Association between functional aspects and health-related quality of life in patients with colorectal cancer: can handgrip strength be the measure of choice in clinical practice?

PURPOSE: We aimed to investigate the association between handgrip strength (HGS) and health-related quality of life (HRQoL) in patients with colorectal cancer (CRC). A cross-sectional study was conducted including CRC patients. METHODS: We performed an assessment of aspects of functional health using the criteria of frailty phenotype (defined by Fried et al., 2001), sarcopenia (defined by the European Working Group on Sarcopenia in Older People 2, 2018) and by HGS, which measures muscle strength using a manual dynamometer. HRQoL was assessed using the EORTC questionnaire QLQ-C30. Analyses of variance and multivariate linear regression were used to compare frailty, sarcopenia, and HGS with HRQoL. RESULTS: A total of 142 patients were included (age 62.7 ± 11.4 years; 56.3% women; 18.3% of patients with frailty; 9.9% with sarcopenia, and 15.5% had low HGS). After adjusting for sociodemographic, clinical, and nutritional variables, the regression analysis showed that frailty and sarcopenia were associated with worse HRQoL. Low HGS was associated with worse HRQoL in patients with CRC regardless of both frailty components (global health status: B = - 13.4, p = 0.004; physical function: B = - 10.4, p = 0.006; emotional function: B = - 18.1, p = 0.041; fatigue: B = 9.1, p = 0.027; dyspnea: B = 10.7, p = p = 0.024; appetite loss: B = 12.4, p = 0.041) and sarcopenia components (global health status: B = - 13.2, p = 0.004; physical function: B = - 15.0, p = 0.001; emotional function: B = - 25.1, p = 0.006; fatigue: B = 15.2, p = 0.007; pain: B = 18.7, p = 0.024, dyspnea: B = 11.4, p = 0.017). CONCLUSION: We concluded that HGS was positively associated with HRQoL in patients with CRC and may initially be the variable of choice in clinical practice, which is associated with HRQoL.

Nutritional status at hospital admission and prediction of clinical outcomes in children and adolescents with cancer: Results of the Brazilian survey on oncological nutrition in paediatrics.

BACKGROUND: Changes in nutritional status are recognised as predictors of unfavourable outcomes in children and adolescents with cancer, particularly in developing countries. There have been no studies on children and adolescents with cancer from every region of Brazil or on the impact of nutritional status on clinical outcomes. The aim of this study is to assess the association between the nutritional status of children and adolescents with cancer and the prediction of clinical outcomes. METHODS: This was a longitudinal, multicentre, hospital-based study. An anthropometric nutritional assessment was performed, and the Subjective Global Nutritional Assessment (SGNA) was administered within 48 h of admission. Seven hundred and twenty-three patients (aged 2-18 years) were included in the sample, undergoing cancer treatment. They were recruited in 13 reference centres in the five macro-regions of Brazil between March 2018 and August 2019. The outcomes evaluated were readmission within 30 days and death within 60 days of admission. To identify predictors of 60-day survival, Cox regression and log-rank statistics were used to compare Kaplan-Meier curves between the strata. RESULTS: About 36.2% (n = 262) of the samples were malnourished according to the SGNA. Severe malnutrition by the SGNA (relative risk [RR] = 8.44, 95% confidence interval [CI]: 3.35-21.3, P = 0.001) and living in the North region (RR = 11.9, 95% CI: 3.34-42.7, P = 0.001) were associated with the poorest survival. The North (RR = 5.77, 95% CI: 1.29-25.8, P = 0.021), Northeast (RR = 1.46, 95% CI: 1.01-2.11, P = 0.041), Midwest (RR = 0.43, 95% CI: 0.20-0.095, P = 0.036), age group 10-18 years (RR = 0.65, 95% CI: 0.45- 0.94, P = 0.022) and haematologic malignancy (RR = 1.52, 95% CI: 1.10-2.10, P = 0.011) were predictors of readmission within 30 days. CONCLUSIONS: The prevalence of malnutrition was high and related to death. These results highlight the need to use the SGNA in clinical practice alongside classic anthropometric methods for the diagnosis of malnutrition, and the need to standardise care across all Brazilian regions, which should include nutritional care for children and adolescents with cancer.

Predictive validity of GLIM malnutrition diagnosis in patients with colorectal cancer.

BACKGROUND: Considering that the validation of the Global Leadership Initiative on Malnutrition (GLIM) remains unclear in patients with colorectal cancer, the present study aimed to assess the agreement, accuracy, sensitivity, specificity, and prognostic effect of the GLIM on survival when compared with the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: Patients with colorectal cancer who were scheduled to undergo a routine abdominal computed tomography (CT) scan were recruited. Using the GLIM two-step approach, the patients were first screened for malnutrition by using the PG-SGA Short Form (score ≥3). The malnutrition diagnosis was based on the etiologic (disease burden [cancer] or reduced food intake) and phenotypic GLIM criteria, including weight loss, body mass index, and skeletal muscle index at the third lumbar vertebra when using the CT scans. The food intake was assessed by the PG-SGA. RESULTS: This study included 191 patients (age, 60.5 ± 11.3 years; 57% men), and 23% and 32% were malnourished according to the GLIM and the PG-SGA, respectively. The GLIM revealed fair sensitivity (64%), good agreement (kappa = 0.65), specificity (96%), and diagnostic accuracy for detecting malnutrition (area under the receiver operating characteristic curve = 0.80; 95% CI, 0.72-0.88) when compared with the PG-SGA. The malnutrition value according to the GLIM and the PG-SGA was associated with short-term survival. However, only the PG-SGA was associated with long-term survival. CONCLUSIONS: Although showing fair sensitivity, the GLIM had good agreement, specificity, and diagnostic accuracy for malnutrition detection and was an independent predictor of short-term survival in patients with colorectal cancer.

Construction of a nutritional assessment tool for the pediatric cancer population (ANPEDCancer): content validation using the Delphi method / Construção de um instrumento de avaliação nutricional para a população pediátrica com câncer (ANPEDCancer): validação de conteúdo pelo método Delphi

ABSTRACT Objective: To develop and establish content validation of a nutritional assessment tool for pediatric cancer patients using the Delphi method. Methods: A literature review was performed and the nutritional assessment in pediatrics and cancer construct was discussed with experts. Forty-six nutrition experts from Brazil with experience in oncology participated in the panel. Rounds were held to discuss and judge the items that should be included in this tool. With the aid of an algorithm, it was possible to simultaneously consider the adequacy, relevance and measurement of the items. The consensus was reached with an agreement equal to or greater than 80% among the experts. Results: From the 7 domains suggested by the literature, the first round generated 81 items, which were assessed for adequacy, relevance and the possibility of being measured in the routine of nutritional assessment, by specialists in the following two rounds. The percentage of specialists who responded to each round was high (above 90%) and the dropout rate between the stages was relatively low. After applying the algorithm, the ANPEDCancer tool had 36 items considered appropriate by specialists from the five different geographical regions of Brazil. Conclusions: The Delphi method allowed the construction and content validation of the nutritional assessment tool for children and adolescents with cancer, providing the first stage for use in the Brazilian hospital setting.

RESUMO Objetivo: Desenvolver e estabelecer a construção, a validação de conteúdo e a elaboração de um plano de ação para cada diagnóstico nutricional de um instrumento de avaliação nutricional para pacientes pediátricos com câncer por meio do método Delphi. Métodos: Foi realizada uma revisão da literatura e discutido com especialistas o constructo avaliação nutricional em pediatria em câncer. Participaram do painel 46 especialistas nutricionistas do Brasil com experiência em oncologia. Rodadas ocorreram, para discutir e julgar os itens que deveriam constar do instrumento. Com o auxílio de um algoritmo, foi possível ponderar simultaneamente a adequação, relevância e mensuração dos itens. O consenso foi atingido com concordância igual ou superior a 80% entre os especialistas. Resultados: Com base nos sete domínios sugeridos pela literatura científica, a primeira rodada gerou 81 itens, que foram avaliados quanto à adequação, relevância e possibilidade de ser medido na rotina de avaliação nutricional pelos especialistas nas duas rodadas seguintes. O percentual de especialistas que responderam a cada rodada foi alto (acima de 90%), e a desistência entre as etapas, relativamente baixa. Após aplicação do algoritmo, o instrumento ANPEDCancer contou com 36 itens considerados apropriados pelos especialistas das cinco distintas regiões geográficas do Brasil. Conclusões: O método Delphi permitiu a construção e validação de conteúdo do instrumento de avaliação nutricional para crianças e adolescentes com câncer, fornecendo uma primeira versão a ser aplicada e avaliada no cenário hospitalar brasileiro.

Construction of a nutritional assessment tool for the pediatric cancer population (ANPEDCancer): content validation using the Delphi method.

OBJECTIVE: To develop and establish content validation of a nutritional assessment tool for pediatric cancer patients using the Delphi method. METHODS: A literature review was performed and the nutritional assessment in pediatrics and cancer construct was discussed with experts. Forty-six nutrition experts from Brazil with experience in oncology participated in the panel. Rounds were held to discuss and judge the items that should be included in this tool. With the aid of an algorithm, it was possible to simultaneously consider the adequacy, relevance and measurement of the items. The consensus was reached with an agreement equal to or greater than 80% among the experts. RESULTS: From the 7 domains suggested by the literature, the first round generated 81 items, which were assessed for adequacy, relevance and the possibility of being measured in the routine of nutritional assessment, by specialists in the following two rounds. The percentage of specialists who responded to each round was high (above 90%) and the dropout rate between the stages was relatively low. After applying the algorithm, the ANPEDCancer tool had 36 items considered appropriate by specialists from the five different geographical regions of Brazil. CONCLUSIONS: The Delphi method allowed the construction and content validation of the nutritional assessment tool for children and adolescents with cancer, providing the first stage for use in the Brazilian hospital setting.

Performance of subjective global nutritional assessment in predicting clinical outcomes: Data from the Brazilian survey of pediatric oncology nutrition.

BACKGROUND: Methods for assessing nutritional status in children and adolescents with cancer is a difficult in clinical practice. The study aimed to evaluate the performance of Subjective Global Nutritional Assessment (SGNA) in predicting clinical outcomes in children and adolescents with cancer in Brazil. METHODS: This was a prospective cohort multicenter study. It was included 723 children and adolescents with cancer aged 2-18 years between March 2018 and August 2019. Nutritional assessment was performed according to World Health Organization recommendations and using SGNA within 48h of hospitalization. Unplanned readmission, length of hospital stay, and post-discharge death were analyzed. Cohen's kappa coefficient was used to ascertain the agreement between body mass index for age (BMI/A) and SGNA. The sensitivity, specificity, positive and negative predictive values, and accuracy of SGNA were estimated. Odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated using multiple logistic regression. RESULTS: The mean patient age was 9.4 ± 4.9 years. SGNA showed that 29.7% (n = 215) and 6.5% (n = 47) patients had moderate and severe malnutrition, respectively. Considering the concurrent validity criterion, SGNA had an OR (95% CI) of 6.8 (3.1-14.9) for predicting low and very low weight for age at admission, with a sensitivity and specificity of 72.4% (59%-82.1%) and 72% (64.2%-78.9%), respectively. SGNA could predict death in children with severe/moderate malnutrition, with an accuracy of 63.8% (63%-65.1%). Logistic multivariate analysis showed that the adjusted effect of death; hematological tumor; living in the northeast, southeast, and midwest regions of Brazil; and older age was associated with malnutrition according to SGNA. CONCLUSION: Based on concurrent validity between SGNA and anthropometry, SGNA performed well and had a good ability to predict death in Brazilian children with cancer.

Phase angle as a marker for muscle abnormalities and function in patients with colorectal cancer.

BACKGROUND AND AIMS: Considering the applicability of phase angle (PhA) as a marker of muscle mass and function, we aimed to investigate whether PhA is a predictor of muscle abnormalities and function in patients with cancer. METHODS: In a sample of patients with colorectal cancer (CRC), PhA was obtained from measurements of resistance and reactance from bioelectrical impedance analysis. Computerized tomography imaging at the third lumbar vertebra was used to evaluate muscle abnormalities by quantifying skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD). Muscle function was assessed by handgrip strength (HGS) and gait speed (GS). RESULTS: This cross-sectional study included 190 participants (X±SD), mean age 60.5 ± 11.3 years; 57% men; 78% had cancer stages III to IV. PhA was highly correlated with SMI (r = 0.70) and moderately correlated with HGS (r = 0.54). PhA explained 48% of the SMI variability (R2 = 0.485), 21% of the SMD variability (R2 = 0.214), 26% of HGS (R2 = 0.261) and 9.8% of GS (R2 = 0.098). In the multivariate model adjusted for age, sex, body mass index, performance status, comorbidities and cancer stage, 1-degree decrease in PhA was associated with low SMI (Odds Ratio (OR) = 6.56, 95% CI: 2.90-14.86) and with low SMI and HGS combined (OR = 11.10, 95% CI: 2.61-47.25). In addition, Receiving Operating Characteristics curve analysis showed that PhA had a good diagnostic accuracy for detecting low SMI, low SMI and SMD combined, low SMD and HGS and low SMI and HGS combined (AUC = 0.81, 95% CI: 0.74-0.88; AUC = 0.88, 95% CI: 0.81-0.95; AUC = 0.80, 95% CI: 0.70-0.91; AUC = 0.82, 95% CI: 0.74-0.89; respectively). CONCLUSIONS: PhA was a predictor of muscle abnormalities and function and had a good diagnostic accuracy for detecting low muscle mass, low muscle mass and radiodensity, low muscle radiodensity and strength, and low muscle mass and strength in patients with CRC.

Association between nutritional status and muscle strength in pediatric cancer patients.

BACKGROUND & AIMS: Cancer provides a catabolic state, leading to weight loss and depletion of lean mass, which is accompanied by loss of muscle strength in pediatric patients. Muscle strength is considered a predictor of nutritional status. The aim was to evaluate the association between nutritional status and muscle strength in pediatric cancer patients hospitalized at the Cancer Hospital I. METHODS: A cross-sectional study was carried out with cancer patients aged 6-19 years hospitalized in the period from February to November 2019. In the first 48 h of hospitalization, anthropometric (body weight, height, mid-upper arm circumference - MUAC, tricipital skinfold - TSF, calculated body mass index - BMI and mid-arm muscle circumference - MAMC) and handgrip strength (HGS) assessments were performed. The statistical analysis for the data correlation was performed using Pearson's coefficient, linear regression, and association by χ2 test. The HGS values were distributed in quartiles. P-value < 0.05 was considered significant. RESULTS: The sample consisted of 63 patients, 52.40% male and 47.60% female. The mean age was 13.01 (±3.83; 6.20-19.78) years. The frequency of adequate BMI was 45.60% and the mean HGS was 17.10 kg (±8.93). There was a strong positive correlation between HGS and MAMC and weight (r = 0.743; p < 0,001 and r = 0.706; p < 0,001, respectively), and association with MAMC independently of age and sex. According to quartile distribution, the lowest HGS quartile also showed association with below adequate MAMC (p = 0.005). CONCLUSIONS: These results showed muscle strength was associated with nutritional status and low muscle strength was associated with low muscle mass, independently of age and sex.

Influence of nutritional status and frailty phenotype on health-related quality of life of patients with bladder or kidney cancer.

PURPOSE: This research aimed to assess the impact of nutritional status and frailty in the health-related quality of life (HRQoL) of patients with bladder or kidney cancer. METHODS: This was a cross-sectional study with individuals aged 20 years or older. Frailty phenotype was defined using the criteria of Fried et al. (2001). Patient-Generated Subjective Global Assessment (PG-SGA) classified nutritional status. The European Organization for Research and Treatment of Cancer Quality of life questionnaire Core-30 third version (EORTC QLQ-C30) assessed HRQoL. RESULTS: Forty-four patients with bladder and 44 with kidney cancer, mostly male, with a mean age of 65.9 and 58.6 years, respectively, were evaluated. Presence of frailty was not different between young and older adults. More than 80% of the robust subjects were well-nourished, while there was a predominance of frail with some degree of malnutrition (p < 0.05). The summary score of HRQoL was worse among the frails than pre-frails and robusts, both in bladder (68.5 vs 86.8 vs 89.5; p = 0.002) and in kidney cancer (54.9 vs 82.9 vs 91.4; p < 0.001), as well as in malnourished compared to well-nourished with bladder (72.9 vs 90.3; p = 0.003) and kidney cancer (69.4 vs 88.3; p = 0.001). After adjusted, frailty and malnutrition continued associated with poor summary score (p < 0.05). CONCLUSION: These findings indicate that frailty and malnutrition negatively affect HRQoL of patients with bladder or kidney cancer in several aspects.

Dados do Inquérito Brasileiro de Nutrição Oncológica em Pediatria: Estudo Multicêntrico e de Base Hospitalar / Data from the Brazilian Survey of Pediatric Oncology Nutrition: Multicenter, Hospital-Based Study / Datos de Encuesta Brasileña de Nutrición en Oncología Pediátrica: Estudio Multicéntrico Hospitalario

Introdução: A desnutrição é observada em crianças com câncer e está associada a desfechos clínicos negativos. Objetivo: Descrever a prevalência de inadequação do estado nutricional de crianças e adolescentes com neoplasia maligna na admissão hospitalar em Centros de Referência do câncer infantil no Brasil. Método: Estudo transversal aninhado a um estudo de coorte, multicêntrico, de base hospitalar. A amostra probabilística foi feita em dois estágios em cada estrato por Macrorregião pelo método de probabilidade proporcional ao tamanho com um ano de coleta em cada instituição. Foram coletados em 13 instituições de referência dados clínicos, antropométricos, de composição corporal e sobre o questionário de Avaliação Nutricional Subjetiva Global Pediátrica (ANSGP), em até 48 horas da admissão hospitalar, entre março de 2018 e agosto de 2019. Resultados: O estudo totalizou 723 pacientes nas cinco regiões do Brasil. A prevalência de desnutrição moderada e grave foi de 25,9% na faixa etária de 2 a 5 anos, 40,1% de 5 a 10 anos e 39,7% de 10 a 19 anos, de acordo com ANSGP. Segundo o Índice de Massa Corporal/Idade (IMC/I), magreza e magreza acentuada totalizaram 13%, risco de sobrepeso, sobrepeso e obesidade apresentaram uma prevalência de 26,7% de 2 a 5 anos; 24,9% de 5 a 10 anos; e 25,7% de 10 a 19 anos. Conclusão: Evidenciou-se alta prevalência de inadequação nutricional pela ANSGP, sugerindo que a desnutrição pode ser subdiagnosticada quando utilizado somente o IMC/I, fortalecendo a necessidade de utilização de métodos complementares na avaliação nutricional de crianças com câncer

Introduction: Malnutrition is found in children with cancer and is associated with negative clinical outcomes. Objective: To describe the prevalence of inadequate nutritional status of children and adolescents with malignant neoplasm at hospital admission in childhood cancer reference centers in Brazil. Method: Cross-sectional study nested in a multicenter, hospital-based cohort study. The probabilistic sample was carried out in two stages in each stratum by macro-region using the probability method proportional to the size with one year of collection in each institution. Clinical, anthropometric, body composition data and the Pediatric Subjective Global Nutritional Assessment (SGNA) questionnaire were collected from 13 reference institutions within 48 hours of hospital admission, from March 2018 to August 2019. Results: The study totaled 723 patients in the 5 regions of Brazil. The prevalence of moderate and severe malnutrition was 25.9% in the age group of 2 to 5 years, 40.1% in 5 to 10 years and 39.7% in 10 to 19 years, according to the SGNA. According to the Body Mass/Age Index (BMI/I), thinness and marked thinness totaled 13%, risk of overweight, overweight and obesity showed a prevalence of 26.7% from 2 to 5 years, 24.9% from 5 to 10 years and 25.7% from 10 to 19 years. Conclusion: There was a high prevalence of nutritional inadequacy by the SGNA, suggesting that malnutrition can be underdiagnosed when using only the BMI/I, strengthening the need to use complementary methods in the nutritional assessment of children with cancer

Introducción: La desnutrición se observa en niños con cáncer y se asocia con resultados clínicos negativos. Objetivo: Describir la prevalencia del estado nutricional inadecuado de niños y adolescentes con neoplasia maligna al ingreso hospitalario en centros de referencia de cáncer infantil en Brasil. Método: Estudio transversal anidado en un estudio de cohorte hospitalario multicéntrico. La muestra probabilística se realizó en dos etapas en cada estrato por macrorregión utilizando el método de probabilidad proporcional al tamaño con un año de recolección en cada institución. Se recopilaron datos clínicos, antropométricos, de composición corporal y el cuestionario Global Pediatric Subjective Nutritional Assessment (ANSGP) de 13 instituciones de referencia dentro de las 48 horas posteriores al ingreso hospitalario, desde marzo de 2018 hasta agosto de 2019. Resultados: El estudio totalizó 723 pacientes en las 5 regiones de Brasil. La prevalencia de desnutrición moderada y severa fue de 25,9% en el grupo de edad de 2 a 5 años, 40,1% de 5 a 10 años y 39,7% de 10 a 19 años, según la ANSGP. Según el Índice de Masa Corporal/ Edad (IMC/I), la delgadez y la delgadez marcada totalizaron 13%, el riesgo de sobrepeso, sobrepeso y obesidad mostró una prevalencia de 26,7% de 2 a 5 años, 24,9% de 5 a 10 años y 25,7% de 10 a 19 años. Conclusión: Hubo una alta prevalencia de insuficiencia nutricional por parte de la ANSGP, lo que sugiere que la desnutrición puede ser infradiagnosticada cuando se utiliza solo el IMC/I, fortaleciendo la necesidad de utilizar métodos complementarios en la evaluación nutricional de los niños con cáncer

Caracterização do perfil alimentar e nutricional dos sobreviventes de câncer de cavidade oral e grau de adesão às recomendações de prevenção ao câncer emitidas pelo Fundo Mundial de Pesquisa de câncer e Instituto Americano de Pesquisa de Câncer / Characterization of the food intake and nutritional profile of oral cavity cancer survivors and the adherence degree to cancer prevention recommendations issued by the World Cancer Research Fund and the American Institute for Cancer Research Institute

Introdução: Sobreviventes do câncer de cavidade oral (SCCO) em controle normalmente apresentam inúmeras sequelas derivadas do tratamento oncológico, o que pode comprometer sua alimentação e, por extensão, o atendimento às diretrizes de alimentação e peso adequado emitidas pelo Fundo Mundial para Pesquisa do Câncer/Instituto Americano de Pesquisa para o Câncer (WCRF/AICR). Objetivo: Avaliar o perfil alimentar e o estado nutricional de sobreviventes de câncer de cavidade oral e verificar o grau de sua adesão, as diretrizes de alimentação saudável e peso corporal emitidas pela WCRF / AICR. Método: Estudo transversal que avaliou o estado nutricional pela Avaliação Subjetiva Global produzida pelo paciente (ASG-PPP) e índice de massa corporal (IMC) de 20 pacientes. Dados como condição social e histórico clínico foram coletados em prontuário. O consumo alimentar foi avaliado por meio de um diário alimentar de 30 dias. Os dados alimentares e o peso corporal receberam um escore de pontos conforme maior ou menor grau de adesão às recomendações WCRF / AICR. Resultados: 80% dos pacientes encontravam-se com desnutrição moderada ou suspeita de desnutrição pela ASG-PPP. Pelo IMC, 10% dos participantes estavam desnutridos, 45% eutróficos e 35% apresentavam sobrepeso. Foi encontrado escore médio 2,64 ±0.55 de adesão às recomendações de peso adequado e alimentação saudável, demonstrando atendimento de menos de 50% das recomendações WCRF / AICR. Conclusão: Os pacientes SCCO do presente estudo apresentam risco de desnutrição ou estão com desnutrição moderada; e possuem alta sintomatologia, que impacta negativamente na ingestão alimentar e na adesão às recomendações da WCRF / AICR. (AU)

Introduction: Survivors of oral cavity cancer (OCC) under control usually have numerous sequelae resulting from oncological treatment, which can compromise their diet and, by extension, meet the guidelines for diet and proper weight issued by the World Cancer Research Fund International-WCRF and the American Institute for Cancer Research-AICR. Objective: To evaluate the dietary profile and nutritional status of oral cancer survivors and verify the degree of their adherence, the guidelines for healthy eating and body weight issued by WCRF/AICR. Method: Cross-sectional study which assessed the nutritional status by the Subjective Global Assessment produced by the patient (PG-SGA) and body mass index (BMI) of 20 patients. Data such as social condition and clinical history were collected from medical records. Food consumption was assessed using a 30-day food diary. Food data and body weight received a score of points according to a greater or lesser degree of adherence to WCRF/AICR recommendations. Results: 80% of patients were moderately malnourished or suspected of malnutrition by PG-SGA. According to BMI 10% of participants were malnourished, 45% eutrophic and 35% were overweight. An average score of 2.64 ± 0.55 adherence to the recommendations of adequate weight and healthy eating was found, showing compliance with less than 50% of the WCRF/AICR recommendations. Conclusion: Survivor patients of OCC patients from the present study are at risk of malnutrition or have moderate malnutrition; and have high symptomology, which negatively impacts food intake and adherence to recommendations of WCRF/AICR. (AU)

Frailty is associated with myosteatosis in obese patients with colorectal cancer.

BACKGROUND & AIMS: We aimed to explore the determinants of muscle fat infiltration and to investigate whether myosteatosis, assessed as muscle fat infiltration percentage (%MFI) and muscle attenuation from computed tomography (CT), is associated with frailty in a group of patients with colorectal cancer (CRC). METHODS: Cross sectional study including CRC patients. CT scan of the third lumbar vertebra was used to quantify body composition and the degree of %MFI (reported as percentage of fat within muscle area). Frailty was defined by Fried et al. (2001) as the presence of more than 3 criteria: unintentional weight loss, self-reported exhaustion, weakness (low handgrip strength), slow walking speed (gait speed) and low physical activity. Obesity was defined according to sex-and-age-specific body fat percentage (%BF) cutoff. RESULTS: A sample of 184 patients (age 60 ± 11 years; 58% men; 29% of patients with frailty) was studied. The sample was divided according to tertiles of MFI% (1st tertile 0 to 2.89%, n = 60; 2nd tertile ≥ 3.9-8.19%, n = 64; 3rd tertile ≥ 8.2-26%, n = 60). Age, females, body mass index, %BF, subcutaneous and visceral adipose tissue and the proportion of patients with frailty were significantly higher in the 3rd %MFI tertile. Phase angle and muscle attenuation were significantly lower in the 3rd %MFI tertile. The determinants of %MFI (r2 = 0.49), which was log transformed due to its normal distribution, were %BF (ß = 0.54; eß = 1.72; 95% CI: 0.032 to 0.051; P < 0.01), age (ß = 0.34; eß = 1.40; 95% CI: 0.016 to 0.032; P < 0.01) and gait speed (ß = -0.12; eß = 0.87; 95% CI: -0.84 to -0.001; P = 0.049). In addition, in obese patients (n = 74) presenting 4 or 5 frailty criteria increased the chance of having higher %MFI and lower muscle attenuation, after adjustment for sex, age and comorbidities when compared to none or 1 criteria. CONCLUSIONS: In a sample of CRC patients, %BF and gait speed were the determinants of %MFI. In addition, markers of myostetatosis were associated with frailty in the obese patients.

Comparative Analysis Between Computed Tomography and Surrogate Methods to Detect Low Muscle Mass Among Colorectal Cancer Patients.

BACKGROUND: We aimed to evaluate the agreement between computed tomography (CT) and surrogate methods applied in clinical practice for the assessment of low muscle mass. In addition, we assessed the association between different muscle-assessment methods and nutrition status, as well as the prognostic value of low muscle mass on survival in patients with colorectal cancer (CRC). METHODS: This is a cohort including 188 CRC patients with 17 months' follow-up (interquartile range: 12-23 months) for mortality. Low muscle mass was evaluated by corrected mid-upper arm muscle area (AMAc) and calf circumference, skeletal muscle mass by bioelectrical impedance analysis (BIA), muscle deficit by physical examination with the Patient-Generated Subjective Global Assessment (PG-SGA), and lumbar muscle cross-sectional area by CT (reference method). RESULTS: The prevalence of low muscle mass ranged from 9.6% to 54.3% according to the method used. The physical examination had the highest κ coefficient compared with CT. Low muscularity was associated with the presence of malnutrition, lower body fat, and low phase angle. The Cox regression models-adjusted for age, sex, and treatment 3 months before study inclusion-showed that severe muscle loss measured by BIA and CT and low muscle mass measured by PG-SGA predicted higher mortality rates. CONCLUSIONS: Compared with CT, the physical examination had the best agreement to assess low muscle mass. Low muscle mass assessed by PG-SGA, BIA, and CT showed similar prognostic values for survival.

Postoperative complication rate and survival of patients with gastric cancer undergoing immunonutrition: A retrospective study.

OBJECTIVES: This study aimed to evaluate the effect of preoperative immunonutrition on the rate of postoperative complication and survival of patients with gastric cancer. METHODS: A retrospective cohort was formed after data collection of patients hospitalized with gastric cancer. Postoperative complications classified according to the Clavien-Dindo classification system, length of hospital stay, readmissions, and rates of survival at 6 mo, 1 y, and 5 y were analyzed. A χ2 or Fisher's exact test, Student or Mann-Whitney t test, and Kaplan-Meier and Cox regressions were used in the statistical analysis. RESULTS: A total of 164 patients were included in the study, with 56 patients assigned to the immunonutrition group and 108 to the conventional group. There were no significant differences in postoperative complications between the immunonutrition and conventional groups (51.8% versus 58.3%; P = 0.423). The most frequent complications were fistula and surgical wound infection. Length of hospital stay did not differ between the groups (median of 7.0 d: P = 0.615) and the presence of readmissions did not differ either (12.5% versus 15.7%; P = 0.648). In the multivariate Cox regression, in a pooled model for group, age, sex, body mass index, Charlson comorbidity index, staging, neoadjuvant chemotherapy, and type of surgery, there was a significant difference in survival rates at 6 mo (P = 0.011), 1 y (P = 0.006), and 5 y (P < 0.001). CONCLUSIONS: Preoperative immunonutrition in patients with gastric cancer did not reduce postoperative complications or length of hospital stay. More studies are needed to confirm the benefit of immunonutriton supplementation for overall survival when associated with other protective factors.

Patient-generated subjective global assessment predicts cachexia and death in patients with head, neck and abdominal cancer: A retrospective longitudinal study.

BACKGROUND & AIMS: Cancer is a complex disease, with poor prognosis when associated with malnutrition. This condition can lead to Cancer Cachexia (CC), a syndrome characterized by loss of muscle mass with or without fat loss, often associated with higher risk of death. Although there are recommended screening tools to assess nutritional status in cancer patients, such as Patient-Generated Subjective Global Assessment (PG-SGA), little is known about CC prediction. The aim was to investigate the association between nutritional status of patients with head, neck and abdominal cancer, assessed by PG-SGA at the day of hospitalization, with CC, hospitalization time and death. METHODS: This is a retrospective longitudinal study, where we collected data of 97 patients about PG-SGA nutritional classification, anthropometry, gender, age, cachexia diagnosis and death. RESULTS: PG-SGA classification was strongly associated with all the anthropometric measures (p < 0.0001). According to PG-SGA classification, 30.61% (n = 15) of patients in group A developed pre-cachexia; 38.24% in group B developed CC (n = 13); and 60% (n = 9) in group C developed refractory cachexia (p < 0.0001). Death rate was 24.49% (n = 12), 54.55% (n = 18) and 80% (n = 12) in groups A, B and C, respectively (p < 0.0001). PG-SGA had good sensibility (89.5%) and accuracy (72%) for CC, and also good specificity (75.51%) and accuracy (69%) for death. CONCLUSIONS: PG-SGA demonstrated a significative association with the variables measured and was able to predict CC and death. This, in addition to its simple applicability, suggests that PG-SGA can be a useful tool to screen cancer patients for CC establishment and death risk.

Lycopene inhibits hepatic stellate cell activation and modulates cellular lipid storage and signaling.

Hepatic stellate cells are liver-specific perivascular cells, identified as the major source of collagen in liver fibrosis, following their activation and conversion to myofibroblast-like cells. Lycopene is a carotenoid with biological activities and protective effects described in different pathologies, but little is known about its role in liver protection. We evaluated the influence of lycopene on the cell cycle and lipid metabolism and monitored the possible pathways involved in lycopene inhibition of stellate cell activation. Lycopene induced expression of the lipocyte phenotype, with an accumulation of fat droplets in cytoplasm, with high synthesis and turnover of phospholipids and triglycerides. Cell proliferation analysis showed that lycopene reduced the growth of GRX cells. Lycopene induced an arrest in the G0/G1 phase, followed by a decrease of cells in the G2/M phase, regardless of the concentration of lycopene used. Lycopene modulated relevant signaling pathways related to cholesterol metabolism, cellular proliferation, and lipid metabolism. Also, lycopene treatment increased the expression of RXR-α, RXR-ß, and PPARγ, important biomarkers of liver regeneration. These results show that lycopene was able to negatively modulate events related to the activation of hepatic stellate cells through mechanisms that involve changes in expression of cellular lipid metabolism factors, and suggest that this compound might provide a novel pharmacological approach for the prevention and treatment of fibrotic liver diseases.

Factors Associated with Sarcopenia in Patients with Colorectal Cancer.

Introduction; Sarcopenia are frequently observed in cancer patients and was associated with poor prognosis. Objectives; to determine the association of nutritional status, body composition, and clinic parameters with sarcopenia in patients with colorectal cancer (CRC). Methods; We conducted a cross-sectional study of 197 patients with CRC. The sarcopenia elements, including lumbar skeletal muscle index (SMI), handgrip strength, and gait speed were measured. The SMI was assessed by computed tomography at third lumbar vertebra. Phase angle (PA), serum albumin (SAlb), muscle attenuation (MA), and the scored patient-generated subjective global assessment (PG-SGA) were also evaluated. Univariate and multivariate analysis of factors associated with sarcopenia were performed. Results; Sarcopenia was present in 29 of 195 patients (15%) and was significantly correlated with advance age, lower body mass index (BMI), SAlb, PA, MA, higher PG-SGA score, and malnutrition (PG-SGA B). In univariate analysis, age, BMI, SAlb, PA, MA, PG-SGA score, and malnutrition (PG-SGA B) were associated with sarcopenia. Multivariable analysis revealed that BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia. Conclusion; BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia in patients with CRC.

Estado Nutricional de Pacientes Pediátricos Recém-Diagnosticados com Leucemia Linfoblástica Aguda em um Instituto de Referência em Oncologia do Rio de Janeiro / Nutritional Status of Pediatric Patients Newly Diagnosed with Acute Lymphoblastic Leukemia at an Institute of Reference in Oncology of Rio de Janeiro / Estado Nutricional de Pacientes Pediátricos Recién diagnosticados con leucemia linfoblástica Aguda en un Instituto de Referencia en Oncología de Río de Janeiro

Introdução: a leucemia linfoblástica aguda (lla) constitui a neoplasia mais comum em pediatria e a avaliação nutricional é um instrumento essencial para conhecer as condições de saúde dos pacientes. o presente estudo teve como objetivo avaliar e descrever o estado nutricional de pacientes pediátricos recém-diagnosticados com lla e verificar a relação do índice de massa corporal para idade (iMc/i) com as demais medidas antropométricas. Método: estudo observacional, transversal, realizado com pacientes de 1 a 18 anos, recém- -diagnosticados com lla, no período de janeiro/2004 a dezembro/2009. os dados coletados foram idade, peso corporal, estatura, prega cutânea tricipital (Pct), circunferência do braço (cB) e circunferência muscular do braço (cMB). o iMc foi calculado e a classificação iMc/i utilizada na análise. o teste Qui-quadrado de Pearson e exato de Fisher foram utilizados para analisar a associação entre os parâmetros antropométricos. Resultados: Foram incluídos no estudo 54 pacientes. a classificação do "estado nutricional adequado" foi a mais frequente em todos os parâmetros antropométricos. em adição, observou-se que a associação do estado nutricional pela cMB com o iMc/i (p=0,001) demonstra que este último pode ser adequado para classificação dos pacientes pediátricos com lla ao diagnóstico. e a concordância da cB com a cMB (p=0,01) de 43% (p=0,001) também ratifica a utilização da cB frente à cMB, por ser uma medida mais simples. Conclusão: na população estudada, o estado nutricional encontrava-se preservado. assim como a associação da cMB com o iMc/i, a cB demonstrou ser um parâmetro sensível para classificar eutrofia.

Introduction: acute lymphoblastic leukemia (all) is the most common neoplasm in pediatrics, and nutritional assessment is an essential tool for understanding patients' health conditions. The present study aimed to evaluate and describe the nutritional status of pediatric patients newly diagnosed with all and to verify the relation between body mass index for age (BMi-for-age) and other anthropometric measurements. Method: a cross-sectional, observational study was performed with patients from 1 to 18 years of age, newly diagnosed with all, from January 2004 to december 2009. The data collected were age, body weight, height, triceps skinfold (ts), arm circumference (ac) and arm muscle circumference (aMc). The BMi was calculated and the BMi-for-age classification used in the analysis. Pearson's chi-square test and Fisher's exact test were used to analyze the association between anthropometric parameters. Results: 54 patients were included in the study. The classification of "adequate nutritional status" was the most frequent in all anthropometric parameters. in addition, we observed that the association of nutritional status by aMc with BMi-for-age (p=0.001) shows that the BMi-for-age may be adequate for classification of pediatric patients with all at diagnosis. in addition, ac agreement with aMc (p=0.01) of 43% (p=0.001) also confirmed the use of ac versus aMc, as it is a simpler measure. Conclusion: in the studied population the nutritional status was preserved. Just as the association of aMc with BMi-for-age, ac has been shown to be a sensitive parameter for classifying eutrophy

Introducción: la leucemia linfoblástica aguda (lla) constituye la neoplasia más común en pediatría y la evaluación nutricional es un instrumento esencial para conocer las condiciones de salud de los pacientes. el presente estudio tuvo como objetivo evaluar y describir el estado nutricional de pacientes pediátricos recién diagnosticados con lla y verificar la relación del Índice de masa corporal por edad (iMc/i) con las demás medidas antropométricas. Método: estudio observacional, transversal, realizado con pacientes de 1 a 18 años recién diagnosticados con lla en el período de enero / 2004 a diciembre / 2009. los datos recogidos fueron edad, peso corporal, estatura, pliegue cutáneo tricipital (Pct), circunferencia del brazo (cB) y circunferencia muscular del brazo (cMB). el iMc fue calculado y la clasificación iMc/i utilizada en el análisis. la prueba chi-cuadrado de Pearson y exacto de Fisher se utilizaron para analizar la asociación entre los parámetros antropométricos. Resultados: se incluyeron en el estudio 54 pacientes. la clasificación del "estado nutricional adecuado", fue la más frecuente, en todos los parámetros antropométricos. en adición, se observo que la asociación del estado nutricional por la cMB con el iMc/i(p=0,001) demuestra que este último puede ser adecuado para clasificación de los pacientes pediátricos con lla al diagnóstico. Y la concordancia de la cB con la cMB (p=0,01) del 43% (p=0,001), también ratifica la utilización de la cB frente a la cMB, por ser una medida más simple. Conclusión: en la población estudiada el estado nutricional se encontraba preservado. así como la asociación de la cMB con el iMc/i, la cB demostró ser un parámetro sensible para clasificar eutrofia.

Impact of Treatment Type on Overall Survival in ElderlyBrazilian Women with Breast Cancer

Objective: To analyze the survival of elderly patients with breast cancer according to the type of treatment used. Methods: A cohort study of women aged 80 or over with breast cancer registered with the Brazilian National Cancer Institute (Instituto Nacional do Câncer - INCA) between 2008 and 2009 was conducted. Prognosis was analyzed according to the cancer treatment performed: surgery, radiotherapy, or hormone therapy. Analysis of the overall 5-year survival rate was performed using the Kaplan - Meier method, and comparisons of curves were undertaken using the log-rank test. For multiple regression analysis, Cox regression was used, adjusting for age and clinical stage, considering values of p < 0.05 as significant. Data were all analyzed using the statistical package SPSS version 20. Results: 70 women with a mean age of 84.0 ± 3.7 years at diagnosis participated in the study. The median follow-up time was 37.1 months (range 0.5­75.5), and 31 deaths (44.3%) occurred during this time. The median survival time was 51.2 months (95% CI, 44.9­57.4), higher in those who underwent surgery (p = 0.012) and those who had hormone therapy (p=0.001). Treatment with surgery reduced the risk of death by 61.7% (HR 0.3; 95% CI, 0.1­0.6; p = 0.001) when adjusted for clinical stage and age at diagnosis. However, there was no significant benefit from radiotherapy (HR 1.2; 95% CI, 0.5­2.5; p = 0.694). Conclusion: Treatment with surgery and hormone therapy increased the survival of our Brazilian patients with breast cancer aged 80 or over.

Impacto do uso de dieta imunomoduladora em pacientes com câncer colorretal submetidos a cirurgias eletivas com abreviação de jejum pré-operatório / Impact of the use of immunomodulatory diet in colorectal cancer patients under elective surgeries with preoperative fasting abbreviation / Impacto del uso de la dieta inmunomoduladora en pacientes con cáncer colorrectal sometidos a cirugía electiva con abreviatura de ayuno preoperatorio

Introdução: A função imune é geralmente suprimida por procedimentos cirúrgicos de grande porte e pela desnutrição proteico-energética. A imunomodulação se torna uma opção de terapêutica para pacientes com câncer submetidos a cirurgias, reduzindo complicações infecciosas no pós-operatório e tempo de internação hospitalar. Objetivo: Avaliar o impacto do uso de dieta imunomoduladora em pacientes com câncer colorretal submetidos a cirurgias eletivas com abreviação de jejum pré-operatório. Método: Foi realizada uma coorte de dados retrospectivos com pacientes com câncer colorretal submetidos à cirurgia no Instituto Nacional de Câncer José Alencar Gomes da Silva, em 2013. A amostra foi dividida em grupo 1 - pacientes que realizaram abreviação de jejum pré-operatório e receberam suplementação nutricional com dieta imunomoduladora no pré-operatório (n=20); e grupo 2 - pacientes que realizaram apenas a abreviação de jejum pré-operatório (n=30). Foram coletados dados de identificação do paciente, clínicos e cirúrgicos dos prontuários. As análises estatísticas foram realizadas utilizando o programa SPSS, 17.0. Resultados: A amostra foi composta por 50 pacientes, submetidos à ressecção anterior do reto, com idade média de 61,9 anos ±13,8 anos, sendo 52% do sexo masculino. O sítio tumoral mais prevalente foi o reto (44%). Não foram observadas diferenças significativas entre os grupos em relação às características nutricionais, clínicas e cirúrgicas, aos exames bioquímicos (pré e pós-operatórios), às intercorrências gastrointestinais, à ocorrência de complicações no pós-operatório e à permanência hospitalar. Conclusão: Nas condições estudadas, a imunomodulação no pré-operatório não contribuiu para redução de complicações pós-operatórias, da incidência de intercorrências gastrointestinais e do tempo de internação hospitalar.

Introduction: The immune function is usually suppressed by major surgical procedures and protein-energy malnutrition. The immunomodulation becomes a therapeutic option for cancer patients undergoing surgery, reducing infectious complications after surgery, as well as hospital stay. Objective: To evaluate the impact of the use of an immunomodulatory diet in colorectal cancer patients undergoing elective surgeries with preoperative fasting abbreviation. Method: A cohort with retrospective data was performed with colorectal cancer patients who underwent surgery in the Brazilian National Cancer Institute José Alencar Gomes da Silva, in 2013. The sample was divided into two groups. Group 1: patients who underwent preoperative fasting abbreviation and who received nutritional supplementation with a preoperative immunomodulatory diet (n=20); and group 2: patients who underwent only the abbreviation of fasting preoperatively (n= 0). The study collected patient identification data, together with clinical and surgical data from the records. Statistical analyzes were performed using SPSS, 17.0. Results: The sample consisted of 50 patients who underwent an anterior resection of the rectum, with a mean age of 61.9 years ± 13.8 years; and 52% male. The most prevalent tumor site was the rectum (44%). No significant differences were observed between the groups regarding nutritional, clinical and surgical characteristics, the biochemical tests (pre and postoperative), gastrointestinal complications, the occurrence of complications after surgery and hospital stay. Conclusion: Within the studied conditions, preoperative immunomodulation did not contribute to a reduction of postoperative complications, incidences of gastrointestinal complications and hospital stay.

Introducción: La función inmune generalmente se suprime por procedimientos quirúrgicos mayores y por la malnutrición proteico-energética. La inmunomodulación se convierte en una opción terapéutica para los pacientes con cáncer sometidos a cirugía mediante la reducción de las complicaciones infecciosas después de la cirugía y la estancia hospitalaria. Objetivo: Evaluar el impacto del uso de la dieta inmunomoduladora en pacientes con cáncer colorrectal sometidos a cirugía electiva con abreviatura ayuno preoperatorio. Método: A los datos retrospectivos de cohortes de pacientes con cáncer colorrectal que se sometió a una cirugía en el Instituto Nacional del Cáncer José Alencar Gomes da Silva se llevó a cabo en 2013. La muestra se dividió en el grupo 1: pacientes que se sometieron abreviatura ayuno preoperatorio y recibieron suplementos nutricionales con una dieta inmunomoduladora antes de la operación (n=20); y el grupo 2: pacientes que se sometieron a sólo abreviatura ayuno preoperatorio (n=30). Se recogieron los datos de identificación del paciente, clínica y quirúrgicos de los registros médicos. Los análisis estadísticos se realizaron con SPSS, 17.0. Resultados: La muestra estuvo constituida por 50 pacientes, que fueron sometidos a la que se sometieron a resección anterior rectal, con una edad media 61,9 años ± 13,8 años, 52% varones, (44%) No se observaron diferencias significativas entre los grupos en relación a las características nutricionales, clínicas y quirúrgicas, exámenes bioquímicos (pre y postoperatorios), a las complicaciones gastrointestinales, la aparición de complicaciones postoperatorias y la estancia hospitalaria. Conclusión: En las condiciones estudiadas, la inmunomodulación en el preoperatorio no contribuyó a la reducción de las complicaciones postoperatorias, la incidencia de complicaciones gastrointestinales y la estancia hospitalaria.