International Journal of Nutrology
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Off-label pharmacotherapy of obesity: a systematic review
Get PDFIntroduction: In the context of obesity pharmacotherapy, some anti-obesity medications (monoamine oxidase inhibitors - MAOIs) have been approved by the Federal Drug Administration (FDA). MAOIs is indicated in combination with lifestyle changes to control overweight and obesity. Some drugs used off-label are accumulating evidence for weight management. Objective: It was to carry out a systematic review to present the off-label pharmacotherapy of obesity through the outcomes of clinical studies. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from May to July 2023 and developed based on Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 2002 to 2023. The low quality of evidence was attributed to case reports, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument using the Funnel Plot chart. Results and Conclusion: It was found 132 studies that were submitted to the eligibility analysis and, then, 16 of the 48 total studies were selected. Most studies showed homogeneity in their results, with X2 =95.1% >50%. The Funnel Plot graph showed a symmetrical behavior, not suggesting a significant risk of bias in the studies. Some drugs used off-label are accumulating evidence for weight management. As an example, tirzepatide is a new drug approved by the FDA in May 2022 for the treatment of type 2 diabetes mellitus and can be used off-label for the treatment of obesity. In 2013, the first published study showed that metformin up to a dose of 2500 mg per day is an effective medication to reduce weight. AMPK2 is one of the possible targets of metformin for the treatment of obesity. Although metformin treatment in participants receiving a placebo appears to result in an initial decrease in BMI and HOMA-IR, there is no evidence of a sustained effect after prolonged use in adolescents. Low-certainty evidence suggests that off-label fluoxetine may decrease weight compared with placebo. Sustained-release bupropion was more effective than placebo in weight loss when combined with a 500 kcal deficit diet. Treatment with pramlinitide (up to 240 mg three times daily) for 16 weeks resulted in a placebo-corrected reduction in body weight of 3.7%, and 31% of subjects treated with pramlinitide achieved ≥5% weight loss vs. 2% with placebo. Oral melatonin replacement increases the volume and activity of brown adipose tissue, promoting thermogenesis and adipose tissue metabolism with consequent weight loss
The role of gut microbiota in the obesity: a literature review
Get PDFIntroduction: Obesity is a multifactorial and polygenic condition that, according to the World Obesity Federation, will affect over 1 billion people by 2030. In this regard, research is being conducted regarding gut microbiota influence on the pathogenesis of this disease, such as inflammation and insulin resistance. Therefore, understanding the gut microbiota and the mechanism by which its modulation through diet and/or the use of probiotics can impact the host and contribute to the treatment of obesity is essential. Methods: A systematic review was conducted on the PubMed, Scielo, and ScienceDirect databases, following the PRISMA protocol, from January 2018 to September 2022. Results and Conclusion: 415 articles were found. 36 studies were evaluated, and 20 were included in this review. The use of calorierestricting diets, along with the consumption of grains and cereals, was found to be useful in reducing strains that promote inflammation and insulin resistance, factors that are associated with obesity pathogenesis, leading to weight reduction. Other studies examined probiotics use, which led to lipopolysaccharides and insulin resistance reduction, as well as a decrease in the quantity of pro-inflammatory cytokines associated with obesity and type 2 diabetes mellitus. Therefore, combining diets with probiotic therapies may be a strategy for microbiota modulation, aiming to reduce inflammatory markers and insulin resistance
Major clinical outcomes of nutrology and lifestyle in the metabolic processes of healthy aging: a systematic review
Get PDFIntroduction: Centenarians exemplify the concept of healthy aging and therefore provide an invaluable resource for identifying novel host-intestinal microbiota relationships concerning aging. Approximately 18 micronutrients, composed of minerals and vitamins, facilitate the optimal utilization of macronutrients through their role in catalyzing numerous biochemical processes, increasing their bioavailability and absorption, and balancing the microbiome. In the context of aging, a major challenge to maintaining health in old age is unbalanced nutritional intake, resulting in nutritional deficiency or malnutrition. Objective: The main clinical outcomes of nutrology and lifestyle in the metabolic processes of healthy aging were listed through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from July to August 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 118 articles were found. A total of 39 articles were fully evaluated and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 15 that did not meet the GRADE and AMSTAR-2 criteria. Most studies showed homogeneity in their results, with X2=82.7%>50%. Zinc and copper govern many functions that characterize the so-called “oxy-aging”. Selenium (Se) is a fundamental cofactor in many redox functions, the role of vitamin C in aging has been investigated particularly for skin health and immunity, particularly in inflammatory and degenerative diseases. Retinoids, which represent a synthetic form of vitamin A, appear effective in preventing skin degeneration due to aging. The role of vitamin E in the prevention and reduction of ROS-induced lesions has been well described. Supplementation with selenium and coenzyme Q10 influenced the analyzed biomarkers in a way that indicated an anti-aging effect. It was concluded that an adequate plasma level of trace elements, such as Zn or copper (Cu), promotes an optimal function of the immune response. Selenium (Se) is a key cofactor in many redox functions, which reduces ROS-induced degeneration in the senescent phenotype. The role of vitamin C in aging has been investigated particularly for skin health and immunity, particularly in inflammatory and degenerative diseases. Vitamin A acts in the prevention of skin degeneration due to aging. The role of vitamin E in the prevention and reduction of ROS-induced lesions has been well described, as well as it has been associated with the prevention of cognitive decline during senescence, particularly in Alzheimer's disease. Good fats, vitamins, minerals, or polyphenols can have antioxidant and anti-inflammatory activities, with anti-aging effects. Recent studies have shown that vitamin K is a vital cofactor in the activation of several proteins, which act against age-related syndromes
Anais do XXVIII Congresso Brasileiro de Nutrologia - n. 28, v. 1, 2024
No full textO Congresso Brasileiro de Nutrologia, maior evento da área na América Latina e do mundo, está na sua 28ª edição.
O CBN 2024 tem como missão prover articulação entre os mais renomados palestrantes nacionais e internacionais, juntamente com os profissionais da saúde - acadêmicos, médicos, nutricionistas, psicólogos - com o objetivo de transmitir conhecimento e atualização sobre os mais variados temas que envolvem nossa especialidade.
Nesse contexto, é de grande valia que os novos conhecimentos científicos que estão sendo produzido pela comunidade acadêmica, envolvidos pela Nutrologia em todo o país, sejam compartilhados.
Dessa forma, além das conferências e palestras, foram selecionados 363 trabalhos, que estão publicados nesses Anais, e 10 foram escolhidos para serem apresentados oralmente durante o evento. Toda esta difusão de conhecimento enriquecerá ainda mais o CBN 2024
Nutrological modulation of cannabidiol in the inflammatory processes of athletes: a systematic review
Get PDFIntroduction: The correct interaction between the elements of the endocannabinoid system plays an important role in the development of the central nervous system. Clinical and preclinical studies suggest that cannabidiol (CBD) may be useful for athletes due to its anti-inflammatory, analgesic, anxiolytic, and neuroprotective properties and its influence on the sleep-wake cycle. Furthermore, a series of implications for epigenetic processes were also proven, through changes in the expression of exosomes and microRNAs responsible for modulating the immune and inflammatory systems. Objective: It was to list the main clinical considerations of the nutritional modulation of cannabidiol in inflammatory and immunological processes in athletes through a systematic review. 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 AMSTAR-2, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 88 articles were found. A total of 36 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 26 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. CBD has been reported to exert a range of physiological, biochemical, and psychological effects with the potential to benefit human health. For example, there is preliminary supporting evidence for CBD's anti-inflammatory, neuroprotective, analgesic, and anxiolytic actions and the possibility that it may protect against gastrointestinal damage associated with inflammation and promote the healing of traumatic skeletal injuries. The combination of Δ9-THC and CBD can alter the activity of microRNAs responsible for increasing the biosynthesis of inflammatory mediators, leading to a reduction in the inflammatory profile. Despite these findings, there is still a lack of randomized and/or prospective controlled clinical studies with a robust sample size to better understand the safety and effectiveness of the use of cannabidiol by medium to high-performance athletes, as well as better understand the dosages for each type of sports performance
Tactile and smell/taste sensitivity and accepted foods according to sensory properties: a cross-sectional study with children from a reference center in feeding difficulties
Get PDFIntroduction: Children with feeding difficulties are more likely to present sensory sensitivities and detect meaningful changes in the sensory properties of foods and reject new foods. Objective: The aims of the study were to identify the top food sources of energy according to children sensitivity profile, and investigate whether there are differences between children sensitivity profile and number of food categories consumed according to their sensory properties. Methods: This was a cross-sectional study with 65 children recruited from an outpatient clinic for children with feeding difficulties, Brazil. Socio-demographics and weight status were included to characterize the sample. Sensory processing using the adapted and validated Short Sensory Profile (SSP) and included the tactile and smell/taste processing domains. Parents reported the number and sources of foods/preparations accepted/consumed by their children. Foods accepted were classified according to the adapted “What We Eat in Latin American - WWELA” classification system. Four aspects of sensory properties were subjectively evaluated for all foods accepted in taste, color, consistency, and texture. Results: Most of the children with tactile and smell/taste sensitivities were classified as combined probable/definite differences, with 52.3% and 92.3%, respectively. Average number of foods categories accepted was 18.81. Rice, whole milk, and banana were among the top food sources for each of sensory processing domains examined. Only children in smell/taste sensitivity showed significant differences for consuming more fibrous foods, with children under typical performance accepting more foods (28.50 2.12) than combined probable/definite differences (16.86± 5.25). Conclusion: Child sensory processing aspects are important when considering the exposure in relation to child acceptance of foods
The weight of obesity: a retrospective analysis of the direct costs of hospitalizations due to obesity between 2011 and 2020 for the unified health system in Brazil
Get PDFAim: This study aimed to analyze the evolution of obesity-related costs over the past 10 years for Brazil's Unified Health System (SUS) and provide insights for guiding and expanding health management and promotion measures. Methods: An observational and retrospective study was conducted using secondary data from 2011 to 2020, extracted from DataSUS with the ICD-10 code for obesity. Statistical analysis was performed to assess trends in hospitalizations and costs related to obesity. Results: During the analyzed period, there was a substantial increase of 110% in hospitalizations and 167% in obesity-related costs for SUS. Female patients (86%) accounted for the majority of hospitalizations, while males (14%) had lower representation. Predominantly, white individuals (62%) were admitted, whereas indigenous individuals had the lowest representation (0,007%). The Southern region contributed to 46% of total cases, in contrast to the Northern region, which accounted for only 0,9%. Conclusion: The findings of this study indicate a significant rise in hospitalizations and associated costs related to obesity for Brazil's Unified Health System. These results underscore the urgency of implementing health promotion and prevention measures, both in the public and private sectors. There is a need for optimized allocation of human resources, including trained professionals for obesity treatment, to mitigate the burden of obesity-related morbidity and mortality and alleviate the strain on the healthcare system
Major clinical evidence on the use of low-dose naltrexone in the treatment of cancer: a systematic review
Get PDFIntroduction: Opioid receptors are groups of receptors (γ-, κ-, δ-, and ζ-opioid receptors) that are widely distributed in nerve cells in the brain, spinal cord, and digestive tract. Naltrexone is a type of general opioid receptor antagonist. It has been used to treat chronic pain syndrome, autoimmune diseases, and cancer at a dose of 5 mg/day, which is generally called low-dose naltrexone (LDN). Objective: It was to analyze the pharmacological functions of low-dose naltrexone, especially in anti-inflammation and immunoregulation, and its therapeutic potential against cancer. Methods: The research and development of the work were carried out from June to July 2024 in the Scopus, PubMed, Science Direct, and Scielo databases, using scientific articles from the last 15 years, following the PRISMA rules. The quality of the studies was based on the GRADE and AMSTAR2 instruments, and the risk of bias was assessed using the Cochrane instrument (Funnel Plot). Results and Conclusion: Fifteen studies were included in the systematic review out of 30. Most studies showed homogeneity in their results, with X2=94.5%>50%. Low-dose naltrexone has immunomodulatory and therapeutic effects. Low-dose naltrexone regulates the production of inflammatory cytokines, influencing the level of endogenous opioid peptides in the body. Furthermore, low-dose naltrexone has an antitumor effect and can modulate the neuroblastoma tumor response, delaying the onset and reducing the incidence rate of tumors, significantly decreasing tumor volume and weight, and DNA synthesis in cancer
Action of cannabidiol in interaction with microRNAs and exosomes in modulation of inflammatory and immune processes in athletes: a systematic review
Get PDFIntroduction: The correct interaction between elements of the endocannabinoid system plays an important role in the development of the central nervous system. Clinical and preclinical studies suggest that cannabidiol (CBD) may be useful for athletes due to its anti-inflammatory, analgesic, anxiolytic, and neuroprotective properties and its influence on the sleep-wake cycle. In addition, a series of implications for epigenetic processes have also been proven, through changes in the expression of microRNAs responsible for modulating the immune and inflammatory systems. Objective: It was to develop a systematic review study to highlight the main aspects of cannabidiol in the interaction with microRNAs and exosomes in the modulation of inflammatory and immunological processes in athletes. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from February to April 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 228 articles were found, and 84 articles were evaluated in full and 33 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 90 studies that did not meet GRADE. CBD has been reported to exert a range of physiological, biochemical, and psychological effects with the potential to benefit human health. For example, there is preliminary supporting evidence for the anti-inflammatory, neuroprotective, analgesic, and anxiolytic actions of CBD and the possibility that it may protect against gastrointestinal damage associated with inflammation and promote the healing of traumatic skeletal injuries. The combination of Δ9-THC and CBD can alter the activity of microRNAs responsible for increasing the biosynthesis of inflammatory mediators, leading to a reduction in the inflammatory profile. However, it is important to recognize that these findings are very preliminary, sometimes inconsistent, and largely derived from preclinical studies. These studies are limited in their generalizability to athletes and often administer high doses of CBD. The central observation is that there is a lack of studies that directly investigate CBD and sports performance
Enteral and parenteral therapy in the regulation of microRNAs to mitigate inflammatory processes and metabolic disorders in patients with obesity: a systematic review
Get PDFIntroduction: Obesity establishes a long-term chronic imbalance between calorie intake and energy expenditure, which causes serious comorbidities. MicroRNAs stand out, which are a class of small non-coding RNAs that regulate gene expression. Changes in their expression and functions have been associated with several diseases, including metabolic disorders and obesity. Enteral and parenteral nutrition therapy functions as an important regulator of microRNAs against inflammatory and metabolic processes. Objective: It was to carry out a systematic review of the main approaches to enteral and parenteral nutrition therapy in patients with obesity, to regulate the gene expression of microRNAs to mitigate inflammatory processes and metabolic disorders. Methods: The PRISMA Platform systematic review rules were followed. The search 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 117 articles were found. A total of 41 articles were evaluated in full and 30 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 24 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =59.2% >50%. It was concluded that studies accumulate evidence that circulating miRNAs are associated with obesity. Some microRNAs have been implicated in the control of body weight gain, glucose homeostasis, insulin resistance, and lipid metabolism. In this sense, enteral feeding is an effective and safe treatment before bariatric surgery, with ketogenic enteral nutrition leading to better clinical results than hypocaloric enteral nutritional protocols in glycemic and lipid profiles. A diverse range of nutritional interventions are effective in treating obesity and its comorbidities, mainly through nutrotherapy triggers on microRNAs