International Journal of Nutrology
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Metabolic actions of the gut microbiota in obesity: a systematic review
No full textIntroduction: Obesity is a multifactorial disease that is difficult to manage and causes several comorbidities, such as physiological and mental disorders, diabetes, stroke, and depression. Worldwide, more than 2.3 billion people are overweight or obese. The gut microbiota interacts with several organs, including the brain, and can regulate metabolism, adiposity, homeostasis, energy balance, and central signaling of appetite and food reward. Objective: To explore and describe the metabolic actions of the gut microbiota and probiotics in the management of patients with obesity. Methods: The systematic review guidelines of the PRISMA Platform were followed. The search was conducted from August to November 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 125 articles were found. A total of 32 articles were fully evaluated, and 21 were included and developed in this systematic review. Using the Cochrane risk of bias tool, the overall assessment resulted in 23 studies with a high risk of bias and 25 studies that did not meet the GRADE and AMSTAR-2 criteria. Most studies presented homogeneous results, with X2=74.8%>50%. It was concluded that bidirectional signaling occurs within the gut-brain axis in the pathophysiology of obesity, mediated by metabolic, endocrine, neural, and immune system mechanisms. Fecal microbiota transplantation and supplementation with probiotics and prebiotics may be potential treatments for obesity. Diet is a determining factor for healthy colonization of the gut microbiota. Studies in obese humans also found a lower proportion of Bacteroidetes compared to those in normal-weight individuals. After weight loss, the proportion of Firmicutes is reduced and becomes more similar to that of lean individuals. Inulin supplementation can significantly promote intestinal bacterial diversity and improve gut microbiota dysbiosis in obese patients. Low-carb diets and time-restricted feeding are effective in weight management and produce profound changes in the gut microbiome and metabolome, in addition to caloric restriction
Major considerations of parenteral nutrological therapy in short bowel syndrome: a systematic review
Full text linkIntroduction: Short bowel syndrome (SBS) is a result of surgical resection or destruction of the bowel associated with the disease. Patients with SBS with intestinal failure (II) (SBS-II) experience decreased quality of life (QOL) and increased morbidity and mortality due to their dependence on parenteral support (PS). Patients treated with teduglutide have been able to reduce and even discontinue PS with varying degrees of success. Objective: To analyze the scientific evidence for teduglutide in parenteral support in patients with short bowel syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from August to October 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 91 articles were found. 29 articles were fully evaluated and 07 were included and developed in the present 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 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=91.5%>50%. It was concluded that teduglutide can restore intestinal structural and functional integrity, promote mucosal growth, reduce gastric emptying and secretion, and increase nutrient absorption and enteral independence from parenteral nutrition. The 24-week treatment time with teduglutide was generally well tolerated in patients with short bowel syndrome with intestinal failure. The clinical studies showed that teduglutide treatment reduced the volumes and number of days of parenteral support for patients with short bowel syndrome with intestinal failure
Major clinical outcomes of the action of the co-agonist tirzepatide to liraglutide and semaglutide in the treatment of obesity and type 2 diabetes mellitus: a systematic review
Full text linkIntroduction: Obesity is a chronic disease that affects a significant portion of the population. In Brazil, in surveillance research on risk and protective factors for diseases, more than half of the Brazilian population, 56% are overweight. In this scenario, liraglutide and semaglutide are medication for the treatment of type 2 diabetes mellitus (T2DM) and obesity. Tirzepatide is the first dual GLP1/GIP receptor co-agonist that has been approved for the treatment of T2DM and obesity. Objective: It was to present the major clinical outcomes of the action of the co-agonist tirzepatide to liraglutide and semaglutide in the treatment of obesity and type 2 diabetes mellitus. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September 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 84 articles were found, and 52 articles were evaluated and 23 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 8 studies with a high risk of bias and 19 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =79.8% >50%. It was concluded that in people without diabetes, 5 to 15 mg of tirzepatide once weekly for the treatment of obesity (SURMOUNT-1) resulted in substantial reductions in body weight (16.5% to 22.4%) over some time. 72 weeks. Furthermore, liraglutide (3.0 mg) as a medication for the treatment of obesity, in association with lifestyle changes, in patients with and without diabetes proved to be a good therapeutic option with a response about weight loss and maintenance, in addition to benefits secondary to clinical comorbidities associated with obesity
Metabolic significance of nutritional treatment before and after bariatric surgery: a systematic review
Full text linkIntroduction: According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the rate of bariatric surgery (BS) increased from 158 thousand in 2011 to 196 thousand in 2015. Lifestyle modifications, such as healthy eating and correct physical activity programs, can improve surgical results. Thus, the most important aspect in the medical management of bariatric patients refers to nutritional management. Objective: It was to carry out a systematic review to list the main approaches and significance of nutritional treatment before and after bariatric surgery, to mitigate the metabolic damage caused by nutrient deficits. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 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: 127 articles were found. A total of 45 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 25 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=62.5%>50%. It was concluded that the most important aspects of the medical management of bariatric patients refer to nutritional management. Before bariatric surgery, nutritional status should be checked and preoperative weight loss may be attempted. Very low-calorie diets and very low-calorie ketogenic diets are often prescribed in the last few months before surgery. It was observed that the recommendations were gathered to assist in individualized clinical practice in the nutritional management of patients with obesity, including nutritional management. Iron status can be affected by inflammation of adipose tissue and increased expression of the systemic iron-regulating protein hepcidin. The postoperative recommendation for vitamin B12 (cobalamin) should be 350-500 micrograms/1000 micrograms monthly, and postoperative folate (folic acid) should be 1,000 micrograms per day
Palliative medicine and nutritional therapy in critically ill oncological patients: a systematic review
Full text linkIntroduction: In nutritional therapies, appropriate or precise nutritional interventions are used in critically ill patients. Nutrition is considered a palliative treatment. Dietary counseling, provision of nutritional support, and alleviation of diet-related issues should be an essential component of a holistic approach to palliative and end-of-life care. Objective: This study aimed to highlight the main clinical outcomes and guidelines on nutritional therapies and palliative care in critically ill cancer patients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June 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: 133 articles were found. A total of 44 articles were evaluated in full and 22 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 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=75.7%>50%. It was concluded that according to the ESPEN and ASPEN guidelines, no differences in clinical outcomes were identified between numerous nutritional interventions, including increased energy or protein intake, parenteral nutrition or isocaloric enteral nutrition, supplemental parenteral nutrition or different mixed oil lipid injectable emulsions. However, clinical judgment and close monitoring along with appropriate palliative care are required. Decisionmaking in this field must be carried out on an individual basis, weighing the benefits and harms that may cause to patients' quality of life. The guidelines recommend that, if oral food intake remains inadequate despite counseling and oral nutritional supplements, enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition (supplemental or total) should be considered
Major metabolic and inflammatory considerations of childhood obesity through immunological predictors and microRNAs: a systematic review
Full text linkIntroduction: In the scenario of chronic non-communicable diseases, obesity stands out as a multifactorial disease affecting around 30% of the world's population. 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 considerations metabolic and inflammatory mechanisms of childhood obesity through immunological predictors and microRNAs. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from January to March 2025 in the Scopus, Embase, 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, immunemediated inflammation, adipokine expression, adipogenesis, lipid metabolism, and regulation of food intake
Family and community medicine as an important primary care tool for managing patients with obesity: a systematic review
Full text linkIntroduction: Obesity stands out as a multifactorial disease that can cause several public health problems. Currently, more than 30% of the world's population is overweight or obese, representing more than 2.3 billion people. Family and community medicine plays a crucial role in the primary care of patients with obesity and their families. Objective: This systematic review examined the relevant aspects of obesity and its comorbidities as a societal burden, as well as the role of family and community medicine as a crucial primary care tool for managing patients with obesity. Methods: The PRISMA Platform systematic review guidelines were followed. The search was conducted from May to June 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and risk of bias was analyzed according to the Cochrane tool. Results and Conclusion: A total of 123 articles were found. A total of 34 articles were evaluated, and 16 were included in this systematic review. Using the Cochrane risk of bias tool, the overall assessment revealed 16 studies with a high risk of bias and 31 studies that did not meet the GRADE and AMSTAR-2 criteria. The studies showed homogeneity in their results, with X2=87.5%. It was concluded that obesity is a serious public health concern, representing a complex interaction between multiple genetic, socioeconomic, and cultural factors that are also associated with existing or resulting comorbidities and their treatments. The prevalence of obesity remains high, as do associated comorbidities and healthcare costs. Early primary care through family and community medicine is a significant strategy for reducing costs and improving outcomes for these patients. Awareness of obesity risk factors, especially those that are preventable, is important so that physicians can counsel patients on how to avoid or minimize them. Motivational interviewing can be effective in brief interventions to engage families in the initiation of treatment for childhood obesity in primary care. Connecting with specialist physicians can be important for supporting the engagement of adolescents with obesity. An evaluation and monitoring tool for family and community medicine residency programs can be a facilitating tool for program managers and enable evaluation and monitoring, providing ongoing training
Major clinical, nutrological and immunological considerations and treatments of vulvar lichen sclerosus: an integrative systematic review
Full text linkIntroduction: Vulvar Lichen Sclerosus (VLS) is characterized by being a chronic progressive inflammatory skin disease, mediated by lymphocytes, which mainly affects the anogenital area. Its prevalence is higher in the female population (10:1), especially in postmenopausal women, and is associated with autoimmune diseases, although it can affect both sexes. It is one of the diseases that most causes structural damage to the vulva and consequent physical and mental suffering. The diagnosis of vulvar lichen sclerosus is clinical. Biopsy is indicated only in cases of non-typical lesions. Objective: This was to conduct an integrative systematic review to present the main clinical, nutrological, and immunological considerations of vulvar lichen sclerosus, as well as the treatment challenges. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from September 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 112 articles were found. 38 articles were fully evaluated and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 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=90.7%>50%. It was concluded that the exact cause of VLS is not fully understood. Still, it is believed that nutritional factors, dysbiosis of the intestinal microbiota, genetics, autoimmunity, and hormonal imbalance may play an important role in its development. The main risk factor for vulvar cancer associated with VLS is delayed diagnosis, so controlling symptoms and preventing complications is crucial, and regular follow-up is necessary to monitor response to treatment and disease recurrence
Major considerations of immune strengthening and health longevity in the light of nutrology and lifestyle change: a systematic review
Full text linkIntroduction: In the scenario of nutritional impacts on quality of life, genetic, environmental, and lifestyle factors can determine the life expectancy of human beings. Nutrition is a key component that affects our health, and several studies show that nutrition also has the potential to increase life expectancy. Objective: A systematic review was developed to describe immune strengthening and healthy longevity in light of nutrology and lifestyle changes. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from March to April 2025 in the Scopus, Embase, 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 134 articles were found, and 36 articles were evaluated, and 09 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 32 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=82.7%>50%. It was concluded that nutrients and natural substances from human physiology and biochemistry such as melatonin and coenzyme Q10 control the functions of the immune system. Many metabolic or chronic diseases have been implicated in poor diet and lifestyle. Improving diet quality is associated with reduced all-cause mortality, considering that multivitamin and multimineral supplements can improve life expectancy. Overall well-being is improved when sedentary but sufficiently physically active adults reduce the time spent sedentary and increase physical activity levels. The results of the pandemic indicate there have been a variety of lifestyle changes, physical inactivity, and psychological problems
Metabolomics of microRNAs in cardiovascular events in patients with obesity: a systematic review
Full text linkIntroduction: In the metabolomics scenario of obesity and cardiovascular disease, epitranscriptomics establishes a novel mechanism of post-transcriptional RNA regulation. There is growing evidence supporting the role of intra- and extracellular microRNAs (miRNAs) as determinants of cross-talk between adipose tissue, liver, skeletal muscle, and other organs, triggering paracrine communication between different tissues. Objective: To describe, through a systematic literature review, the main approaches to metabolomics of microRNAs and exosomes in cardiovascular disease in obese patients. Methods: The systematic review guidelines of the PRISMA Platform were followed. The search was conducted from March to May 2025 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and risk of bias was analyzed according to the Cochrane tool. Results and Conclusion: A total of 121 articles were found. A total of 18 articles were fully evaluated, and 9 were included and developed in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 32 studies with a high risk of bias and 21 studies that did not meet the GRADE and AMSTAR-2 criteria. Most studies presented homogeneity in their results, with X2=91.4%>50%. It was concluded that the decrease in circulating miR-19 levels during dietary interventions for weight loss was associated with a significant reduction in the risk of atherosclerotic cardiovascular disease. Epicardial adipose tissue-derived miRNAs exert paracrine effects on the human heart. Epicardial adipose tissue-derived miR-92a-3p is associated with improved clinical outcomes and is a therapeutic target for the prevention and treatment of obesity-related heart disease. An increased profile of plasma miR-126-3p was identified in hypertensive patients with albuminuria. The Mediterranean diet better modulates endothelial function compared to a low-fat diet. Therefore, the potential of microRNAs, particularly miR-133b and miR-126, is postulated as diagnostic biomarkers to distinguish patients with ST-segment elevation from those with non-ischemic chest discomfort