Pre-sarcopenia and bone mineral density in adults submitted to hematopoietic stem cell transplantation.

BACKGROUND: The aim of this study was to evaluate the prevalence of pre-sarcopenia and bone mineral density after hematopoietic stem cell transplantation. METHODS: The study group consisted of over 18-year-old patients who had been submitted to allogeneic transplantation at least one year previously. Patients and healthy controls were matched by sex, ethnic background, age, and body mass index. Body composition and bone mineral density were measured by dual-energy X-ray absorptiometry. A 24-h food recall and food frequency survey were performed. The biochemical evaluation included calcium, parathormone and vitamin D. Eighty-seven patients (52 men; age: 37.2±12.7 years; body mass index: 25±4.5kg/m2) were compared to 68 controls [31 men; age 35.4±15.5 years (p=0.467); body mass index 25.05±3.7kg/m2 (p=0.927)]. RESULTS: There was no significant difference in the dietary intake between patients and controls. The mean levels of vitamin D were 23.5±10.3ng/mL; 29 patients (41.0%) had insufficient and 26 (37.14%) deficient levels. A higher prevalence of reduced bone mineral density was observed in 24 patients (25%) compared to 12 controls (19.1% - p<0.001). Pre-sarcopenia was diagnosed in 14 (14.4%) patients and none of the controls (p=0.05). There was a higher prevalence of pre-sarcopenia (66%) in patients with grades III and IV compared to those with grades 0-II graft-versus-host disease (10.9%) (p=0.004). CONCLUSION: patients submitted to transplantation had a higher prevalence of pre-sarcopenia and greater changes in bone mineral density compared to controls; the severity of graft-versus-host disease had an impact on the prevalence of pre-sarcopenia.

Picolés hiperprotéicos e hipercalóricos são uma boa alternativa dietética no tratamento de pacientes em terapia antineoplásica ambulatorial? / Are hypercaloric and hyperproteic popsicles a good dietetic alternative for outpatients on chemotherapy treatment?

INTRODUÇÃO: A quimioterapia é um dos tratamentos para o câncer e os efeitos adversos implicam na alteração do paladar e redução da ingestão alimentar. Dentre as possibilidades de intervenção dietética, a oferta de suplementos e alimentos de maior densidade energética é uma alternativa. OBJETIVO: Analisar as características sensoriais dos suplementos hipercalóricos e hiperproteicos na forma de picolé. METODOLOGIA: Estudo transversal, realizado com pacientes maiores de 18 anos, em tratamento quimioterápico ambulatorial. Foram obtidos dos prontuários dados como: idade, sexo, diagnóstico e comorbidades. O picolé foi produzido à base de alimentos lácteos, sacarose e módulo proteico. Contém aproximadamente 127 kcal e 8g de proteína. Foram oferecidos nos sabores leite, frutas e chocolate durante a quimioterapia. A análise sensorial foi feita com escala hedônica de 5 pontos para atributos: doçura, coloração, sabor, sabor residual, além de questionados sobre intenção de consumo e sentimentos. RESULTADOS: Foram avaliados 33 pacientes, entre 33 e 76 anos, prevalecendo o sexo feminino (60%), diagnosticados com neoplasias hematológicas e tumores sólidos, sendo os mais presentes leucemia, linfoma, câncer de mama e de próstata. Quanto à análise sensorial, os picolés tiveram boa aceitação por parte da maioria dos pacientes. Cerca de 97% avaliou como "gostei muito" e "gostei ligeiramente" na aceitação global. Os atributos analisados tiveram aproximadamente 84% de nota 3, considerados dentro do ideal. A maioria dos participantes (84%) relataram que consumiriam "com frequência" ou "sempre" e 94% relataram se sentirem satisfeitos ao provar o picolé. Na questão aberta todos expressaram sentimentos positivos em relação ao picolé, relatando se sentirem bem, alegres e felizes. CONCLUSÃO: Considerando a boa avaliação sensorial dos picolés, estes poderão contribuir na melhora da ingestão alimentar energético-proteica

INTRODUCTION: Chemotherapy is one of the cancer treatments and its adverse effects can induce taste alteration and reduction of food intake. Among the possible dietetic interventions, the offering of food supplements and higher density preparations is an alternative. OBJECTIVES: analise the sensory characteristics of hypercaloric and hyperproteic food supplements in the shape of popsicles. METHODS: cross-sectional study, conducted with adult outpatients over 18 years, in chemotherapy treatment. Data was collected from patients' medical records, such as age, gender, diagnosis and comorbidities. The popsicle was made out of dairy, sugar and proteic protein module. Contains aproximadamente 127 kcal and 8 g of protein. The flavours offered where milk, fruit and chocolate. The sensory analysis was carried out based on a scale of 5 point for the attributes sweetness, color, flavour and residual flavour. Moreover, patients where asked regarding consumption intention and feelings. RESULTS: 33 outpatients from 33 to 76 years of age where evalued, with a prevalence of women (60%), diagnosed with hematological cancer or tumors. The most present diagnosis where leukemia, lymphoma, breast and prostate cancer. Regarding sensory analysis, the popsicles where well accepted by most of the patients. About 97% evaluated as "liked a lot" or "liked slightly". Most of participants (84%) reported that they would consume "frequently" or "always" and 94% reported feeling satisfied while tasting the popsicle. In the open question, all of the patients described positive feelings related to the popsicles (felt well, happy). CONCLUSION: considering the good results on the sensory analysis, the popsicles may contribute in the improvement of energy and protein intake

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Dietary recommendations for immunosuppressed patients of 17 hematopoietic stem cell transplantation centers in Brazil.

INTRODUCTION: Low-microbial diets are recommended to reduce the risk of foodborne infections when hematopoietic stem cell transplantation patients have neutropenia. However there is no pattern concerning the composition of such a diet. OBJECTIVE: To collect information concerning the structure of nutrition departments and the diets recommended for immunosuppressed patients in transplant centers in Brazil. METHODS: Questionnaires were sent to the 45 Bone Marrow Transplantation Centers listed by the Sociedade Brasileira de Transplante de Medula Óssea (SBTMO). Completed questionnaires were returned by 17 centers. The questions were related to the profile and the structure of the nutrition department, at what point a general diet is allowed after transplantation, and which food is allowed during the critical period of immunosuppression and soon after transplantation. RESULTS: Of the 17 centers that participated, 82% have a professional nutritionist exclusively for the Transplant Department but only 41% have an area specifically for the preparation of diets for immunosuppressed patients. The patients are released from the low-microbial diet to general diets 90-100 days after allogeneic hematopoietic stem cell transplantation by 29% of the centers and only after suspension of immunosuppressive drugs in 24%. Most centers (88%) restrict the consumption of raw fruits, all restrict the consumption of raw vegetables and 88% forbid the consumption of yogurt in the critical period of immunosuppression. There was no consensus on forbidden foods soon after transplantation. CONCLUSION: Major differences in diets recommended to hematopoietic stem cell transplantation patients were observed between the different centers.

Pre-sarcopenia and bone mineral density in adults submitted to hematopoietic stem cell transplantation

Abstract Background: The aim of this study was to evaluate the prevalence of pre-sarcopenia and bone mineral density after hematopoietic stem cell transplantation. Methods: The study group consisted of over 18-year-old patients who had been submitted to allogeneic transplantation at least one year previously. Patients and healthy controls were matched by sex, ethnic background, age, and body mass index. Body composition and bone mineral density were measured by dual-energy X-ray absorptiometry. A 24-h food recall and food frequency survey were performed. The biochemical evaluation included calcium, parathormone and vitamin D. Eighty-seven patients (52 men; age: 37.2 ± 12.7 years; body mass index: 25 ± 4.5 kg/m2) were compared to 68 controls [31 men; age 35.4 ± 15.5 years (p = 0.467); body mass index 25.05 ± 3.7 kg/m2 (p = 0.927)]. Results: There was no significant difference in the dietary intake between patients and controls. The mean levels of vitamin D were 23.5 ± 10.3 ng/mL; 29 patients (41.0%) had insufficient and 26 (37.14%) deficient levels. A higher prevalence of reduced bone mineral density was observed in 24 patients (25%) compared to 12 controls (19.1% - p < 0.001). Pre-sarcopenia was diagnosed in 14 (14.4%) patients and none of the controls (p = 0.05). There was a higher prevalence of pre-sarcopenia (66%) in patients with grades III and IV compared to those with grades 0-II graft-versus-host disease (10.9%) (p = 0.004). Conclusion: patients submitted to transplantation had a higher prevalence of pre-sarcopenia and greater changes in bone mineral density compared to controls; the severity of graft-versus-host disease had an impact on the prevalence of pre-sarcopenia.

Dietary recommendations for immunosuppressed patients of 17 hematopoietic stem cell transplantation centers in Brazil

INTRODUCTION: Low-microbial diets are recommended to reduce the risk of foodborne infections when hematopoietic stem cell transplantation patients have neutropenia. However there is no pattern concerning the composition of such a diet. OBJECTIVES: To collect information concerning the structure of nutrition departments and the diets recommended for immunosuppressed patients in transplant centers in Brazil. METHODS: Questionnaires were sent to the 45 Bone Marrow Transplantation Centers listed by the Sociedade Brasileira de Transplante de Medula Óssea (SBTMO). Completed questionnaires were returned by 17 centers. The questions were related to the profile and the structure of the nutrition department, at what point a general diet is allowed after transplantation, and which food is allowed during the critical period of immunosuppression and soon after transplantation. RESULTS: Of the 17 centers that participated, 82% have a professional nutritionist exclusively for the Transplant Department but only 41% have an area specifically for the preparation of diets for immunosuppressed patients. The patients are released from the low-microbial diet to general diets 90-100 days after allogeneic hematopoietic stem cell transplantation by 29% of the centers and only after suspension of immunosuppressive drugs in 24%. Most centers (88%) restrict the consumption of raw fruits, all restrict the consumption of raw vegetables and 88% forbid the consumption of yogurt in the critical period of immunosuppression. There was no consensus on forbidden foods soon after transplantation. CONCLUSION: Major differences in diets recommended to hematopoietic stem cell transplantation patients were observed between the different centers.