Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity.

OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.

Cinnamon Infusion Reduces Satiety and Increases Energy Intake: A Randomized Crossover Trial.

BACKGROUND/AIMS: This study aimed to evaluate the effects of the intake of a single dose of cinnamon infusion on energy metabolism, appetite responses, and food intake in healthy individuals. METHODS: This was an open randomized crossover clinical trial, with a minimum washout of 7 days, in which two standardized breakfasts were served randomly: one with cinnamon infusion (2 g, Cinnamomum sp.) and one with water (control). The study included 21 healthy volunteers. Energy expenditure (EE), diet-induced thermogenesis (DIT), respiratory quotient (RQ), substrate oxidation, and appetite responses were evaluated, as well as prospective food intake. RESULTS: Ingestion of cinnamon infusion did not alter EE, DIT, RQ, or substrate oxidation. The incremental area under the curve for hunger, satiety, and desire to eat did not differ between the treatment with cinnamon infusion and water; however, there was a reduction in the feeling of satiety (p = 0.021) compared to the control treatment. The energy consumption of the first meal after treatment was higher (p = 0.05) in the treatment with cinnamon infusion than in the control treatment. Regarding macronutrients or food intake throughout the day, there was no difference between treatments. CONCLUSIONS: Although it did not affect energy metabolism, consuming a single dose of cinnamon infusion promoted less feeling of satiety and increased energy intake in the first meal after treatment. The study protocol was registered at the Brazilian Clinical Trials Registry Platform (RBR-5ftg3z).

Effect of thermal processing on the antigenicity of allergenic milk, egg and soy proteins.

The detection of allergenic proteins and the influence of processing on the structure and antigenicity of these proteins are relevant topics. Using commercial enzyme-linked immunosorbent assay kits, this study aimed to evaluate the degradation profiles of milk, egg and soy proteins during the processing of semisweet biscuits. The formulations were baked under different conditions according to a complete factorial experiment that included a three-level temperature factor and a six-level time factor. ß-lactoglobulin and egg white proteins were severely degraded, the degradation of casein was intermediate, and soy proteins were the most stable. Complete allergen protein degradation was found under only the extreme baking conditions, which resulted in products that were not sensorily acceptable. Residual levels of the proteins were detected after baking, indicating that this thermal processing reduced but did not eliminate the antigenicity of these proteins; thus, baking cannot be considered a strategy to protect allergic consumers.

The impact of L-branched-chain amino acids and L-leucine on malnutrition, sarcopenia, and other outcomes in patients with chronic liver disease.

INTRODUCTION: Metabolic and hormonal disorders resulting from chronic liver diseases culminate in increased proteolysis and decreased protein synthesis, which contributes to the development and progression of malnutrition and, consequently, sarcopenia. Nutritional management of sarcopenia in liver cirrhosis is a continuously evolving field and data on essential amino acid supplementation in chronic liver diseases is scarce. AREAS COVERED: This review encompasses the current literature on oral amino acids supplementation in patients with chronic liver disease or patients with liver cirrhosis to try to elucidate the possible effects of L-branched-chain amino acids and isolated L-leucine as a therapeutic approach to malnutrition and sarcopenia. EXPERT COMMENTARY: To ensure an optimal nutritional status and to reduce sarcopenia, it is necessary to assess nutritional status in all patients with liver cirrhosis and to apply nutritional interventions accordingly. The supply of calories, proteins, and essential amino acids is necessary for the maintenance of muscle mass and function. Although supplementation of L-branched-chain amino acids plays an important role in liver disease, L-leucine has been described as the main amino acid involved in protein turnover, reducing proteolysis, and stimulating protein synthesis.

Energy expenditure in the immediate postpartum period: Indirect calorimetry versus predictive equations.

OBJECTIVE: The aim of this study was to evaluate the resting energy expenditure (REE) of postpartum women by indirect calorimetry and to provide the most appropriate predictive equations to estimate it. METHODS: This was a cross-sectional study with 79 women in the maternity unit of a Brazilian city hospital. Information regarding age, income, gestational age, and breastfeeding was collected. Height, weight, and body composition were measured. We measured REE by indirect calorimetry and predicted REE using eight equations. Analysis of comparison, correlation, agreement, and accuracy was performed. RESULTS: The median of measured REE was 1224 kcal (95% confidence interval [CI], 1157.4-1330), and the predicted REE ranged from 1213.8 (95% CI, 1207.3-1261.9) to 1553.1 kcal (95% CI, 1430.8-1488.5). No difference was found in REE between mothers who breastfed and those who did not (P = 0.994); however, there was a positive correlation with lean mass (r = 0.336; P = 0.003) and weight (r = 0.237; P = 0.036). The best predictor of REE was the Harris Benedict equation, with lower difference (P = 0.876), better median of adequacy (99.8%), and better interclass correlation coefficient (0.289). The Schofield equation was next, with greater percentage of accuracy (33.3%) and lower opposite agreement (7.6%). CONCLUSIONS: All predictive equations showed low agreement and accuracy, and, in most cases, the results were overestimated. These findings indicate the need for continued studies to propose more suitable methods to determine the energy requirements for this population.

[Perception of students of a public university on the Education Program for Work in Health]. / Percepção dos alunos de uma universidade pública sobre o Programa de Educação pelo Trabalho para a Saúde.

This study sought to analyze the Education Program for Work in Health from the perspective of students at a public university in Belo Horizonte, State of Minas Gerais, in their first year and its impact on the students' qualification. It is a prospective cohort study with students who participated on this program, and the data was collected by a structured and self-applied questionnaire, during the sixth and tenth months of the program, with sociodemographic questions, methodology, aims and impact of the program. The majority reported that the program's proposed aims were attained, especially interdisciplinary work and academic research focused on the Unified Health System's needs. The program also contributed to training in research, teaching and extension work, and in the second evaluation, the students reported greater interaction with social equipment. It is considered that the program is an important strategy for human resources training in accordance with the Unified Health System's needs, by enabling the exercise of teamwork, communication, agility and creativity to deal with adverse situations, as well as the practice of the primary health care principles integrated in the community.