Pomegranate juice (PJ; also known as pomegreat pure juice) provides a rich and varied source of polyphenolic compounds that may offer cardioprotective, anti-atherogenic and antihypertensive effects. The aim of this study was to investigate the effect of PJ consumption on glucocorticoids levels, blood pressure (BP) and insulin resistance in volunteers at high CVD risk. Subjects (twelve males and sixteen females) participated in a randomised, placebo-controlled cross-over study (BMI: 26·77 (sd 3·36) kg/m2; mean age: 50·4 (sd 6·1) years). Volunteers were assessed at baseline, and at weeks 2 and 4 for anthropometry, BP and pulse wave velocity. Cortisol and cortisone levels in urine and saliva were determined by specific ELISA methods, and the cortisol/cortisone ratio was calculated. Fasting blood samples were obtained to assess plasma lipids, glucose, insulin and insulin resistance (homeostasis model assessment of insulin resistance). Volunteers consumed 500 ml of PJ or 500 ml of a placebo drink containing a similar amount of energy. Cortisol urinary output was reduced but not significant. However, cortisol/cortisone ratios in urine (P = 0·009) and saliva (P = 0·024) were significantly decreased. Systolic BP decreased from 136·4 (sd 6·3) to 128·9 (sd 5·1) mmHg (P = 0·034), and diastolic BP from 80·3 (sd 4·29) to 75·5 (sd 5·17) mmHg (P = 0·031) after 4 weeks of fruit juice consumption. Pulse wave velocity decreased from 7·5 (sd 0·86) to 7·44 (sd 0·94) m/s (P = 0·035). There was also a significant reduction in fasting plasma insulin from 9·36 (sd 5·8) to 7·53 (sd 4·12) mIU/l (P = 0·025) and of homeostasis model assessment of insulin resistance (from 2·216 (sd 1·43) to 1·82 (sd 1·12), P = 0·028). No significant changes were seen in the placebo arm of the study. These results suggest that PJ consumption can alleviate key cardiovascular risk factors in overweight and obese subjects that might be due to a reduction in both systolic and diastolic BP, possibly through the inhibition of 11β-hydroxysteroid dehydrogenase type 1 enzyme activity as evidenced by the reduction in the cortisol/cortisone ratio. The reduction in insulin resistance might have therapeutic benefits for patients with non-insulin-dependent diabetes, obesity and the metabolic syndrome.

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s u m m a r y Background and aims: Malnutrition (under and overnutrition) in paediatric cancer patients during and after treatment increases short and long-term side-effects; however, factors contributing to malnutrition and patterns of change in nutritional status are still unclear. The aims were to investigate the prevalence of malnutrition, patterns of change in nutritional status and factors contributing to malnutrition in Scottish paediatric cancer patients. Methods: A prospective cohort study of Scottish children aged <18 years, diagnosed with and treated for cancer between Aug 2010 and Jan 2014 was performed. Clinical and nutritional data were collected at defined periods up to 36 months. Measurements of weight and height/length and arm anthropometry (mid-upper arm circumference (MUAC) and triceps skin-fold thickness (TSF)) were collected. Body composition was estimated from arm anthropometry using Frisancho's references and bio-electrical impedance (BIA). Malnutrition was defined according to UK BMI curves; undernutrition (<2.3rd centile; À2 SD), overweight (!85th < 95th centile; !þ1.05 SD < 1.63 SD) and obese (!95th centile; !1.63 SD). We performed descriptive statistics and multilevel analysis. p < 0.05 was considered statistically significant. Results: Eighty-two patients [median (IQR) age 3.9 (1.9e8.8) years; 56% males] were recruited. At diagnosis, the prevalence of undernutrition was 13%, overweight 7% and obesity 15%. TSF identified the highest prevalence of undernutrition (15%) and the lowest of obesity (1%). BMI [p < 0.001; 95% CI (1.31 e3.47)] and FM (BIA) [p < 0.05; 95% CI (0.006e0.08)] significantly increased after 3 months of treatment, whilst FFM (BIA) [p < 0.05; 95% CI (À0.78 to (À0.01))] significantly decreased during the first three months and these patterns remained until the end of the study. High-treatment risk significantly contributed to undernutrition during the first three months of treatment [p ¼ 0.04; 95% CI (À16.8 to (À0.4))] and solid tumours had the highest prevalence of undernutrition [BMI (17%)]. Conclusions: Arm anthropometry (or BIA) alongside appropriate nutritional treatment that targets undernutrition initially and overnutrition at later stages should be implemented in routine clinical practice of paediatric cancer patients. Crown

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