ORCID Profile
0000-0001-7752-6279
Current Organisations
Monash University
,
Monash Health
,
Royal Australasian College of Physicians
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Publisher: Informa UK Limited
Date: 09-02-2019
DOI: 10.1080/01635581.2018.1542011
Abstract: Combination gemcitabine and nab-paclitaxel (Gem-Nab-P) is a common regimen used to treat metastatic pancreatic ductal adenocarcinoma (PDAC). Toxicity from this regimen is associated with significant morbidity. Currently, Gem-Nab-P is dosed using estimated body surface area, derived from height and weight. This study investigates whether skeletal muscle assessment could be a useful tool in the dosing of Gem-Nab-P in metastatic PDAC. This study included 52 patients who had received first-line treatment with Gem-Nab-P for PDAC. Demographic and chemotherapy treatment information was gathered from medical records and body composition analysis was performed using single slice computed tomography methods, at spinal level L3. Patients who experienced first-cycle chemotherapy-associated toxicity did not have a different median skeletal muscle area (SkMA) to those who did not (128.6 cm
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/IMJ.14786
Publisher: Wiley
Date: 28-02-2017
DOI: 10.1111/APT.14018
Abstract: Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease. To determine whether body composition is associated with outcome in a prospective study of post-operative Crohn's disease patients. The POCER study evaluated management strategies for prevention of post-operative Crohn's disease recurrence subjects were enrolled after resection of all macroscopic Crohn's disease and were randomised to early endoscopy and possible treatment escalation, or standard care. The primary endpoint was endoscopic recurrence at 18 months. 44 subjects with cross-sectional abdominal imaging were studied, and body composition analysis performed using established techniques to measure visceral adipose tissue area, subcutaneous adipose tissue area, and skeletal muscle area. The body composition parameter with the greatest variance was visceral adipose tissue. Regardless of treatment, all subjects with visceral adipose tissue/height Visceral adiposity is an independent risk factor for endoscopic recurrence of Crohn's disease after surgery. Sarcopenia correlates with inflammatory biomarkers. Measures of visceral adipose tissue may help to stratify risk in post-operative management strategies.
Publisher: Research Square Platform LLC
Date: 07-04-2023
DOI: 10.21203/RS.3.RS-2641051/V1
Abstract: Background: Non-alcoholic fatty liver disease (NAFLD) is associated with visceral adiposity. We assessed the effectiveness of intermittent fasting (IF) for 16 hours daily without calorie restriction, compared to standard care (SC diet and lifestyle advice) in improving visceral adiposity and steatosis by controlled attenuation parameter (CAP). Methods: In a prospective single-blind randomized controlled trial, 32 participants with NAFLD were randomly assigned to IF or SC for 12 weeks. Secondary endpoints were changes in liver stiffness, anthropometry, blood pressure, and other metabolic factors. Results: Twenty-eight participants completed the first arm of the study (IF = 14, SC = 14), with 23 completing the cross over arm (IF = 10, SC = 13). Baseline demographics were similar between the groups. Intermittent fasting caused a significant decrease in hepatic steatosis (p = 0.038), weight (p=0.005), waist circumference (p=0.001), and BMI (p=0.005) compared to standard care. Intermittent fasting also resulted in additional within group changes, not seen in the standard care intervention. Conclusion: IF offers superior improvements in patients with NAFLD, improving steatosis, weight and waist circumference, despite no change in overall caloric intake. Time restricted fasting should be considered as a primary weight loss intervention in the context of NAFLD. Trial registration: ACTRN12613000935730
Publisher: Wiley
Date: 05-2018
DOI: 10.1111/IMJ.13788
Publisher: Wiley
Date: 12-06-2023
DOI: 10.1111/APT.17607
Abstract: Disturbance of skeletal muscle mass has clinically important implications in patients with inflammatory bowel disease (IBD), but accurate quantification requires radiation‐intense techniques. We aimed to compare point‐of‐care muscle assessments and their change with therapy with those using reference‐standard whole‐body dual energy X‐ray absorptiometry (DXA). Adult patients with IBD and healthy controls underwent prospective assessment of muscularity by ultrasound of the dominant arm and both thighs, bioelectrical impedance analysis (BIA), anthropometric measurements, and DXA. Patients with active IBD were assessed again ≥13 weeks after initiating biologic induction therapy. In 54 patients with IBD and 30 controls, all muscle assessments correlated significantly with DXA‐derived skeletal muscle index (SMI). In IBD, ultrasound of the arm and legs had the best agreement with DXA‐derived SMI (mean difference 0 kg/m 2 , 95% limits of agreement −1.3 to 1.3), while BIA overestimated DXA‐derived SMI by 1.07 (−0.16 to +2.30) kg/m 2 . In 17 patients who underwent biologic therapy, the percentage change in DXA‐derived SMI correlated significantly with the percentage change in all other muscle assessment techniques. Responders ( n = 9) increased SMI from baseline to follow‐up when derived from DXA (mean 7.8–8.5 kg/m 2 , p = 0.004), ultrasound of the arm and legs (300–343 cm 2 , p = 0.021) and BIA (9.2–9.6 kg/m 2 , p = 0.011). Ultrasound of the arm and legs out‐performed other point‐of‐care methods in its accuracy of measuring muscle mass. All methods, except mid‐arm circumference, were responsive to therapy‐induced change. Ultrasound is the preferred non‐invasive test for measuring muscle mass in patients with IBD.
Publisher: Wiley
Date: 06-2019
DOI: 10.1111/IMJ.14150
Abstract: Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Two hundred and twenty-four patients were identified 139 (62.1%) on combination therapy and 85 (37.9%) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years 59.4% on combination therapy and 40.6% on monotherapy (P = 0.533). The median time to LOR was not different between groups 1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.
Publisher: Wiley
Date: 18-07-2023
DOI: 10.1111/IMJ.16176
Abstract: Cytomegalovirus (CMV) colitis is associated with negative outcomes in inflammatory bowel disease (IBD) and immunosuppressed cohorts and therefore requires timely recognition for appropriate management. We aimed to evaluate the diagnostic tools for CMV colitis and their associations with clinical outcomes. A retrospective cohort study of patients in a metropolitan health service with colonic s les analysed for CMV between 2012 and 2022, stratified into IBD and non‐IBD groups, was performed. The main outcome measures were the prevalence of positive and negative results for each CMV test, as well as need for colectomy, use of antiviral and hospital length of stay. Five hundred eighty‐two biopsies from 418 patients were included the median age was 36 years (interquartile range, 24–52 years) and 223 (53.3%) were men. Four hundred sixty‐one (79.2%) biopsies were from patients with IBD and 121 (20.8%) were from those without IBD. There were similar proportions of positive CMV histology (IBD 5.9% and non‐IBD 7.4%) and tissue CMV polymerase chain reaction (PCR) in the two groups (IBD 5.6% and non‐IBD 5.0%), but within each group, results were discordant. Positive CMV histology was significantly associated with need for colectomy in the IBD group, while positive tissue CMV PCR was not. Positive CMV histology, and tissue and serum CMV PCR were all significantly associated with antiviral use. Positive serum CMV PCR was significantly associated with colectomy. Histopathology remains the most predictive tool in assessing CMV colitis, while qualitative tissue CMV PCR was found to have limited utility. Quantitative serum CMV PCR may be useful but requires further evaluation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
DOI: 10.1038/CTG.2016.56
Publisher: Wiley
Date: 29-07-2016
Publisher: Wiley
Date: 15-05-2017
DOI: 10.1111/APT.14102
Publisher: Wiley
Date: 14-07-2017
DOI: 10.1111/JHN.12400
Abstract: Diet and body composition play unclear roles in the pathogenesis, activity and symptoms of inflammatory bowel disease (IBD). Evidence-based guidance regarding dietary modification in IBD is lacking. We aimed to determine the attitudes of IBD patients and clinicians to diet. The present cross-sectional study comprised an online questionnaire distributed to members of a national IBD patient organisation, assessing demographics, anthropometry, disease phenotype and dietary beliefs. Dietitians, gastroenterologists and surgeons were targeted for a similar questionnaire as a result of membership of national professional bodies. Nine hundred and twenty-eight patients (72.2% female mean age 39.5 years age range 5-91 years) responded. Two-thirds of the patients had Crohn's disease. The mean reported body mass index was 24.9 kg m The present study demonstrates that IBD patients consider diet to be important in their disease. IBD clinicians from different disciplines have erse views of the role of diet. Advice given to patients is heterogeneous, often perceived as inadequate and poorly followed.
Publisher: Informa UK Limited
Date: 22-03-2016
DOI: 10.3109/00365521.2016.1161069
Abstract: Crohn's Disease is associated with body composition changes, which have important treatment and prognostic implications. Measurement of body composition usually requires dedicated scanning or measurement, with retrospective analysis of existing datasets impossible. We sought to determine whether single slice analysis of abdominal scans, obtained during routine clinical care, in patients with Crohn's Disease accurately predicts body composition compartments. Abdominal CT images of patients with Crohn's disease were analyzed and comparison was made with total body fat-free mass, total body fat mass, femoral neck t-score, and other parameters reported from DXA, the reference method. Thirty-seven subjects were identified, 15 male and 22 female, with a mean age of 43.8 years. There was significant correlation (Pearson r = 0.923, p < 0.001) between skeletal muscle area from CT and total fat-free mass measured by DXA. Similarly, total body fat mass correlated strongly (r = 0.928, p < 0.0001) with subcutaneous fat area. In this cohort of ambulatory Crohn's Disease patients, low muscle mass/sarcopenia was prevalent and predictive of lower bone mineral density. Fat mass, fat-free mass, and appendicular skeletal muscle index can be predicted by analysis of a single CT slice in patients with Crohn's Disease. Similar to published data from healthy subjects, the L3 vertebral body level provided the most robust correlation with most parameters. This study represents the first published use of routinely obtained abdominal imaging to demonstrate this relationship - and to predict body composition components - in patients with inflammatory bowel disease.
Publisher: Oxford University Press (OUP)
Date: 03-2016
Publisher: Wiley
Date: 06-2015
DOI: 10.1111/IMJ.12705
Abstract: Percutaneous endoscopic gastrostomy (PEG) placement is performed in a patient group with high mortality in the short and medium term. For a significant proportion of patients, the procedure provides no increase in survival. There are no standardised assessment tools available to determine the clinical appropriateness of PEG placement, nor any to predict clinical outcome. The study aims to determine whether clinical assessment, by a trained dietitian, of the appropriateness of PEG placement is predictive of mortality in the short and medium terms. A prospective audit was undertaken of all requests for PEG placement at a single large, publicly funded Australian tertiary hospital. The clinical appropriateness of each request was assessed by a trained dietitian, and data on age, sex, reason for referral, comorbidities and satisfaction of assessment criteria were collected, and patient outcome and survival were compared for all patients according to whether a PEG was inserted or not. Main outcome measures were mortality at 30 and 150 days after referral. During the period 2005-2008, 198 patients were referred for PEG 94 were assessed as appropriate referrals, 104 as inappropriate. Eighty-four patients who underwent gastrostomy, after being assessed as appropriate, had significantly reduced mortality at 30 days (96.4% vs 74.6%, P < 0.0001) and 150 days (82.1% vs 57.9%, P = 0.0001) compared with all other patients. Patients who received PEG despite contrary advice had no significant survival advantage, at 30 days or 150 days, over patients who did not receive PEG. The application of selection criteria by trained assessors improves patient selection for PEG insertion and predicts mortality at early and later time points, by identifying patients unlikely to benefit from PEG. The group of patients who received a gastrostomy despite an adverse assessment had no mortality benefit - in these patients, the procedure may have been futile.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2017
DOI: 10.1038/EJCN.2017.10
Abstract: Delayed treatment failure occurs in a significant proportion of inflammatory bowel disease (IBD) patients treated with tumor necrosis factor-alpha (TNF) antagonists. Identification of predictors of loss of response (LOR) may help to optimize therapy. We sought to determine whether body composition parameters at the commencement of anti-TNF therapy were associated with earlier treatment failure. A retrospective cohort study was performed on 68 patients who had undergone cross-sectional abdominal imaging coincident with the commencement of anti-TNF drugs. Analysis of the images at the third lumbar vertebra was performed using standard techniques to determine cross-sectional areas of skeletal muscle (SM), visceral adipose tissue, subcutaneous adipose tissue and intermuscular adipose tissue. Treatment failure was defined as: post-induction hospital admission or surgery for IBD, escalation of TNF dose or immunosuppressants for clinical LOR, emergence of a new fistula or Crohn's Disease Activity Index (CDAI) >150. Two-thirds of patients had myopenia. Patients with less than gender-specific median SM area had a median time to failure of 520 (s.d. 135) days compared to 1100 (s.d. 151) days for those with more than median SM area (P=0.036). No difference was found in disease duration, inflammatory markers or CDAI between quartiles of SM area. No relation between outcomes and measures of adipose tissue, weight or body mass index was observed. Identifying low muscle mass at anti-TNF induction as a risk factor for treatment failure may contribute to a more tailored approach to IBD therapy.
Publisher: Springer Science and Business Media LLC
Date: 18-04-2018
DOI: 10.1007/S00384-018-3058-Y
Abstract: Diverticular disease is a common, chronic inflammatory disease of the bowel. This study investigates the differences in body composition between patients with erticular disease and those without. Appropriate patients were identified using a search of the radiology database. Demographic and disease information was gathered using scanned medical records. Body composition analysis was performed at level L3 using single-slice computed tomography techniques. Two hundred seventy-one patients were included in this study: 83 controls, 93 with erticulosis and 95 with erticulitis. Diverticulitis and erticulosis were associated with a significantly higher visceral fat area (VFA), than the control group (p < 0.001, p < 0.001). Diverticulitis and erticulosis were associated with a significantly higher visceral fat area to subcutaneous fat area ratio (VFA:SCFA), than the control group (p = 0.005, p = 0.019). Only erticulosis was associated with increased levels of extramyocellular fat, when compared to the control group (p = 0.001). Diverticular disease is associated with a higher amount and a higher proportion of visceral fat than seen in controls without erticular disease.
No related grants have been discovered for Darcy Holt.