Prognostic Value of the Geriatric Nutritional Risk Index in Patients Exceeding 70 Years Old with Esophageal Squamous Cell Carcinoma

Abstract

To investigate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy (RT) or definitive concurrent chemoradiotherapy (dCRT). Fifty-two ESCC patients were included from July 2014 to December 2018. RT was delivered at a dose of 1.8–2.0?Gy per day to a total dose of 50–60?Gy. Tumor response was assessed using the RECIST 1.1 system. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan–Meier method. Multivariate analysis of predictive factors of response and survival was performed using a logistic regression and a Cox model, respectively. In multivariate analysis, GNRI score (HR 0.278, P?=?0.036) was the only independent prognostic factor for tumor response. As for survival outcomes, GNRI score (OS: HR 0.505, P?=?0.028; PFS: HR 0.583, P?=?0.045) and treatment modality (OS: HR 0.356, P?=?0.015; PFS: HR 0.392, P?=?0.0014) were both independent prognostic factors for better OS and PFS. Additionally, there was no correlation between GNRI score and treatment modality (Spearman’s ρ?=?0.200; P?=?0.154). In conclusion, routine use of the GNRI criteria may help in the risk stratification of elderly patients undergoing RT/dCRT. The dCRT treatment could provide survival benefits for elderly ESCC patients.     

Neutrophil-lymphocyte ratio and nutritional status are clinically useful in predicting prognosis in colorectal cancer patients

Abstract

Background: Neutrophil-lymphocyte ratio (NLR) and nutritional status may provide a prognostic value in colorectal cancer (CRC). Thus, aim of this study was to evaluate the prognostic value of nutritional status and NLR in CRC patients.

Methods: A retrospective analysis was conducted in CRC patients. The independent variables were body mass index (BMI), weight loss (WL) and NLR. Logistic regression was used to estimate the odds chance of low NLR. Kaplan-Meier curves and Cox regression were used to evaluate the overall survival at 5?years old.

Results: In the 148 patients evaluated, the most prevalent nutritional status was overweight/obesity (43.2%) and 27.0% had severe WL. Sixty-seven subjects (45.3%) had NLR ≥ 3 that was associated with the lower OS (P?<?0.001). There was a higher OS for overweight/obese patients (P?=?0.002) and a lower among subjects with severe WL (P?=?0.009). The NLR ≥3 (HR: 3.639; 95% CI, 1.708–7.771) was an independent poor prognostic factor for OS. Patients without WL (HR: 0.367, 95% CI, 0.141–0.954) and classified as overweight/obesity (HR: 0.260; 95% CI, 0.106–0.639) presented better prognostic.

Conclusion: NLR, WL, BMI assessments are promising prognostic indicators in the CRC.     

Modeling strategies to improve parameter estimates in prognostic factors analyses with patient-reported outcomes in oncology

Purpose

The inclusion of patient-reported outcome (PRO) questionnaires in prognostic factor analyses in oncology has substantially increased in recent years. We performed a simulation study to compare the performances of four different modeling strategies in estimating the prognostic impact of multiple collinear scales from PRO questionnaires.

Methods

We generated multiple scenarios describing survival data with different sample sizes, event rates and degrees of multicollinearity among five PRO scales. We used the Cox proportional hazards (PH) model to estimate the hazard ratios (HR) using automatic selection procedures, which were based on either the likelihood ratio-test (Cox-PV) or the Akaike Information Criterion (Cox-AIC). We also used Cox PH models which included all variables and were either penalized using the Ridge regression (Cox-R) or were estimated as usual (Cox-Full). For each scenario, we simulated 1000 independent datasets and compared the average outcomes of all methods.

Results

The Cox-R showed similar or better performances with respect to the other methods, particularly in scenarios with medium–high multicollinearity (ρ?=?0.4 to ρ?=?0.8) and small sample sizes (n?=?100). Overall, the Cox-PV and Cox-AIC performed worse, for example they did not select one or more prognostic collinear PRO scales in some scenarios. Compared with the Cox-Full, the Cox-R provided HR estimates with similar bias patterns but smaller root-mean-squared errors, particularly in higher multicollinearity scenarios.

Conclusions

Our findings suggest that the Cox-R is the best approach when performing prognostic factor analyses with multiple and collinear PRO scales, particularly in situations of high multicollinearity, small sample sizes and low event rates.

     

Prognostic Nutritional Index Predicts Outcomes of Patients after Gastrectomy for Cancer: A Systematic Review and Meta-Analysis of Nonrandomized Studies

Objective: The primary aim of this systematic review was to evaluate the survival predication value of preoperative prognostic nutritional index (PNI) in patients with gastric cancer. The second aim was to explore the relationship between preoperative PNI and clinicopathological features.

Methods: A systematic search of the electronic databases identified studies that investigated the association of preoperative PNI with short or long-term outcomes among patients after gastrectomy for cancer. Qualitative and quantitative analysis of results was conducted.

Results: Twenty-five studies with a total of 14,403 patients with gastric cancer met inclusion criteria for this review. Pooled analysis demonstrated that low preoperative PNI was associated with significantly reduced overall survival (HR 1.81, 95% CI: 1.56–2.09; P?=?0.000), cancer-specific survival (HR 1.61, 95% CI: 1.24–2.10; P?=?0.000), and recurrence-free survival (HR 1.82, 95% CI: 1.20–2.77; P?=?0.005). In addition, risk of postoperative complications (POCs) and mortality was significantly higher in patients with lower preoperative PNI (RR 1.77, 95% CI: 1.44–2.17; P?=?0.000 and RR 5.14, 95% CI: 2.23–11.79; P?=?0.000, respectively).

Conclusion: This study suggests that patients with low preoperative PNI may have a high incidence of POCs and poor prognosis following gastrectomy for cancer.     

Dairy Products and Cancer Risk in a Northern Sweden Population

Abstract

The role of dairy products in cancer is unclear. We assessed consumption of fermented milk, non-fermented milk, cheese, and butter, estimated from semi-quantitative food frequency questionnaires, in relation to prospective risk of breast, prostate, colorectal, smoking-, and obesity-related cancers in 101,235 subjects, including 12,552 cancer cases, in the population-based Northern Sweden Health and Disease Study. Most analyses (n?=?20) rendered null results. In men, we observed an increased prostate cancer risk among high-consumers of cheese (hazard ratio (HR) for highest vs. lowest quintile (Q5–Q1), 1.11; 95% CI, 0.97–1.27; P^trend?=?0.013). In women, high-consumers of cheese had a decreased risk of overall cancer (HR Q5–Q1, 0.95; 95% CI, 0.88–1.04; P^trend?=?0.039), smoking-related (HR Q5–Q1, 0.84; 95% CI, 0.72–0.97; P^trend ≤ 0.001), and colorectal cancers (HR Q5–Q1, 0.82; 95% CI, 0.63–1.07; P^trend?=?0.048). Butter yielded a weak decreased obesity-related cancer risk in women (HR Q5–Q1, 0.91; 95% CI, 0.81–1.02; P^trend?=?0.049). Fermented milk yielded HRs below zero in women, but with no clear linear associations. In conclusion, this study does not support any major adverse or beneficial effects of fermented milk, non-fermented milk, cheese, and butter in the diet from a cancer risk perspective.     

Fracture risk of patients suffering from dizziness: A retrospective cohort study

Abstract

Background: Dizziness is known to be associated with the risk of falls. However, there is not much evidence for the increase of fractures caused by dizziness. Objectives: The aim of the study was to investigate whether the symptom of dizziness is associated with an increased fracture rate. Methods: We performed a retrospective cohort study using a population-based administrative database in the Province of Quebec, Canada. A cohort of n = 2 442 patients with at least one diagnosis of dizziness was compared to n = 16 125 unexposed patients. The main outcome measure was any kind of first fracture after the index date of dizziness. Results: Analysis revealed a moderate effect of dizziness as an independent contributing factor to fractures (adjusted hazard ratio (HR) 1.26, 95% confidence interval 1.03 to 1.55). A fracture in the year before the index date was highly associated with the incidence of a subsequent fracture (HR 2.69, 2.09 to 3.47), and fractures were less frequent in women (HR 0.70, 0.60–0.82). Analysis further revealed that dizziness (HR 1.31, 1.05–1.64) and prior fractures (HR 2.41, 1.81–3.22) were associated with non-osteoporotic fractures, which were also less frequent in women (HR 0.59, 0.50–0.71). The incidence of fractures in sites typical for osteoporosis correlated with a precedent fracture (HR 3.91, 2.31–6.63), but not with dizziness (HR 1.10, 0.69–1.75).

Conclusion: Besides the ‘typical’ elderly female patient being at risk of osteoporotic fractures, male patients suffering from dizziness should be carefully evaluated, and prevention strategies should be considered to minimise their risk of suffering non-osteoporotic fractures.     

Predicting the Prognosis of Gastric Cancer by Albumin/Globulin Ratio and the Prognostic Nutritional Index

Abstract

Background: Albumin-to-globulin ratio (AGR) and the prognostic nutrition index (PNI) are used to assess the nutritional status and severity of disease for a cancer patient. However, the clinical significance of combining these two predictors in gastric cancer (GC) remains unclear. This study evaluated the prognostic value of pretreatment serum AGR and the PNI for GC.

Methods: A total of 273 patients with GC, diagnosed between January 2010 and January 2014, were enrolled. The association of AGR, PNI with clinicopathological characters and prognosis were assessed by Cox regression and Kaplan–Meier methods.

Results: Both low AGR group and low PNI group had poor overall survival (OS) and progression-free survival (PFS) (all p?<?0.001), while patients with low AGR and PNI had the lowest OS rate. Multivariate analyses revealed that AGR (for OS HR?=?0.657, 95%CI: 0.449–0.962, p?=?0.031; for PFS HR?=?0.684, 95%CI: 0.528–0.895, p?=?0.035) was an independent prognostic factor for OS and PFS in patients with GC, and PNI was verified as a predictor for OS (HR?=?0.782, 95%CI: 0.503 –0.997, p?=?0.048).

Conclusions: Low level of pretreatment AGR and PNI may be independent prognostic factors for patients with GC, and patients with both factors indicated the worst OS.     

Serum Albumin at Diagnosis is an Independent Predictor of Early Mortality in Veteran Patients with Esophageal Cancer

Aims: To identify independent factors that could predict mortality within 6 months in a cohort of patients with esophageal cancer.

Methods: Esophageal cancer patients were grouped into early (≤6 months, n?=?41) and late (>6 months, n?=?81) mortality groups. 52 variables were analyzed by univariable analysis (UA). A multivariable (MVA) regression model was created to identify predictors of early mortality.

Results: When comparing early and late mortality groups, there was no difference in age, BMI, race, histology, or anatomic location between the two groups. UA demonstrated that the early mortality group had a lower mean albumin level (3.3?±?0.1?g/dl vs. 3.8?±?0.1?g/dl; P?<?0.001), poorer ECOG performance status (1.9?±?0.2 vs. 1.1?±?0.1, P?=?0.02), higher WBC count (9.6?±?0.7 K/µL vs. 8.2?±?0.3 K/µL, P?=?0.04), and were less likely to receive surgery (2.4% vs. 22.2%; P?=?0.003), neoadjuvant treatment (4.9% vs. 28.4%; P?=?0.009) and definitive chemoradiation (7.3% vs. 27.2%; P?=?0.01). MVA revealed that only low albumin at diagnosis was an independent predictor of survival (P?=?0.016).

Conclusion: Albumin level at diagnosis is an independent predictor of early mortality and might be used with other variables to provide prognostic information for patients and to guide treatment.     

Acute effects of theanine,caffeine and theanine–caffeine combination on attention

Objective: l-theanine is a constituent of tea which is claimed to enhance cognitive functions. We aimed to determine whether theanine and theanine–caffeine combination have acute positive effects on cognitive and neurophysiological measures of attention, compared to caffeine (a positive control) and a placebo in healthy individuals.

Design: In a placebo-controlled, five-way crossover trial in 20 healthy male volunteers, we compared the effects of l-theanine (200?mg), caffeine (160?mg), their combination, black tea (one cup) and a placebo (distilled water) on cognitive (simple [SVRT] and recognition visual reaction time [RVRT]) and neurophysiological (event-related potentials [ERPs]) measures of attention. We also recorded visual (VEPs) and motor evoked potentials (MEPs) to examine any effects of treatments on peripheral visual and motor conduction, respectively.

Results: Mean RVRT was significantly improved by theanine (P?=?0.019), caffeine (P?=?0.043), and theanine–caffeine combination (P?=?0.001), but not by tea (P?=?0.429) or placebo (P?=?0.822). VEP or MEP latencies or SVRT did not show significant inter-treatment differences. Theanine (P?=?0.001) and caffeine (P?=?0.001) elicited significantly larger mean peak-to-peak N2-P300 ERP amplitudes than the placebo, whereas theanine–caffeine combination elicited a significantly larger mean N2-P300 amplitude than placebo (P?P?=?0.029) or caffeine (P?=?0.005). No significant theanine?×?caffeine interaction was observed for RVRT or N2-P300 amplitude.

Discussion: A dose of theanine equivalent of eight cups of back tea improves cognitive and neurophysiological measures of selective attention, to a degree that is comparable with that of caffeine. Theanine and caffeine seem to have additive effects on attention in high doses.     

Associations of smoking with cardiometabolic profile and renal function in a Romanian population-based sample from the PREDATORR cross-sectional study

Background: The impact of smoking on morbidity is well known, but in Romania, limited data are available regarding the smoking prevalence and relationship with cardiometabolic profile and kidney function.

Objectives: To assess the association of smoking with cardiometabolic traits and kidney function, in a Romanian population-based sample from the PREDATORR study.

Methods: PREDATORR was an epidemiological cross-sectional study. Between 2012 and 2014, participants were randomly selected from the lists of general practitioners and enrolled if they were aged 20 to 79 years, born and living in the past 10 years in Romania. Sociodemographic and lifestyle characteristics were collected through interviewer-administered questionnaires.

Results: Overall, 2704 participants were included in the analysis, 18% of them being current smokers and 30.8% former smokers. Current smokers compared to non-smokers had higher total cholesterol (220.6?±?50.4 versus 213.9?±?86.8?mg/dl, P?=?0.017), LDL-cholesterol (137.8?±?45.2 versus 130.7?±?83.7?mg/dl, P?=?0.004) and glomerular filtration rate (96.9?±?16.8 versus 90.7?±?19.1?ml/min/1.73?m², P?<0.001) in women and higher triglycerides (170.7?±?129.8 versus 144.3?±?94.2?mg/dl, P?=?0.007), glomerular filtration rate (97.6?±?17 versus 90.3?±?18?ml/min/1.73?m², P?P?=?0.002) in men. Active smoking was associated with hypercholesterolaemia [OR: 1.40 (95% CI: 1.01–1.96), P?=?0.04] and low HDL-cholesterolaemia [OR: 1.39 (95% CI: 1.01–1.91), P?=?0.04] and negatively associated with overweight/obesity [OR: 0.67 (95% CI: 0.48–0.94), P?=?0.02]. Male former smokers had higher prevalence of abdominal obesity (82.4% versus 76.4%, P?=?0.02), hypertriglyceridaemia (43.6% versus 35.6%, P?=?0.01), hypertension (64% versus 56.4%, P?=?0.01) and ischaemic vascular disease (40.5% versus 30.9%, P?=?0.003) than male non-smokers.

Conclusion: The PREDATORR study showed a high prevalence of smoking in the adult Romanian population providing data on the association of smoking with cardiometabolic traits.     

The effects of probiotics on mental health and hypothalamic–pituitary–adrenal axis: A randomized,double-blind,placebo-controlled trial in petrochemical workers

Objective: The aim of this study was to determine effects of probiotic yogurt and multispecies probiotic capsule supplementation on mental health and hypothalamic–pituitary–adrenal axis in petrochemical workers.

Methods: The present randomized double-blind, placebo-controlled trial was conducted on 70 petrochemical workers. Subjects were randomly divided into three groups to receive 100?g/day probiotic yogurt?+?one placebo capsule (n?=?25) or one probiotic capsule daily?+?100?g/day conventional yogurt (n?=?25) or 100?g/day conventional yogurt?+?one placebo capsule (n?=?20) for 6 weeks. Mental health parameters including general health questionnaire (GHQ) and depression anxiety and stress scale (DASS) scores were measured. Fasting blood samples were obtained at the beginning and 6 weeks after the intervention to quantify hypothalamic–pituitary–adrenal axis.

Results: After 6 weeks of intervention, a significant improvement of GHQ was observed in the probiotic yogurt (18.0?±?1.5 vs. 13.5?±?1.9, P?=?0.007) and in the probiotic capsule group (16.9?±?1.8 vs. 9.8?±?1.9, P?=?0.001), as well as a significant improvement in DASS scores in the probiotic yogurt (23.3?±?3.7 vs. 13.0?±?3.7, P?=?0.02) and the probiotic capsule group (18.9?±?3.2 vs. 9.4?±?4.0, P?=?0.006). However, there was no significant improvement in the conventional yogurt group (P?=?0.05 for GHQ and P?=?0.08 for DASS).

Discussion: The consumption of probiotic yogurt or a multispecies probiotic capsule had beneficial effects on mental health parameters in petrochemical workers.     

The impact of the modified Atkins diet on lipid profiles in adults with epilepsy

Objectives: The modified Atkins diet (MAD) is a high fat, low carbohydrate ketogenic diet used to treat intractable seizures in children and adults. The long-term impact on fasting lipid profiles (FLPs) remains unknown. This study was designed to detect significant lipid changes in adults on MAD.

Methods: Patients were observed prospectively. A FLP was obtained in all patients at the first visit then serially. Patients were started on a 20?g per day net carbohydrate limit MAD. They were screened for risk for coronary heart disease and counseled to reduce saturated fats by a registered dietitian if deemed at risk. Patients that remained on MAD for 3 or more months with one or more follow-up FLP were included.

Results: Thirty-seven patients (14 male), mean age 33 years (SD 13, range 18–59) met study criteria. Median diet duration was 16 months (range 3–41). Total cholesterol and low-density lipoprotein (LDL) increased significantly over the first 3 months of MAD (P?=?0.01 and 0.008, respectively), but were not significantly different from baseline after 1 year of treatment (P?=?0.2 and P?=?0.5, respectively). High-density lipoprotein levels trended upward in the first 3 months (P?=?0.05) and triglycerides remained unchanged (P?=?0.5). In 12 patients followed for 3 or more years, no cardiovascular or cerebrovascular events were reported.

Discussion: Although total cholesterol and LDL increased over the first 3 months of the MAD, these values normalized within a year of treatment, including in patients treated with MAD for more than 3 years.     

Coenzyme Q10 as a treatment for fatigue and depression in multiple sclerosis patients: A double blind randomized clinical trial

Objectives: Multiple sclerosis (MS) is the chronic inflammatory and demyelinating disorder of central nervous system which is accompanied with disability and negative life style changes such as fatigue and depression. The aim of this study is to investigate the effect of coenzyme Q10 (CoQ10) supplementation on fatigue and depression in patients with MS.

Methods: We performed a randomized, double-blinded, placebo-controlled trial to determine the effect of CoQ10 supplement (500?mg/day) vs. placebo for 12?weeks. Fatigue symptoms were quantified by means of fatigue severity scale (FSS) and the Beck depression inventory (BDI) was used to assess depressive symptoms.

Results: A significant decrease of FSS was observed in CoQ10 group during the intervention (P?=?0.001) and significant increase of FSS change was observed within placebo group (P?=?0.001). Repeated measure analysis of variance showed a significant time-by-treatment interaction for FSS (baseline 41.5?±?15.6 vs. endpoint 45?±?13.6; F_1,45?=?55.23, P?<?0.001, η²?=?0.56) and BDI (baseline 17.8?±?12.2 vs. endpoint 20.4?±?11.4; F_1,45?=?40.3, P?<?0.001, η²?=?0.48), indicating significant decrease of FSS and BDI in CoQ10 group compared to placebo group.

Conclusion: Our study suggests that CoQ10 supplementation (500?mg/day) can improve fatigue and depression in patients with multiple sclerosis.     

Assessment and longitudinal analysis of health impacts and stressors perceived to result from unconventional shale gas development in the Marcellus Shale region

Abstract

Introduction: Concerns for health and social impacts have arisen as a result of Marcellus Shale unconventional natural gas development. Our goal was to document the self-reported health impacts and mental and physical health stressors perceived to result from Marcellus Shale development.

Methods: Two sets of interviews were conducted with a convenience sample of community members living proximal to Marcellus Shale development, session 1 March–September 2010 (n?=?33) and session 2 January–April 2012 (n?=?20). Symptoms of health impacts and sources of psychological stress were coded. Symptom and stressor counts were quantified for each interview. The counts for each participant were compared longitudinally.

Results: Participants attributed 59 unique health impacts and 13 stressors to Marcellus Shale development. Stress was the most frequently-reported symptom. Over time, perceived health impacts increased (P?=?0·042), while stressors remained constant (P?=?0·855).

Discussion: Exposure-based epidemiological studies are needed to address identified health impacts and those that may develop as unconventional natural gas extraction continues. Many of the stressors can be addressed immediately.     

Low Transthyretin Levels Predict Poor Prognosis in Cancer Patients in Palliative Care Settings

Objectives: Although transthyretin (TTR) is a nutritional indicator and is influenced by systemic inflammation, it may be a good prognostic indicator for cancer patients in palliative care settings. This study investigates the correlation between low TTR levels and survival among cancer patients in palliative care settings.

Methods: This was a sub-analysis of a prospective, multicenter cohort study. Patients who had advanced-stage cancer and who were newly referred to palliative care services were eligible to participate; however, those receiving anti-tumor therapy were excluded. Survival analyses were performed to clarify predictors of poor prognosis.

Results: A total of 144 patients were enrolled (45.1% female; median age, 72?years). Cox regression analysis revealed that low TTR levels (<10.9?mg/l) (hazard ratio 1.74, P?=?0.025), poor muscle power (1.71, P?=?0.045), and fatigue (1.89, P?=?0.024) were predictors of poor prognosis. Median survival in patients with low TTR levels (<10.9?mg/l) was 26?days, which was significantly shorter than those with high TTR levels (≥10.9?mg/l) (50?days; P?<?0.001).

Conclusion: Low TTR levels may be indicators for poor prognosis among cancer patients in palliative care settings.     

The impact of transvenous cardioverter-defibrillator implantation on quality of life,depression and optimism in dialysis patients: report on the secondary outcome of QOL in the randomized controlled ICD2 trial

Rationale

The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown.

Objective

We aimed to identify the effect of primary ICD implantation on quality of life (QoL), mood and dispositional optimism in patients undergoing dialysis.

Methods and results

We performed a prespecified subanalysis of the randomized controlled ICD2 trial. In total, 177 patients on chronic dialysis, with an age of 55–81 years, and a left ventricular ejection fraction of?≥?35%, were included in the per-protocol analysis. Eighty patients received an ICD for primary prevention, and 91 patients received standard care. The Short Form-36 (SF-36), Geriatric Depression Scale-15 (GDS-15), Revised Life Orientation Test (LOT-R) questionnaires were administered prior to ICD implantation (T0), and at 1-year follow-up (T1) to assess QoL, depression and optimism, respectively. The patients were predominantly male (76.0%), with a median age of 67 years. Hemodialysis was the predominant mode of dialysis (70.2%). The GDS-15 score difference (T1 ? T0) was 0.5 (2.1) in the ICD group compared with 0.3 (2.2) in the control group (mean difference ? 0.3; 95% CI ? 1.1 to 0.6; P?=?0.58). The LOT-R score difference was ? 0.2 (4.1) in the ICD group compared with ? 1.5 (4.0) in the control group (mean difference ? 1.1 (0.8); 95% CI ? 2.6 to 0.4; P?=?0.17). The mean difference scores of all subscales of the SF-36 were not significantly different between randomization groups.

Conclusions

In our population of patients on dialysis, ICD implantation did not affect QoL, mood or dispositional optimism significantly during 1-year follow-up.

Clinical Trial Registration

Unique identifier: ISRCTN20479861. http://www.controlled-trials.com.

     

Prevalence of vitamin D deficiency in childhood acute lymphoblastic leukemia and its association with adverse outcomes during induction phase of treatment

Abstract

Background: Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Vitamin D inadequacy is now an internationally recognized health problem. Some relation has been observed between Vitamin D insufficiency and poor outcome in ALL though evidence is limited. Methods: A prospective observational study was done including children (1–15?years) with newly diagnosed ALL. Vitamin D estimation was performed at baseline and at end of induction chemotherapy. Results: Ninety-three patients were recruited in the study. Majority of them belonged to lower socio-economic status (75.3%), and were from rural background (89.2%). Vitamin D deficiency was found in 84.95% of the study population. Seventy-five children (80.6%) completed induction, 9 (9.7%) abandoned treatment and 9 (9.7%) died during induction. Vitamin D levels were significantly low in children with ALL who died (P?=?0.016), who had complications (P?=?0.002), females (P?=?0.036), and those with high risk ALL (P?=?0.001). There was a significant drop in the Vitamin D levels (P?<?0.001) from pre to post induction phase of chemotherapy. Conclusion: Vitamin D deficiency is prevalent in patients with ALL and is also associated with adverse outcome in these children. Further studies are needed on possible benefits of vitamin D supplementation for preventing complications during treatment of ALL.     

Docosahexaenoic acid biostatus is associated with event-related functional connectivity in cortical attention networks of typically developing children

Objective: Although extant preclinical evidence suggests that the long-chain omega-3 fatty acid docosahexaenoic acid (DHA) is important for neurodevelopment, little is known about its role in human cortical structural and functional maturation. In the present cross-sectional study, we investigated the relationship between DHA biostatus and functional connectivity in cortical attention networks of typically developing children.

Methods: Male children (aged 8–10 years, n?=?36) were divided into ‘low-DHA’ (n?=?18) and ‘high-DHA’ (n?=?18) biostatus groups by a median split of erythrocyte DHA levels. Event-related functional connectivity during the performance of a sustained attention task (identical pairs continuous performance task (CPT-IP)) was conducted using functional magnetic resonance imaging. A voxelwise approach used the anterior cingulate cortex (ACC) as the seed-region.

Results: Erythrocyte DHA composition in the low-DHA group (2.6?±?0.9%) was significantly lower than the high-DHA group (4.1?±?1.1%, P?≤?0.0001). Fish intake frequency was greater in the high-DHA group (P?=?0.003) and was positively correlated with DHA levels among all subjects. The low-DHA group exhibited reduced functional connectivity between the ACC and the ventrolateral prefrontal cortex, insula, precuneus, superior parietal lobule, middle occipital gyrus, inferior temporal gyrus, and lingual gyrus compared with the high-DHA group (P?P?=?0.03) which was inversely correlated with erythrocyte DHA among all subjects.

Discussion: These data suggest that low-DHA biostatus is associated with reduced event-related functional connectivity in cortical attention networks of typically developing children.     

Macular pigment optical density is positively associated with academic performance among preadolescent children

Objective: Macular pigment optical density (MPOD) – a non-invasive indicator of retinal xanthophylls and correlate of brain lutein – has been associated with superior cognitive function among adult populations. Given that lutein accumulation in the brain occurs in early life, it is possible that the cognitive implications of greater MPOD may be evident in childhood.

Methods: Participants aged 8–9 years (n?=?56) completed MPOD measurements via heterochromatic flicker photometry. Academic performance was assessed using the Kaufman Test of Academic and Educational Achievement II (KTEA). Habitual dietary intake of L and Z was measured among a subsample of participants (n?=?35) using averaged 3-day food records. Stepwise hierarchical regression models were developed to determine the relationship between MPOD and academic achievement tests, following the adjustment of key covariates including sex, aerobic fitness, body composition, and intelligence quotient (IQ).

Results: The regression analyses revealed that MPOD improved the model, beyond the covariates, for overall academic achievement (ΔR²?=?0.10, P?R²?=?0.07, P?=?0.02), and written language composite standard scores (ΔR²?=?0.15, P?Discussion: This is the first study to demonstrate that retinal L and Z, measured as MPOD, is positively related to academic achievement in children, even after accounting for the robust effects of IQ and other demographic factors. These findings extend the positive associations observed between MPOD and cognitive abilities to a pediatric population.

Trail registration: The Fitness Improves Thinking in Kids 2 (FITKids2) trial was registered at www.clinicaltrials.gov as NCT01619826.