Clinical Nutrition ESPEN

The causal relationship between hydatidiform mole and nutrients: A two-sample Mendelian randomization study

Hydatidiform mole (HM), a subset of gestational trophoblastic disease, is considered precancerous and exhibits geographical variation. The incidence of HM is linked to nutritional factors. This study aimed to investigate the causal relationship between nutrients and HM using a bidirectional two-sample Mendelian randomization (MR) approach. We utilized publicly available genome-wide association study data to assess the causal associations between levels of specific vitamins (retinol, vitamins B12, B6, C, D, E, folate, and carotene) and minerals (iron, calcium, and magnesium) with HM. The MR analysis was conducted and reported following the STROBE-MR guidelines, employing MR Egger and inverse variance weighted (IVW) methods to estimate associations, with MR-PRESSO for pleiotropy testing. The study revealed vitamin B6 as a significant protective factor against HM (MR-Egger OR: 0.094, 95 % CI: 0.011-0.0778, P < 0.05; IVW OR: 0.365, 95 % CI: 0.142-0.936, P < 0.05). Folate and magnesium showed suggestive associations with HM, whereas most other nutrients did not exhibit a causal relationship. MR-PRESSO analysis supported the absence of horizontal pleiotropy of vitamin B6. Besides, reverse MR analysis did not reveal a significant causal association between HM and serum nutrient levels, suggesting that differences of nutrients in HM patients may not be directly attributed to the mole. This MR study provides evidence that vitamin B6 may protect against HM, and suggests potential roles for folate and magnesium in HM development, while highlighting the need for further research to confirm these findings.

Association of serum folate and vitamin B12 with pre-neoplastic cervical lesions

Diet and lifestyle play an important role in etiology of various tumors. Serum concentration of folate and vitamin B12may be associated with carcinogenesis since they are involved in DNA methylation and nucleotide synthesis. However, the role of these micronutrients on development of cervical cancer is still controversial. Thus, the aim of this study was to analyze the association of lower status of folate and vitamin B12 with the risk of pre-neoplastic cervical lesions. Our sample group was divided in Control group (n = 120) - women with normal cytology, and Case groups (n = 57) - women presenting Atypical Squamous Cells of Undetermined Significance (ASC-US, n = 21), Low Grade Squamous Intraepithelial Lesion (LSIL; n = 16), and High-Grade lesions (n = 20). We obtained cervical samples for cytology analysis and HPV detection, and blood samples for evaluation of serum concentration of folate and vitamin B12. No difference of serum folate was observed among Cases and Control groups. On the other hand, women with High-Grade lesions presented significant lower median concentration of vitamin B12 if compared to another groups. Then, we observed increased risk of High-Grade lesions among participants with low vitamin B12 levels was observed in relation to women that presented high levels of the micronutrient and from Control group [OR (95% CI): 2.09 (0.65-6.76), p = 0.216], ASC-US [OR (95% CI): 3.15 (0.82-12.08), p = 0.095], and LSIL [OR (95% CI): 3.10 (0.76-12.70), p = 0.116]. Low concentration of vitamin B12 was associated with an increased risk of High-Grade cervical lesions. Besides, we did not observe any difference of serum folate among women with normal cytology and women with pre-neoplastic cervical lesions.

Role of probiotics in the management of cervical cancer: An update

Studies have extensively investigated a variety of health benefits associated with probiotic supplements, which often contain live microorganisms. The effect of probiotic supplements on cancer prevention and on chemotherapy effectiveness and toxicity are major areas that researchers have focused on. Recently, several researchers have concentrated on assessing the efficacy of probiotics in the treatment of cervical cancer, a leading malignancy in gynecology worldwide, especially in developing countries. To date, numerous clinical studies have demonstrated the efficacy of probiotics in preventing cervical cancer, but their dosages, bacterial strains, and duration of therapy are somewhat inconsistent. In this review, we have systematically updated the role of probiotics in cervical cancer management.

Impact of metabolic syndrome on the prognosis of endometrial cancer: A systematic review of evidence

Endometrial cancer (EC) stands out as the 7th most frequent malignancy among women around the globe and as the most common gynecologic cancer in the developed world. Metabolic syndrome (MetS), the silent epidemic of the Western World and a major risk factor for cardiovascular disease, has already been recognized as a contributor to the genesis of EC. In this review, we aimed to examine the respective influence of MetS on the prognosis of EC. A systematic literature research was conducted in PubMed, Embase and Web of Science databases up to August 19th, 2024. Observational studies (retrospective cohorts, prospective cohorts and case-control studies) were included. The endpoint of our systematic review was the impact of MetS on survival, recurrence, aggression, perioperative outcomes and generally the prognosis of EC. A total of 1139 studies were identified in our initial literature search. 272 duplicates were recognized and subtracted with 867 studies remaining for screening. Finally, 13 studies including 20.297 women with EC were included in our systematic review. In four studies, a worse overall survival (OS) had been reported in patients with MetS and EC compared to patients without MetS while in two studies the impact of MetS on the survival of patients with EC was found to be non-significant. A worse cancer-specific survival (CSS) in patients with MetS was reported in one study while MetS had an unfavorable impact on recurrence-free survival (RFS) in three studies. In terms of perioperative outcomes, the rates of outcomes pertinent to an increased morbidity were higher in patients with MetS while the same population suffered from a more aggressive disease compared to patients without MetS in three studies. The coexistence of MetS could be regarded as a worse prognostic factor for patients with EC based on our findings. Intervention on prevention and treatment of MetS should be pursued but further research is needed in the field.

Body composition phenotypes and long-term survival of endometrial cancer

Although overweight and obesity are associated with a higher risk of cancer, some studies have been reporting a better prognosis among overweight patients. The obesity paradox in cancer needs further investigation, since data are still controversial. The study aimed to examine if there is an association between different phenotypes of body composition and 5-year overall survival (OS) among patients with endometrial cancer. In a retrospective cohort study, we enrolled 486 endometrial cancer patients who had computed tomography images available prior to first treatment for body composition assessment. Both adipose and skeletal muscle index (SMI) compartments were presented in tertiles. The lower tertile of SMI was considered low SMI. For visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT), values above the highest tertile were classified as high adiposity. Skeletal muscle radiodensity (SMD) was obtained by averaging the HU of skeletal muscle (SM). The primary outcome was 5-year (OS). A significantly shorter median survival was found for patients with low SMI, low SMD, and high TAT. The combined decline in SMI and SMD had the greatest impact on survival. In adjusted Cox regression models, low SMI and low SMD were independently associated with increased mortality risk, whereas high TAT showed a protective effect against mortality. Phenotypes combining low SMI with low SMD and high or normal adipose tissue (SAT, VAT, or TAT) were linked to reduced survival, except for 'low SMI + normal SAT'. Conversely, normal SMI with high SAT and TAT was associated with lower mortality risk. Our findings underscore the important role of SM mass, especially when combined to muscle radiodensity and adipose tissue in predicting OS in endometrial cancer patients.