title: Effect of fasting on the size of lymphangioleiomyomas in patients with lymphangioleiomyomatosis.
abstract: BACKGROUND
  Lymphangioleiomyomas occur in 38% of patients with sporadic lymphangioleiomyomatosis (LAM) and may cause pain and increased abdominal girth, mimicking the presence of a malignancy. Lymphatic involvement in LAM is closely associated with elevated serum levels of vascular endothelium growth factor-D (VEGF-D). Because lymphangioleiomyomas undergo diurnal variation in volume, we hypothesized that daytime ingestion of food, by increasing chyle formation and lymphatic flow, is the cause of an increase in lymphangioleiomyoma volume.
  
  
  METHODS
  Subjects had abdominopelvic sonograms and blood drawn for measurement of serum VEGF-D levels under nonfasting (day 1) and fasting (day 2) conditions. The size of the lymphangioleiomyomas was determined by a radiologist who was blinded to the subjects' status. The Wilcoxon signed rank test was used to determine whether the nonfasting tumor size was different from the fasting tumor size.
  
  
  RESULTS
  Thirty-five women were studied (aged 45.2 ± 8.5 years; FEV1, 82% ± 25%; diffusing capacity of the lung for carbon monoxide, 64% ± 25% predicted). Images suitable for volume measurements were obtained in 30 subjects. Fasting decreased the tumor size by 20.7 ± 39.3 cm3 (24% ± 40%, P < .001). Fasting VEGF-D levels (10,650 ± 900 pg/mL) were not significantly different from nonfasting values (12,100 ± 800 pg/mL, P = .56).
  
  
  CONCLUSIONS
  Lymphangioleiomyoma volume decreased during the fasting state. Conversely, a combination of food intake and decreased chyle flow through lymphatics partially obstructed by LAM cells may account for increases in lymphangioleiomyoma size. Imaging studies performed under fasting conditions may help in determining whether an abdominal tumor is a result of LAM or malignancy.
authors.affiliation: Cardiovascular and Pulmonary Branch, Bethesda, MD. Electronic address: dasilvaa@nhlbi.nih.gov.
authors.forename: Angelo M
authors.initials: AM
authors.lastname: Taveira-DaSilva
authors.affiliation: Cardiovascular and Pulmonary Branch, Bethesda, MD.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Jones
authors.affiliation: Cardiovascular and Pulmonary Branch, Bethesda, MD.
authors.forename: Patricia
authors.initials: P
authors.lastname: Julien-Williams
authors.affiliation: Radiology and Imaging Sciences Department, National Institutes of Health, Bethesda, MD.
authors.forename: Thomas
authors.initials: T
authors.lastname: Shawker
authors.affiliation: Cardiovascular and Pulmonary Branch, Bethesda, MD.
authors.forename: Connie G
authors.initials: CG
authors.lastname: Glasgow
authors.affiliation: Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD.
authors.forename: Mario
authors.initials: M
authors.lastname: Stylianou
authors.affiliation: Cardiovascular and Pulmonary Branch, Bethesda, MD.
authors.forename: Joel
authors.initials: J
authors.lastname: Moss
mesh_terms: D000008:Abdominal Neoplasms / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018192:Lymphangioleiomyomatosis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008203:Lymphangiomyoma / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D009367:Neoplasm Staging; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D042643:Vascular Endothelial Growth Factor D / Q000097:blood
chemical_list: D014408:Biomarkers, Tumor; C579459:VEGFD protein, human; D042643:Vascular Endothelial Growth Factor D