Canadian Nutrition Society Dialogue on disease-related malnutrition: a commentary from the 2022 Food For Health Workshop.

This commentary represents a dialogue on key aspects of disease-related malnutrition (DRM) from leaders and experts from academia, health across disciplines, and several countries across the world. The dialogue illuminates the problem of DRM, what impact it has on outcomes, nutrition care as a human right, and practice, implementation, and policy approaches to address DRM. The dialogue allowed the germination of an idea to register a commitment through the Canadian Nutrition Society and the Canadian Malnutrition Task Force in the UN/WHO Decade of Action on Nutrition to advance policy-based approaches for DRM. This commitment was successfully registered in October 2022 and is entitled CAN DReaM (Creating Alliances Nationally for Policy in Disease-Related Malnutrition). This commitment details five goals that will be pursued in the Decade of Action on Nutrition. The intent of this commentary is to record the proceedings of the workshop as a stepping stone to establishing a policy-based approach to DRM that is relevant in Canada and abroad.

Acute green tea infusion ingestion effect on energy metabolism, satiety sensation and food intake: A randomized crossover trial.

BACKGROUND: Green tea (Camellia sinensis L.) has an effect on energy metabolism, but little is known about its infusion intake impact on satiety responses. OBJECTIVE: This paper aimed at analyzing the effect of green tea on energy expenditure, satiety response, and food intake in humans. METHODS: The study involved 21 individuals (11 women, 10 men), and consisted of an open-label, crossover, randomized clinical trial (RBR-928HCW). Evaluation of subjects was performed as an acute study on two different days, after having a standardized breakfast accompanied by water or green tea. Indirect calorimetry was used to evaluate resting energy expenditure (REE), and a visual analogue scale to assess satiety. Food records were used to assess food intake along the day of the trial. RESULTS: Acute ingestion of green tea infusion with the standardized breakfast increased REE (p = 0.014) by 7.2 ± 11.7% at 240min compared to fasting (mean difference of REE between the time of 240min and fasting: +91 ± 157.6 kcal). No significant alterations were observed for substrate oxidation and respiratory quotient compared to the water treatment. A greater feeling of hunger was observed when volunteers ingested green tea (water -828.75 ± 494.2  cm min; green tea -549.8 ± 545.6  cm min; p = 0.026). No significant differences were observed regarding food intake energy and macronutrients between treatments. CONCLUSIONS: Green tea increased energy expenditure and the subjective response of hunger in healthy individuals. This study is registered in the ReBEC Platform of the Brazilian Clinical Trials Registry (RBR-928HCW).

Hibiscus sabdariffa tea affects diet-induced thermogenesis and subjective satiety responses in healthy men but not in women: a randomized crossover trial.

The aim of this study was to investigate the effect of Hibiscus sabdariffa tea on energy expenditure, satiety response and food intake. This is an open-label, crossover, randomized clinical trial that comprised 21 subjects (11 women, 10 men). The individuals were evaluated at acute moments (fasting and after eating standardized breakfast accompanied by water or H. sabdariffa tea). Resting energy expenditure was measured by indirect calorimetry, subjective satiety responses were evaluated with a visual analogue scale and food intake was assessed by using food records. The volunteers who drank the H. sabdariffa tea had lower perception of hunger (p = 0.002) and greater feeling of satiety (p = 0.01) and fullness (p = 0.009) compared to control. Men who ingested the H. sabdariffa tea had an increase in nitrogen energy expenditure (water: 1501 ± 290.7 kcal, H. sabdariffa tea: 1619 ± 288.9 kcal; p = 0.029). In comparison to control, men presented less perception of hunger (p = 0.003) and desire to eat (p = 0.016), increased satiety (p = 0.021) and fullness (p = 0.01), and women oxidized more fat (p = 0.034) when they drank H. sabdariffa tea. There was no difference between treatments regarding the energy and macronutrient intake from the first meal and throughout the day (p > 0.05) for all participants. The H. sabdariffa tea only affected energy expenditure and satiety responses in men. Clinical trial registry: ReBEC Platform of the Brazilian Clinical Trials Registry (https://ensaiosclinicos.gov.br/) - RBR-5HZ86T. Novelty: H. sabdariffa tea promoted an increase in energy expenditure and caused less perception of hunger/desire to eat in men. H. sabdariffa tea intake increased postprandial fat oxidation in women.

SHORT-TERM EFFECT OF WHEY PROTEIN SUPPLEMENTATION ON THE QUALITY OF LIFE OF PATIENTS WAITING FOR LIVER TRANSPLANTATION: A DOUBLE BLINDED RANDOMIZED CLINICAL TRIAL.

BACKGROUND: Chronic liver disease is associated with malnutrition that negatively impacts a patient's health-related quality of life (HRQoL). AIM: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. METHODS: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. RESULTS: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. CONCLUSION: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

Critical analysis of factors affecting the efficiency of nutrition therapy teams.

BACKGROUND: Nutrition therapy (NT), defined as the provision of oral, enteral, or parenteral nutrition, should be considered a part of the holistic approach to patient care, while quality assessment of its practices is crucial. The present study aimed to identify variables capable of explaining the reason behind compliance of NTTs with the regulatory requirements. METHODS: A cross-sectional study focused on assessing the quality of nutritional therapy practices among NTTs who previously stated to be able to comply with requirements of the Brazilian law versus those who were not able to meet these demands. Hospitals were classified as A (teams that had previously reported to be able to meet the requirements) and B (those unable to comply with them). The study was approved by the ethics committees of all participant institutions. RESULTS: Twenty six hospitals met the inclusion criteria. The main hospital features, such as size, classification, service type, and percentage of hospitals providing NT were similar. Hospitals differed on the median number of patients undergoing NT per week: in group B (41.0; IR = 28.0-58.0) and group A (11.0; IR = 5.0-48.0) (p < 0.05), but there were no differences regarding personnel expertise. Both hospital groups had low quality control of the NT processes. CONCLUSION: Lack of quality assurance is responsible for the inadequate services in both type of institutions.

Clinical nutrition and human rights. An international position paper.

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

Clinical Nutrition and Human Rights. An International Position Paper.

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

Acute effects of dry extract of ginger on energy expenditure in eutrophic women: A randomized clinical trial.

BACKGROUND & AIMS: The thermic effect of food (TEF) is one of the components of total energy expenditure (TEE). Some bioactive compounds present in food could be useful to increase TEE. In this context, ginger has been extensively used as a thermogenic food despite no clear effect has been demonstrated yet. Herein, we evaluated the acute thermogenic effect of gingerol, a bioactive compound present in ginger, in healthy women. METHODS: We carried out a randomized double-masked, cross-over and placebo-controlled clinical trial with 20 healthy eutrophic women. Anthropometric, body composition, indirect calorimetry and clinical variables were collected at baseline and throughout the intervention phase. A standardized breakfast was offered together with two dry extract of ginger capsules (5% gingerol) or a placebo (cellulose). Indirect calorimetry, blood pressure, heart rate, axillary temperature and blood collection were assessed at baseline and thereafter, at 30, 60, 120, 180 and 240 min postprandial. The analyses were repeated with a minimum of seven days' washout period. RESULTS: Ginger intake did not increase the TEF of a standardized breakfast compared to the placebo. Oxygen consumption, respiratory quotient, blood pressure, heart rate, axillary temperature and metabolic profile were not different as well. CONCLUSIONS: Our data show that gingerol did not modify the acute TEF in healthy women. More studies in human subjects, using different concentrations of gingerol, administration methods and intervention type (chronic effect) are necessary to clarify the putative thermogenic effect of ginger. Registered at ClinicalTrials.gov (Thermogenic Effect of Ginger - NCT03089593).

ACERTO Project - 15 years changing perioperative care in Brazil.

The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group "Acerto em Nutrição e Cirurgia", refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.

Short-term effect of whey protein supplementation on the quality of life of patients waiting for liver transplantation: a double blinded randomized clinical trial / Efeito a curto prazo da suplementação com proteína do soro do leite sobre a qualidade de vida de pacientes em fila de espera para o transplante hepático: ensaio clínico randomizado

ABSTRACT Background: Chronic liver disease is associated with malnutrition that negatively impacts a patient's health-related quality of life (HRQoL). Aim: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. Methods: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. Conclusion: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

RESUMO Racional: A doença hepática crônica está associada à desnutrição que afeta negativamente a qualidade de vida relacionada à saúde (QVRS). Objetivo: Avaliar o efeito da suplementação aguda de proteína do soro de leite na QVRS e no estado nutricional e funcional dos pacientes em lista de espera para o transplante hepático. Métodos: Ensaio clínico randomizado com pacientes à espera do transplante hepático que foram randomizados em dois grupos: PS (suplementação com proteína do soro de leite) e Controle (suplementação com caseína). Ambos os grupos receberam 40 g das proteínas (20 g pela manhã e 20 g à noite) por 15 dias. O estado nutricional e funcional foi avaliado. O balanço energético foi calculado como a diferença entre a ingestão energética (recordatório de 24 horas) e o gasto energético total (avaliado por calorimetria indireta). O questionário de doença hepática crônica (CDLQ) foi utilizado para avaliar a QVRS. Todas as medidas foram realizadas antes e após a intervenção. Resultados: Cinquenta e seis pacientes foram avaliados. A desnutrição esteve presente em 56,9% e, diretamente associada à baixa QVRS (p<0,05). A suplementação, com ambas as proteínas, não alterou o estado nutricional e funcional dos pacientes (p>0,05). Entretanto, a QVRS melhorou após a suplementação com PS e caseína, sem diferenças entre os grupos (p>0,05). Pacientes que alcançaram as necessidades proteicas e com balanço energético positivo tiveram maior escore de QVRS (4,9; p<0,05), sem diferenças entre os grupos (p>0,05). Conclusão: A desnutrição reduz substancialmente a QVRS. A suplementação aguda com PS ou caseína melhorou de forma similar a QVRS.

Acerto Project - 15 years changing perioperative care in Brazil / Projeto Acerto - 15 anos modificando cuidados perioperatórios no Brasil

ABSTRACT The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group "Acerto em Nutrição e Cirurgia", refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.

RESUMO O projeto ACERTO é um protocolo multimodal de cuidados perioperatórios. Implementado em 2005, o projeto, nos últimos 15 anos, tem disseminado a ideia de moderno protocolo de cuidados perioperatórios baseados em evidência e com atuação interprofissional. Dezenas de estudos publicados com o uso do protocolo têm mostrado benefícios como redução do tempo de internação, complicações pós-operatórias e custos hospitalares. Disseminado pelo Brasil, o projeto tem apoio do Colégio Brasileiro de Cirurgiões e da Sociedade Brasileira de Nutrição Parenteral e Enteral, entre outros. Este artigo compila publicações dos autores que compõem o grupo de pesquisa do CNPq "Acerto em Nutrição e Cirurgia", cita a experiência de outros autores nacionais em diversas especialidades cirúrgica e finalmente, delineia a evolução do projeto ACERTO ao longo da linha do tempo.

Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy.

INTRODUCTION: The implementation of quality assessment in nutrition therapy (NT) is an important strategy, with the potential to contribute to the reduction of malnutrition and improve the cost-effectiveness of NT. Studies on this subject are scarce in the world. Our objective was to evaluate the practice of NT in hospitals located in the third-most-developed state of Brazil. METHODS: A cross-sectional study, using data collected through interviews with members of the clinical staff/interdisciplinary NT team (NTT) and audits of clinical protocols and medical records, was carried out. Both non-probability and probability sampling techniques were used to select the hospitals. RESULTS: Thirty-three hospitals were included (10 public, 10 philanthropic, 9 private, and 4 university). Twenty-six institutions reported to have an NTT. There was no statistically significant difference in the existence and performance of the teams or in the presence of protocols and quality indicators between the types of hospitals. However, the inspection of 172 medical records showed that essential items for the nutrition care of the patient were not fully in agreement with the previous provided information, and this varied according to the type of hospital. CONCLUSION: The majority of hospitals had an NTT as well as protocols and quality indicators. However, patient records were not in accordance with the essential items to guarantee NT quality and safety, indicating a gap between theory and practice.

Effect of Oral Nutrition Supplements and TGF-ß2 on Nutrition and Inflammatory Patterns in Patients With Active Crohn's Disease.

BACKGROUND: Crohn's disease (CD) is often associated with nutrition disorders. Many nutrition therapeutic alternatives have been studied. Nevertheless, the actual role of nutrition therapy is still controversial. The objective of this study was to assess the effects of nutrition supplementation with and without transforming growth factor-beta 2 (TGF-ß2) on inflammatory, endoscopic, histopathologic, and nutrition parameters in active CD. MATERIALS AND METHODS: Thirty-eight patients were allocated into 3 groups: group 1 (patients who received only nutrition orientation), group 2 (nutrition orientation and a normoproteic, normocaloric nutrition supplement), and group 3 (nutrition orientation and the nutritional supplement with TGF-ß2). Clinical and nutrition evaluation, C-reactive protein (CRP) levels, and assessment of endoscopic and histologic parameters in the intestinal mucosa were performed before and after nutrition intervention. RESULTS: The mean follow-up period was 3 months. In the beginning of the study, groups were homogeneous regarding age, gender, CD behavior and localization, and medication in use. In the end of the study, the Clinical Disease Activity Index score was reduced in groups 2 and 3; in group 3, a reduction in CRP levels and an improvement in histologic findings were observed. Among patients who received nutritional supplement, some anthropometric patterns were improved. CONCLUSION: The results of the study indicate that nutritional supplementation improved nutrition and inflammatory patterns in patients with active CD. However, only patients receiving TGF-ß2-enriched formula showed improvement in histologic parameters and significant reduction in CRP levels.

Omega-3 fatty acids, inflammatory status and biochemical markers of patients with systemic lupus erythematosus: a pilot study / Ácidos graxos ômega-3, estado inflamatório e marcadores bioquímicos de pacientes com lúpus eritematoso sistêmico: estudo piloto

Abstract Background: Studies have shown that omega-3 fatty acids reduce the concentrations of eicosanoids, cytokines, chemokines, C-reactive protein (CRP) and other inflammatory mediators. Objective: To investigate the effects of omega-3 fatty acids on circulating levels of inflammatory mediators and biochemical markers in women with systemic lupus erythematosus (SLE). Methods: Experimental clinical study (clinical trial: NCT02524795); 49 women with SLE (ACR1982/1997) were randomized: 22 to the omega-3 group (daily intake of 1080 mg EPA + 200 mg DHA, for 12 weeks) and 27 to the control group. The inflammatory mediators and biochemical markers at T0 and T1 in omega-3 group were compared using Wilcoxon test. U-Mann-Whitney test was used to compare variations of measured variables [ΔV = pre-treatment (T0) − post-treatment (T1) concentrations] between groups. p < 0.05 was considered significant. Results: The median (interquartile range - IQR) of age was 37 (29-48) years old, of disease duration was 7 (4-13) years, and of SLEDAI-2K was 1 (0-2). The median (IQR) of variation in CRP levels between the two groups showed a decrease in omega-3 group while there was an increase in control group (p = 0.008). The serum concentrations of IL-6 and IL-10, leptin and adiponectin did not change after a 12 week treatment. Conclusions: Supplementation with omega-3 had no impact on serum concentrations of IL-6, IL-10, leptin and adiponectin in women with SLE and low disease activity. There was a significant decrease of CRP levels as well as evidence that omega-3 may impact total and LDL-cholesterol.

Resumo Introdução: Estudos têm mostrado que os ácidos graxos ômega-3 reduzem as concentrações de eicosanoides, citocinas, quimiocinas, proteína C-reativa (PCR) e outros mediadores inflamatórios. Objetivo: Investigar os efeitos dos ácidos graxos ômega-3 sobre os níveis circulantes de mediadores inflamatórios e marcadores bioquímicos em mulheres com lúpus eritematoso sistêmico (LES). Métodos: Ensaio clínico randomizado (ensaio clínico: NCT02524795); randomizaram-se 49 mulheres com LES (ACR1982/1997): 22 para o grupo ômega-3 (dose diária de 1.080 mg de EPA + 200 mg de DHA durante 12 semanas) e 27 para o grupo controle. Os mediadores inflamatórios e marcadores bioquímicos em T0 e T1 no grupo ômega-3 foram comparados pelo teste de Wilcoxon. O teste U de Mann-Whitney foi usado para comparar variações das variáveis mensuradas [ΔV = concentrações pré-tratamento (T0) menos concentrações pós-tratamento (T1)] entre os grupos. Um p < 0,05 foi considerado significativo. Resultados: A mediana (intervalo interquartil-IIQ) da idade foi de 37 anos (29-48), a duração da doença foi de sete anos (4-13) anos e o Systemic Lupus Disease Activity Index (Sledai-2 K) foi de 1 (0-2). A mediana (IIQ) da variação nos níveis de PCR entre os dois grupos mostrou um decréscimo no grupo ômega-3, enquanto houve um aumento no grupo controle (p = 0,008). As concentrações séricas de IL-6 e IL-10, leptina e adiponectina não se alteraram após um tratamento de 12 semanas. Conclusões: A suplementação de ômega-3 não teve impacto sobre as concentrações séricas de IL-6, IL-10, leptina e adiponectina em mulheres com LES e baixa atividade da doença. Houve uma diminuição significativa nos níveis de PCR, bem como evidências de que o ômega-3 pode impactar sobre o colesterol total e LDL.

Hospital and homecare malnutrition and nutritional therapy in Brazil. Strategies for alleviating it: a position paper.

INTRODUCTION: Malnutrition in hospitalized patients is not evaluated frequently. However, it is a critical issue given that it has been related to a high rate of infectious complications and increased mortality rates. There is a high prevalence of patients with nutritional impairment in the home environment, which favors their clinical worsening, the increase of re-hospitalizations and, consequently, the increase in public health expenditures. OBJECTIVE: Nutrition experts have thoroughly discussed and written this positioning paper on hospital and homecare malnutrition to describe the prevalence of malnutrition in Brazil. Best practice recommendations for nutrition therapy of patients in hospital and homecare, in particular the use of oral nutritional supplements (ONS), to those who are at risk of malnutrition or malnourished were evaluated, and the impact on clinical and economic data were assessed. In addition, they emphasize that investments in oral nutritional supplementation are also important in the homecare environment (home or nursing homes). MATERIALS AND METHODS: Selected scientific articles on disease-related malnutrition, especially those carried out in Brazil, were assessed. Data on prevalence, clinical outcomes, and economic burdens were reviewed. RESULTS AND CONCLUSION: Several studies have shown the importance of in-hospital nutritional assessment for early detection of malnutrition and early intervention with nutrition therapy, in particular with oral nutritional therapy. Unfortunately, hospital malnutrition remains high in Brazil, with severe consequences for patients. The implementation of universal nutritional screening and diagnosis as well as the therapeutic approach of malnutrition, particularly with the use, when possible, of oral nutrition supplements as the first step to address this condition is still low, and demands the investment in educational resources to change practices. Routine use of nutritional therapy in hospital and homecare settings improves clinical outcomes, is cost effective, and would be expected to help reduce healthcare costs.

Hospital and homecare malnutrition and nutritional therapy in Brazil. Strategies for alleviating it: a position paper / Desnutrición y terapia nutricional en hospitales y en domicilios en Brasil. Estrategias para aliviarlo: posicionamiento

Introduction: Malnutrition in hospitalized patients is not evaluated frequently. However, it is a critical issue given that it has been related to a high rate of infectious complications and increased mortality rates. There is a high prevalence of patients with nutritional impairment in the home environment, which favors their clinical worsening, the increase of re-hospitalizations and, consequently, the increase in public health expenditures. Objective: Nutrition experts have thoroughly discussed and written this positioning paper on hospital and homecare malnutrition to describe the prevalence of malnutrition in Brazil. Best practice recommendations for nutrition therapy of patients in hospital and homecare, in particular the use of oral nutritional supplements (ONS), to those who are at risk of malnutrition or malnourished were evaluated, and the impact on clinical and economic data were assessed. In addition, they emphasize that investments in oral nutritional supplementation are also important in the homecare environment (home or nursing homes). Materials and methods: Selected scientific articles on disease-related malnutrition, especially those carried out in Brazil, were assessed. Data on prevalence, clinical outcomes, and economic burdens were reviewed. Results and conclusion: Several studies have shown the importance of in-hospital nutritional assessment for early detection of malnutrition and early intervention with nutrition therapy, in particular with oral nutritional therapy. Unfortunately, hospital malnutrition remains high in Brazil, with severe consequences for patients. The implementation of universal nutritional screening and diagnosis as well as the therapeutic approach of malnutrition, particularly with the use, when possible, of oral nutrition supplements as the first step to address this condition is still low, and demands the investment in educational resources to change practices. Routine use of nutritional therapy in hospital and homecare settings improves clinical outcomes, is cost effective, and would be expected to help reduce healthcare costs (AU)

Introducción: la desnutrición en pacientes hospitalizados no se evalúa con frecuencia. Sin embargo, es un problema crítico dado que se ha relacionado con una alta tasa de complicaciones infecciosas y con el incremento de la mortalidad. Se observa una alta prevalencia de pacientes desnutridos en el entorno domiciliario, lo que favorece su deterioro clínico, el aumento de las rehospitalizaciones y, como consecuencia, el aumento del gasto sanitario público. Objetivo: expertos en nutrición realizaron una revisión detallada de los estudios para redactar un posicionamiento sobre la situación en Brasil respecto a la prevalencia de la desnutrición hospitalaria y domiciliaria. Se identificaron las mejores prácticas recomendadas para la terapia nutricional de los pacientes hospitalarios y en domicilio en riesgo de desnutrición o desnutridos y se evaluó la utilidad de los suplementos nutricionales orales (SNO) a través de datos clínicos y económicos. Adicionalmente, se evidenció que las inversiones en suplementos nutricionales orales son también importantes en el entorno domiciliario (domicilio o residencia). Materiales y métodos: se evaluaron artículos científicos seleccionados, especialmente los realizados en Brasil, sobre la desnutrición relacionada con enfermedades. Se revisaron los datos sobre la prevalencia, los resultados clínicos y las cargas económicas. Resultados y conclusión: varios estudios han demostrado la importancia de la evaluación nutricional en el hospital para la detección precoz de la desnutrición y la intervención temprana con terapia nutricional oral, siempre que sea posible, como estrategia inicial para abordar el problema. Desafortunadamente, la desnutrición hospitalaria continúa siendo elevada en Brasil, con consecuencias graves para los pacientes. La identificación del estado nutricional deficiente a través del cribado y el inicio de la terapia nutricional, particularmente con el uso, cuando es posible, de suplementos nutricionales orales, como primera etapa para combatir la desnutrición no está aún establecida y requiere una inversión en recursos educativos para cambiar las prácticas actuales. El uso rutinario de la terapia nutricional en el entorno hospitalario y domiciliario mejora los resultados clínicos y tiene un impacto positivo en la disminución de los costes asociados y, de esta forma, se espera que contribuya a la reducción de los costes de atención sanitaria (AU)

Pretreatment With L-Citrulline Positively Affects the Mucosal Architecture and Permeability of the Small Intestine in a Murine Mucositis Model.

BACKGROUND: Mucositis is a common complication in patients undergoing radiotherapy and chemotherapy. It is associated with pain, poor quality of life, and malnutrition, leading to an increased number of hospital admissions and prolonged hospitalization. The use of immunonutrients may be an alternative treatment option, which may help to improve patient outcome. OBJECTIVE: Here we assessed the impact of L-citrulline (CIT) on a murine model of 5-fluorouracil (5FU)-induced mucositis. METHODS: Swiss male mice were randomized into 4 groups: control, CIT, 5FU, and 5FU+CIT. Mice were fed with commercial chow and supplemented with an oral solution of alanine (control and 5FU groups) or CIT (CIT and 5FU+CIT groups). On the seventh day, mice received intraperitoneal phosphate-buffered saline or 5FU (200 mg/kg, single dose) to induce mucositis. On the 10th day, mice were euthanized, and the blood and small intestines were harvested. Body weight, morphology, histopathology score (hematoxylin and eosin) of the small intestine (from 0-12), myeloperoxidase activity, oxidative stress level, and intestinal permeability were assessed. RESULTS: We observed significant weight loss after the administration of 5FU in both treated and control animals. CIT administration contributed to a partial recovery of the mucosal architecture as well as an intermediate reduction of the histopathologic score, and functional intestinal permeability was partially rescued. CONCLUSIONS: CIT administration attenuated 5FU-mediated damage to the mucosal architecture of the small intestine, decreasing the size of the injured areas and promoting decreased intestinal permeability.

[Polyunsaturated omega-3 fatty acids and systemic lupus erythematosus: what do we know?]. / Ácidos graxos poli-insaturados ômega-3 e lúpus eritematoso sistêmico: o que sabemos?

Various studies have demonstrated the impact of omega-3 fatty acids on the concentration of C reactive protein (CRP), pro-inflammatory eicosanoids, cytokines, chemokines and other inflammatory mediators. Therefore, the supplementation of these types of lipids may represent additional option treatment for chronic systemic diseases, such as Systemic Lupus Erythematous and other rheumatic diseases. The role of these lipids has not been well established, yet. However, it seems there is a direct relationship between its intake and the decrease of the disease clinical manifestations as well as of the inflammatory status of the patients. Thus, the aim of this manuscript is to present a thorough review on the effects of omega-3 fatty acids in patients with SLE. Bibliographic data set as the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) were searched using as key words: systemic lupus erythematous (SLE), polyunsaturated fatty acids omega-3, eicosapentanoic acid (EPA), docosahexanoic acid (DHA), antioxidants and diet. Manuscripts published up to September 2013 were included. There were 43 articles related to the topic, however only 15 pertained human studies, with three review articles and 12 clinical studies.

The role of L-arginine and inducible nitric oxide synthase in intestinal permeability and bacterial translocation.

BACKGROUND: Arginine has been shown to have several immunological and trophic properties in stressful diseases. Its metabolites, nitric oxide (NO) and polyamines, are related to arginine's effects. Thus, the aim of this study was to determine the effects of the NO donor L-arginine and the role of inducible NO synthase (iNOS) on intestinal permeability and bacterial translocation in a model of intestinal obstruction (IO) induced by a simple knot in the terminal ileum. MATERIAL AND METHODS: Male C57BL6/J wild-type (WT) and iNOS knockout (iNOS-/-) mice were randomized into 6 groups: Sham and Sham-/- (standard chow), IO and IO-/- (standard chow +IO), and Arg and Arg-/- (standard chow supplemented with arginine + IO). After 7 days of treatment with standard or supplemented chows, IO was induced and intestinal permeability and bacterial translocation were evaluated. The small intestine and its contents were harvested for histopathological and morphometric analysis and the determination of polyamine concentration. RESULTS: Pretreatment with arginine maintained intestinal permeability (P > .05; Arg and Arg-/- groups vs Sham and Sham-/- groups), increased polyamine concentration in intestinal content (P < .05; Arg vs IO group), and decreased bacterial translocation in WT animals (Arg group vs IO and IO-/- groups). Absence of iNOS also presented a protective effect on permeability but not on bacterial translocation. CONCLUSION: Arginine supplementation and synthesis of NO by iNOS are important factors in decreasing bacterial translocation. However, when intestinal permeability was considered, NO had a detrimental role.

Impact of probiotic supplementation on mortality of induced 1,2-dimethylhydrazine carcinogenesis in a mouse model.

RATIONALE: Probiotic bacterial strains have been increasingly used in clinical practice as many health benefits result from their use. However, severe side effects such as bacteremia and fungemia have been reported in inmunocompromised patients and those with chronic disease. OBJECTIVE: The purpose of this study was to report the impact of probiotic supplementation on the mortality of mice undergoing carcinogenesis induction with 1,2-dimethylhydrazine (DMH). METHODS: Two treatment protocols were used. In experiment 1, Lactobacillus delbrueckii UFV-H2b20, Bifidobacterium animalis var. lactis Bb12, and Saccharomyces boulardii were added to the drinking water, to control mice and those undergoing injections of DMH daily. Probiotic supplementation was started 1 wk before and continued throughout the 6 wk of DMH injections. In experiment 2, the same probiotics were administered daily, except on the first day that DMH was administered. The mortality of these animals was recorded. Bacterial translocation was determined in mice in experiment 1. RESULTS: Groups with DMH-induced injury treated with lactobacilli, bifidobacteria, and the mixture of lactobacilli and bifidobacteria presented with 40%, 30%, and 60% mortality, respectively. Death happened mainly between 48 h and 72 h after the first injection of DMH. On the other hand, no mice in experiment 2 died during the study period. Bacteria were found to be translocated to mesenteric lymph nodes, spleen, and liver. CONCLUSION: Supplementation of L. delbrueckii UFV-H2b20 and B. animalis var. lactis Bb12 in mice with DMH-induced injury led to death in some animals. The results suggest that increased bacterial translocation was probably related to mortality. These findings are an alert to the potentially severe side effects associated with the use of probiotics under extremely stressful situations.