Browsing by Person "Revuelta-Iniesta, Raquel"

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25-hydroxyvitamin D concentration in paediatric cancer patients from Scotland: A prospective cohort study
(Cambridge University Press, 2016-12-15) Revuelta-Iniesta, Raquel; Paciarotti, Ilenia; Davidson, Isobel; McKenzie, Jane; Brand, Celia; Chin, Richard; Brougham, Mark FH; Wilson, D. C.
Children with cancer are potentially at high risk of plasma 25-hydroxyvitamin D [25(OH)D] inadequacy and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged <18 years, diagnosed with and treated for cancer (patients) between Aug 2010-Jan 2014 was performed, with control data from Scottish healthy children (controls). Clinical and nutritional data were collected at defined periods up to 24 months. 25(OH)D status was defined by the Royal College of Paediatrics and Child Health (2013); inadequacy [<50 nmol/L: deficiency (<25 nmol/L), insufficiency (25-50 nmol/L)], sufficiency (51-75 nmol/L), optimal (>75 nmol/L). Eighty-two patients [median(IQR) age 3.9(1.9-8.8); 56% males)] and 35 controls [median(IQR) age (6.2(4.8-9.1); 49% males] were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63%; 22/35), and in the patients (64%; 42/65) at both baseline and during treatment (33-50%). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median(IQR) ranging from 32.0 (21.0-46.5) nmol/L to 45.0(28.0-64.5) nmol/L. Older age at baseline [R=-0.46; p<0.001], overnutrition (BMI ≥85th centile) at 3 months [p=0.005; RR=3.1] and not being supplemented at 6 months (p=0.04; RR=4.3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented.
Assessment of Plasma Antioxidants, Oxidative Stress and Polyunsaturated Fatty Acids in Paediatric Cancer Patients: A Prospective Cohort Pilot Study
(ECronicon Open Access, 2015-10-07) Revuelta-Iniesta, Raquel; Wilson, David C.; Brougham, Mark FH; Smail, Nacer Foudil; Davidson, Isobel; McKenzie, Jane; Fergus Maclay Leukaemia Trust; Queen Margaret University; Cancer and Leukaemia Trust
Background: Paediatric cancer patients may have a limited dietary intake, particularly nutrients high in antioxidants, docosahexanoic acid (DHA) and eicosapentanoic acid (EPA). Objective: To investigate the antioxidant status (TAS), antioxidant capacity (TAC), oxidative stress, DHA and EPA of paediatric cancer patients during treatment. Methods: A prospective cohort study of Scottish children aged <18 years, diagnosed with and treated for cancer between April-2013 to Jan-2014 was performed. Clinical data and blood samples were collected at baseline and 6 months. Data were stratified by treatment risk (low, medium and high) and nutritional support. We used Oxygen Radical Absorbance Capacity (ORAC) Antioxidant Assay to measure TAC, thiobarbituric acid reactive substances (TBARS) for lipid peroxidation and high performance liquid chromatography and Inductively Coupled Plasma Mass Spectrometry for TAS. The analyses of DHA and EPA were performed by analysing fatty acidmethyl esters (FAME) using gas-liquid chromatography. The reference ranges used were: Yagi 1998 (1.86-3.94) _mol for lipid peroxidation and Damsgaard.,et al. 2014 for EPA (0.45-0.77) % and DHA (2.22-3.76) %. Results: 20 patients (median (IQR) age 4.2 (1.5-8.5) years; 50% males) were recruited. There were no significant changes in plasma TAS, TAC and EPA, but lipid peroxidation significantly decreased from 7.4 (6.2-9.0) at baseline to 5.3 (4.5-6.4) _mol/MDA at 6 months(p = 0.003). The median (IQR) blood percentage of DHA significantly increased from 1.3 (0.9-1.9) to 1.8 (1.3-2.1) (p = 0.001). Lipid peroxidation was high in 95% (19/20) of patients at baseline and 94% (15/16) at 6 months; whilst DHA and EPA were low in 95%(19/20) and 70% (14/20) at baseline and 87.5% (14/16) and 60% (12/16) at 6 months. Children on high-treatment risk exhibited the highest oxidative stress levels. No statitically significant differences were found between non-supplemented and supplemented children in any of the following parameters (TAS, TAC, oxidative stress, EPA and DHA). Conclusion: There was a high prevalence of oxidative stress, especially in children treated with high-risk protocols and during the initial phases of treatment. Nutritional support does not appear to provide enough TAS, EPA and DHA in this cohort; however, larger high-quality population based studies are warranted to confirm these findings. Keywords: Paediatric cancer; Antioxidants; Oxidative stress; Docosahexanoic acid; Eicosapentanoic acid
Complementary and alternative medicine usage in Scottish children and adolescents during cancer treatment
(Churchill Livingstone, 2014-11) Revuelta-Iniesta, Raquel; Wilson, M.; White, K.; Stewart, L.; McKenzie, Jane; Wilson, D. C.
Aim: To determine the prevalence of the use of CAM and spiritual practices in the paediatric oncology population of SE Scotland and to establish both the reasons for their use and the perceived benefits. Methods: A retrospective survey was performed using previously piloted questionnaires. These were distributed to families whose children were <18 years and diagnosed with cancer. Demographic and clinical data were collected, descriptive statistics were used to establish frequencies and univariate associations were established by 2 test. Results: Of 169 families approached, 74 (44%) returned completed questionnaires. 41 (55%) families used CAM and 42 (57%) sought spiritual remedies whilst receiving conventional treatment. Higher socioeconomic status was the only factor associated with CAM usage and the most popular therapies were vitamins and minerals ( n=22; 53%), followed by massage ( n=12; 29%) and fish oils ( n=12; 29%). Most families used CAM to reduce stress and, overall, CAM was perceived to be beneficial. Conclusion: The high prevalence of CAM usage in this population highlights the need for physicians to enquire routinely about CAM use and warrants high-quality interventional studies to assess safety and efficacy. Summary: The use of Complementary and Alternative Medicine (CAM) among paediatric patients during cancer treatment is popular worldwide, yet data from the UK are scarce. This study showed that more than half of this Scottish cohort used CAM and that there was an overall positive perception of the effect that these therapies had on the patients. Also, socio-economically advantaged families might be more likely to use CAM in Scotland. 2014 Elsevier Ltd.
Consumption of Green Coffee Reduces Blood Pressure and Body Composition by Influencing 11_-HSD1 Enzyme Activity in Healthy Individuals: A Pilot Crossover Study Using Green and Black Coffee
(2014-07) Revuelta-Iniesta, Raquel; Al-Dujaili, Emad A. S.
Dietary polyphenols may have a protective role against the development of CVD. Thus, we aimed to investigate the effects of green coffee (GC), rich in chlorogenic acid, and black coffee (BC) on cardiovascular markers. A randomised pilot crossover study was performed on healthy subjects who consumed both coffees for 2 weeks. We measured anthropometry, blood pressure, and arterial elasticity after each intervention and collected urine samples to monitor antioxidant capacity. Free cortisol and cortisone levels were obtained from urine and analysed by specific ELISA methods. Systolic blood pressure (P = 0.018) and arterial elasticity (P = 0.001) were significantly reduced after GC. BMI (P = 0.04 for BC; P = 0.01 for GC) and abdominal fat (P = 0.01 for BC; P = 0.009 for GC) were also significantly reduced with no changes in energy intake. Urinary free cortisol was significantly reduced from 125.6 85.9 nmol/day to 76.0 54.9 nmol/day following GC and increased to 132.1 89.1 nmol/day after BC. Urinary free cortisone increased by 18% following BC and 9% following GC (nonsignificant). Cortisol/cortisone ratio (indicating 11_-HSD1 activity) was reduced after GC (from 3.5 1.9 to 1.7 1.04, P = 0.002). This suggests that GC can play a role in reducing cardiovascular risk factors. Further research including hypertensive and overweight individuals will now be justified to clarify whether GC could have a therapeutic role in CVD. 2014 R. Revuelta-Iniesta and E. A. S. Al-Dujaili.
Dietary sources of vitamin D in school children in Northern Ireland
(The Nutrition Society, 2021-08-17) Benson, H.; Glatt, Dominique; Beggan, L.; McSorley, E. M.; Pourshahidi, L. K.; McCluskey, Jane T.; Revuelta-Iniesta, Raquel; Gleeson, Nigel; Magee, P. J.
Effect of Vitamin D supplementation on aerobic exercise performance in healthy adults; a randomised single blinded placebo controlled pilot study
(ECronicon, 2016-09-27) Ferrington, Linda; Bell, Steph; Robertson, Amy; Revuelta-Iniesta, Raquel
Background: 1,25-dihydroxyvitamin D (1,25(OH)D), the biologically active form of vitamin D, is thought to be directly related to exercise induced inflammation and skeletal muscle performance and deficiency has catabolic effects on muscle tissue, causes muscle weakness and impairs cross-bridge formation. 1,25(OH)D may also affect cardiovascular risk factors such as blood pressure (BP), which in turn may have an effect on aerobic exercise; however, at present evidence investigating this association are lacking. Therefore,the aim of this study was to investigate the effect of vitamin D supplementation on aerobic exercise following two weeks of intervention. Methods: A randomised placebo controlled single-blinded pilot study aimed to investigate the short term effects of vitamin D supplementation on aerobic exercise performance in a group of healthy adults. Eleven healthy adults were allocated to receive either 2000IU (50_g/day) of vitamin D or a placebo (sucrose) for 14 days. Physical activity and diet diaries were completed throughout the study. Aerobic exercise performance was assessed at baseline and day 14 following a 15-minute run on a treadmill set at a gradient of 1.5%. Height, weight, systolic/diastolic BP and heart rate (HR) were recorded at baseline and day 14 before running. Parameters of aerobic exercise exertion (BP, %HR and difference in blood lactate) were recorded before and after each run. The rate of perceived exertion (RPE) was recorded after each run. Results: HR reduced significantly by 2.5% (p = 0.002) from 91.5 4.5% to 89.0 3.7% in the intervention group, but not in the placebo group (1.2%; 87.8 4.5% to 86.6 5.1%. p = 0.4). The difference in blood lactate between pre and post run was smaller in the intervention group [(3.9 3.7 mmol/L; p = 0.2 SEM (1.5)] than in the placebo group [(5.5 3.8 mmol/L; p = 0.1; SEM (5.9)]; however,this did not statistically differ between [p = 0.5; SEM (2.2)] and within the groups. Finally, a statistically significant reduction [(p = 0.001; SEM (0.7)] in RPE was found in the intervention group only (15.8 1.9 to 14.7 2.2). Conclusion: The significant reduction in both percentage heart rate and rate of perceived exertion found in this study over a two week period suggest that short term vitamin D supplementation may improve aerobic exercise performance. However, larger scale studies are now warranted to verify these findings.
Effect of vitamin D supplementation on cardiovascular disease risk factors and exercise performance in healthy participants: a randomized placebo-controlled preliminary study
(Sage, 2016-06-30) Al-Dujaili, Emad A. S.; Munir, Nimrah; Revuelta-Iniesta, Raquel
Background and objectives: Evidence suggests associations between vitamin D deficiency and cardiovascular disease (CVD) risk factors, including hypertension and excessive cortisol levels. Also, vitamin D levels may impact exercise performance. Thus, we aimed to investigate the effects of vitamin D intake on cardiovascular risk factors, free urinary cortisol and exercise performance. Methods: A randomized placebo-controlled single-blinded parallel trial was conducted in healthy participants (n = 15). They received 2000 IU (50 _g) vitamin D3 per day (n = 9) or placebo (lactose) (n = 6) for 14 days. Body composition, systolic blood pressure (SBP), diastolic blood pressure (DBP) and arterial elasticity (as measured by pulse wave velocity, (PWV) were recorded at baseline, day 7 and day 14 of intervention. A total of two 24-hour urine samples were collected to estimate free cortisol and cortisone levels. Exercise performance was assessed at the baseline and day 14 of the intervention using a bike ergometer in which BP and PWV were measured before and after exercise. The distance cycled in 20 minutes and the Borg Scale rate of perceived exertion (RPE) were recorded. Results: In the intervention arm, at day 14, vitamin D supplementation significantly reduced SBP and DBP from 115.8 17.1 and 75.4 10.3 at baseline to 106.3 10.9 (p = 0.022) and 68.5 10.1 mmHg (p = 0.012) respectively. Also arterial stiffness was markedly reduced in the vitamin D group (from 7.45 1.55 to 6.11 1.89, p = 0.049). Urinary free cortisol levels and cortisol/cortisone ratio were significantly reduced from 162.65 58.9 nmol/day and 2.22 0.7 to 96.4 37.2 (p = 0.029) and 1.04 0.4 (p = 0.017) respectively. Exercise induced SBP and DBP were significantly reduced post vitamin D intake from 130.7 12.2 to 116.1 8.1 (p = 0.012) and from 76.2 8.4 to 70.5 7.7 mmHg (p = 0.042) respectively. The distance cycled in 20 minutes significantly increased from 4.98 2.65 to 6.51 2.28km (p= 0.020), while the Borg Scale RPE reduced from 5.13 1.36 to 4.25 0.71 RPE (p = 0.021). In the placebo arm, no significant effects on CVD risk factors and exercise performance were observed. Conclusion: These results suggest that daily vitamin D supplementation may ameliorate CVD risk factors including a decrease in 11_-HSD1 activity, as evidenced by the decrease in the cortisol/cortisone ratio, and improve exercise performance in healthy individuals. However, large scale studies are required to verify our findings.
Effects of pediatric cancer and its treatment on nutritional status: A systematic review
(2015-03-28) Revuelta-Iniesta, Raquel; Paciarotti, Ilenia; Brougham, F. H. M.; McKenzie, Jane; Wilson, D. C.
Context: Malnutrition in pediatric cancer is common worldwide, yet its prevalence and effects on clinical outcomes remain unclear. Objective: The aim of this review was to evaluate primary research reporting the prevalence of malnutrition in pediatric cancer patients and to assess the effects of pediatric cancer and its treatment on nutritional status. Data Sources: Electronic databases of MEDLINE, CINHAL, and PubMed were searched (January 1990-February 2013). Study Selection: Studies of patients aged <18 years who were diagnosed with and treated for cancer and for whom measurements of anthropometry were reported were included. The primary outcome was the prevalence of malnutrition (undernutrition and overnutrition), expressed as body mass index (BMI), in children diagnosed with and treated for cancer. Data Extraction: Evidence was appraised critically by employing the Critical Appraisal Skills Program tool, and data was extracted from original articles. Data Synthesis: A total of 46 studies were included, most of which were considered to be of low quality on the basis of heterogeneity in both the criteria and the measurements used to define malnutrition. Undernutrition was identified by measuring BMI, weight loss, mid-upper arm circumference, and triceps skinfold thickness, while overnutrition was assessed using BMI. Overall, the prevalence of undernutrition ranged from 0% to 65% and overnutrition from 8% to 78%. Finally, undernutrition in pediatric cancer at diagnosis was associated with poor clinical outcomes in 6 of 9 studies. Conclusion: The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, populationbased, longitudinal studies using standard criteria to identify malnutrition.
Hyperferritinemia in Pediatric Acute Lymphoblastic Leukemia: What Does it Mean?
(Wolters Kluwer, 2016-11-22) Brierley, Charlotte K.; Revuelta-Iniesta, Raquel; Storrar, Neil; Thomas, Angela E.; The Leukaemia Fund Trust
Knowledge, attitudes and perceptions towards Vitamin D in a UK adult population: A cross-sectional study
(MDPI, 2018-10-27) O’Connor, Clodagh; Glatt, Dominique; White, Lois; Revuelta-Iniesta, Raquel
The prevalence of vitamin D deficiency in the United Kingdom is high, despite updated Scientific Advisory Committee on Nutrition (SACN) guidelines. Therefore, our aims were to identify population knowledge, attitudes and perceptions of vitamin D supplementation and factors contributing to supplement use in a UK adult population. A cross-sectional study was performed between April–June 2018 using a newly designed piloted questionnaire. Scores for knowledge were calculated as a percentage (Boland et al. 2015). Logistic regression analysis was used to predict supplement use. 209 participants (82% female), mean (±SD) age 34.9 (±12.3) completed the questionnaire. The mean (±SD) vitamin D knowledge score was 56.6% (±19.9%); only 48% were concerned about their vitamin D concentration and 57% did not take vitamin D. Most participants (86%) wished to learn more about vitamin D. Knowledge score (OR 2.5; p = 0.01; 95% CI 1.2–5.3), concern (OR 2.1; p = 0.03; 95% CI 1.0–4.2) and location (OR 0.3; p = 0.006; 95% CI 0.1–0.7) predicted supplemented use. Individuals living in England had 2.9 (95% CI 1.4–6.3) lower odds of taking vitamin D than those living in Scotland. As a result of these findings, this study suggests that vitamin D supplementation and fortification, alongside education strategies, may be an effective method for improving UK vitamin D health; however, more research is warranted.
Low Plasma Vitamin D (25-Hydroxycholecalciferol) in Children and Adolescents Diagnosed with Cancer: A Case-Control Study
(ECronicon, 2015-12) Paciarotti, Ilenia; Revuelta-Iniesta, Raquel; McKenzie, Jane; Brand, Celia; Richard, Chin FM; Brougham, Mark FH; Wilson, David C.; Fergus Maclay Leukaemia Trust; GI-Nutrition Research fund of Child Life and Health; Roald Dahl Marvellous Children's Charity; Burdett Trust for Nursing
Introduction: Children and young people with cancer are less likely to spend time outdoors and they may also have a limited dietary intake. In addition, some cancer treatments can increase vitamin D catabolism. Objectives: This study aimed to investigate if there was an increased risk of poor vitamin D status in newly diagnosed childhood cancer patients compared to healthy controls in Scotland. Methods: Plasma 25 (OH) D was measured in children and adolescents during initial cancer treatment and compared to 33 healthy controls. Vitamin D deficiency was classified as plasma 25 (OH) D <25 nmol/l, with a plasma 25 (OH) D of 25-49 nmol/l classified as insufficient. Results: Forty-one patients (median age 3.8 years, IQR 1.9-8.0) were diagnosed with cancer, 63% were male. Twenty-three (56 %) had solid tumours, 18 (44%) had haematological cancers. Median (IQR) plasma 25 (OH) D at recruitment was 37.0 nmol/l (23.7-58.2). Ten patients (24%) had vitamin D deficiency and 17 (41%) patients were classified as insufficient. The median (IQR) plasma 25 (OH) D in the control group (n = 33) was 37.5 nmol/l (29.0-58.0). Six controls (18%) had vitamin D deficiency and 14 (42%) were classified as having insufficient results. Plasma 25 (OH) D did not differ (p > 0.05) between the patients and the controls. Conclusions: Almost three in four Scottish children treated for cancer had vitamin D deficiency or insufficiency; there was no increased risk of poor vitamin D status compared to healthy controls. Assessment of vitamin D status at diagnosis and in response to the course of treatment appears necessary to optimise nutritional management.
Micronutrient status influences clinical outcomes of paediatric cancer patients during treatment: A prospective cohort study
(2021-03-20) Revuelta-Iniesta, Raquel; Gerasimidis, Konstantinos; Paciarotti, Ilenia; McKenzie, Jane; Brougham, Mark F. H.; Wilson, David C.
Research reporting plasma micronutrient status and its impact on clinical outcomes in paediatric cancer is scarce. Therefore, we investigated the prevalence of plasma micronutrient abnormalities and their impact on clinical outcomes and treatment complications. A multicentre prospective-cohort study of children aged <18 years diagnosed with cancer was performed between Aug 2010-Jan 2014. Clinical and nutritional data were collected at diagnosis, 3, 6, 9, 12 and 18 months. Micronutrient status was established using in-house laboratory references (vitamin B12, vitamin A and Vitamin E/Ch) and aged adjusted Z-scores (Mg, Se, Zn and Cu) generated from a cohort of healthy Scottish children. Clinical outcomes were classified as "event free survival (EFS)" or "event" (relapse, death, new metastasis or becoming palliative) and treatment complications. Descriptive statistics, logistic regression multilevel analysis were performed. Eighty-two patients [median (IQR) 3.9 (1.9-8.8) years, 56% males] were recruited. Of these, 72 (88%) samples were available, 74% (53/72) patients had micronutrient abnormalities at baseline; deficiencies (25%, 18/72), excesses (19%, 14/72) and a combination of both (29%, 21/72), which continued for 18 months. Vitamin A deficiency (15%, 3/20) and excess (50%, 10/20) were most prevalent at 18 months, whilst vitamin E/Cholesterol and vitamin B12 were mostly within the normal range. Prevalence of Zn deficiency at diagnosis was 36% (16/44 adjusted for CRP), which remained at these levels throughout the study. Reduction in each selenium concentration unit increased the odds of an event by 2% (OR 0.02) and lower Se predicted higher complications at diagnosis [β (-1.2); t (-2.1); 95% CI (-2.9 - (-0.04)); p = 0.04], 3 months [β (-3.9); t (-4.2); 95% CI (-5.57 - (-2.02)); p < 0.001] and 12 months [β (-2.3); t (-2.4); 95% CI (-4.10 - (-0.34)); p = 0.02]. Given the prevalence of micronutrient abnormalities and the negative impact of low selenium on clinical outcome, micronutrient status should be assessed and monitored in paediatric cancer patients. Larger multicentre population based studies and clinical trials are now warranted.
Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results)
(European Society for Clinical Nutrition and Metabolism, 2020-04-14) Glatt, Dominique; Hughes, Caoimhe; McCarthy, Orlaith; O'Shea, Fiona; Brougham, Mark F. H.; Wilson, David C.; Revuelta-Iniesta, Raquel
The department of Haematology and Oncology at the Royal Hospital for Sick Children (RHSC) in Edinburgh have developed their own nutritional standards specific to paediatric cancer. We aimed to audit the current nutritional practice in anthropometry, nutritional biochemistry and malnutrition screening for paediatric cancer patients against nutritional standards to identify areas for nutritional-practice improvement and progress nutrition-related clinical outcomes. A Clinical audit was conducted >20 weeks between 2015 and 2017 in three data collection locations (inpatient (IP), day-care (DC), or outpatient (OP)) at RHSC. We included patients aged 0-18 years and undergoing treatment for diagnosed malignant childhood cancer (ICCC-3 or Langerhans Cell Histiocytosis). Data were collected by analysing documentation and observing clinical practice for frequency and mode of administration of anthropometry, malnutrition screening, nutritional biochemistry and resulting documentation completion. Results were presented as descriptive statistics and stratified by percentage of standard met (100%, 99-70%, <70%). 185 audited patient records (22 IP, 54 DC and 109 OP) were analysed. The areas which were <70% of the standard were: height and weight documentation for DC; head-circumference for IP; arm anthropometry assessment for all locations; initial PYMS screening and re-screening in IP; malnutrition screening in DC and OP; and initial assessment and re-assessment for serum vitamins D, A, E, B and parathyroid hormone levels. Baseline nutritional practice was successfully established, identifying areas for practice improvement in the RHSC Paediatric Oncology and Haematology Department; this will be implemented in the next step of the audit to optimise patient care. [Abstract copyright: Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.]
Nutritional status of children and adolescents with cancer in Scotland: A prospective cohort study
(Elsevier, 2019-05-17) Revuelta-Iniesta, Raquel; Paciarotti, Ilenia; Davidson, Isobel; McKenzie, Jane M.; Brougham, Mark F. H.; Wilson, David C.
Background and aims Malnutrition (under and overnutrition) in paediatric cancer patients during and after treatment increases short and long-term side-effects; however, factors contributing to malnutrition and patterns of change in nutritional status are still unclear. The aims were to investigate the prevalence of malnutrition, patterns of change in nutritional status and factors contributing to malnutrition in Scottish paediatric cancer patients.
Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients
(Elsevier, 2015-01-16) Revuelta-Iniesta, Raquel; Rush, Robert; Paciarotti, Ilenia; Rhatigan, E. B.; Brougham, F. H. M.; McKenzie, Jane; Wilson, D. C.
Background and aims: Vitamin D inadequacy is now an internationally recognized health problem and pediatric cancer patients may be at even higher risk than healthy children. We aimed to evaluate primary research to establish the prevalence of vitamin D inadequacy and to explore its possible causes in pediatric cancer patients. Methods: Electronic databases were searched (no restriction-Aug 2013) with no language restrictions and keywords related to cancer and vitamin D. We included studies of patients aged <18 years, diagnosed with and treated for cancer and reporting plasma vitamin D status. Evidence was critically appraised employing the CASP tool. Meta-analysis was performed when appropriate. Results: We included 19 studies, which were mainly of moderate-quality and heterogeneous in the definitions of vitamin D deficiency and insufficiency. The median (range) prevalence of vitamin D deficiency was 14% (0-61.5%) and insufficiency 23% (0-83%). Finally, a significant effect of younger age with vitamin D inadequacy was shown (effect size:-0.132; 95%CI-0.203,-0.060). Conclusion: There is a possibility of a high prevalence of vitamin D inadequacy in pediatric cancer patients, especially older children, urging the need for high-quality population-based longitudinal studies using standard definitions.
A systematic review of N-3 and N-6 polyunsaturated fatty acid concentration in childhood cancer patients and associated clinical outcomes
(E-Cronicon Open Access, 2019-08-22) Revuelta-Iniesta, Raquel; Wyness, Laura; Wilson, David C.
Background: This systematic review evaluated primary research to establish blood omega-3 polyunsaturated fatty acids (n-3 PUFA); eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and omega-6 polyunsaturated fatty acids (n-6 PUFA); arachidonic acid (AA) concentration. The effectiveness of their supplementation on clinical and nutritional outcomes and associations between their concentration and clinical and nutritional outcomes were also evaluated.
The Determinants of Nutritional Risk in Paediatric Cancer
(Queen Margaret University, Edinburgh, 2015) Revuelta-Iniesta, Raquel
The five-year survival rates of paediatric cancer patients have improved considerably in the last 40 years with the implementation of more intensive and progressive treatments. Consequently attention is shifting to the reduction of treatment-related sequelae during and after the completion of therapy. Malnutrition and vitamin D inadequacy are a major concern as they are thought to increase the risk of short- and long-term complications in this population. Furthermore, emerging evidence has found a protective role of antioxidants and docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) against chronic conditions, including cardiovascular disease and cancer, which are common long-term complications in survivors of paediatric cancer. Therefore, this thesis aimed to investigate the nutritional status (NS), vitamin D, antioxidants and oxidative stress levels, as well as DHA and EPA levels of paediatric cancer patients. Potential factors that may contribute to the development of malnutrition in this population were also investigated. A prospective cohort-study of SE Scottish children aged <18 years, diagnosed with and treated for cancer between Aug 2010-Jan 2014 was performed. Clinical and nutritional data were collected at defined periods up to 36 months. NS was assessed using anthropometry, bioelectrical impedance analyisis (BIA), plasma micronutrients and dietary intake. DHA, EPA, antioxidant capacity and oxidative stress were measured at baseline and 6 months between April 2013-Jan 2014. Paediatric cancer was stratified by treatment risk (high, medium and low) and by diagnostic criteria. The primary outcome was malnutrition defined as body mass index (BMI) according to UK growth chart centiles; underweight (<2.3rd), overweight (85-95th) and obese (>95th). Vitamin D status was defined by the Endocrine Society Clinical Practice Guidelines (2011); inadequacy (<50nmol/L). Eighty-two patients [median(IQR) age 3.9(1.9-8.8) years; 56% males)] were recruited. At diagnosis, the prevalence of undernutrition was 13%, overweight 7% and obesity 15%. TSF identified the highest prevalence of undernutrition (15%) and the lowest of obesity (1%). BMI [p<0.001; 95% CI (1.31-3.47)] and FM (BIA) [p<0.05; 95% CI (0.006-0.08)] significantly increased after 3 months of treatment, whilst FFM (BIA) [p<0.05; 95% CI (-0.78-(-0.01)] significantly decreased during the first three months and these patterns remained until the end of the study. High-treatment risk significantly contributed to undernutrition during the first three months of treatment [p=0.04; 95% CI (-16.8-(-0.4)] and solid tumours had the highest prevalence of undernutrition [BMI (17%)]. Vitamin D inadequacy was highly prevalent (64%; 42/65) at both baseline and during treatment (33-50%) and those children who were not supplemented had the lowest vitamin D levels at every stage with median(IQR) levels ranging from 32.0(21.0-46.5)nmol/L to 45.0(28.0-64.5)nmol/L. Paediatric cancer patients had high levels of oxidative stress and low levels of DHA and EPA, especially at baseline. Antioxidant status remained steady at 6 months, however antioxidant capacity increased slightly. Finally, antioxidant levels, antioxidant capacity, oxidative stress and EPA and DHA did not statistically differ between children receiving nutritional support and those who were not. Arm anthropometry (or BIA) alongside appropriate nutritional supplementation should be implemented in clinical practice due to the high risk of malnutrition (undernutrition and obesity), the changes in body composition (increase in fat mass and reduction in lean mass) and vitamin D inadequacy, as well as the low levels of EPA and DHA seen in this paediatric cancer cohort.
Vitamin D status and health outcomes in school children in Northern Ireland: Year one results from the D-VinCHI study
(MDPI, 2022-02-14) Glatt, Dominique; McSorley, Emeir; Pourshahidi, L. Kirsty; Revuelta-Iniesta, Raquel; McCluskey, Jane T.; Beggan, Laura; Slevin, Mary; Gleeson, Nigel; Cobice, Diego F.; Dobbin, Sara; Magee, Pamela J.
(1) Background: Vitamin D status has never been investigated in children in Northern Ireland (UK). (2) Methods: Children (4−11 years) (n = 47) were recruited from November 2019 to March 2020 onto the cross-sectional study. Anthropometry was assessed. Plasma 25-hydroxyvitamin D (25(OH)D) was analysed. Vitamin D intake, parental knowledge and perceptions, participant habits, physical activity and sedentary behaviour were established via questionnaire. Muscle strength was assessed via isometric grip strength dynamometry and balance via dominant single-leg and tandem stance. Parathyroid hormone, bone turnover markers (OC, CTX and P1NP), glycated haemoglobin and inflammatory markers (CRP, IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8 and TNF-α) were analysed. (3) Results: Mean (SD) 25(OH)D was 49.17 (17.04) nmol/L (n = 47); 44.7% of the children were vitamin D sufficient (25(OH)D >50 nmol/L), 48.9% were insufficient (25−50 nmol/L) and 6.4% were deficient (25 nmol/L). 25(OH)D was positively correlated with vitamin D intake (µg/day) (p = 0.012, r = 0.374), spring/summer outdoor hours (p = 0.006, r = 0.402) and dominant grip strength (kg) (p = 0.044, r = 0.317). Vitamin D sufficient participants had higher dietary vitamin D intake (µg/day) (p = 0.021), supplement intake (µg/day) (p = 0.028) and spring/summer outdoor hours (p = 0.015). (4) Conclusion: Over half of the children were vitamin D deficient or insufficient. Wintertime supplementation, the consumption of vitamin D rich foods and spring/summer outdoor activities should be encouraged to minimise the risk of vitamin D inadequacy.