Monitorización del grado de satisfacción tras intervención nutricional en pacientes con cáncer / Monitoring satisfaction level after nutritional intervention in cancer patients

Introducción: La identificación temprana de la angustiapsicosocial y el impacto de la caquexia permiten intervencio-nes oportunas para mejorar los síntomas.Los PREM (Patient-Reported Experience Measures) aportanvalor a pacientes y organizaciones sanitarias. El poder real delos mismos se encuentra en la posibilidad de cruzarlos con da-tos clínicos. Esto permite identificar puntos críticos y áreas demejora de la calidad asistencial de los procesos. La intervención nutricional en pacientes seleccionadosbrinda un beneficio significativo para algunos aspectos comoel funcionamiento emocional, la disnea, la pérdida de apetitoy el estado de salud global.Por ello, se propone evaluar el grado de satisfacción de lospacientes en los que se ha realizado una intervención nutri-cional durante el tratamiento oncológico activo.Metodología: Estudio retrospectivo, exploratorio, delgrado de satisfacción, en referencia a la intervención nutricio-nal, en pacientes tratados por cáncer en el Hospital de Día deOncología del hospital Universitario Doctor Peset de Valencia,entre enero de 2022 y enero de 2023. Resultados: Se incluyeron un total de 93 pacientes. Seelaboró un cuestionario de 15 preguntas que se ofreció a los50 últimos pacientes incluidos. Respondieron de forma volun-taria y anónima 28 (56%). En el 95% de los casos la inter-vención nutricional se valoró de forma satisfactoria.Conclusiones: La identificación temprana de la desnutri-ción y la intervención oportuna tienen un impacto favorableen el grado de satisfacción del paciente.(AU)

Introduction: Early identification of psychosocial distressand the impact of cachexia allows for timely interventions toimprove symptoms. Patient-Reported Experience Measures(PREMs) add value to patients and healthcare organizations.Their true power lies in the ability to cross-reference themwith clinical data. This enables the identification of criticalpoints and areas for improving the quality of care processes.Nutritional intervention in selected cancer patients providessignificant benefits for aspects such as emotional functioning,dyspnea, loss of appetite, and overall health status. Therefore, we propose to evaluate the satisfaction level ofpatients who have undergone nutritional intervention duringactive oncological treatment. Methodology: Retrospective exploratory study of satisfac-tion levels regarding nutritional intervention in cancer patientstreated at the Oncology Day Hospital of the UniversityHospital Doctor Peset in Valencia, between January 2022 andJanuary 2023.Results: A total of 93 patients were included. A question-naire consisting of 15 questions was developed and offered tothe last 50 included patients. Twenty-eight (56%) respondedvoluntarily and anonymously. In 95% of cases, nutritional in-tervention was evaluated satisfactorily.Conclusions: Early identification of malnutrition andtimely intervention have a favorable impact on patient satis-faction levels.(AU)

Eficácia e segurança do acetato de megestrol para o tratamento da anorexia nos cuidados paliativos: revisão rápida de evidências / Efficacy of the megestrol acetate in the treatment of anorexia in palliative care: a rapid response review of evidence

Acetato de Megestrol (AM). Indicação: Tratamento da Síndrome anorexia-caquexia (SAC) em doentes crônicos em fase de cuidados paliativos. Objetivo: Avaliar a eficácia e segurança do uso do AM em doentes crônicos sob cuidados paliativos. Métodos: Foi realizada uma revisão rápida de revisões sistemáticas, com levantamento bibliográfico nas bases de dados PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web Of Science e em registros de revisões sistemáticas e ensaios clínicos. A qualidade metodológica dos estudos incluídos foi avaliada com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: A busca recuperou um total de 2.370 após exclusão das duplicatas; 1003 estudos foram triados pelo título e resumo, de acordo com os critérios de inclusão previamente estabelecidos. Dezesseis RSs foram selecionadas para leitura completa, sendo que, destas, apenas 1 RS foi classificado com alta qualidade metodológica. Após a análise dos ECR das RSs excluídas, um ECR foi incluído considerando os critérios de inclusão. Dois estudos adicionais publicados posteriormente a RS de Ruiz-Garcia et al. Conclusão: Com base nas evidências disponíveis, o AM proporciona leve ganho de peso e melhora o apetite, porém esses resultados não refletem melhoria na qualidade de vida dos pacientes, além de haver risco considerável de desenvolver fenômenos tromboembólicos

Megestrol acetate (MA). Indication: treatment of anorexia-cachexia syndrome (ACS) in chronic diseases patients, under palliative care. Objective: Evaluate the efficacy and safety of the use of Megestrol Acetate to treat ACS in patients under palliative care. Methods: Rapid review protocol of Systematic Reviews and Clinical Trials. A literature Search was performed in PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web of Science databases and in clinical trials records, following a predefined strategy. The methodological quality of the selected articles was assessed through AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2) tool. Results: the search resulted in 2,370 articles, after the duplicates exclusion. 1003 were analyzed by tittle and abstracts according the inclusion criteria. 16 were selected for full text reading, and only one considered to have high methodological quality. After the analyses of the Randomized Clinical Trials of the excluded Systematic Reviews, one RCT was included. Two additional studies published after the SR of Ruiz-Garcia et al were also included. Conclusion: based on available evidence, the MA promoted a small gain in body weight and a slight appetite improvement, although these results did not imply an enhancement in their quality of life. Moreover, there is a considerable risk of causing thromboembolic disorders

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y caquexia tumoral.

Introduction: Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.

Introducción: La diabetes es una comorbilidad frecuente en pacientes con cáncer, ya que comparten factores de riesgo comunes. En la enfermedad oncológica, la presencia de caquexia tumoral representa un factor de mal pronóstico, que se ve agravado por un estado nutricional deficiente. Clínicamente, la caquexia se manifiesta como una reducción significativa del peso corporal, acompañado de cambios en la composición corporal y alteraciones en el equilibrio del sistema biológico, y causa una disfunción progresiva. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con caquexia tumoral concurrente.

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y caquexia tumoral / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia

La diabetes es una comorbilidad frecuente en pacientes con cáncer, ya que comparten factores de riesgo comunes. En la enfermedad oncológica, la presencia de caquexia tumoral representa un factor de mal pronóstico, que se ve agravado por un estado nutricional deficiente. Clínicamente, la caquexia se manifiesta como una reducción significativa del peso corporal, acompañado de cambios en la composición corporal y alteraciones en el equilibrio del sistema biológico, y causa una disfunción progresiva. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con caquexia tumoral concurrente. (AU)

Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia. (AU)

Desnutrição e Caquexia na Insuficiência Cardíaca Descompensada e Cardiomiopatia Chagásica: Ocorrência e Associação com Desfechos Hospitalares / Undernutrition and Cachexia in Patients with Decompensated Heart Failure and Chagas Cardiomyopathy: Occurrence and Association with Hospital Outcomes

Resumo Fundamento Problemas nutricionais são comuns em pacientes com insuficiência cardíaca (IC) e estão associados a um prognóstico ruim. É relevante mencionar que algumas populações de pacientes, como os com Doença de Chagas, são normalmente excluídas da maioria das análises. Objetivo Buscamos analisar a ocorrência de desnutrição e caquexia em pacientes com Doença de Chagas durante episódios de IC descompensada (ICD) em comparação a outras etiologias, e investigar a influência desses achados em desfechos hospitalares. Método Realizamos um estudo de série de casos consecutivos com pacientes hospitalizados com ICD. Os pacientes foram submetidos à Avaliação Nutricional Subjetiva Global (ASG), além de medidas antropométricas e laboratoriais, e foram avaliados para a ocorrência de caquexia, baixa massa muscular e força. Estudamos a ocorrência de morte e transplante cardíaco de urgência durante a internação. Resultados Ao todo, 131 pacientes foram analisados e 42 (32,1%) tinham Doença de Chagas. Pacientes com Doença de Chagas apresentavam índice de massa corporal (IMC) menor (22,4 kg/m2 [19,9-25,3] vs. 23,6 kg/m2 [20,8-27,3], p=0,03), maior frequência de desnutrição (76,2% vs 55,1%, p=0,015) e mais ocorrências de morte ou transplante (83,3% vs. 41,6%, p<0,001). Observamos que, dentre os pacientes com etiologia da Doença de Chagas, a ocorrência de morte ou transplante cardíaco esteve associada com desnutrição (3 [42,9%] pacientes com alta hospitalar vs. 29 [82,9%] pacientes que morreram ou receberam transplante cardíaco, P=0,043). Conclusões Ao todo, nossos resultados indicam que pacientes com Doença de Chagas internados com ICD costumam apresentar problemas nutricionais, principalmente desnutrição. É importante mencionar que este achado esteve associado à ocorrência de morte e transplante cardíaco durante a internação.

Abstract Background Nutritional disorders are common among patients with heart failure (HF) and associated with poor prognosis. Importantly, some populations of patients, like the ones with Chagas disease, are frequently excluded from most analyses. Objective We sought to study the occurrence of undernutrition and cachexia in patients with Chagas disease during episodes of decompensated HF (DHF) as compared to other etiologies, and to investigate the influence of these findings on hospital outcomes. Methods We performed a consecutive case series study with patients hospitalized with DHF. Patients underwent the Subjective Global Assessment of nutritional status (SGA), besides anthropometric and laboratorial measures, and were evaluated for the occurrence of cachexia, low muscle mass and strength. We studied the occurrence of death or urgent heart transplantation during hospitalization. Results Altogether, 131 patients were analyzed and 42 (32.1%) had Chagas disease. Patients with Chagas disease had lower Body Mass Index (BMI) (22.4 kg/m2[19.9-25.3] vs. 23.6 kg/m2 [20.8-27.3], p=0.03), higher frequency of undernutrition (76.2% vs 55.1%, p=0.015) and higher occurrence of death or transplant (83.3% vs. 41.6%, p<0.001). We found that, in patients with Chagas etiology, the occurrence of death or cardiac transplantation were associated with undernutrition (3 [42.9%] patients with hospital discharge vs 29 [82.9%] patients with death or heart transplant, p=0.043). Conclusions Taken together, our results indicate that patients with Chagas disease hospitalized with DHF often present with nutritional disorders, especially undernutrition; importantly, this finding was associated with the occurrence of death and heart transplant during hospitalization.

Dronabinol en manejo de apetito y pérdida de peso en pacientes con cáncer terminal, VIH, cuidados paliativos y vejez. Revisión de la literatura / Dronabinol in appetite management and weight loss in patients with terminal cancer, HIV, palliative care and old age. Literature review

Resumen: Introducción: La caquexia es un síndrome asociado al cáncer avanzado, VIH, pacientes en quimioterapia y quienes tienen seguimiento en cuidados paliativos. La prevalencia es de 25% de los pacientes con diagnóstico de cáncer, 26% en quienes reciben quimioterapia y de 14 a 38% de pacientes con VIH. Un pilar para el manejo es el cannabis debido al efecto del delta-9-tetrahidrocanabinol (THC), del cual se derivó el dronabinol, un fármaco desarrollado para estimular apetito y ganancia de peso. El objetivo de esta revisión bibliográfica es obtener la información sobre los cannabinoides y la evidencia más sólida existente con respecto al uso del dronabinol en pacientes que han presentado pérdida de peso y apetito. Material y métodos: Revisión de la bibliografía con buscador PubMed con las palabras clave Palliative care (cuidados paliativos), Cannabinoids (cannabinoides), cachexia (caquexia), Dronabinol (dronabinol), Appetite (apetito), de 1990 a 2018, limitado a humanos, obteniendo 259 artículos, eliminando 222 por repetirse o tener poca relevancia, dejando 37 artículos para análisis. Resultados: De 37 artículos revisados, nueve fueron estudios experimentales, 10 revisiones sistematizadas, un metaanálisis y 16 artículos de recomendaciones y sugerencias de manejo. Conclusión: El manejo del apetito y pérdida de peso en pacientes en cuidados paliativos, VIH, ancianos o en quimioterapia debe ser multidisciplinario, involucrando nutriólogos, psicólogos y médicos, ajustando el manejo a las características individuales que manifiesten. El dronabinol es un fármaco de primera elección para el manejo de dichos síntomas cuando la historia natural de la enfermedad se acompaña de náusea, vómito o dolor.

Abstract: Introduction: Cachexia is a syndrome associated with advanced cancer, HIV, patients on chemotherapy and those who are followed in palliative care. The prevalence is 25% of patients diagnosed with cancer, 26% in those receiving chemotherapy and 14 to 38% of patients with HIV. A mainstay for management is cannabis, due to the effect of delta-9-tetrahydrocannabinol (THC) from which dronabinol, a drug developed to stimulate appetite and weight gain, was derived. The aim of this literature review is to obtain information on cannabinoids and the strongest existing evidence regarding the use of dronabinol in patients who have presented weight and appetite loss. Material and methods: Literature review with PubMed search engine with the keywords Palliative care, Cannabinoids, cachexia, Dronabinol, Appetite, from 1990 to 2018, limited to humans, obtaining 259 articles, eliminating 222 for repetition or low relevance, leaving 37 articles for analysis. Results: Out of 37 articles reviewed 9 were experimental studies, 10 systematized reviews, 1 meta-analysis and 16 articles of recommendations and management suggestions. Conclusion: The management of appetite and weight loss in palliative care, HIV, elderly or chemotherapy patients should be multidisciplinary, involving nutritionists, psychologists and physicians, adjusting the management to the individual characteristics manifested. Dronabinol is a drug of first choice for the management of these symptoms when the natural history of the disease is accompanied by nausea, vomiting or pain.

NUTRI-ONCOCARE: Nuevo modelo integralde atención nutricional para prevenir y tratar la desnutrición en pacientes con cáncer / NUTRI-ONCOCARE: New integral nutrition care model to prevent and treat malnutrition in cancer patients

Objetivo: La máxima expresión de la desnutrición en los pacientesoncológicos es la caquexia cancerosa, siempre vinculada a un pronósticodesfavorable. Dado su carácter evolutivo se recomienda detectar y actuarprecozmente en aquellos pacientes con riesgo nutricional. El objetivo esdefinir un algoritmo de actuación para el abordaje nutricional de pacientes con tumores sólidos.Método: Mediante la técnica de grupo nominal se reunió a especialistas en farmacia hospitalaria, nutrición y oncología que establecieron unapriorización de temas relacionados con el estado nutricional y su abordaje en pacientes con tumores sólidos. Su discusión y análisis permitierondiseñar un algoritmo de actuación.Resultados: El algoritmo diferencia dos grupos de pacientes según lalocalización del tumor y su impacto en el estado nutricional: los tumores dealto riesgo (grupo 1) incluyen cánceres de cabeza y cuello, del tracto digestivo superior y colorrectal, y los tumores de bajo riesgo (grupo 2) englobanel resto de neoplasias. Los pacientes del grupo 1 (a excepción de aquellos con cáncer colorrectal) son directamente valorados nutricionalmenteen los primeros 3-5 días tras su presentación en el comité de tumores, iniciando el soporte nutricional requerido en ese momento. Los pacientes delgrupo 2 y los diagnosticados de cáncer colorrectal son cribados (medianteNUTRISCORE) tras su presentación en el comité, derivándose a consulta nutricional a aquellos con riesgo positivo para realizar una evaluación completa y proponer opciones de tratamiento, y reevaluándose periódicamentelos pacientes sin riesgo nutricional. (AU)

Objective: The maximum expression of malnutrition in cancer patientsis cancerous cachexia, always linked to an unfavorable prognosis. Givenits evolutionary nature it is recommended to detect and act early in thosepatients with nutritional risk. The objective is to propose an action algorithm for the nutritional approach of patients with solid tumors.Method: Through the nominal group technique, specialists in hospitalpharmacy, nutrition and oncology who established a prioritization ofissues related to nutritional status and its approach in patients with solidtumors were brought together. Their discussion and analysis allowed us todesign a performance algorithm.Results: The algorithm differentiates two groups of patients accordingto the location of the tumor and its impact on nutritional status: high-risktumors (group 1) include cancers of the head and neck, upper digestivetract and colorectal and low-risk tumors (group 2) include the rest of theneoplasms. Group 1 patients (with the exception of those with colorectalcancer) are directly assessed nutritionally in the first 3-5 days after theirpresentation in the Tumor Committee, starting the nutritional support required at that time. Patients in group 2 and those diagnosed with colorectalcancer are screened (through NUTRISCORE) after their presentation in theCommittee, those with positive risk being referred to nutritional consultationto perform a complete evaluation and propose treatment options. Patients without nutritional risk are periodically re-evaluated. Follow-up is plannedaccording to cancer therapy, with continuous monitoring in each treatmentcycle or during the perioperative period. (AU)

Implicaciones médicas y nutricionales en insuficiencia cardiaca crónica: fortalezas y limitaciones / Medical and nutritional implications in chronic heart failure: strengths and limitations

Resumen La insuficiencia cardiaca (IC) representa uno de los problemas mundiales de salud pública más importantes, ya que existe un aumento en su prevalencia y se estima que 23 millones de la población mundial viven con este problema. Esta entidad se define por la presencia de anormalidades estructurales y funcionales del músculo cardiaco que conducen a un deterioro en la capacidad del llenado y eyección ventricular. Múltiples comorbilidades se han asociado a un incremento en el riesgo de desarrollo de enfermedades cardiovasculares. La hipertensión se ha reconocido como uno de los factores más importantes, sin embargo, la obesidad, el síndrome metabólico, así como la diabetes, también juegan un papel importante en la aparición de dicha enfermedad. Es frecuente encontrar en pacientes hospitalizados con IC deterioro en el estado nutricional caracterizado principalmente por la presencia de deficiencias nutricionales y sarcopenia, que, en ocasiones, puede progresar y manifestarse como caquexia. Por lo anterior, una evaluación adecuada mediante el uso correcto de herramientas para detección de riesgo nutricional es imperativa, se hace necesaria para prevenir los riesgos que esto implica. Existen múltiples parámetros antropométricos y bioquímicos para definir el estado nutricional de los pacientes hospitalizados, sin embargo, las alteraciones en el volumen sanguíneo presentes en pacientes con IC pueden alterar el resultado de dicha evaluación. Las modificaciones dietéticas en la prevención y tratamiento de diversas enfermedades cardiovasculares mediante un buen apego a patrones de alimentación tales como la dieta DASH (enfoques dietéticos para detener la hipertensión, por sus siglas en inglés) y la dieta mediterránea se han asociado inversamente con la incidencia de IC.

Abstract Heart failure (HF) is one of the most important global public health problems, as there is an increase in its prevalence and an estimated 23 million of the world's population live with this problem. HF is defined by the presence of structural and functional abnormalities of the cardiac muscle leading to an impairment of ventricular filling and ejection. Multiple comorbidities have been associated with an increased risk of developing cardiovascular diseases. Hypertension has been recognized as one of the most important factors, however, obesity, metabolic syndrome, as well as diabetes also play an important role in the onset of the disease. It is common to find in decompensated heart failure hospitalized patients an impaired nutritional status characterized mainly by the presence of nutritional deficiencies and sarcopenia, which can sometimes progress to cachexia. Therefore, an adequate evaluation through the correct use of nutritional risk tools should be the cornerstone to the prevention of risks. Multiple anthropometric and biochemical parameters are available to establish the nutritional status of hospitalized patients, however, alterations in blood volume presented in patients with HF may alter the result of such assessment. The effectiveness of dietary modifications in the prevention and treatment of different cardiovascular diseases enhanced by appropriate adherence to eating patterns such as the DASH and Mediterranean diet have been inversely associated with the incidence of HF.

Todos los caminos conducen a la pérdida de masa muscular: desnutrición, fragilidad, sarcopenia y caquexia / All roads lead to loss of muscle mass: malnutrition, frailty, sarcopenia and cachexia

Las enfermedades crónicas degenerativas han ganado gran interés e importancia en el ámbito de la salud debido a la alta carga mundial de morbilidad y la gran tasa de discapacidad que las mismas generan. A su vez, la prevalencia de desnutrición afecta un 40-60% de los pacientes hospitalizados, lo que supone un aumento de los costos sanitarios, mayor morbimortalidad y aumento de las tasas de discapacidad. Diversos conceptos surgen en la literatura relacionando la pérdida de masa muscular, la enfermedad y la desnutrición. El objetivo del presente artículo es definir los conceptos de desnutrición, fragilidad, caquexia y sarcopenia. Se buscó describir su prevalencia, diferenciar los mecanismos que generan cada situación y su impacto en la composición corporal(AU)

Abstract Chronic degenerative diseases have won great interest and value in the field of health due to the high global burden of morbidity and the high rate of disability that they generate. At the same time, the prevalence of malnutrition affects 40-60% of hospitalized patients, which implies an increase in health costs, greater morbi mortality and an increase in disability rates. Various concepts emerge in the literature in which the loss of muscle mass, disease and malnutrition are related. The objective of this article is to define the concepts of malnutrition, frailty, cachexia and sarcopenia. The aim was to describe its prevalence, to differentiate the mechanisms that generate each situation and its impact on body composition(AU)

Efeito do treinamento resistido na sobrevida de camundongos c57bl/6 com caquexia associada ao melanoma cutâneo / Effect of resisted training on survival of c57bl / 6 mice with cachexia associated with cutaneous melanoma

OBJETIVO: O objetivo desse estudo foi verificar o efeito do treinamento resistido na sobrevida de camundongos C57BL/6 com caquexia associada ao melanoma cutâneo. MATERIAL E MÉTODOS: A amostra foi constituída por 64 (camundongos C57BL/6 fêmeas, com idade entre 10 e 12 semanas, com cerca de 50 ± 5 gramas de peso corporal. Os camundongos foram distribuídos aleatoriamente em quatros grupos: i. camundongos controle, com indução de tumor, inativos fisicamente (Controle, n = 16); ii. camundongos submetidos ao treinamento resistido diário somente antes da indução tumoral (Treino 1, n = 16); iii. camundongos submetidos ao treinamento resistido diário antes e após da indução tumoral (Treino 2, n = 16); iv. camundongos submetidos ao treinamento resistido diário após a indução tumoral e apresentado quadro caquético (Treino 3, n = 16). No procedimento para treinamento resistido (TR) com choque, foi utilizada uma escada com 110 cm de altura, 18 cm de largura, 2 cm entre os degraus e 80 graus de inclinação. No procedimento para TR com choque, foi utilizada uma escada 110 cm de altura, 18 cm de largura, 2 cm entre os degraus e 80 graus de inclinação. O exercício resistido baseia-se na subida dos camundongos. Na plataforma de saída, aplicava-se um choque elétrico como estímulo para subir as escadas, nesta etapa era aplicada o choque nas quatro patas do animal com uma tensão elétrica de 20 volts a uma frequência de 45 Hertz durante seis séries de oito repetições, cada uma com noventa segundos de intervalo entre as séries. Os grupos de camundongos foram submetidos a acompanhamento por no máximo 15 dias após o diagnóstico da caquexia a fim de comparar a sobrevida geral relacionada ao câncer entre os grupos de estudo. As curvas de sobrevivência de KaplanMeier foram estimadas para cada evento e as curvas dos diferentes grupos foram comparadas usando o teste de Log-rank. O tempo de sobrevida proposta foi de 25 dias após inoculação. RESULTADOS: Os resultados apresentados nesse estudo mostraram que não houve diferença significativa (p <0,05) entre as propostas de treino. CONCLUSÃO: Não houve diferença na sobrevida de animais com caquexia associada ao modelo tumoral singênico de melanoma cutâneo com intervenção de exercício resistido ou sedentários.

OBJECTIVE: The objective of this study was to verify the effect of resistance training on the survival of C57BL / 6 mice with cachexia associated with cutaneous melanoma. MATERIAL AND METHODS: The sample consisted of 64 (female C57BL/6 mice, aged between 10 and 12 weeks, with approximately 50 ± 5 grams of body weight. The mice were randomly distributed into four groups: i. control mice, with tumor induction, physically inactive (Control, n = 16); ii. mice submitted to daily resistance training only before tumor induction (Training 1, n = 16); iii. Mice submitted to daily resistance training before and after tumor induction (Training 2, n = 16); iv. Mice submitted to daily resistance training after tumor induction and presented a cachectic condition (Training 3, n = 16). In the resistance training procedure (RT) with shock, a 110 cm high, 18 cm wide, 2 cm between the steps, and 80 degrees inclination ladder was used. In the procedure for shock resistance training (TR), a ladder 110 cm high, 18 cm wide, 2 cm between the rungs, and 80 degrees of inclination was used. The resisted exercise is based on the climbing of the mice. On the exit platform, an electric shock was applied as a stimulus to climb the stairs. In this step, the shock was applied to the four legs of the animal with an electric voltage of 20 volts at a frequency of 45 Hertz during six series of eight repetitions, each with ninety-seconds intervals between the series. The mice groups underwent follow-up for no more than 15 days after diagnosis of cachexia to compare overall cancer-related survival between the study groups. Kaplan-Meier survival curves were estimated for each event, and the curves of the different groups were compared using the Log-rank test. The proposed survival time was 25 days after inoculation. RESULTS: The results presented in this study showed no significant difference (p <0.05) between the training proposals. CONCLUSION: There was no difference in animals' survival with cachexia associated with the syngeneic melanoma skin tumor model with either resistance exercise or sedentary intervention.

Medical and nutritional implications in chronic heart failure: strengths and limitations.

Heart failure (HF) is one of the most important global public health problems, as there is an increase in its prevalence and an estimated 23 million of the world's population live with this problem. HF is defined by the presence of structural and functional abnormalities of the cardiac muscle leading to an impairment of ventricular filling and ejection. Multiple comorbidities have been associated with an increased risk of developing cardiovascular diseases. Hypertension has been recognized as one of the most important factors, however, obesity, metabolic syndrome, as well as diabetes also play an important role in the onset of the disease. It is common to find in decompensated heart failure hospitalized patients an impaired nutritional status characterized mainly by the presence of nutritional deficiencies and sarcopenia, which can sometimes progress to cachexia. Therefore, an adequate evaluation through the correct use of nutritional risk tools should be the cornerstone to the prevention of risks. Multiple anthropometric and biochemical parameters are available to establish the nutritional status of hospitalized patients, however, alterations in blood volume presented in patients with HF may alter the result of such assessment. The effectiveness of dietary modifications in the prevention and treatment of different cardiovascular diseases enhanced by appropriate adherence to eating patterns such as the DASH and Mediterranean diet have been inversely associated with the incidence of HF.

La insuficiencia cardiaca (IC) representa uno de los problemas mundiales de salud pública más importantes, ya que existe un aumento en su prevalencia y se estima que 23 millones de la población mundial viven con este problema. Esta entidad se define por la presencia de anormalidades estructurales y funcionales del músculo cardiaco que conducen a un deterioro en la capacidad del llenado y eyección ventricular. Múltiples comorbilidades se han asociado a un incremento en el riesgo de desarrollo de enfermedades cardiovasculares. La hipertensión se ha reconocido como uno de los factores más importantes, sin embargo, la obesidad, el síndrome metabólico, así como la diabetes, también juegan un papel importante en la aparición de dicha enfermedad. Es frecuente encontrar en pacientes hospitalizados con IC deterioro en el estado nutricional caracterizado principalmente por la presencia de deficiencias nutricionales y sarcopenia, que, en ocasiones, puede progresar y manifestarse como caquexia. Por lo anterior, una evaluación adecuada mediante el uso correcto de herramientas para detección de riesgo nutricional es imperativa, se hace necesaria para prevenir los riesgos que esto implica. Existen múltiples parámetros antropométricos y bioquímicos para definir el estado nutricional de los pacientes hospitalizados, sin embargo, las alteraciones en el volumen sanguíneo presentes en pacientes con IC pueden alterar el resultado de dicha evaluación. Las modificaciones dietéticas en la prevención y tratamiento de diversas enfermedades cardiovasculares mediante un buen apego a patrones de alimentación tales como la dieta DASH (enfoques dietéticos para detener la hipertensión, por sus siglas en inglés) y la dieta mediterránea se han asociado inversamente con la incidencia de IC.

Comprometimento do apetite e fatores associados em pessoas idosas hospitalizadas com câncer / Impairment of appetite and associated factors in older adults hospitalized with cancer

Resumo Objetivo Investigar o comprometimento do apetite em pessoas idosas hospitalizadas com câncer e sua associação com estado nutricional e presença de caquexia. Métodos Estudo transversal realizado com pessoas idosas de ambos os sexos, diagnosticadas com neoplasia maligna, de julho de 2017 a março de 2019 em um hospital universitário. A amostra final foi composta por 90 pacientes. O comprometimento do apetite foi identificado pelo Questionário de Apetite e Sintomas para Pacientes com Câncer (CASQ) e o estado nutricional pela Avaliação Subjetiva Global Produzida pelo Próprio Paciente (ASG-PPP). A presença de caquexia foi avaliada pela perda de peso >5% nos últimos 6 meses; ou índice de massa corporal (IMC) <20 kg/m2 e perda de peso >2%; ou índice de músculo esquelético apendicular consistente com sarcopenia e perda de peso >2%. Resultados Houve predomínio de indivíduos do sexo masculino (56,7%), autodeclarados não brancos (56,7%), com tumores localizados no trato gastrointestinal (75,6%) e mediana de idade de 67 anos. 75,6% dos indivíduos apresentaram comprometimento do apetite, 57,8% suspeita de desnutrição ou desnutrição de algum grau, 54,4% caquexia e 92,2% necessidade de intervenção nutricional. Houve associação entre as categorias do CASQ com estado nutricional (p=0,001) e presença de caquexia (p=0,050). Após análise de regressão logística, a desnutrição permaneceu associada ao comprometimento do apetite [OR: 4,68 (IC 95%: 1,50-14,56), p=0,008]. Conclusão A presença de desnutrição aumentou as chances de comprometimento do apetite, o que reforça a necessidade da triagem e intervenção nutricional precoces, a fim de reduzir e/ou evitar os agravos nutricionais.

Abstract Objective To investigate appetite impairment in older adults hospitalized with cancer and its association with nutritional status and cachexia. Method A cross-sectional study, conducted with older adults men and women diagnosed with malignant neoplasia from July 2017 to March 2019 at a university hospital. The final sample consisted of 90 patients. Appetite was evaluated using the Cancer Appetite and Symptom Questionnaire (CASQ) and nutritional status was determined using the Patient-Generated Subjective Global Assessment (PG-SGA). Presence of cachexia was assessed by weight loss >5% in the last 6 months; or body mass index (BMI) <20 kg/m2 and weight loss >2%; or appendicular skeletal muscle index consistent with sarcopenia and weight loss >2%. Results There was a predominance of male (56.7%) self-declared non-white individuals (56.7%), with tumors in the gastrointestinal tract (75.6%) and median age of 67.0 years. 75.6% of the individuals have impaired appetite, 57.8% suspected malnutrition or malnutrition of some degree, 54.4% cachexia and 92.2% needed nutritional intervention. There was significant association between CASQ categories with nutritional status (p= 0.001) and presence of cachexia (p=0.050). After logistic regression analysis, malnutrition remained associated with impaired appetite assessed by CASQ score [OR: 4.68 (CI 95%: 1.50-14.56), p=0.008] Conclusion The presence of malnutrition increased the chances of appetite impairment, which reinforces the need for early nutritional screening and intervention, in order to reduce and/or avoid nutritional problems.

[Frequency of sarcopenia, cachexia, and associated factors in patients with chronic kidney disease in dialysis treatment]. / Frecuencia de la sarcopenia, la caquexia y los factores asociados en los pacientes con enfermedad renal crónica en terapia dialítica.

INTRODUCTION: Introduction: sarcopenia and cachexia are syndromes that result in a reduction of skeletal muscle mass, being associated with the aging process and many chronic diseases. Objective: to assess the frequency of sarcopenia as well as of cachexia and their associated factors in patients in dialysis treatment. Methodology: a cross-sectional study conducted in two dialysis treatment centers in Recife between March and September 2016. The diagnosis of sarcopenia was made according to the criteria issued by the Sarcopenia European Consensus, while that of cachexia was made in consonance with the Society for Cachexia and Wasting Disorders (SCWD). The association variables were demographic (age and sex), laboratory (C-reactive protein, serum albumin, hemoglobin, parathyroid hormone, serum creatinine), and anthropometric indicators (body mass index BMI, arm circumference AC, midarm muscular circumference MMC, triceps skinfold thickness TST). Results: the study involved 66 patients, 43.9 % men, 56.1 % women, with a mean age of 53.15 ± 15.24 years; 43.9 % were elderly subjects. Sarcopenia occurred in 59.1 % of patients; of these, 15.2 % presented with severe sarcopenia. Pre-sarcopenia was found in 4.5 %. With regard to cachexia, 15.2 % were diagnosed with this syndrome. The variables associated with sarcopenia were reduced serum albumin (p = 0.013) and cachexia (p = 0.039), and those associated with cachexia were female gender (p = 0.036) and BMI (p < 0.001). Conclusion: the main finding of the present study was the high frequency of sarcopenia found in patients on treatment with dialysis. In the patients studied, sarcopenia was significantly associated with a decrease in serum albumin. Reduced serum albumin is a predictor of mortality in patients on renal replacement therapy. A high frequency of sarcopenia has been observed among study patients. Thus, the tools currently available to assess muscle mass and muscle strength should be implemented as much as possible in clinical practice to enable the incorporation of appropriate preventive and therapeutic interventions.

INTRODUCCIÓN: Introducción: la sarcopenia y la caquexia son síndromes que producen una reducción de la masa muscular esquelética y que se asocian al proceso de envejecimiento y a muchas enfermedades crónicas. Objetivo: verificar la frecuencia de la sarcopenia, la caquexia y los factores asociados en pacientes en tratamiento dialítico. Metodología: estudio transversal realizado en dos centros de tratamiento dialítico de Recife entre marzo y septiembre de 2016. El diagnóstico de sarcopenia se realizó según el criterio del Consenso Europeo de Sarcopenia, mientras que el de caquexia se hizo por el criterio de la Society for Cachexia and Wasting Disorders (SCWD). Las variables de asociación fueron demográficas (sexo y edad), analíticas (proteína C-reactiva, albúmina sérica, hemoglobina, paratohormona y creatinina sérica) y antropométricas: índice de masa corporal (IMC), circunferencia del brazo (CB), circunferencia muscular del brazo (CMB) y pliegue cutáneo tricipital (PCT). Resultados: se estudió a 66 pacientes: el 43,9 % eran hombres y el 56,1 % mujeres, con una media de edad de 53,15 ± 15,24 años. El 43,9 % eran ancianos. La sarcopenia estuvo presente en el 59,1 % de los pacientes y, entre estos, el 15,2 % presentaban sarcopenia grave. La pre-sarcopenia se verificó en el 4,5 %. En cuanto a la caquexia, se diagnosticó en el 15,2 %. Las variables asociadas a la sarcopenia fueron la albúmina sérica reducida (p = 0,013) y la caquexia (p = 0,039); las relacionadas con la caquexia fueron el sexo femenino (p = 0,036) y el IMC (p < 0,001). Conclusión: la principal constatación es la elevada frecuencia de la sarcopenia en los pacientes que realizan terapia dialítica. En los pacientes estudiados, la sarcopenia se asoció significativamente a la disminución de la albúmina sérica. La albúmina sérica reducida es un predictor de mortandad en los pacientes en terapia renal sustitutiva. La frecuencia de la sarcopenia fue elevada en los pacientes estudiados. De este modo, las herramientas actualmente disponibles para evaluar la masa y la fuerza muscular deben aplicarse en la medida de lo posible en la práctica clínica, viabilizando la incorporación de las intervenciones preventivas y terapéuticas apropiadas.

Utilidade clínica do escore prognóstico de Glasgow modificado para classificação de caquexia em pacientes com câncer avançado em cuidados paliativos / [Clinical utility of the modified Glasgow prognostic score for classification of cachexia in patients with advanced cancer in palliative care]

Introdução e objetivo: A identificação e caracterização dos estágios da caquexia no câncer é um desafio na prática clínica. Atualmente, discute-se que alterações nos marcadores inflamatórios seriam capazes de indicar a presença de caquexia. Esse estudo teve por objetivo avaliar a relevância clínica da classificação de caquexia por meio do Escore Prognóstico de Glasgow modificado (EPGm) em pacientes com câncer avançado em cuidados paliativos. Métodos: Estudo observacional de coorte prospectivo realizado em uma Unidade de Cuidados Paliativos no Brasil. A caquexia foi classificada de acordo com o EPGm (composto por albumina e proteína C reativa) em quatro estágios: não caquético (NCa), desnutrido (Un), pré-caquético (PCa) e caquético refratário (RCa). Modelos de regressão logística foram utilizados para avaliar a associação entre os estágios de caquexia e domínios clínicos, nutricionais e funcionais. Curvas de Kaplan-Meier e o modelo multivariado de Cox foram usados para analisar a sobrevida. Resultados: Foram incluídos 1.166 pacientes. De acordo com o critério baseado no EPGm 37,5% dos pacientes foram considerados NCa, 32,3% Un, 3,9% PCa e 26,4% RCa. Foram observadas diferenças significativas na maioria dos desfechos estudados de acordo com os estágios de caquexia. Houve diferença significativa na sobrevida global entre os grupos estudados (77 versus 37 versus 31 versus 17 dias, respectivamente; p-valor <0,001). Além disso, a classificação utilizada foi capaz de predizer a mortalidade em 90 dias [Un (HR, 1,55; IC 95%, 1,25-1,93); PCa (HR, 2,00; IC 95%, 1,34-2,98); RCa (HR, 2,45; IC 95%, 1,34-2,98)]. Conclusão: Os estágios de caquexia foram associados à piores desfechos clínicos e capazes de predizer a sobrevida. Este método, baseado em um critério simples e objetivo, pode ser usado na rotina para caracterizar a presença e os estágios de caquexia em pacientes com câncer avançado.

Background & Aims: It is a challenge in clinical practice to identify and classify cancer cachexia. Currently, it has been extensively discussed if the presence of alterations in inflammatory biomarkers implies the presence of cachexia. This study aimed to evaluate the clinical relevance of cachexia classification through modified Glasgow Prognostic Score (mGPS) in advanced cancer patients in palliative care. Methods: Observational prospective cohort study conducted at a Palliative Care Unit in Brazil. Cachexia classification was performed according to mGPS (based on albumin and C-reactive protein) in four different stages: no cachexia (NCa), undernourished (Un), pre cachexia (PCa), and refractory cachexia (RCa). Logistic regression models were used to test the association between cachexia stages and clinical, nutritional and functional domains. Kaplan-Meier curve and Cox multivariate model were used to analyze overall survival (OS). Results: A total of 1,166 patients were included in the study. According to the cachexia framework 37.5% were NCa, 32.3% Un, 23.9% PCa and 26.4% RCa. Significant differences were observed among cachexia stages for most of the outcome measures. There was also a significant difference of OS between cachexia groups (77 versus 37 versus. 31 versus 17 days, respectively; p-value <0.001). In addition, this classification was able to predict mortality in 90 days [Un (HR, 1.55; 95% CI, 1.25;1.93); PCa (HR, 2.00; 95% CI, 1.34;2.98); RCa (HR, 2.45; 95% CI, 1.34;2.98)]. Conclusion: Cachexia stages were associated with significant differences in poor clinical outcomes and were also capable of predicting OS. This framework based on simple and objective criteria can be used as part of the routine to characterize the presence and stages of cachexia in advanced cancer patients.

Adropin and Irisin in Patients with Cardiac Cachexia / Adropina e Irisina em Pacientes com Caquexia Cardíaca

Abstract Background: Cardiac cachexia is an important predictive factor of the reduction in survival of patients with heart failure with reduced ejection fraction. Objectives: The aims of the present study were to evaluate adropin and irisin levels in cachectic and non-cachectic subjects and the relationships between the levels of these proteins and clinical and laboratory parameters in patients with HFrEF. Methods: The clinical records of patients who were admitted to the cardiology outpatient clinic for heart failure with reduced ejection fraction were screened. Cachectic patients were identified and assigned to the study group (n = 44, mean age, 65.4 ± 11.2 y; 61.4% men). Heart failure with reduced ejection fraction patients without weight loss were enrolled as the control group (n = 42, mean age, 61.0 ± 16.5 y; 64.3% men). The serum adropin and irisin levels of all patients were measured. A p-value < 0.05 was considered significant. Results: Serum adropin and irisin levels were significantly higher in the cachexia group than in the controls (Adropin (ng/L); 286.1 (231.3-404.0) vs 213.7 (203.1-251.3); p < 0.001, Irisin (µg/mL); 2.6 (2.2-4.4) vs 2.1 (1.8-2.4); p = 0.001). Serum adropin and irisin levels were positively correlated with brain natriuretic peptide (BNP) levels and New York Heart Association (NYHA) class and negatively correlated with body mass index (BMI) and serum albumin levels (all p values: < 0.001). In a multivariate analysis, adropin was the only independent predictor of cachexia in the heart failure with reduced ejection fraction patients (OR: 1.021; 95% CI: 1.004−1.038; p = 0.017). Conclusions: The results suggest that adropin and irisin may be novel markers of cardiac cachexia in heart failure with reduced ejection fraction patients. Adropin and irisin are related with the severity of heart failure.

Resumo Fundamento: A caquexia cardíaca é um importante preditor de redução de sobrevida em pacientes com insuficiência cardíaca com fração de ejeção reduzida (ICFER). O objetivo deste estudo foi avaliar os níveis de adropina e irisina em pacientes com ICFER caquéticos e não caquéticos, assim como a relação entre os níveis dessas proteínas e os parâmetros clínicos e laboratoriais nesses pacientes. Objetivos: Os objetivos do presente estudo foram avaliar os níveis de adropina e irisina em indivíduos caquéticos e não caquéticos e as relações entre os níveis dessas proteínas e os parâmetros clínicos e laboratoriais em pacientes com ICFEN. Métodos: Os prontuários de pacientes atendidos no ambulatório de cardiologia para ICFER foram triados. Aqueles com ICFER caquéticos foram identificados e constituíram o grupo de estudo (n = 44; idade média, 65,4 ± 11,2 anos; 61,4% de homens). Aqueles com ICFER e sem perda de peso foram arrolados como grupo controle (n = 42; idade média, 61,0 ± 16,5 anos; 64,3% de homens). Os níveis séricos de adropina e irisina de todos os pacientes foram medidos. Considerou-se significativo um p-valor < 0,05. Resultados: Os níveis séricos de adropina e irisina foram significativamente mais altos nos pacientes caquéticos do que nos controles [adropina (ng/l): 286,1 (231,3-404,0) vs 213,7 (203,1-251,3); p < 0,001; irisina (µg/ml): 2,6 (2,2-4,4) vs 2,1 (1,8-2,4); p = 0,001]. Os níveis séricos de adropina e irisina correlacionaram-se positivamente com os níveis de peptídeo natriurético cerebral (BNP) e a classe funcional da New York Heart Association (NYHA), e negativamente com o índice de massa corporal (IMC) e os níveis séricos de albumina (todos os p-valores: < 0,001). Na análise multivariada, a adropina foi o único preditor independente de caquexia nos pacientes com ICFER (OR: 1,021; IC 95%: 1,004−1,038; p = 0,017). Conclusões: Os resultados sugerem que a adropina e a irisina possam ser novos marcadores de caquexia cardíaca em pacientes com ICFER. Adropina e irisina estão relacionadas com a gravidade da insuficiência cardíaca.

Rheumatoid arthritis-increased gene expressions in muscle atrophy are restored back to control as a response to acute resistance exercise / Estímulo agudo de musculação promove regulação de genes alterados pela atrofi a muscular

This study had as objective to analyze the acute eff ects of resistance exercise (RE) on the mRNA levels of the following genes (MyoD, myogenin, IGF-1, atrogin-1, MuRF-1, and myostatin) in rheumatoid arthritis (experimental arthritis). Therefore, 26 females rats were randomly allocated into four groups, control (CT, n=7), exercise (Ex, n=6), rheumatoid arthritis (RA, n=6) and RA with exercise (RAEx, n=7). Met-BSA was injected into the tibiotarsal joint in the RA and RAEx groups. After 15 days from injection, the animals were submitted to an acute bout of RE and six hours post protocol the animals were euthanized. We evaluated the joint thickness, infl ammation score, cross-sectional area (CSA) of gastrocnemius muscle fi bers and mRNA expression of the IGF-1, MyoD, myogenin, myostatin, MuRF-1, atrogin-1 and GAPDH. It was observed that the joint thickness and score strongly increased in arthritic rats (p <0.001) while the CSA decreased (p ≤ 0.05). Increased mRNA levels of IGF-1 (2.0 fold), myostatin (4.5 fold), atrogin-1 (2.5 fold), MyoD (3.7-fold) and myogenin (5 fold) were observed in muscle of arthritic rats. The mRNA expression of myostatin, atrogin-1, MyoD and myogenin decreased in the RAEx group. In this way, we can conclude that experimental arthritis-increased gene expressions in muscle atrophy myostatin, atrogin-1, MyoD and myogenin) are restored back to control as a response to acute RE....(AU)

O presente estudo teve como objetivo analisar o efeito agudo do Exercício com pesos sobre os níves de mRNA de genes envolvidos no anabolismo ou catabolismo muscular em um modelo experimental de Artrite Reumatóide. Para tanto, 26 ratas fêmeas foram randomicamente alocadas em quatro grupos, controle (CT, n=7), Exercício (Ex, n=6), Artrite Reumatóide (AR, n=6) e Artrite Reumatóide com exercício (AREx, n=7). Uma substância contendo Albumina bovina metilada foi injetada na articulação tíbio-tarsal nos grupos AR e AREx para indução da Artrite Reumatóide. Após 15 dias da injeção, os animais foram submetidos a um estímulo agudo de treinamento com pesos e 6 horas após o exercício os animais foram eutanasiados. Nós avaliamos a espessura da articulação, escore de infl amação, a área de secção transversa (AST) das fi bras do músculo Gastrocnêmio e a mRNA de IGF-1, MyoD, Myogenina (genes envolvidos no anabolismo muscular), e MuRF-1, atrogina-1 (genes envolvidos no catabolismo muscular), além do gene controle , GAPDH. Foi observado que a espessura articular e o escore de infl amação aumentaram fortemente nas ratas induzidas a Artrite Reumatóide (p <0,001), enquanto a AST reduziu (p ≤ 0,05). Um aumento nos níveis de mRNA de IGF-1 (2,0 vezes), miostatina (4,5 vezes), atrogina-1 (2,5 vezes), MyoD (3,7 vezes) e miogenina (5 vezes) foi observado no músculo das ratas induzidas a Artrite Reumatóide. mRNA de miostatina, atrogina-1, MyoD e miogenina reduziu no grupo RAEx. Desta forma, podemos concluir, que o modelo experimental de Artrite Reumatóide induziu um aumento da expressão de genes durante a atrofi a muscular (myostatin, atrogin-1, MyoD and myogenin) e que estas alterações foram reguladas pelo Exercício com peso....(AU)