The clock diet: a practical nutritional guide to manage obesity through chrononutrition.

Chronobiology studies the biological rhythms or circadian cycles of living organisms and their adaptation to external changes. Biological rhythms can affect hormone production cycles such as sleep/wake, and nutrition/fasting, but these factors can also alter the circadian rhythm (CR). In recent years, numerous studies have highlighted how feeding times and frequency can influence biological rhythms. Additionally, individuals' chronotype, working shifts, and food intake can make a deep impact on people's tendency to develop obesity and metabolic diseases. In this context, a single food and a specific combination of these, can also affect the CR and fasting cycle and consequently body weight and viceversa. The purpose of the review is to propose practical nutritional recommendations to help in resynchronizing the circadian rhythm as a tool in weight control.

Polycystic ovary syndrome and obesity: clinical aspects and nutritional management.

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine and metabolic disorder characterized by androgen excess, oligo-anovulatory infertility, polycystic ovaries in ultrasound examination, insulin resistance, and cardiometabolic disorders, with overweight/obesity and visceral adiposity. This review aims to provide an overview of the clinical characteristics and nutritional therapy of PCOS and obesity. The authors analyzed the updated and relevant publications found on PubMed about clinical aspects and nutritional management of PCOS and obesity in studies done in animal and human models. It is crucial an early detection and intervention in PCOS patients to avoid the more challenging control of the onset of more impaired-health conditions that this pathology causes. It is presented evidence that clearly shows the close interaction among oxidative stress, low-grade inflammation, and PCOS. It is also analyzed the relevance of treating metabolic and nutritional correlations of PCOS with a complete therapeutic strategy that includes individualized medication, diet, and healthy habits. By an integral approach and treatment that includes not only medications for PCOS symptoms, supplementation of minerals and vitamins to control PCOS complications but an anti-inflammatory diet, nutritional education, exercise individualized program, lifestyle changes, it is possible to improve insulin resistance, sustained weight loss, ovulation rates, among other goals for the management of this disease. Further studies are needed to clarify mechanisms, beneficial effects, and doses of supplements and precise medication to determine the best combination of diets and exercise programs according to these patients' specific requirements.

Cancer-Related Malnutrition: Epidemiological Results from the Latin American Study of Malnutrition in the Oncology Practice.

Malnutrition can affect the patient diagnosed with, and treated for, cancer. However, until a dedicated study is completed, estimates of malnutrition rates will be disparate and unrepresentative of cancer patients' nutritional reality. Objective: To estimate the prevalence of malnutrition among patients being cared for cancer in Latin American (LATAM) hospitals by means of a multicenter, multinational study. Methods: The Latin American Study of Malnutrition in Oncology (LASOMO) was completed with 1,842 patients (Women: 56.2%; Age ≥ 60 years: 43.2%; Chemotherapy: 55.1%; Radiotherapy: 17.8%; Surgery: 27.1%) assisted at 52 health centers from 10 LATAM countries. Malnutrition prevalence was estimated from the (B + C) scores assigned to the patient with the Subjective Global Assessment by Detsky et al. (1987). Malnutrition prevalence was distributed regarding the demographic features of the patient, the primary tumor location, and the current cytoreducing treatment. Results: Malnutrition affected 59.1% of the surveyed patients. Malnutrition prevalence was higher among male patients and those with tumors of the digestive tract and the hemolymphopoietic system. Malnutrition was also associated with the current cytoreducing modality, with chemotherapy returning the highest prevalence. Conclusions: Malnutrition can be present in more than half of the patients being cared for cancer in LATAM health centers.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.2014902.

Recomendaciones en el tratamiento nutricional para pacientes oncológicos ante Covid - 19 / Recommendations in the nutritional treatment for cancer patients before Covid ­ 19

Los pacientes con cáncer tienen alto riesgo de infección y muerte por Covid-19 tras exposición a dicho virus. En estos pacientes confluyen la edad avanzada, inmunodepresión, desnutrición, anemia, exposición a varios prestatarios de cuidados de salud durante el tratamiento citorreductor, estadía en hospitales y unidades cerradas, y los tiempos dilatados de los esquemas terapéuticos como factores de riesgo para desarrollar una infección por dicho virus. Esta revisión presenta recomendaciones sobre acciones requeridas para la identificación, evaluación del impacto sobre el estado de salud y la respuesta terapéutica, e intervención de la desnutrición presente en el paciente con cáncer. Las intervenciones alimentarias y nutricionales se adecúan a la etapa del tratamiento citorreductor, y las terapias empleadas, se orientan a la restauración de una inmunocompetencia requerida para prevención de la infección y la continuidad de los tratamientos antineoplásicos. Se prevén acciones nutricionales en aquellos pacientes con cáncer en caso de la ocurrencia de la Covid-19 a fin de preservar la vida del enfermo y prevenir complicaciones mayores. El presente manuscrito enfatiza las medidas de protección personal, familiar y ambiental contra la Covid-19 que son aplicables con iguales propósitos en el paciente con cáncer. El objetivo de esta revisión narrativa es proporcionar recomendaciones nutricionales claras para el paciente con cáncer en situaciones de alta vulnerabilidad inmunológica y nutricional, para lograr una disminución del riesgo de contagio viral con sus consecuentes complicaciones, asegurando así la continuidad de las acciones citorreductoras en el enfermo con cáncer.

Cancer patients are at high risk of infection and death from Covid-19 after exposure to this virus. In these patients, advanced age, immunosuppression, malnutrition, anemia, exposure to several health care providers during cytoreductive treatment, length of stay in hospitals and closed units, and lengthy therapeutic regimens converge as risk factors to developed an infection by Covid-19. This review presents recommendations on actions required for the identification, evaluation of the impact on the health status and therapeutic response, and intervention of malnutrition present in cancer patients. The food and nutritional interventions are adapted to the cytoreductive treatment stage, and the therapies used aim to restore the immunocompetence required for the prevention of infection and the continuity of antineoplastic treatments. Nutritional actions are foreseen in cancer patients with Covid-19 in order to preserve the life of the patient and prevent major complications. This manuscript emphasizes the personal, family, and environmental protection measures against Covid-19 that are applicable to the same purposes in cancer patients. This narrative review aims to provide clear nutritional recommendations for the cancer patient in high immunological and nutritional vulnerability to achieve a reduction in the risk of viral infection with its consequent complications, thus ensuring the continuity of cytoreductive actions in cancer patients.

Requerimientos ajustados a la Desnutrición del Paciente Oncológico / Requirements adjusted to the Malnutrition of the Oncological Patient

Propósito de la revisión: Este artículo explica las causas de desnutrición en el paciente con cáncer y los requerimientos de energía y nutrientes específicos para esta población. Recientes Hallazgos: En la caquexia cancerosa del paciente tumoral existe una incrementada lipólisis, favorecida por una disminución de la actividad de la Lipoproteína Lipasa (LPL) del Tejido Adiposo Blanco (TAB) y que propicia un aumento de niveles de Triacilgliceroles (TAG) circulantes. No existe evidencia de que el soporte nutricional incremente el crecimiento tumoral. Extracto: La desnutrición en los pacientes con cáncer se debe a tres grandes grupos, el primero relacionado a nutrientes (su déficit, metabolismo, alteraciones de absorción), el segundo grupo por la presencia de la Caquexia Cancerosa y el tercer grupo relacionado con el tumor, el paciente y los tratamientos recibidos. De acuerdo a las Guías de la Sociedad Europea de Nutrición para pacientes con cáncer, se recomienda que si el gasto de energía en pacientes oncológicos no es medido específicamente a cada paciente se haga un cálculo de 25 - 30 Kcal/Kg de peso/día.

Purpose of the Review: This article explains the causes of malnutrition in the cancer patient and the specific energy and nutrient requirements for this population. Recent Findings: In the cancerous cachexia of the tumor patient there is an increased lipolysis, favored by a decrease in the activity of the White Adipose Tissue Lipoprotein (LPL) and that promotes an increase in circulating Triacylglycerols (TAG) levels. There is no evidence that nutritional support increases tumor growth. Excerpt: Malnutrition in cancer patients is due to three large groups, the first related to nutrients (their deficit, metabolism, absorption disorders), the second group due to the presence of Cancerous Cachexia and the third group related to the tumor, the patient and the treatments received. According to the Guidelines of the European Nutrition Society for cancer patients, it is recommended that if the energy expenditure in cancer patients is not measured specifically for each patient an estimate of 25 - 30 Kcal / Kg of weight / day.

[Cartagena Declaration. The International Declaration on the Right to Nutritional Care and the Fight against Malnutrition]. / Declaración de Cartagena. Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición.

INTRODUCTION: The need to promote the right to nutritional care, to fight against malnutrition and to advance in education and research in clinical nutrition has led all the FELANPE's societies to sign on May 3rd, during the 33rd Congress of the Colombian Clinical Nutrition Association (ACNC) in the city of Cartagena, the International Declaration on the Right to Nutritional Care and the Fight against Malnutrition, "Declaration of Cartagena". The Declaration provides a coherent framework of 13 principles which can serve as a guide for societies, schools and associations affiliated to FELANPE in the development of action plans. In addition, it will serve as an instrument to promote, through governments, the formulation of policies and legislation in the field of clinical nutrition. We believe that the general framework of principles proposed by the Declaration can contribute to raise awareness about the magnitude of this problem and to promote cooperation networks among Latin-American countries. Although this Declaration does not have a binding legal effect, it has an undeniable moral strength and it can provide practical guidance to States. An implementation program will allow developing a toolkit to transform principles into actions.

INTRODUCCIÓN: Frente a la necesidad de promover el derecho al cuidado nutricional, de luchar contra la malnutrición y de avanzar en temas de educación e investigación en nutrición clínica, las sociedades que constituyen la FELANPE firmaron la Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición, "Declaración de Cartagena", el 3 de mayo del presente año en la ciudad de Cartagena, en el marco del 33º Congreso de la Asociación Colombiana de Nutrición Clínica. La Declaración proporciona un marco coherente de 13 principios, los cuales podrán servir de guía a las sociedades afiliadas a la FELANPE en el desarrollo de los planes de acción. Además, servirá como un instrumento para que promuevan, a través de los gobiernos, la formulación de políticas y legislaciones en el campo de la nutrición clínica. Consideramos que el marco general de principios propuesto por la Declaración puede contribuir a crear conciencia acerca de la magnitud de este problema y a forjar redes de cooperación entre los países de la región. Aunque esta Declaración no tiene un efecto jurídico vinculante (obligatorio), tiene una fuerza moral innegable y puede proporcionar orientación práctica a los estados. Un plan de implementación permitirá desarrollar la caja de herramientas necesaria para transformar los principios en acciones.

Diagnóstico nutricional en el paciente oncológico: Importancia y Herramientas para realizarla / Nutritional diagnosis in cancer patients: Importance and Tools to perform it

Debido a la alta incidencia de diferentes patologías oncológicas a nivel mundial y mortalidad relacionada a ellas resulta fundamental conocer formas de prevenir sus complicaciones que muchas veces son decisivas en la sobrevida del paciente. Esto lo evidencia la relación de un 30 % de las muertes por cáncer asociado a cinco factores de riesgo comportamentales y alimentarios. Ya que éstos pueden ser prevenidos, es urgente ahondar en conocimientos al respecto. Actualmente varios estudios confirman la vital importancia del estado nutricional de los pacientes con cáncer y su impacto positivo en la evolución de la enfermedad. Un diagnóstico e intervención nutricional tempranos aseguran múltiples beneficios, reducción de complicaciones, recuperaciones más rápidas, reducción de estancia hospitalaria, mejor tolerancia a los esquemas terapéuticos, entre otros. Existen varias herramientas para realizar un correcto cribado nutricional. En este artículo se describirán el Método del Nutritional Risk Screening 2002 y Valoración Global Subjetiva generada por el Paciente.

Due to the high incidence of different types of cancer worldwide and mortality related to them, it is essential to know ways to prevent their complications that have a direct impact on the survival of the patient. 30 % of cancer deaths are associated with five behavioral and food risk factors. By deepening knowledge in this regard, we can avoid them. Several studies affirm the vital importance of the nutritional status of cancer patients and their positive impact on the evolution of the disease. The early diagnosis and nutritional intervention assure multiple benefits, reduction of complications, faster recoveries, reduction of length of stay at hospitals, better tolerance to cancer treatments, among others. There are several tools to perform correct nutritional screening. In this article, we will describe the Nutritional Risk Screening 2002 and the Patient-Generated Subjective Global Assessment.