ADIPONECTIN, VITAMIN D AND NUTRITIONAL STATUS IN PATIENTS WITH ADVANCED COLORECTAL CANCER OR DURING FOLLOW-UP.

BACKGROUND: Considering the high incidence of colorectal cancer (CRC) related deaths, many studies have investigated variables that can affect survival, with the aim of prolonging survival. The nutritional status can also be predict survival in patients with CRC. OBJECTIVE: The aim of the present study was to evaluate if BMI, %FAT, PhA, PG-SGA, adiponectin levels, and vitamin D levels are relevant to the characterization and differentiation of patients with advanced CRC and patients with a history of CRC. METHODS: The study was carried out by patients with advanced colorectal cancer (Group 1) and patients in follow-up after colorectal cancer treatment (Group 2). Nutritional status was assessed using the body mass index, body fat percentage, phase angle from bioelectrical impedance, Patient-Generated Subjective Global Assessment score. Adiponectin concentrations were determined using an enzyme-linked immunosorbent assay, and vitamin D levels were measured using high performance liquid chromatography. RESULTS: Groups 1 and 2 consisted of 23 and 27 patients, respectively. The body mass index, body fat percentage, phase angle, vitamin D and adiponectin levels were not significantly different between the groups. The mean Patient-Generated Subjective Global Assessment score was significantly higher in group 1 compared with group 2, and was significantly correlated with the long-term mortality risk. CONCLUSION: Among the nutritional status parameters, only the Patient-Generated Subjective Global Assessment score was significantly different between the groups and was an important predictor of survival in patients with advanced colorectal cancer.

Impact of genetic mutations and nutritional status on the survival of patients with colorectal cancer.

BACKGROUND: The prognosis of colorectal cancer (CRC) patients can be influenced by genetic mutations and nutritional status. The relationship between these variables is unclear. The objective of the study was to verify the variables involved in the nutritional status and genetic mutations, which correlate with survival of CRC patients. METHODS: Patients with surgical intervention for tumor resection were evaluated using body mass index, nutritional screening, patient self-produced global subjective assessment, phase angle, and computed tomography to calculate the areas of visceral adipose tissue (VAT) and subcutaneous adipose tissue, and muscle mass for the determination of sarcopenia. Ten gene mutations involved in CRC carcinogenesis were studied (PIK3CA, KRAS, BRAF, EGFR, NRAS, TP53, APC, PTEN, SMAD4, and FBXW7). DNA was extracted from fresh tumor or paraffin tissues. RESULTS: Of the 46 patients, 29 (64.4%) were at nutritional risk and 21 (45.7%) were moderately malnourished. However, there was a high percentage of VAT in 24 (61.5%) and sarcopenia in 19 (48.7%) patients. These variables were associated with a higher risk of mortality. Nutritional risk, moderate or severe malnutrition, phase angle < 5°, VAT < 163.8 cm2 in men and <  80.1 cm2 in women, and sarcopenia were associated with the relative risk of death, with respective hazard ratios/odds ratios and 95% confidence intervals of 8.77 (1.14-67.1), 3.95 (1.11-14.0), 3.79 (1.10-13.1), 3.43 (1.03-11.4), and 3.95 (1.06-14.6). Increased VAT was associated with a lower risk of death, even in patients older than 60 years or those harboring mutated KRAS. CONCLUSIONS: Patients with positive indicators for malnutrition or risk of malnutrition had an increased risk of death. No relationship was identified between the presence of mutations and survival.

Adiponectina, vitamina D e estado nutricional em pacientes com câncer colorretal avançado e em seguimento / Adiponectin, vitamin d and nutritional status in patients with advanced colorectal cancer or during follow-up

ABSTRACT BACKGROUND: Considering the high incidence of colorectal cancer (CRC) related deaths, many studies have investigated variables that can affect survival, with the aim of prolonging survival. The nutritional status can also be predict survival in patients with CRC. OBJECTIVE: The aim of the present study was to evaluate if BMI, %FAT, PhA, PG-SGA, adiponectin levels, and vitamin D levels are relevant to the characterization and differentiation of patients with advanced CRC and patients with a history of CRC. METHODS: The study was carried out by patients with advanced colorectal cancer (Group 1) and patients in follow-up after colorectal cancer treatment (Group 2). Nutritional status was assessed using the body mass index, body fat percentage, phase angle from bioelectrical impedance, Patient-Generated Subjective Global Assessment score. Adiponectin concentrations were determined using an enzyme-linked immunosorbent assay, and vitamin D levels were measured using high performance liquid chromatography. RESULTS: Groups 1 and 2 consisted of 23 and 27 patients, respectively. The body mass index, body fat percentage, phase angle, vitamin D and adiponectin levels were not significantly different between the groups. The mean Patient-Generated Subjective Global Assessment score was significantly higher in group 1 compared with group 2, and was significantly correlated with the long-term mortality risk. CONCLUSION: Among the nutritional status parameters, only the Patient-Generated Subjective Global Assessment score was significantly different between the groups and was an important predictor of survival in patients with advanced colorectal cancer.

RESUMO CONTEXTO: Considerando a alta incidência de óbitos devido ao câncer coloretal (CCR), estudos investigaram variáveis que podem afetar a sobrevida, com objetivo de prolongar a sobrevida. O estado nutricional desses pacientes também pode predizer a sobrevida. OBJETIVO: O objetivo do presente estudo foi avaliar se o índice de massa corporal (IMC), a porcentagem de gordura, os níveis séricos de adiponectina e de vitamina D são relevantes para a caracterização e diferenciação de pacientes com CCR avançado e pacientes com histórico de CCR. MÉTODOS: O estudo foi realizado por pacientes com câncer colorretal avançado (Grupo 1) e pacientes em acompanhamento após o tratamento do CCR (Grupo 2). O estado nutricional foi avaliado por meio do IMC, percentual de gordura corporal, ângulo de fase da bioimpedância elétrica, escore de Avaliação Global Subjetiva Gerada pelo Paciente. As concentrações de adiponectina foram determinadas por ELISA e os níveis de vitamina D foram medidos por meio de cromatografia líquida de alta performance. RESULTADOS: Os grupos 1 e 2 consistiram de 23 e 27 pacientes, respectivamente. O IMC, percentual de gordura corporal, ângulo de fase, níveis de vitamina D e adiponectina não foram significativamente diferentes entre os grupos. O escore médio da Avaliação Global Subjetiva Gerada pelo Paciente foi significativamente maior no grupo 1 em comparação com o Grupo 2, e foi significativamente correlacionado com o risco de mortalidade a longo prazo. CONCLUSÃO: Entre os indicadores do estado nutricional, apenas o escore da Avaliação Global Subjetiva Gerada pelo Paciente foi significativamente diferente entre os grupos e foi um importante preditor de sobrevida em pacientes com câncer colorretal avançado.

Cachexia Stage, Patient-Generated Subjective Global Assessment, Phase Angle, and Handgrip Strength in Patients with Gastrointestinal Cancer.

The aim of this study was to correlate patients with gastrointestinal cancer, classified according to different stages of cancer cachexia (SCC) as proposed by Fearon, with nutritional assessment tools such as PG-SGA, phase angle (PA), and handgrip strength. One hundred one patients with a mean age of 61.8 ± 12.8 yr, with 58.4% being men were included. 32.6% were malnourished according to the body mass index (BMI). A severe or moderate malnutrition had been diagnosed in 63.3% when assessed using the PG-SGA, 60.4% had decreased handgrip strength, and 57.4% had lower grades of PA. Among the patients in the study, 26% did not have cachexia, 11% had precachexia, 56% cachexia, and 8% refractory cachexia. The PG-SGA, PA, and handgrip strength were associated with cachexia (P ≤ 0.001). An increased risk of death was found in patients with cachexia [RR: 9.1; confidence interval (CI) 95%: 0.1-90.2, P = 0.039], refractory cachexia (RR: 69.4, CI 95%: 4.5-1073.8, P = 0.002), and increased serum C-reactive protein (CRP) levels (P < 0.001). In conclusion, most of the patients with digestive system cancer had cachexia or refractory cachexia in the first nutritional assessment. Nutritional risk, as determined by PG-SGA, was correlated with PA and handgrip strength. High CRP levels, cachexia, and refractory cachexia were prognostic factors for cancer patients.

Association Between Nutrition Status and Survival in Elderly Patients With Colorectal Cancer.

BACKGROUND: Aging patients with cancer have a higher risk of mortality and treatment-associated morbidity than younger patients. Nutrition status may play an important role in cancer mortality. We aimed to evaluate the survival time of elderly patients with colorectal cancer and its association with body mass index (BMI), the patient-generated subjective global assessment (PG-SGA), and phase angle (PA). MATERIALS AND METHODS: BMI, PG-SGA, and PA were determined for all patients (n = 250) at first assessment. RESULTS: Seventy-one (28.4%) patients were in active oncologic treatment (group 1) and 179 (71.6%) were in remission (group 2). At the time of the analysis, 73 (29.2%) patients had died and 177 (70.8%) were censored. The mean (standard deviation) age was 70.9 (7.49) years; 17.2% were undernourished, 56% normal weight, and 26.8% were overweight. According to the PG-SGA, 35.2% of patients needed some nutrition intervention and 4.4% needed it urgently. The mean PA was 4.94 ± 1°. PG-SGA, tumor stage, and PA differed significantly ( P < .001) between the groups; BMI did not ( P = .459). Severe malnutrition (PG-SGA C), compared with PG-SGA A, was associated with a relative hazard of death of 12.04 (95% confidence interval [CI], 3.43-42.19, P < .001). PA >5° was associated with better prognosis: a relative hazard of 0.456 (95% CI, 0.263-0.792; P < .005). CONCLUSION: Among elderly patients with colorectal cancer, PA and PG-SGA were prognosis factors. PA >5° was associated with best survival and PG-SGA C with worst survival.

The influence of nutritional status and disease on adiponectin and TNF-α; levels in colorectal cancer patients.

BACKGROUND: The aim of this study was to evaluate the association between adiponectin and tumor necrosis factor-α;(TNF-α;) serum levels in colorectal cancer (CRC) patients and compare these levels to clinical stage and nutritional status. METHODS: A total of 79 patients were enrolled in the study (39 with CRC and 40 in the control). Nutritional status was assessed by Patient-Generated Subjective Global Assessment (PG-SGA), body mass index (BMI), and phase angle (PhA). Adiponectin and TNF-α;serum concentrations were determined using an enzyme-linked immunosorbent assay. RESULTS: Serum adiponectin levels were higher among CRC patients (p = 0.001). TNF-α;serum levels were not significantly different between the groups, but patients with stage III or IV CRC had higher levels of TNF-α;than those with lower stage disease (p = 0.037). The three tools used for the assessment of nutritional status (BMI, PhA, and PG-SGA) demonstrated that patients with a more severe nutritional deficit had higher adipocytokine levels, although these differences were significant only to TNF- , when distributed PhA in tertiles. CONCLUSIONS: Adiponectin levels were higher among CRC patients. Although TNF-α;serum levels from CRC patients did not differ significantly to the control group, CRC patients with stage III or IV had higher levels compared to those with stage I and II tumors. Nutritional status, as determined by BMI, PhA, and PG-SGA, demonstrated that patients with a greatest nutritional deficit, had higher levels of adipocytokines; however, these differences were significant only for TNF-, when distributed PhA in tertiles.

ANTECEDENTES: El propósito de este estudio fue evaluar la asociación entre las concentraciones séricas de adiponectina y de factor de necrosis tumoral-(TNF-) en paciente con cáncer colorrectal (CCR) y comparar estas concentraciones con el estadio clínico y el estado nutritivo. MÉTODOS: Se reclutó a un total de 79 pacientes en el estudio (39 con CCR y 40 en el grupo control). Se evaluó el estado nutritivo mediante la Evaluación Global Subjetiva Generada por el Paciente (PG-SGA), el índice de masa corporal (IMC) y el ángulo de fase (AF). Se determinaron las concentraciones séricas de adiponectina y de TNF-mediante un inmunoensayo de absorción ligado a enzima. RESULTADOS: Las concentraciones séricas de adiponectina fueron superiores en los pacientes con CCR (p = 0,001). Las concentraciones séricas de TNF-no fueron significativamente distintas entre los grupos pero los pacientes con CC en estadios III o IV tuvieron mayores concentraciones de TNF-que aquellos con un menor estadio de la enfermedad (p = 0,037). Las tres herramientas empleadas para evaluar el estado nutritivo (IMC, AF y PG­SGA) demostraron que los pacientes con un déficit nutricional más pronunciado presentaban mayores concentraciones de adipocitocina, aunque algunas diferencias sólo fueron significativas para el TNF-cuanto se distribuyó el AF en terciles. CONCLUSIONES: Las concentraciones de adiponectina fueron superiores en pacientes con CCR. Aunque las concentraciones séricas de TNF-de los pacientes con CCR no diferían significativamente de las del grupo control, los pacientes con CCR en estadios III o IV tuvieron concentraciones superiores en comparación con aquellos con tumores en estadios I y II. El estado nutritivo, determinado por IMC, AF y PG-SGA, demostró que los pacientes con un mayor déficit nutricional tenían concentraciones superiores de adipocitocinas; sin embargo, estas diferencias sólo fueron significativas para el TNF-cuando el AF se distribuyó en terciles.

The influence of nutritional status and disease on adiponectin and TNF-ALFA levels in colorectal cancer patients / Influencia del estado nutritivo y la enfermedad sobre las concentraciones de adiponectina y TNF-ALPHA en pacientes con cáncer colorrectal

Background: The aim of this study was to evaluate the association between adiponectin and tumor necrosis factor-α (TNF-α) serum levels in colorectal cancer (CRC) patients and compare these levels to clinical stage and nutritional status. Methods: A total of 79 patients were enrolled in the study (39 with CRC and 40 in the control). Nutritional status was assessed by Patient-Generated Subjective Global Assessment (PG-SGA), body mass index (BMI), and phase angle (PhA). Adiponectin and TNF-α serum concentrations were determined using an enzyme-linked immunosorbent assay. Results: Serum adiponectin levels were higher among CRC patients (p = 0.001). TNF-α serum levels were not significantly different between the groups, but patients with stage III or IV CRC had higher levels of TNF-α than those with lower stage disease (p = 0.037). The three tools used for the assessment of nutritional status (BMI, PhA, and PG-SGA) demonstrated that patients with a more severe nutritional deficit had higher adipocytokine levels, although these differences were significant only to TNF- α, when distributed PhA in tertiles. Conclusions: Adiponectin levels were higher among CRC patients. Although TNF-α serum levels from CRC patients did not differ significantly to the control group, CRC patients with stage III or IV had higher levels compared to those with stage I and II tumors. Nutritional status, as determined by BMI, PhA, and PG-SGA, demonstrated that patients with a greatest nutritional deficit, had higher levels of adipocytokines; however, these differences were significant only for TNF-α, when distributed PhA in tertiles (AU)

Antecedentes: El propósito de este estudio fue evaluar la asociación entre las concentraciones séricas de adiponectina y de factor de necrosis tumoral-α (TNF-α) en paciente con cáncer colorrectal (CCR) y comparar estas concentraciones con el estadio clínico y el estado nutritivo. Métodos: Se reclutó a un total de 79 pacientes en el estudio (39 con CCR y 40 en el grupo control). Se evaluó el estado nutritivo mediante la Evaluación Global Subjetiva Generada por el Paciente (PG-SGA), el índice de masa corporal (IMC) y el ángulo de fase (AF). Se determinaron las concentraciones séricas de adiponectina y de TNF-α mediante un inmunoensayo de absorción ligado a enzima. Resultados: Las concentraciones séricas de adiponectina fueron superiores en los pacientes con CCR (p = 0,001). Las concentraciones séricas de TNF-α no fueron significativamente distintas entre los grupos pero los pacientes con CC en estadios III o IV tuvieron mayores concentraciones de TNF-α que aquellos con un menor estadio de la enfermedad (p = 0,037). Las tres herramientas empleadas para evaluar el estado nutritivo (IMC, AF y PG-SGA) demostraron que los pacientes con un déficit nutricional más pronunciado presentaban mayores concentraciones de adipocitocina, aunque algunas diferencias sólo fueron significativas para el TNF-α cuanto se distribuyó el AF en terciles. Conclusiones: Las concentraciones de adiponectina fueron superiores en pacientes con CCR. Aunque las concentraciones séricas de TNF-α de los pacientes con CCR no diferían significativamente de las del grupo control, los pacientes con CCR en estadios III o IV tuvieron concentraciones superiores en comparación con aquellos con tumores en estadios I y II. El estado nutritivo, determinado por IMC, AF y PG-SGA, demostró que los pacientes con un mayor déficit nutricional tenían concentraciones superiores de adipocitocinas; sin embargo, estas diferencias sólo fueron significativas para el TNF-α cuando el AF se distribuyó en terciles (AU)

What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer?

OBJECTIVE: To evaluate methods for the identification of nutrition risk and nutritional status in outpatients with colorectal (CRC) and gastric cancer (GC), and to compare the results to those obtained for patients already treated for these cancers. METHODS: A cross-sectional study was conducted on 137 patients: group 1 (n = 75) consisting of patients with GC or CRC, and group 2 (n = 62) consisting of patients after treatment of GC or CRC under follow up, who were tumor free for a period longer than 3 months. Nutritional status was assessed in these patients using objective methods [body mass index (BMI), phase angle, serum albumin]; nutritional screening tools [Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Nutritional Risk Index (NRI)], and subjective assessment [Patient-Generated Subjective Global Assessment (PGSGA)]. The sensitivity and specificity of each method was calculated in relation to the PG-SGA used as gold standard. RESULTS: One hundred thirty seven patients participated in the study. Stage IV cancer patients were more common in group 1. There was no difference in BMI between groups (p = 0.67). Analysis of the association between methods of assessing nutritional status and PG-SGA showed that the nutritional screening tools provided more significant results (p < 0.05) than the objective methods in the two groups. PG-SGA detected the highest proportion of undernourished patients in group 1. The nutritional screening tools MUST, NRI and MST were more sensitive than the objective methods. Phase angle measurement was the most sensitive objective method in group 1. CONCLUSION: The nutritional screening tools showed the best association with PG-SGA and were also more sensitive than the objective methods. The results suggest the combination of MUST and PG-SGA for patients with cancer before and after treatment.

Objetivo: Evaluar los métodos para la identificación del riesgo nutricional y del estado nutricional en pacientes ambulatorios con cáncer colorrectal (CCR) y cáncer gástrico (CG) y comparar los resultados con los obtenidos por los pacientes ya tratados por estos cánceres. Métodos: Se realizó un estudio transversal en 137 pacientes: el grupo 1 (n = 75) comprendía pacientes con CG o CCR y el grupo 2 (n = 62) comprendía pacientes tras el tratamiento de CG o CCR en seguimiento y que estaban libres de tumor por un periodo mayor de 3 meses. Se evaluó el estado nutricional de estos pacientes usando métodos objetivos [índice de masa corporal (IMC), el ángulo de fase y la albúmina sérica]; herramientas de cribado nutricional [Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Nutritional Risk Index (NRI)] y una evaluación subjetiva [Evaluación Global Subjetiva Generada por el Paciente (EGS-GP)]. La sensibilidad y especificidad de cada método se calcularon con relación a la EGS-GP, que se empleó como prueba de referencia. Resultados: 137 pacientes participaron en el estudio. Los pacientes con cáncer en estadio IV fueron más frecuentes en el grupo 1. No hubo diferencias en el IMC entre los grupos (p = 0,67). El análisis de la asociación entre los métodos de evaluación nutricional y la EGSGP mostró que las herramientas de cribado nutricional proporcionaban resultados más significativos (p < 0,05) que los métodos objetivos en ambos grupos. La EGS-GP detectó la mayor proporción de pacientes desnutridos en el grupo 1. Las herramientas de cribado nutricional MUST, NRI y MST eran más sensibles que los métodos objetivos. La medición del ángulo de fase fue el método objetivo más sensible en el grupo 1. Conclusión: Las herramientas de cribado nutricional mostraron la mejor asociación con la EGS-GP y también fueron más sensibles que los métodos objetivos. Los resultados sugieren el uso de la combinación de MUST y EGSGP en pacientes con cáncer antes y después del tratamiento.

What are the most effective methods for assessment of nutritional statusin outpatients with gastric and colorectal cancer? / ¿Cuáles son los métodos más eficaces de valoración del estado nutricional en pacientes ambulatorios con cáncer gástrico y colorrectal?

OBJECTIVE: To evaluate methods for the identification of nutrition risk and nutritional status in outpatients with colorectal (CRC) and gastric cancer (GC), and to compare the results to those obtained for patients already treated for these cancers.METHODS:A cross-sectional study was conducted on 137 patients: group 1 (n = 75) consisting of patients with GC or CRC, and group 2 (n = 62) consisting of patients after treatment of GC or CRC under follow up, who were tumor free for a period longer than 3 months. Nutritional status was assessed in these patients using objective methods [body mass index (BMI), phase angle, serum albumin]; nutritional screening tools [Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Nutritional Risk Index (NRI)], and subjective assessment [Patient-Generated Subjective Global Assessment (PGSGA)]. The sensitivity and specificity of each method was calculated in relation to the PG-SGA used as gold standard.RESULTS:One hundred thirty seven patients participated in the study. Stage IV cancer patients were more common in group 1. There was no difference in BMI between groups (p = 0.67). Analysis of the association between methods of assessing nutritional status and PG-SGA showed that the nutritional screening tools provided more significant results (p < 0.05) than the objective methods in the two groups. PG-SGA detected the highest proportion of undernourished patients in group 1. The nutritional screening tools MUST, NRI and MST were more sensitive than the objective methods. Phase angle measurement was the most sensitive objective method in group 1.CONCLUSION:The nutritional screening tools showed the best association with PG-SGA and were also more sensitive than the objective methods. The results suggest the combination of MUST and PG-SGA for patients with cancer before and after treatment (AU)

Objetivo: Evaluar los métodos para la identificación del riesgo nutricional y del estado nutricional en pacientes ambulatorios con cáncer colorrectal (CCR) y cáncer gástrico (CG) y comparar los resultados con los obtenidos por los pacientes ya tratados por estos cánceres. Métodos: Se realizó un estudio transversal en 137 pacientes: el grupo 1 (n = 75) comprendía pacientes con CG o CCR y el grupo 2 (n = 62) comprendía pacientes tras el tratamiento de CG o CCR en seguimiento y que estaban libres de tumor por un periodo mayor de 3 meses. Se evaluó el estado nutricional de estos pacientes usando métodos objetivos [índice de masa corporal (IMC), el ángulo de fase y la albúmina sérica]; herramientas de cribado nutricional [Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Nutritional Risk Index (NRI)] y una evaluación subjetiva [Evaluación Global Subjetiva Generada por el Paciente (EGS-GP)]. La sensibilidad y especificidad de cada método se calcularon con relación a la EGS-GP, que se empleó como prueba de referencia. Resultados: 137 pacientes participaron en el estudio. Los pacientes con cáncer en estadio IV fueron más frecuentes en el grupo 1. No hubo diferencias en el IMC entre los grupos (p = 0,67). El análisis de la asociación entre los métodos de evaluación nutricional y la EGSGP mostró que las herramientas de cribado nutricional proporcionaban resultados más significativos (p < 0,05) que los métodos objetivos en ambos grupos. La EGS-GP detectó (..) (AU)

Body mass index: different nutritional status according to WHO, OPAS and Lipschitz classifications in gastrointestinal cancer patients.

CONTEXT: The body mass index (BMI) is the most common marker used on diagnoses of the nutritional status. The great advantage of this index is the easy way to measure, the low cost, the good correlation with the fat mass and the association to morbidity and mortality. OBJECTIVE: To compare the BMI differences according to the WHO, OPAS and Lipschitz classification. METHODS: A prospective study on 352 patients with esophageal, gastric or colorectal cancer was done. The BMI was calculated and analyzed by the classification of WHO, Lipschitz and OPAS. RESULTS: The mean age was 62.1 ± 12.4 years and 59% of them had more than 59 years. The BMI had not difference between the genders in patients <59 years (P = 0.75), but over 59 years the BMI was higher in women (P<0.01). The percentage of undernourished was 7%, 18% and 21% (P<0.01) by WHO, Lipschitz and OPAS, respectively. The overweight/obesity was also different among the various classifications (P<0.01). CONCLUSIONS: Most of the patients with gastrointestinal cancer had more than 65 years. A different cut off must be used for this patients, because undernourished patients may be wrongly considered well nourished.

Body mass index: different nutritional status according to WHO, OPAS and Lipschitz classifications in gastrointestinal cancer patients / Índice de massa corpórea: estados nutricionais divergem de acordo com as classificações de WHO, OPAS e Lipschitz em pacientes com câncer gastrointestinal

CONTEXT: The body mass index (BMI) is the most common marker used on diagnoses of the nutritional status. The great advantage of this index is the easy way to measure, the low cost, the good correlation with the fat mass and the association to morbidity and mortality. OBJECTIVE: To compare the BMI differences according to the WHO, OPAS and Lipschitz classification. METHODS: A prospective study on 352 patients with esophageal, gastric or colorectal cancer was done. The BMI was calculated and analyzed by the classification of WHO, Lipschitz and OPAS. RESULTS: The mean age was 62.1 ± 12.4 years and 59% of them had more than 59 years. The BMI had not difference between the genders in patients <59 years (P = 0.75), but over 59 years the BMI was higher in women (P<0.01). The percentage of undernourished was 7%, 18% and 21% (P<0.01) by WHO, Lipschitz and OPAS, respectively. The overweight/obesity was also different among the various classifications (P<0.01). CONCLUSIONS: Most of the patients with gastrointestinal cancer had more than 65 years. A different cut off must be used for this patients, because undernourished patients may be wrongly considered well nourished.

CONTEXTO: O índice de massa corpórea (IMC) é largamente usado no diagnóstico do estado nutricional. As principais vantagens deste índice são a facilidade de obtenção, o baixo custo e a correlação com o índice de massa gorda. OBJETIVO: Comparar as diferenças entre o IMC de acordo com as classificações da OMS, OPAS e Lipschitz. MÉTODO: Foi realizado estudo prospectivo com 352 pacientes com câncer esofágico, gástrico ou colorretal. O IMC foi calculado e analisado pelas classificações da OMS, de Lipschitz e da OPAS. RESULTADOS: A média de idade foi de 62,1 ± 12,4 anos e 59% dos pacientes tinham mais que 59 anos. O IMC não variou entre os sexos nos pacientes com idade < 59 anos (P = 0,75), mas após os 59 anos o IMC foi maior entre as mulheres (P<0,01). O percentual de desnutridos foi de 7%, 18% e 21% (P<0,01) segundo as classificações da OMS, Lipschitz e OPAS, respectivamente. O sobrepeso/obesidade também diferiu entre as várias classificações (P<0,01). CONCLUSÕES: Os pacientes com câncer gastrointestinal têm com frequência idade superior a 65 anos. Um diferente nível de corte deve ser usado para estes pacientes porque os desnutridos podem ser erroneamente considerados bem nutridos.

Abordagem dos efeitos colaterais da cisplatina no estado nutricional dos pacientes com carcinoma de cabeça e pescoço / Approach the side effects of cisplatin on the nutritional status of patients with head and neck carcinoma / Enfoque de los efectos secundarios del cisplatino en el estado nutricional de los pacientes con carcinoma de cabeza y cuello

Introdução: A tendência dos pacientes com carcinoma da cabeça e pescoço (CCP) é cursar com desnutrição e caquexia. Objetivo: Avaliar o estado nutricional (EN) do paciente com CCP antes e durante a quimioterapia com o uso da cisplatina no ambulatório de quimioterapia de um hospital público de São Paulo. Método: Por meio da elaboração de um questionário de efeitos colaterais (DEC) as reações foram avaliadas juntamente com a avaliação antropométrica. Resultados: Apesar da cisplatina, 100% dos pacientes não apresentaram emese, observou-se que 83% faziam radioterapia e quimioterapia associadas, sendo que 50% destes haviam feito cirurgia. Conclusão: Os danos provocados pela cisplatina são menores do que o diagnóstico tardio, que é o verdadeiro responsável pelo prognóstico reservado do paciente de CCP, pois, além de limitar a qualidade de vida, eleva muitos os custos do tratamento.

Introduction: The tendency of patients with carcinoma of the head and neck (CCP) is present with malnutrition and cachexia. Objective: To evaluate the nutritional status (EN) of patients with PBC before and during chemotherapy using cisplatin chemotherapy in the outpatient clinic of a public hospital in São Paulo. Method: Through the development of a questionnaire on side effects (DEC) reactions were evaluated with anthropometric measurements. Results: Although cisplatin, 100% of patients had no emesis was observed that 83% were associated with radiotherapy and chemotherapy, and 50% of these had surgery done. Conclusion: The damage caused by cisplatin are smaller than late diagnosis, which is the true responsible for the prognosis of PBC patients, because in addition to limiting the quality of life raises many of the costs of treatment.

Introducción: La tendencia de los pacientes con carcinoma de cabeza y cuello (CCP) se presenta con la desnutrición y caquexia. Objetivo: Evaluar el estado nutricional (EN) de los pacientes con PBC antes y durante la quimioterapia con cisplatino en la clínica ambulatoria de un hospital público de São Paulo. Método: Mediante el desarrollo de un cuestionario sobre los efectos secundarios (DEC), las reacciones fueron evaluados con las medidas antropométricas. Resultados: Aunque el cisplatino, el 100% de los pacientes no emesis se observó que 83% estaban asociados con la radioterapia y la quimioterapia, y hecho el 50% de estos tenían la cirugía. Conclusión: Los daños causados ​​por el cisplatino es menor que el diagnóstico tardío, que es el responsable de verdad para el pronóstico de los pacientes con CBP, ya que además de limitar la calidad de vida plantea muchos de los costos del tratamiento.