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.
Key points
Malnutrition, according to Subjective Global Nutritional Assessment (SGNA), was high and related to death in Brazilian children and adolescent with cancer.
Patients from more economically disadvantaged regions of Brazil, aged 10–18 years and in haematological treatment, had higher readmission rates.
A Revista Demetra: Alimentação, Nutrição & Saúde, antes Revista Ceres: Nutrição e Saúde, vem mantendo suas atividades desde o ano de 2006. Durante esses mais de 15 anos, a revista passou por mudanças ...e aprimoramentos, aumentando sua importância e relevância na missão de ampliar a comunicação de trabalhos científicos desenvolvidos no campo da Alimentação, Nutrição e Saúde.De 2018 a 2021, a revista foi coordenada pelas Professoras Josely Koury e Luciana Castro, sucedendo as Professoras Fabiana Kraemer e Shirley Prado, todas do Instituto de Nutrição da Universidade do Estado do Rio Janeiro, às quais agradecemos por toda dedicação e empenho na manutenção da publicação e pelo constante avanço na qualidade do periódico. Neste momento de renovação, também gostaríamos de agradecer à equipe editorial e aos editores associados e pareceristas, que têm o importante papel de fazer a revista acontecer. Nosso “muito obrigada” a todos.Nos últimos anos, a revista passou por uma série de melhorias, como a indexação na plataforma LILACS, além da indexação em outras bases (J4F - Journals for Free; FMJ - Free Medical Journals; LATINDEX - Sistema Regional de Información en Línea para Revistas Científicas de América Latina, el Caribe, España y Portugal; DOAJ - Directory of Open Access Journals; ROAD - Directory of Open Access Scholarly Resource; DRJI - Directory of Research Journals Index; OAJI - Open Academic Journals Index; DIADORIM - Diretório de Políticas de Acesso Aberto das Revistas Científicas Brasileiras; PERIÓDICA - Índice de Revistas Latinoamericanas en Ciencias; GALE - Cengage-Learning; PERIÓDICOS CAPES; GOOGLE SCHOLAR; REDIB - Red Iberoamericana de Innovación y Conocimiento Científico), instituição de um Conselho Editorial Deliberativo, ampliação do corpo de editores assistentes, com representação das diversas regiões do país, readequação do layout da página da revista, instituição do fluxo contínuo para publicação de artigos, criação de perfil nas redes sociais e a manutenção de todas as atividades durante o período de isolamento social. Atualmente, a Revista Demetra é classificada como B4 na área da Nutrição (classificação QUALIS da Capes - 2016).No próximo período, teremos novos desafios na condução da revista, como a indexação na plataforma SciELO e a manutenção dos patamares de qualidade alcançados. Reconhecemos que muito foi feito e que ainda há uma série de conquistas e desafios que se colocam na editoria de uma revista cada vez mais conceituada na área de Alimentação, Nutrição e Saúde. Para este ano, será publicado um suplemento temático sobre “Dietética e promoção da alimentação adequada e saudável”, sobre o qual divulgaremos mais notícias em breve. Esperamos poder oferecer, em um futuro próximo, a oportunidade de novos suplementos em outras áreas temáticas de interesse dos leitores.Agradecemos o convite para ocupar a editoria da Revista Demetra e esperamos entregar para a comunidade acadêmica um trabalho à altura das expectativas. Sigamos juntos!
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.
This study used data from 723 children from the Brazilian Survey of Pediatric Oncology Nutrition and reported that more patients were classified as having malnutrition with SGNA than with classification of nutritional status based on body mass index.
This study evaluated the effect of an immune-modulatory diet on patients with gastric cancer and identified the parameters associated with postoperative outcomes. This was a single-arm prospective ...intervention study. At baseline, patients were assessed for nutrition (Patient-Generated Subjective Global Assessment), inflammatory markers (albumin, C-reactive protein, and interleukin 6 IL-6), and immune markers (percentage NK, CD4, CD8, and CD4:CD8 ratio); they also received nutrition counseling and high-calorie/protein supplement. A week before surgery, they were assessed for nutrition and inflammatory/immune markers and started on an immune-modulatory supplement until the day before surgery, when they were evaluated again. On the second postoperative day, patients were assessed for inflammatory/immune parameters, and a final nutrition evaluation was performed until the day of discharge. Complications were recorded daily and up to 30 days after discharge. Thirty-seven patients (60 ± 10 years old) were included, and 57% were classified as malnourished. Maintenance of nutrition and immune parameters occurred throughout the study period, but we found a preoperative increase in C-reactive protein (0.1-1.5 mg/dL) and IL-6 (2.0-14.2 pg/mL) and a postoperative increase in the CD4:CD8 ratio (2.3 ± 1.0). Complications and death were seen in 35%, especially patients with higher preoperative IL-6 (2.2-46 pg/mL), lower CD4:CD8 ratio (1.7 ± 0.5), and lower protein (1.2 ± 0.5 g/kg/d) and calorie intake (1552 ± 584 kcal/kg/d). The high-calorie/protein supplementation with the immune-modulating diet was able to maintain the nutrition and immune status of patients with gastric cancer.
This study aimed to evaluate the effect of preoperative immunonutrition on the rate of postoperative complication and survival of patients with gastric cancer.
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.
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).
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.
•This is a retrospective study of immunonutriton in 164 patients with gastric cancer.•Immunonutrition does not reduce postoperative complications and length of hospital stay.•Immunonutrition can improve short- and long-term survival.
This study aimed to investigate the impact of nutritional status and frailty phenotype and the predictors of temporal changes on health-related quality of life (HRQoL) of patients with bladder or ...kidney cancer.PURPOSEThis study aimed to investigate the impact of nutritional status and frailty phenotype and the predictors of temporal changes on health-related quality of life (HRQoL) of patients with bladder or kidney cancer.Frailty phenotype, Patient-Generated Subjective Global Assessment, and Quality-of-life questionnaire Core-30 were applied twice to patients diagnosed with bladder or kidney cancer. Patients also completed a sociodemographic questionnaire, and clinical data were collected from records.METHODSFrailty phenotype, Patient-Generated Subjective Global Assessment, and Quality-of-life questionnaire Core-30 were applied twice to patients diagnosed with bladder or kidney cancer. Patients also completed a sociodemographic questionnaire, and clinical data were collected from records.Sixty-two individuals completed the study, mostly male, with a mean age of 62.5 (± 11.4) years. The median time of follow-up was 14.5 months. Role functioning, emotional functioning, and fatigue improved over time (p < 0.05). The factors that negatively affected the long-term quality of life summary score were being female, malnourished, pre-frail and frail, cancer treatment, performance status, and lower income. Using the multivariate model, being malnourished (β = - 7.25; 95% CI, - 10.78 to - 3.71; p < 0.001), frail (β = - 7.25; 95% CI, - 13.39 to - 1.11; p = 0.021), and each one-point increase in performance status (β = - 6.9; 95% CI, - 9.54 to - 4.26; p < 0.001), were the ones that most negatively impacted the HRQoL between the two assessments.RESULTSSixty-two individuals completed the study, mostly male, with a mean age of 62.5 (± 11.4) years. The median time of follow-up was 14.5 months. Role functioning, emotional functioning, and fatigue improved over time (p < 0.05). The factors that negatively affected the long-term quality of life summary score were being female, malnourished, pre-frail and frail, cancer treatment, performance status, and lower income. Using the multivariate model, being malnourished (β = - 7.25; 95% CI, - 10.78 to - 3.71; p < 0.001), frail (β = - 7.25; 95% CI, - 13.39 to - 1.11; p = 0.021), and each one-point increase in performance status (β = - 6.9; 95% CI, - 9.54 to - 4.26; p < 0.001), were the ones that most negatively impacted the HRQoL between the two assessments.This study confirmed that frailty, nutritional status, and performance status are the main predictors of HRQoL of patients with bladder or kidney cancer over time.CONCLUSIONThis study confirmed that frailty, nutritional status, and performance status are the main predictors of HRQoL of patients with bladder or kidney cancer over time.These findings may be the first step towards highlighting the importance of preventing malnutrition and frailty, in favor of a better long-term QoL for cancer patients.IMPLICATIONS FOR CANCER SURVIVORSThese findings may be the first step towards highlighting the importance of preventing malnutrition and frailty, in favor of a better long-term QoL for cancer patients.
In dialysis patients, cross-sectional studies show that total and abdominal body fat associate with inflammatory markers. Whether this is true in earlier disease stages is unknown. We evaluated the ...cross-sectional and longitudinal (12-month interval) association between body fat markers and C-reactive protein (CRP) in pre-dialysis chronic kidney disease (CKD) patients.
We studied, over a period of 1 year, clinically stable CKD patients at Stages 3-4 who were under treatment in a single outpatient clinic. Fifty-seven patients were included and 44 concluded the observational period males: 66%; age: 62.9±13.9 years; body mass index (BMI): 25.5±5.1 kg/m2; estimated glomerular filtration rate (eGFR): 34±12.3 mL/min/1.73 m2. Total body fat (skinfold thicknesses), waist circumference (WC), laboratory measurements (serum creatinine, total cholesterol, albumin, high-sensitivity CRP and leptin) and food intake (24-h food recall) were assessed at baseline and after 12±2 months.
Most patients had anthropometric parameters in the range of overweight/obesity and none had signs of protein-energy wasting. In univariate analysis, changes (delta: end-baseline) in CRP were associated (P<0.05) with changes in BMI (r=0.39) and WC (r=0.33). In multiple regression analysis, these associations remained significant (P<0.05) even after adjusted by potential confounders (sex, diabetes, baseline age and eGFR).
During a follow-up of 12 months, changes in BMI and WC were directly associated with changes in CRP. Our results support the concept that interventions aimed at reducing weight and/or abdominal adiposity in pre-dialysis CKD patients may also translate into reduced systemic inflammation.
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.
Lycopene, a major carotenoid component of tomato, has a potential anticancer activity in many types of cancer. Epidemiological and clinical trials rarely provide evidence for mechanisms of the ...compound's action, and studies on its effect on cancer of different cell origins are now being done. The aim of the present study was to determine the effect of lycopene on cell cycle and cell viability in eight human cancer cell lines.
Human cell lines were treated with lycopene (1-5 μM) for 48 and 96 h. Cell viability was monitored using the method of MTT. The cell cycle was analyzed by flow cytometry, and apoptotic cells were identified by terminal deoxynucleotidyl transferase-mediated dUTP nick labeling (TUNEL) and by DAPI.
Our data showed a significant decrease in the number of viable cells in three cancer cells lines (HT-29, T84 and MCF-7) after 48 h treatment with lycopene, and changes in the fraction of cells retained in different cell cycle phases. Lycopene promoted also cell cycle arrest followed by decreased cell viability in majority of cell lines after 96 h, as compared to controls. Furthermore, an increase in apoptosis was observed in four cell lines (T-84, HT-29, MCF-7 and DU145) when cells were treated with lycopene.
Our findings show the capacity of lycopene to inhibit cell proliferation, arrest cell cycle in different phases and increase apoptosis, mainly in breast, colon and prostate lines after 96 h. These observations suggest that lycopene may alter cell cycle regulatory proteins depending on the type of cancer and the dose of lycopene administration. Taken together, these data indicated that the antiproliferative effect of lycopene was cellular type, time and dose-dependent.
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