal cancer risk and treatments

Purpose of reviewThe review aims at elucidating the role of lipid peroxidation of polyunsaturated fatty acids (PUFAs) in colorectal cancer (CRC) risk and treatment. Recent findingsCRC is one of the most overriding threats to public health. Despite a broad range of treatments, up to 50% of patients will inevitably develop incurable metastatic disease. Peroxidation of PUFAs contributes to augmentation of oxidative stress and causes in consequence inflammation, which is one of the possible carcinogenic factors of CRC. End products of PUFAs might be used as biomarkers for CRC detection and surveillance for treatment. They also have cytotoxic effect in CRC cells. Experimental results suggest that &ohgr;-3 PUFAs could increase the efficacy of radiotherapy and chemotherapy of CRC. SummaryLipid peroxidation, one factor of oxidative stress, might play a paramount role not only in carcinogenesis but also in potential therapeutic strategy on CRC. End products of lipid peroxidation, such as malondialdehyde, 4-hydroxy-2-nonenal, and isoprostanes, could be used as biomarkers for cancer detection, surveillance of treatment outcome and prognostic index for CRC patients. Furthermore, malondialdehyde and 4-hydroxy-2-nonenal have cytotoxic effect not only in normal cells but also in CRC cancer cells, which implies the potential role of PUFAs in CRC treatment.

Physical characteristics of total parenteral nutrition bags significantly affect the stability of vitamins C and B1: a controlled prospective study.

BACKGROUND Vitamin degradation occurring during the storage of total parenteral nutrition (TPN) mixtures is significant and affects clinical outcome. This study aimed to assess the influence of the TPN bag material, the temperature, and the duration of storage on the stability of different vitamins. METHODS Solutions of multivitamin and trace elements at recommended doses were injected into either an ethylvinyl acetate (EVA) bag or a multilayered (ML) bag filled with 2500 mL of an identical mixture of carbohydrates (1200 kcal), fat (950 kcal), and amino acids (380 kcal). The bags were then stored at 4 degrees C, 21 degrees C, or 40 degrees C. Concentrations of vitamins A, B1, C, and E were measured up to 72 hours after compounding, using high-pressure liquid chromatography. RESULTS Ten percent to 30% of vitamin C degradation occurred within the first minutes after TPN compounding. Vitamin C was more stable in ML bags (half-life: 68.6 hours at 4 degrees C, 24.4 hours at 21 degrees C, and 6.8 hours at 40 degrees C) than in EVA bags (half-life: 7.2 hours at 4 degrees C, 3.2 hours at 21 degrees C, and 1.1 hour at 40 degrees C). Moreover, appearance of dehydroascorbic acid in the TPN mixture did not compensate for vitamin C losses. Vitamin B1 was stable at 21 degrees C, but a 43% loss occurred at 40 degrees C after 72-hour storage in EVA bags. The other vitamins were stable in the TPN mixture stored in both bags at any temperature and without daylight protection. CONCLUSIONS Degradations of vitamins C and B, are significantly reduced in ML bags compared with EVA bags. To prevent vitamin C deficiencies, its initial dose should be adapted to its degradation rate, which depends on the TPN bag material, the ambient temperature, and the length of time between TPN compounding and the end of infusion to the patient.

Angiogenesis as a potential target of pharmaconutrients in cancer therapy.

Purpose of reviewThe aim of this review is to provide insight into tumor angiogenesis inhibition by pharmaconutrients through description of the most relevant and recent findings in cancer research. Recent findingsCancer growth needs oxygen and nutrients supplied through blood vessels to the tumor site. New vessel formation named angiogenesis can be prevented to avoid cancer invasion. Epidemiological studies suggested that specific food intakes could decrease incidence of many cancers. Recently, scientists were interested in the potential antitumor effects of nutrients because of their safety and general acceptance. Many excellent publications demonstrated that a large class of natural compounds including pharmaconutrients exhibits antitumoral activities in selected cancer types. This review focuses on the antiangiogenic role of natural products in cancer treatment, used alone or in combination with conventional chemotherapy. SummaryThere is strong evidence that natural diets influence cancer development by modulating signaling pathways. Our goal is to highlight the specific impact of specific nutrients in the modulation of vascular network leading to tumor angiogenesis inhibition.

Clinical relevance of parenteral nutrition prescription and administration in 200 hospitalized patients: A quality control study *

BACKGROUND & AIMS Optimal implementation of parenteral nutrition (PN) is required to promote clinical outcome and costs control. This prospective quality control study examined if PN prescription was justified and PN administration was adequate to cover the nutritional needs of patients hospitalized in the Geneva University Hospital. METHODS Two-hundred consecutive patients receiving PN were included from Medicine, Intensive Care or Surgery Units. PN prescription was considered justified if oral feeding or enteral nutrition were contraindicated or provided less than 40% of the energy target after 5 days. PN was considered adequate if it covered 90%-110% of the recommended need for energy (i.e., 110% of the Harris-Benedict formula) and proteins (i.e., 1.2 or 1.0 g protein/kg body weight/day for patients < or = or >65 years, respectively), and was supplemented with vitamins and trace elements. RESULTS PN prescription was justified in all but 14 patients (7%). However, PN administration was frequently inadequate: overfeeding (62%) was more often observed than underfeeding (14%), particularly among thin, elderly and female patients (P<0.01). Moreover, PN was not supplemented with vitamins and/or trace elements in 47 patients (24%). CONCLUSION PN prescription is generally justified but PN administration is often inadequate. Further teaching of medical teams and quality control surveys are warranted to optimize PN practices.