Omega-3 supplementation effects on cardiovascular risk and inflammatory profile in chronic kidney disease patients in hemodialysis treatment: An intervention study.

BACKGROUND AND AIMS: Chronic Kidney Disease (CKD) is characterized by slow, progressive, and irreversible kidney function loss and the disease itself and hemodialysis treatment can predispose an inflammatory state that increased cardiovascular complications, being one of major mortality causes in kidney patients. The study purpose was to evaluate nutritional profile and impacts of w-3 fatty acid supplementation on inflammatory parameters and cardiovascular events risk in patients with CKD undergoing hemodialysis treatment. METHODS: Non-randomized clinical trial, patients with CKD were randomly grouped into a control (n = 29) and supplemented (n = 30) group. Supplemented group patients were instructed to consume two w-3 capsules a day (2g/day) for 8 weeks for further analysis of pre- and post-supplementation C-reactive protein (CRP) and other blood parameters. To nutritional status assessment, anthropometric and bioelectrical impedance data were measured, carried out close to supplementation start. RESULTS: 59 patients were evaluated, 49.1% (n = 29) were overweight and 70.7% (n = 41) had high percentage of body fat. Comparing control versus supplemented groups after supplementation serum CRP levels have reduced, no differences were observed (p = 0.716) nevertheless there was reduction in cardiovascular events risk according to C-reactive protein classification (p = 0.004). Ferritin levels have improved in all groups. Changes in the levels of other biochemical markers hemoglobin, hematocrit, urea, creatinine, and Kt/v have happened. However, group that received w-3 showed an improvement in serum albumin levels (p = 0.014), in addition to demonstrating greater adequacy classification of albumin after supplementation (p = 0.022). CONCLUSION: Omega-3 supplementation have caused an improvement in albumin plasma levels suitableness in Chronic Kidney Disease patients, however, it did not demonstrate statistical effects to reducing CRP levels, although this helped to reduce cardiovascular risk.

COVID-19 related to sarcopenia: Current perspectives on etiology, clinical implications, and nutritional rehabilitation

Sarcopenia is a progressive skeletal muscle disorder characterized by reduced strength and quality. Pathophysiological mechanisms, clinical aspects, and nutritional points were related to sarcopenia in COVID-19 found in skeletal muscle during and after the disease course, which corroborated the development of adverse events. Declining physical activity, insufficient protein intake, and worsened proinflammatory response have been shown to have negative consequences on muscle protein synthesis, potentiating the risk of acute sarcopenia. Obesity sarcopenia has also been shown to worsen the prognosis of patients with SARS-CoV-2. Nutritional rehabilitation is used to prevent or minimize the development of acute sarcopenia. Dietary recommendations include increased energy supply and protein intake of 1.2 to 2.0 g/kg of body weight. Evidence suggests that aging with sedentary behaviors, pathophysiological changes, and inflammation alter body composition. In addition, nutritional deficiencies are predictors and aggravators of acute sarcopenia in COVID-19.

Sarcopenia é um distúrbio progressivo do músculo esquelético caracterizado pela redução da força e qualidade. Mecanismos fisiopatológicos, aspectos clínicos e nutricionais foram relacionados à sarcopenia no COVID-19 encontrada no músculo esquelético, durante e após o curso da doença, o que corroborou para o desenvolvimento de eventos adversos. O declínio da atividade física, a ingestão insuficiente de proteínas e piora da resposta pró-inflamatória demonstraram ter consequências negativas na síntese de proteínas musculares, potencializando risco de sarcopenia. A obesidade sarcopênica também demonstrou piorar o prognóstico de pacientes infectados com SARS-CoV-2. A reabilitação nutricional pode prevenir ou minimizar o desenvolvimento de sarcopenia. As recomendações dietéticas incluem maior oferta de energia e maior ingestão de proteínas de 1,2 a 2,0 g/kg de peso corporal. Evidências sugerem que o envelhecimento com comportamentos sedentários, alterações fisiopatológicas e inflamação, alterações na composição corporal, deficiências nutricionais são preditores e agravantes da sarcopenia aguda na COVID-19.

Risco nutricional e fatores associados em pacientes hospitalizados pelo sistema único de saúde: comparação entre os sexos / Nutricional risk and associated factors in hospitalized patients: comparison between genders

Introdução: a desnutrição representa um problema clínico-nutricional frequente em pacientes hospitalizados, sendo que a detecção precoce do risco nutricional torna-se fundamental, pois possibilita à equipe multidisciplinar o início imediato de uma conduta dietética adequada, minimizando o sinergismo entre a desnutrição e os demais fatores clínicos. Objetivo: determinar o risco nutricional, associando com o estado nutricional, estilo de vida e variáveis clínicas de hospitalização de pacientes internados pelo SUS, comparando tais condições entre os sexos. Metodologia: trata-se de estudo transversal. Para avaliação do risco nutricional dos pacientes hospitalizados foi utilizado o protocolo de triagem nutricional Nutricional Risk Screening (NRS) 2002, além disso foram coletados dados antropométricos, clínicos, sociodemográficos e dietéticos para comparação com o risco nutricional. Resultados: a amostra foi composta por 100 pacientes, sendo 50% adultos e 50% idosos, com média de idade de 56,11±19 anos, sendo a maioria do sexo masculino (51%). O risco nutricional esteve presente em 34% dos pacientes avaliados, sendo 58,8% no sexo feminino e 41,2% no sexo masculino. Não houve diferença das demais variáveis quando comparadas entre os sexos (p>0,05). A maior prevalência de risco observada foi em idosos (27%). Conclusão: o risco nutricional obteve maior prevalência nos pacientes idosos, porém não houve diferença entre os sexos. Sabe-se que a presença de comorbidades e uma inadequada aceitação da dieta por parte dos mesmos pode levar a uma piora significativa do estado nutricional.

Malnutrition is a frequent clinical and nutritional problem in hospitalized patients, and early detection of nutritional risk is essential, as it allows the multidisciplinary team to immediately start an adequate dietary approach, minimizing the synergism between malnutrition and other clinical factors. Objective: to determine the nutritional risk, associating it with the nutritional status, lifestyle and clinical variables of hospitalization of patients hospitalized by the SUS, comparing such conditions between the sexes. Methodology: this are a cross-sectional study. To assess the nutritional risk of hospitalized patients, the Nutritional Risk Screening (NRS) 2002 protocol was used. In addition, anthropometric, clinical, sociodemographic and dietary data were collected for comparison with nutritional risk. Results: the sample consisted of 100 patients, 50% adults and 50% elderly, with a mean age of 56.11±19 years, the majority being male (51%). Nutritional risk was present in 34% of the patients evaluated, being 58.8% female and 41.2% male. There was no difference in the other variables when compared between the sexes (p>0.05). The highest prevalence of risk observed was in the elderly (27%). Conclusion: nutritional risk was more prevalent in elderly patients, but there was no difference between the sexes. It is known that the presence of comorbidities and an inadequate acceptance of the diet by them can lead to a significant worsening of the nutritional status.

Interdisciplinary Educational Interventions Improve Knowledge of Eating, Nutrition, and Physical Activity of Elementary Students.

This research aimed to evaluate the interdisciplinary educational intervention effects on knowledge of eating, nutrition, and physical activity in elementary-school students. Participants were 368 school children enrolled in public schools. The research was organized in three stages: pre-intervention, intervention and post-intervention. In pre-intervention, children were evaluated regarding their nutritional status. They also answered questionnaires related to eating and nutrition and physical activity. In the intervention stage, educational interventions were carried out on the same topics for a period of five months; in post-intervention, children answered the same questionnaires applied in pre-intervention. Despite most children having normal nutritional status (58.2%), a high number of students were overweight (38%). In the initial phase, it was found that most children had excellent knowledge of eating, nutrition, and good physical activity knowledge (p-value < 0.05). Educational health intervention significantly increased children's knowledge of eating, nutrition, and physical activity, when evaluated in the post-intervention period. Both boys and girls increased their knowledge of eating, nutrition, and physical activity after the application of interdisciplinary interventions (p-value < 0.05). A similar effect was observed for children with different nutritional status. It is concluded that interdisciplinary educational interventions carried out for children in an elementary-school environment are effective for improving knowledge of eating, nutrition, and in physical activity, promoting healthier habits among children.

Comparação do efeito de beta alanina, bicarbonato de sódio e limão como agentes tamponantes entre ciclistas em exercício de alta intensidade / Comparison of the effect of beta alanine, sodium bicarbonate and lemon as tamponant agents among high-intensity exercise cyclists

Alguns suplementos exercem atividade tamponante e têm sido reconhecidos por sua contribuição anaeróbica em exercícios de alta intensidade, retardando a fadiga muscular periférica e potencializando assim a performance esportiva. O objetivo deste estudo foi comparar o benefício ergogênico no tamponamento e dano muscular, dos suplementos beta alanina, bicarbonato de sódio e suco de limão por meio da dosagem de lactato sanguíneo e creatinofosfoquinase (CPK) e na performance de ciclistas submetidos a exercício anaeróbico de alta intensidade. Estudo transversal crossover, realizado em quatro etapas, com ciclistas do sexo masculino. A suplementação foi constituída de 6 g de beta alanina, 0,2 g/kg de bicarbonato de sódio e 30 mL de suco de limão. Lactato sanguíneo e enzima CPK foram dosados pelo método teste ultravioleta enzimático e cinético, respectivamente, em cada uma das etapas. A performance correspondeu à rotação máxima por minuto (RPM) da Air Bike. Participaram do estudo sete ciclistas, com média de idade de 31,14 ± 3,71 anos. O lactato e a CPK apresentaram significância entre os momentos em todas as etapas avaliadas, porém as suplementações comparadas entre si não apresentaram diferença estatística. Não houve melhora da performance (p>0,05) com as utilizações de bicarbonato de sódio, beta alanina e suco de limão em ciclistas. Para os parâmetros avaliados, nenhum dos suplementos apresentou superioridade nas variáveis de tamponamento, dano muscular e performance no treinamento.

Some supplements exert buffering activity and have been recognized for their anaerobic contribution to high-intensity exercise, delaying peripheral muscle fatigue and thus enhancing sports performance. The aim of this study was to compare the ergogenic benefit in muscle buffering and damage of beta alanine, sodium bicarbonate and lemon juice supplements through the measurement of blood lactate and creatine phosphokinase (CPK) and on the performance of cyclists submitted to high intensity anaerobic exercise. Cross-sectional study, carried out in 4 stages, with male cyclists. Supplementation was 6 g beta alanine, 0.2 g/kg of sodium bicarbonate and 30 mL of lemon juice. Blood lactate and creatine phosphokinase enzyme were measured by the enzymatic and kinetic ultraviolet test method, respectively, in each of the steps. Performance corresponded to the maximum rotation per minute (RPM) of the Air Bike. Seven cyclists participated in the study, with a mean age of 31.14 ± 3.71 years. Lactate and CPK presented significance between the moments in all the evaluated stages, however the supplements compared to each other showed no statistical difference. There was no performance improvement (p>0.05) with the use of sodium bicarbonate, beta alanine and lemon juice in cyclists. For the parameters evaluated, none of the supplements showed superiority in the variables of buffering, muscle damage and training performance.

The Relationship between Unintentional Weight Loss, Grading System and Overall Survival in Gastric Cancer Patients.

Cancer patients are highly vulnerable to weight loss and malnutrition, before chemotherapy, thus reducing overall survival (OS). The objective was assessing weight loss and OS prognostication in gastric cancer patients at baseline of chemotherapy treatment. Observational retrospective study with patients who were treating in cancer public clinic in Brazil, was evaluated weight loss and cachexia. It was evaluated by sex, BMI, grade system classification (GSC) and stage the OS by Kaplan-Meier method and Cox proportional hazards model. Ninety-two patients, 73.9% were male. At baseline chemotherapy patients have presented 15.3% of body weight loss, 28.3% were malnourished, 86.8% classified witch cachexia, 80.3% were grade 3-4 in GSC and 86.9% at cancer stage 3-4. OS was lower for male (15.9 mo.), malnourished (12.0 mo.), GCS-4 (16.3 mo.) and Stage 4 (13.3 mo.) patients. GSC grade four and BMI classification to underweight comparing obesity are associated with reduced OS, together to male sex and cancer stage 4, have gotten together shown that seems to confer a survival disadvantage to other patients in these parameters too. Cox regression analysis have not shown statistical significance for sex, Initial BMI Class, GSC, cancer stage. Gastric cancer patients at chemotherapy treatment outset present high weight loss, cachexia prevalence and OS reduction.

Clinical and nutritional characteristics on overall survival impact in patients with gastrointestinal cancer.

BACKGROUND AND AIMS: Weight loss is present in most cancer patients, being even more frequent in gastrointestinal tract tumors (GIT). Malnourished patients may be at greater toxicity risk during treatment, which may interfere with survival. Tumor-triggered hypercatabolism can lead to impaired nutritional status. In addition, other factors such as the presence of nutritional impact symptoms (NIS) can lead to decrease food consumption, influencing weight loss. The purpose of this study was verify nutritional status and understand which factors are related to survival and weight loss in patients with gastrointestinal tract cancers. METHODS: This study is a retrospective cross-sectional, with data collected from patient's medical records with the gastrointestinal tract cancers, between the years 2012-2019. Data were classified of tumor location, disease staging, weight change, number of nutritional impact symptoms and diet at the treatment beginning. Survival was calculated using the start of treatment and death dates. RESULTS: A total of 388 medical patient's records were analyzed, most of which presented weight loss (82.5%) with an average weight loss of 9.0 kg representing 12.2% of body weight. The main NIS presented by the patients were dry mouth, abdominal pain, constipation and esophagitis. According to predetermined groups, the highest weight loss percentages were for patients with stomach and pancreatic cancer, Stage 4, the presence of 3 or more NIS and enteral diet. The lowest survival and highest death risk were observed at the univariable analysis to patients that have the presence of 3 or more NIS 8.3 months and HR 1.51 (IC95% 1.1-2.1) and to the multivariable analysis, for patients with pancreatic cancer 4.8 months HR 3.13 (IC95% 1.9-5.2), stage IV 9.8 months and HR 4.8 (IC95% 1.7-13.2). CONCLUSION: Tumor location, cancer stage and the presence of nutritional impact symptoms influenced weight loss and survival of oncologic patients.

Prepubertal acrylamide exposure causes dose-response decreases in spermatic production and functionality with modulation of genes involved in the spermatogenesis in rats.

The increase in human infertility prevalence due to male reproductive disorders has been associated with extensive endocrine-disrupting chemical (EDC) exposure. Acrylamide (AA) is a compound formed spontaneously during heat processing of some foods that are mainly consumed by children and adolescents. In this study, we evaluated the prepubertal AA exposure effects on male adult reproductive physiology using a prepubertal experimental model to analyze the pubertal development, spermatogenesis hormones levels and genes expression involved in male reproductive function. This study is the first one to use the validated protocol to correlate the AA exposure with puberty development, as well as the AA-induced endocrine disrupting effects on reproductive axis. AA did not affect the age at puberty, the reproductive organ's weight and serum hormonal levels. AA reduces spermatogenesis, induces morphological and functional defects on sperm and alters transcript expression of sexual hormone receptors (Ar and Esr2), the transcript expression of Tnf, Egr2, Rhcg and Lrrc34. These findings suggest that excessive AA consumption may impair their reproductive capacity at adulthood, despite no changes in hormonal profile being observed.

Acrylamide induces a thyroid allostasis-adaptive response in prepubertal exposed rats.

Some endocrine-disrupting chemicals (EDCs) can affect the endocrine system through covalent interactions with specific sites, leading to deregulation of physiological homeostasis. The acrylamide (AA) present in some fried or baked foods is an example of an electrophile molecule that is able to form adducts with nucleophilic regions of nervous system proteins leading to neurological defects. A positive correlation between increased urinary AA metabolite concentration and reduced levels of thyroid hormones (TH) was described in adolescents and young adults. Thus, this study aimed to evaluate whether AA affects the physiology of the hypothalamus-pituitary-thyroid (HPT) axis and the possible repercussions in peripheral TH-target systems. For this, male Wistar rats were exposed to doses of 2.5 or 5.0 mg AA/Kg/day, based on the LOAEL (Lowest Observed Adverse Effect Level) during prepubertal development. The expression of molecular markers of HPT functionality was investigated in the hypothalamus, pituitary, thyroid, heart and liver, as well as the hormonal and lipid profiles in blood samples. Herein, we showed that AA acts as EDCs for thyroid gland function, increasing the transcript expression of several proteins related to TH synthesis and altering hypothalamus-pituitary-thyroid axis homeostasis, an effect evidenced by the higher levels of THs in the serum. Compensatory mechanisms were observed in TH-target tissues, such as an increase in Dio3 mRNA expression in the liver and a reduction in Mct8 transcript content in the hearts of AA-treated rats. Together, these results pointed out an allostatic regulation of the HPT axis induced by AA and suggest that chronic exposure to it, mainly associated with food consumption, might be related to the higher prevalence of thyroid dysfunctions.

Análise da efetividade de estratégia nutricional em mulheres com síndrome metabólica / Analysis of the efficaciousness of nutritional strategy in females with metabolic syndrome

O objetivo deste estudo foi analisar a efetividade de uma estratégia nutricional em mulheres obesas com Síndrome Metabólica (SM). Estudo longitudinal caso-controle estruturado com dois grupos, sendo mulheres obesas com diagnóstico clínico de SM (Grupo Caso) e mulheres obesas sem diagnóstico de SM (Grupo Controle), em acompanhamento nutricional na Clínica Escola de Nutrição da Unicentro. A coleta de dados ocorreu em duas etapas, com intervalos de um mês, sendo realizadas medidas antropométricas, análise do consumo alimentar e exames bioquímicos. A estratégia nutricional utilizada foram orientações nutricionais e plano alimentar individualizado. Foram avaliadas 20 mulheres, cada grupo com número equivalente. Pacientes com SM apresentaram valores de CC e glicemia em jejum superiores ao grupo controle (p<0,005), ingestão de ácidos graxos acima do recomendado. A intervenção nutricional foi efetiva em pacientes com SM, demonstrando em curto prazo melhora da qualidade da alimentação e do perfil sérico glicêmico e lipídico, redução de medidas antropométricas.

The efficaciousness of nutritional strategy in obese females with metabolic syndrome (MS) is evaluated. Current case-controlled longitudinal study was structured on two groups, with obese women with a clinical diagnosis of MS (Case Group) and obese females without MS (Control Group), within the context of nutritional follow-up in the Clinical Nutritional School of the Unicentro. Data were collected in two stages, at a month´s interval, with anthropometric measurements, analysis of food consumption and biochemical tests. Nutritional strategy comprised nutritional supervision and personal food planning. Twenty females were assessed for each group. MS patients had CC and glycaemia rates higher than those of control group (p<0.005) and ingestion of fatty acids above that recommended. Nutritional intervention was effective in patients with MS and revealed that in a short time there was an improvement in food quality, in glycemic and lipid serum and in anthropometric measurements.

Can fish oil supplementation in breast cancer patients with neoadjuvant chemotherapy alter nutritional, biochemical and immunological parameters? / Suplementação de óleo de peixe em pacientes com câncer de mama com quimioterapia neoadjuvante pode alterar parâmetros nutricionais, bioquímicos e imunológicos?

The aim of this study was to evaluate the n-3 fatty acid supplementation effects in breast cancer patients. Methods: it was a prospective longitudinal study performed in breast cancer patients supplemented with fish oil during 8 weeks in neoadjuvant AC-T regimen. Anthropometric, Bioelectrical impedance (BIA) ((Lean Body Mass (LBM), and Phase Angle (PA)), food consumption, nutritional impact symptoms (NIS), metabolic and inflammatory profile were evaluated for 2 months. Results: supplemented patients presented weight gain of 1.4 kg, representing 1.8% of body weight. LBM was 42.3 Kg and PA 6.1º. Nausea, diarrhea and anorexia were the main NIS with reduction in incidence with the supplementation, but xerostomia and heartburn had increase. There was significant drop in hemoglobin values to 12.3 mg/ dL, metabolic parameters and nutritional prognosis (CRP/albumin ratio) were not altered. Cytokines levels of TNF-α and interleukin-6 did not change, however interleukin-2 have shown significant increasing. Conclusion: Body weight gain was noticed in breast cancer patients, independent of food consumption. Fish oil supplementation during neoadjuvant chemotherapy was able to reduce NIS incidence, but not avoiding the decrease of hemoglobin levels, but it keeps the maintenance of proinflammatory parameters, except for increased the cytokine IL-2 (AU)

O objetivo foi avaliar os efeitos da suplementação de ácidos graxos n-3 em pacientes com câncer de mama. Metodologia: estudo prospectivo longitudinal realizado em pacientes suplementados com óleo de peixe durante 8 semanas em quimioterapia neoadjuvante com regime AC-T. Antropometria e impedância bioelétrica (massa corporal magra (massa magra) - ângulo de fase (AP)), consumo alimentar, sintomas de impacto nutricional (SIN) e perfil metabólico e inflamatório foram avaliados. Resultados:Os pacientes apresentaram ganho de peso de 1,4 kg, representando 1,8% do peso corporal. LBM foi 42,3 kg e AP 6,1º. Náusea, diarreia e anorexia foram o SIN com redução na incidência com a suplementação, mas a xerostomia e a azia aumentaram. Houve uma queda significativa nos valores de hemoglobina para 12,3 mg/dL, parâmetros metabólicos e prognóstico nutricional (relação PCR/albumina) não foram alterados. Os níveis de citocinas de TNF-α e interleucina-6 não mudaram, entretanto a interleucina-2 mostrou um aumento significativo. Conclusão: O ganho de peso corporal foi observado nas pacientes com câncer de mama, independente do consumo alimentar. Durante a quimioterapia neoadjuvante com suplementação de óleo de peixe houve redução da presença de SIN, diminuição dos níveis de hemoglobina e manutenção de parâmetros bioquímicos e inflamatórios, exceto pelo aumento da citocina IL-2 (AU)

Ação de prebióticos e simbióticos na obstipação intestinal de indivíduos com paralisia cerebral / Action of prebiotics and symbiotic on constipation bowel in individuals with cerebral paralysis

Introdução: A adição de simbióticos em fórmulas alimentares é evidenciada como uma opção para melhorar a imunidade e reduzir os distúrbios gastrointestinais, como a obstipação intestinal em indivíduos com paralisa cerebral. Objetivo: Avaliar o funcionamento intestinal de indivíduos com paralisia cerebral que receberam intervenção nutricional por meio da suplementação de simbióticos e consumo de alimentos prebióticos. Métodos: O estudo foi realizado com crianças e adolescentes da Associação Pais e Amigos dos Excepcionais de Guarapuava-PR. Estudo de curta comunicação caracterizado por dois grupos: Grupo com suplementação de simbióticos, no qual foi orientado a suplementação diária de colônia 4x109 Bifidobacterium infantis, Bifidobacterium longum, Lactobacilus casei, Lactobacilus plantarum, Lactobacilus rhamnosus e 2g Frutooligossacarídeos, em forma de sachê e Grupo orientação nutricional com foco no consumo de alimentos prebióticos, o qual recebeu orientações nutricionais com o objetivo de consumo diário de alimentos com prebióticos. A coleta de dados foi realizada por meio de dois questionários e avaliação antropométrica no início das intervenções nutricionais e após 2 meses as intervenções. Resultados: Participaram do estudo 20 indivíduos, sendo 10 em cada grupo. Por meio da avaliação antropométrica identificou-se aumento de peso do grupo simbiótico e orientação nutricional. Observou-se melhora significante na consistência das fezes após 2 meses de avaliação no grupo simbióticos (p=0,002) e no grupo orientação nutricional (p=0,005). Conclusão: A suplementação com simbióticos como a orientação nutricional auxiliou no aumento da frequência de evacuações e melhorou a consistência das fezes nestes indivíduos

Introduction: The addition of symbiotics in dietary formulas is evidenced as an option to improve immunity and reduce gastrointestinal disorders such as intestinal constipation in individuals with cerebral palsy. Objetive: To assess the bowel function of individuals with cerebral palsy who received nutritional intervention through supplementation symbiotic and prebiotics food consumption. Methods: The study was conducted with children and adolescents of Parents and Friends of Exceptional Guarapuava- PR. Short communication study was characterized by two groups: Group with synbiotic supplementation, which was instructed to daily supplementation colony 4x109 Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus rhamnosus and 2g Fructooligosaccharides, shaped sachet and Nutritional counseling group focusing on consumer prebiotic foods, which received nutritional guidelines with the aim of daily consumption of food with prebiotics. Data collection was performed by means of two questionnaires and anthropometric assessment at the beginning of nutritional interventions and 2 months after the intervention. Results: Through anthropometric assessment identified an increase in weight of the symbiotic group and nutritional counseling. There was significant improvement in stool consistency after 2 months of evaluation in the symbiotic group (p=0.002) and nutritional counseling group (p=0.005). Conclusion: The supplementation with both symbiotic as nutritional counseling assisted in increased frequency of bowel movements and improved stool consistency in these individuals

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Alterações nutricionais e fatores associados em pacientes hospitalizados por Pancreatite Aguda / Nutritional changes and factors associated with patients hospitalized by Acute Pancreatitis

Introdução: A pancreatite aguda (PA) é uma inflamação abrupta do pâncreas. Esta doença pode influenciar em alguns fatores, como alterações no estado nutricional e na ingestão alimentar. Objetivo: Estimar o estado nutricional, a dieta intrahospitalar e os fatores associados à doença em pacientes hospitalizados por PA. Método: Estudo transversal com pacientes diagnosticados com PA durante hospitalização. O estado nutricional dos pacientes foi avaliado por meio de peso e estatura para posterior cálculo do índice de massa corporal (IMC) e consumo dietético (com recordatório de dia alimentar habitual) e hospitalar (com avaliação da aceitação da dieta). Resultados: Foram avaliados 26 pacientes sendo 57,7% do sexo masculino e 46,1% hospitalizados por pancreatite de causa biliar. O sintoma mais comum apresentado foi a dor abdominal (57,7%) e 53,8% estavam em eutrofia no momento da avaliação de acordo com o IMC. Este valor não foi significativo quando comparado os sexos (p>0,05). A maioria dos pacientes recebeu prescrição de jejum (57,7%); 61,5% apresentaram perda de peso, não houve diferença estatística quando se comparou as variáveis do estudo com a classificação do estado nutricional (p>0,05). Conclusão: A maior parte dos pacientes estava com estado nutricional adequado, com ressalvas pois haviam relatos de perda de peso na maioria dos avaliados. A prescrição de jejum esteve presente na maior parte da amostra.

Introduction: Acute pancreatitis (AP) is an abrupt inflammation of the pancreas. This disease may influence some factors, such as changes in nutritional status and food intake. Objective: Evaluate the nutritional status, the hospital diet and the factors associated with the disease in patients hospitalized (BMI) and habitual with usual intake (food day recall) and hospital (with evaluation of diet acceptance). Results: Twenty-Six inpatients were evaluated 57.7% were male and 46.1% were hospitalized for biliary pancreatitis. The most common symptom presented was abdominal pain (57.7%) and according to BMI 53.8% were eutrophic at the time of evaluation, and was not significant when compared to sex (p> 0.05). Most patients received fasting prescription (57.7%); 61.5% presented weight loss, there was no statistical difference when comparing the study variables with the nutritional status classification (p> 0.05). Conclusion: The majority of inpatients had normal nutritional status, with reservations because there was a report of weight loss in the majority of the evaluated ones. The fasting prescription was present in most of the sample.

Perfil clínico e nutricional de pacientes hospitalizados acometidos por acidente vascular cerebral / Clinical and nutritional profile of stroke patients

Objetivo: objetivo desse trabalho foi traçar o perfil clínico e nutricional de pacientes acometidos por acidente vascular cerebral (AVC). Metodologia: trata-se de estudo retrospectivo realizado em prontuários de pacientes internados em Hospitais de Guarapuava, Paraná no período de maio a setembro de 2016. Foram aferidos peso e estatura, e posteriormente calculado o índice de massa corporal (IMC). Ainda foi avaliada circunferência do braço (CB), aceitação da dieta e dieta prescrita pelo nutricionista. Para análise dos dados obtidos foi realizada estatística descritiva e também inferência estatística. Resultados: foram avaliados 28 pacientes que tiveram diagnóstico de AVC, com média de idade 66,2±16,3 anos, 75% da amostra constituída por idosos e 50% do sexo feminino. A dieta oferecida com maior frequência nesses pacientes foi a dieta via sonda (35,7%); 42,9% (N=12) foram classificados como eutróficos e 39,3% (n=11) como magreza. Conclusão: assim, foi possível observar que magreza foi significativa nessa amostra, mas em sua maioria prevaleceu a eutrofia, a rejeição da dieta hospitalar foi marcante principalmente em pacientes com magreza percebe-se que pacientes acometidos de AVC são vulneráveis a presença de risco nutricional.

Objective: the objective of this study was to outline the nutritional clinical profile of patients with stroke. Metodology: this is a retrospective study carried out in medical records of patients hospitalized in Hospitals of Guarapuava, Paraná from May to September, 2016. Weight and height were measured, and the body mass index (BMI) was subsequently calculated. Arm circumference (AC), diet acceptance and diet prescribed by the nutritionist were also evaluated. For the analysis of the data obtained, descriptive statistics and statistical inference were also performed. Results: we evaluated 28 patients who suffered a stroke, with a mean age of 66.2 ± 16.3 years, 75% of the sample consisting of elderly and 50% female. The diet most frequently offered in these patients was diet through nutritional therapy through a probe (35.7%). 42.9% (N = 12) were classified as eutrophic and 39.3% (n = 11) as malnourished. Conclusion: thus, it was possible to observe that malnutrition was significant in this sample, but most eutrophy prevailed, the rejection of the hospital diet was marked mainly in patients with malnutrition, it is perceived that patients affected by stroke are vulnerable to the presence of nutritional risk.

Does Oil Rich in Alpha-Linolenic Fatty Acid Cause the Same Immune Modulation as Fish Oil in Walker 256 Tumor-Bearing Rats?

OBJECTIVE: Polyunsaturated fatty acids n-3 (PUFA n-3) have shown effects in reducing tumor growth, in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) abundantly present in fish oil (FO). When these fatty acids are provided in the diet, they alter the functions of the cells, particularly in tumor and immune cells. However, the effects of α-linolenic fatty acid (ALA), which is the precursor of EPA and DHA, are controversial. Thus, our objective was to test the effect of this parental fatty acid. METHODS: Non-tumor-bearing and tumor-bearing Wistar rats (70 days) were supplemented with 1 g/kg body weight of FO or Oro Inca® (OI) oil (rich in ALA). Immune cells function, proliferation, cytokine production, and subpopulation profile were evaluated. RESULTS: We have shown that innate immune cells enhanced phagocytosis capacity, and increased processing and elimination of antigens. Moreover, there was a decrease in production of pro-inflammatory cytokines (tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6)) by macrophages. Lymphocytes showed decreased proliferation capacity, increased cluster of differentiation 8 (CD8+) subpopulation, and increased TNF-α production. CONCLUSIONS: Oil rich in ALA caused similar immune modulation in cancer when compared with FO.

Comparação energética e de micronutrientes entre dietas enterais fornecidas pelo Sistema Único de Saúde / Comparison between energy and enteral micro diets provided by the Unified Health System

A Nutrição Enteral é considerada como um alimento utilizado para fins especiais, com a ingestão controlada de nutrientes, na forma isolada ou combinada, de composição definida, especialmente formulada e elaborada para uso por sondas ou via oral, industrializado ou não. O objetivo desse estudo foi analisar os rótulos de alimentos de Nutrição Enteral comparando energia e micronutrientes entre dietas alimentares especiais fornecidas pelo Sistema Único de Saúde de Guarapuava, Paraná. A pesquisa foi realizada na Secretaria de Saúde do município, e foram analisados 15 rótulos de embalagens de fórmulas de NE. Foram analisadas fórmulas enterais indicadas para via oral e sonda e avaliados os valores de energia macronutrientes (carboidratos, proteína e lipídios) além de vitaminas (A, C e B12) e minerais (cálcio e ferro). A padronização dos nutrientes está de acordo com 100 gramas do produto e também no total diário, de acordo com o fabricante considerando, 6 refeições ao dia, com cerca de 35g do produto reconstituído em água. Seis produtos (40%) eram fórmulas completas, e somente uma (6,7%) era especializada, para distúrbios renais. Ainda, observa-se que a frequência maior de produtos era de módulos (46,7%). Quanto ao custo, observou-se que a diferença aproximadamente entre o mínimo e máximo é de R$50,00 para cada produto. Quando há comparação entre as fórmulas enterais em termos de vitaminas e minerais obtém-se diferença estatística entre todos os micronutrientes avaliados. Para a vitamina A média foi de 490,70mg, para a vitamina C 51,27mg, para a vitamina B12 a média foi 1,52mg, para o ferro foi 7,63mg, e por fim o cálcio com a média 418,25mg. Quando consideradas apenas as fórmulas completas, a média de calorias diárias foi diferente entre as fórmulas analisadas (867,2±270,5 Kcal) (p<0,05). O mesmo ocorreu com os carboidratos, proteínas e lipídios (p<0,05). Vale ressaltar que poucas fórmulas conseguem suprir as necessidades de pacientes que necessitam de dieta especializada e com valores especiais de calorias diárias com melhoria de nutrientes.

Enteral Nutrition is all food for special purposes, with controlled nutrients intake, alone or in combination, defined composition, specially formulated and designed for use by probes or oral, industrialized or not. The aim of this study was to analyze the Enteral Nutrition food labels comparing energy and micronutrients between special diets provided by the Brazilian Unit health care system (SUS) at Guarapuava, Paraná, Brazil. It Were analyzed 15 labels Enteral Nutrition formulas packaging and it was analyzed energy and micronutrient composition. Enteral formulas given orally and probe were analyzed. They evaluated the energy values macronutrients (carbohydrates, protein and lipids) as well as vitamins (A, B12 and C) and minerals (calcium and iron). Nutrients standardization is in accordance with 100 grams per product and also the total daily according to the manufacturer 6 meals a day, about 35g of the reconstituted product in water. Six (40%) were complete formulas and only one (6.7%) was specialized, for kidney disorders. Thus, it is observed that the higher frequency products were modules (46.7%). As for the cost it was observed that the difference approximately between the minimum and maximum is R$50.00 for each product. When no comparison between the enteral formulas in terms of vitamins and minerals obtained statistical difference between all micronutrient, vitamin A the average was 490.70mg, as the vitamin C 51.27mg, vitamin B12 average was 1.52 mg, since iron was 7.63 mg, and finally with calcium media was 418.25mg. When considering only the complete formulas, the average daily calorie was different among the formulas analyzed (867.2±270.5kcal) (p<0.05). The same happened with carbohydrates, proteins and lipids (p <0.05). It can be seen that formulas few can meet the needs of patients requiring specialized diet and daily calorie special values with improved nutrients.

Incidência de caquexia, anemia e sintomas de impacto nutricional em pacientes oncológicos / Cachexia incidence, anemia and nutritional impact symptoms in cancer patients

Sintomas de impacto nutricional (SIN) e anemia são alterações fisiológicas frequentemente observadas em pacientes oncológicos antes do diagnóstico e durante o tratamento da radioterapia e quimioterapia podendo interferir na condição geral do paciente e na incidência da caquexia do câncer. O objetivo deste estudo foi avaliar a incidência de caquexia, SIN e anemia em pacientes oncológicos. Foi avaliado o peso, sintomas que interferem no consumo alimentar e a hemoglobina (usual/inicial/final) em pacientes com câncer atendidos no ambulatório de oncologia em GuarapuavaPR, vinculado ao Sistema Único de Saúde. Participaram do estudo 147 pacientes, sendo o câncer de mama o mais prevalente (45,6%). A caquexia esteve presente em diferentes graus no momento do diagnóstico ao final do tratamento. Ao agrupar por tipos de câncer no período inicial ao tratamento o câncer de estômago foi o que apresentou maior percentual de caquexia terminal (n=5, 31,3%) e o câncer de mama o que apresentou maior percentual de ganho de peso (n=25; 37,3%), com consequente redução dos indivíduos com caquexia. No período final do tratamento os pacientes com câncer de estômago mantiveram a maior prevalência de caquexia terminal (n=7; 43,8%) e o câncer de mama o que apresentou maior ganho de peso (n=39; 58,2%). Os sintomas de impacto nutricional mais frequentes foram xerostomia (n=84; 57,1%) e constipação intestinal (n=33; 22,4%). Entre os períodos, pacientes com câncer de estômago apresentaram maior percentual de anemia, respectivamente (n=10; 62,5%; n=11; 68,8%), e somente os pacientes com câncer de mama que apresentaram diferença significante (p=0,01). Evidenciou-se no estudo grande prevalência de caquexia, frequente incidência de anemia e de sintomas de impacto nutricional.

Nutritional Impact Symptoms (NIS) and anemia are physiological changes commonly observed in cancer patients at earlier the diagnosis and during the radiotherapy and chemotherapy therapy that may interfere in general condition and cancer cachexia incidence. The goal of this study was evaluate cachexia, NIS and anemia incidence in cancer patients. It was evaluated, weight symptoms that interfere in food consumption and hemoglobin (usual/initial/ending period) in cancer patients attended in oncology clinic at Guarapuava-PR, linked to Brazil's publicly funded health care system (SUS). It was enrolled 147 patients, and breast cancer was more prevalent (45.6%). Cachexia has been present in varying degrees at the diagnosis to treatment ending. Grouping by cancer type in treatment initial period, stomach cancer has shown the highest terminal cachexia percentage (n= 5, 31.3%) and breast cancer presented highest weight gain percentage (n = 25; 37.3%) with consequent reduction in cachexia subjects. At the treatment ending, stomach cancer patients remained highest terminal cachexia prevalence (n = 7; 43.8%) and breast cancer presented highest weight gain (n = 39; 58.2%). The most frequent NIS were xerostomia (n=84, 57.1%) and constipation (n=33, 22.4%). Between periods, stomach cancer patients have had higher of anemia percentage, respectively (n = 10, 62.5%; n = 11; 68.8%), and only breast cancer patients have had significant difference (p = 0.01). It was demonstrated in this study that greater cachexia degree is the most common incidence of anemia and symptoms of nutritional impact. It was evident in this study, high cachexia prevalence, frequent anemia and nutritional impact symptoms incidence.

α-Linolenic Fatty Acid Supplementation Decreases Tumor Growth and Cachexia Parameters in Walker 256 Tumor-Bearing Rats.

Fish oil (FO) has been shown to affect cancer cachexia, tumor mass, and immunity cell. n-3 PUFA, specifically α-linolenic fatty acid (ALA), has controversial effects. We investigated this in nontumor-bearing Wistar rats fed regular chow (C), fed regular chow and supplemented with FO or Oro Inca oil (OI), and Walker 256 tumor-bearing rats fed regular chow (W), fed regular chow and supplemented with FO (WFO) or OI (WOI). Rats were supplemented (1g/kg body weight/day) during 4 wk and then the groups tumor-bearing were inoculated with Walker 256 tumor cells suspension and 14 days later the animals were killed. WFO increased EPA fivefold and DHA 1.5-fold in the tumor tissue compared to W (P < 0.05). OI supplementation increased of threefold of ALA when compared to W (P < 0.05). Tumor mass in WFO and OI was of 2.3-fold lower, as well as tumor cell proliferation of 3.0-fold tumor tissue lipoperoxidation increased of 76.6% and cox-2 expression was 20% lower. Cachexia parameters were attenuate, blood glucose (25% higher), Triacylglycerolemia (50% lower), and plasma TNF-α (65% lower; P < 0.05) and IL-6 (62.5% lower). OI, rich in ALA, caused the same effect on cancer as those seen in FO.

Definitions and tools to assessing cancer cachexia: a review / Definições e Ferramentas para Avaliar a Caquexia no Câncer: uma Revisão / Definiciones y Herramientas para evaluar la Caquexia en el Cáncer: una Revisión

Introduction: Weight loss is the main feature in cachectic cancer patient leading a significant muscle mass and adipose tissue depletion which have being increasing mortality. Actual interest in cancer cachexia has caused a development of different tools, scores or criteria used to assessing the staging of malnutrition and/or weight loss cachexia related. Purpose: This review aims to show new cachexia definitions and tools that have been discussed to determinate cachexia in cancer.Method: It was performed a literature review of definitions and tools to determine and/or diagnose cancer cachexia. Articles published from January 2000 until August 2013. The base data used was the PubMed/Medline (www.ncbi.nlm.nih.gov/pubmed). Results: Recently three cachexia definitions have been published by Society for Cachexia and Wasting Disorders, European Palliative Care Research Collaborative; Special Interest Group on Cachexia and Anorexia of the European Society for Enteral and Parenteral Nutrition. Many tools to determine cancer cachexia are useful like weight loss, body mass index, nutritional screening and Body composition (Bioelectrical Impedance), Image tools (Dual energy X-ray absorptiometry, Computed tomography and Magnetic Resonance) and Combining assessment with inflammatory markers. Conclusion: Studies had been considered clinically important weight loss (varying from 5% to 20% or more) and this are correlated with increased morbidity and mortality. Weight loss is the main symptom reported by cancer patients leading to cachexia and it is too critical for disease progression, therefore, clinicians should be watchful to this complaint

Perfil de Risco de Doenças Cardiovasculares e Estado Nutricional de Idosos Ativos de Guarapuava - Paraná / Risk Profile of Cardiovascular Disease and Nutritional Status of Elderly

O envelhecimento da população é um fenômeno de amplitude mundial, sendo que a análise do estado nutricional torna-se relevante, visto que os idosos apresentam condições peculiares que comprometem sua saúde geral. O presente estudo teve por objetivo avaliar o estado nutricional e o risco de doenças cardiovasculares de um grupo de idosos ativos da cidade de Guarapuava - PR. O estudo envolveu 46 indivíduos, de ambos os gêneros, sendo que a maioria apresentou obesidade (51,1%), circunferência do pescoço, da cintura e índice de conicidade aumentados, além de hábitos alimentares inadequados. Observou-se significância estatística na associação entre indicadores socioeconômicos e fatores de risco para desenvolvimento de doenças cardiovasculares (etnia e circunferência do pescoço aumentada (p=0,03); hipertensão e índice de conicidade aumentado (p=0,05); hipertensão e circunferência da cintura aumentada (p=0,02) e circunferência da cintura e índice de conicidade aumentados (p=0,00)), indicando tais fatores como preditivos para o desenvolvimento de doenças cardiovasculares entre a população estudada. O diagnóstico de excesso de peso em idosos esteve associado a risco cardiovascular, pois se verificou forte associação entre o estado nutricional, determinado pelo índice de massa corporal, e fatores de risco já estabelecidos, como circunferência da cintura e do pescoço aumentadas, o que induz, consequentemente, ao aumento de índice de conicidade e risco de desenvolvimento de doenças cardiovasculares. Concluiu-se que o diagnóstico de excesso de peso em idosos está associado ao risco cardiovascular, e que o índice de conicidade se mostra um importante preditor para o desenvolvimento de doenças cardiovasculares. Também, evidenciou-se que os hábitos alimentares de idosos encontram-se inadequados.

Population aging is a worldwide phenomenon, and the analysis of nutritional status is relevant, since the elderly have unique conditions that affect overall health. This study aimed to assess the nutritional status and risk of cardiovascular disease in a group of active seniors in the city of Guarapuava - PR The study involved 46 individuals of both sexes, and most obese (51.1%), neck circumference, waist and conicity index increased, and poor eating habits. There was a statistically significant association between socioeconomic indicators and risk factors for developing cardiovascular disease (ethnicity and increased neck circumference (p=0.03), hypertension and conicity index increased (p=0.05), hypertension and increased waist circumference (p=0.02) and waist circumference and conicity index increased (p=0.00)), indicating such factors as predictors for the development of cardiovascular disease among the population studied. Diagnosis of overweight in the elderly was associated with cardiovascular risk, because there was a strong association between nutritional status determined by index body weight and established risk factors such as waist circumference and neck, which leads to increased rate of taper and risk of developing cardiovascular disease. It is concluded that the diagnosis of overweight in the elderly is associated with cardiovascular risk, and the conicity index may be an important predictor for the development of cardiovascular disease. In addition, the eating habits of older people are inadequate.