Effects of Fasting on Chemotherapy Treatment Response: A Systematic Review of Current Evidence and Suggestions for the Design of Future Clinical Trials.

Fasting associated with chemotherapy could improve the efficacy of anticancer treatments without increasing their adverse effects. We conducted a systematic review following the PRISMA Statement to summarize the evidence on the effects of fasting on treatment response of adults undergoing chemotherapy and make suggestions for the design of future clinical trials The search was performed on CENTRAL, PubMed/MEDLINE, LILACS and Embase. Randomized and non-randomized clinical trials evaluating the effects of fasting (above 12 h, at anytime) on treatment response of adult cancer patients undergoing chemotherapy were included. The risk of bias assessment was conducted in accordance with the Cochrane Handbook. Literature search retrieved 1393 citations and three studies were included in the review. All studies had as an intervention fasting of at least 24 h, before chemotherapy. Two studies showed that immediately after chemotherapy, damage to healthy cells was increased, however after 48 and 72 h, of fasting there was a decrease on damage magnitude. There was no difference in chemotherapy-related adverse events between intervention and control groups. All studies presented two or more criteria with a high risk of bias. Fasting of at least 24 h, appears to be safe and showed some beneficial effects on chemotherapy toxicity, that could be further investigated, however studies presented heterogeneous samples and protocols. We highlight the need and provide recommendations for well-designed randomized clinical trials that evaluate the effect of fasting on chemotherapy-related adverse events. This systematic review was registered on PROSPERO as CRD42019120071.

Use of nutritional food labels and consumers confidence in label information / Uso da rotulagem nutricional e percepção sobre a confiabilidade das informações por consumidores

ABSTRACT Objective This investigation evaluated the use of food labels and consumers' perception of the reliability of food labels nutritional information. Methods This is a transversal exploratory quantitative investigation, carried out in Curitiba, Brazil. A total of 536 students from a public institution participated in the survey answering a structured questionnaire. Descriptive analyses, Chi-Square test and Fisher's exact test were performed considering a significance level of 5%. Results The participants' mean age was 21.11±2.83 years, and 59.3% were female. It was noticed that 41.6% of consumers used the nutritional information sometimes and 14.7% always, mainly because they liked to know what they were buying and consuming (35.8%). Lack of patience (29.5%) and concern about the composition of the food purchased (34.2%) were the main reasons for not using the information provided. The most commonly used nutrition claim was "trans fat-free" (42.5%) and the type of food in which nutrition labeling was used most was milk and dairy products (42.0%). Frequent use of nutritional information was higher among women (p<0.01) and among those who practice physical activity (p=0.04). Many individuals relied on food labels nutritional information (61.9%), but out of these, 43.6% did not use that information at the time of purchase. There was no difference between respondents' confidence in the information, sociodemographic and health data. Conclusion Many people still do not use the label nutrition information. Efforts should be made to change this scenario. Changes in nutrition labeling can help modify this situation, with the use of clearer label information, more easily understood, that does not raise any doubts in the consumers' mind.

RESUMO Objetivo Este estudo avaliou o uso da rotulagem nutricional e a percepção sobre a confiabilidade das informações por consumidores. Métodos Pesquisa transversal, exploratória e de abordagem quantitativa, realizada no município de Curitiba, Brasil. Participaram 536 estudantes, de uma instituição pública, respondendo um questionário estruturado. Foram realizadas análises descritivas, teste Qui-Quadrado e teste exato de Fisher, considerando nível de significância de 5%. Resultados A idade média dos participantes foi 21,11±2,83 anos, sendo 59,3% do sexo feminino. Quanto ao uso das informações nutricionais, 41,6% utilizavam às vezes e 14,7% sempre, principalmente porque gostavam de saber o que estavam comprando e consumindo (35,8%). A falta de paciência (29,5%) e de preocupação com a composição do alimento comprado (34,2%) foram os principais motivos pelos quais não utilizarem as informações. A alegação nutricional mais utilizada foi "sem gordura trans" (42,5%) e o tipo de alimento em que mais se utilizou a rotulagem nutricional foi leite e derivados (42,0%). O uso frequente das informações nutricionais foi maior entre as mulheres (p<0,01) e os praticantes de atividade física (p=0,04). Muitos indivíduos confiavam nas informações presentes nos rótulos dos alimentos (61,9%), porém, destes, 43,6% não as utilizavam no momento da compra. Não foram observadas diferenças entre a confiança das informações, os dados sociodemográficos ou de saúde dos entrevistados. Conclusão Muitas pessoas ainda não usam as informações nutricionais, sendo necessário esforços para mudar este panorama. Alterações na rotulagem nutricional podem mudar este processo, com o uso de informações mais claras, de fácil entendimento, que não gerem dúvida ao consumidor.