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Cancer cachexia is a complex multifactorial syndrome whose hallmarks are weight loss due to the wasting of muscle tissue with or without the loss of adipose tissue, anorexia, systemic inflammation, and multi-organ metabolic alterations, which negatively impact patients’ response to anticancer treatments, quality of life, and overall survival. Despite its clinical relevance, cancer cachexia often remains an underestimated complication due to the lack of rigorous diagnostic and therapeutic pathways. A number of studies have shown alterations in gut microbiota diversity and composition in association with cancer cachexia markers and symptoms, thus supporting a central role for dysbiosis in the pathogenesis of this syndrome. Different tools of microbiota manipulation, including probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have been investigated, demonstrating encouraging improvements in cachexia outcomes. Albeit pioneering, these studies pave the way for future research with the aim of exploring the role of gut microbiota in cancer cachexia more deeply and setting up effective microbiota-targeting interventions to be translated into clinical practice.

The aim of this study was to identify and quantify faecal indicator bacteria in blackwater collected from a source separation unit and determine the amount of E. coli isolates resistant to antimicrobials and their potential to produce extended spectrum β-lactamases (ESβLs) and metallo-β-lactamases (MβLs), which hydrolyse the most important antibiotics used in clinical practice. Most of the isolates were resistant to amoxicillin with clavulanic acid (36.4 %), followed by ticarcillin with clavulanic acid (22.7 %) and tetracycline (18.2 %). ESβL-producing genes blaCTX-M and blaTEM were found in three (13.6 %) and four (18.2 %) E. coli strains, respectively, while MβL genes were found in two (9.1 %). By separating at source, this pilot study clearly shows that gastrointestinal bacteria of healthy people can be an important source of antibiotic resistance released into the environment through wastewaters. One way to prevent that is to treat wastewater with a combination of TiO2, UV light, or ozone, as successful methods to remove resistant bacteria and prevent their spread in the environment., V vzorcih črne vode, ki je ena od frakcij odpadne vode, smo ugotavljali prisotnost in število fekalnih indikatorskih bakterij, vključno z bakterijo Escherichia coli (E. coli). Pri osamljenih sevih E. coli smo ugotavljali njihovo odpornost proti izbranim antibiotikom in njihov potencial za tvorbo nekaterih β-laktamaz razširjenega spektra in metalo-β-laktamaz. Preizkušeni sevi so bili najpogosteje odporni proti amoksicilinu s klavulansko kislino (36,4 %), tikarcilinu s klavulansko kislino (22,7 %) in tetraciklinu (18,2 %). Nukleotidne sekvence za blaCTX-M in blaTEM smo našli pri treh (13,6 %) in štirih (18,2 %) sevih, medtem ko smo gene za izbrane metalo-β-laktamaze ugotovili pri dveh (9,1 %) sevih E. coli. Pilotna študija, z ločevanjem odpadne vode na viru nastanka, kaže, da so bakterije v prebavnem traktu zdravih ljudi lahko pomemben vir prenosa odpornosti proti antibiotikom v okolju preko odpadne vode. Eden izmed načinov za preprečevanje širjenja odpornosti proti antibiotikom je čiščenje odpadne vode z uporabo kombinacije TiO2, UV svetlobe in ozona, ki so se pokazale kot uspešne metode za odstranjevanje bakterij, odpornih proti antibiotikom.

Reactive oxygen species (ROS) are substances generated as a result of metabolic reactions in the eukaryotic cells’ mitochondria. Tumor cells, which show an accelerated metabolism, require elevate concentrations of ROS to maintain a high rate of cell proliferation. The implications for the regulation of ROS are very significant for cancer therapy, because the radiotherapeutic and chemotherapeutic drugs, that are generally used, influence the outcome of the tumor through modulation of ROS. Omega-3 polyunsaturated fatty acids (PUFA) are considered as immunonutrients and are commonly used in the nutritional therapy of cancer patients because of their broad biological effects. Omega-3 PUFA play an essential role in cell signaling, during the formation of the cell structure and for the membrane fluidity. They also participate in the resolution of inflammation and have an anti-inflammatory action. This chapter focuses on the assumptions that support the use of omega-3 fatty acids as a tool to reduce oxidative stress in cancer patients.

Melanoma is an aggressive skin cancer, whose incidence rates have increased over the past few decades. Risk factors for melanoma are both intrinsic (genetic and familiar predisposition) and extrinsic (environment, including sun exposure, and lifestyle). The recent advent of targeted and immune-based therapies has revolutionized the treatment of melanoma, and research is focusing on strategies to optimize them. Obesity is an established risk factor for several cancer types, but its possible role in the etiology of melanoma is controversial. Body mass index, body surface area, and height have been related to the risk for cutaneous melanoma, although an ‘obesity paradox’ has been described too. Increasing evidence suggests the role of nutritional factors in the prevention and management of melanoma. Several studies have demonstrated the impact of dietary attitudes, specific foods, and nutrients both on the risk for melanoma and on the progression of the disease, via the effects on the oncological treatments. The aim of this narrative review was to summarize the main literature results regarding the preventive and therapeutic role of nutritional schemes, specific foods, and nutrients on melanoma incidence and progression.

Objective Some authors have hypothesized that caloric restriction (CR) could determine a reduction in the onset of some types of cancer and in their progression. The aim of the study is to compare the efficacy of CR combined with neoadjuvant chemotherapy versus a standard diet combined with neo-CT in women with breast cancer (BC). Methods and procedures 81 patients were enrolled, 22 in the CR group and 59 in the control group. CR scheme was designed as follow: caloric intake reduced by 50% of total energy expenditure in the 48h before and in the neo-CT day; by 30% the following days until T2 (6 months). Results The analysis at T2 are showing that in the CR group 72,2% had a complete response to the treatment while in the control group the 28,8% had a complete response. The results highlight a positive effect of the CR on the response to the therapy (OR=4.12 95%CI from 1.29 to 13.11). Conclusion The results obtained show that CR, monitored by a nutritionist and a trained dietitian, could represent an effective and inexpensive method in strengthening the cytotoxicity of standard neo-CT, both in terms of size reduction and malignancy reduction in BC, leading to a better clinical outcome.

Medical nutritional therapy is the first-line approach in managing gestational diabetes mellitus (GDM). Diet is also a powerful modulator of the gut microbiota, whose impact on insulin resistance and the inflammatory response in the host are well known. Changes in the gut microbiota composition have been described in pregnancies either before the onset of GDM or after its diagnosis. The possible modulation of the gut microbiota by dietary interventions in pregnancy is a topic of emerging interest, in consideration of the potential effects on maternal and consequently neonatal health. To date, very few data from observational studies are available about the associations between diet and the gut microbiota in pregnancy complicated by GDM. In this review, we analyzed the available data and discussed the current knowledge about diet manipulation in order to shape the gut microbiota in pregnancy.

Objectives Breast cancer (BC) is the most diagnosed cancer in women. Increasing survival rates shift attention to preventive strategies. Obesity and intestinal microbiota composition may be associated with BC. A Mediterranean diet (MD) proved to be protective. The aim of this study was to assess the efficacy of probiotics in addition to an MD versus diet alone in influencing gut microbiota and metabolic profile in overweight BC survivors. Methods A total of 34 BC survivors were randomly assigned to an MD for 4 mo plus 1 sachet/d of probiotics (Bifidobacterium longum BB536, Lactobacillus rhamnosus HN001) for the first 2 mo (intervention group, n = 16) or an MD alone for 4 mo (control group, n = 18). Anthropometric and nutritional assessments, adherence to the MD, compliance with physical activity, and metabolic parameters dosage were performed at baseline (T0), at 2 mo (T2), and at 4 mo (T4). Intestinal microbiota analysis was performed at T0 and T2. Results After 2 mo of probiotic administration the number of bacterial species (P = 0.01) and the bacterial diversity assessed with the Chao1 index (P = 0.004) significantly increased; no significant variations were detected after diet alone. The Bacteroidetes-to-Firmicutes ratio significantly decreased in the intervention group and increased in controls (P = 0.004). Significant reductions of body weight, body mass index, fasting glucose, and homeostasis model assessment of insulin resistance were identified at T4 in both groups; in the intervention group waist circumference (P = 0.012), waist-to-hip ratio (P = 0.045), and fasting insulin (P = 0.017) also significantly decreased. Conclusions Probiotics in addition to an MD positively influence gut microbiota and improve metabolic and anthropometric parameters compared with an MD alone.

In the original publication, article was published with a wrong title as 'Risk, prevalence, and impact of hospital malnutrition in a Tertiary Care Referral University Hospital: a cross-sectional study' and also one of the references has been omitted in the reference list. The correct article title should be read as 'Clinical impact of hospital malnutrition'.

Summary Aims Consumption of Western foods with high dietary glycemic load is associated with breast cancer development, whereas adherence to Mediterranean diet has been linked to a reduced risk. Changing lifestyle can decrease risk of recurrences and mortality. Thus decreasing the weight, improving the diet and promoting lifestyle are among of the most important issues of public health. We evaluated the effects of a specific educational intervention conducted by dietitians, nutritionists physicians, oncologist and sport physician to promote lifestyle in breast cancer survivors. Methods We recruited 100 pts in breast cancer follow up. The intervention program consisted of four meetings once a week including lectures, training sessions and workshops lasting overall a month. Dietary recommendations were provided on the basis of WCRF/AICR guidelines and were modelled on Mediterranean diet. Sport physician recommended adapted physical activity, based on clinical experiences and scientific evidences. Results Significantly decrease of BMI and waist circumference was observed after 2 and 6 months. Adherence to Mediterranean diet was significantly improved, both in heightening typical Mediterranean foods, both in decreasing consumption of non typical foods. At baseline 63% of women was inactive, 37% was mild active and 0% active, while at the end inactive patients felt by half (30%) and mild active women almost doubled (67%). Conclusions We found this dietary intervention effective in reducing BMI and waist circumference, and enhancing healthy lifestyle in BC survivors. It has surely contributed to achieve these results besides the change in diet quality, mostly a marked reduction in sedentary habits.

Reactive oxygen species (ROS) are involved in both cancer generation and therapy. Lung carcinogenesis agents, such as tobacco-smoking or inorganic substances, exert their carcinogenic effects through oxidative stress. The presence of a chronic inflammatory microenvironment, which is associated with oxidative stress, is also important in carcinogenesis. Conversely, some antineoplastic agents, including radiation and chemotherapeutics, exert their antineoplastic effect by inducing cell damage via ROS-mediated toxicity. Since the production of ROS can also cause cell injury, by stimulating lipid peroxidation, increasing the substrate for lipid peroxidation in tumor cells may be an important goal in improving the effects of antineoplastic agents. Some studies suggest that n-3 polyunsaturated fatty acids (PUFAs) enhance oxidative stress in cancer cells and, at the same time, decrease the inflammatory response during radiotherapy and chemotherapy; they might thus be considered a preliminary goal in anticancer and anticachectic therapy.

PUFA from fish oil appear to have anti-inflammatory and anti-oxidative effects and improve nutritional status in cancer patients. With this as background, the aim of the present study was to investigate the effect of EPA plus DHA on inflammatory condition, and oxidative and nutritional status in patients with lung cancer. In our multicentre, randomised, double-blind trial, thirty-three patients with a diagnosis of advanced inoperable non-small-cell lung cancer and undergoing chemotherapy were divided into two groups, receiving four capsules/d containing 510 mg of EPA and 340 mg of DHA, or 850 mg of placebo, for 66 d. At the start of chemotherapy (T0), after 8 d (T1), 22 d (T2) and 66 d (T3), biochemical (inflammatory and oxidative status parameters) and anthropometric parameters were measured in both groups. A significant increase of body weight in the n-3 group at T3v. T0 was observed. Concerning inflammation, C-reactive protein and IL-6 levels differed significantly between the n-3 and placebo groups at T3, and progressively decreased during chemotherapy in the n-3 group, evidencing n-3 PUFA anti-inflammatory action. Concerning oxidative status, plasma reactive oxygen species levels increased in the placebo group v. the n-3 group at the later treatment times. Hydroxynonenal levels increased in the placebo group during the study, while they stabilised in the n-3 group. Our data confirm that the continual assumption of EPA plus DHA determined an anti-inflammatory and anti-oxidative action which could be considered a preliminary goal in anti-cachectic therapy.

In clinical practice, basal insulin dosage (BID) for the treatment for type 2 diabetes given as slow-acting analogues or NPH insulin varies widely when adjusted for body weight (UI/kg). In this study, we investigated the interrelationship between BID and anthropometric, laboratory and clinical parameters. A total of 681 type 2 diabetic patients, treated with bedtime insulin in association with other antidiabetic drugs (preprandial insulin and/or oral agents), were studied. Anthropometric, clinical and biochemical parameters, as well as micro- and macrovascular complications, were evaluated. Non-alcoholic fatty liver disease (NAFLD) was assessed by liver ultrasound. BID was titrated to achieve a fasting blood glucose target of ≤6.7 mmol/L (120 mg/dL). In the multivariate analysis, BID was significantly associated with waist circumference (p = 0.04) and the insulin treatment duration (p = 0.004) as the type of insulin treatment (“basal-bolus” regimen vs. basal insulin only, p < 0.0001), the use of lipid-lowering drugs (p = 0.0003) and insulin sensitizers (p = 0.005). Several glycometabolic parameters were strongly associated with BID (HbA1c p = 0.01, FPG p < 0.0001, HDL p = 0.02, triglycerides p = 0.03). Moreover, the presence of severe NAFLD resulted in a higher BID (p = 0.03). We concluded that when starting and titrating the basal insulin in type 2 diabetes, certain anthropometric, laboratory and clinical factors can be useful to find optimal BID more quickly and appropriately.

Objective To evaluate the efficacy and safety of T therapy in the induction of pubic hair growth in women with congenital panhypopituitarism. Design Prospective clinical study. Setting Patients followed at the University Endocrinology Clinic. Patients Four women with congenital panhypopituitarism, showing no pubic hair development, currently treated with substitutive therapy with L-thyroxine, cortisone acetate, and estrogen-progestin combination. Interventions A long-acting T preparation (25 to 50 mg) was given IM each month; serum T levels were determined before and after 12 and 24 months of therapy. Main Outcome Measure Evaluation of pubarche stages (according to Tanner classification of stages). Results Patients developed pubarche (Tanner stage 3 to 5) after 3 to 18 months of T therapy. Testosterone levels were within the normal range during treatment. No hirsutism or other side effects were recorded. Conclusion A cautious T treatment represents an effective and safe approach to the problem of pubarche induction in women with congenital panhypopituitarism.

Percutaneous endoscopic gastrostomy (PEG) is the preferred method of long-term tube feeding, but only a few studies describe a long-term follow-up. The purpose of this study is to analyze the follow-up of PEG enteral feeding patients in the long term, and to report on the complication and survival rates. Between January 1991 and June 1995, we studied 136 patients (49% cancer and 51% non-cancer patients; male = 68%, female = 32%) after PEG insertion. One hundred twenty-eight patients had a long-term follow-up of over 31 d. The mean duration of PEG feeding was 277 ± 358 d (range 31–1590): 17% of patients returned to oral feeding, 34% continued enteral nutrition, and 49% died. Major complications occurred in 3% of the patients: 1 aspiration pneumonia, 1 subcutaneous abscess, 2 buried bumper syndrome. Minor complications arose in 14% of our cases: 8 tube blockages, 4 tube dislodgements, 6 site infections. For the whole group of 136 patients, survival probabilities after PEG insertion at 1, 6, 12, and 24 mo were 90.5%, 52%, 42%, and 35%, respectively. After 180 d, the difference in survival probabilities between cancer and non-cancer patients became significant (P < 0.02). Median survival probability was 64% for non-cancer and 39% for cancer patients, and this trend did not change over 2 y.

Background Macrovascular diseases (MVD) in type 2 diabetes mellitus (T2DM) are often considered all together, without discriminating the areas involved. The aim of our study was to analyse MVD prevalence in a large population of T2DM patients by dividing the cases into subgroups according to MVD sites (NMVD, no MVD; NSCS, non-significant carotid stenosis; CBVD, cerebrovascular disease; CAD, coronary artery disease; PAD, peripheral artery disease; PVD, polyvascular disease) and studying the anthropometric, clinical and laboratory parameters in each group. Methods A diabetic outpatient cohort (n = 1199) was retrospectively studied. Demographic, clinical and laboratory parameters were included in analyses. A thorough cardiovascular history as documented by previous medical records (including medical and hospital records) and vascular laboratory studies (including standardised electrocardiogram, echocardiogram, provocative tests for cardiac ischaemia, ankle/brachial index, duplex ultrasonography of the carotid and lower limbs and, in selected cases, computed tomography angiography, carotid and peripheral arteriography and evaluation of transcutaneous oxygen pressure), was collected for all of the patients. Standardised procedures were used to assess microvascular complications as well as metabolic syndrome (Mets). Results The unadjusted MVD prevalence was 46.4% among the participants. The majority of patients with MVD were in the PVD group. In the multivariate analysis, age, male sex and diabetes duration were independent risk factors for PAD and PVD (P < 0.01). A low HDL-C value was an independent risk factor in the CAD and PVD groups (P = 0.03). Very high frequencies of MetS were observed in the PAD and PVD groups (94.9 and 95.7% respectively). The most MetS diagnostic criteria were recorded among members of the CAD group (all or all-1 criteria were present in 73% of patients). The average age in the CAD group (64.5 y) was comparable to that of the NMVD group. Microvascular complications were more frequent in the PAD and PVD patients. Conclusion Phenotypic heterogeneity is associated with different macrovascular complications in T2DM patients. These findings might have clinical implications for developing diagnostic and therapeutic strategies targeting type 2 diabetes.

Erratum to: Support Care Cancer DOI 10.1007/s00520-012-1387-x Unfortunately, the spelling of Giovanni Capuano’s name was incorrect. It should read Giorgio Capuano.