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Background Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are slow-growing cancers that arise from diffuse endocrine cells in the gastrointestinal tract (GI-NETs) or the pancreas (P-NETs). They are relatively uncommon, accounting for 2% of all gastrointestinal malignancies. The usual treatment options in advanced GEP-NET patients with metastatic disease include chemotherapy, biological therapies, and peptide receptor radionuclide therapy. Understanding the impact of treatment on GEP-NET patients is paramount given the nature of the disease. Health-related quality of life (HRQoL) is increasingly important as a concept reflecting the patients' perspective in conjunction with the disease presentation, severity and treatment. Aim To conduct a systematic literature review to identify literature reporting HRQoL data in patients with GEP-NETs between January 1985 and November 2019. Methods The PRISMA guiding principles were applied. MEDLINE, Embase and the Cochrane library were searched. Data extracted from the publications included type of study, patient population data (mid-gut/hind-gut/GI-NET/P-NET), sample size, intervention/comparators, HRQoL instruments, average and data spread of overall and sub-scores, and follow-up time for data collection. Results Forty-three publications met the inclusion criteria. The heterogeneous nature of the different study populations was evident; the percentage of female participants ranged between 30%-60%, whilst average age ranged from 53.8 to 67.0 years. Eight studies investigated GI-NET patients only, six studies focused exclusively on P-NET patients and the remaining studies involved both patient populations or did not report the location of the primary tumour. The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (n = 28) with consistent results across studies; the GI-NET-specific module Quality of Life Questionnaire-GINET21 was used in six of these studies. A number of randomised trials demonstrated no HRQoL changes between active treatment and placebo arms. The Phase III NETTER-1 study provides the best data available for advanced GEP-NET patients; it shows that peptide receptor radionuclide therapy can significantly improve GEP-NET patients' HRQoL. Conclusion HRQoL instruments offer a means to monitor patients' general disease condition, disease progression and their physical and mental well-being. Instruments including the commonly used European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and GINET21 lack, however, validation and a defined minimal clinical important difference specifically for GI-NET and P-NET patients.

Much of the protein in the diets of European livestock is sourced from imported soybeans produced in the Americas. This protein deficit in livestock production presents a risk to social, economic and environmental progress in Europe. In this study the impact of incorporating novel ingredients into future chicken diet formulations to serve as European sourced alternatives to imported soybeans was investigated. The novel ingredients considered were: microalgae, macroalgae, duckweed, yeast protein concentrate, bacterial protein meal, leaf protein concentrate and insects. Using horizon scanning and a modelling approach, the nutritional requirements of two potential meat-producing chicken lines were simulated. The two chicken lines were a fast-growing line based on the apparent maximum feed efficiency that could be achieved through further artificial selection, and a reduced growth rate for high welfare line. Diets were formulated to include the novel ingredients, whilst meeting the nutritional requirements of the birds. The effects of diet composition on indicators of environmental burdens, associated with feed production for the poultry industry, were then assessed. We found that soybean products can be completely replaced by novel feed ingredients, whilst reducing the greenhouse gas emissions and arable land requirements for feed provision relative to conventional diets formulated for both chicken lines. Switching from conventional diets to diets which incorporate novel ingredients was also shown to mitigate the increased environmental burdens associated with moving towards higher welfare livestock systems. Incorporation of novel ingredients in diet formulations offers a viable option for providing sustainable and nutritionally balanced livestock feed in the future and thus provides huge potential for facilitating bespoke feeding strategies and specific management choices for mitigating environmental impacts of chicken systems.

Modern broiler chickens are a major animal husbandry success story, both in terms of efficient resource utilisation and environmental sustainability. However, continuing artificial selection for both efficiency and rapid growth will be subject to both biological limits and animal welfare concerns. Using a novel analytical energy flow modelling approach, we predict how far such selection can go, given the biological limits of bird energy intake and partitioning of energy. We find that the biological potential for further improvements in efficiency, and hence environmental impact reduction, is minimal relative to past progress already made via artificial selection. An alternative breeding strategy to produce slower-growing birds to meet new welfare standards increases environmental burdens, compared to current birds. This unique analytic approach provides biologically sound guidelines for strategic planning of sustainable broiler production.

The environmental impacts associated with broiler production arise mainly from the production and consumption of feed. The aim was to develop a tool for formulating broiler diets designed to target and reduce individually specific environmental impact categories in two contrasting regions, the UK and USA. Using linear programming, least cost broiler diets were formulated for each region, using the most common genotype specific to each region. The environmental impact of the systems was defined using 6 categories calculated through a Life Cycle Assessment (LCA) method: global warming potential (GWP), fresh water eutrophication potential (FWEP), marine eutrophication potential (MEP), terrestrial acidification potential (TAP), non-renewable energy use (NREU) and agricultural land use (ALU). Diets were then formulated for each region to minimise each impact category, without compromising bird performance. The diets formulated for environmental impact objectives increased their cost in most cases by between 20 and 30% (the cost increase limit), with the exception of the least GWP (+ 16%) and the least NREU (+ 4%) diets in the UK, and the least TAP diet in the USA (+ 14%). The degree of flexibility to reduce simultaneously several environmental impact categories in the UK and the USA differed due to the different feed ingredients available to each region. The results suggested there was potential to minimise several impact categories simultaneously by reducing the impact of one impact category compared to least cost, through diet formulation in the UK; this was shown to a greater and lesser extent in the least FWEP and the least NREU diet formulations respectively. In the USA, there was no way to minimise one impact category through diet formulation without increasing other impact categories caused by the system. Employing a multi-criteria approach to diet formulation methodologies, where environmental impact as well as economic implications are considered, will form an important pillar in broader efforts to improve the sustainability of animal production.

Modern broiler chickens are a major animal husbandry success story, both in terms of efficient resource utilisation and environmental sustainability. However, continuing artificial selection for both efficiency and rapid growth will be subject to both biological limits and animal welfare concerns. Using a novel analytical energy flow modelling approach, we predict how far such selection can go, given the biological limits of bird energy intake and partitioning of energy. We find that the biological potential for further improvements in efficiency, and hence environmental impact reduction, is minimal relative to past progress already made via artificial selection. An alternative breeding strategy to produce slower-growing birds to meet new welfare standards increases environmental burdens, compared to current birds. This unique analytic approach provides biologically sound guidelines for strategic planning of sustainable broiler production.

International audience; AbstractArtificial selection of broiler chickens for commercial objectives has been employed at an unprecedented magnitude over the recent decades. Consequently, the number of days, total feed and in turn energy, required to raise a broiler to slaughter weight, have decreased dramatically. Feed provision is the poultry industry’s biggest environmental hotspot; hence, understanding the interactions between the birds’ genetic change and their energy use efficiency forms the necessary starting point for quantifying and predicting and thereby mitigating the future environmental impact of the poultry sector. This review assesses the consequences of artificial selection on the following traits: digestive efficiency, body composition and utilisation of metabolisable energy for growth and metabolic activity. The main findings were (1) the digestive system has been subjected to much physical change due to selection in the recent decades, but this has not led to any apparent change in digestion efficiency. (2) Both the energy intake per day and the metabolic heat production rate have increased in the recent decades whilst (3) the efficiency of utilising energy for growth has also increased; this is due to an increased growth rate, so that broilers reach slaughter weight more quickly and therefore need to allocate less energy overall to metabolic processes, with the exception of growth. (4) There may have been a reduction in the tendency to waste feed through spillage and carry out energetically expensive behaviors. There is a discrepancy in the literature with regards to the influence of selection on body composition and its contribution to feed efficiency. In this review, two scenarios are demonstrated, whereby body composition either has or has not altered via artificial selection. Understanding the effects of artificial selection on the traits that relate to the feed efficiency of the broilers will contribute towards the reduction of the environmental impacts that arise from such systems.