Papers by NADA ROTOVNIK KOZJEK
Journal of clinical oncology, Jun 1, 2024
Radiology and oncology, Feb 21, 2024
Background. Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly prese... more Background. Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly presented as a large tumour mass at time of diagnosis. We investigated the impact of body composition on outcome in patients operated on for primary localized RPS. Patients and methods. We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cutoff values of body composition parameters. Myosteatosis was defined based on determined MRA cutoffs. Results. In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2% vs. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity. Conclusions. Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.
Radiology and Oncology, Nov 29, 2023
Background. In patients with gastrointestinal cancer with planned elective surgery, malnutrition ... more Background. In patients with gastrointestinal cancer with planned elective surgery, malnutrition increases the risk of adverse outcomes in the postoperative period. The phase angle, measured by the bioelectrical impedance analysis is an indicator of the metabolic and functional status of the patient. It may be an important prognostic indicator for the clinical outcome of post-surgical treatment in patients with gastrointestinal cancer. Patients and methods. In this prospective study, 70 patients with gastrointestinal cancer had their phase angles measured by the bioelectrical impedance analysis before the surgery. During the first month after the surgery, we documented the postoperative complications from the patient's records and classified them according to the Clavien Dindo classification of surgical complications. The time of hospitalization was also recorded. The data was statistically analysed in SPSS. Results. We found a statistically significant difference (p = 0.036) in the average value of phase angles between the group of patients who had postoperative complications (phase angle 5.09°) and the group without postoperative complications (5.64°). We noted a correlating trend of decreasing phase angle values and increasing hospitalization time (Pe R =-0,40, p = 0,001). The phase angle cutoff value (5.5°) was calculated using the ROC curve method, predicting a higher risk of the postoperative complications (p = 0,037) in patients with lower phase angle. Conclusions. Lower phase angle values before surgery were associated with more complications during the first month after surgery and longer hospitalization time. We found that a phase angle below than 5.5° could serve as a marker that predicts a greater risk of postoperative complications.
Mišica v zdravju in bolezni
Mišica v zdravju in bolezni
Slovenian Medical Journal, Jun 30, 2023
Izobraževalna pot študentov medicine je dolgotrajna in zahtevna. Usklajevanje študijskih obveznos... more Izobraževalna pot študentov medicine je dolgotrajna in zahtevna. Usklajevanje študijskih obveznosti, obštudijskih dejavnosti in skrbi za zdravje je lahko za mlade velik izziv, za katerega so posamezniki različno dobro opremljeni. Naš narativni pregledni članek povzema doslej znane raziskave o vplivu študija medicine na dejavnike življenjskega sloga in determinante zdravja ter s tem na telesno in duševno zdravje posameznika. Raziskave glede vpliva teh dejavnikov smo pridobili prek iskalnih nizov s ključnimi besedami. Ugotovili smo, da nekakovostna, nezadostna in neredna prehrana v kombinaciji s pomanjkanjem telesne dejavnosti in sedečim slogom življenja vpliva na neželene spremembe telesne sestave ter poveča tveganje za razvoj presnovnih motenj ter akutnih in kroničnih zdravstvenih težav. Zdravstvene težave dodatno poglablja tudi pomanjkanje spanja in kronični stres zaradi zahtev študija, kar lahko vodi tudi v razvoj duševnih motenj. Vse to ne prispeva le k zmanjšanju študijskega uspeha študentov, temveč tudi do zdravstvenih težav številnih mladih, ki se že na začetku svoje zahtevne kariere soočajo z njimi. V Sloveniji zaenkrat nimamo sistematičnih raziskav, ki bi omogočale oceno vpliva dejavnikov življenjskega sloga in kroničnega stresa na zdravje slovenskih študentov medicine.
Radiology and Oncology, Jul 13, 2023
Background. The significance of nutritional care in the management of cancer, particularly in the... more Background. The significance of nutritional care in the management of cancer, particularly in the surgical treatment of abdominal cancer, is increasingly acknowledged. Body composition analysis, such as the Bioelectric impedance assay (BIA), and functional tests, e.g., handgrip strength, are used when assessing nutritional status alongside general and nutritional history, clinical examination, and laboratory tests. The primary approach in nutritional care is individually adjusted nutritional counselling and the use of medical nutrition, especially oral nutritional supplements. The aim of the study was to investigate the effects of perioperative nutritional care on body composition and functional status in patients with carcinoma of the gastrointestinal tract, hepatobiliary system, and pancreas. Patients and methods. 47 patients were included, 27 received preoperative and postoperative nutritional counselling and oral nutritional supplements (Group 1), while 20, due to surgical or organisational reasons, received nutritional care only postoperatively (Group 2). The effect of nutritional therapy was measured with bioimpedance body composition and handgrip measurements. Results. Group 2 had a higher average Nutritional Risk Screening (NRS) 2002 score upon enrolment (3 vs. 2 points); however, there was no difference when malnutrition was assessed using Global Leadership in Malnutrition (GLIM) criteria. There was a relative increase in lean body mass and fat-free mass index (FFMI) 7 days after surgery in group 1 (+4,2% vs.-2,1% in group 2). There was no difference in handgrip strength. Conclusions. Our results indicate that combined preoperative and postoperative nutritional care is superior to only postoperative nutritional care. It seems to prevent statistically significant lean mass loss 7 days after surgery but not after 14 days or 4 weeks.
JCO global oncology, Aug 1, 2023
138 Background: Communication with breast cancer patients is crucial within individualised integr... more 138 Background: Communication with breast cancer patients is crucial within individualised integrated rehabilitation, where the patients are at the centre of the provided health care services. Anonymous surveys could be used as one of the tools to check the needs of patients, the effectiveness of various aspects of the interventions offered and to obtain valuable feedback from patients. Our aim was to determine which manner of conducting anonymous surveying among breast cancer patients would be most suitable for improving the health service of individualized integrated rehabilitation. Methods: The subjects of our prospective study were 600 females (29-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients receiving treatment at Institute of Oncology Ljubljana in 2019-2022. Questionnaires of implemented surveys were anonymous with different manners of distribution and on three different topics. The first survey was conducted via standard post sending questionnaires on papers to the patients to inquire about their satisfaction with the provided services after the conclusion of their treatment. The second survey was conceded via email, sending online questionnaires to inquire about appropriateness of interventions and patients' opinions about spa treatment. The third survey was conducted half via email and half via text message on mobile phone (SMS) to inquire about the most suitable terms of the regular physical activity during oncological treatment. The survey response rate was calculated as the number of valid surveys received (numerator) divided by the number of surveys distributed (denominator). If all questions were not answered, the survey was invalid. Results: There was a significant difference in the response rate of the patients to the anonymous surveys, depending on the manner of distribution of the survey. The response rate of patients who got questionnaires by regular mail were 51%, 28% and 13% if received by e-mail and 27% if sent via SMS. The difference in the response rate in the survey on physical activity, received by email or by SMS, was statistically significant (p= 0,0026). Conclusions: The highest response rate of breast cancer patients was received by sending the questionnaires via regular post. Clinical trial information: V3-1906. [Table: see text]
Clinical Nutrition, Oct 1, 2011
Background & aims: Enteral glutamine may have protective effects on gut function and reduce metab... more Background & aims: Enteral glutamine may have protective effects on gut function and reduce metabolic stress in patients receiving radiochemotherapy. The aim of our study was to evaluate its influence in patients with rectal cancer undergoing preoperative radiochemotherapy. Methods: We performed a randomized double blind, placebo controlled pilot study in 33 patients. 30 g of glutamine, average dose 0.41 g/kg (SD ¼ 0.07) g/kg/day was administered orally in three doses per day for five weeks during preoperative radiochemotherapy of rectal cancer. 30 g of maltodextrin was given as placebo. Body weight was measured and NRS 2002 screening was performed before and after treatment. Bowel function was evaluated by stool consistency and frequency. Plasma levels of inflammatory parameters and hormones were measured. Results: There was no difference between groups in frequency and severity of diarrhoea during radiochemotherapy (p ¼ 0.5 and p ¼ 0.39 respectively), insulin levels significantly increased in both groups, IL-6 only in glutamine group. Conclusion: Results of this small pilot study in rectal cancer patients receiving preoperative radiochemotherapy, showed that ingestion of larger quantities of glutamine given more often as previously reported did not diminish the incidence and severity of diarrhoea and did not affect inflammatory and metabolic activity compared to the placebo treatment with maltodextrin.
Clinical Nutrition, Sep 1, 2019
European Journal of Clinical Nutrition, Feb 24, 2016
BACKGROUND/OBJECTIVES: Malnutrition and cachexia have a negative impact on the course of treatmen... more BACKGROUND/OBJECTIVES: Malnutrition and cachexia have a negative impact on the course of treatment in patients with head and neck squamous cell carcinoma (HNSCC). Good evidence exists for the practical use of the bioelectrical impedance analysis (BIA) parameter phase angle (PA) for the evaluation of nutritional and overall health status in cancer patients. In the present study, two hypotheses were tested: that PA can distinguish between malnutrition and cachexia; in non-cachectic patients, pre-treatment PA is predictive for cachexia development during (chemo)radiation. SUBJECTS/METHODS: In 55 head and neck cancer patients, nutritional status was determined by the NRS-2002, anthropometric, laboratory tests and BIA before and after (chemo)radiotherapy. For the diagnosis of cachexia, the international consensus criteria were used. Patients were categorized as well-nourished, malnourished or cachectic. The resulting group distribution was compared with pre-and post-treatment PA values. RESULTS: Before treatment, 69.1% of patients were well-nourished, 16.4% malnourished and 14.5% cachectic; post-treatment proportions were 16.4%, 45.4% and 38.2%, respectively. Well-nourished patients had a higher pre-treatment mean PA value compared with the others (P = 0.045). The risk of malnutrition/cachexia increased by 1.71 (95% confidence interval (CI) 1.10-2.66) per mean PA decrease by one unit (P = 0.018). In 47 initially non-cachectic patients, PA failed to show any predictive value for cachexia (area under the receiver operating characteristic curve: 0.578, 95% CI 0.385-0.772, P40.05). CONCLUSIONS: PA did not distinguish between malnourished and cachectic patients with HNSCC, and pre-treatment PA did not predict cachexia development during (chemo)radiation. Nevertheless, PA seems to be a good marker of nutritional status in HNSCC patients.
Clinical Nutrition, Sep 1, 2018
Background & Aims: Discharge of materials from ileostomy in a fluid, inconsistent form may lead t... more Background & Aims: Discharge of materials from ileostomy in a fluid, inconsistent form may lead to water and electrolyte imbalance and decreased nutrient absorption, followed by the risk of malnutrition. The present study aimed to investigate the effects of smartphone-based nutritional education on the biochemical indicators of patients with ileostomy. Materials & Methods: This quasi-experimental clinical trial was conducted with a control group on 72 patients with ileostomy in 2018. The patients were selected via continuous sampling and non-randomly allocated to two groups of intervention and control. After ileostomy implantation, both groups received training on proper dietary habits by the ward staff. In addition, the patients in the intervention group were provided with smartphone-based nutritional education by the researcher. Evaluation of biochemical indicators was performed one day before ileostomy implantation and three weeks after surgery by the researcher. Data were collected using demographic forms and biochemical indicator reports. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics. Results: Before ileostomy implantation, biochemical indicators had no significant differences in the intervention and control groups. Three weeks after ileostomy implantation, the only significant difference was observed in the level of C-reactive protein (CRP), which was significantly higher in the control group compared to the intervention group. Moreover, changes in the biochemical indicators in the study groups before ileostomy implantation and three weeks after the procedure indicated that the levels of albumin and total protein increased more significantly in the intervention group compared to the control group, while the level of CRP increased in the control group. Conclusion: Although statistically significant changes were denoted in the assessed biochemical indicators, the changes were not considered clinically significant and reliable. Therefore, the increasing of time intervals in larger sample populations with more generalizable results could determine the functional role of the training intervention, so that it could be applicable for patients with ileostomy.
European Journal of Clinical Nutrition, Mar 8, 2017
We conducted a randomized double-blind placebo-controlled study evaluating the influence of 5 wee... more We conducted a randomized double-blind placebo-controlled study evaluating the influence of 5 weeks' duration of 30 g enteral glutamine supplementation on inflammatory and hormonal responses in 73 patients with rectal cancer undergoing preoperative radiochemotherapy. Plasma levels of inflammatory and hormonal parameters were controlled at the beginning and at the end of supplementation. Enteral glutamine resulted in modulation of inflammatory and hormonal responses as shown by a decreased plasma interleukin 6 and cortisol levels in glutamine compared with placebo group: 5.5 ± 3.8 versus 11.1 ± 19.9 ng/l (P = 0.02) for IL-6 and 386 ± 168.4 to 312.7 ± 111.7 nmol/l (P = 0.03) for cortisol. We conclude that enteral glutamine exhibits some anti-inflammatory activity and, consequently, leads to a lower hormonal stress response during radiochemotherapy in patients with rectal cancer.
Clinical Nutrition Supplements, 2010
Nutrition and cancer II 133 been shown to play important roles in the mechanisms that influence a... more Nutrition and cancer II 133 been shown to play important roles in the mechanisms that influence angiogenesis. Evidence suggests that n-3 fatty acids (FAs) have anti-angiogenic properties but the method of action remains unknown however it is likely to be complex and multifactorial. No human studies have examined levels of EGF, HGF and ANG2 in response to n-3FA infusion. Methods: We studied the effect of n-3FAs on EGF, HGF and ANG2 levels in patients with malignancy. 20 patients with colorectal liver metastasis were randomised to receive a 72 hour infusion of TPN with (Lipidem ® 20%, BBraun) or without (Lipofundin ® MCT 20%, BBraun) eicosapentaenoic acid and docosahexaenoic acid. Circulating serum EGF, HGF and ANG2 levels were measured at nine time points from baseline during and after the infusion (0, 1, 3, 6, 20, 44, 68 & 74 hours) using ELISA. Statistical analysis was performed using two way ANOVA. Results: EGF levels in the n-3FA group were significantly less than placebo at all time points with maximal difference at 66 hours following the start of the infusion (p = 0.008). A similar trend was seen with ANG-2 (p = 0.018). Levels of both EGF and ANG2 recovered towards baseline 2 hours after cessation of the infusion. There was no significant change in levels of HGF between the groups. Conclusion: This study supports evidence that n-3FAs have potential anticancer properties in humans. Methods of action are still unknown but these results demonstrate that some of the putative mechanisms do occur. Further investigation is warranted to identify in more detail the pathways involved in reducing EGF and ANG2 levels and the subsequent effect on angiogenesis to further confirm the potential benefit of n-3FAs.
Nutrients, Feb 20, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European Archives of Oto-rhino-laryngology, Nov 27, 2022
Purpose To determine whether muscle mass, defined by fat-free mass index (FFMI) measured with bio... more Purpose To determine whether muscle mass, defined by fat-free mass index (FFMI) measured with bioelectrical impedance analysis (BIA), is predictive of survival of head and neck squamous cell carcinoma (HNSCC) patients. Methods HNSCC patients treated between 2014 and 2018 at the Department for Nutrition of the Institute of Oncology Ljubljana were reviewed. The FFMI values from the pretreatment BIA measurements and pretreatment body mass index (BMI) were used to categorize patients into groups with low and normal muscle mass and BMI using the Global Leadership Initiative on malnutrition (GLIM) recommended cutoff values. The impact of FFMI on disease-free survival (DFS) and overall survival (OS) was determined. Results Of the 71 included patients, 31 (43.7%) had normal FFMI, and 40 (56.3%) had low FFMI, whereas 44 (62%) and 27 (38%) of the patients had normal and low BMI, respectively. Between FFMI and BMI values, a significant correlation was found (R P = 0.75, p < 0.001). Univariate regression analysis showed that FFMI (as a continuous variable) was of prognostic significance for OS (p = 0.039), which was confirmed by multivariate regression analysis (p = 0.029). The model where BMI replaced FFMI negated the prognostic value of BMI (as a continuous variable). Neither FFMI nor BMI was found to be a predictor of DFS on univariate or multivariate analysis. Conclusions In the present group of HNSCC patients, low FFMI adversely influenced OS, emphasizing the importance of using body composition measurement over BMI alone for pretreatment nutritional evaluation of these patients. Keywords Fat-free mass index • Bioelectrical impedance analysis • Body mass index • Head and neck cancer • Overall survival
Slovenian Medical Journal
Sarkopenija je izguba mišične mase in funkcije, ki zmanjša kakovost življenja, povzroči fizično o... more Sarkopenija je izguba mišične mase in funkcije, ki zmanjša kakovost življenja, povzroči fizično oslabelost in je povezana z večjo umrljivostjo. Za postavitev zgodnje diagnoze in za uspešno zdravljenje sarkopenije so potrebne varne, dostopne in natančne diagnostične metode. Ultrazvočna slikovna preiskovalna metoda se vse pogosteje uporablja za oceno mišične mase in kakovosti mišic. S pomočjo različnih ultrazvočnih parametrov lahko sklepamo o količini mišične mase kot tudi o kakovosti mišičnega tkiva. Z uporabo standardiziranih protokolov opravljanja meritev lahko dosežemo večjo natančnost in ponovljivost preiskave. Pomanjkanje jasno določenih mejnih vrednosti in nepopolna standardizacija protokolov in ponekod slaba korelacija parametrov z dejansko fizično zmogljivostjo bolnikov za zdaj še zavirajo širšo uporabo ultrazvočne preiskave v kliničnem okolju. Kljub temu z naraščujočim številom raziskav na tem področju ultrazvočna preiskava pridobiva veljavo pri vsakdanji klinični obravnavi ...
Nephrology Dialysis Transplantation
Background and Aims Gastrointestinal symptoms are prevalent in patients with end-stage renal dise... more Background and Aims Gastrointestinal symptoms are prevalent in patients with end-stage renal disease. Gastrointestinal symptoms in such patients are related to gastric hypomotility, increased medication intake, uremia, and changes in diet. In addition GI symptoms and problems associated with bowel dysfunction are a common cause of technique failure and poor dialysis efficacy. The reason for presence of some gastrointestinal symptoms is also chronic inflammatory state. Inflammation can have many negative effects, including decreased appetite, accelerated protein skeletal muscle breakdown and hypercatabolism. Method 14 peritoneal dialysis patients were included in single Department of Nephrology in the University Medical Center in Ljubljana. All patients were interviewed by a dietitian and nutritional assessment was conducted. Gastrointestinal symptom Rating Scale (GSRS) with 7-grade Likert scale was used to evaluate the intensity of GI symptoms and Bristol Stool Form Scale (BSFS) to ...
Slovenian Journal of Public Health
Objective The syndrome of relative energy deficiency in sports (RED-S) is the result of a prolong... more Objective The syndrome of relative energy deficiency in sports (RED-S) is the result of a prolonged period of low energy availability in athletes and leads to the deterioration of health and physical performance. Our study aimed to investigate the prevalence of RED-S-related health and performance problems in young Slovenian athletes, comparing middle (14–17 years) with late (18–21 years) adolescents. Methods We analysd data of 118 young athletes (61 females, 57 males) who had nutritional assessments. Statistical analysis was carried out to determine the prevalence of RED-S-related problems. RED-S was diagnosed using the Relative Energy Deficiency Tool and the Sports Clinical Assessment Tool. Nutrition-related risk factors for RED-S were assessed with the use of a questionnaire and analysis of a three-day food diary. Results The majority of athletes had at least one RED-S-related health disorder. The number of health-related disorders was significantly higher in females 3.0 (0.2) co...
Clinical Nutrition ESPEN, 2020
Background: It has been proposed that information derived from cardiopulmonary exercise testing (... more Background: It has been proposed that information derived from cardiopulmonary exercise testing (CPET) may provide additional prognostic information; but there are few studies evaluating for coronary artery disease (CAD). By measuring a broad range of variables, CPET can precisely determine aerobic capacity and independent and coupled functions of the cardiovascular, pulmonary and skeletal muscle systems. We tested the prognostic relevance of CPET by comparing its functional data to coronary artery calcium (CAC) score. CAC is highly predictive for cardiovascular events and provides unique anatomic information regarding coronary atherosclerotic burden.
Uploads
Papers by NADA ROTOVNIK KOZJEK