Xie, Rui

Abstract Background: Nutritional and inflammatory factors collected in routine cancer labs, neutrophil percentage to albumin ratio (NPAR), neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet lymphocyte ratio (PLR), have been shown feasible in identification of patients at risk of increased treatment complications, decreased cognition, anxiety and depression, and increased mortality. These have proven sensitive to multiple cancer types and stages, though little is known about causal pathways. The Vitamin/Mineral and Inflammatory Correlations To Understand Chronic Stress in the U.S. (The VICTUS Study) sought to elucidate a relationship between diet and food insecurity within these panels. Methods: Using NHANES 2017/2018 surveys, adults > 18 years without renal or hepatic disorders, pregnancy, alcohol, or supplement use were included. NPAR, NLR, MLR, and PLR were categorized as quartiles and compared to demographic, food security, plasma micronutrient statuses [vitamins A, B9, C, D, E, calcium (Ca), ferritin (Fe), phosphorus (P), potassium (K), sodium (Na)], and smoking, activity level, and sun exposure, using chi-square and ANOVA. ANOVA models compared food security and poverty to NPAR, NLR, MLR, and PLR means. Results: From 3,317 participants, 50.2% were male, 54.3% non-Hispanic White, 33.7%, food insecure, 51.1% food stamp recipients, 27.7% smokers, with a mean age of 42.5 (SD 0.44), poverty to income ratio 2.79 (SD 0.08), CRP 3.90 (SD 0.18), NPAR 14.1 (SD 0.14), NLR 2.07 (SD 0.04), MLR 0.28 (SD 0.003), and PLR 118.7 (SD 1.61). CRP was found to be statistically significantly associated with all biomarker ratios (p < 0.018). Significant micronutrient biomarker-inflammatory biomarker associations were identified in Fe [NPAR, MLR, PLR (p < 0.001)], P [NPAR, NLR, MLR, PLR (p < 0.033)], C [NPAR, NLR (p < 0.008)], E [MLR, PLR (p < 0.016)], K [NPAR, NLR, MLR, PLR (p < 0.015)], Ca [NPAR, PLR (p < 0.04)], A [NPAR (p < 0.023)] and D [NLR (p < 0.035)]. Significant micronutrient intake-inflammatory biomarker associations were detected in vitamin A [NPAR, PLR (p < 0.013)], lycopene [NLR, PLR (p < 0.035)], and B12 [NLR, PLR (p < 0.031)]. Age [NPAR, NLR, MLR, PLR (p < 0.001)], gender [NPAR, MLR, PLR (p < 0.001)], ethnicity [NPAR, NLR, MLR (p < 0.006)], and sedentariness [MLR, PLR (p < 0.039)] were also associated with inflammatory markers. Poverty was significantly associated with NPAR, NLR, MLR, and CRP (p < 0.018). Food insecurity was significantly associated with NPAR (p < 0.001) and CRP (p < 0.001). Discussion: Food insecurity and poverty were significantly associated with NPAR, a ratio implicated in overall poorer cancer health outcomes. Multiple inadequate micronutrient intakes and plasma biomarkers were associated with inflammatory panels, though neither nutritional biomarker nor food insecurity statuses and their contributions to inflammatory processes are routinely surveilled within cancer disease and treatment. Citation Format: Jennifer Crook, Eunkyung Lee, Rui Xie, Opeyemi Bolajoko, Victoria Loerzel. Nutritional mediators of inflammation: A cause for increased surveillance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2171.

Abstract Background: Though widely recognized in cancer pathogenesis, inflammatory pathways of allostatic load remain vaguely understood. A partial explanation may be found within the realm of food insecurity and micronutrient inadequacies, defined as nutrient intake less than the estimated average requirement. Many micronutrient deficiencies contribute to pro-inflammatory and immunocompromised milieus. Inadequacies, however, which may present without overt symptoms, are not currently well studied. The purpose of this study was to examine relationships between known inflammation-associated nutritional biomarkers of micronutrients and biomarker variables of allostatic load. Methods: Using NHANES 2017/2018 surveys, adults > 18 years without renal or hepatic disorders, pregnancy, alcohol, or supplement use were included. Plasma levels of vitamins A, B9, C, D, E, calcium (Ca), ferritin (Fe), phosphorus (P), potassium (K) and sodium (Na) were grouped into deficiency, inadequate and adequate groups based on clinically recognized standards. Micronutrient prevalence was assessed and variables of allostatic load [blood pressure, glucose, albumin, creatinine, red cell distribution width (RDW), high density lipoprotein (HDL), low density lipoprotein (LDL), cholesterol and triglycerides] were analyzed for mean differences among micronutrient groups, food security and poverty. Results: From 3,317 unique participants, inadequacy prevalence percentages were quantified as: vitamins A (0.4%), B9 (12.2%), C (58.3%), D (39.6%), E (21.0%), P (11.4%), K (3.4%), Na (24.2%), Ca (59.5%), and Fe (37.4%) [p < 0.001]. Statistically significant differences were identified in age [C, D, E, Ca, Fe, P, Na (p < 0.004)], race/ethnicity [B9, C, D (p < 0.006)], gender [C, E, Ca, Fe, P, K, Na (p < 0.018)], poverty [A, B9, C, D, E, Fe, K (p < 0.025)], and food security [B9, C, D, E, P (p < 0.032)]. Associations to allostatic load were discovered in: albumin [A, C, D, Ca, Fe, P, Na (p < 0.025)], glucose [C, E, Fe, P, Na (p < 0.009)], HDL [C, D, E, Fe, P, K (p<0.045)], LDL [E, Ca, Fe, Na (p<0.028)], creatinine [C, D, Ca, Fe (p<0.001)], triglycerides [B9, D, E, Fe (p<0.033)], cholesterol [C, D, E, Ca, Fe, Na (p<0.006)], B/P [C, E, Fe, P, Na (p < 0.035)], and RDW [C, D, Ca, Fe (p < 0.001)]. Poverty was significantly associated with all variables of allostatic load (F = 2.85, p = 0.002). Food security was significantly correlated with albumin (p < 0.001), glucose (p = 0.005) and HDL (p < 0.001). Conclusion: Allostatic load, poverty, and food security were significantly associated with subclinical micronutrient statuses, which may not present with signs of deficiency and are not currently well assessed. Similarly, poverty was significantly associated with all variables of allostatic load, though food security was only identified to be associated with albumin, glucose, and HDL, suggesting that food security may not be currently adequately defined for surveillance. Citation Format: Jennifer M. Crook, Eunkyung Lee, Opeyemi Bolajoko, Rui Xie. Poverty, food insecurity, and nutritional inflammatory mediators of allostatic load [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2198.