International Journal of Nutrology
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Clinical evidence of low-calorie and ketogenic nutrological therapy before, during and after bariatric surgery: a systematic review
Get PDFIntroduction: Obesity is a multifactorial disease that causes serious comorbidities. There are more than 2.2 billion overweight and obese people in the world. Obese patients tend to be predisposed to micronutrient deficiency even before bariatric surgery, therefore, it is imperative to supplement nutrients orally, enterally, or parenterally, according to the indications of each patient. Objective: It was highlighted the importance of low-calorie and ketogenic nutritional therapy before, during, and after bariatric surgery through the systematic analysis of clinical studies. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June 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: 119 articles were found. A total of 40 articles were fully evaluated 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 23 studies with a high risk of bias and 27 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X2=76.5%>50%. It was concluded that nutrological therapy strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to following the prescribed diet before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects on 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 are useful to provide optimal care to patients, especially in nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures such as RYGB. Immediate administration of thiamine is essential. 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 a multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. In addition, serum micronutrient levels should be monitored regularly and additional supplementation should be prescribed as indicated
Nutrological aspects of polyphenols and gut microbiota in sports performance: a systematic review
Get PDFIntroduction: In the context of nutrology and sports performance, the focus for intake in athletes and physically active individuals has been directed to the main class of polyphenols. Interest in a personalized approach is increasing in sports to maximize each individual's athletic ability in endurance and strength sports. Polyphenols represent a heterogeneous class of compounds with marked antioxidant and anti-inflammatory properties. The impact of the gut microbiota on the bioavailability and activity of polyphenols is highlighted. Objective: It was to carry out a systematic review to highlight the main relationships between polyphenols, gut microbiota, and sports performance. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to July 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 115 articles were found, and 81 articles were evaluated in full and 76 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 6 studies with a high risk of bias and 10 studies that did not meet GRADE. As a result and conclusion, it was shown that the metabolic mechanisms favored by polyphenols improve sports performance, improve cardiometabolic functions, reduce recovery times and post-exercise pain, maintain a low degree of oxidative stress, and avoid unregulated inflammatory processes. Thus, polyphenols are able, through their interaction with the gut microbiota, to favor the proliferation of bacterial genera of great importance for metabolic and cognitive functions, such as Akkermansia, Lactobacilli, and Bifidobacteria. Gut microbiota metabolizes polyphenols in the colon to produce small bioactive molecules that exert epigenetic mechanisms on biochemical pathways modulating gene expression. Polyphenols have multiple biological effects, and future exercise studies should be appropriately and specifically designed to determine the physiological interactions between exercise and the selected supplement, rather than just considering performance
MDPL syndrome (mandibular hypoplasia, deafness, progeroid features, and lipodystrophy) and nutrological management: a rare case report
Get PDFIntroduction: Congenital lipodystrophies comprise a rare group of heterogeneous disorders that affect adipose tissue distributions and are characterized by varying degrees of body fat loss. Genetic damage, telomere shortening, cellular senescence, and proliferation defects are hallmarks of the aging process. Metabolism and mitochondrial activity play an important role in the pathogenesis of MDPL syndrome (mandibular hypoplasia, deafness, progeroid features, and lipodystrophy). Objective: It was to report the case and diagnosis of a patient with MDPL syndrome and the nutrological management. Case report: The information was obtained during the patient's medical consultation with the author, interview with the patient and family, photographic record, and literature review. This study followed ethics committee compliance and preserved the patient's anonymity, as well as the patient's rights and care, as per the 1964 Declaration of Helsinki. The total fat percentage of 32% (54th percentile), a very low relative musculoskeletal index of 2.56 kg/m2, and also a low fat mass index of 3.89 g/m2. Laboratory tests showed a low leptin of 1.90 ng/mL, basal insulin of 166.3 μUI/mL, HOMA IR of 38.2, and triglycerides of 205 mg/dL. Analysis of DNA extracted by oral SWAB was positive for alteration in the POLD1 gene, confirming the diagnosis of MDPL. After initiating treatment with a diet adjusted in proteins, calories, index, and glycemic load, metformin, the patient presented new exams with HOMA-IR 8.3, evolving with a gain of 2.5 kilos, now with 33.1 kilograms of weight, reporting improvement. Final considerations: The reported case and raised publications bring to light the discussion of the diagnosis and treatment of a complex syndrome such as MDPL. The absence of a cure, the difficulty in diagnosis, and the unavailability of some of the therapeutic resources make the syndrome of mandibular hypoplasia, deafness, progeroid characteristics, and lipodystrophy an extremely rare syndrome, difficult to diagnose, and difficult to manage. Progress in identifying lipodystrophy genes will help to better understand the role of pathways involved in the complex physiology of fat. Studies have shown mitochondrial dysfunction as well as morphological alterations in mitochondria in patients with MDPL
Importance of melatonin and its supplementation in the treatment of obesity, inflammatory processes, non-alcoholic hepatic steatosis, and hepatocellular carcinoma: a systematic review
Get PDFIntroduction: There are more than 2.3 billion overweight and obese people in the world. One of the important neurohormones responsible for adipose tissue metabolism is melatonin (N-acetyl-5-methoxytryptamine) (MEL), which can modulate inflammatory processes by eliminating nitric oxide, reducing synthesis or inhibiting other pro-inflammatory mediators, including tumor necrosis factor-alpha (TNF-a), interleukin 6 (IL-6) and interleukin 8 (IL-8). Objective: It was to highlight the main considerations and clinical evidence of the importance of melatonin and its supplementation in the treatment of obesity, inflammatory processes, non-alcoholic fatty liver disease, and hepatocellular carcinoma. 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: A total of 115 articles were found. A total of 28 articles were evaluated and 25 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 25 studies that did not meet the GRADE. Most studies presented homogeneity in their results, with X2=85.7%>50%. It was concluded that obesity-related inflammation is related to a state of oxidative stress with high production of reactive oxygen species. Melatonin has been highlighted for its antioxidant and anti-inflammatory properties. The high prevalence of obesity in the world population also confers an increased risk for the development of non-alcoholic fatty liver disease (NAFLD), as well as other liver diseases including hepatocellular carcinoma (HCC). Studies involving drug and molecular therapies are proposed to control the progression of these diseases. It is necessary to perform a molecular analysis involving epigenetic, biochemical, and inflammatory aspects related to melatonin supplementation, clarifying the effect of melatonin supplementation on obesity and liver diseases, including NAFLD and HCC. Thus, it is highlighted that the antioxidant and anti-inflammatory effect of melatonin is essential as a synergistic agent in weight loss and as prophylaxis and/or treatment of liver diseases
Major clinical and metabomic approaches to childhood obesity: a systematic review
Get PDFIntroduction: In the context of childhood obesity, of children under 5 years of age in Brazil, 7% are overweight and 3% meet the criteria for obesity. Globally, according to a report from the World Health Organization (WHO), it is estimated that the total number of overweight and obese children in the world could reach 75 million by the year 2025. Objective: It was to carry out a systematic review to present the main approaches to clinical and metabolomics of childhood obesity. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from February to April 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: 110 articles were recruited for the initial evaluation. A total of 41 articles were evaluated and 19 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 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=58.7%>50%. It was concluded that miRNAs are potential biomarkers for the development of pathologies, such as obesity. A heterogeneous group of these molecules was found to be associated with obesity in children. miR-15b-5p, miR-486-5p and hsa-miR-122-5p were considered good candidates for childhood obesity biomarkers. MiRNA-dependent mechanisms regulate up to 60% of all human genes. MiRNAs influence multiple pathways, including insulin signaling, immune-mediated inflammation, adipokine expression, adipogenesis, lipid metabolism, and regulation of food intake
Major approaches to endoscopic treatment of gastrojejunal anastomosis post gastric bypass with argon plasma and dietary monitoring: a systematic review
Get PDFIntroduction: Obesity is a serious chronic non-communicable disease (NCD) that has several consequences for public health. In this scenario, there are more than 2.2 billion people who are overweight or obese in the world, and the latest census showed that Brazil is in fifth place in the world ranking with 18.0 million obese individuals, tending to reach 70.0 million patients. Roux-en-Y Gastric Bypass (RYGB) is one of the most performed surgeries in the world, however, approximately 20% of patients undergoing this surgery do not lose the desired weight in the first year and 15% of patients regain weight after 18 to 24 months. Anastomotic diameters above 15.0 mm have been associated with a recurrence of obesity and may be associated with complaints of decreased satiety. Thus, the application of argon plasma in gastrojejunal anastomosis has been proposed to reduce weight in patients undergoing RYGB who presented recurrent obesity. Objective: It was to develop current scientific approaches through a systematic review of the main approaches and application of argon plasma and dietary monitoring in the reduction of dilated gastrojejunal anastomosis and the consequent reduction of recurrent weight after gastric bypass. Methods: The research and development of the work were carried out from May to July 2024 in the Scopus, PubMed, Science Direct, and Scielo databases, using the main scientific articles on nutrigenomics, and following the PRISMA rules. The quality of the studies was based on the GRADE and AMSTAR-2 instruments, and the risk of bias by the Cochrane instrument (Funnel Plot). Results and Conclusion: Twentyone studies were included out of a total of 125. According to the GRADE instrument, most studies presented homogeneity in their results, with X2=88.6%>50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 37 studies with a high risk of bias and 25 studies that did not meet the GRADE and AMSTAR-2 criteria. The application of argon plasma in the treatment of dilated gastrojejunal anastomosis and dietary monitoring have been highlighted as effective and safe methods in the treatment of recurrent obesity. The application of argon plasma via an endoscopic approach is very effective in its indications, technically easy to perform, and has numerous advantages over conventional electrocoagulation. Complications are rare. The limit of tissue penetration depth of 2 to 3 mm associated with excellent coagulation allows its application in critical areas such as the duodenum and colon
Major clinical implications of adequate nutrition in children and adolescents with attention-deficit/hyperactivity disorder: a concise systematic review
Get PDFIntroduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inappropriate levels of impulsive behavior, hyperactivity, and/or inattention, with a worldwide prevalence estimated at around 7% in childhood and adolescence, and around 3 % in adulthood, with a higher prevalence in boys than in girls. Objective: It was to present the main clinical implications of adequate nutrition in children and adolescents with attention-deficit/hyperactivity disorder. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from January to March 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: A total of 84 articles were found, 21 articles were evaluated, and 14 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 30 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=62.8%>50%. Intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) fatty acids daily for 8 weeks is associated with less impulsive behavior in children with ADHD. Dietary supplementation with omega-3 fatty acids reduces ADHD symptoms in both individuals with ADHD and typically developing children. A Mediterranean diet may improve BIS results, although our results are not conclusive in this population. The daily intake of calories and nutrients in patients taking methylphenidate is generally lower than in a healthy population of similar age. Co-supplementation of vitamin D and magnesium over 8 weeks may improve behavioral function and mental health in children with ADHD
Consensus of the Brazilian Association of Nutrology and the Brazilian Society for Food and Nutrition on the consumption of cow's milk by humans
Get PDFMajor evidence of nutritional and metabolic management in the context of bariatric surgery: a systematic review
Get PDFIntroduction: Approximately $315 billion is spent annually on the medical cost of obesity in adult patients in the United States alone. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the rate of bariatric surgery (BS) increased from 158,000 in 2011 to 196,000 in 2015. This increase in invasive techniques does not eliminate unhealthy habits, therefore, lifestyle modifications, such as healthy eating and correct physical activity programs, can improve surgical results. Objective: To establish the main nutritional and metabolic management strategies in the context of bariatric surgery, to modulate and reduce the problems caused by nutrient deficit. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from May to June 2024 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 135 articles were found. 42 articles were fully evaluated 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 22 studies with a high risk of bias and 24 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X2=79.7%>50%. It was concluded that the recommendations were gathered to assist in individualized clinical practice in the nutritional management of patients with obesity. In general, patients with obesity have significantly lower concentrations of serum iron, folic acid, vitamins A, B6, B12, C, 25-hydroxyvitamin D, and lipid-standardized vitamin E. Before bariatric surgery, nutritional status should be analyzed and preoperative weight loss can be attempted. Very low-calorie diets and very low-calorie ketogenic diets are prescribed in the last months before surgery. It was noted that the recommendations were gathered to assist in individualized clinical practice in the nutritional management of patients with obesity, including nutritional management. Iron status may be affected by adipose tissue inflammation and increased expression of the systemic iron regulatory protein hepcidin. The postoperative recommendation for vitamin B12 (cobalamin) should be 350-500 micrograms/1000 micrograms monthly, and for folate (folic acid) in the postoperative period should be 1000 micrograms per day
Major clinical outcomes and discussions of the impacts of religiousity/spirituality in patients with palliative care and nutrology therapy: a concise systematic review
Get PDFIntroduction: In the scenario of nutritional therapy and religiosity/spirituality (R/S), several factors can impact the nutritional status of patients in palliative care. These include knowledge of nutrition, the level of emotional support required for the patient, their motivation, and the nature, impact, and severity of the illness. A diet suitable for weight stabilization provides patients with the energy necessary to meet physical, psychological, social, and R/E aspects. Objective: It was to carry out a concise systematic review to present the main clinical outcomes and discussions about the impacts of religiosity/spirituality in patients with palliative care undergoing nutritional therapy. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 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: A total of 91 articles were found, and 24 articles were evaluated in full, and 17 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=72.8%>50%. It was concluded that when the natural oral intake of food and liquids is disturbed, the role of caregivers is to assist the patient in covering the individual's nutritional needs through nutritional therapy and religiosity and spirituality as metabolic and immunological stimuli. Nutritional therapy requires indication to achieve a treatment goal and informed consent from the patient. The suspension and withdrawal of nutritional therapy and artificial hydration must be evaluated in specific situations (terminally ill, palliative care, dementia, elderly patients) and always on a case-by-case basis, according to the cultural and spiritual needs of the patients. Caregivers must emphasize the right to self-determination and therefore respect the patient's autonomy, and also the particular vulnerability of the patient who suffers from or is at risk of malnutrition