- Email: [email protected]
The effect of diet changes on the immune system of breast cancer patients
TUESDAY, OCTOBER 26 POSTER SESSION: CLINICAL NUTRITION THE EFFECT OF DIET CHANGES ON THE IMMUNE SYSTEM OF BREAST CANCER PATIENTS. B.K. Garritson, MS, RD, LD, A. Nikaein, PhD, M.A. Goeran, PhD, RD, LD, G.N. Peters, MD, C. King, PhD, and G.U. Liepa, PhD, Department of Nutrition, Texas Woman's University, Denton, TX and Baylor University Medical Center, Dallas, TX A pilot study was conducted to evaluate the effect of diet on immune function in breast cancer patients. Nine premenopausal post therapy breast cancer patients were included in this study. On day 0, patients were instructed to go off their own diet and to follow the American Cancer Society (ACS) dietary guidelines for the next 28 days. The ACS dietary guidelines followed were high in fiber and consisted of 20% of total calories frm fat. On day 29, patients were instructed to continue following the ACS dietary guidelines but to also include fish which were high in w-3 fatty acids (fa) [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] in their diet 5 times per week through day 56. Twenty-four hour urine samples, blood samples, and 3 day diet records were obtained on days 0, 28, and 56. Patients were monitored for their lymphocyte subsets, T cell function (T cell proliferation and cytolytic response), and urinary prostaglandin E2 (PGE 2 ). Due to diet changes, percent calories from fat decreased from day 0 to days 28 (p=.002) and 56 (p=.004). Serum -3 fa, EPA increased from day 28 to 22 56 (p=.016), and DHA increased from day 28 to 56 (p=.0 ). The pecentage of C04 T cells (helper T cells) increased from day 0 to day 28 and day 56 (p=.0476). The percentage of CD8 T cells (cytotoxic/suppressor 4 T ells) deceased from day 0 to days 28 and 56 (p=.002 ). The CD4/CD8 ratio also changed by days 28 and 56 (p=.0004). Functional studies showed that proliferation of T helper cells [measured in mixed lymphocyte culture 0 52 (MLC)] increased from day 0 to days 28 and 56 (p=.0 ). Significant changes were not observed in cytolytic activity of T cells [measured by cell mediated lysis (CML)], NK cells, total T and B cells, or in urinary PGE 2 . The results of the study suggest that breast cancer patients may benefit from following ACS dietary guidelines and consuming fish high in w-3 fi to enhance their immune system.
NITROGEN, CALCIUM, PHOSPHORUS, AND FAT BALANCE STUDIES IN HEALTHY INFANTS FED AN ISOLATED WHEY PROTEIN-BASED FORMULA. M. Giotta, MS, RD, M. Rice-Asaro, MS, RD, and W.L. Nyhan, MD, PhD, Department of Pediatrics, University of California-San Diego, San Diego CA
LOSERS CAN BECOME BIG WINNERS:THE DALLAS COWBOYS COACHES STUDY.C.S.Ireton-Jones,PhD,RD and P.G. Snell, PhD, Good Nutrition for Good Living and University of Texas Southwestern Medical Center, Dallas, TX. This study was done to examine the efficacy of strength (weight) training and moderately decreased caloric intake to increase lean body mass and decrease body fat. We tested the hypothesis that increasing lean mass (LM) during fat loss would prevent a decrease in resting metabolic rate (RMR). Subjects followed a specific diet plan with daily caloric intake decreased by 100 kcal every two weeks for 6 weeks (males 1600 to 1400 kcal, females 1400 to 1200 kcal) while they began an ascending exercise program of weight training. Weight training consisted of 3 sessions/week, averaging 20 minutes/session, using a very slow protocol of 10 seconds of weight lifting and 2 seconds of weight lowering for 3-6 repetitions. Body fat % and LM were assessed from multiple site skinfold measurements. RMR(kcal/d) was measured using indirect calorimetry (MRMR) and predicted from the Harris-Benedict equations (PRMR). Results for 6 male NFL coaches(ht-73+3 ins,age-41+3 yrs) and 5 females (ht-67+2 ins, age-35+4 yrs) are: Pre and Post Data Collected (Mean + SD): Males Females Wt(lbs)221+ 10(a) 201+ 9(b) 144+ 15 136+ 15 Fat(%) 30+ 3(a) 20+ 4(b) 31+ 5(c) 21+ 2(d) LM(lbs)156+ 12 162+ 12 102+ 10 108+ 11 PRMR 2098+ 12 1980+ 71 1425+ 80 1389+ 84 MRMR 1730+203(c) 2002+192(d)1453+123 1381+117 (a vs b, p = 0.001, c vs d, p = 0.05) All subjects lost weight and body fat and increased lean mass during the study. Males lost significantly more weight and fat than females, however there was no difference in LM gained. Body fat % was significantly lower in both males and females. At the conclusion of the 6 week study period, MRMR was significantly higher in the males but did not change in the females indicating preservation of LM during weight reduction combined with weight training exercise.
SUCCESSFUL TREATMENT OF LONG-CHAIN 3HYDROXYACYL-COENZYME A DEHYDROGENASE DEFICIENCY WITH AN ELEMENTAL FORMULA PREPARATION.
Although modern infant formulas meet the needs of infants when breast milk is not available, the optimum formula for normal full-term infants has probably not yet been defined. The source of the macronutrients protein, carbohydrate, and fat differs significantly among specific formula types. These are formulas based on cow's milk protein, soy protein, or hydrolyzed protein; those with and without lactose; and containing various blends of vegetable and animal oils. Formulas undergo clinical testing to assure adequate nutritional utilization before they are marketed according to the requirements of the Food and Drug Administration. In an attempt to more closely define an optimum formula, a whey-based ironfortified formula from Nutricia-Loma Linda, Inc., was fed ad lib to 6 full-term healthy weight-appropriate infants, 4 male and 2 female, 2 to 6 months of age. Infants were fed the study formula 2 weeks prior to the metabolic balance studies; only study formula was permitted 48 hrs. prior to collections. Infants were admitted to a clinical research center for 3-day collections of urine and stool to analyze nitrogen, calcium, phosphorus, and fat absorption and retention while being fed the study formula ad lib. Biochemical parameters monitored included a hemogram and chemistry panel. Mean caloric intake was 108.16 + 22.96 kcals/kg/d. Mean absorption and retention percentages were, respectively: nitrogen (92.30 + 5.63; 36.70 + 7.28); calcium (57.17 + 23.30; 49.54 + 25.18); phosphorus (89.42 + 7.00; 57.51 + 8.50); fat (97.80 + 0.76; 97.80 + 0.76). The formula met or exceeded the nutrient absorption and retention ratios of previously published data on infants fed a similar whey-based formula. All biochemical determinations were within normal limits. This study indicated the formula tested was nutritionally adequate for nitrogen, calcium, phosphorus, and fat in healthy, term infants.
C.B. Kusenda, RD, CNSD and S.M. Willi, MD, Department of Pediatrics, Medical University of South Carolina, Charleston, SC. Tolerex" supplemented with medium-chain triglyceride (MCT) was used to treat an infant with a rare inborn error of long-chain fatty acid metabolism. A 3 month old infant was admitted to the Medical University of South Carolina with dehydration, diarrhea, vomiting, lethargy, failure to thrive, and hepatitis of unknown etiology. During the course of her hospitalization she received Pregestimil concentrated to 24 Calories Cals) per ounce. Pregestimil has 36 grams of fat per liter with 60% as MCT and 40% as long-chain triglyceride (LCT). She failed to gain weight after five weeks, so LCT was added to increase caloric density to 28 Cals per ounce. Due to increased stooling on this formulation, the LCT supplementation was discontinued. During her hospitalization, she was subjected to a fasting study. This was terminated at 19 hours when her blood sugar fell to 36 mgidl. Serum free fatty acid levels rose but ,-hydroxybutyrate failed to rise above 10% of expected. In addition, a serum acyl carnitine profile showed dramatic elevations of long-chain species including 3-hydroxy compounds. A diagnosis of long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency was made based on these findings. Since this condition is characterized by an inability to break down long-chain fatty acids, it was deemed appropriate to use a formula that is low in LCT. Tolerex, a low fat formula, was supplemented with MCT oil as the primary fat source and enough safflower oil to meet essential fatty acid needs. By contrast, this formulation contains 40 Cals per ounce and provides 150 Calslkg and 2.3 grams protein/kg. The RDA for all nutrients was satisfied by the addition of appropriate vitamins and minerals. Frequent feedings were provided to allow a constant supply of energy and prevent the mobilization of stored long-chain fats. Over a two month period on this formula, the patient experienced dramatic catch-up growth. Weight increased from below the first percentile(%) to the 10%, head circumference increased from the 10% to the 25%, and weight for height ratio increased from < 5% to the 25% on the National Center for Health Statistic Growth Charts. Average weight gain increased from 7.6 grams to 28.5 grams per day when the Tolerex formulation was used. Liver function tests also normalized. This patient's successful recovery with the use of a diet very low in long-chain fatty acids validates the diagnosis and confirms the mode of dietary treatment.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-29
NITROGEN, CALCIUM, PHOSPHORUS, AND FAT BALANCE STUDIES IN HEALTHY INFANTS FED AN ISOLATED WHEY PROTEIN-BASED FORMULA. M. Giotta, MS, RD, M. Rice-Asaro, MS, RD, and W.L. Nyhan, MD, PhD, Department of Pediatrics, University of California-San Diego, San Diego CA
LOSERS CAN BECOME BIG WINNERS:THE DALLAS COWBOYS COACHES STUDY.C.S.Ireton-Jones,PhD,RD and P.G. Snell, PhD, Good Nutrition for Good Living and University of Texas Southwestern Medical Center, Dallas, TX. This study was done to examine the efficacy of strength (weight) training and moderately decreased caloric intake to increase lean body mass and decrease body fat. We tested the hypothesis that increasing lean mass (LM) during fat loss would prevent a decrease in resting metabolic rate (RMR). Subjects followed a specific diet plan with daily caloric intake decreased by 100 kcal every two weeks for 6 weeks (males 1600 to 1400 kcal, females 1400 to 1200 kcal) while they began an ascending exercise program of weight training. Weight training consisted of 3 sessions/week, averaging 20 minutes/session, using a very slow protocol of 10 seconds of weight lifting and 2 seconds of weight lowering for 3-6 repetitions. Body fat % and LM were assessed from multiple site skinfold measurements. RMR(kcal/d) was measured using indirect calorimetry (MRMR) and predicted from the Harris-Benedict equations (PRMR). Results for 6 male NFL coaches(ht-73+3 ins,age-41+3 yrs) and 5 females (ht-67+2 ins, age-35+4 yrs) are: Pre and Post Data Collected (Mean + SD): Males Females Wt(lbs)221+ 10(a) 201+ 9(b) 144+ 15 136+ 15 Fat(%) 30+ 3(a) 20+ 4(b) 31+ 5(c) 21+ 2(d) LM(lbs)156+ 12 162+ 12 102+ 10 108+ 11 PRMR 2098+ 12 1980+ 71 1425+ 80 1389+ 84 MRMR 1730+203(c) 2002+192(d)1453+123 1381+117 (a vs b, p = 0.001, c vs d, p = 0.05) All subjects lost weight and body fat and increased lean mass during the study. Males lost significantly more weight and fat than females, however there was no difference in LM gained. Body fat % was significantly lower in both males and females. At the conclusion of the 6 week study period, MRMR was significantly higher in the males but did not change in the females indicating preservation of LM during weight reduction combined with weight training exercise.
SUCCESSFUL TREATMENT OF LONG-CHAIN 3HYDROXYACYL-COENZYME A DEHYDROGENASE DEFICIENCY WITH AN ELEMENTAL FORMULA PREPARATION.
Although modern infant formulas meet the needs of infants when breast milk is not available, the optimum formula for normal full-term infants has probably not yet been defined. The source of the macronutrients protein, carbohydrate, and fat differs significantly among specific formula types. These are formulas based on cow's milk protein, soy protein, or hydrolyzed protein; those with and without lactose; and containing various blends of vegetable and animal oils. Formulas undergo clinical testing to assure adequate nutritional utilization before they are marketed according to the requirements of the Food and Drug Administration. In an attempt to more closely define an optimum formula, a whey-based ironfortified formula from Nutricia-Loma Linda, Inc., was fed ad lib to 6 full-term healthy weight-appropriate infants, 4 male and 2 female, 2 to 6 months of age. Infants were fed the study formula 2 weeks prior to the metabolic balance studies; only study formula was permitted 48 hrs. prior to collections. Infants were admitted to a clinical research center for 3-day collections of urine and stool to analyze nitrogen, calcium, phosphorus, and fat absorption and retention while being fed the study formula ad lib. Biochemical parameters monitored included a hemogram and chemistry panel. Mean caloric intake was 108.16 + 22.96 kcals/kg/d. Mean absorption and retention percentages were, respectively: nitrogen (92.30 + 5.63; 36.70 + 7.28); calcium (57.17 + 23.30; 49.54 + 25.18); phosphorus (89.42 + 7.00; 57.51 + 8.50); fat (97.80 + 0.76; 97.80 + 0.76). The formula met or exceeded the nutrient absorption and retention ratios of previously published data on infants fed a similar whey-based formula. All biochemical determinations were within normal limits. This study indicated the formula tested was nutritionally adequate for nitrogen, calcium, phosphorus, and fat in healthy, term infants.
C.B. Kusenda, RD, CNSD and S.M. Willi, MD, Department of Pediatrics, Medical University of South Carolina, Charleston, SC. Tolerex" supplemented with medium-chain triglyceride (MCT) was used to treat an infant with a rare inborn error of long-chain fatty acid metabolism. A 3 month old infant was admitted to the Medical University of South Carolina with dehydration, diarrhea, vomiting, lethargy, failure to thrive, and hepatitis of unknown etiology. During the course of her hospitalization she received Pregestimil concentrated to 24 Calories Cals) per ounce. Pregestimil has 36 grams of fat per liter with 60% as MCT and 40% as long-chain triglyceride (LCT). She failed to gain weight after five weeks, so LCT was added to increase caloric density to 28 Cals per ounce. Due to increased stooling on this formulation, the LCT supplementation was discontinued. During her hospitalization, she was subjected to a fasting study. This was terminated at 19 hours when her blood sugar fell to 36 mgidl. Serum free fatty acid levels rose but ,-hydroxybutyrate failed to rise above 10% of expected. In addition, a serum acyl carnitine profile showed dramatic elevations of long-chain species including 3-hydroxy compounds. A diagnosis of long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency was made based on these findings. Since this condition is characterized by an inability to break down long-chain fatty acids, it was deemed appropriate to use a formula that is low in LCT. Tolerex, a low fat formula, was supplemented with MCT oil as the primary fat source and enough safflower oil to meet essential fatty acid needs. By contrast, this formulation contains 40 Cals per ounce and provides 150 Calslkg and 2.3 grams protein/kg. The RDA for all nutrients was satisfied by the addition of appropriate vitamins and minerals. Frequent feedings were provided to allow a constant supply of energy and prevent the mobilization of stored long-chain fats. Over a two month period on this formula, the patient experienced dramatic catch-up growth. Weight increased from below the first percentile(%) to the 10%, head circumference increased from the 10% to the 25%, and weight for height ratio increased from < 5% to the 25% on the National Center for Health Statistic Growth Charts. Average weight gain increased from 7.6 grams to 28.5 grams per day when the Tolerex formulation was used. Liver function tests also normalized. This patient's successful recovery with the use of a diet very low in long-chain fatty acids validates the diagnosis and confirms the mode of dietary treatment.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-29