e-SPEN Journal - Articles in Press

A double blind, randomised, placebo controlled, feasibility phase III clinical trial of peri-operative immune-enhancing enteral nutrition in patients undergoing surgery for advanced head and neck cancer - Corrected Proof

2012-05-17

Summary: Background & aims: Conflicting evidence exists as to whether post-operative infections in patients with Squamous Cell carcinoma of the Head and Neck (SCCHN) are reduced by peri-operative enteral feeding with immune-enhancing feeds such as Impact, which contains l-arginine, nucleotides and omega-3 fatty acids. Our study aimed to address this conflict.Methods: We conducted a single centre, double blind, randomised, placebo controlled, clinical trial. Patients undergoing surgery for SCCHN were fed enterally with either Impact or an iso-nitrogenous, iso-caloric control feed for five days pre and seven days post-surgery. The rates of systemic and local infective complications, length of hospital stay and peri-operative mortality rates were compared between the two groups.Results: Data for analysis were available for 57 patients; 28 who received IMPACT and 29 the control feed. A primary infection occurred in 35% (20/57) of patients; 43% (12/28) in the Impact group and 28% (8/29) in the control group, (P = 0.27, Fishers Exact test). No differences in secondary infection rates or length of hospital stay were observed between the groups.Conclusions: In this under-powered study, peri-operative use of Impact in patients undergoing surgery for SCCHN did not lead to significant differences in infective complications, length of hospital stay or peri-operative mortality. Larger studies are required.

Risk factors associated with gallstone disease in women - Corrected Proof

2012-05-07

Summary: Background & aims: Gallstone disease in middle-aged women has been increasing due to changing dietary and environmental factors varying from country to country. The aim of the study was to determine the risk factors associated with gallstone disease in women aged ≥35 years of the district of Peshawar, Pakistan.Study design: A hospital-based case–control study.Methods: One hundred and ten women (55 cases and 55 controls) attending the Surgical Departments of two Government hospitals were enrolled for the study. All subjects were screened for ultra-sonography; biochemical and anthropometric measurements. They were interviewed for their past medical history; physical activity; 24-hr dietary recall and for demographic and socio-economic characteristics. Data were analyzed using Student's t-test, chi-square and multivariate conditional logistic regression to determine mean differences between the continuous variables; establish association between the categorical variables and to determine risk factors associated with gallstone disease, respectively.Results: Of 55 cases, 15 (27%) had a family history of gallstone disease. Thirty five percent of the cases had a single calculus while 65% had multiple calculi with mean size of 14.85 ± 14.46 mm. Conditional logistic regression analysis demonstrated that the body mass index was the most significant risk factor for women's gallstone disease. The adjusted odds ratio for women's BMI ≥ 25 kg/m2 was 2.93 (95% CI: 1.43–6.01), indicating almost a three times higher risk of gallstone disease than women with BMI 1.3) and having dietary vitamin C intake ≥ 75 mg per day.Conclusion: High body mass index, physical inactivity and low vitamin C intake are associated with gallstone disease in Pakistani women. Longitudinal studies are needed to confirm these findings.

Effect of supraphysiological concentration of serum folate on natural killer cell activity in healthy subjects - Corrected Proof

2012-03-19

Summary: Background & aims: During the past few years, consumption of high amounts of folic acid and high serum levels of folate have been associated with cancer risk. Several mechanisms have been proposed to explain this association. One of them is that supraphysiological levels of folate may diminish natural killer (NK) cell cytotoxic activity and its action as an antitumoral barrier. To demonstrate this hypothesis, we studied the effect of serum folate levels on NK cell cytotoxic activity in healthy subjects.Methods: We recruited 227 healthy subjects of both sexes and measured serum folate levels and NK cell cytotoxic activity. Serum folate was adjusted for sex, age and body mass index to look for an association between its levels and cytotoxic activity of NK cell.Results: We found supraphysiological serum folate levels in 24% of studied subjects. NK cell cytotoxic activity was not associated with serum folate levels. There was no relation between NK cell activity and other variables such as age, sex and BMI.Conclusions: In this study, NK cell cytotoxic activity was not associated with serum folate levels. It is necessary to search for other hypothesis in order to explain the observed association between folic acid and cancer.

Hypolipidemic and antioxidant effect of polyphenol-rich extracts from Moroccan thyme varieties - Corrected Proof

2012-03-13

Summary: Background & aims: In the present study, the polyphenol-rich extracts of four endemic medicinal plants (Thymus satureioides, Thymus zygis L., Thymus atlanticus and Thymus vulgaris) widely used in the Errachidia area (south east of Morocco) were analyzed for their hypocholesterolemic, hypotriglyceridemic, and antioxidant activities.Methods: Hyperlipidemia was induced in rats by intraperitoneal injection of Triton WR-1339 at a dose of 200 mg/kg body weight. The animals were divided into seven groups: the normolipidemic control group (NCG), the hyperlipidemic control group (HCG), the T. atlanticus-treated group (TA), the T. zygis-treated group (TZ), the T. satureioides-treated group (TS), the T. vulgaris-treated group (TV) and the Fenofibrate-treated group (FF). The hyperlipidemic groups were treated with herbal extracts at a dose of 0.2 g/100 g body weight and with fenofibrate at a dose of 6.5 mg/100 g body weight. The antioxidant activity of the polyphenol-rich extracts was assessed by using the Ferric Reducing Antioxidant Power assay (FRAP), the Radical Scavenging Activity method (RSA) and the inhibition of 2,2′-azobis (2-amidinopropane) hydrochloride (AAPH) that induces oxidative erythrocyte hemolysis.Results: After 24 h of treatment with polyphenol-rich extract from T. atlanticus, plasma total cholesterol, triglycerides and LDL-cholesterol decreased by 82.8% (P < 0.001), 96.4% (P < 0.001) and 82.2% (P < 0.001), respectively. The results demonstrate that the four aqueous thyme extracts possess antioxidant activity as evidenced by ferric reducing/antioxidant activity (equivalent to 50.79 ± 2.02 mmol Trolox/g of extract) and radical scavenging activity (IC50: 0.44 ± 0.02 mg/mL of extract).Conclusion: Our findings suggest that polyphenol-rich thyme extracts might be considered for therapeutic use to treat atherosclerosis.

Validation of a new index of body adiposity (BAI) to assess body fat in normal weight premenopausal Caucasian women - Corrected Proof

2012-03-12

Summary: Background & aims: Recently, a new index of body adiposity (BAI) calculated from height and hip circumference has been proposed. In this study we sought to validate BAI as an index of body fat assessment in 145 healthy, premenopausal, normal weight Caucasian women.Methods: Using dual-energy X-ray absorptiometry (DXA) as a reference method we measured percentage body fat (%BF) as well as abdominal and hip fat. Additionally %BF was measured by bioelectric impedance analysis (BIA).Results: %BF as measured by two methods (DXA and BIA) was better correlated with waist than hip circumference. On the contrary, BAI showed a better correlation with hip circumference but was not correlated with the waist-to-hip ratio. BAI was only moderately correlated with %BF assessed by DXA (R = 0.455) but weaker than the correlation using BIA (R = 0.631) or BMI (R = 0.601). In comparison with the reference method, BAI identified women with BF > 30% at high specificity (96%) but very low sensitivity (15%), whilst BIA had similar specificity (96%) but better sensitivity (35%). BAI showed a moderate correlation with abdominal fat (but weaker than the correlation using BIA). BF assessed by BAI and BIA correlated more weekly with abdominal (R = 0.453; 0.618, respectively) and hip fat (R = 0.459; R = 0.417, respectively) than BF assessed by DXA (R = 0.893; 0.849, respectively).Conclusions: In normal weight women BAI is a poor measure of %BF, comparable with BMI. Further studies are needed to develop more accurate, age- gender- and ethnicity-specific indices of total and visceral adiposity calculated from simple anthropometric measurements.