International Journal of Nutrology
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Adequate nutrological treatment for patients with chronic kidney disease: a systematic review
Get PDFIntroduction: In the scenario of chronic kidney disease (CKD), data from the World Health Organization show that CKD affects approximately 10% of the world population, particularly in low- and middle-income countries. In the USA alone, approximately 37 million adults are affected, given that diagnosis is late due to the lack of apparent symptoms in the early stages. Due to limited access to diagnosis and treatment, CKD has become the 12th leading cause of death in the world, making adequate nutritional therapy necessary as the main treatment. Objective: It was to highlight the importance of adequate nutrological treatment for patients with chronic kidney disease. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to September 2024 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 124 articles were found. 22 articles were evaluated and 18 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =84.6% >50%. It was concluded that chronic kidney disease is a growing health crisis in the world, accompanying the increase in the number of patients with obesity. Diabetes and hypertension are the main causes of the development of chronic kidney disease. Lifestyle changes, adequate nutritional therapy, and lipid-lowering medications can contribute to improving the clinical outcome of patients with chronic kidney disease. Medical nutritional therapy is fundamental and vital for the treatment of chronic kidney disease, as it can delay disease progression and prevent comorbidities and mortality
Influences of probiotics and gut microbiota on immunomodulation for the treatment of patients with cancer: a systematic review
Get PDFIntroduction: Immunomodulation and immunostimulation are the main mechanisms of action of probiotics in the fight against cancer. Objective: It was to carry out a systematic review of the influences of probiotics and gut microbiota on immunomodulation for the treatment of cancer patients. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 125 articles were found, and 35 articles were evaluated in full and 18 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 45 studies with a high risk of bias and 15 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=55.4%>50%. It was concluded that probiotics suppress inflammation by inhibiting several signaling pathways and reducing the global activation of NF-κβ and the production of pro-inflammatory cytokines. Probiotics influence receptor antagonism, receptor expression, binding and expression of adapter proteins, expression of negative regulatory signal molecules, and mainly the induction of microRNAs. These microRNAs can modulate the gene expression of tumor cells together with regulatory T cells that have important functions in the tumor microenvironment, mainly in inducing immune evasion. Some modulatory effects of probiotics include the production of cytokines by epithelial cells, increased mucin secretion and phagocytosis and NK cell activity, activation of T and NKT cells, stimulation of IgA production, and decreased proliferation of T cells. The gut microbiota has a major impact on the systemic immune system. The specific microbiota controls cell differentiation in which CD4+ T cells (Th17 cells) secrete IL-17. The presence of Th17 cells and regulatory T cells is associated with the gut microbiota
Nutritional modulation of gut microbiota in inflammatory bowel disease: a systematic review
Get PDFIntroduction: Inflammatory bowel diseases (IBD) have shown an increase in incidence worldwide. The pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microbiota (dysbiosis) and chronic inflammation develops as a result of poor dietary triggers. Diet plays an important role in modulating the gut microbiota and can be applied as a therapeutic tool to improve the course of the disease. Objective: It was to carry out a systematic review of the main interactions between nutrology, gut microbiota, and inflammatory bowel disease, to elucidate the main clinical outcomes of the disease after nutrological treatment, analyzing the main macro and micronutrients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 144 articles were found. A total of 39 articles were evaluated in full and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=59.9%>50%. With nutritional treatment, several micronutrients have the potential to modulate intestinal inflammation. Immunonutrition has demonstrated its importance through vitamins A, C, E, and D, folic acid, beta-carotene, and trace elements such as zinc, selenium, manganese, and iron. The Specific Carbohydrate Diet, fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet, and the Mediterranean diet also appear to show strong anti-inflammatory properties and promise to improve symptoms of inflammatory bowel disease. Diet modulation can control IBD by reducing persistent intestinal symptoms, balancing the gut microbiota, and reducing markers of inflammation. Dietary therapy can improve the quality of life of IBD patients
Assessment of the knowledge on nutrology among medical course students: an observational cross-sectional study
Get PDFIntroduction: An unbalanced diet is responsible for more deaths than any other risk factor, including smoking. By definition, Nutrology is the medical specialty whose function is to prevent, diagnose and treat nutroneurometabolic diseases. As it is a relatively new specialty, it has not yet become part of the basic curriculum as a mandatory subject in most medical schools. This fact means that students have little or no contact with the specialty during their academic training. Objective: The objective of this study was to evaluate the knowledge on Nutrology among medical students. Methods: An observational and cross-sectional study was conducted to assess the knowledge of students enrolled in the Ugraft Journey of the Plastic Surgery Leagues of Rio Grande do Sul. Data collection took place through the application of an online questionnaire comprising 14 questions. Results: A total of 170 participants spanning across all semesters of the course, representing 7 universities (UFSM, UFCSPA, UFN, UFAL, Unoeste, Univates, and Unijuí). The participants were aged between 18 and 43 years old, 114 were female and 56 were male. In regard to the question of which course Nutrology is a part of, 84.1% answered Medicine, 14.7% answered Nutrition, and 1.2% answered another course. Additionally, 67.6% stated that they do not know or are not sure about the area of activity of Nutrology, while only 17.6% have already consulted a Nutrologist. Concerning the significance of dietary guidance and supplementation during the pre- and post-operative phases of surgery, 98.2% deemed it advantageous for the patient. When it came to distinguishing between the various indications for oral dietary supplementation, enteral, or parenteral therapy, 74.7% did not know how to differentiate them. Regarding the safety of prescribing a food supplement, 90% do not feel able to do so. As for the meaning of the acronym MNTT, 93% are unaware. Regarding obesity being a chronic disease, 92.4% agreed. Regarding the desire to undertake a residency in Nutrology, 12.9% expressed interest. Finally, regarding the importance of the subject of Nutrology in the curriculum, 94% considered it important. Conclusion: Despite the increasing prevalence of nutrition-related diseases and the evidence showing that poor diet is responsible for more deaths than any other risk factor, studies have observed that the majority of medical students feel unprepared regarding the subject. The findings of this study could serve as motivation for institutions to reconsider the significance of incorporating the discipline of Nutrology into the medical curriculum
Fistuloclysis in the nutritional management of a enteroatmospheric fistula: case report and literature review
Get PDFIntroduction: The open abdomen (OA) strategy has been widely adopted as a life-saving intervention in critically ill patients. Initially described as part of the damage control surgery in trauma practice, OA techniques have since further expanded its indications, being successfully adapted to many non-trauma emergent surgical conditions, including abdominal compartment syndrome, severe acute pancreatitis, vascular diseases, and peritonitis/intra-abdominal sepsis. Case Report: This report presents a successful application of this technique in the management of a high-output enteroatmospheric fistula following abdominal complications in a trauma patient. Final considerations: Fistuloclysis is a promising modality for the nutritional support of complex cases of enteroatmospheric fistula in OA patients that also align with the recent efforts to ensure enteral nutrition whenever feasible. Besides its advantages over prolonged exclusive parenteral nutrition in terms of morbidity and costs, the improvement in bowel mucosal trophism is critical for the definitive reconstructive surgery. Future clinical guidelines may encourage the use of fistuloclysis as a safe and effective alternative method for the management of these challenging cases
Management of enteral/parenteral therapy in patients with obesity in the light of exosomes/microRNAs: a systematic review
Get PDFIntroduction: Alteration in the homeostasis of the intestinal microbiota is related to the prevalence of obesity, which could reach up to 57.8% of the adult world population by 2030. Likewise, the global incidence rate of type 2 diabetes, which represents 90-95 % of all diabetes cases. Extracellular vesicles (exosomes and microRNAs) have emerged as main vehicles for intercellular and intermolecular communication, including those established between the intestinal microbiota and mammals. Providing adequate nutritional therapy with essential nutrients can help mitigate the consequences of the catabolic response. Objective: It was to bring together the main considerations of enteral/parenteral nutritional therapy in patients with obesity, highlighting the management of inflammatory and metabolic processes through exosomes and microRNAs. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found. A total of 44 articles were evaluated in full and 39 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =52.5%>50%. It was concluded that exosomes and miRNAs, through enteral/parenteral nutritional therapy, are involved in the control of weight gain, glucose homeostasis, and lipid metabolism. Some clinical studies have shown that enteral nutritional therapy is effective and safe before bariatric surgery, with ketogenic enteral nutrition leading to better clinical outcomes than hypocaloric enteral nutritional protocols in glycemic and lipid profiles to satisfy better regulation of exosomes. and microRNAs, mainly from the intestinal microbiota, for the control of inflammatory and metabolic processes
Clinical approaches to the ketogenic diet in the treatment of obesity and other chronic diseases: a systematic review
Get PDFIntroduction: The ketogenic diet, a restrictive diet, is mainly characterized by high fat content, low or absent carbohydrate content, and low or normal amounts of protein. Objective: It was to present the important role of the ketogenic diet in the treatment of obesity and other chronic diseases. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 111 articles were found, and 44 articles were evaluated, and 22 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 19 studies with a high risk of bias and 32 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=65.7%>50%. It was concluded that the therapeutic use of the ketogenic diet is relevant in the treatment of obesity and metabolic syndrome. Furthermore, this work also showed the benefits of the metabolism of ketone bodies in the adjuvant treatment of cancer, diabetes, and obesity, thus contributing to updating knowledge about the use of the ketogenic diet in the therapy of diseases of great clinical and epidemiological importance. When it comes to obese and diabetic people, it is important to highlight that due to the lower consumption of fiber, and an increased consumption of proteins (mainly of animal origin) and fat, the risk of heart disease, colon cancer, and intestinal constipation increases
Investigation of regenerative nutrology of cells/molecules to the organism: a systematic review
Get PDFIntroduction: In the context of tissue regeneration and nutrology, stem cells from adult tissue mediate homeostasis and regeneration of tissues and organs. These decisions are directly integrated with the body's energy balance and nutritional status. Endogenous metabolites and dietary nutrients can directly influence epigenetic enzymes. Objective: It was to carry out a systematic review of the regenerative nutrology of cells and molecules in the body. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April to June 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. A total of 45 articles were evaluated in full and 25 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 18 studies that did not meet GRADE. It was evidenced that the metabolism of stem cells was centered on the central metabolism of carbon and the balance between glycolysis versus oxidative phosphorylation in the regulation of cell destiny. Epigenetic modifications to DNA and histones, proteins that alter cellular fate, control chromatin accessibility and downstream gene expression. In addition to the connection between metabolism and epigenetic pathways, nutrients can impact cellular status by modulating signaling pathway activity. A clear example is through the mechanistic targeting of the rapamycin (mTOR) signaling pathway, and in particular the mTOR 1 complex. Nutritional supplementation accelerated the healing of skin ulcers and reduced the intensity of wound care in non-malnourished patients
Precise nutrition in the metabolic and nutritional management of bariatric surgery: a systematic review
Get PDFIntroduction: Obesity is a chronic relapsing disease characterized by abnormal or excessive adiposity with health risks. Any nutritional intervention in patients who are candidates for or have already undergone bariatric surgery must be based on a detailed nutritional assessment, including an assessment of personal values, preferences, and social determinants of eating habits. Objective: It was to carry out a systematic review to explore and present nutritional importance before, during, and after bariatric surgery. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 122 articles were found. A total of 43 articles were evaluated in full and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=64.5%>50%. It was concluded that enteral nutrition strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to the diet prescribed before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects in reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology help provide optimal care to patients, especially nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures, such as RYGB. It is essential to immediately administer thiamine. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. Additionally, serum micronutrient levels should be monitored regularly and additional supplemental measures prescribed as indicated
Major relationships among nutrology, gut microbiota and lifestyle change in healthy longevity: a systematic review
Get PDFIntroduction: In the healthy longevity scenario, individuals over 65 and over 80 years old will be the fastest growing segment of the population. This is associated with the intensification of chronic diseases, such as cardiovascular diseases, diabetes, cancer, sarcopenia, and degenerative diseases (non-communicable diseases). Genetic, epigenetic, and lifestyle factors can determine the longevity of humans. Certain healthy foods are associated with longer telomere lengths. Objective: To describe, through a systematic literature review, the main relationships between nutrology, gut microbiota, and lifestyle changes in healthy longevity. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from May to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 139 articles were found. A total of 51 articles were fully assessed and 22 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 32 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2 =77.5%>50%. It was concluded that nutrients that can modulate epigenetic pathways, positively influence the outcomes associated with healthy longevity. Studies have shown that the gut microbiota in longlived individuals has a high capacity for lipid metabolism, amino acid degradation, and potential signs of a chronic inflammatory state. Probiotics and prebiotics may be effective alternatives, considering the relationship between the microbiome and healthy aging. Furthermore, resveratrol can modulate epigenetic pathways and may affect outcomes associated with aging, exerting favorable metabolic changes, such as reductions in inflammatory markers or low-density lipoprotein. Nutrients and natural substances of human physiology and biochemistry such as melatonin, coenzyme Q10, and selenium control the functions of the immune and metabolic systems. Many metabolic or chronic diseases have been implicated in poor diet and lifestyle. Improving the quality of diet is associated with reduced mortality from all causes, whereas multivitamin and multimineral supplements can improve life expectanc