News Round-up
Do vitamin D levels affect the body’s response to anti-cancer immunotherapy?
Study’s findings suggest that maintaining normal vitamin D levels may benefit patients.
Research indicates that for patients with advanced skin cancer, it may be important to maintain normal vitamin D levels when receiving immunotherapy medications called immune checkpoint inhibitors. The findings have been published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
To see whether levels of vitamin D might impact the effectiveness of immune checkpoint inhibitors, investigators analysed the blood of 200 patients with advanced melanoma both before and every 12 weeks during immunotherapy treatment. A favourable response rate to immune checkpoint inhibitors was observed in 56.0% of patients in the group with normal baseline vitamin D levels or normal levels obtained with vitamin D supplementation, compared with 36.2% in the group with low vitamin D levels without supplementation. Progression‐free survival in these groups was 11.25 and 5.75 months, respectively.
“Of course, vitamin D is not itself an anti-cancer drug, but its normal serum level is needed for the proper functioning of the immune system, including the response that anti-cancer drugs like immune checkpoint inhibitors affect,” said lead author Łukasz Galus, MD, of Poznan University of Medical Sciences, in Poland. “In our opinion, after appropriately randomised confirmation of our results, the assessment of vitamin D levels and its supplementation could be considered in the management of melanoma.”
Paper: Galus L, et al. (2023). Vitamin D supplementation increases objective response rate and prolongs progression‐free time in patients with advanced melanoma undergoing anti‐PD1 therapy. CANCER.; doi: 10.1002/cncr.34718.
New Resource for Gastroenterologists on Using Probiotics and Prebiotics in Clinical Practice
The World Gastroenterology Organisation (WGO) recently published an updated guideline document, aimed at helping gastroenterologists and other physicians understand appropriate clinical applications for probiotics or prebiotics. The guideline was created with contributions from experts in gastroenterology, probiotics, and prebiotics, with the efforts co-led by experts from the International Scientific Association for Probiotics and Prebiotics (ISAPP).
To create the guideline, the experts comprehensively evaluated the evidence from randomised, controlled trials on gastrointestinal conditions, including which strain or specific prebiotic substance showed a positive effect. The guideline features a list of conditions that have positive evidence for the efficacy of probiotics and/or prebiotics. A condition was included in the list if at least one randomised, controlled trial demonstrated a beneficial effect. The guideline also includes the level of evidence supporting benefits in each condition, based on a classification from Oxford Centre for Evidence-Based Medicine.
Prof. Francisco Guarner, MD, PhD, leader of the WGO project, commented: “Our goal for this project was to provide a guideline to global gastroenterologists and other healthcare professionals to enable them to integrate probiotics and prebiotics in an evidence-based manner into their daily work of patient care.”
The conditions for which probiotics/prebiotics show benefits include some well-known ones: diarrheal conditions, irritable bowel syndrome, inflammatory bowel disease and lactose maldigestion. For infants, infantile colic and necrotizing enterocolitis are included in the list. Yet positive evidence also exists for some conditions that are not often associated with probiotic/prebiotic benefits: insulin resistance, non-alcoholic fatty liver disease, H. pylori infection, and even general health-related quality of life. The evidence summarised in the guideline reinforces the notion that not all probiotics are equal and that positive results in trials depend on which probiotics or prebiotic substances are being tested, and at what dose. The experts were careful to note that not all of the products shown to be effective are found in all countries. In addition, despite overall favourable evidence in the listed conditions, clinicians should not expect all probiotics or prebiotics to be effective for every person.
Dr Mary Ellen Sanders PhD, ISAPP executive science officer and co-chair of the project, stated: “This guideline recognises that actionable evidence exists for probiotic and prebiotic use in clinical practice. It is an excellent tool for healthcare providers to aid them in matching the probiotic or prebiotic to patient needs.”
About ISAPPISAPP is a nonprofit organization founded in 2002 to advance the science of probiotics and prebiotics, and more recently synbiotics, postbiotics, and fermented foods. ISAPP communicates scientifically accurate information to healthcare providers, scientists, consumers, and regulatory bodies through its many resources. For more information about ISAPP, see: www.ISAPPscience.org.
About WGO
World Gastroenterology Organisation (WGO) is a federation of over 100 Member Societies and four Regional Associations of gastroenterology representing over 60,000 individual members worldwide. The WGO Guidelines Library contains practice guidelines written from a viewpoint of global applicability. The Guidelines go through a rigorous process of authoring, editing, and peer review and are as evidence based as possible.
Study Reveals Thousands of Prenatal Supplements Fail to Provide Adequate Nutrition for Pregnant Women and Babies
Study published in The American Journal of Clinical Nutrition shows a need for doctors, patients, and supplement companies to develop new approaches to nutritional health management during pregnancy.
A new study from researchers in the Lifecourse Epidemiology of Adiposity (LEAD) Center at the University of Colorado Anschutz Medical Campus shows that 90% of pregnant women do not receive adequate nutrients during pregnancy from food alone and must look to supplements to fill that deficit. However, they also discovered that 99% of the affordable dietary supplements on the market do not contain appropriate doses of key micronutrients that are urgently needed to make up for the nutritional imbalance.
“Nutrition is critical for a healthy mom and a healthy baby. Too little of certain nutrients can cause pre-term birth, low birthweight, birth defects and other health challenges. At the same time, too much could change how a baby’s body develops and their risk of having health problems in the future,” said Katherine Sauder, PhD, Deputy Director of the LEAD Center and Associate Professor of Paediatrics in the University of Colorado School of Medicine and lead author of the study. “That’s why eating a balanced diet and choosing a good prenatal vitamin is so important.”
The study followed 2,450 women throughout their pregnancy. Researchers first analysed data about what the participants ate and drank during their pregnancies. They then determined what amounts of vitamin A, vitamin D, folic acid, calcium, iron and omega-3 fatty acids each participant was getting from the food alone and determined how much they needed in order to meet the nutritional guidelines recommended by the National Institutes of Health (NIH) during pregnancy. Then, compared more than 20,000 vitamins that are available in the U.S. that contained additional nutrients.
“Out of all the prenatal and general vitamins analysed, we found only one that may potentially give pregnant patients the optimal amounts of the most important nutrients. But, the monthly cost of this supplement can be too high for some people, and it requires pregnant people to take seven pills a day,” Sauder said. Sauder says she hopes doctors, patients and companies use this information to help improve nutritional care during pregnancy.
“This research will inform pregnant patients and their doctors about key nutrients they may be missing in their diet and help them choose prenatal vitamins that can provide the nutrients they need,” Sauder said. “Dietary supplement manufacturers can also use these results to inform better dosing in their products.”
Sauder says the results of the study highlight an ongoing need for prenatal vitamin options that are low cost and convenient, while still containing the optimal amounts of key nutrients. She says more research on nutrients in foods is also needed to help pregnant patients get more of these key nutrients in their daily diets.
This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program and The National Institutes of Health.CN Awards Shortlist Revealed
Complete Nutrition (CN) Magazine were delighted to reveal the 2023 CN Awards shortlist at the start of May.
The CN Awards provide the chance for all readers, advertisers, and contributors of CN Magazine to come together to recognise the achievements of those whose great work has made a significant difference within the nutrition industry – whether an individual, group or organisation.
To see who has made this year’s shortlist and cast your votes, visit: https://nutrition2me.com/cn-awards
Reduced Cancer Mortality with Daily Vitamin D Intake
Vitamin D intake could reduce cancer mortality in the population by twelve percent - provided the vitamin is taken daily. This was the result of an evaluation of 14 studies of the highest quality conducted at the German Cancer Research Center with a total of almost 105,000 participants.
Vitamin D deficiency is widespread worldwide and is particularly common among cancer patients. Averaged over the year, the vitamin D blood levels of about 15% of German adults are below the threshold for a pronounced vitamin D deficiency*. In contrast, in a study of colorectal cancer patients, researchers diagnosed vitamin D3 deficiency in 59% of participants, which was also associated with unfavourable prognosis.
Potential effects of vitamin D supplementation and the development or prognosis of cancer have already been investigated in numerous studies. "Based on current studies, vitamin D3 supplementation probably does not protect against developing cancer, but it could reduce the likelihood of dying from cancer. However, previous studies on cancer mortality have yielded very different results, and we were interested in the reasons for this," said Ben Schöttker, an epidemiologist at the German Cancer Research Center. "By re-evaluating all previous studies on the topic, we wanted to help produce robust results on this issue, which is so relevant to population health".
To investigate the effectiveness of vitamin D3 on cancer mortality in the population and on the survival of cancer patients, Ben Schöttker and colleagues conducted a systematic literature search that identified 14 studies with a total of nearly 105,000 participants. The researchers considered only studies of the highest quality whose participants had been randomly assigned to the vitamin D3 arm or the placebo arm.
When all 14 studies were pooled, no statistically significant results emerged. However, when the studies were divided according to whether vitamin D3 was taken daily in a low dose** or in higher doses administered at longer intervals**, a large difference was seen. In the four studies with the infrequent higher doses, there was no effect on cancer mortality. In contrast, in the summary of the ten studies with daily dosing, the researchers determined a statistically significant 12% reduction in cancer mortality.
"We observed this 12% reduction in cancer mortality after untargeted vitamin D3 administration to individuals with and without vitamin D deficiency. We can therefore assume that the effect is significantly higher for those people who are actually vitamin D deficient," says Ben Schöttker. He explains the better efficacy of daily doses of vitamin D3 by the more regular bioavailability of the active agent, the hormone 1,25-dihydroxyvitamin D, which is only produced by reactions of vitamin D in the body and can presumably inhibit tumour growth.
A more detailed analysis of the studies with daily intake further revealed that people aged 70 and older benefited most from vitamin D3 therapy. In addition, the effect was most evident when vitamin D intake was started before the cancer diagnosis.
Hermann Brenner, epidemiologist and prevention expert at DKFZ, adds: "This work underlines the great potential of vitamin D3 administration in the prevention of cancer deaths. Regular intake at low doses** is associated with almost negligible risk and very low cost."
The current work was supported by German Cancer Aid.
* The threshold blood 25-hydroxyvitamin D level used for vitamin D deficiency was 30 nmol/L (= 12 ng/ml). If individuals with less severe vitamin D deficiency (blood 25-hydroxyvitamin D level < 50 nmol/L (= 20 ng/ml)) are added, slightly more than half of Germans have at least one deficiency. However, there are also guidelines that use other thresholds. Since the vitamin D level in the blood depends primarily on the tanning of the skin, this percentage also varies greatly with the seasons.** In the studies, daily low doses were 400 to 4000 IU per day, and higher-doses administered at longer intervals were 60,000 to 120,000 IU once per month or less.
Paper: Kuznia S, et al. (2023). Efficacy of vitamin D3 supplementation on cancer mortality: Systematic review and individual patient data meta-analysis of randomised controlled trials. Ageing Res Rev.; DOI: 10.1016/j.arr.2023.101923.