A triple-masked, two-center, randomized parallel clinical trial to assess the superiority of eight weeks of grape seed flour supplementation against placebo for weight loss attenuation during perioperative period in patients with cachexia associated with colorectal cancer: a study protocol.

Background: Progressive, involuntary weight and lean mass loss in cancer are linked to cachexia, a prevalent syndrome in gastrointestinal malignancies that impacts quality of life, survival and postoperative complications. Its pathophysiology is complex and believed to involve proinflammatory cytokine-mediated systemic inflammation resulting from tumor-host interaction, oxidative stress, abnormal metabolism and neuroendocrine changes. Therapeutic options for cachexia remain extremely limited, highlighting the need for clinical research targeting new interventions. Thus, this study primarily assesses the effects of grape-seed flour (GSF), rich in polyphenols and fibers, for attenuating perioperative weight loss in colorectal cancer. Methods: This is a dual-center, triple-masked, placebo-controlled, parallel-group, phase II, randomized clinical trial designed to investigate GSF supplementation in subjects with pre- or cachexia associated with colorectal cancer during the perioperative period. Eighty-two participants will receive 8g of GSF or cornstarch (control) for 8 weeks. Assessments are scheduled around surgery: pre-intervention (4 weeks prior), day before, first week after, and post-intervention (4 weeks later). The primary endpoint is the difference in body weight mean change from baseline to week 8. The secondary endpoints describe the harms from 8-week supplementation and assess its superiority to improve body composition, post-surgical complications, quality of life, anorexia, fatigue, gastrointestinal symptoms, and handgrip strength. The study will also explore its effects on gut bacteria activity and composition, systemic inflammation, and muscle metabolism. Discussion: The current trial addresses a gap within the field of cancer cachexia, specifically focusing on the potential role of a nutritional intervention during the acute treatment phase. GSF is expected to modulate inflammation and oxidative stress, both involved in muscle and intestinal dysfunction. The research findings hold substantial implications for enhancing the understanding about cachexia pathophysiology and may offer a new clinical approach to managing cachexia at a critical point in treatment, directly impacting clinical outcomes. Trial registration: The Brazilian Registry of Clinical Trials (ReBEC), RBR-5p6nv8b; UTN: U1111-1285-9594. Prospectively registered on February 07, 2023.

Feeding Pattern, Circadian Rhythm, and Immune Function: What do we know about?

Feeding pattern is related to health status or chronic diseases, and this depends on the individual's eating habits. Feeding organized with the right time to start and end during the day, promotes an internal biological rhythm, favoring molecular synchronization of the clock genes, which impose an effect on metabolism and immune cells, creating a physiological response related to a healthy profile. On the other hand, a feeding pattern disorganized, without the right time to start and end eating during the day, might lead to nonsynchronization of the clock genes, a disruption condition, which is related to chronic diseases, such as obesity and diabetes type 2. A strategy that should be adopted to favor molecular synchronization is time-restricted eating (TRE), which can organize the initial and end of the eating patterns during the day. Our review points out some cues that suggest TRE as an efficient strategy for healthy profile and can be a good intervention for the treatment of chronic diseases.

Effects of Capsiate Supplementation on Maximal Voluntary Contraction in Healthy Men.

This study aimed to investigate the effects of acute capsaicin analog (Capsiate - CAP) supplementation on maximal voluntary isometric contraction (MVIC) performance in healthy young men. Thirteen subjects (25.2±3.2 yrs) participated in the present study. In two different days separated by one week, the subjects ingested capsiate (12 mg) or placebo (starch: 12 mg) 45 minutes before a MVIC test. The MVIC test consisted of five 10-second knee extension maximal isometric contractions with 45 seconds of recovery between efforts. The peak force, mean force, minimum force, fatigue index, and area under the curve of each contraction were calculated. Main condition effect was found, with higher values of peak force (+4.83%, F=6.867, p=0.02), fatigue index (+8.96%, F=5.228, p=0.041), and area under the curve (+4.19%, F=4.774, p=0.04) for CAP compared to placebo, however, no interaction effect was found for any variable (F=0.090 to 1.356, p≥0.276). In summary, healthy young men produced higher maximal isometric force and delayed fatigue in the CAP condition compared to placebo condition (condition effect) but without significant difference between each effort.

Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link?

Coronavirus disease 2019 (COVID-19) is an emerging disease that has reached pandemic status by rapidly spreading worldwide. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension show a higher risk of hospitalization, severe disease, and mortality by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These patients frequently show exacerbated secretion of proinflammatory cytokines associated with an overreaction of the immune system, the so-called cytokine storm. Host nutritional status plays a pivotal role in the outcome of a variety of different infectious diseases. It is known that the immune system is highly affected by malnutrition, leading to decreased immune responses with consequent augmented risk of infection and disease severity. Body composition, especially low lean mass and high adiposity, has consistently been linked to worsened prognosis in many different diseases. In this review, evidence concerning the impact of nutritional status on viral infection outcomes is discussed.

Myokines in treatment-naïve patients with cancer-associated cachexia.

Cancer-associated cachexia is a complex metabolic syndrome characterized by weight loss and systemic inflammation. Muscle loss and fatty infiltration into muscle are associated with poor prognosis in cancer patients. Skeletal muscle secretes myokines, factors with autocrine, paracrine and/or endocrine action, which may be modified by or play a role in cachexia. This study examined myokine content in the plasma, skeletal muscle and tumor homogenates from treatment-naïve patients with gastric or colorectal stages I-IV cancer with cachexia (CC, N = 62), or not (weight stable cancer, WSC, N = 32). Myostatin, interleukin (IL) 15, follistatin-like protein 1 (FSTL-1), fatty acid binding protein 3 (FABP3), irisin and brain-derived neurotrophic factor (BDNF) protein content in samples was measured with Multiplex technology; body composition and muscle lipid infiltration were evaluated in computed tomography, and quantification of triacylglycerol (TAG) in the skeletal muscle. Cachectic patients presented lower muscle FSTL-1 expression (p = 0.047), higher FABP3 plasma content (p = 0.0301) and higher tumor tissue expression of FABP3 (p = 0.0182), IL-15 (p = 0.007) and irisin (p = 0.0110), compared to WSC. Neither muscle TAG content, nor muscle attenuation were different between weight stable and cachectic patients. Lumbar adipose tissue (AT) index, visceral AT index and subcutaneous AT index were lower in CC (p = 0.0149, p = 0.0455 and p = 0.0087, respectively), who also presented lower muscularity in the cohort (69.2% of patients; p = 0.0301), compared to WSC. The results indicate the myokine profile in skeletal muscle, plasma and tumor is impacted by cachexia. These findings show that myokines eventually affecting muscle wasting may not solely derive from the muscle itself (as the tumor also may contribute to the systemic scenario), and put forward new perspectives on cachexia treatment targeting myokines and associated receptors and pathways.

Liver lipid metabolism disruption in cancer cachexia is aggravated by cla supplementation -induced inflammation.

BACKGROUND & AIMS: The liver is the main organ regulating metabolism. In spite of that, few studies examine liver metabolism in cachexia, a wasting syndrome associated with increased morbidity and mortality in cancer. Cachexia induces major metabolic disruption, inflammation and fat and lean mass loss. We have previously shown impairment of hepatic lipid metabolism in cancer cachexia that contributes to the aggravation of the symptoms. The present study addresses the effects of Conjugated Linoleic Acid supplementation upon liver lipid metabolism in cachectic rats. METHODS: Male Wistar rats were randomly assigned to control groups (C) receiving 0.9 NaCl (Placebo CP); or to groups supplemented with sunflower oil (CSF), supplemented with CLA (CCLA), or still, to tumour bearing animals (T) receiving NaCl (TP), sunflower oil (TSF), or CLA (TCLA). Supplementation (0.5 ml) by gavage was carried out for 14 days. Body weight, dietary intake, glucose, cholesterol and triacylglycerol plasma content, liver glycogen and triacylglycerol content and mRNA expression of liver carnitine palmitoyltransferase I and II (CPT I and II), as well as microsomal triglyceride transfer protein (MTP), liver fatty acid-binding protein (L-FABP), peroxisome proliferator-activated receptor-alpha (PPAR-alpha), and apolipoprotein B (apoB), were assessed. RESULTS: Liver CPT II activity was reduced in all groups, when compared with CP. Hepatic mRNA expression of MTP, apoB and FABP was reduced in TCLA, when compared with all groups. TCLA also presented increased hepatic and plasma triacylglycerol content, when compared with all T groups. Adipose tissue-derived inflammatory factors were assessed. No differences among the groups were observed in regard to Retro Peritoneal Adipose Tissue cytokine (IL-1ß, IL-6, and TNF-α) protein content and expression, with the exception of IL-10 in tumour-bearing animals. In the Epididymal Adipose Tissue, the inflammatory cytokines were augmented in TCLA, compared with all other groups. CONCLUSION: CLA supplementation fails to promote the re-establishment of hepatic lipid metabolism in tumour-bearing animals, and therefore is not recommended in cancer-related cachexia.

Formação interprofissional e produção do cuidado: análise de uma experiência / Interprofessional education and provision of care: analysis of an experience

Resumo Este artigo tem como objetivo apresentar e analisar uma experiência de formação interprofissional que ocorre desde 2008, envolvendo estudantes do terceiro ano de graduação dos cursos de Educação Física, Nutrição, Psicologia, Fisioterapia e Terapia Ocupacional de uma universidade pública. Ao longo do semestre, equipes mistas de estudantes, supervisionadas por duplas de docentes, também de diferentes áreas profissionais, realizam atendimentos semanais e elaboram projetos de cuidado para pessoas/grupos selecionados por equipes dos serviços. A metodologia utilizada envolveu a produção de narrativas de situações marcantes vivenciadas por docentes nas atividades de ensino, das quais foram discernidas questões que têm se colocado nesta proposta de formação. A discussão de tais questões indicou as potencialidades de intervenções em comum e os desafios da supervisão docente para sustentar a experiência dos estudantes e possibilitar a constituição de uma clínica que valorize a perspectiva dos usuários.(AU)

Resumen El objetivo de este artículo es presentar y analizar una experiencia de formación interprofesional que se realiza desde 2008, con estudiantes del tercer año de graduación de los cursos de Educación Física, Nutrición, Psicología, Fisioterapia y Terapia Ocupacional de una universidad pública brasileña. A lo largo del semestre, equipos mixtos de estudiantes, supervisados por dúos de docentes, también de diferentes áreas profesionales, realizan atenciones semanales y elaboran proyectos de cuidado para personas/grupos seleccionados por equipos de los servicios. La metodología utilizada envolvió la producción de narrativas de situaciones señaladas vividas por docentes en las actividades de enseñanza, a partir de las cuales surgieron cuestiones que se plantean en esta propuesta de formación. La discusión de estas cuestiones mostró las potencialidades de intervenciones en común y los desafíos de la supervisión docente para mantener la experiencia de los estudiantes y posibilitar la constitución de una clínica que valore la perspectiva de los usuarios.(AU)

Abstract This article This article aims to present and analyze an interprofessional education experience that started in 2008 involving third-year students of the undergraduate courses of Physical Education, Nutrition, Psychology, Physiotherapy and Occupational Therapy of a public university. During the semester, teams of different students supervised by two teachers each, also from different professional areas, provided weekly care service and developed care projects aimed at specific people/groups chosen by the service team. The methodology included the production of narratives of significant situations experienced by the teachers in their education activities. Based on these narratives, the issues presented in this education proposal were detected. The discussion of these issues showed potential common interventions and the challenges faced by teacher supervision in maintaining the students' experience and enabling the creation of a clinic that values the users' perspective.(AU)

Efeito da temporada de basquetebol profissional sobre o perfil lipídico / Effect of the professional basketball season on the lipids profile

O objetivo do presente estudo foi verificar o efeito da temporada de basquetebol profissional sobre o perfil lipídico. Sete jogadores profissionais (idade: 23,6 mais ou menos 4,3 anos; massa corporal: 110,2 mais ou menos 17,5 kg; estatura: 195,4 mais ou menos 10,3 cm) foram avaliados antes e após um período de 4 meses, relativos a uma temporada nacional de basquetebol profissional (2 partidas por semana, 2 a 3 sessões de treinos técnicos e tático, 2 a 3 sessões de treino de musculação, 1 a 2 sessões de treino regenerativo e 1 dia de descanso passivo, sendo todos a média por semana) . Os jogadores foram submetidos a análise antropométrica e coleta sanguínea. A primeira visita foi feita antes do início da temporada e a segunda visita dois dias (48 horas) após o término da última partida da temporada. Foram realizadas análises do perfil lipídico (TAG - Triacilglicerol, VLDL - Very low density lipoprotein, LDL-c – Low density lipoprotein cholesterol, HDL-c –high density lipoprotein cholesterol, e colesterol total) por kits comerciais (Labtest®, Brasil). A comparação entre os resultados foi realizada pareadamente (antes e depois o início da temporada) por teste não paramétrico de Wilcoxon. Utilizou-se o nível de significância de 5% (p menor que 0,05). Após a temporada, foi demonstrada diminuição nas concentrações da LDL-c (pré: 111,40 mais ou menos 9 mg/dL vs pós: 84,60 mais ou menos 8,50 mg/dL; p menor que 0,05), bem como do colesterol total (pré: 171,20 mais ou menos 6,44 mg/dL vs pós: 148,20 mais ou menos 6,37 mg/dL; p menor que 0,05). Além disso, foi encontrado aumento na taxa HDL/colesterol total (pré: 0,22 mais ou menos 0,03 vs pós: 0,27 mais ou menos 0,06; p menor que 0,05)...

The aim of the present study was to verify the effect of the professional basketball season on the lipids profile. Seven professional players (age: 23.6 more or less 4.3 years; body mass: 110.2 more or less 17.5 kg; height: 195.4 more or less 10.3 cm) were evaluated before and after a period ranging 4 moths, during national professional basketball season (2 games per week, 2 to 3 tactical and technical exercise workout, 2 to 3 strength exercise workout, 1 to 2 recuperative workout and 1 day of passive rest, all of then as a median per week). Blood samples and anthropometric measures were taken. The first visit was made before the beginning of the season and the second visit two days (48 hours) after the ending of the last game of the season. The lipids profile (TG - Triglyceride, VLDL - very low density lipoprotein, LDL-c – Low density lipoprotein cholesterol, HDL-c – High density lipoprotein cholesterol, and total cholesterol) was analyses by commercial kits (Labtest®, Brazil). The comparison between the results (before and after) was carried through by non parametric Wilcoxon pair test. The level of significance of 5% was used (p smaller that 0.05). After basketball season, a reduction in the LDL-c plasma concentrations was demonstrated (before: 111.40 more or less 9 mg/dL after: 84.60 more or less 8.50mg/dL; p smaller that 0.05), as well as in total cholesterol (before: 171.20 more or less 6.44 mg/dL after: 148.20 more or less 6.37 mg/dL; p smaller that 0.05). Besides, increase in rate the HDL/total cholesterol was found (before: 0.22 more or less 0.03 after: 0.27 more or less 0.06; p smaller that 0.05). The results herein found indicate that the basketball season may induce changes in LDL-c, total cholesterol and in rate the HDL/total cholesterol concentrations, suggesting a modulatory effect on the lipid profile in professional basketball player after 4 moths season.

Influência do treinamento físico aeróbio no transporte mitocondrial de ácidos graxos de cadeia longa no músculo esquelético: papel do complexo carnitina palmitoil transferase / Influence of aerobic physical training in the motochondrial transport of long chain fatty acids in the skeletal muscle: role of the carnitine palmitoil transferase

O ácido graxo (AG) é uma importante fonte de energia para o músculo esquelético. Durante o exercício sua mobilização é aumentada para suprir as necessidades da musculatura ativa. Acredita-se que diversos pontos de regulação atuem no controle da oxidação dos AG, sendo o principal a atividade do complexo carnitina palmitoil transferase (CPT), entre os quais três componentes estão envolvidos: a CPT I, a CPT II e carnitina acilcarnitina translocase. A função da CPT I durante o exercício físico é controlar a entrada de AG para o interior da mitocôndria, para posterior oxidação do AG e produção de energia. Em resposta ao treinamento físico há um aumento na atividade e expressão da CPT I no músculo esquelético. Devido sua grande importância no metabolismo de lipídios, os mecanismos que controlam sua atividade e sua expressão gênica são revisados no presente estudo. Reguladores da expressão gênica de proteínas envolvidas no metabolismo de lipídios no músculo esquelético, os receptores ativados por proliferadores de peroxissomas (PPAR) alfa e beta, são discutidos com um enfoque na resposta ao treinamento físico.

Fatty acids are an important source of energy for the skeletal muscle. During exercise, their mobilization is increased to supply the muscle energetic needs. Many points of regulation act in the fatty acids metabolism, where the carnitine palmytoiltransferase (CPT) complex is the main control system. Three compounds named CPT I, CPT II and carnitine acyl carnitine translocase (CACT) are components of this system. Its function is to control the influx of fatty acids inside the mitochondria for posterior oxidation and energy production. There is a pronounced increase in both activity and gene expression of CPT I in the skeletal muscle in response to exercise. Due to its importance in lipid metabolism, the controlling mechanisms are reviewed in the present study. The modulation of gene expression by peroxisome proliferator-activated receptors (PPARs) alpha and beta during the physical training is also discussed in this review.