Nutritional Status, Functional Status, and Quality of Life - What is the Impact and Relationship on Cancer Patients?

RATIONALE AND AIMS: Malnutrition is common and multifactorial in cancer patients (CP), combining the systemic inflammatory process with decreased food intake, loss of muscle and bone mass, and decreased functional status (FS). We aimed to track and evaluate the nutritional status (NS) of CP; associate results between hospitalized patients (HP) and day hospital patients (DHP); associate NS with tumor, symptoms, and FS. METHODS: Cross-sectional observational study in HP or DHP from Garcia de Orta Hospital, over 18 years old. NS was monitored and evaluated using Nutritional Risk Screening (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA), and anthropometric and biochemical parameters. To assess FS we used the Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Scale Index (KPSI), and handgrip dynamometer (HGD). RESULTS: The 265 CP (114-HP, 151-DHP), of which 34.2%-HP and 17.2%-DHP had low BMI. From NRS-2002, 86.0% and 35.8% were respectively at nutritional risk. Using PG-SGA, 93.0% and 39.7% were respectively malnourished. PG-SGA were positively correlated with ECOG (p < 0.01) and negatively correlated with KPSI (p < 0.01), BMI (p < 0.01), and handgrip strength-HGS (p < 0.01-DHP and p < 0.05-HP). CONCLUSIONS: PG-SGA and FS scales are appropriate and validated tools for early identification of malnutrition and FS in CP. HGD can be a useful tool for assessing FS and NS.

Handgrip Dynamometry and Patient-Generated Subjective Global Assessment in Patients with Nonresectable Lung Cancer.

INTRODUCTION: Undernutrition is frequently associated with advanced lung cancer. Accurate nutritional assessment tools are important to provide the proper nutritional therapy. Handgrip dynamometry has already been used in these patients, and the findings suggest that it is a good indicator of nutritional status. AIMS: The aim of this study was to evaluate the association between nutritional status and handgrip strength (HGS) in patients with nonresectable lung cancer. METHODS: Cross-sectional study involving thirty-seven subjects with nonresectable lung cancer. Nutritional status was obtained using Patient Generated Subjective Global Assessment (PG-SGA), and muscle function was evaluated by HGS using a Jamar® handgrip dynamometer on the nondominant hand. The results of both methods were compared and correlated. RESULTS: According to PG-SGA, 73% (n = 27) of the patients were moderately undernourished, and 8% (n = 3) were severely undernourished. In total, 81% (n = 30) were undernourished. HGS was below the 50th percentile in 57% of the patients (n = 21). We found a significant association between nutritional status according to PG-SGA and HGS (P = 0.026, CI = 95%). CONCLUSIONS: Handgrip dynamometry can be a useful tool to evaluate the functional and nutritional status. It can be included in lung cancer patients evaluation, along with other nutritional assessment tools.

Protein Intake, Adherence to Vitamin-Mineral Supplementation, and Dumping Syndrome in Patients Undergoing One Anastomosis Gastric Bypass.

INTRODUCTION: One anastomosis gastric bypass (OAGB) is an effective bariatric procedure. However, nutritional deficiencies or dumping syndrome (DS) may occur. The aim of this study was to assess adherence to nutritional recommendations and development of DS in a 3-year OAGB patient follow-up. METHODS: For 150 OAGB patients, in our center, data were collected through the electronic platform and by an individual telephone interview. The inclusion criterion is OAGB as a primary bariatric procedure, no revisional surgery, or no pregnancy. The adequacy of daily protein intake cutoff was defined as 60 g. Adherence to micronutrient supplementation protocol was considered if a minimum of 5 takes/week were reported. To evaluate the occurrence of DS, the Sigstad score questionnaire was used. For statistical analysis, a significance level less than 5% (p < 0.05) was considered. RESULTS: A total of 150 patients (80% females), BMI 44.3 ± 21.3 kg/m2, were subjected to the OAGB procedure. Of those, 128 fulfilled the study inclusion criteria. After 3 years, the mean %EBMIL was 78.4 ± 14.4. During the 3-year follow-up, the average protein intake was 60 g/day, and 48% reported an adequate daily protein intake. Adherence to the micronutrient supplementation protocol was reported by 70%. According to the Sigstad score questionnaire, DS was present in 24% of patients. CONCLUSION: A significant part of OAGB patients does not comply with the nutrition prescription assessed, emphasizing the need to improve team/patient communication strategies. Long-term studies are needed to characterize and assess the health impact of protein, vitamin, and mineral malnutrition in patients undergoing OAGB.

Association between whey protein, regional fat mass, and strength in resistance-trained men: a cross-sectional study.

The purpose of this study was to evaluate the association between whey protein supplementation, body composition, and muscle strength in resistance-trained individuals. Forty-nine healthy males, aged 18 to 35 years and were engaged in resistance training for at least 1 year, were assigned into 2 groups according to whey protein intake (whey - n = 26, age: 30.7 ± 7.4 years, body mass: 75.8 ± 9.0 kg; without whey: n = 23, age: 31.0 ± 7.4 years, body mass: 77.9 ± 9.3 kg). Using a cross-sectional design, a morning assessment of body fat mass (FM) (by dual-energy X-ray absorptiometry) and strength (using 1-repetition maximum for bench press and back squat) was performed. Nutritional assessment was performed by 3-day food records. Regarding nutritional habits, differences between total energy intake (kcal) and estimated energy requirements (kcal) were observed. Results, from raw data or controlling for energy intake, estimated energy requirements, or achieved percentage of energy requirements, showed that whey protein supplementation was inversely correlated with whole-body FM (R = -0.367 (p = 0.010); R = -0.317 (p = 0.049); R = -0.380 (p = 0.011); R = -0.321 (p = 0.047), respectively), trunk FM (R = -0.396 (p = 0.005), R = -0.367 (p = 0.022), R = -0.423 (p = 0.004), R = -0.369 (p = 0.021), respectively) and android FM (R = -0.381 (p = 0.007), R = -0.332 (p = 0.039), R = -0.383 (p = 0.010), R = -0.336 (p = 0.036), respectively). No correlations were found between muscle strength outcomes and whey protein supplementation. The present data suggest that whey protein ingestion has a positive association with whole-body and regional (trunk and android) FM.

Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of ≥ 1 year.

BACKGROUND: Bariatric surgery is indicated as the most effective treatment for morbid obesity; the Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice. However, nutritional deficiency may occur in the postoperative period as a result of reduced gastric capacity and change in nutrients absorption in the gastrointestinal tract. The prescription of vitamin and mineral supplementation is a common practice after RYGB; however, it may not be sufficient to prevent micronutrient deficiencies. The aim of this study was to quantify the micronutrient intake in patients undergoing RYGB and verify if the intake of supplementation would be enough to prevent nutritional deficiencies. METHODS: The study was conducted on 60 patients submitted to RYGB. Anthropometric, analytical, and nutritional intake data were assessed preoperatively and 1 and 2 years postoperatively. The dietary intake was assessed using 24-h food recall; the values of micronutrients evaluated (vitamin B12, folic acid, iron, and calcium) were compared to the dietary reference intakes (DRI). RESULTS: There were significant differences (p < 0.05) between excess weight loss at the first and second year (69.9 ± 15.3 vs 9.6 ± 62.9 %). In the first and second year after surgery, 93.3 and 94.1 % of the patients, respectively, took the supplements as prescribed. Micronutrient deficiencies were detected in the three evaluation periods. At the first year, there was a significant reduction (p < 0.05) of B12, folic acid, and iron intake. CONCLUSIONS: Despite taking vitamin and mineral supplementation, micronutrient deficiencies are common after RYGB. In the second year after surgery, micronutrient intake remains below the DRI.

[Reference values for bone strength assessed by quantitative ultrasound early after birth in term and preterm neonates]. / Valores de referência de robustez óssea avaliados próximo ao nascimento por ultrassonografia quantitativa em recém-nascidos de termo e pré-termo.

AIM: To obtain reference values for bone strength assessed early after birth for term and preterm neonates in Portugal. METHODS: Speed of sound (SOS) (m/s) was measured using the quantitative ultrasound method in a systematic sample of appropriate-for-gestationalage term and preterm neonates, within the first two and five days after birth, respectively. Homogeneity of values between genders and between gestational age groups was assessed. RESULTS: A sample of 158 neonates was enrolled, 34 full-term and 124 preterm (26-41 weeks of gestation), birth weights of 595g-4195g, 84 males (53.2%) and 20 twins (10.8%). The mean of the SOS significantly increases with gestational age. Reference values of SOS for gestational age groups are provided as 10th, 25th, 50th, 75th and 90th centiles without gender distinction. CONCLUSION: Reference values for SOS early after birth are made available for term and preterm appropriate-for-gestational age neonates, reflecting the intrauterine bone status, a baseline for follow-up studies on bone strength in Portugal.