In preclinical studies, fasting was found to potentiate the effects of several anticancer treatments, and early clinical studies indicated that patients may benefit from regimes of modified fasting. However, concerns remain over possible negative impact on the patients’ nutritional status. We assessed the feasibility and safety of a 5-day “Fasting-Mimicking Diet” (FMD) as well as its effects on body composition and circulating growth factors, adipokines and cyto/chemokines in cancer patients. In this single-arm, phase I/II clinical trial, patients with solid or hematologic malignancy, low nutritional risk and undergoing active medical treatment received periodic FMD cycles. The body weight, handgrip strength and body composition were monitored throughout the study. Growth factors, adipokines and cyto/chemokines were assessed by ELISA. Ninety patients were enrolled, and FMD was administered every three weeks/once a month with an average of 6.3 FMD cycles/patient. FMD was largely safe with only mild side effects. The patients’ weight and handgrip remained stable, the phase angle and fat-free mass increased, while the fat mass decreased. FMD reduced the serum c-peptide, IGF1, IGFBP3 and leptin levels, while increasing IGFBP1, and these modifications persisted for weeks beyond the FMD period. Thus, periodic FMD cycles are feasible and can be safely combined with standard antineoplastic treatments in cancer patients at low nutritional risk. The FMD resulted in reduced fat mass, insulin production and circulating IGF1 and leptin. This trial was registered on Clinicaltrials.gov in July 2018 with the identifier NCT03595540.

A low protein diet (LPD) has historically been used to delay uremic symptoms and decrease nitrogen (N)-derived catabolic products in patients with chronic kidney disease (CKD). In recent years it has become evident that nutritional intervention is a necessary approach to prevent wasting and reduce CKD complications and disease progression. While a 0.6 g/kg, high biological value protein-based LPD has been used for years, recent observational studies suggest that plant-derived LPDs are a better approach to nutritional treatment of CKD. However, plant proteins are less anabolic than animal proteins and amino acids contained in plant proteins may be in part oxidized; thus, they may not completely be used for protein synthesis. In this review, we evaluate the role of LPDs and plant-based LPDs on maintaining skeletal muscle mass in patients with CKD and examine different nutritional approaches for improving the anabolic properties of plant proteins when used in protein-restricted diets.

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To evaluate if regional wall motion (RWM) abnormalities detected at rest in patients with high presumption of right ventricular dysplasia (RVD) are confirmed by stress test and could be considered of diagnostic value in the clinical setting of the disease, 12 patients underwent first-pass radionuclide angiography (RA) at rest and during exercise. The mean global right ventricular ejection fraction (EF) was 29.83 +/- 7.91 at rest; during exercise, we found a non-significant increase (32.16 +/- 9.8, P greater than 0.05). Six segments with systo-diastolic dyskinesis, three segments with diastolic dyskinesis, and 10 segments with akinesis at rest confirmed the same degrees of dysfunction during exercise. Eight of the 15 hypokinetic segments at rest showed normal function during exercise; the remaining seven confirmed the same degree of dysfunction during exercise. We conclude that various degrees of RWM abnormalities are found in all patients with RVD; hypokinetic dysfunction has to be confirmed by exercise. RWM abnormalities are not specific for RVD, and clinical and electrophysiological data should be combined to obtain as much evidence as possible for diagnosis.