The Difficult Decision Not to Prescribe Artificial Nutrition by Health Professionals and Family: Bioethical Aspects.

Introduction: Bioethics and nutrition are essential issues in end of life, advanced dementia, life-sustaining therapies, permanent vegetative status, and unacceptably minimal quality of life. Even though artificially administered nutrition (AAN), for this type of health condition, does not improve quality of life and extension of life, and there is evidence of complications (pulmonary and gastrointestinal), it has been used frequently. It had been easier considering cardiopulmonary resuscitation as an ineffective treatment than AAN for a healthy team and/or family. For this reason, many times, this issue has been forgotten. Objectives: This study aimed to discuss bioethical principles and AAN in the involved patients. Discussion: The AAN has been an essential source of ethical concern and controversy. There is a conceptual doubt about AAN be or not be a medical treatment. It would be a form of nourishment, which constitutes primary care. These principles should be used to guide the decision-making of healthcare professionals in collaboration with patients and their surrogates. Conclusions: This difficult decision about whether or not to prescribe AAN in patients with a poor prognosis and without benefits should be based on discussions with the bioethics committee, encouraging the use of advanced directives, education, and support for the patient, family, and health team, in addition to the establishment of effective protocols on the subject. All of this would benefit the most important person in this process, the patient.

Weight Gain during Systemic Oncologic Therapy for Breast Cancer: Changes in Food Intake and Physical Activity / Ganho Ponderal durante o Tratamento Oncológico Sistêmico para Câncer de Mama: Mudanças na Ingestão Alimentar e na Atividade Física / Aumento de Peso durante el Tratamiento Oncológico Sistémico para Cáncer de Mama: Cambios en la Ingestión de Alimentos y Actividad Física

Introduction: Weight gain frequently occurs during treatment for breast cancer. Objective: To evaluate changes in dietary intake and physical activity in the weight evolution of women on systemic oncologic treatment for breast cancer. Method: The prospective and comparative study included 89 women submitted to systemic oncologic treatment for breast cancer, grouped according to the occurrence of weight gain in relation to body weight documented before beginning treatment. Patients were classified as 1) Group with weight gain (those with an increase in body weight greater than or equal to 2% over pre-treatment weight); 2) Group without weight gain (those who maintained or lost weight during treatment). We calculated body mass index (BMI) of patients and analyzed their body composition by bioelectrical impedance (BIA). Changes in food intake, gastrointestinal symptoms, and physical activity level, as well as reductions in muscle and fat mass, were documented. Results:Tumor staging (p=0.24), use of antineoplastic drugs (p=0.23) and intention of treatment (p=0.61) were no different between the weight gain group (n=36) and no weight gain group (n=53). No difference was found in anthropometric and BIA data between the groups during oncologic treatment. Frequency of gastrointestinal symptoms was not different between the groups. However, increased food intake and bed rest, and a decrease in physical activity level were more frequent among women who gained weight during therapy. Conclusions: Weight gain in women undergoing systemic oncologic therapy for breast cancer may be, at least in part, caused by higher energy intake and lower physical activity.

Introdução: O ganho ponderal ocorre com frequência durante o tratamento oncológico para o câncer de mama. Objetivo: Avaliar as mudanças da ingestão alimentar e da atividade física na evolução ponderal de mulheres sob tratamento oncológico sistêmico para câncer de mama. Método: Estudo prospectivo e comparativo que incluiu 89 mulheres submetidas a tratamento oncológico sistêmico para neoplasia mamária, agrupadas de acordo com a ocorrência de aumento ponderal em relação ao peso corporal documentado antes do início do tratamento. As pacientes foram classificadas em 1) Grupo com ganho ponderal (aumento ≥2% em relação ao peso pré-tratamento); 2) Grupo sem ganho ponderal (ganho ou manutenção do peso durante o tratamento). O índice de massa corporal foi calculado e a composição corporal foi determinada por impedância bioelétrica. Foram documentadas mudanças na ingestão de alimentos e no padrão de atividade física, queixas digestivas e alterações da massa corporal muscular e adiposa. Resultados: Os grupos com ganho ponderal (n=36) e sem ganho ponderal (n=53) foram semelhantes quanto ao estadiamento tumoral (p=0,24), emprego das classes de drogas antineoplásicas (p=0,23) e modalidade de tratamento oncológico (p=0,61). Durante o tratamento oncológico sistêmico, a composição corporal foi semelhante entre os grupos de estudo. Comparadas com o grupo sem ganho de peso, houve maior proporção de aumento na ingestão alimentar e de restrição na atividade física entre as mulheres que ganharam peso. Conclusão: O ganho ponderal em mulheres com neoplasia mamária em tratamento oncológico sistêmico pode ser atribuído à maior ingestão energética e à redução na atividade física.

Introducción: El aumento de peso es frecuente durante el tratamiento oncológico para el cáncer de mama. Objetivo: Evaluar los cambios de la ingesta alimentaria y de la actividad física en la evolución ponderal de las mujeres en tratamiento oncológico sistémico para el cáncer de mama. Método: El estudio prospectivo y comparativo incluyó 89 mujeres sometidas a tratamiento sistémico oncológico por neoplasia mamaria, agrupadas de acuerdo con la ocurrencia de aumento ponderal en relación al peso corporal al início del tratamiento. Las pacientes fueron clasificadas en 1) Grupo con ganancia ponderal (≥2% en relación al peso pretratamiento); 2) Grupo sin ganancia ponderal (mantenimiento o pérdida de peso durante el tratamiento). El índice de masa corporal fue calculado y la composición corporal fue determinada por impedancia bioeléctrica. Fueron documentadas las variaciones en la ingestión de alimentos y el patrón de actividad física, quejas digestivas y redución en la masa corporal. Resultados: Los grupos con ganancia ponderal (n=36) y sin ganancia ponderal (n=53) fueron semejantes cuanto a estadificación tumoral (p=0,24), empleo de medicamentos antineoplásicos (p=0,23) y modalidad del tratamiento oncológico (p=0,61). Durante el tratamiento oncológico, la composición corporal fue semejante entre los grupos de estudio. Comparados con el grupo sin aumento de peso, se observó aumento en la ingestión de alimentos y restricción en la actividad física entre las mujeres que ganaron peso. Conclusión: El aumento de peso en mujeres sometidas a tratamiento oncológico para cáncer de mama, puede ser atribuido a mayor ingestión energética y reducción de actividad física.

Longitudinal assessment of nutritional risk in patients under chemo or radiotherapy.

OBJECTIVE:: To compare nutritional risk in adult patients undergoing chemotherapy and radiotherapy in the beginning, middle, and end of oncologic treatment. METHOD:: This prospective, comparative study included 83 adult patients, 44 undergoing chemotherapy (CT group) and 39 undergoing radiotherapy (RT group) at an oncology treatment center. Nutritional risk was determined by NRS-2002 in the beginning, middle, and end of therapy. Statistical analysis was performed using Statistica 8.0 software. RESULTS:: No differences in food intake or body mass index were observed between the CT (24.6±4.8 kg/m²) and RT groups (25.0±5.9 kg/m², p=0.75). Weight loss in the preceding 3 months was detected in 56.8% of CT group and 38.5% of RT group (p=0.09). The weight loss percentage compared with the usual weight within 3 months was greater (p<0.001) in the CT (11.4±6.5%) than in the RT group (3.9±6.8%). In the beginning of treatment, we observed high percentages of patients at moderate (18.2 vs. 15.4%, p=0.73) and high nutritional risk (61.4 vs. 48.7%, p=0.25), with no statistical difference between the CT and RT groups, respectively. During therapy, the nutritional risk remained unaltered in both groups. In the end of therapy, the majority of patients were at moderate (18.2 vs. 12.8%, p=0.50) or severe nutritional risk (50.0 vs. 51.3%, p=0.91), in the CT and RT groups, respectively, regardless of the type of oncologic treatment. CONCLUSION:: The high prevalence of patients at moderate or high nutritional risk in the beginning of treatment indicates the need for an early and continuous follow-up of the nutritional status of patients undergoing oncologic treatment.

Longitudinal assessment of nutritional risk in patients under chemo or radiotherapy / Avaliação longitudinal do risco nutricional em pacientes sob quimio ou radioterapia

Summary Objective: To compare nutritional risk in adult patients undergoing chemotherapy and radiotherapy in the beginning, middle, and end of oncologic treatment. Method: This prospective, comparative study included 83 adult patients, 44 undergoing chemotherapy (CT group) and 39 undergoing radiotherapy (RT group) at an oncology treatment center. Nutritional risk was determined by NRS-2002 in the beginning, middle, and end of therapy. Statistical analysis was performed using Statistica 8.0 software. Results: No differences in food intake or body mass index were observed between the CT (24.6±4.8 kg/m²) and RT groups (25.0±5.9 kg/m², p=0.75). Weight loss in the preceding 3 months was detected in 56.8% of CT group and 38.5% of RT group (p=0.09). The weight loss percentage compared with the usual weight within 3 months was greater (p<0.001) in the CT (11.4±6.5%) than in the RT group (3.9±6.8%). In the beginning of treatment, we observed high percentages of patients at moderate (18.2 vs. 15.4%, p=0.73) and high nutritional risk (61.4 vs. 48.7%, p=0.25), with no statistical difference between the CT and RT groups, respectively. During therapy, the nutritional risk remained unaltered in both groups. In the end of therapy, the majority of patients were at moderate (18.2 vs. 12.8%, p=0.50) or severe nutritional risk (50.0 vs. 51.3%, p=0.91), in the CT and RT groups, respectively, regardless of the type of oncologic treatment. Conclusion: The high prevalence of patients at moderate or high nutritional risk in the beginning of treatment indicates the need for an early and continuous follow-up of the nutritional status of patients undergoing oncologic treatment.

Resumo Objetivo: comparar o risco nutricional de pacientes adultos submetidos a quimio e radioterapia no início, no meio e ao término do tratamento oncológico. Método: estudo prospectivo e comparativo conduzido com 83 pacientes adultos de um centro de tratamento oncológico, sendo 44 sujeitos sob quimioterapia (grupo QTx) e 39 sob radioterapia (grupo RTx). O risco nutricional foi determinado pelo questionário NRS-2002 no início, ao meio e ao término da terapia. A análise estatística foi feita com o software Statistica 8.0. Resultados: não houve diferença no padrão de ingestão alimentar e no IMC (24,6±4,8 vs. 25±5,9 kg/m²; p=0,75) nos grupos QTx e RTx, respectivamente. Perda de peso nos 3 meses precedentes ocorreu em 56,8% dos pacientes sob quimioterapia e em 38,5% daqueles sob radioterapia (p=0,09). Os pacientes do grupo QTx apresentaram maior porcentagem de perda de peso em relação ao habitual em 3 meses (11,4±6,5 vs. 3,9±6,8%; p<0,001). No início do tratamento, houve alta taxa de risco nutricional moderado (18,2 vs. 15,4%; p=0,73) e grave (61,4 vs. 48,7%; p=0,25), sem diferença estatística entre os grupos QTx e RTx, respectivamente. No meio do tratamento, o risco nutricional foi mantido em ambos os grupos. Ao término da terapia, mais da metade dos pacientes apresentava risco nutricional moderado (18,2 vs. 12,8%; p=0,50) ou grave (50 vs. 51,3%; p=0,91), independentemente da modalidade de tratamento oncológico. Conclusão: a alta prevalência de risco nutricional moderado ou grave no início do tratamento aponta para a necessidade de abordagem nutricional precoce e permanente durante a terapia oncológica.

Copper-Zinc ratio and nutritional status in colorectal cancer patients during the perioperative period.

PURPOSE: This study aimed to determine Cu/Zn ratio, nutritional and inflammatory status in patients during the perioperative period for colorectal cancer. METHODS: The study included patients with histological diagnosis of colorectal adenocarcinoma (Cancer Group, n=46) and healthy volunteers (Control Group, n=28). We determined habitual food intake, body composition, laboratory data of nutritional status, serum calprotectin and plasma Cu and Zn concentrations. Mann-Whitney U-test was performed between-group comparisons and Spearman correlation test for correlations between the variables. RESULTS: Individuals in the Cancer Group presented significantly lower BMI, fat mass, plasma hemoglobin, total protein and albumin as compared with the Control Group. Serum calprotectin[70.1 ng/mL (CI95% 55.8-84.5) vs.53.3 ng/mL (40.3-66.4), p=0.05], plasma Cu concentrations [120 µg/dL(CI95% 114-126) vs. 106 µg/dL(CI95% 98-114), p<0.01] and the Cu/Zn ratio [1.59 (CI95% 1.48-1.71)vs. 1.35 (CI95% 1.23-1.46), p=0.01]were higher in patients with colorectal cancer than in controls. Additionally, the Cancer Group showed negative correlations between the Cu/Zn ratio and Zn intake, hemoglobin, serum albumin, and positive correlation between the Cu/Zn ratio and serum calprotectin. CONCLUSION: These results indicate that an increased plasma Cu/Zn ratio and serum calprotectin, and decreased protein values may be a result of the systemic inflammatory response to the tumor process.

Effect of Zinc Supplementation on Antioxidant Defenses and Oxidative Stress Markers in Patients Undergoing Chemotherapy for Colorectal Cancer: a Placebo-Controlled, Prospective Randomized Trial.

The study aimed to investigate the effect of oral zinc supplementation on antioxidant defenses and oxidative stress markers during chemotherapy for colorectal cancer. Twenty-four patients who had undergone surgical resection of colorectal cancer participated in this placebo-controlled, prospective randomized study. The supplementation was started in the perioperative period, in which 10 patients received 70 mg of zinc (zinc group, n = 10) and 14 patients received placebo (placebo group, n = 14) for 16 weeks. Approximately 45 days after surgical resection of tumor, all patients received a chemotherapeutic regimen (capecitabine, capecitabine combined with oxaliplatin or 5-fluorouracil). Vitamin C, vitamin E, antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx), and lipid peroxidation markers malondialdehyde (MDA) and 8-isoprostane were determined before the first, second, third, and fourth chemotherapy cycles. Compared with the placebo group, the zinc group presented higher SOD values before the first, second, and fourth chemotherapy cycles and lower GPx values before the third cycle. There were no statistical differences between the study groups in vitamin C, vitamin E, MDA, or 8-isoprostane plasma values. Longitudinal analysis revealed decreased vitamin E concentration in the placebo group before the second and fourth cycles as compared with the initial values. Zinc supplementation during chemotherapy cycles increased SOD activity and maintained vitamin E concentrations. Although no effect of zinc supplementation on oxidative stress markers was observed, the increase in SOD activity indicates a production of stable free radicals, which may have a positive effect in cancer treatment.

Copper-Zinc ratio and nutritional status in colorectal cancer patients during the perioperative period

PURPOSE : This study aimed to determine Cu/Zn ratio, nutritional and inflammatory status in patients during the perioperative period for colorectal cancer. METHODS: The study included patients with histological diagnosis of colorectal adenocarcinoma (Cancer Group, n=46) and healthy volunteers (Control Group, n=28). We determined habitual food intake, body composition, laboratory data of nutritional status, serum calprotectin and plasma Cu and Zn concentrations. Mann-Whitney U-test was performed between-group comparisons and Spearman correlation test for correlations between the variables. RESULTS: Individuals in the Cancer Group presented significantly lower BMI, fat mass, plasma hemoglobin, total protein and albumin as compared with the Control Group. Serum calprotectin[70.1 ng/mL (CI95% 55.8-84.5) vs.53.3 ng/mL (40.3-66.4), p=0.05], plasma Cu concentrations [120 µg/dL(CI95% 114-126) vs. 106 µg/dL(CI95% 98-114), p<0.01] and the Cu/Zn ratio [1.59 (CI95% 1.48-1.71)vs. 1.35 (CI95% 1.23-1.46), p=0.01]were higher in patients with colorectal cancer than in controls. Additionally, the Cancer Group showed negative correlations between the Cu/Zn ratio and Zn intake, hemoglobin, serum albumin, and positive correlation between the Cu/Zn ratio and serum calprotectin. CONCLUSION: These results indicate that an increased plasma Cu/Zn ratio and serum calprotectin, and decreased protein values may be a result of the systemic inflammatory response to the tumor process.

Copper-Zinc ratio and nutritional status in colorectal cancer patients during the perioperative period

PURPOSE : This study aimed to determine Cu/Zn ratio, nutritional and inflammatory status in patients during the perioperative period for colorectal cancer. METHODS: The study included patients with histological diagnosis of colorectal adenocarcinoma (Cancer Group, n=46) and healthy volunteers (Control Group, n=28). We determined habitual food intake, body composition, laboratory data of nutritional status, serum calprotectin and plasma Cu and Zn concentrations. Mann-Whitney U-test was performed between-group comparisons and Spearman correlation test for correlations between the variables. RESULTS: Individuals in the Cancer Group presented significantly lower BMI, fat mass, plasma hemoglobin, total protein and albumin as compared with the Control Group. Serum calprotectin[70.1 ng/mL (CI95% 55.8-84.5) vs.53.3 ng/mL (40.3-66.4), p=0.05], plasma Cu concentrations [120 µg/dL(CI95% 114-126) vs. 106 µg/dL(CI95% 98-114), p 0.01] and the Cu/Zn ratio [1.59 (CI95% 1.48-1.71)vs. 1.35 (CI95% 1.23-1.46), p=0.01]were higher in patients with colorectal cancer than in controls. Additionally, the Cancer Group showed negative correlations between the Cu/Zn ratio and Zn intake, hemoglobin, serum albumin, and positive correlation between the Cu/Zn ratio and serum calprotectin. CONCLUSION: These results indicate that an increased plasma Cu/Zn ratio and serum calprotectin, and decreased protein values may be a result of the systemic inflammatory response to the tumor process.(AU)

Effect of Zinc Supplementation on Serological Response to Vaccination Against Streptococcus Pneumoniae in Patients Undergoing Chemotherapy for Colorectal Cancer.

The aim of the study was to evaluate the effect of zinc supplementation on the antibody titer and the 23-valent pneumococcal seroconversion after vaccination in patients undergoing chemotherapy for colorectal cancer. The study included 25 patients undergoing postsurgery chemotherapy for colorectal adenocarcinoma (chemo group). Subjects were assessed in the perioperative period (prevaccination), before chemotherapy (4th wk) and after 3 cycles of chemotherapy (16th wk). Thirty-two healthy volunteers (control group) were included in the study. Participants received the 23-valent pneumococcal conjugate vaccine, and capsules containing zinc (Zn) sulfate (70 mg daily) or identical placebo capsules (containing wheat starch with no added Zn) for 16 wk and were randomly allocated on one of the following groups: chemo-Zn (n = 10), chemo-placebo (n = 15), control-Zn (n = 21), and control-placebo (n = 11). The antipneumococcal antibody titer against 6 polysaccharides was analyzed by ELISA and compared using linear mixed models. The seroconversion rate was compared using Fisher's exact test. An immune response to the vaccination against pneumococcus was observed in all participants. In the 16th wk, the polysaccharide 6 concentration was lower in the chemo-Zn group [2.96 (1.74-5.03) µg/mL] compared with the Chemo-Placebo group [10.75 (5.37-21.54) µg/mL] and the seroconversion rate was lower in the chemo-placebo (36%) compared with the control-placebo (85%) (P = 0.027). Zinc supplementation did not change the antibody titer after vaccination. However, the lower seroconversion rate observed in the chemo-placebo suggests an influence of zinc in the vaccinal protection.

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K.

OBJECTIVE: Bone loss has been established as a major extra-intestinal complication of short bowel syndrome (SBS). The purpose of this study was to correlate bone mineral density (BMD) with body mass index (BMI), serum vitamin and mineral levels in patients with SBS. MATERIAL AND METHODS: The study was conducted on 13 patients (8 male and 5 female, 54.7 ± 11.4 years) with SBS (residual small bowel length of 10 to 100 cm). We determined the food ingestion, anthropometry, serum levels of vitamins C, A, D, E and K, as well as serum and urinary levels of phosphorus and calcium. BMD was measured by dual-energy x-ray absorptiometry (DXA). RESULTS: Osteopenia and osteoporosis was diagnosed in all but one SBS patient. Serum levels of vitamin D were low in all volunteers. Sixty-one percent of patients had vitamin E deficiency; hypovitaminosis A and C occurred in one subject. BMI and C, E and K vitamin serum levels correlated with T-score of BMD. CONCLUSIONS: Osteopenia and osteoporosis were common in SBS patients. There was a correlation between BMD and the serum levels of vitamins C, E and K, an indicative that such vitamins may influence bone health.

Copper and magnesium deficiencies in patients with short bowel syndrome receiving parenteral nutrition or oral feeding.

BACKGROUND: Patients with short bowel syndrome have significant fluid and electrolytes loss. OBJECTIVE: Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. METHODS: Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. RESULTS: The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. CONCLUSION: Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies.

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

Objective Bone loss has been established as a major extra-intestinal complication of short bowel syndrome (SBS). The purpose of this study was to correlate bone mineral density (BMD) with body mass index (BMI), serum vitamin and mineral levels in patients with SBS.Material and methods The study was conducted on 13 patients (8 male and 5 female, 54.7 ± 11.4 years) with SBS (residual small bowel length of 10 to 100 cm). We determined the food ingestion, anthropometry, serum levels of vitamins C, A, D, E and K, as well as serum and urinary levels of phosphorus and calcium. BMD was measured by dual-energy x-ray absorptiometry (DXA).Results Osteopenia and osteoporosis was diagnosed in all but one SBS patient. Serum levels of vitamin D were low in all volunteers. Sixty-one percent of patients had vitamin E deficiency; hypovitaminosis A and C occurred in one subject. BMI and C, E and K vitamin serum levels correlated with T-score of BMD.Conclusions Osteopenia and osteoporosis were common in SBS patients. There was a correlation between BMD and the serum levels of vitamins C, E and K, an indicative that such vitamins may influence bone health. Arch Endocrinol Metab. 2015;59(3):252-8.

Copper and magnssium deficiencies in patients wth short bowel syndrome receiviing parenteral nutrition or oral feedngg / Deficiência de cobre e magnésio em pacientes com Síndrome do Intestino Curto sob nutrição parenteral ou alimentação por via oral

Background Patients with short bowel syndrome have significant fluid and electrolytes loss. Objective Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. Methods Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. Results The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. Conclusion Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies. .

Contexto Ressecções intestinais extensas resultam em perda de fluídos e eletrólitos. Objetivo Avaliar os níveis séricos de minerais e eletrólitos em pacientes com síndrome do intestino curto, dependentes ou não de nutrição parenteral. Métodos O estudo incluiu 22 adultos com síndrome de intestino curto, sendo 11 dependentes de nutrição parenteral (Grupo NP) e 11 sujeitos que recebiam todo aporte nutricional por via oral (Grupo VO). Foram incluídos 14 voluntários saudáveis, pareados para a idade e o gênero (Grupo Controle). A avaliação da ingestão alimentar, antropometria, níveis sanguíneos de sódio, potássio, fósforo, magnésio, cálcio, zinco, ferro e cobre foram documentados em todos os voluntários. Resultados Os níveis sanguíneos de sódio, potássio, fósforo, cálcio e zinco foram similares entre os grupos de estudo. Os níveis séricos de magnésio foram menores no Grupo NP (1,0±0,4 mEq/L) em relação aos demais grupos. Além disso, a concentração desse eletrólito foi menor no Grupo VO (1,4±0,3 mEq/L) em relação ao Grupo Controle (1,8±0,1 mEq/L). Foram documentados menores valores cobre (69±24 vs 73±26 vs 109±16 µg/dL) nos grupos NP e VO quando comparados com o Grupo Controle, respectivamente. Conclusão Hipomagnesemia e hipocupremia são distúrbios eletrolíticos comumente observados na síndrome de intestino curto. Os pacientes com ressecção intestinal extensa requerem monitorização e suplementação de magnésio e cobre a fim de prevenir deficiências. .

Peroxisome proliferator-activated receptors alpha and gamma2 polymorphisms in nonalcoholic fatty liver disease: a study in Brazilian patients.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) refers to the accumulation of hepatic steatosis in the absence of excess alcohol consumption. The pathogenesis of fatty liver disease and steatohepatitis (NASH) is not fully elucidated, but the common association with visceral obesity, hyperlipidemia, hypertension and type 2 diabetes mellitus (T2DM) suggests that it is the hepatic manifestation of metabolic syndrome. Peroxisome proliferator-activated receptor PPARα and PPARγ are members of a family of nuclear receptors involved in the metabolism of lipids and carbohydrates, adipogenesis and sensitivity to insulin. The objective of this study was to analyze the polymorphisms Leu162Val of PPARα and Pro12Ala of PPARγ as genetic risk factors for the development and progression of NAFLD. METHODS: One hundred and three NAFLD patients (89 NASH, 14 pure steatosis) and 103 healthy volunteers were included. Single nucleotide polymorphisms (SNPs) Leu162Val and Pro12Ala were analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). RESULTS: NASH patients presented higher BMI, AST and prevalence of T2DM than patients with pure steatosis. A higher prevalence of 12Ala allele was observed in the NASH Subgroup when compared to Control Group. When we grouped NASH and Steatosis Subgroups (NAFLD), we found lower serum glucose and more advanced fibrosis in the Leu162Val SNP. On the other hand, there was no statistical difference in clinical, laboratorial and histological parameters according to the Pro12Ala SNP. CONCLUSIONS: We documented a lower prevalence of 12Ala allele of gene PPARγ in the NASH Subgroup when compared to Control Group. In NAFLD patients, there were no associations among the occurrence of Pro12Ala SNP with clinical, laboratorial and histological parameters. We also documented more advanced fibrosis in the Leu162Val SNP. The obtained data suggest that Pro12Ala SNP may result in protection against liver injury and that Leu162Val SNP may be involved in the progression of NAFLD.

Vitamin serum level variations between cycles of intermittent parenteral nutrition in adult patients with short bowel syndrome.

BACKGROUND: An alternative form of nutrition therapy for patients with short bowel syndrome (SBS) who do not have home parenteral nutrition (PN) available is the administration of the PN cycle during regular hospital admissions and oral vitamin supplement at home. The aim of this study was to evaluate serum levels of folic acid and vitamins A, B(12), C, and E before and after the PN cycle in patients with SBS. MATERIALS AND METHODS: This research was conducted with 10 patients with SBS (less than 15 minutes of total barium transit time) who were receiving the PN cycle and oral vitamin supplement at home. Patients were evaluated regarding total food ingestion and oral vitamin supplement intake. Serum levels of vitamins were evaluated immediately after the end of each PN cycle (phase 1) and before the beginning of the next PN cycle (phase 2). RESULTS: Patients' nutrient ingestion was in accordance with recommendations for healthy individuals. Regarding the oral vitamin supplement intake, 20% of the patients presented low adherence. Although all patients had a normal serum level of folic acid and vitamin B(12), PN vitamin infusion during hospitalization and home oral vitamin supplement were not enough to make the serum levels of vitamins A, C, and E achieve normal values. CONCLUSION: This study documented that patients did not receive an adequate administration of oral vitamin supplements of vitamins A, C, and E through PN. More studies need to be conducted investigating higher doses of vitamin administration (oral or intravenous administration), assessing differences between water and liposoluble supplements.

Acrodermatitis due to zinc deficiency after combined vertical gastroplasty with jejunoileal bypass: case report.

CONTEXT: Nutritional complications may occur after bariatric surgery, due to restriction of food intake and impaired digestion or absorption of nutrients. CASE REPORT: After undergoing vertical gastroplasty and jejunoileal bypass, a female patient presented marked weight loss and protein deficiency. Seven months after the bariatric surgery, she presented dermatological features compatible with acrodermatitis enteropathica, as seen from the plasma zinc levels, which were below the reference values (34.4 mg%). The skin lesions improved significantly after 1,000 mg/day of zinc sulfate supplementation for one week. CONCLUSIONS: The patient's evolution shows that the multidisciplinary team involved in surgical treatment of obesity should take nutritional deficiencies into consideration in the differential diagnosis of skin diseases, in order to institute early treatment.

Evaluation of plasma homocysteine level according to the C677T and A1298C polymorphism of the enzyme MTHRF in type 2 diabetic adults.

OBJECTIVE: To determine plasma homocysteine levels during fasting and after methionine overload, and to correlate homocysteinemia according to methylenetetrahydrofolate reductase (MTHFR) polymorphism in type 2 diabetic adults. SUBJECTS AND METHODS: The study included 50 type 2 diabetic adults (DM group) and 52 healthy subjects (Control group). Anthropometric data, and information on food intake, serum levels of vitamin B12, folic acid and plasma homocysteine were obtained. The identification of C677T and A1298C polymorphisms was carried out in the MTHFR gene. RESULTS: There was no significant difference in homocysteinemia between the two groups, and hyperhomocysteinemia during fasting occurred in 40% of the diabetic patients and in 23% of the controls. For the same polymorphism, there was not any significant difference in homocysteine between the groups. In the Control group, homocysteinemia was greater in those subjects with C677T and A1298C polymorphisms. Among diabetic subjects, those with the A1298C polymorphism had lower levels of homocysteine compared with individuals with C677T polymorphism. CONCLUSION: The MTHFR polymorphism (C677T and A1298C) resulted in different outcomes regarding homocysteinemia among individuals of each group (diabetic and control). These data suggest that metabolic factors inherent to diabetes influence homocysteine metabolism.

Evaluation of plasma homocysteine level according to the C677T and A1298C polymorphism of the enzyme MTHRF in type 2 diabetic adults / Avaliação da homocisteína plasmática de acordo com o polimorfismo C677T e A1298C da enzima MTHRF em adultos diabéticos tipo 2

OBJECTIVE: To determine plasma homocysteine levels during fasting and after methionine overload, and to correlate homocysteinemia according to methylenetetrahydrofolate reductase (MTHFR) polymorphism in type 2 diabetic adults. SUBJECTS AND METHODS: The study included 50 type 2 diabetic adults (DM group) and 52 healthy subjects (Control group). Anthropometric data, and information on food intake, serum levels of vitamin B12, folic acid and plasma homocysteine were obtained. The identification of C677T and A1298C polymorphisms was carried out in the MTHFR gene. RESULTS: There was no significant difference in homocysteinemia between the two groups, and hyperhomocysteinemia during fasting occurred in 40% of the diabetic patients and in 23% of the controls. For the same polymorphism, there was not any significant difference in homocysteine between the groups. In the Control group, homocysteinemia was greater in those subjects with C677T and A1298C polymorphisms. Among diabetic subjects, those with the A1298C polymorphism had lower levels of homocysteine compared with individuals with C677T polymorphism. CONCLUSION:The MTHFR polymorphism (C677T and A1298C) resulted in different outcomes regarding homocysteinemia among individuals of each group (diabetic and control). These data suggest that metabolic factors inherent to diabetes influence homocysteine metabolism.

OBJETIVO: Determinar os níveis plasmáticos de homocisteína de jejum e após sobrecarga de metionina e correlacionar a homocisteinemia com o polimorfismo C677T e A1298C da metilenotetra-hidrofolato redutase (MTHFR) em diabéticos tipo 2. SUJEITOS E MÉTODOS: O estudo incluiu 50 adultos diabéticos tipo 2 (Grupo DM) e 52 indivíduos saudáveis (Grupo controle). Obtiveram-se os dados antropométricos, de ingestão alimentar, níveis séricos de vitamina B12, ácido fólico e homocisteína plasmática. Os polimorfismos C677T e A1298C foram identificados no gene da enzima MTHFR. RESULTADOS: Não houve diferença na homocisteinemia entre os grupos, embora a hiper-homocisteinemia de jejum tenha ocorrido em 40% dos diabéticos e 23% dos controles. Para o mesmo polimorfismo, não houve diferenças na homocisteinemia entre os grupos de estudo. Nos controles, a homocisteína foi maior entre aqueles com polimorfismos C677T e A1298C. Os diabéticos com polimorfismo A1298C apresentaram menores níveis de homocisteína quando comparados àqueles com polimorfismo C677T. CONCLUSÃO: Os polimorfismos da MTHFR (C677T e A1298C) resultaram em resposta distinta na homocisteinemia entre os indivíduos dentro de cada grupo (diabéticos e controles). Os dados sugerem que fatores metabólicos inerentes ao estado diabético influenciam o metabolismo da homocisteína.