ABSTRACT
BACKGROUND & AIMS: Patients with cancer and coronavirus disease 2019 (COVID-19) have characteristics that can cause the most severe forms of the disease and higher mortality. We aimed to assess the association between computed tomography (CT)-derived muscle abnormalities, anthropometric parameters, inflammation, and mortality in patients with cancer and COVID-19. METHODS: This retrospective study included patients with cancer and COVID-19 admitted between March 1st and December 31st, 2020. All information was collected from medical records (clinical and nutritional parameters, serum albumin, and C-reactive protein [CRP]). Weight loss and body mass index (BMI) were assessed using Global Leadership Initiative on Malnutrition phenotypic criteria. Skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) at the fourth thoracic vertebra level were assessed using computed tomography scans. RESULTS: This study included 80 patients (61% men, mean age: 58 ± 17 years). Of the patients analyzed, 49% had weight loss >5%, and 14% had low BMI. The median length of hospital stay was 7 (interquartile range: 4-14 days), 27% needed mechanical ventilation, 34% died as a direct consequence of COVID-19 infection and 15% to complications associated with cancer condition. In multivariate logistic regression analysis, low SMI was associated with increased in-hospital mortality [odds ratio (OR): 4.81; 95% confidence interval (95% CI): 1.63; 14.2; p = 0.005), while CRP was associated with COVID-19-related mortality (OR: 1.08; 95% CI: 1.01; 1.15, p = 0.018). CONCLUSION: SMI independently predicts in-hospital mortality in patients with cancer and COVID-19. Additionally, an independent association was observed between CRP and mortality specifically related to COVID-19.
Subject(s)
Body Mass Index , COVID-19 , Inflammation , Muscle, Skeletal , Neoplasms , SARS-CoV-2 , Humans , COVID-19/mortality , COVID-19/complications , Male , Middle Aged , Female , Retrospective Studies , Neoplasms/mortality , Neoplasms/complications , Aged , Muscle, Skeletal/diagnostic imaging , Adult , C-Reactive Protein/analysis , C-Reactive Protein/metabolism , Tomography, X-Ray Computed , Nutritional StatusABSTRACT
Introdução: Pacientes com câncer apresentam uma tendência à perda ponderal e à desnutrição energético-proteica. Isso ocorre em razão das modificações que o organismo sofre pelo desenvolvimento da doença e pelos efeitos adversos do tratamento oncológico que contribuem para a redução da ingestão alimentar. Objetivo: Identificar evidências disponíveis na literatura científica sobre a ingestão alimentar de mulheres com tumores ginecológicos em tratamento oncológico. Método: Revisão integrativa da literatura cujas buscas foram realizadas nas bases de dados Embase, MEDLINE e LILACS por meio da associação de termos descritores e palavras livres. Foram incluídos nas análises estudos observacionais que avaliaram a ingestão alimentar de mulheres adultas com tumores ginecológicos durante o tratamento oncológico, redigidos em português, inglês e espanhol. Resultados: Esta revisão analisou seis estudos que investigaram a mudança na ingestão alimentar dessa população. Identificou-se uma redução da ingestão em até 31% de energia, 39,9% de proteínas, 33,7% de lipídeos, 28,7% de carboidratos e uma inadequação da ingestão de determinados micronutrientes. Conclusão: Mulheres com tumores ginecológicos durante o tratamento oncológico apresentam redução significativa da ingestão de energia, proteínas, lipídeos, carboidratos e micronutrientes. Considerando que a perda de peso e a desnutrição em pacientes com câncer está associada a desfechos clínicos negativos, a avaliação e a análise da ingestão alimentar desses indivíduos são fundamentais para possibilitar uma intervenção nutricional precoce, boa resposta ao tratamento e consequente melhoria da qualidade de vida
Introduction: Cancer patients tend to lose weight and energy-protein malnutrition because of the changes the organism undergoes caused by the progression of the disease and treatment-related adverse effects that contribute for the reduction of food intake. Objective: To identify scientific literature-based evidences on food intake of women with gynecological tumors undergoing cancer treatment. Method: Integrative literature review through searches at the Embase, MEDLINE and LILACS databases with the association of descriptive terms and free words. Observational studies in Portuguese, English and Spanish that evaluated the food intake of this population were included in the analyzes. Results: This review identified 6 studies that investigated the change in food intake of women with gynecological cancer undergoing cancer treatment. A reduction in intake was identified in until 31% of energy, 39.9% of proteins, 33.7% of lipids, 28.7% of carbohydrates and inadequate intake of certain micronutrients. Conclusion: Women with gynecological tumors during cancer treatment present significant reduction of energy, proteins, lipids, carbohydrates and micronutrients intake. Considering that weight loss and malnutrition in cancer patients are associated with negative clinical outcomes, the evaluation and analysis of the food intake of this population individuals is essential for early nutritional intervention, good response to treatment and improvement of the quality of life
Introducción: Los pacientes con cáncer tienen tendencia a la pérdida de peso y a la desnutrición calórico-proteica. Esto ocurre debido a los cambios que sufre el organismo debido al desarrollo de la enfermedad y los efectos adversos del tratamiento del cáncer que contribuyen a la reducción de la ingesta alimentaria. Objetivo: Identificar la evidencia disponible en la literatura científica sobre la ingesta alimentaria de mujeres con tumores ginecológicos en tratamiento oncológico. Método: Revisión integrativa de la literatura cuyas búsquedas se realizaron en las bases de datos Embase, MEDLINE y LILACS mediante la asociación de términos descriptivos y palabras libres. Se incluyeron en los análisis estudios observacionales que evaluaron la ingesta de alimentos de mujeres adultas con tumores ginecológicos durante el tratamiento del cáncer, escritos en portugués, inglés y español. Resultados: Esta revisión analizó seis estudios que investigaron el cambio en la ingesta de alimentos en esta población. Cuantificamos una reducción de la ingesta de hasta un 31% en energía, 39,9% en proteínas, 33,7% en lípidos, 28,7% en carbohidratos y una ingesta inadecuada de determinados micronutrientes. Conclusión: Las mujeres con tumores ginecológicos durante el tratamiento del cáncer tienen una reducción significativa en la ingesta de energía, proteínas, lípidos, carbohidratos y micronutrientes. Teniendo en cuenta que la pérdida de peso en pacientes con cáncer se asocia con resultados clínicos negativos, la evaluación de la ingesta alimentaria de estos individuos es fundamental para permitir una intervención nutricional precoz, una buena respuesta al tratamiento y la consecuente mejora de la calidad de vida
Subject(s)
Humans , Female , Eating , Genital Neoplasms, Female/drug therapy , Genital Neoplasms, Female/radiotherapy , Antineoplastic AgentsABSTRACT
Non-alcoholic fatty liver disease (NAFLD) presents with growing prevalence worldwide, though its pharmacological treatment remains to be established. This study aimed to evaluate the effects of a PPAR-alpha agonist on liver tissue structure, ultrastructure, and metabolism, focusing on gene and protein expression of de novo lipogenesis and gluconeogenesis pathways, in diet-induced obese mice. Male C57BL/6 mice (three months old) received a control diet (C, 10% of lipids, n = 10) or a high-fat diet (HFD, 50% of lipids, n = 10) for ten weeks. These groups were subdivided to receive the treatment (n = 5 per group): C, C-alpha (PPAR-alpha agonist, 2.5 mg/kg/day mixed in the control diet), HFD and HFD-alpha group (PPAR-alpha agonist, 2.5 mg/kg/day mixed in the HFD). The effects were compared with biometrical, biochemical, molecular biology and transmission electron microscopy (TEM) analyses. HFD showed greater body mass (BM) and insulinemia than C, both of which were tackled by the treatment in the HFD-alpha group. Increased hepatic protein expression of glucose-6-phosphatase, CHREBP and gene expression of PEPCK in HFD points to increased gluconeogenesis. Treatment rescued these parameters in the HFD-alpha group, eliciting a reduced hepatic glucose output, confirmed by the smaller GLUT2 expression in HFD-alpha than in HFD. Conversely, favored de novo lipogenesis was found in the HFD group by the increased expression of PPAR-gamma, and its target gene SREBP-1, FAS and GK when compared to C. The treatment yielded a marked reduction in the expression of all lipogenic factors. TEM analyses showed a greater numerical density of mitochondria per area of tissue in treated than in untreated groups, suggesting an increase in beta-oxidation and the consequent NAFLD control. PPAR-alpha activation reduced BM and treated insulin resistance (IR) and NAFLD by increasing the number of mitochondria and reducing hepatic gluconeogenesis and de novo lipogenesis protein and gene expressions in a murine obesity model.
