Effect of Creatine Supplementation on Body Composition and Malnutrition-Inflammation Score in Hemodialysis Patients: An Exploratory 1-Year, Balanced, Double-Blind Design.

Hemodialysis has a detrimental effect on fat-free mass (FFM) and muscle strength over time. Thus, we aimed to evaluate the effect of creatine supplementation on the body composition and Malnutrition-Inflammation Score (MIS) in patients with chronic kidney disease (CKD) undergoing hemodialysis. An exploratory 1-year balanced, placebo-controlled, and double-blind design was conducted with hemodialysis patients (≥18 years). The creatine group (CG) received 5 g of creatine monohydrate and 5 g of maltodextrin per day and the placebo group (PG) received 10 g of maltodextrin per day. MIS and body composition were analyzed at three time points: pre, intermediate (after 6 months), and post (after 12 months). After 6 months, 60% of patients on creatine experienced an increase in FFM compared to a 36.8% increase for those on placebo. Moreover, 65% of patients on creatine increased their skeletal muscle mass index (SMMI) compared to only 15.8% for those on placebo. Creatine increased intracellular water (ICW) in 60% of patients. MIS did not change after the intervention. In the CG, there was an increase in body weight (p = 0.018), FFM (p = 0.010), SMMI (p = 0.022). CG also increased total body water (pre 35.4 L, post 36.1 L; p = 0.008), mainly due to ICW (pre 20.2 L, intermediate 20.7 L, post 21.0 L; p = 0.016). Long-term creatine supplementation in hemodialysis patients did not attenuate the MIS, but enhanced FFM and SMMI, which was likely triggered by an increase in ICW.

A Randomized Controlled Trial on the Effects of Leucine-Supplement Combined with Nutritional Counseling on Body Composition in Mix Cancer Older Men.

BACKGROUND: Malnutrition and metabolic alterations of cancer cachexia are often associated with negative weight loss and muscle mass wasting. In this sense, protein supplementation can be a strategy to help counteract the loss and/or maintenance of mass in these patients. The aim of this study was to evaluate the effect of leucine supplementation on body composition in outpatients with gastrointestinal tract cancer. METHODS: It was a randomized, blinded, controlled, parallel trial, performed in male patients with a cancer diagnosis of the gastrointestinal tract and appendix organs undergoing chemotherapy. All the patients were allocated to one of the protocol groups: L-leucine supplement or the control group, during 8 weeks of intervention. We evaluated the body composition through bioelectrical impedance analysis, the cancer cachexia classification, and the diet intake before and after the intervention protocol. The intention-to-treat approach was performed to predict the missing values for all patients who provide any observation data. RESULTS: The patients were an average age of 65.11 ± 7.50 years old. In the body composition analysis with patients who finished all the supplementation, we observed a significant gain in body weight (61.79.9 ± 9.02 versus 64.06 ± 9.45, p = 0.01), ASMM (7.64 ± 1.24 versus 7.81 ± 1.20, p = 0.02) in the Leucine group, whereas patients in the control did not present significant variation in these parameters. There was no significant intergroup difference. While in the analysis included the patients with intention-to-treat, we found a significant increase in body weight (p = 0.01), BMI (p = 0.01), FFM (p = 0.03), and ASMM (p = 0.01) in the Leucine group. No significant intergroup differences. These results also similar among cachectic patients. CONCLUSION: A balanced diet enriched with free-Leucine supplementation was able to promotes gains in body weight and lean mass in older men diagnosticated with gastrointestinal and appendix organs of digestion cancer after 8 weeks. However, the fact that most men are non-cachectic or pre-cachectic is not clear if the increase in muscle mass was due to a high intake of leucine, since no difference between groups was detected. Moreover, we know that benefits on body composition are due to adequate calorie and macronutrients consumption and that balanced feeding according to nutrition Guidelines seems crucial and must be advised during the oncological treatment.

Amino acids and cancer: potential for therapies?

PURPOSE OF REVIEW: Cancer patients may have a variety of disorders associated with systemic inflammation caused by disease progression. Consequently, we have protein hypercatabolism. In view of this, protein and amino acid adequacy should be considered in relation to nutritional behavior. Therefore, this review aims to evaluate the influence of protein and amino acids in the nutritional therapy of cancer. RECENT FINDINGS: Diets with adequate protein levels appear to be beneficial in the treatment of cancer; guidelines suggest consumption of greater than 1.0-1.5 g/kg body weight/day. In patients diagnosed with malnutrition, sarcopenia, or cachexia, it is recommended to use the maximum amount of protein (1.5 g/kg of weight/day) to adapt the diet. In addition, based on the evidence found, there is no consensus on the dose and effects in cancer patients of amino acids such as branched-chain amino acids, glutamine, arginine, and creatine. SUMMARY: When evaluating the components of the diet of cancer patients, the protein recommendation should be greater than 1.0-1.5 g/kg of weight/day, with a distribution between animal and vegetable proteins. We found little evidence demonstrating clinical benefits regarding individual or combined amino acid supplementation. Still, it is unclear how the use, dose, and specificity for different types of cancer should be prescribed or at what stage of treatment amino acids should be prescribed.

Effects of Juçara (Euterpe edulis Martius) on Health: An Overview of Clinical and Experimental Studies and Call for Action.

BACKGROUND AND AIMS: Juçara is a fruit of ecological and nutritional importance. Its fruits represent an option for the sustainable use of the plant due to its vulnerability to extinction. Thus, the aim of this review was to analyze clinical and experimental studies and highlight the literature gaps regarding the effects of supplementation with Juçara on health. METHODS: For this scoping review, we consulted the Medline (PubMed), Science Direct, and Scopus databases in March, April, and May 2022. Experimental studies and clinical trials published in the last ten years (2012-2022) were analyzed. Data were synthesized and reported. RESULTS: A total of 27 studies were included, 18 of which were experimental studies. Of these, 33% evaluated inflammatory markers associated with fat accumulation. Most of these studies (83%) used pulp in lyophilized form, and the others (17%) involved juçara extract mixed in water. In addition, 78% of the studies showed positive results with respect to the lipid profile, reduction of oncological lesions, inflammation, microbiota modulation, and improvement in obesity and glycemia-related metabolic complications. Nine clinical trials with results similar to those of experimental trials were found. The majority (56%) were chronic (four to six weeks into the intervention), and 44% were acute. Three offered juçara supplementation in the form of juice, four used freeze-dried pulp, two used fresh pulp, and one used a 9% dilution. The dose was fixed at 5 g, but the dilution ranged from 200 to 450 mL. These trials assessed mainly healthy, physically active, and obese individual adults (19-56 years old), and cardioprotective and anti-inflammatory effects, as well as improvement in the lipid profile and prebiotic potential, were observed. CONCLUSION: Juçara supplementation showed promising results with respect to its effect on health. However, further studies are needed to clarify these possible effects on health and their mechanisms of action.

C-reactive protein, but not neutrophil-lymphocyte ratio, is inversely associated with muscle strength only in older men: NHANES 1999-2002.

To evaluate the association of inflammation (C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels) with muscle strength in older adults. We also aimed to evaluate whether these associations are sex-specific. A cross-sectional study was performed with data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002. A total of 2387 individuals over 50 years of both sexes were evaluated, according to the eligibility criteria for the strength test. Muscle strength was measured by Kinetic Communicator isokinetic dynamometer; while the NLR was obtained by the ratio of the total neutrophil for lymphocyte count and CRP was quantified by latex nephelometry. Linear regression analyses, crude and adjusted for confounders, were used to estimate the coefficients and 95 % confidence intervals for peak strength (muscle strength) by tertiles of NLR and CRP. There was no association between NLR and peak strength for both sexes. CRP levels were inversely associated with peak force in men [2nd tertile ß = -3.33 (-15.92; 9.25); 3rd tertile ß = -24.69 (-41.18; -8.20), p for trend = 0.005], but not in women [2nd tertile ß = -3.22 (-15.00; 8.56); 3rd tertile ß = -9.23 (-28.40; -9.94), p for trend = 0.332]. In conclusion, NLR levels were not associated with muscle strength in both sexes. CRP levels were inversely associated with muscle strength in older men, but not in women, suggesting that the association between inflammation and muscle strength in older adults can be sex-specific.

Effects of whey protein supplementation on adiposity, body weight, and glycemic parameters: A synthesis of evidence.

AIMS: The aim of this review was to analyze the evidence of whey protein supplementation on body weight, fat mass, lean mass and glycemic parameters in subjects with overweight or type 2 diabetes mellitus (T2DM) undergoing calorie restriction or with ad libitum intake. DATA SYNTHESIS: Overweight and obesity are considered risk factors for the development of chronic noncommunicable diseases such as T2DM. Calorie restriction is a dietary therapy that reduces weight and fat mass, promotes the improvement of glycemic parameters, and decreases muscle mass. The maintenance of muscle mass during weight loss is necessary in view of its implication in preventing chronic diseases and improving functional capacity and quality of life. The effects of increased protein consumption on attenuating muscle loss and reducing body fat during calorie restriction or ad libitum intake in overweight individuals are discussed. Some studies have demonstrated the positive effects of whey protein supplementation on improving satiety and postprandial glycemic control in short term; however, it remains unclear whether long-term whey protein supplementation can positively affect glycemic parameters. CONCLUSIONS: Although whey protein is considered to have a high nutritional quality, its effects in the treatment of overweight, obese individuals and those with T2DM undergoing calorie restriction or ad libitum intake are still inconclusive.

Assessment of Nutritional Risk at ICU Admission and Mortality in Patients with Suspected COVID-19.

Background/Objectives: The association between the nutritional risk and mortality in Brazilians with COVID-19 is poorly documented. Therefore, this study, for the first time, aimed at investigating the length of stay in the ICU and the chance of dying in patients with suspected COVID-19, without and with nutritional risk. Subjects/Methods: This retrospective monocentric study enrolled adult, COVID-19-positive patients that were admitted to the ICU at a university hospital. Biochemical analysis and clinical data were collected from medical records and the nutritional risk was assessed according to the Modified-Nutrition Risk in the Critically Ill (mNUTRIC) score. The Cox model was used to assess the chance of mortality in the patients with and without nutritional risk. Results: Out of 71 patients, 63.3% were male and 52% were older (≥60 years). Although no differences were found between groups for the length of stay in ICU, C-reactive protein, alanine aminotransferase and aspartate aminotransferase concentrations, the mNUTRIC ≥ 5 group had higher D-dimer than the mNUTRIC < 5 group. Regarding ICU mortality, most patients (69.5%) in the mNUTRI ≥ 5 group died while in the mNUTRIC < 5 group 33.3% died (p = 0.0001). In addition, patients with mNUTRIC ≥ 5 had (HR: 2.04 [95% CI: 1.02−4.09], p = 0.04) a more likely chance of dying than patients in the mNUTRIC < 5 group, even that adjusted by BMI and D-dimer concentrations (HR: 2.18 [95% CI: 1.04−4.56], p = 0.03). Conclusion: In patients with COVID-19, an mNUTRIC ≥ 5 score at admission leads to a more likely chance of death even after controlling for confounding variables.

MSRA has low concordance with skeletal muscle mass index in mixed cancer patients: A preliminary and feasibility study.

BACKGROUND AND AIMS: Currently, there are no studies evaluating the agreement between the Mini Sarcopenia Risk Assessment (MSRA) questionnaire and skeletal muscle mass index (SMI) in cancer patients. Thus, this study aimed to evaluate the agreement of the MSRA questionnaire with SMI in cancer patients. METHODS: Cross-sectional study with 132 unselected cancer patients. The risk of sarcopenia was determined using the MSRA of 5 and 7 questions. Men and women were divided into subgroups with and without risk of sarcopenia, according to MSRA. SMI was assessed by the muscle mass divided by heigh using the Lee's formula. The ROC curve was used to estimate sensitivity, specificity, and area under the curve between MSRA 5 and 7 versus SMI. The Kappa index was used to assess the agreement between them. RESULTS: MSRA 5 and 7 showed better sensitivity values in women when compared to men. However, better specificity values were obtained in men when compared to women. Although, there was better agreement between MSRA 5/7 and SMI in women, kappa values indicated low agreement in both sexes (MSRA 5: women: 0.36 vs. men: 0.07 and MSRA 7: women: 0.22 vs. men: - 0.07). CONCLUSION: MSRA 5 and 7 questionnaires has low agreement with SMI to identify risk of sarcopenia in unselected cancer patients.

Neutrophil-to-lymphocyte ratio is not associated with risk of sarcopenia in elderly COVID-19 patients.

BACKGROUND: To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. METHODS: A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. RESULTS: Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1-3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9-6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5-20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). CONCLUSION: In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR.

Neutrophil-to-lymphocyte ratio is not associated with risk of sarcopenia in elderly COVID-19 patients / La proporción de neutrófilos a linfocitos no está asociada con el riesgo de sarcopenia en pacientes ancianos con COVID-19

Background: To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. Methods: A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. Results: Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1–3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9–6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5–20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). Conclusion: In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR. (AU)

Objetivo: Evaluar la existencia de asociación entre la relación neutrófilos a linfocitos (RNL) y el riesgo de sarcopenia en pacientes con COVID-19. Métodos: Se realizó un estudio transversal retrospectivo en un hospital universitario con pacientes con infección activa por COVID-19 ingresados en sala de enfermería o unidad de cuidados intensivos (UCI) entre septiembre a diciembre de 2020. El riesgo de sarcopenia se evaluó utilizando: fuerza, ayuda para caminar, levantarse de una silla, subir escaleras y caídas (SARC-F). Los análisis bioquímicos se evaluaron mediante circulación de proteína C reactiva, dímero D, neutrófilos, recuento de linfocitos y RNL. Sesenta y ocho pacientes fueron evaluados y divididos en terciles de valores de RNL y la asociación entre RNL y el riesgo de sarcopenia se evaluó mediante análisis de regresión lineal; p<0,05 se consideró significativo. Resultados: Sesenta y ocho pacientes fueron evaluados y divididos en terciles de RNL, siendo el primero (hombres=52,2%; 71,1±9,0años; RNL: 1,1-3,85), el segundo (mujeres=78,3%; 73,2±9,1años; RNL: 3,9-6,0) y el tercero (hombres=72,7%; 71,7±10,4años; RNL: 6,5-20,0). Hubo diferencia entre los terciles con relación al primero en los parámetros bioquímicos de recuento de neutrófilos totales (p=0,001), proteínaC reactiva (p=0,012) y dímeroD (p=0,012). Sin embargo, no se encontró diferencia en el análisis de regresión lineal entre terciles de RNL y SARC-F, si en muestra total (p=0,054) o dividida por sexo, si hombres (p=0,369) o mujeres (p=0,064). Conclusiones: En pacientes ancianos hospitalizados con COVID-19 no encontramos asociación entre el riesgo de sarcopenia y RNL. (AU)

Krill Oil Supplementation Does Not Change Waist Circumference and Sagittal Abdominal Diameter in Overweight Women: A Pilot Balanced, Double-Blind, and Placebo-Controlled Clinical Trial.

An excess of body fat is one of the biggest public health concerns in the world, due to its relationship with the emergence of other health problems. Evidence suggests that supplementation with long-chain polyunsaturated fatty acids (omega-3) promotes increased lipolysis and the reduction of body mass. Likewise, this clinical trial aimed to evaluate the effects of supplementation with krill oil on waist circumference and sagittal abdominal diameter in overweight women. This pilot, balanced, double-blind, and placebo-controlled study was carried out with 26 women between 20 and 59 years old, with a body mass index >25 kg/m2. The participants were divided into the control (CG) (n = 15, 3 g/daily of mineral oil) and krill oil (GK) (n = 16, 3 g/daily of krill oil) groups, and received the supplementation for eight weeks. Food intake variables were obtained using a 24 h food recall. Anthropometric measurements (body mass, body mass index, waist circumference, and sagittal abdominal diameter) and handgrip strength were obtained. After the intervention, no changes were found for the anthropometric and handgrip strength variables (p > 0.05). Regarding food intake, differences were found for carbohydrate (p = 0.040) and polyunsaturated (p = 0.006) fatty acids, with a reduction in the control group and an increase in krill oil. In conclusion, supplementation with krill oil did not reduce the waist circumference and sagittal abdominal diameter. Therefore, more long-term studies with a larger sample size are necessary to evaluate the possible benefits of krill oil supplementation in overweight women.

Effect of caffeine on mitochondrial biogenesis in the skeletal muscle - A narrative review.

Caffeine is one of the most widely used substances as recreational drug for performance-enhancement in sport, underpinned by a strong evidence base. Although the effects of caffeine are widely investigated within the scope of performance physiology, the molecular effects of caffeine within skeletal muscle remain unclear. Evidence from in vitro and in vivo models suggest that caffeine regulates the glucose metabolism in the skeletal muscle. Moreover, caffeine seems to stimulate CaMKII, PPARδ/ß, AMPK and PGC1α, classical markers of exercise-adaptations, including mitochondrial biogenesis and mitochondrial content. This review summarizes evidence to suggest caffeine-effects within skeletal muscle fibers, focusing on the putative role of caffeine on mitochondrial biogenesis to explore whether caffeine supplementation might be a strategy to enhance mitochondrial biogenesis.

Acute Supplementation of Yerba Mate Extract Did Not Change Muscle Strength in Physically Active Men Following the Strength Muscle Test: A Pilot Clinical Trial.

Polyphenol supplementation may be useful during exercise. However, there is no evidence indicating yerba mate (YM) increases muscle strength. Thus, this study sought to evaluate the effect of acute YM supplementation on muscle strength following the strength test. In a crossover and pilot clinical trial, ten men were divided into two groups, receiving either supplementation with YM or a placebo. One hour after consumption of beverages, the participants were submitted to tests of one-repetition maximum (1 RM) on the bench press and leg press. The average age of the participants was 25.5 ± 4.1 years, and the average body mass index was 24.4 ± 2.9 kg/m². YM was not able to increase muscle strength when compared to the placebo in either the 1RM leg press exercise (YM: 225 ± 56.2 kg, vs. placebo: 223 ± 64.3 kg, p = 0.743, Cohen's d = 0.03) or in the 1 RM bench press exercise (YM: 59.5 ± 20.7 kg vs. placebo: 59.5 ± 21.5 kg, p = 1.000, Cohen's d = 0.) In conclusion, acute intake of YM did not change muscle strength in physically active men.

Neutrophil-lymphocyte Ratio and C-Reactive Protein Levels are not Associated with Strength, Muscle Mass, and Functional Capacity in Kidney Transplant Patients.

Chronic inflammation has been associated with components of sarcopenia; however, these associations are unknown in kidney transplant patients (KTPs). The aim of this study was to associate neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) with strength, muscle mass, and functional capacity in KTPs. A cross-sectional study evaluating 108 KTPs was performed. Strength was evaluated by handgrip strength and five-times-sit-to-stand test (5STS), and appendicular skeletal muscle mass (ASM) was estimated by bioelectrical impedance analysis. The ASM index (ASMI) was calculated using the ASM (kg)/height (m2). Functional capacity was assessed by the 4-m gait speed test and short physical performance battery (SPPB). The electrochemiluminescence method was used for analyzing CRP levels, and the cytometric method XN-3000 Sysmex was used for obtaining leukogram values to calculate the NLR. Linear regression analysis was used to assess the association between systemic inflammation and sarcopenia components, adjusting for confounders. NLR and CRP levels were not associated with handgrip strength (ß = - 0.231, p = 0.389; ß = - 0.291, p = 0.577), 5STS (ß = - 0.114, p = 0.288; ß = - 0.202, p = 0.334), ASM (ß = - 0.027, p = 0.813; ß = 0.062, p = 0.788), ASMI (ß = - 0.036, p = 0.242; ß = 0.040, p = 0.505), 4-m gait speed (ß = 0.013, p = 0.082; ß = 0.004, p = 0.769), and SPPB (ß = 0.076, p = 0.170; ß = 0.152, p = 0.157), respectively. In conclusion, NLR and CRP levels were not associated with muscle mass, strength, and functional capacity in KTPs.

High Charlson comorbidity index value is not associated with muscle strength in unselected cancer patients.

BACKGROUND AND AIMS: Cancer patients usually lose muscle mass and strength during progression of tumor or treatment. One of the simplest, easiest, and cheapest methods to assess muscle strength is by handgrip strength (HGS), which has been widely used during clinical practice. However, it is not established whether the presence of comorbidities, when assessed by the Charlson Comorbidities Index (CCI), is associated with lower HGS in cancer patients. Thus, this study sought to verify if low HGS is associated with highest CCI in cancer patients. METHODS: Cross-sectional study enrolled 167 cancer patients of both sexes diagnosed with cancer. The sample was divided into two groups, CCI <5: low comorbidity or CCI ≥5: high comorbidity number. Muscle strength was assessed by digital dynamometer. Student t and Chi-square tests were performed to analyze the differences between groups and logistic regression was used to verify the association between CCI and HGS, in the crude (model 1) and adjusted for confounding variables (model 2). RESULTS: Patients from the CCI ≥5 group were older (65.0 ± 11.3 vs. 55.3 ± 13.1; p < 0.05), hospitalized (p < 0.05), and the gastrointestinal and accessory organs of digestion tumors were more prevalent when compared to the CCI <5 group. The logistic regression in the crude model showed a negative association between CCI and HGS (OR: 0.94 [95%CI: 0.90-0.98], p = 0.006), however, after adjusting for confounders variables this association was lost (OR: 0.98 [95%CI: 0.94-1.03], p = 0.58). CONCLUSION: In patients with cancer, there is no independent association between HGS and CCI.

Charlson comorbidity index is not associated with neutrophil-lymphocytes ratio in unselected hospitalized cancer patients: A cross-sectional study.

This study sought to evaluate the association between Charlson Comorbidity Index (CCI) and neutrophil lymphocyte ratio (NLR). Cross-sectional study evaluated 134 patients of both sexes diagnosed with several types of cancer. NLR was calculated by dividing the absolute value of neutrophils by lymphocytes count, and the CCI questionnaire was used to assess the risk of comorbidities and mortality. The sample was dichotomized in CCI < 5 or ≥5. Student's t-test and Chi-square test were calculated to analyze the differences. The association between CCI and NLR was investigated by logistic regression analysis, performed with model 1 (crude) and model 2 (adjusted). The patients in the CCI ≥ 5 group were older, with higher neutrophil levels and prevalence of solid tumor type. There was no difference between groups regarding type of treatment, body weight, body mass index, performance status, lymphocyte count and NLR. There was no association between CCI and NLR, in both crude model (OR: 1.04 [95% CI: 0.99-1.09], p = 0.09), as well as adjusted for sex, age, physical activity, alcohol consumption, smoking habit, type of treatment, and performance status (OR: 1.04 [95% CI:0.97-1.12], p = 0.19). In hospitalized unselected cancer patients, despite of small sample size and design of study, we showed the presence of comorbidities is not related to the NLR.

Acute supplementation with whey protein or collagen does not alter appetite in healthy women: a randomised double-blind and crossover pilot study.

Protein quality has an important role in increasing satiety. Evidence suggests that whey protein (WP) provides satiety via gastrointestinal hormone secretion. Hydrolysed collagen supplementation can also stimulate the production of incretins and influence satiety and food intake. Thus, we sought to compare the effect of acute supplementation of WP or hydrolysed collagen on post-intervention appetite and energy consumption. This was a randomised, double-blind, crossover pilot study with ten healthy adult women (22·4 years/old) who were submitted to acute intake (single dose) of a beverage containing WP (40 g of concentrated WP) or hydrolysed collagen (40 g). Subjective appetite ratings (feelings of hunger, desire to eat and full stomach) were measured using the Visual Analog Scale (VAS), energy intake was quantified by ad libitum cheese bread consumption 2 hours after supplementation and blood was collected for leptin and glucose determination. There was no difference between treatment groups in the perception of hunger (P = 0·983), desire to eat (P = 0·326), full stomach feeling (P = 0·567) or food consumption (P = 0·168). Leptin concentrations at 60 min post supplementation were higher when subjects received hydrolysed collagen (P = 0·006). Acute supplementation with hydrolysed collagen increased leptin levels in comparison with WP, but had no effect on appetite measured by feelings of hunger, desire to eat, full stomach feeling (VAS) or energy consumption.