Role that anorexia and weight loss play in patients with stage IV lung cancer / Papel do binômio anorexia e perda de peso em pacientes com câncer de pulmão em estádio IV

ABSTRACT Objective: To evaluate the prevalence of anorexia and weight loss at diagnosis (pre-treatment), to identify the factors associated with pre-treatment weight loss, and to determine the prognostic role of anorexia and weight loss in the overall survival of patients with stage IV lung cancer. Methods: This was a retrospective observational cohort study. The patients were stratified by the presence/absence of anorexia and of pre-treatment weight loss, which generated a measure composed of four categories, which were the independent variables. Results: Among the 552 patients included in the study, anorexia and pre-treatment weight loss were present in 39.1% and 70.1%, respectively. After adjusting for age, male gender, and Karnofsky performance status, we found that anorexia and tumor size were significantly associated with pre-treatment weight loss. In a Cox multivariate analysis, adjusted for age, male gender and low Karnofsky performance status were found to be independent predictors of worse survival, as was concomitance of anorexia and weight loss. Conclusions: Anorexia and pre-treatment weight loss appear to be relevant problems in the follow-up of patients with advanced (stage IV) lung cancer Specific interventions are of crucial importance in individualized treatment plans, even within the context of palliative care.

RESUMO Objetivo: Avaliar a prevalência de anorexia e perda de peso ao diagnóstico (pré-tratamento), os fatores associados à perda de peso pré-tratamento e o papel prognóstico da anorexia e da perda de peso na sobrevida global de pacientes com câncer de pulmão em estádio IV. Métodos: Estudo de coorte retrospectivo observacional. Os pacientes foram estratificados, dependendo da presença/ausência de anorexia e da presença/ausência de perda de peso pré-tratamento, o que gerou uma medida composta de anorexia e perda de peso de quatro níveis, que foi a variável independente. Resultados: Entre os 552 pacientes incluídos no estudo, as prevalências de anorexia e de perda de peso pré-tratamento foram de 39,1% e 70,1%, respectivamente. Após ajustar para idade, sexo masculino e índice de Karnofsky, a presença de anorexia e o tamanho do tumor foram significativamente associados à perda de peso pré-tratamento. Na análise multivariada de Cox, após ajustar para a idade, as variáveis sexo masculino, presença concomitante de anorexia e perda de peso e índice de Karnofsky reduzido foram preditores independentes de pior probabilidade de sobrevida. Conclusões: O presente estudo demonstrou que a presença de anorexia e de perda de peso pré-tratamento são problemas relevantes no seguimento de pacientes com câncer de pulmão avançado (estádio IV). Intervenções específicas são de crucial importância no plano de assistência individualizada, mesmo dentro da proposta de cuidados paliativos.

Antioxidant effects of açaí seed ( Euterpe oleracea ) in anorexia-cachexia syndrome induced by Walker-256 tumor

ABSTRACT PURPOSE: To assess antioxidant effects of açaí seed extract on anorexia-cachexia induced by Walker-256 tumor. METHODS: A population of 20 lab rats were distributed into four groups (n=5): Control Group (CG), which only received tumor inoculation. Experimental Group-100 (EG-100), with animals submitted to tumor inoculation and treated with seed extract in a 100 mg / ml concentration through gavage. Experimental Group-200 (EG-200), with animals submitted to tumor inoculation and treated with seed extract in a 200 mg / ml concentration. Placebo Group (GP), which received tumor inoculation and ethanol-water solution. We analyzed proteolysis, lipid peroxidation, tumor diameter and weight. RESULTS: Lipid peroxidation was representative only in the cerebral cortex, where there was more oxidative stress in rats treated with the extract (p = 0.0276). For proteolysis, there was less muscle damage in untreated rats (p = 0.0312). Only tumor diameter in treated rats was significantly lower (p = 0.0200) compared to untreated ones. CONCLUSIONS: The açaí seed extract showed no beneficial effect on the general framework of the cachectic syndrome in lab rats. However, some anticarcinogenic effects were observed in the tumor diameter and weight.

Psychometric Properties and Item Evaluation of Korean Version of Night Eating Questionnaire (KNEQ)

PURPOSE: The aim of this study was to develop a Korean version of Night Eating Questionnaire (KNEQ) and test its psychometric properties and evaluate items according to item response theory. METHODS: The 14-item NEQ as a measure of severity of the night eating syndrome was translated into Korean, and then this KNEQ was evaluated. A total of 1171 participants aged 20 to 50 completed the KNEQ on the Internet. To test reliability and validity, Cronbach's alpha, correlation, simple regression, and factor analysis were used. Each item was analyzed according to Rasch-Andrich rating scale model and item difficulty, discrimination, infit/outfit, and point measure correlation were evaluated. RESULTS: Construct validity was evident. Cronbach's alpha was .78. The items of evening hyperphagia and nocturnal ingestion showed high ability in discriminating people with night eating syndrome, while items of morning anorexia and mood/sleep provided relatively little information. The results of item analysis showed that item2 and item7 needed to be revised to improve the reliability of KNEQ. CONCLUSION: KNEQ is an appropriate instrument to measure severity of night eating syndrome with good validity and reliability. However, further studies are needed to find cut-off scores to screen persons with night eating syndrome.

Toxicity Profile of Temozolomide in the Treatment of 300 Malignant Glioma Patients in Korea

This study evaluated the toxicity profiles of temozolomide in the treatment of malignant glioma as either concurrent or adjuvant chemotherapy. We retrospectively reviewed the medical records of 300 malignant glioma patients treated with temozolomide in two medical institutions in Korea between 2004 and 2010. Two hundred nine patients experienced a total of 618 toxicities during temozolomide therapy. A total of 84.8% of the 618 toxicities were Common Terminology Criteria for Adverse Events (CTCAE) grade 1 or 2, while 15.2% were grade 3 or 4. Among the hematologic toxicities, thrombocytopenia (13.7%), anemia (11.0%), and AST/ALT increases (7.0%) were common. Among the non-hematologic toxicities, nausea (44.3%), vomiting (37.0%), and anorexia (14.3%) were the three most common toxicities. There was no mortality due to temozolomide. Although temozolomide showed many types of toxicities, the majority of the toxicities were tolerable and of lower grade. Gastrointestinal troubles are the most common toxicities in Korean patients treated with temozolomide.

Terapia nutricional em crianças e adolescentes com cirrose: uma visão atual / Nutritional therapy in children and adolescents with cirrhosis: current status

A anorexia e o hipermetabolismo são aspectos clínicos importantes em crianças com cirrose. Embora muitas das complicações da cirrose sejam semelhantes àquelas encontradas em adultos, a etiologia e a história natural da progressão da doença e o tratamento clínico em pacientes pediátricos podem ser significativamente diferentes. As alterações metabólicas da doença hepática crônica agravada pela anorexia e desnutrição podem ter implicações negativas no crescimento e desenvolvimento infantil. Crianças com cirrose de evolução progressiva são frequentemente desnutridas e, no entanto, os métodos comumente empregados para avaliação nutricional têm uso limitado nestes pacientes. Mesmo que a importância do estado nutricional sobre o prognóstico destes pacientes seja clara, poucos estudos sobre a terapia nutricional nas hepatopatias da infância têm sido realizados. A avaliação nutricional em crianças com cirrose hepática deve incluir uma completa história clínica e dietética, medidas antropométricas e parâmetros laboratoriais. A recomendação nutricional na cirrose infantil pode variar de acordo com o estado nutricional, idade e quadro clínico. Como a doença hepática crônica em crianças pode impactar significativamente sobre o estado nutricional e consequentemente no crescimento e desenvolvimento, o objetivo deste artigo é revisar os aspectos clínicos e fisiopatológicos envolvidos no diagnóstico e manejo nutricional da cirrose hepática em pacientes pediátricos.

Anorexia and hypermetabolism are disorders of paramount importance in children with cirrhosis. Although many complications caused by cirrhosis in children are similar to those found in adults, the etiologic spectrum and natural history of this disease progression and its clinical management in pediatric patients may be significantly different. The metabolic changes caused by chronic liver disease aggravated by anorexia and malnutrition can affect child growth and development. Malnutrition is common in children with cirrhosis and the methods commonly used for their nutritional assessment are limited. Although the importance of the nutritional status on the prognosis of these patients is clear, there are few studies about nutritional therapy in children with cirrhosis. Nutritional assessment in children with liver cirrhosis should include full clinical and nutritional history, anthropometric measurements, and laboratory parameters. The nutritional recommendation for cirrhosis in children may vary depending on age and nutritional and clinical status. Because chronic liver disease in children may have a significant impact on nutritional status, growth, and development, the objective of this study is to review the clinical and pathophysiological aspects involved in the diagnosis and nutritional management of liver cirrhosis in children.

Gastrointestinal manifestations of nephropathic cystinosis in children

Cystinosis is an autosomal recessive disorder which is characterized by both renal and extrarenal symptoms. Gastrointestinal dysfunction has been reported in adolescent with cystinosis, and it is rarely considered in the infants. The present case series reviewed gastrointestinal manifestations of these patients. Gastrointestinal signs and symptoms of 23 children aged 5.99 +/- 0.50 years [range, 1.0 to 12.5 years] on average with cystinosis, admitted to our department of nephrology between 1996 and 2005, were retrospectively reviewed. The inclusion criteria were the presence of the crystals of cystine in bone marrow aspiration and corneal deposition detected by slit lamp examination. Gastrointestinal signs and symptoms were as follows: vomiting in 16 patients [69.6%], hepatomegaly in 8 [34.8%], diarrhea in 6 [26.1%], splenomegaly in 5 [21.7%], constipation in 4 [17.4%], anorexia in 4 [17.4%], abdominal pain in 3 [13.0%], nausea in 2 [8.7%], and ascites in 2 [8.7%]. Height below the 3rd percentile in was seen in 16 patients [69.6%] and weight below the 3rd percentile, in 17 [73.9%]. Fifteen patients [65.2%] had both low weight and low height. Esophagogastroduodenoscopy had been performed in 6 cases and chronic inactive gastritis with H pylori infection was detected in 2 patients [8.7%]. Our study revealed a wide spectrum of gastrointestinal disturbances in young patients with cystinosis. Such findings should lead to greater awareness of the presence of gastrointestinal dysfunction in these children, encourage prompt gastrointestinal evaluation, and encourage treatment of more severely affected patients

Anorexia em comunidades virtuais: práticas e visões culturais do corpo / Anorexia in virtual communities: practices and cultural views of the body

O presente estudo investigou as práticas alimentares, os comportamentos e os valores das integrantes de comunidades virtuais pró-anorexia. Foram analisadas duas comunidades virtuais pró-anorexia, acessadas através das seguintes palavras-chaves: “perfeição/esforço” e “anorexic”. O critério de escolha utilizado foi identificar aquela que possuía o maior número de membros. As comunidades selecionadas para o estudoatravés das palavras-chaves descritas acima possuíam, respectivamente, um total de 1.616 e 1.480 membros. A comunidade com 1616 usuários foi denominada de “Comunidade OP”. Nessa comunidade foi utilizada a metodologia de “observação passiva”, onde a pesquisadora não se identificou e não interagiu com os membros dacomunidade, somente observou. Na comunidade com 1480 integrantes foi adotada a metodologia de “observação participante protegida”, onde a pesquisadora interagiu com as demais participantes da Comunidade Virtual através de uma Identidade VirtualAnônima. Essa comunidade foi denominada neste trabalho de “Comunidade OPP”. Asobservações foram realizadas entre de Janeiro a Março de 2009. O consentimento informado não foi necessário visto que as comunidades são de domínio público e foipreservado o anonimato das participantes. O estudo verificou que as pró-anoréxicas selecionadas para análise foram, principalmente, participantes do sexo feminino comidades que variam de 13 a 24 anos e o Índice de Massa Corporal de 59,7% dasparticipantes estava classificado de acordo com a Organização Mundial de Saúde na faixa de normalidade. Esse resultado se mostrou contrário ao que as ‘pró-anas’ defendem que é atingir o menor peso possível e ter um corpo magro...

Síndrome de anorexia-caquexia en el paciente oncológico / The cachexia-anorexia syndrome among oncological patients

Se estima que dos terceras partes de los pacientes con cáncer sufren anorexia o pérdida significativa de apetito, lo que conduce a pérdida acentuada de peso y a desnutrición grave (caquexia), una de las principales causas contribuyentes de la muerte. Se ha observado que el síndrome de anorexia-caquexia en cáncer difiere de la desnutrición simple, si bien aún no se conocen los mecanismos exactos que lo ocasionan. Diversas hipótesis proponen que la patogénesis es multicausal, destacándose diversas características del tumor, del huésped y variables del tratamiento. Desafortunadamente, con frecuencia la pérdida acentuada de peso representa para el paciente la progresión del proceso de la enfermedad, lo que puede tener repercusiones significativas en su calidad de vida y en sus interacciones familiares y sociales. Se lleva a cabo una revisión bibliográfica de los procesos etiológicos del síndrome, así como de las posibles medidas terapéuticas y farmacológicas.

Approximately two thirds of cancer patients at advanced stages of the disease suffer from anorexia, which leads to significant weight loss and progressive cachexia, an important factor that contributes to death. It has been observed that cancer cachexia differs from simple starvation, although the exact mechanisms associated with cancer cachexia are not well known. Several theories regarding its pathogenesis point to a complex mixture of tumor, host and treatment variables. Unfortunately, the wasting syndrome also constitutes for the patient, a progression of the cancer process, significantly affecting quality of life and social interactions. Treatable causes should be identified and treated. Knowledge of the mechanisms underlying the effects of caquexia on the patient may play a role in identifying treatment measures targetted to muscle wasting and to maintain body strength. In this article we review the main features and mechanisms of the anorexia-cachexia syndrome in patients with cancer.

The hemolytic component of cancer anemia: effects of osmotic and metabolic stress on the erythrocytes of rats bearing multifocal inoculations of the Walker 256 tumor

Cancer anemia is classified as an anemia of chronic diseases, although it is sometimes the first symptom of cancer. Cancer anemia includes a hemolytic component, important in the terminal stage when even transfused cells are rapidly destroyed. The presence of a chronic component and the terminal complications of the illness limit studies of the hemolytic component. A multifocal model of tumor growth was used here to simulate the terminal metastatic dissemination stage (several simultaneous inoculations of Walker 256 cells). The hemolytic component of anemia began 3-4 days after inoculation in 100 percent of the rats and progressed rapidly thereafter: Hb levels dropped from 14.9 +/- 0.02 to 8.7 +/- 0.06 from days 7 to 11 (~5 times the physiologically normal rate in rats) in the absence of bleeding. The development of anemia was correlated (r2 = 0.86) with the development of other systemic effects such as anorexia. There was a significant decrease in the osmotic fragility of circulating erythrocytes: the NaCl concentration causing 50 percent lysis was reduced from 4.52 +/- 0.06 to 4.10 +/- 0.01 (P<0.01) on day 7, indicating a reduction in erythrocyte volume. However, with mild metabolic stress (4-h incubation at 37§C), the erythrocytes showed a greater increase in osmotic fragility than the controls, suggesting marked alteration of erythrocyte homeostasis. These effects may be due to primary plasma membrane alterations (transport and/or permeability) and/or may be secondary to metabolic changes. This multifocal model is adequate for studying the hemolytic component of cancer anemia since it is rapid, highly reproducible and causes minimal animal suffering.

Estudo de fase II de acetato de megestrol em anorexia e perda de peso em pacientes com AIDS / Phase II trial of megestrol acetate in patients with Aids-related anorexia and weight loss

Objetivos: Avaliar o efeito da suspensäo oral de acetato de megestrol na alteraçäo de peso corpóreo, na diminuiçäo da anorexia e na melhora da qualidade de vida de pacientes com AIDS. Desenho do Estudo: Estudo aberto, com 600 mg de acetato de megestrol em suspensäo oral, por dia, por 12 semanas. Pacientes: Foram envolvidos no estudo 20 pacientes soropositivos para HIV, estando na faixa de 30 porcento de seu peso ideal e que perderam mais de 10 por cento de seu peso corpóreo inicial desde o diagnóstico da infecçäo por HIV. Resultados: Foram avaliados 20 pacientes soropositivos para HIV, sendo 8 (40 por cento) do sexo feminino, 12 (60 por cento) do sexo masculino, com idade média de 33,7 anos, recebendo 600mg/dia de acetato de megestrol. Antes do uso da medicaçäo do estudo, os pacientes apresentavam peso médio de 55,3 Kg e após o uso da mesma este valor passou a 62,8 Kg com ganho percentual de 13,6 porcento. Conclusöes: A ingestäo do medicamento acetato de megestrol teve grande importância na melhora do estado nutricional dos pacientes, uma vez que a maioria apresentou aumento de apetite e conseqüente aumento de peso sem apresentar intercorrências que pudessem interferir no diagnóstico do seu estado nutricional.

Prevalencia de trastornos del comportamiento alimentario en estudiantes de la Universidad Nacional de Colombia entre Julio de 1994 y diciembre de 1995

Objetivos: validación de un instrumento de autorreporte para detectar trastornos del comportamiento alimentario (TCA), determinar su frecuencia en estudiantes de la Universidad Nacional y su relación con ansiedad y depresión