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Systematic Review of the Integrative Medicine Recommendations for Patients with Pancreatic Cancer. SURGERIES 2021. [DOI: 10.3390/surgeries2020022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Integrative medicine (IM) is a relatively new field where non-traditional therapies with peer-reviewed evidence are incorporated or integrated with more traditional approaches. Methods: A systematic review of the literature from the last 10 years was done by searching clinical trials and randomized-controlled trials on Pubmed that discuss nutrition, supplementation, and lifestyle changes associated with “Pancreatic Cancer.” Results: Only 50 articles ultimately met the inclusion criteria for this review. A total of 15 articles discussed the role of obesity and 10 discussed the influence of stress in increasing the risk of pancreatic cancer. Six discussed the potential beneficial role of Vitamins, 5 of cannabinoids, 4 an anti-inflammatory diet, 3 of nut consumption, 2 of green tea consumption, 2 of curcumin supplementation, 1 role of melatonin, and 1 of probiotics. One article each was found on the theoretical benefits of adhering to either a Mediterranean or ketogenic diet. Discussion: As more surgeons become interested in IM, it is hoped that more diseases where the curative treatment is mainly surgical can benefit from the all-encompassing principles of IM in an effort to improve quality of life and survival in patients with pancreatic cancer.
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Hoogenboom SA, Bolan CW, Chuprin A, Raimondo MT, van Hooft JE, Wallace MB, Raimondo M. Pancreatic steatosis on computed tomography is an early imaging feature of pre-diagnostic pancreatic cancer: A preliminary study in overweight patients. Pancreatology 2021; 21:428-433. [PMID: 33485792 DOI: 10.1016/j.pan.2021.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/07/2020] [Accepted: 01/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of pancreatic ductal adenocarcinoma (PDAC) is on the rise, driven by factors such as aging and an increasing prevalence of obesity and diabetes mellitus. To improve the poor survival rate of PDAC, early detection is vital. Recently, pancreatic steatosis has gained novel interest as a risk factor for PDAC. This study aimed to investigate if pancreatic steatosis on computed tomography (CT) is an early imaging feature in patients with pre-diagnostic PDAC. METHODS A retrospective case-control study was performed. Patients diagnosed with PDAC (2010-2016) were reviewed for abdominal non-contrast CT-imaging 1 month-3 years prior to their diagnosis. Cases were matched 1:4 with controls based on age, gender and imaging date. Unenhanced CT-images were evaluated for pancreatic steatosis (pancreas-to-spleen ratio in Hounsfield Units <0.70) by a blinded radiologist and results were compared between cases and controls. RESULTS In total, 32 cases and 117 controls were included in the study with a comparable BMI (29.6 and 29.2 respectively, p = 0.723). Pancreatic steatosis was present in 71.9% of cases compared to 45.3% of controls (Odds ratio (OR) 3.09(1.32-7.24), p = 0.009). Adjusted for BMI and diabetes mellitus, pancreatic steatosis on CT remained a significant independent risk factor for PDAC (Adjusted OR 2.70(1.14-6.58), p = 0.037). CONCLUSION Pancreatic steatosis measured on CT is independently associated with PDAC up to three years before the clinical diagnosis in overweight patients. If these data are confirmed, this novel imaging feature may be used to identify high-risk individuals and to stratify the risk of PDAC in individuals that already undergo PDAC screening.
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Affiliation(s)
- Sanne A Hoogenboom
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Candice W Bolan
- Department of Radiology, Mayo Clinic Jacksonville, Florida, USA
| | - Anthony Chuprin
- Department of Radiology, Mayo Clinic Jacksonville, Florida, USA
| | - Maria T Raimondo
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA
| | - Massimo Raimondo
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA
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Soeda J, Mouralidarane A, Cordero P, Li J, Nguyen V, Carter R, Kapur SR, Pombo J, Poston L, Taylor PD, Vinciguerra M, Oben JA. Maternal obesity alters endoplasmic reticulum homeostasis in offspring pancreas. J Physiol Biochem 2016; 72:281-91. [PMID: 26979740 PMCID: PMC4873529 DOI: 10.1007/s13105-016-0476-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/29/2016] [Indexed: 12/11/2022]
Abstract
The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is increasing in parallel with obesity rates. Stress-related alterations in endoplasmic reticulum (ER), such as the unfolded protein response (UPR), are associated with obesity. The aim of this study was to investigate ER imbalance in the pancreas of a mice model of adult and perinatal diet-induced obesity. Twenty female C57BL/6J mice were assigned to control (Con) or obesogenic (Ob) diets prior to and during pregnancy and lactation. Their offspring were weaned onto Con or Ob diets up to 6 months post-partum. Then, after sacrifice, plasma biochemical analyses, gene expression, and protein concentrations were measured in pancreata. Offspring of Ob-fed mice had significantly increased body weight (p < 0.001) and plasma leptin (p < 0.001) and decreased insulin (p < 0.01) levels. Maternal obesogenic diet decreased the total and phosphorylated Eif2α and increased spliced X-box binding protein 1 (XBP1). Pancreatic gene expression of downstream regulators of UPR (EDEM, homocysteine-responsive endoplasmic reticulum-resident (HERP), activating transcription factor 4 (ATF4), and C/EBP homologous protein (CHOP)) and autophagy-related proteins (LC3BI/LC3BII) were differently disrupted by obesogenic feeding in both mothers and offspring (from p < 0.1 to p < 0.001). Maternal obesity and Ob feeding in their offspring alter UPR in NAFPD, with involvement of proapoptotic and autophagy-related markers. Upstream and downstream regulators of PERK, IRE1α, and ATF6 pathways were affected differently following the obesogenic insults.
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Affiliation(s)
- Jumpei Soeda
- Institute for Liver and Digestive Health, University College London, London, UK
| | | | - Paul Cordero
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Jiawei Li
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Vi Nguyen
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Rebeca Carter
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Sabrina R Kapur
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Joaquim Pombo
- Division of Women's Health, King's College London, London, UK
| | - Lucilla Poston
- Division of Women's Health, King's College London, London, UK
| | - Paul D Taylor
- Division of Women's Health, King's College London, London, UK
| | - Manlio Vinciguerra
- Institute for Liver and Digestive Health, University College London, London, UK.
- International Clinical Research Center (ICRC), Center for Translational Medicine (CTM), St. Anne's University Hospital, Brno, Czech Republic.
- Centro Studi Fegato (CSF)-Liver Research Center, Fondazione Italiana Fegato, Trieste, Italy.
| | - Jude A Oben
- Institute for Liver and Digestive Health, University College London, London, UK.
- Department of Gastroenterology and Hepatology, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, UK.
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Abstract
More research is now focused on pancreatic steatosis. Multiple definitions, clinical associations and synonyms for pancreatic steatosis are described in the literature and can be confusing. The integration and comparison of several studies concerning this topic is therefore challenging. In the past, pancreatic steatosis was considered an innocuous condition, a bystander of many underlying diseases (such as congenital syndromes, hemochromatosis and viral infection). However, evidence that pancreatic steatosis (strongly associated with obesity and the metabolic syndrome) has a role in type 2 diabetes mellitus, pancreatic exocrine dysfunction, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula after pancreatic surgery is emerging. This Review focuses on the different etiological factors and the clinical consequences of pancreatic steatosis.
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Affiliation(s)
- Mark M Smits
- Department of Gastroenterology & Hepatology, Vrije Universiteit University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
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Oben JA, Patel T, Mouralidarane A, Samuelsson AM, Matthews P, Pombo J, Morgan M, McKee C, Soeda J, Novelli M, Poston L, Taylor P. Maternal obesity programmes offspring development of non-alcoholic fatty pancreas disease. Biochem Biophys Res Commun 2010; 394:24-8. [PMID: 20170634 PMCID: PMC2877817 DOI: 10.1016/j.bbrc.2010.02.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 02/11/2010] [Indexed: 01/09/2023]
Abstract
Background and aims The prevalence of pancreatic adenocarcinoma (PAC) parallels rising rates of obesity and dysmetabolism, a possible link being non-alcoholic fatty pancreas disease (NAFPD). We have recently shown that maternal obesity programmes the development of a dysmetabolic and fatty liver (non-alcoholic fatty liver disease, NAFLD) phenotype in adult offspring. Since the pancreas and liver originate from the same embryonic bud, it is plausible that maternal obesity may similarly programme the development of NAFPD. Our objective was to determine the effect of maternal obesity on development of NAFPD in offspring and ascertain contributions of the intra/extra-uterine periods. Methods Female C57BL/6J mice were fed either a standard chow (3% fat, 7% sugar) or a hypercalorific diet (16% fat, 33% sugar) for six weeks prior to mating and throughout pregnancy and lactation. Female offspring were cross-fostered for suckling to dams on the same or opposite diet to yield four groups: offspring of lean suckled by lean dams (n = 6), offspring of obese suckled by obese dams (n = 6), offspring of lean suckled by obese dams (n = 5) and offspring of obese suckled by lean dams (n = 6). All offspring were weaned onto a standard chow diet at 21 days and sacrificed at 3 months post-partum for tissue collection. Results Offspring subjected to an adverse suckling environment showed significant increases in body weight, pancreatic triglyceride content, TGF-β, collagen gene expression and SBP at rest along with an enhanced restraint stress response, indicating a dysmetabolic and NAFPD phenotype. Conclusions Developmental programming is involved in the pathogenesis of NAFPD and appears to be largely dependent on an adverse extra-uterine environment.
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Affiliation(s)
- Jude A Oben
- Centre for Hepatology, University College London, Royal Free Hospital, London NW3 2PF, UK.
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Butler AE, Galasso R, Matveyenko A, Rizza RA, Dry S, Butler PC. Pancreatic duct replication is increased with obesity and type 2 diabetes in humans. Diabetologia 2010; 53:21-6. [PMID: 19844672 PMCID: PMC2789928 DOI: 10.1007/s00125-009-1556-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 09/15/2009] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS In a high-fat-fed rat model of type 2 diabetes we noted increased exocrine duct replication. This is a predisposing factor for pancreatitis and pancreatic cancer, both of which are more common in type 2 diabetes. The aim of the study reported here was to establish if obesity and/or type 2 diabetes are associated with increased pancreatic ductal replication in humans. METHODS We obtained pancreas at autopsy from 45 humans, divided into four groups: lean (BMI <25 kg/m(2)); obese (BMI >27 kg/m(2)); non-diabetic; and with type 2 diabetes. Pancreases were evaluated after immunostaining for the duct cell marker cytokeratin and Ki67 for replication. RESULTS We show for the first time that both obesity and type 2 diabetes in humans are associated with increased pancreatic ductal replication. Specifically, we report that (1) replication of pancreatic duct cells is increased tenfold by obesity, and (2) lean subjects with type 2 diabetes demonstrate a fourfold increase in replication of pancreatic duct cells compared with their lean non-diabetic controls. CONCLUSIONS/INTERPRETATION Pancreatic duct cell replication is increased in humans in response to both obesity and type 2 diabetes, potentially providing a mechanism for the increased risk of pancreatitis and pancreatic cancer in those with obesity and/or type 2 diabetes.
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Affiliation(s)
- A. E. Butler
- Larry Hillblom Islet Research Center, UCLA David Geffen School of Medicine, 900 Weyburn Place #A, Los Angeles, CA 90024-2852 USA
| | - R. Galasso
- Larry Hillblom Islet Research Center, UCLA David Geffen School of Medicine, 900 Weyburn Place #A, Los Angeles, CA 90024-2852 USA
| | - A. Matveyenko
- Larry Hillblom Islet Research Center, UCLA David Geffen School of Medicine, 900 Weyburn Place #A, Los Angeles, CA 90024-2852 USA
| | - R. A. Rizza
- Endocrine Research Unit, Mayo Medical College, Rochester, MN USA
| | - S. Dry
- Department of Pathology, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - P. C. Butler
- Larry Hillblom Islet Research Center, UCLA David Geffen School of Medicine, 900 Weyburn Place #A, Los Angeles, CA 90024-2852 USA
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Gumbs AA, Bessler M. Comment on: Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis 2008; 4:696-7. [PMID: 19026374 DOI: 10.1016/j.soard.2008.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
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Obesity, Pancreatitis, and Pancreatic Cancer. Obes Surg 2008; 18:1183-7. [DOI: 10.1007/s11695-008-9599-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 05/23/2008] [Indexed: 12/20/2022]
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