Herbal Health Connections

Ryan, Aoife M. PhD; Reynolds, John V. MD; Healy, Laura BSc; Byrne, Miriam MD; Moore, Jennifer RN; Brannelly, Niamh BSc; McHugh, Aisling BSc; McCormack, Deirdre BSc; Flood, Philomena BSc

Abstract

Background: Esophagectomy represents an exemplar of controlled major trauma, with marked metabolic, immunologic, and physiologic changes as well as an associated high incidence of complications. Eicosapentaenoic acid (EPA) enriched enteral nutrition (EN) modulates immune function and limits catabolism in patients with advanced cancer, but its impact in the peri-operative period is unclear.

Objectives: To examine the effects of perioperative EPA enriched EN on the metabolic, nutritional, and immuno-inflammatory response to esophagectomy, and on postoperative complications.

Methods: In a double-blind design, patients were randomized to a standard EN formula or a formula enriched with 2.2 g EPA/d for 5 days preoperatively (orally) and 21 days postoperatively (jejunostomy). Segmental bioelectrical impedance analysis was performed preoperatively and on POD 21. Postoperative complications were monitored, as well as the acute phase response, coagulation markers, and serum cytokines.

Results: Fifty-three patients (28 EPA, 25 standard) completed the study, and both groups were well matched. Serum and peripheral blood mononuclear cell (PBMC) membrane EPA levels were significantly increased in the EPA group. There was no difference in the incidence of major complications. The EPA group maintained all aspects of body composition postoperatively, whereas patients in the standard EN group lost significant amounts of fat-free mass (1.9 kg, P = 0.030) compared with the EPA group [leg (0.3 kg, P = 0.05), arm (0.17 kg, P = 0.01), and trunk (1.44 kg, P = 0.03)]. The EPA group had a significantly (P < 0.05) attenuated stress response for TNFα, IL-10, and IL-8 compared with the standard group.

Conclusions: EPA supplemented early EN is associated with preservation of lean body mass post esophagectomy compared with a standard EN. These properties may merit longer-term study to address its impact on recovery of function and quality of life in models of complex surgery or multimodal cancer treatment regimens.

Annals of Surgery:

March 2009 - Volume 249 - Issue 3 - pp 355-363

Background: The positive association between obesity and postmenopausal breast cancer has been attributed, in part, to the fact that estrogen, a risk factor for breast cancer, is synthesized in adipose tissue. Obesity is also associated with high levels of insulin, a known mitogen. However, no prospective studies have directly assessed associations between circulating levels of insulin and/or insulin-like growth factor (IGF)-I, a related hormone, and the risk of breast cancer independent of estrogen level.

Methods: We conducted a case–cohort study of incident breast cancer among nondiabetic women who were enrolled in the Women’s Health Initiative Observational Study (WHI-OS), a prospective cohort of 93 676 postmenopausal women. Fasting serum samples obtained at study entry from 835 incident breast cancer case subjects and from a subcohort of 816 randomly chosen WHI-OS subjects were tested for levels of insulin, glucose, total IGF-I, free IGF-I, insulin-like growth factor binding protein-3, and estradiol. Multivariable Cox proportional hazards models were used to estimate associations between levels of the serologic factors and baseline characteristics (including body mass index [BMI]) and the risk of breast cancer. All statistical tests were two-sided.

Results: Insulin levels were positively associated with the risk of breast cancer (hazard ratio [HR] for highest vs lowest quartile of insulin level = 1.46, 95% confidence interval [CI] = 1.00 to 2.13, P_trend = .02); however, the association with insulin level varied by hormone therapy (HT) use (P_interaction = .01). In a model that controlled for multiple breast cancer risk factors including estradiol, insulin level was associated with breast cancer only among nonusers of HT (HR for highest vs lowest quartile of insulin level = 2.40, 95% CI = 1.30 to 4.41, P_trend < .001). Obesity (BMI 30 kg/m²) was also associated with the risk of breast cancer among nonusers of HT (HR for BMI 30 kg/m² vs 18.5 to <25 kg/m² = 2.12, 95% CI = 1.26 to 3.58, P_trend = .003); however, this association was attenuated by adjustment for insulin (P_trend = .40).

Conclusion: These data suggest that hyperinsulinemia is an independent risk factor for breast cancer and may have a substantial role in explaining the obesity–breast cancer relationship.

J Natl Cancer Inst 2009 101: 1. [Extract] [Full Text] [PDF]

Figueiredo JC, Grau MV, Haile RW, Sandler RS, Summers RW, Bresalier RS, Burke CA, McKeown-Eyssen GE, Baron JA.

Affiliations of authors: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (JCF, RWH); Departments of Medicine and Community and Family Medicine, Dartmouth Medical School, Hanover, NH (MVG, JAB); Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC (RSS); Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA (RWS); Department of Gastrointestinal Medicine and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX (RSB); Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH (CAB); Dalla Lana School of Public Health and Department of Nutritional Sciences, University of Toronto, Toronto, Canada (GEM-E).

Data regarding the association between folate status and risk of prostate cancer are sparse and conflicting. We studied prostate cancer occurrence in the Aspirin/Folate Polyp Prevention Study, a placebo-controlled randomized trial of aspirin and folic acid supplementation for the chemoprevention of colorectal adenomas conducted between July 6, 1994, and December 31, 2006. Participants were followed for up to 10.8 (median = 7.0, interquartile range = 6.0-7.8) years and asked periodically to report all illnesses and hospitalizations. Aspirin alone had no statistically significant effect on prostate cancer incidence, but there were marked differences according to folic acid treatment. Among the 643 men who were randomly assigned to placebo or supplementation with folic acid, the estimated probability of being diagnosed with prostate cancer over a 10-year period was 9.7% (95% confidence interval [CI] = 6.5% to 14.5%) in the folic acid group and 3.3% (95% CI = 1.7% to 6.4%) in the placebo group (age-adjusted hazard ratio = 2.63, 95% CI = 1.23 to 5.65, Wald test P = .01). In contrast, baseline dietary folate intake and plasma folate in nonmultivitamin users were inversely associated with risk of prostate cancer, although these associations did not attain statistical significance in adjusted analyses. These findings highlight the potential complex role of folate in prostate cancer and the possibly different effects of folic acid-containing supplements vs natural sources of folate.

J Natl Cancer Inst. 2009 Mar 10. [Epub ahead of print]

Cramp F, Daniel J.

University of the West of England, School of Allied Health Professions, Glenside Campus, Blackberry Hill, Bristol, UK, BS16 1DD. fiona.cramp@uwe.ac.uk

BACKGROUND: Cancer-related fatigue is now recognised as an important symptom associated with cancer and its treatment. A number of studies have investigated the effects of physical activity in reducing cancer-related fatigue with no definitive conclusions regarding its effectiveness.

OBJECTIVES: To evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment.

SEARCH STRATEGY: The Cochrane Controlled Trials Register (CENTRAL/CCTR), MEDLINE (1966 to July 2007), EMBASE (1980 to July 2007), CINAHL (1982 to July 2007), British Nursing Index (January 1984 to July 2007), AMED (1985 to July 2007), SIGLE (1980 to July 2007), and Dissertation Abstracts International (1861 to July 2007) were all searched using key words. Reference lists off all studies identified for inclusion and relevant reviews were also searched. In addition, relevant journals were hand searched and experts in the field of cancer-related fatigue were contacted.

SELECTION CRITERIA: Randomised controlled trials (RCTs) that investigated the effect of exercise on cancer-related fatigue in adults were included.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the methodological quality of studies and extracted data based upon predefined criteria. Where data were available meta-analyses were performed for fatigue using a random-effects model.

MAIN RESULTS: Twenty-eight studies were identified for inclusion (n = 2083 participants), with the majority carried out on participants with breast cancer (n = 16 studies; n = 1172 participants). A meta-analysis of all fatigue data, incorporating 22 comparisons provided data for 920 participants who received an exercise intervention and 742 control participants. At the end of the intervention period exercise was statistically more effective than the control intervention (SMD -0.23, 95% Confidence Interval (CIs) -0.33 to -0.13).

AUTHORS’ CONCLUSIONS: Exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post cancer therapy. Further research is required to determine the optimal type, intensity and timing of an exercise intervention.

Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006145.

Comment in:

Aust J Physiother. 2008;54(3):216.