News Round-up
Does gut microbiota hold the key to improved diagnosis and treatment of oesophageal cancer?
Oesophageal microbiota may help to improve the diagnosis and management of oesophageal cancer.
Oesophageal microbiota may help to improve the diagnosis and management of oesophageal cancer, according to the results of a study presented at UEG Week 2018 in Vienna, Austria. Researchers from Italy directed by Professor Cammarota have found a unique pattern of microbes living in the oesophagus of people with oesophageal cancer or Barrett's oesophagus, which could potentially be used to identify at-risk individuals and pave the way for new types of treatment in the future.
Lead researcher, Dr Loris Riccardo Lopetuso from the Catholic University of Rome, Italy, said: "Despite the introduction of novel therapies such as surgery, chemotherapy, and radiotherapy, the prognosis for people with oesophageal cancer remains poor. We need to develop a better understanding of what causes normal oesophageal cells to become malignant so we can find at-risk individuals as early as possible and develop alternative therapeutic strategies."
Oesophageal cancer is the 8th most common cancer worldwide and the 6th most common cause of cancer-related death. Most people present with established disease, so rates of mortality are high in most countries. Known risk factors include gastroesophageal reflux disease (GORD), obesity, smoking, low fruit/vegetable intake, and alcohol consumption, but other factors, including upper digestive tract microbiota are thought to be involved.
In the study presented today, researchers aimed to characterize the composition of the oesophageal microbiota in patients with oesophageal cancer compared with patients with Barrett's oesophagus and a control group of people with no evidence of the disease. Biopsy samples from six newly-diagnosed patients with oesophageal cancer, 10 with Barrett's oesophagus and 10 controls were analysed for microbiota composition.
A higher level of bacterial diversity was reported for patients with oesophageal cancer compared with the controls; there was a relative abundance of Bacteroidetes and a relative paucity of Firmicutes (different categories of microbiota) in the patients with oesophageal cancer compared with the controls. There were also lower levels of Streptococcus, and higher levels of Veillonella, Porphyromonas, and Prevotella (different types of bacteria) in those with oesophageal cancer compared with Barrett's oesophagus patients and the controls.
"These results indicate that there is a unique microbial signature for oesophageal cancer that might represent a risk factor for this condition," said Dr Lopetuso. "If these findings are confirmed in our further analyses, it may be possible to imagine innovative diagnostic and therapeutic tools to help us manage this condition more successfully."
References: • Lopetuso LR, Ianiro G, Severgnini M, et al. Characterization of esophageal microbiota in patients with Barrett's esophagus and esophageal adenocarcinoma. UEG Journal 2018. Presented at UEG Week Vienna 2018. • Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5): E359-86. • Gupta B, Kumar N. Worldwide incidence, mortality and time trends for cancer of the oesophagus. Eur J Cancer Prev. 2017; 26(2): 107-118. • Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003 Sep 17; 95(18): 1404-13. • Yang L, Chaudhary N, Baghdadi J, et al. Microbiome in reflux disorders and esophageal adenocarcinoma. Cancer J. 2014; 20(3): 207-10.
Online Survey – 'Annual review provisions for adults and children with coeliac disease'
An unknown proportion of adults and children with coeliac disease are offered an annual review. Within the NHS it will depend on where they live, and what it consists of varies greatly.
National guidance is based on a predominance of expert opinion due to the lack of high-quality studies informing the provision of coeliac disease follow up care. The traditional annual review, consisting of an individual appointment is already changing into a variety of different services.
Dr Yvonne Jeanes, Registered Dietitian at the University of Roehampton, is collating data for a comprehensive study* on the impact of annual review provisions for adults and children with coeliac disease.
This study aims to provide a comprehensive description of 'follow-up' and annual review provision for adults and children with coeliac disease across the UK, in the process it will highlight innovative practice. Reporting national data will provide a stronger voice for improving the management of coeliac disease and informing national guidelines. A key strength of this study will be presenting data from all geographical regions.
As part of this study, an online survey is being conducted 'Are annual reviews available to ADULTS or CHILDREN with coeliac disease in YOUR area?' and the study researchers would be grateful for your participation. For further details and to access to the survey, please visit: https://roehamptonuniversity.onlinesurveys.ac.uk/coeliac_disease. The survey takes up to 30 minutes to complete, and you will be invited to take part in a prize draw (two £50 shopping vouchers of your choice to be won).
*This is a British Dietetic Association GET funded project, led by Dr Yvonne Jeanes RD, University of Roehampton & Education and Training Lead, BDA Gastroenterology group.
Guts UK/Dr Falk Awards – Call for entries 2018/19
The Guts UK/Dr Falk Awards recognise the achievements of those who bring new insight to gastroenterology and hepatology, and the collaboration that furthers patient care. For those committed to furthering research or improving patient care these awards are an opportunity to achieve national recognition as well as the financial support for career progression. This year colleagues may nominate a nurse for the Nurse Prize..
Prizes available:
- A £1,000 prize for the best essay on gastroenterology or hepatology research personally undertaken by medical students who were on an intercalated BSc/MRes/MSc/MPH/MBPhD* course during the previous academic year (2017/18)
- Four £1,500 prizes for medical students taking full-time science degrees (BSc/MRes/MSc/MPH/MBPhD*) focusing on research into gastrointestinal or liver-related disease in the current academic year (2018/19)
- Two £2,500 awards for F1/F2 doctors to facilitate prospective research in an area relevant to gastroenterology or hepatology
- A £1,000 award for primary and secondary care gastrointestinal/liver nurses for initiatives that have advanced patient care
- A £1,000 award for dietitians working in the gastrointestinal / liver field for initiatives that have advanced or improved patient care
SpR Trainee Audit/Quality Improvement Awards
- Up to £10,000 is available for UK-based gastroenterology / hepatology specialty trainees who would like to conduct an audit or quality improvement project in any area of gastroenterology, liver disease or nutrition.
The application deadline is 5pm on Monday 4th March 2019. Applications received after this time will not be considered.
For further information and to apply: https://gutscharity.org.uk/research/grants-and-awards/the-guts-uk-dr-falk-awards/
* PhD students should note that they may apply for the medical student prize only once during their three-year studentship and that they may apply for the essay prize when their PhD has been completed.
Vitamin D Supplements May Promote Weight Loss in Obese Children
Vitamin D supplements may promote weight loss and reduce risk factors for future heart and metabolic disease in overweight and obese children, according to research presented today at the 57th Annual European Society for Paediatric Endocrinology Meeting. These findings indicate that simple vitamin D supplementation may be part of an effective strategy to tackle childhood obesity and reduce the risk of serious health problems, such as heart disease, in adulthood.
Obesity in childhood and adolescence represents a major health problem worldwide, which leads to the development of expensive, serious and debilitating complications, including heart disease and diabetes, in later life. Although vitamin D deficiency is typically associated with impaired bone health, in recent years it has been increasingly linked with increased body fat accumulation and obesity, with the precise nature of this relationship currently under intense investigation by researchers. However, the effect of vitamin D supplementation on the weight and health of obese children and adolescents had not yet been investigated.
In this study, Dr Christos Giannios, Professor Evangelia Charmandari and colleagues at the University of Athens Medical School and the 'Aghia Sophia' Children's Hospital in Athens, assessed 232 obese children and adolescents over 12 months, with 117 randomly assigned to receive vitamin D supplementation, in accordance with the Endocrine Society's guidelines on treatment and prevention of deficiency. Levels of vitamin D, body fat, and blood markers of liver function and heart health were assessed at the start of the study and 12 months later. The study reported that children given vitamin D supplements had significantly lower body mass index, body fat and improved cholesterol levels after 12 months of supplementation.
"These findings suggest that simple vitamin D supplementation may reduce the risk of overweight and obese children developing serious heart and metabolic complications in later life," says lead researcher Prof Charmandari.
The team now plan to investigate the effects of vitamin D supplementation on the health of obese children and adolescents that already have unhealthy conditions, such as high blood pressure, high blood glucose and high cholesterol, all of which increase the risk of heart disease, stroke and diabetes.
Prof Charmandari cautions: "Although these initial findings indicate that vitamin D could be used in the treatment of obesity, there remains a lack of evidence on the safety and long-term effects of supplementation, particularly if there is no vitamin D deficiency. However, if your child is overweight or obese I recommend that you consult your primary care physician for advice, and consider having their vitamin D levels tested."
Updated European Guidance for the Diagnosis and Management of Osteoporosis in Women
The new publication reviews and updates the 2013 European guidance for the diagnosis and management of osteoporosis in postmenopausal women and provides a platform on which specific guidelines can be developed at the national level.
The clinical significance of osteoporosis lies in the painful, debilitating fractures that arise, which are a major cause of long-term disability in the population. Nevertheless, osteoporosis is under-diagnosed and undertreated: in the European Union, it is estimated that 57 % of women at high risk of fragility fracture due to osteoporosis do not receive bone-specific treatment. In patients with fragility fractures, less than 20 % receive treatment to reduce the chance of a future fracture.
The International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) have published an updated guidance to aid healthcare professionals in diagnosing and managing osteoporosis in postmenopausal women. The present guidance reviews and updates the 2013 guidance in all key areas and includes new information on the evaluation of bone microstructure in fracture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment.
Download European guidance for the diagnosis and management of osteoporosis in postmenopausal women
Endorsed by the Scientific Advisory Board of ESCEO as well as the Committees of Scientific Advisors and National Societies of the IOF, the recommendations in this guideline are intended for all healthcare professionals involved in the management of osteoporosis.
"This new guidance aims to stimulate a cohesive approach to the management of osteoporosis in Europe by providing an updated platform on which specific guidelines can be developed or revised at a national level," explains Professor John Kanis, Honorary President of IOF.
Professor Jean-Yves Reginster, ESCEO President and Chair of the IOF Committee of National Societies, concludes: "Although this guidance has a European perspective and is focussed on postmenopausal women, the recommendations can be of assistance in other regions of the world and in men. The hope is that the recommendations will facilitate improved prevention and management for at-risk individuals and ultimately serve to alleviate the high societal and personal costs posed by osteoporosis to healthcare systems and patients with osteoporosis."
In addition to the full guidance in Osteoporosis International, executive summaries will be published in Calcified Tissue International and Aging Clinical and Experimental Research.
Reference: Kanis JA, Cooper C, Rizzoli R and Reginster JY on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) (2018). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International. https://doi.org/10.1007/s00198-018-4704-5. https://link.springer.com/article/10.1007%2Fs00198-018-4704-5
Gaps in Understanding European Children's Nutrient Intake Levels
Inconsistencies across European national diet surveys hinders wider understanding of children's nutrient intake levels.
Only a third of European countries have robust reporting on child and adolescent nutrient intakes, new research shows. This highlights the potential lack of data to inform the design and monitoring of nutritional policies in some parts of Europe. To better understand energy levels and the nutrient intakes currently consumed by European children, an international team led by the University of Leeds, in collaboration with the World Health Organization's (WHO) Regional Office for Europe, reviewed national diet surveys from the 53 European Member States. They found the majority of the reporting gaps were in Central and Eastern European countries, meaning potential nutritional issues in certain countries may be undetected or underestimated.
Lead author Holly Rippin, a postgraduate researcher from the School of Food Science and Nutrition, said: "The lack of available data for child nutrient intake is concerning. It makes it extremely difficult to identify vulnerable groups, compare nutrient intakes between countries and provide evidence for policies that could improve health. It's similar to trying to describe a complex watercolour when large sections haven't been painted in yet."
The study, published in Nutrition Research Reviews, shows:
- Only around 30 per cent of countries reported nutrient intake data by gender and age group for children and adolescents
- Age groupings varied across counties and several counties did not report nutrients in all age groups or reported on different types of nutrients
- Many countries did not separate intake amounts for girls and boys in the youngest age groups.
Holly Rippin said: "Our assessment also showed a significant amount of under-reporting, which means certain nutrition-related problems, such as deficiencies or overconsumption, could be underestimated and possibly just the tip of the iceberg with so many countries intakes unknown."
The WHO European Food and Nutrition Action Plan encourages Member States to strengthen and expand nationally representative diet and nutrition surveys. However, national diet survey provision across Europe is inconsistent and less than two thirds of WHO European countries have nationally representative diet surveys.
Holly Rippin added: "Insufficient data and the inability to compare countries and age groups highlights the pressing need to dedicate resources to dietary surveillance and harmonise methodologies and approaches in nutrient reporting throughout the WHO European region.
The worry is that it is extremely difficult to design suitable and locally-appropriate nutrition policies in countries without sufficient data. Easily accessed, robust data is critical in tailoring policies to meet national needs and improve diets across Europe."
Falling short of WHO recommended nutrient intakes
The team assessed the limited available data from the national diet surveys against nutrient intakes recommended by WHO. While inconsistent reporting across and within countries hindered comparisons, the study identified some key areas of concern and in particular found that the average intakes for children reported in the majority of countries, including the UK, did not meet most of the WHO recommended nutrient intakes.
Co-author Janet Cade, professor of nutritional epidemiology and public health at Leeds, said: "Our findings indicate that a Europe-wide policy focus could improve intakes of iron, vitamin D, and total folate while also reducing sodium and free sugar intake. A focus on iron and vitamin D intake would be especially beneficial for girls and children over the age of 10.
Iron is a particular issue for adolescent girls. The survey data showed low iron intakes in the vast majority of countries. Adolescent girls continue to be at greater risk of iron-deficiency anaemia, which is associated with reduced intellectual and immune function.
Although a variety of evidence is required to inform national interventions, accurately identifying key dietary trends could help prevent childhood nutrient deficiencies that can cause health issues that extend well into adulthood."
The WHO European Food and Nutrition Action Plan already identifies several of the nutrients highlighted in the report as areas of concern, such as iron and vitamin D, although it refers to all ages rather than specifically children. The Action Plan also calls for the promotion of healthy diets through the reduction in sodium, saturated fats, and free sugars.
Co-author Dr Jayne Hutchinson, also from the School of Food Science and Nutrition at Leeds, said: "The WHO European Food and Nutrition Action Plan is making a concentrated effort to improve nutrient intake across Europe and identifying any additional areas of concern is an important part of advancing these efforts.
Our research shows there are still other areas of concern that need to be better understood and addressed, such as omega fats for which reported intakes were low. Omega fats have important functions for health and studies suggest they may help lower the risk of heart disease and depression.
Identifying these trends allows for the potential to develop targeted policy and guidance, for example encouraging public education on sources of omega fats.
Despite the current lack of data, national nutrition and health surveys remain the best source of information on dietary risk factors. It's vital that government and health bodies should continue to invest and improve efforts to conduct national dietary surveys in a standardised format with a full range of nutrient intakes."
Dr Joao Breda is a study co-author and Programme Manager for Nutrition at WHO Europe and Head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases. He said: "Dietary surveys should be the foundation for all nutrition policies in a country. In many cases, our efforts to support countries in achieving the Sustainable Development Goals are constrained by a lack of data.
Commitment by countries and funders to support the better availability of dietary intake data will help the public health community target policies and interventions to eradicate all forms of malnutrition, including both the remaining pockets of under-nutrition in the region and the rising rates of overweight and unhealthy diets."
The paper Child and adolescent nutrient intakes from current national dietary surveys of European populations is published in Nutrition Research Reviews 31 October 2018 (DOI: 10.1017/S0954422418000161) This research was funded by the WHO Regional office for Europe. Funding for the publication was received from the Government of the Russian Federation within the context of the WHO European Office for the Prevention and Control of Non-communicable Diseases (NCD Office).