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Background Body mass index (BMI) is related with cardiorespiratory fitness (CRF), but less is known regarding the combined relationships between BMI and body fat (BF) on CRF.Design Cross-sectional study included 2361 girls and 2328 boys aged 10–18 years living in the area of Lisbon, Portugal. BMI was calculated by measuring height and weight, and obesity was assessed by international criteria. BF was assessed by bioimpedance. CRF was assessed by the 20-m shuttle run and the participants were classified as normal-to-high or low-CRF level according to Fitnessgram criterion-referenced standards.Results The prevalence of low CRF was 47 and 39% in girls and boys, respectively. The corresponding values for the prevalence of obesity were 4.8 and 5.6% (not significant) and of excess BF of 12.1 and 25.1% (P<0.001), respectively. In both sexes, BMI and BF were inversely related with CRF: r= −0.53 and −0.45 for BMI and % BF, respectively, in boys and the corresponding values in girls were −0.50 and −0.33 (all P<0.01). When compared with a participant with normal BMI and BF, the odds ratios (95% confidence interval) for low CRF were 1.94 (1.46–2.58) for a participant with normal BMI and high BF, and 6.19 (5.02–7.63) for a participant with high BMI and high BF.Conclusion The prevalence of low-CRF levels is high in Portuguese youths. BF negatively influences CRF levels among children/adolescents with normal BMI.

Greater understanding of factors contributing to nutritional deterioration in cancer, as well as patients expectations and the personal disease impact, are required to devise meaningful nutritional therapy. In a cross-sectional study of 205 patients with cancer of the head-neck, oesophagus, stomach, colon/rectum, nutritional deterioration was multifactorial and mainly determined by the tumour burden. In a larger cohort of 271 patients, although cancer stage and location were the major determinants of the patients Quality of Life, nutritional deterioration combined with deficiencies in nutritional intake were functionally more relevant than cancer stage. Based on this framework, we tested the potential role of nutritional intervention on patient predefined outcomes: nutritional status, diet intake, morbidity and Quality of Life. Two prospective randomised controlled trials were conducted in patients with cancer of the colon/rectum (n=111) or head-neck (n=75), in both instances patients were stratified for staging. In order to compare nutritional interventions during radiotherapy, each study had 3 arms: intensive dietary counselling vs oral supplements vs ad libitum intake; outcomes were analysed at the end and 3 months after radiotherapy, the latter period without intervention. In both trials, only nutritional interventions positively influenced outcomes during radiotherapy; 3 months after its completion, intensive counselling was the single method capable of sustaining a significant impact on patients outcomes. Nutrition is central to the improvement of a diversity of patient outcomes in colorectal and head-neck cancer patients.

Goals of workThe aims of this study were (1) to evaluate quality of life (QoL), nutritional status and dietary intake taking into account the stage of disease and therapeutic interventions, (2) to determine potential interrelationships, and (3) to quantify the relative contributions of the cancer, nutrition and treatments on QoL.Patients and methodsIn this prospective cross-sectional study conducted in 271 head and neck, oesophagus, stomach and colorectal cancer patients, the following aspects were evaluated: QoL (EORTC-QLQ C30), nutritional status (percent weight loss over the previous 6 months), usual diet (comprehensive diet history), current diet (24-h recall) and a range of clinical variables.Main resultsUsual and current intakes differed according to the site of the tumour ( P=0.02). Patients with stage III/IV disease showed a significant reduction from their usual energy/protein intake ( P=0.001), while their current intakes were lower than in patients with stage I/II disease ( P=0.0002). Weight loss was greater in patients with stage III/IV disease than in those with stage I/II disease ( P=0.001). Estimates of effect size revealed that QoL function scores were determined in 30% by cancer location, in 20% by nutritional intake, in 30% by weight loss, in 10% by chemotherapy, in 6% by surgery, in 3% by disease duration and in 1% by stage of disease. Likewise in the case of symptom scales, 41% were attributed to cancer location, 22% to stage, 7% to nutritional intake, 7% to disease duration, 4% to surgery, 1% to weight loss and 0.01% to chemotherapy. Finally for single items, 30% were determined by stage, 20% by cancer location, 9% by intake, 4% by surgery, 3% by weight loss, 3% by disease duration and 1% by chemotherapy.ConclusionsAlthough cancer stage was the major determinant of patients’ QoL globally, there were some diagnoses for which the impact of nutritional deterioration combined with deficiencies in nutritional intake may be more important than the stage of the disease process.

Background:When and whether early enteral nutrition (EN) benefits critically ill patients is debatable. This prospective clinical audit aimed to evaluate the feasibility of an early EN protocol and to identify factors that may hinder EN delivery in critically ill patients. Methods:Thirty-six medical patients with severe respiratory failure under invasive ventilation and scheduled to receive early EN, with a length of ICU stay> 72 hours, were included. As asserted by the Society of Critical Care Medicine, 8% of patients were priority 1, 72% priority 2, and 20% priority 3 for intensive therapeutic and vital support interventions. Results:Overall, because of gastrointestinal complications, only 39% of the prescribed EN was administered; only 8 (22%) patients did tolerate EN within the first 48 hours after admission and did achieve their minimum nutritional requirements. The most frequent complication (78%) was high volume of gastric residuals followed by abdominal distention (61%), both associated with hemodynamic instability (HI). Gastrointestinal dysfunction was associated with high Acute Physiologic and Chronic Health Evaluation II score (p= .01), total calorie intake (p= .02), total carbohydrate intake (p= .02), HI (p= .03), malnutrition (p= .04), volume of IV saline (p= .04), and concurrent vasoactive drug administration (p= .05). Conclusions:This audit in extremely severe intensive care patients identified several factors that impair gastrointestinal function and preclude EN at any stage, namely early EN. Nutrition management must take into account concurrent therapies, given their potential interference with nutrition and organ function.