Oral nutritional support to adult patients with acute intestinal Graft Versus Host Disease (GVHD): A proposal for dietary intervention as a model to clinical trials.

BACKGROUND: Acute Graft Versus Host Disease (GVHD) affects about 20%-80% of the patients after the hematopoietic stem cell transplant (HSCT) and it is amongst the main causes of morbidity and mortality both in children and adults. The intestine is one of the most affected organs by GVHD causing important alterations in the nutritional status and quality of life, considering that the dysfunctional intestine could decrease food intake as well as an inappropriate dietary plan could worsen the clinical condition. In addition to GVHD, chemotherapy conditioning regimen suppresses the immune system, promotes mucositis and increases the risk of infectious complications. Taking the above into consideration, when per oral diet is possible; the food choices should be carefully planned and monitored to promote nutritional support and avoid worsening the intestinal function and clinical condition. OBJECTIVE: This work was aimed to present a practice guideline proposal, to be validated, based on literature review, regarding to oral dietary recommendations for acute intestinal GVHD after HTSC. METHODS: Two research phases were defined: Phase one: evidence-based literature review; Phase 2: Practice Guideline Proposal. 1: Evidence based literature review SEARCH METHODS: A literature review (1997-2019) was performed including PubMed, in English, and Lilacs, in Portuguese electronic database to address the subject of dietary intervention for intestinal GVHD related to the HSCT, with children and adults, whose receiving oral or tube feeding nutrition therapy. SELECTION CRITERIA: The study selection was based on the PRISMA method. Controlled clinical trials were searched. Randomization was not possible considering the rare condition. DATA COLLECTION AND ANALYSIS: Two independent authors assessed the abstracts of the selected studies to determine the articles feasible to compose the review as the base to elaborate the practice guideline proposal protocol, object of the present study. To determine the level of evidence of the selected article, GRADE criteria were used. MAIN RESULTS: One controlled clinical trial study was included. The study was developed in Japan with a total of 35 patients. The dietary plan was characterized by gradual increasing food consistency/density. They found better nutritional parameters in the treated group, however, following GRADE criteria, we rated the quality of evidence as very low. AUTHORS' CONCLUSIONS: We could not demonstrate confidence in the effect estimate based on the selected study. However, considering the lack of literature information and the relevance of the topic, we decided to proceed and propose a practice guideline for an oral diet protocol for acute intestinal GVHD as a reference to be a starting point to validate protocols in future clinical trials. 2: Practice Guideline Proposal The criteria to elaborate the protocol were based on the RIGHT Statement. In addition to the literate information about diet and intestinal health, recommendations already adopted in the Service of Bone Marrow Transplant in the Complex Hospital of Clinics of Curitiba, in the state of Paraná, Brazil, were also considered.

Pre-transplant arm muscle area: a simple measure to identify patients at risk.

PURPOSE: This study aims to explore parameters of nutritional assessment and food intake as predictors of clinical outcomes after hematopoietic stem cell transplant (HSCT). METHODS: The study was conducted retrospectively with 56 adult patients undergoing allogeneic HSCT. Energy and protein daily intake were used to calculate the energy and protein cumulative deficit. The nutritional assessment tools were weight, body mass index (BMI), triceps skinfold (TSF), and arm muscle area (AMA) before HSCT and after HSCT. RESULTS: Food intake decreased immediately after the transplant and the energy and protein cumulative deficit increased during hospitalization (p < 0.01). Almost 70 % of patients had severe weight loss (greater than 5 %), and the average percentage of weight loss was 8.5 ± 3.9 %. BMI and weight loss percentage were not correlated with the presence of acute graft versus host disease (GVHD) and mortality within 180 days in this population. On the other hand, correlation was found between the initial (pre-HSCT) AMA equal to or below the 15th percentile, with the presence of acute GVHD (p = 0.024), and mortality within 180 days after HSCT (p = 0.010). CONCLUSIONS: The AMA measured pre-HSCT showed to be a potential predictor of acute GVHD and mortality up to 180 days after transplant in adult patients.

Análise do potencial antioxidante do consumo oral da farinha produzida com micélio de Agaricus brasiliensis em hamsters hipercolesterolêmicos / The antioxidant potential of oral intake of flour produced from Agaricus brasiliensis mycelium in hamsters with hypercholesterolemia

O sistema de defesa antioxidante inibe ou reduz os danos causados às células pelas espécies reativas de oxigênio. Alguns compostos antioxidantes presentes na dieta auxiliam na defesa antioxidante do plasma. O potencial antioxidante do consumo oral de farinha produzida com micélio de Agaricus brasiliensis fermentado sobre grãos de trigo foi analisado nos plasmas de hamsters Golden Syrian machos hipercolesterolêmicos, que foram divididos em quatro grupos: P(dieta padrão), H (dieta hipercolesterolêmica padrão), C (dieta padrão + 10 % de farinha de trigo contendo micélio de A. brasiliensis), e HC (dieta hipercolesterolêmica padrão + 10 % de farinha de trigo contendo micélio deA. brasiliensis). Os animais foram alimentados durante 40 dias e depois sacrificados para coletar materiais biológicos.A análise da capacidade antioxidante mostrou que a dieta do grupo C induziu maior aumento significativo da concentração de antioxidantes no plasma (0,39 mg.mL-1, expresso em ácido ascórbico). O grupo HC apresentou maiorcapacidade antioxidante do que grupo H (p < 0,05), pois inibiu 20,2 % do branqueamento da crocina. O grupo H inibiu10,4 %, porém o grupo HC demonstrou capacidade antioxidante semelhante ao do grupo P (16,64 %). O consumo da farinha de trigo contendo micélio de A. brasiliensis estimulou a proteção antioxidante no plasma dos animais...

Aceitabilidade sensorial de biscoito tipo cracker adicionado de farinha de casca de limão siciliano (Citrus limon L. Burm.) / Sensory acceptability of cream cracker prepared by adding sicilian lemon peel (Citrus limon L. Burm.) flour

Este estudo avaliou a aceitabilidade sensorial de biscoito tipo cracker enriquecido com farinha da casca do limão siciliano (Citrus limon L. Burm.), determinando-se a composição físico-química da formulação de biscoito padrão e mais aceita. Utilizaram-se cinco formulações de biscoitos contendo diferentes concentrações de farinha de casca de limão siciliano, sendo F1 (padrão), F2 (1%), F3 (2%), F4 (3%) e F5(4%). A análise sensorial avaliou os atributos: aparência, aroma, sabor, textura e característica crocante. Ademais, foram realizadas análises da composição físico-química. Sensorialmente, as formulações padrão e adicionada de 1% de farinha de casca de limão siciliano foram as mais aceitas, principalmente nos atributos sabor, aceitação global e intenção de compra. Por meio da análise físico-química dos produtos verificou-se que os teores de fibra bruta, proteínas, cinzas e umidade e o valor calórico foram maiores na formulação F2 do que em F1. O desenvolvimento dos produtos comprovou que a adição de até 1% de farinha de casca de limão siciliano em biscoitos tipo cracker foi o mais aceito pelos provadores entre as demais formulações contendo este ingrediente, com aceitação sensorial semelhante ao produto convencional.