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1.
Malnutrition screening tools in gastrointestinal cancer: A systematic review of concurrent validity.
Deftereos, I, Djordjevic, A, Carter, VM, McNamara, J, Yeung, JM, Kiss, N
Surgical oncology. 2021;:101627
Abstract
OBJECTIVE Malnutrition is a significant problem in gastrointestinal (GI) cancer, and accurate screening and identification is essential to ensure appropriate nutrition intervention. This study aims to determine current evidence for concurrent validity of malnutrition screening tools in GI cancer. METHODS A systematic review was undertaken according to PRISMA guidelines, using four databases. Studies investigating the concurrent validity of malnutrition screening tools against a reference standard of Patient Generated Subjective Global Assessment (PG-SGA) or Subjective Global Assessment (SGA) in adult patients with GI cancer were identified. Screening, quality assessment using the QUADAS-2 checklist, and data extraction were performed by two independent reviewers. Concurrent validity ratings were applied using predefined criteria. RESULTS Six studies investigating concurrent validity of the Nutrition Risk Index (NRI), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST) and Nutrition Risk Screening 2002 criteria (NRS-2002) were included. There was variation in concurrent validity ratings ranging from poor-good for all tools, depending on treatment type, stage and population characteristics. CONCLUSION Recommendations regarding the use of one tool over another could not be made. However, in the absence of a clear recommendation specific to GI cancer, screening tools that are well validated in general clinical populations should be utilised. The MST can be recommended based on validity data against the PG-SGA and SGA from other oncology populations. If indicated, malnutrition screening should then be followed by thorough nutritional assessment.
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2.
Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study.
Deftereos, I, Yeung, JMC, Arslan, J, Carter, VM, Isenring, E, Kiss, N, On Behalf Of The Nourish Point Prevalence Study Group,
Nutrients. 2021;(10)
Abstract
BACKGROUND Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. METHODS Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. RESULTS This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2-4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. CONCLUSIONS Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.
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3.
Home enteral nutrition and oral nutritional supplements in postoperative patients with upper gastrointestinal malignancy: A systematic review and meta-analysis.
Xueting, H, Li, L, Meng, Y, Yuqing, C, Yutong, H, Lihong, Q, June, Z
Clinical nutrition (Edinburgh, Scotland). 2021;(5):3082-3093
Abstract
BACKGROUND The safety and potential benefits of home enteral route nutrition (HERN), referring specifically to home enteral nutrition (HEN) and oral nutritional supplements (ONS) in this article, after upper gastrointestinal (GI) resection are inconsistent. OBJECTIVE To evaluate the impact of HERN on nutritional status, complications, and quality of life (QOL) after upper GI resection. METHODS This systematic review was conducted in accordance with the PRISMA statement. Nine databases were searched from inception to October 2019. Randomized controlled trials (RCTs) comparing the impact of HERN after upper gastrointestinal resection were included. Relative risk/weighted mean difference/standardized mean difference (RR/WMD/SMD) and corresponding 95% confidence intervals (95% CI) were calculated using fixed- or random-effects models. RESULTS Overall, 15 RCTs involving 1059 patients were included. Compared with normal oral diet, HERN significantly prevented weight loss (-3.95 vs -5.82 kg; SMD: 1.98 kg; 95% CI: 1.24-2.73); improved added-level of albumin (3.48 vs 2.41 g/L; SMD: 1.36 g/L; 95% CI: 0.81-1.91), hemoglobin (6.54 vs -1.29 g/L; WMD: 7.45 g/L; 95% CI: 5.05-9.86), pre-albumin (37.59 vs 7.35 mg/L; WMD: 21.6 mg/L; 95% CI: 5.96-37.24), and transferrin (63.08 vs 50.45 mg/L; WMD: 16.44 mg/L; 95% CI: 13.51-19.38); and reduced the incidence of malnutrition or latent malnutrition (RR = 0.54; P < 0.01). Subgroup analysis based on the approach of HERN showed that weight loss in the HEN subgroup was significantly lower than that of the control group (WMD = 2.69, P < 0.01), while there was no significant difference between the ONS subgroup and the control group (P = 0.1). The same results were found in albumin. Physical function (WMD: 5.29; 95% CI: 1.86-8.73) and fatigue (WMD: -8.59; 95% CI: -12.61, -4.58) dimensions in QOL were significantly better in the HERN group. No significant differences in gastrointestinal and tube-related complications. CONCLUSION HERN improved nutritional status and some dimensions of QOL in upper GI malignancy patients after surgery, without increasing complications. Subgroup analysis showed that HEN experienced more benefits than ONS.
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4.
Autophagy and gastrointestinal cancers: the behind the scenes role of long non-coding RNAs in initiation, progression, and treatment resistance.
Shafabakhsh, R, Arianfar, F, Vosough, M, Mirzaei, HR, Mahjoubin-Tehran, M, Khanbabaei, H, Kowsari, H, Shojaie, L, Azar, MEF, Hamblin, MR, et al
Cancer gene therapy. 2021;(12):1229-1255
Abstract
Gastrointestinal (GI) cancers comprise a heterogeneous group of complex disorders that affect different organs, including esophagus, stomach, gallbladder, liver, biliary tract, pancreas, small intestine, colon, rectum, and anus. Recently, an explosion in nucleic acid-based technologies has led to the discovery of long non-coding RNAs (lncRNAs) that have been found to possess unique regulatory functions. This class of RNAs is >200 nucleotides in length, and is characterized by their lack of protein coding. LncRNAs exert regulatory effects in GI cancer development by affecting different functions such as the proliferation and metastasis of cancer cells, apoptosis, glycolysis and angiogenesis. Over the past few decades, considerable evidence has revealed the important role of autophagy in both GI cancer progression and suppression. In addition, recent studies have confirmed a significant correlation between lncRNAs and the regulation of autophagy. In this review, we summarize how lncRNAs play a behind the scenes role in the pathogenesis of GI cancers through regulation of autophagy.
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5.
Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature.
Maida, M, Sferrazza, S, Murino, A, Lisotti, A, Lazaridis, N, Vitello, A, Fusaroli, P, de Pretis, G, Sinagra, E
Surgical endoscopy. 2021;(1):37-51
Abstract
BACKGROUND Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR). METHODS This paper aims to perform a comprehensive review of the current literature related to supporting the underwater resection techniques with the aim to evaluate their safety and efficacy. RESULTS Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associated with higher "en-bloc" and R0 resection rates for colonic lesions, but lower "en-bloc" and R0 resection rates for duodenal non-ampullary lesions, compared to standard EMR. In contrast to U-EMR, little evidence supporting U-ESD are currently available. A single comparison study on gastric lesions showed that U-ESD had shorter procedural times and allowed a similar "en-bloc" resection rates compared to standard ESD. No comparison studies between U-ESD and ESD are available for colonic lesions. Finally, only some anecdotal experiences have been reported for U-POEM or U-EFTR, and the feasibility and effectiveness of these techniques need to be further investigated. CONCLUSIONS Further prospective studies are necessary to better explore the advantages of underwater techniques compared to the respective standards of care, especially in the setting of U-ESD where consistent data are lacking and where standardization of the technique is needed.
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6.
SARC-CalF-assessed risk of sarcopenia and associated factors in cancer patients.
Souza, VF, Ribeiro, TSC, Marques, RA, Petarli, GB, Pereira, TSS, Rocha, JLM, Guandalini, VR
Nutricion hospitalaria. 2020;(6):1173-1178
Abstract
Introduction: sarcopenia is considered a risk factor for cancer patients, as it increases mortality and post-surgical complications, and reduces response to treatment and quality of life. Objective: to identify the risk of sarcopenia by SARC-CalF, as well as the factors associated with this outcome in patients with cancer of the gastrointestinal tract (GIT) and adnexal glands. Methods: this cross-sectional study included patients with cancer of the GIT and adnexal glands, without edema or ascites, of both sexes and aged ≥ 20 years. Conventional anthropometric variables and handgrip strength (HGS) were measured. The risk of sarcopenia was assessed through the SARC-CalF questionnaire, and nutritional status by the Patient-Generated Subjective Global Assessment (PG-SGA). The data analysis was performed using the SPSS® software, 22.0, with a significance of 5 %. Results: seventy patients took part in the study. Of these, 55.7 % were female, 52.9 % were aged over 60 years, and 64.3 % were non-white. PG-SGA identified 50.0 % of patients as well-nourished and 50.0 % as having some degree of malnutrition. The prevalence of risk of sarcopenia was 28.6 %. There were different correlations between the SARC-CalF score and anthropometric variables (p < 0.05) according to life stage (adults and elderly). After a linear regression analysis the measures that most influenced the SARC-CalF score were arm circumference (AC) and adductor pollicis muscle thickness in the dominant hand (DAPMT) for adults, while for the elderly current weight and DAPTM (p < 0.05) were more relevant. Conclusion: SARC-CalF identified 28.6 % of patients at risk for sarcopenia and was associated with body weight and anthropometric variables indicative of muscle reserve in adults and the elderly.
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7.
Diet Quality and Upper Gastrointestinal Cancers Risk: A Meta-Analysis and Critical Assessment of Evidence Quality.
Moazzen, S, van der Sloot, KWJ, Vonk, RJ, de Bock, GH, Alizadeh, BZ
Nutrients. 2020;(6)
Abstract
We aimed to assess the effect of a high-quality diet on the risk of upper gastrointestinal cancer and to evaluate the overall quality of our findings by searching PubMed, EMBASE, Web of Science, Cochrane, and the references of related articles to February 2020. Two reviewers independently retrieved the data and performed the quality assessments. We defined the highest-quality diet as that with the lowest Diet Inflammatory Index category and the highest Mediterranean Diet Score category. Overall odds ratios and 95% confidence intervals were estimated for upper gastrointestinal cancer risk comparing the highest- versus lowest-diet quality. A random-effects meta-analysis was then applied with Review Manager, and the quality of the overall findings was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach. The highest-quality diets were significantly associated with reduced risk of upper gastrointestinal cancers, achieving odds ratios of 0.59 (95% confidence interval: 0.48-0.72) for the Diet Inflammatory Index, pooling the findings from nine studies, and 0.72 (95% confidence interval: 0.61-0.88) for the Mediterranean Diet Score, pooling the findings from 11 studies. We observed a minimum of 69% heterogeneity in the pooled results. The pooled results were graded as low quality of evidence. Although it may be possible to offer evidence-based general dietary advice for the prevention of upper gastrointestinal cancers, the evidence is currently of insufficient quality to develop dietary recommendations.
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8.
Economic value of nutritional support methods in gastrointestinal cancer: A quantitative meta-analysis.
Zhu, M, Chen, W, Jiang, H, Zhu, S, Xu, J, Bao, W, Dang, Y, Wang, MY
Asia Pacific journal of clinical nutrition. 2020;(1):83-93
Abstract
BACKGROUND AND OBJECTIVES Multiple studies of the relative economic value of different nutritional support methods for patients with gastrointestinal cancer have provided inconsistent results. METHODS AND STUDY DESIGN The PUBMED and EMBASE databases were systematically searched through September 30, 2018to identify latent studies of the benefits of parenteral nutrition (PN), enteral nutrition (EN) or conventional intervention (CI) in gastrointestinal cancer patients. A fixed-effects model or random-effects model was applied depending on the heterogeneity of the studies. Statistical analysis was conducted using R software. A total of 728 studies were reviewed, and 21 studies published from 1998 to 2018 were included in the final analysis. RESULTS The results showed that the hospitalization expenditure of the EN group was 3938 RMB less than that of the PN group. Similarly, the EN group had a shorter length of hospitalization than the PN and CI groups. The infection rate was lower in the EN group (12%) than in the PN group (16%) and CI group (20%). Subgroup analysis showed that gastrointestinal cancer patients who received oral nutritional supplements had the lowest infection rate (11%) after surgery. CONCLUSIONS EN, especially oral nutritional supplements, has a positive economic impact on patients with gastrointestinal cancer, based on reductions in the post-operative infection rate, length of hospitalization, and hospitalization expenditure.
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9.
Gastrointestinal malignancy in cystic fibrosis.
Hough, NE, Chapman, SJ, Flight, WG
Paediatric respiratory reviews. 2020;:90-92
Abstract
Cystic fibrosis (CF) is a multisystem disease affecting the gastrointestinal (GI) tract as well as the lungs. As survival has increased significantly over the past few decades, complications not seen previously have become apparent. There is an overall increased rate of malignancy in CF, particularly from the GI tract and in the post-transplant population. The most common sites of malignancy are the pancreatico-biliary and digestive tract, as well as an increased rate of testicular cancer. Using an illustrative case of metastatic oesophageal malignancy which initially appeared to be hepatic in origin, we have reviewed the literature surrounding malignancy in CF with a particular focus on the GI tract.
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10.
Metabolomics studies in gastrointestinal cancer: a systematic review.
Yu, J, Zhao, J, Zhang, M, Guo, J, Liu, X, Liu, L
Expert review of gastroenterology & hepatology. 2020;(1):9-25
Abstract
Introduction: This systemic review provides an overview of metabolic perturbations and possible mechanisms in gastrointestinal cancer. The authors discuss emerging challenges of technical and clinical applications.Areas covered: In this systemic review, the authors summarized the currently available results of metabolomic biomarkers linked to GI cancer, and discussed the altered metabolism pathways including carbohydrate metabolism, amino acid metabolism, lipids, and nucleotide metabolism and other metabolisms. Furthermore, future efforts need to adhere to normalize analysis procedures, validate with the larger cohort and utilize multiple-omics technologies. The search was conducted in PubMed with the following search terms (biomarker, gastrointestinal cancer, colorectal cancer, and esophageal cancer) from 2013 to 2019.Expert opinion: This systemic review summarized the currently available results of metabolomic biomarkers linked to gastrointestinal cancer, and discussed the altered metabolism pathways. The authors believe that metabolomics will benefit deeper understandings of the pathogenic mechanism, discovery of biomarkers and aid the search for drug targets as we move toward the era of personalized medicine. Personalized medication for tumors can improve the curative effect, avoid side effects and medical resource waste. As a promisingtool, metabolomics that targets the entire cancer-specific metabolite network should be applied more widely in cancer research.