Doğan Akagündüz, Diğdem; Şahin, Hilal; Akagündüz, Baran

Sarcopenia, malnutrition, and frailty frequently coexist in older adults with cancer, adversely affecting treatment tolerance, functional independence, and survival. While comprehensive geriatric assessment (CGA) is the gold standard for frailty evaluation, its resource-intensive nature limits routine use, and simple tools are needed. This cross-sectional study included 291 patients aged ≥70 years with histologically confirmed cancer, evaluated at a oncology outpatient clinic between January and November 2024. Sarcopenia was defined according to EWGSOP2 criteria: handgrip strength (HGS) and skeletal muscle index (SMI) by bioelectrical impedance analysis (BIA). Nutritional status was assessed with the Mini Nutritional Assessment–Short Form (MNA-SF), and frailty was defined as G8 ≤ 14. Additional measures included SARC-F, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale. The median age was 74 years, and 53% were male. Possible sarcopenia was identified in 39.5%, confirmed sarcopenia in 33.7%, severe sarcopenia in 26.8%. Nutritional risk was observed in 66.7%, and frailty in 44.7%. Frailty correlated strongly with nutritional status and moderately with muscle strength and mass. In multivariable analysis, low HGS, low SMI, nutritional risk, and depression independently predicted frailty. ROC analysis showed, G8 with HGS and nutritional assessment improved predictive accuracy. These findings highlight that simple measures enhance frailty detection and may support personalized care.

Doğan Akagündüz, Diğdem; Türker, Perim Fatma

Esophageal cancer (EC) is the eighth most prevalent malignancy and the sixth leading cause of cancer-related death worldwide. The proportion of older adults with EC has increased dramatically in recent decades due to increased life expectancy. Older patients with EC are at a highest risk of malnutrition and this predicts early death. In older patients with EC, dysphagia is a common symptom; additionally, comorbidities, polypharmacy, and physiological changes of aging such as decreased muscle mass and geriatric issues including altered cognition, mobility, and mood contribute to malnutrition. Chemoradiotherapy (CRT) is the primary treatment for unresectable locally advanced EC patients, as it successfully reduces local recurrence and distant metastases while also extending survival. In older patients with EC, nutrition is an interventional condition, unlike many other geriatric risk factors. Optimizing nutritional support may reduce treatment toxicity and facilitate the completion of definitive or neoadjuvant CRT. The relevance of nutritional status and food intake is becoming more widely acknowledged, and it now encompasses the entire spectrum of EC treatment in older patients, from diagnosis to perioperative care to long-term care. This review aims to discuss the current research on nutritional support in older patients with esophageal cancer undergoing CRT.

Altay, Ahmet; Bozoğlu, Faruk

Natural products have gained considerable interests because of their use in some industrial areas including nutrition, cosmetic, pharmacy, and medicine. Salvia fruticosa M. (Lamiaceae) is known for its antioxidant, antimicrobial, and antiproliferative activities. Phase I xenobiotic metabolizing enzymes, CYP1A2 and CYP2E1, produce reactive metabolites which are eliminated by the action of phase II enzymes, NQO1, GPx, and glutathione S-transferases (GSTs). In this study, in vitro modulatory effects of S. fruticosa and its major phenolic compound rosmarinic acid (RA) on CYP1A2, CYP2E1, NQO1, GPx, and GSTm1 mRNA expressions and enzyme activities of GPx and GSTs were investigated in HT-29 cells. An mRNA expression analysis revealed that CYP1A2 and CYP2E1 levels were decreased while those of NQO1, GPx, and GSTm1 increased after S. fruticosa and RA treatments. In parallel to gene expressions, enzyme activities of GPx and GSTs by S. fruticosa increased 1.68- and 1.48-fold, respectively. Moreover, RA increased GPx and GSTs activities 1.67- and 1.94-fold, respectively. The results of this preliminary study show that metabolism of xenobiotics may be altered due to changes in the expression and activity of the investigated enzymes by S. fruticosa.