Identifying biomarkers for tDCS treatment response in Alzheimer's disease patients: a machine learning approach using resting-state EEG classification.

Background: Transcranial direct current stimulation (tDCS) is a promising treatment for Alzheimer's Disease (AD). However, identifying objective biomarkers that can predict brain stimulation efficacy, remains a challenge. The primary aim of this investigation is to delineate the cerebral regions implicated in AD, taking into account the existing lacuna in comprehension of these regions. In pursuit of this objective, we have employed a supervised machine learning algorithm to prognosticate the neurophysiological outcomes resultant from the confluence of tDCS therapy plus cognitive intervention within both the cohort of responders and non-responders to antecedent tDCS treatment, stratified on the basis of antecedent cognitive outcomes. Methods: The data were obtained through an interventional trial. The study recorded high-resolution electroencephalography (EEG) in 70 AD patients and analyzed spectral power density during a 6 min resting period with eyes open focusing on a fixed point. The cognitive response was assessed using the AD Assessment Scale-Cognitive Subscale. The training process was carried out through a Random Forest classifier, and the dataset was partitioned into K equally-partitioned subsamples. The model was iterated k times using K-1 subsamples as the training bench and the remaining subsample as validation data for testing the model. Results: A clinical discriminating EEG biomarkers (features) was found. The ML model identified four brain regions that best predict the response to tDCS associated with cognitive intervention in AD patients. These regions included the channels: FC1, F8, CP5, Oz, and F7. Conclusion: These findings suggest that resting-state EEG features can provide valuable information on the likelihood of cognitive response to tDCS plus cognitive intervention in AD patients. The identified brain regions may serve as potential biomarkers for predicting treatment response and maybe guide a patient-centered strategy. Clinical Trial Registration: https://classic.clinicaltrials.gov/ct2/show/NCT02772185?term=NCT02772185&draw=2&rank=1, identifier ID: NCT02772185.

Effects of a multi-professional intervention on body composition, physical fitness and biochemical markers in overweight COVID-19 survivors: a clinical trial.

Introduction: The sequelae post-COVID can affect different systems. In this sense, considering the multi-factorial etiology of COVID-19, multi-professional interventions could be a relevant strategy for recovery health indicators. Objective: This study aimed to investigate the effects of multi-professional intervention on body composition, physical fitness, and biomarkers in overweight COVID-19 survivors with different symptomatology. Methodology: A non-randomized parallel group intervention included 69 volunteers (BMI ≥25 kg/m2), divided into three groups according to SARS CoV-2 symptomatology, but only 35 finished the longitudinal protocol [control group (n = 11); moderate group (n = 17) and severe group (n = 7)]. The groups were submitted to a multi-professional program (nutritional intervention, psychoeducation, and physical exercise intervention) for 8 weeks, and the volunteers underwent body composition assessments (primary outcome) and physical and biochemical tests (secondary outcome) in pre- and post-intervention. This study was registered on the Clinical Trials Registration Platform number: RBR-4mxg57b and with the local research ethics committee protocol under number: 4,546,726/2021. Results: After the 8-week multi-professional intervention, the following results were observed for the moderate COVID-19 group: improved dynamic strength of lower- and (p = 0.003), upper-limbs (p = 0.008), maximal isometric lumbar-traction strength (p = 0.04), flexibility (p = 0.0006), and albumin (p = 0.0005), as well as a reduction in the C reactive protein (CRP) (p = 0.003) and fasting glucose (p = 0.001); for the severe COVID-19 group: an improvement in dynamic lower-body strength (p = 0.001), higher values of albumin (p = 0.005) and HDL-c (p = 0.002), and lower values of CRP (p = 0.05), and for the control group: an improvement in sit-up repetitions (p = 0.008), and a reduction of CRP (p = 0.01), fasting glucose (p = 0.001) and total cholesterol (p = 0.04) were identified. All experimental groups reduced triglycerides after intervention (p < 0.05). Conclusion: Finally, 8 weeks of multiprofessional intervention can be an efficient tool for reversing the inflammatory process and promoting improvements in daily activities and quality of life, although it is believed that the severe COVID-19 group needs longer interventions to improve different health indicators. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-4mxg57b.

Effects of a Multi-Professional Intervention on Mental Health of Middle-Aged Overweight Survivors of COVID-19: A Clinical Trial.

The present study aimed to investigate the effects of a multi-professional intervention model on the mental health of middle-aged, overweight survivors of COVID-19. A clinical trial study with parallel groups and repeated measures was conducted. For eight weeks, multi-professional interventions were conducted (psychoeducation, nutritional intervention, and physical exercises). One hundred and thirty-five overweight or obese patients aged 46.46 ± 12.77 years were distributed into four experimental groups: mild, moderate, severe COVID, and control group. The instruments were used: mental health continuum-MHC, revised impact scale-IES-r, generalized anxiety disorder-GAD-7, and Patient health questionnaire PHQ-9, before and after eight weeks. The main results indicated only a time effect, with a significant increase in global MHC scores, emotional well-being, social well-being, and psychological well-being, as well as detected a significant reduction in global IES-R scores, intrusion, avoidance, and hyperarousal, in addition to a reduction in GAD-7 and PHQ-9 scores (p < 0.05). In conclusion, it was possible to identify those psychoeducational interventions that effectively reduced anxiety, depression, and post-traumatic stress symptoms in post-COVID-19 patients, regardless of symptomatology, in addition to the control group. However, moderate and severe post-COVID-19 patients need to be monitored continuously since the results of these groups did not follow the response pattern of the mild and control groups.

Avaliação cariotípica de pacientes com clínica de Síndrome de Down no HUAP-UFF / Karyotypic evaluation of patients with down syndrome clinic in HUAP-UFF

O objetivo do presente estudo foi analisar o perfil cariotípico de pacietnes que deram entrada no Hospital Universitário Antonio Pedro-HUAP (Universidade Federal Fluminense), durante o período de 2006 a 2010, com clínica de síndrome de Down (SD) e determinar a ocorrência de cariótipos clássicos, mosaicismos e translocações. Para avaliação do cariótipo foi realizada a técnica de bandeamento G a partir de culturas de linfócitos. Dos 157 pacietnes que tiveram avaliação cariotípica solicitada no Laboratório de Hematologia-HUAP, 39 tinham clínica de SD, sendo que 32 apresentavam trissomia do cromossomo 21, um, translocação 21q:21q e, dois, translocação 14q:21q. Dois casos de mosaicismo foram detectados. Duas amostras não foram diagnosticadas como SD. Além disso, dois foram detectados. Duas amostras não foram diagnosticadas como SD. Além disso, dois casos não associados à suspeita clínica de Síndrome de Down foram diagnosticados como trissomia de cromossomo 21. O diagnóstico preciso da SD é fundamental para a orientação clínica adequada dos indivíduos afetados e para o fornecimento de informações relevantes ao planejamento familiar. O presente estudo indica a ocorrência destas alterações genéticas na população encaminhada ao Laboratório de Hematologia-HUAP, para análise do perfil cariotípico, demonstrando que o diagnóstico laboratorial correto é necessário para confirmar a clínica dos pacientes, salientando a importância da interação clínico laboratorial.

Excessive adiposity and sedentary lifestyles are prevalent in cancer patients; a pilot study.

Cancer aetiology is multifactorial; risk factors comprise obesity, central adiposity, physical inactivity and excessive/ deficient intake of foods and/or nutrients with procarcinogenic/ protective effects. We aim to analyze the pattern of nutritional status, food intake and physical activity in a cohort of cancer patients. This pilot crosssectional study was conducted in 64 outpatients referred for Radiotherapy. Nutritional parameters evaluated: BMI, waist circumference, body composition by tetrapolar bioimpedance (Xitron®). Usual food intake was collected with a short food frequency questionnaire and physical activity was assessed with Jacksons' questionnaire. Overweight/obesity and excessive body fat mass prevalence was of 53% and 61%, respectively. Central obesity, which indicates moderate/high cardio-metabolic risk, was found in 78% of patients. Food frequency analysis showed a poor intake in vegetables and a high intake in meat and carbohydrates. Physical inactivity was prevalent. This pilot study in cancer patients, showed a high prevalence of overweight/obesity, excessive fat mass and central obesity, simultaneously with sedentary lifestyles and an inadequate diet, poor in protective foods and excessive in deleterious ones. Thus, these patients exhibit a high risk pattern for cancer development and for a poorer prognosis. The implementation of measures to promote balanced and protective diets and to encourage physical activity practice is urgently needed.

La etiología del cáncer es multifactorial; los factores de riesgo comprenden la obesidad, la adiposidad central, la inactividad física y el consumo excesivo/deficiente de alimentos y/o nutrientes con efectos procarcinógenos/protectores. Nos propusimos analizar el patrón del estado nutricional, el consumo de alimentos y la actividad física en una cohorte de pacientes oncológicos. Este estudio piloto transversal se realizó en 64 pacientes ambulatorios remitidos a radioterapia. Se evaluaron los parámetros nutricionales: IMC, circunferencia de la cintura, composición corporal mediante bioimpedancia tetrapolar (Xitron®). La ingesta alimentaria habitual se recogió mediante un cuestionario abreviado de frecuencia de alimentos y la actividad física se evaluó mediante el cuestionario de Jackson. La prevalencia de sobrepeso/obesidad y de exceso de masa corporal grasa fue del 53% y del 61%, respectivamente. La obesidad central, que indica un riesgo cardiometabólico moderado/alto, se encontró en el 78% de los pacientes. El análisis de la frecuencia de alimentos mostró una ingesta escasa de verduras y un consumo elevado de carne e hidratos de carbono. La inactividad física fue prevalente. Este estudio piloto en pacientes oncológicos mostró una prevalencia elevada de sobrepeso/ obesidad, un exceso de masa grasa y de obesidad central, simultáneamente con estilos de vida sedentarios y una dieta inadecuada, pobre en alimentos productores y un exceso de los deletéreos. Por lo tanto, estos pacientes muestran un patrón de riesgo elevado para el desarrollo de cáncer y un peor pronóstico. Se requiere urgentemente la implantación de medidas que promuevan dietas equilibradas y protectoras así como la promoción de la actividad física.

Excessive adiposity and sedentary lifestyles are prevalent in cancer patients; a pilot study / La adiposidad excesiva y los estilos de vida sedentarios son prevalentes en los pacientes oncológicos; un estudio piloto

Cancer aetiology is multifactorial; risk factors comprise obesity, central adiposity, physical inactivity and excessive/ deficient intake of foods and/or nutrients with procarcinogenic/ protective effects. We aim to analyze the pattern of nutritional status, food intake and physical activity in a cohort of cancer patients. This pilot crosssectional study was conducted in 64 outpatients referred for Radiotherapy. Nutritional parameters evaluated: BMI, waist circumference, body composition by tetrapolar bioimpedance (Xitron®). Usual food intake was collected with a short food frequency questionnaire and physical activity was assessed with Jacksons' questionnaire. Overweight/obesity and excessive body fat mass prevalence was of 53% and 61%, respectively. Central obesity, which indicates moderate/high cardio-metabolic risk, was found in 78% of patients. Food frequency analysis showed a poor intake in vegetables and a high intake in meat and carbohydrates. Physical inactivity was prevalent. This pilot study in cancer patients, showed a high prevalence of overweight/obesity, excessive fat mass and central obesity, simultaneously with sedentary lifestyles and an inadequate diet, poor in protective foods and excessive in deleterious ones. Thus, these patients exhibit a high risk pattern for cancer development and for a poorer prognosis. The implementation of measures to promote balanced and protective diets and to encourage physical activity practice is urgently needed (AU)

La etiología del cáncer es multifactorial; los factores de riesgo comprenden la obesidad, la adiposidad central, la inactividad física y el consumo excesivo/deficiente de alimentos y/o nutrientes con efectos procarcinógenos/protectores. Nos propusimos analizar el patrón del estado nutricional, el consumo de alimentos y la actividad física en una cohorte de pacientes oncológicos. Este estudio piloto transversal se realizó en 64 pacientes ambulatorios remitidos a radioterapia. Se evaluaron los parámetros nutricionales: IMC, circunferencia de la cintura, composición corporal mediante bioimpedancia tetrapolar (Xitron®). La ingesta alimentaria habitual se recogió mediante un cuestionario abreviado de frecuencia de alimentos y la actividad física se evaluó mediante el cuestionario de Jackson. La prevalencia de sobrepeso/obesidad y de exceso de masa corporal grasa fue del 53% y del 61%, respectivamente. La obesidad central, que indica un riesgo cardiometabólico moderado/alto, se encontró en el 78% de los pacientes. El análisis de la frecuencia de alimentos mostró una ingesta escasa de verduras y un consumo elevado de carne e hidratos de carbono. La inactividad física fue prevalente. Este estudio piloto en pacientes oncológicos mostró una prevalencia elevada de sobrepeso/ obesidad, un exceso de masa grasa y de obesidad central, simultáneamente con estilos de vida sedentarios y una dieta inadecuada, pobre en alimentos productores y un exceso de los deletéreos. Por lo tanto, estos pacientes muestran un patrón de riesgo elevado para el desarrollo de cáncer y un peor pronóstico. Se requiere urgentemente la implantación de medidas que promuevan dietas equilibradas y protectoras así como la promoción de la actividad física (AU)

Nutritional status influences generic and disease-specific quality of life measures in haemodialysis patients.

BACKGROUND: Poor nutritional status and worse healthrelated quality of life (QoL) have been reported in haemodialysis (HD) patients. The utilization of generic and disease specific QoL questionnaires in the same population may provide a better understanding of the significance of nutrition in QoL dimensions. OBJECTIVE: To assess nutritional status by easy to use parameters and to evaluate the potential relationship with QoL measured by generic and disease specific questionnaires. METHODS: Nutritional status was assessed by subjective global assessment adapted to renal patients (SGA), body mass index (BMI), nutritional intake and appetite. QoL was assessed by the generic EuroQoL and disease specific Kidney Disease Quality of Life-Short Form (KDQoL-SF) questionnaires. RESULTS: The study comprised 130 patients of both genders, mean age 62.7 ± 14.7 years. The prevalence of undernutrition ranged from 3.1% by BMI ≤ 18.5 kg/m² to 75.4% for patients below energy and protein intake recommendations. With the exception of BMI classification, undernourished patients had worse scores in nearly all QoL dimensions (EuroQoL and KDQoL-SF), a pattern which was dominantly maintained when adjusted for demographics and disease-related variables. Overweight/ obese patients (BMI ≥ 25) also had worse scores in some QoL dimensions, but after adjustment the pattern was maintained only in the symptoms and problems dimension of KDQoL-SF (p = 0.011). CONCLUSION: Our study reveals that even in mildly undernourished HD patients, nutritional status has a significant impact in several QoL dimensions. The questionnaires used provided different, almost complementary perspectives, yet for daily practice EuroQoL is simpler. Assuring a good nutritional status, may positively influence QoL.

Antecedentes: En pacientes en hemodiálisis (HD) se han comunicado un estado nutricional deficiente y una peor calidad de vida (CdV) relacionada con la salud. El uso de cuestionarios de CdV genéricos y específicos de la enfermedad en la misma población puede proporcionar un mejor conocimiento del significado de la nutrición en las dimensiones de CdV. Objetivo: Evaluar el estado nutricional mediante parámetros fáciles de usar y evaluar la relación potencial con la CdV medida mediante cuestionarios genéricos y específicos de la enfermedad. Métodos: Se evaluó el estado nutricional mediante evaluación global subjetiva (EGS) adaptada a pacientes renales, índice de masa corporal (IMC), la ingesta nutricional y el apetito. La CdV se evaluó mediante el cuestionario genérico EuroQoL y el específico de la enfermedad Kidney Disease Quality of Life-Short Form (KDQoL-SF). Resultados: El estudio comprendía 130 pacientes de ambos sexos, edad media 62,7 ± 14,7 años. La prevalencia de la malnutrición varió desde 3,1% por un IMC =?18,5 kg/m2 hasta el 75,4% de los pacientes por debajo de las recomendaciones de ingesta de energía y proteínas. Con la excepción de la clasificación por el IMC, los pacientes malnutridos tenían peores puntuaciones en casi todos los dominios de la CdV (EuroQoL y KDQoL-SF), un patrón que se mantenía de forma dominante cuando se ajustaba para las variables demográficas y relacionadas con la enfermedad. Los pacientes con sobrepeso/obesidad (IMC ≥?25) también mostraron peores puntuaciones en algunas dimensiones de la CdV, pero tras el ajuste el patrón sólo se mantenía en el dominio de síntomas y problemas de KDQoL-SF (p = 0,011). Conclusión: Nuestro estudio reveló que incluso en pacientes en HD malnutridos, el estado nutricional tienen un impacto significativo en diversos dominios de la CdV. Los cuestionarios empleados proporcionaron perspectivas distintas, casi complementarias, si bien para la práctica diaria el EuroQoL es más sencillo. El asegurar un buen estado nutricional podría influir positivamente en la CdV.

Nutritional status influences generic and disease-specific quality of lifemeasures in haemodialysis patients / Estado nutricional influye en la calidad de vida en pacientes en hemodiálisis aplicando cuestionarios genéricos y específicos de la enfermedad

Background: Poor nutritional status and worse health-related quality of life (QoL) have been reported in haemodialysis (HD) patients. The utilization of generic and disease specific QoL questionnaires in the same population may provide a better understanding of the significance of nutrition in QoL dimensions. Objective: To assess nutritional status by easy to use parameters and to evaluate the potential relationship with QoL measured by generic and disease specific questionnaires. Methods: Nutritional status was assessed by subjective global assessment adapted to renal patients (SGA), body mass index (BMI), nutritional intake and appetite. QoL was assessed by the generic EuroQoL and disease specific Kidney Disease Quality of Life-Short Form (KDQoL-SF) questionnaires. Results: The study comprised 130 patients of both genders, mean age 62.7 ± 14.7 years. The prevalence of undernutrition ranged from 3.1% by BMI < 18.5 kg/m2 to 75.4% for patients below energy and protein intake recommendations. With the exception of BMI classification, undernourished patients had worse scores in nearly all QoL dimensions (EuroQoL and KDQoL-SF), a pattern which was dominantly maintained when adjusted for demographics and disease-related variables. Overweight/obese patients (BMI > 25) also had worse scores in some QoL dimensions, but after adjustment the pattern was maintained only in the symptoms and problems dimension of KDQoL-SF (p = 0.011). Conclusion: Our study reveals that even in mildly undernourished HD patients, nutritional status has a significant impact in several QoL dimensions. The questionnaires used provided different, almost complementary perspectives, yet for daily practice EuroQoL is simpler. Assuring a good nutritional status, may positively influence QoL (AU)

Antecedentes: En pacientes en hemodiálisis (HD) se han comunicado un estado nutricional deficiente y una peor calidad de vida (CdV) relacionada con la salud. El uso de cuestionarios de CdV genéricos y específicos de la enfermedad en la misma población puede proporcionar un mejor conocimiento del significado de la nutrición en las dimensiones de CdV. Objetivo: Evaluar el estado nutricional mediante parámetros fáciles de usar y evaluar la relación potencial con la CdV medida mediante cuestionarios genéricos y específicos de la enfermedad. Métodos: Se evaluó el estado nutricional mediante evaluación global subjetiva (EGS) adaptada a pacientes renales, índice de masa corporal (IMC), la ingesta nutricional y el apetito. La CdV se evaluó mediante el cuestionario genérico EuroQoL y el específico de la enfermedad Kidney Disease Quality of Life-Short Form (KDQoL-SF). Resultados: El estudio comprendía 130 pacientes de ambos sexos, edad media 62,7 ± 14,7 años. La prevalencia de la malnutrición varió desde 3,1% por un IMC < 18,5 kg/m2 hasta el 75,4% de los pacientes por debajo de las recomendaciones de ingesta de energía y proteínas. Con la excepción de la clasificación por el IMC, los pacientes malnutridos tenían peores puntuaciones en casi todos los dominios de la CdV (EuroQoL y KDQoL-SF), un patrón que se mantenía de forma dominante cuando se ajustaba para las variables demográficas y relacionadas con la enfermedad. Los pacientes con sobrepeso/obesidad (IMC > 25) también mostraron peores puntuaciones en algunas dimensiones de la CdV, pero tras el ajuste el patrón sólo se mantenía en el dominio de síntomas y problemas de KDQoL-SF (p = 0,011). Conclusión: Nuestro estudio reveló que incluso en pacientes en HD malnutridos, el estado nutricional tienen un impacto significativo en diversos dominios de la CdV. Los cuestionarios empleados proporcionaron perspectivas distintas, casi complementarias, si bien para la práctica diaria el EuroQoL es más sencillo. El asegurar un buen estado nutricional podría influir positivamente en la CdV (AU)

Length of stay in surgical patients: nutritional predictive parameters revisited.

Nutritional evaluation may predict clinical outcomes, such as hospital length of stay (LOS). We aimed to assess the value of nutritional risk and status methods, and to test standard anthropometry percentiles v. the 50th percentile threshold in predicting LOS, and to determine nutritional status changes during hospitalisation and their relation with LOS. In this longitudinal prospective study, 298 surgical patients were evaluated at admission and discharge. At admission, nutritional risk was assessed by Nutritional Risk Screening-2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST) and nutritional status by Subjective Global Assessment (SGA), involuntary % weight loss in the previous 6 months and anthropometric parameters; % weight loss and anthropometry were reassessed at discharge. At admission, risk/undernutrition results by NRS-2002 (P< 0.001), MUST (P< 0.001), % weight loss (P< 0.001) and SGA (P< 0.001) were predictive of longer LOS. A mid-arm circumference (MAC) or a mid-arm muscle circumference (MAMA) under the 15th and the 50th percentile, which was considered indicative of undernutrition, did predict longer LOS (P< 0.001); conversely, there was no association between depleted triceps skinfold (TSF) and longer LOS. In-hospital, there was a high prevalence of weight, muscle and fat losses, associated with longer LOS. At discharge, patients with a simultaneous negative variation in TSF+MAC+MAMA (n 158, 53 %) had longer LOS than patients with a TSF+MAC+MAMA positive variation (11 (8-15) v. 8 (7-12) d, P< 0.001). We concluded that at risk or undernutrition evaluated by all methods, except TSF and BMI, predicted a longer LOS. Moreover, MAC and MAMA measurements and their classification according to the 50th percentile threshold seem reliable undernutrition indicators.

Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy.

BACKGROUND: In our published randomized trial in colorectal cancer, group 1 (n = 37) received individualized nutritional counseling and education about regular foods, group 2 (n = 37) received dietary supplements and consumed their usual diet of regular foods, and group 3 (n = 37) consumed their usual diet of regular foods. Neither group 2 nor group 3 received individualized counseling. Early nutritional counseling during radiotherapy was highly effective at reducing acute radiotherapy toxicity and improving nutritional intake/status and quality of life (QoL). Efficacy persisted for 3 mo after the intervention. OBJECTIVE: The objective was to perform long-term follow-up in survivors of that clinical trial to specifically evaluate survival, late toxicity, QoL, and nutritional variables. DESIGN: Medical data were collected from patients' records, and prescheduled interviews were conducted by dietitians for individualized evaluations. Analyses and comparisons between groups (adjusted for stage) were performed after a median follow-up of 6.5 (range: 4.9-8.1) y. RESULTS: Patients complied with the Radiotherapy Department's follow-up protocol. Nutritional deterioration was higher (P < 0.001) in group 3 (n = 26) and group 2 (n = 29) than in group 1 (n = 34). Adequate nutritional status was maintained in 91% of group 1 patients but not in any of the group 3 patients (P < 0.002). Intakes in group 1 were similar to reference values, and the patients adhered to the prescribed recommendations. Intakes in groups 2 and 3 were lower than recommended intakes: group 3 ≃ group 2 < group 1 (P = 0.001). Median survival in group 3 was 4.9 y (30% died), in group 2 was 6.5 y (22% died), and in group 1 was 7.3 y (only 8% died): group 3 > group 2 > group 1 (P < 0.01). Late radiotherapy toxicity was higher in group 3 (n = 17; 65%) and group 2 (n = 17; 59%) than in group 1 (n = 3; 9%): group 3 ≃ group 2 > group 1 (P < 0.001). QoL was worse in groups 3 and 2 than in group 1: group 3 ≃ group 2 < group 1 (P < 0.002). Worse radiotherapy toxicity, QoL, and mortality were associated with deteriorated nutritional status and intake (P < 0.001). Likewise, depleted intake, nutritional status, and QoL predicted shorter survival and late toxicity (HR: 8.25; 95% CI: 2.74, 1.47; P < 0.001). CONCLUSIONS: This study conveys novel information about the effectiveness of nutrition at improving long-term prognosis in colorectal cancer. Overall, the data indicate that early individualized nutritional counseling and education during radiotherapy is valuable for patients.

Nutritional risk screening in surgery: valid, feasible, easy!

BACKGROUND & AIMS: We aimed to test the capacity in identifying patients at nutritional risk, by comparing BMI, recent %weight loss,Nutritional Risk Screening 2002(NRS-2002),Malnutrition Universal Screening Tool(MUST) and Nutritional Risk Index(NRI) with Subjective Global Assessment(SGA),considered the Standard. The main purpose was to select the most consistent screening method for effective integration in daily surgical wards' practice. METHODS: 300 surgical patients were assessed at admission: BMI(categorized by WHO's criteria), weight loss ≥ 5% in previous 6 months, NRS-2002, MUST, NRI, SGA. Concordances, correlations, sensitivity, specificity, positive(PPV) and negative predictive values(NPV) were calculated to evaluate methods' performance vs the Standard. RESULTS: Prevalence of nutritional risk was 66% by NRS-2002 + MUST, and 87% by NRI. By SGA, 64% patients were undernourished. All methods agreed with SGA(k = 0.85-0.91,p < 0.001), except BMI & NRI(k = 0.07-0.34,p < 0.05). NRS-2002, MUST and %weight loss effectively detected patients at risk: sensitivity 0.8-0.89, specificity 0.89-0.93, PPV 81%-89%, NPV 89%-100%. Conversely, BMI & NRI were ineffective: sensitivity 0.29-0.43, specificity 0.27-0.39, PPV 24%-35%, NPV 27%-31%; %weight loss alone vs MUST/NRS-2002 was explored: sensitivity 0.79-0.87, specificity 0.85-0.89, PPV 84%-85%, NPV 87%-89%, thus successfully identifying undernutrition risk. CONCLUSIONS: In surgical patients, MUST + NRS-2002 are valid for nutritional screening; recent weight loss ≥ 5% also proved highly efficient; its easy/quick calculation may facilitate adherence/integration by health professionals as a minimum obligatory in clinical practice.

Validation of the Malnutrition Universal Screening Tool (MUST) in cancer.

In the present study, we aimed to validate the Malnutrition Universal Screening Tool (MUST) for routine nutritional screening in the radiation oncology setting, thus enabling timely and adequate referrals of patients at risk for individualised or advanced intervention. Towards this objective, we conducted a prospective cross-sectional study in 450 non-selected cancer patients (18-95 years) referred for radiotherapy. The following were the nutritional parameters: BMI (categorised by WHO's age/sex criteria), weight loss >5 % in the previous 3-6 months, Patient-Generated Subjective Global Assessment (PG-SGA - validated/specific for oncology) and nutritional risk by MUST. Sensitivity, specificity, predictive values and concordance were calculated to validate MUST v. PG-SGA and compare single parameters v. PG-SGA/MUST. BMI v. PG-SGA showed a negligible capacity to detect undernutrition: 0.27 sensitivity, 0.23 specificity, 0.35 positive predictive value and 0.31 negative predictive value. Conversely, percentage weight loss v. PG-SGA was highly effective: 0.76 sensitivity, 0.85 specificity, 0.79 positive predictive value and 0.85 negative predictive value. MUST v. PG-SGA successfully detected patients at risk: 0.80 sensitivity, 0.89 specificity, 0.87 positive predictive value and 1.0 negative predictive value; percentage weight loss v. MUST proved able to identify patients likely to be at risk: 0.85 sensitivity, 0.91 specificity, 0.90 positive predictive value and 1.0 negative predictive value. This is the first study in the radiation oncology setting to validate MUST: a simple and quick method applicable by any health professional, with a high validity for early screening, ideally to antedate a comprehensive nutritional assessment and guide for intervention. In this study, percentage weight loss in the previous 3-6 months does seem valid to predict nutritional risk, and may be the minimum in a busy routine.

Teaching nutrition integration: MUST screening in cancer.

RATIONALE: Nutritional risk screening should be routine in order to select patients in need of nutrition care; this conduct change has to rely on education. In this project, radiotherapy department health professionals were trained on how to use the Malnutrition Universal Screening Tool (MUST), to foster its integration into cancer outpatient management; we also aimed to identify those more adherent to screening. METHODS: Research dieticians (the standard) conducted interactive sessions with all physicians, nurses, and radiotherapy (RT) technicians, who were closely supervised to facilitate routine MUST integration. There were two phases: after the first session, phase 1 assessed 200 patients over 4 months; after the second session, phase 2 screened 450 patients, always before RT. Validity was evaluated comparing results from the standard against all other health professionals, adjusted for number. RESULTS: RT technicians were most adherent to the MUST: 80% of patients in phase 1, increasing to 85% in phase 2. Nurses doubled their input, from 19% to 36%. Physicians had poor MUST integration, yet they progressively incorporated percentage weight loss into patient records, increasing from 57% in phase 1 to 84% in phase 2, independently of diagnosis and stage. The highest concordance (κ coefficient) with dieticians was found with RT technicians' use of the MUST (p < .002) and percentage weight loss determination by physicians (p < .001). CONCLUSIONS: We show that systematic screening in cancer is feasible by all professionals involved, once a proximity teaching project is put into practice. RT technicians, who daily treat patients, were highly adherent to integrate the MUST and might be in charge of selecting at-risk patients. Physicians are unlikely to use the MUST, but acknowledged nutrition value and changed their routine by integrating recent percentage weight loss into their approach to patients. Our structured methodology may be used as a model for the development of teaching adapted to different departments with other realities.

[What is the nutrition and lifestyle profile in oncology patient? Cross-sectional study]. / Qual o perfil nutricional e de estilos de vida do doente oncológico? Estudo transversal.

BACKGROUND: Cancer aetiology is multifactorial and risk factors include: obesity, central adiposity, sedentarism, excessive or deficient intake of foods and/or nutrients with pro-carcinogenic effects vs protective ones. OBJECTIVES: To evaluate the pattern of nutritional status, life styles, physical activity and diet in a cohort of cancer patients. METHODS: This pilot cross-sectional study was conducted in 64 patients referred for radiotherapy at the Radiotherapy Department of the University Hospital of Santa Maria (CHLN). Evaluations were: waist circumference associated with potential cardio-metabolic risk, body composition by Tetrapolar Bioimpedance Analysis (XITRON®), Body Mass Index, dietary intake pattern with a short food frequency questionnaire, physical activity with Jackson questionnaire. RESULTS: The most frequent diagnosis were breast and colorectal cancers; 53% of patients were overweight/obese, and there was a significant correlation between this nutritional pattern and weight gain in comparison with usual weight (p<0.005). There were 78% of patients with a waist circumference above the maximum cut-off limit, indicating moderate/ high cardio-metabolic risk, and most were female patients (87%). The great majority of patients (61%) had excessive fat mass highly above the maximum recommended cut-off value, especially male patients (74%). The dietary pattern was poor in vegetables (55%) and excessive in meat and simple carbohydrates (78%); physical activity was low with a high prevalence of sedentarism. CONCLUSIONS: This population presented excessive body weight, excessive fat mass, high cardio-metabolic risk, sedentarism and an unbalanced diet poor in protective foods/nutrients. This population's life styles and nutritional pattern, may be considered of risk in oncology disease. The elevated and growing incidence of cancer in Portugal, reinforces the need for further research in order to identify nutritional factors involved in the etiology/evolution and probably prognosis of cancer.

[The relevance of body composition in cancer patients: what is the evidence?]. / A importância da composição corporal no doente oncológico: qual a evidência?

In the past few years, there has been a growing interest on body composition changes of cancer patients. Muscle mass and fat mass are pointed out as the most important compartments from a physiological point of view, as their changes are the ones with the most impact on disease. The excess of fat mass is related with increased risk of incidence and recurrence of some types of cancer, and some studies identify it as a major contributing factor for increased morbidity and mortality in cancer patients. Weight loss in cancer is frequent and is associated with symptoms, circulating pro-cachectic substances produced by the tumour, and/or hypermetabolism states, not compensated with adequate intake. Muscle mass depletion is the most worrying, and has been associated with decreased functional capacity, increased toxicity of anti-neoplastic treatments, longer length of stay and higher risk of nosocomial infections. In end stage disease, some patients may develop cancer cachexia, an irreversible condition highly associated with mortality. Of note that, lean body mass depletion may occur with excess fat mass (sarcopenic obesity), a condition that combines the health risks of obesity and those of sarcopenia. The high prevalence of malnutrition in cancer patients justifies its relevance. Many patients point it as a cause for the reduction of physical, cognitive, emotional and social functions, as well as anorexia, fatigue, dyspnoea, insomnia, gastrointestinal symptoms and worse Quality of Life. Additionally, body composition may be affected by nutrition, lifestyles and physical activity; therefore, any approach to the patient should include all these dimensions, with special emphasis on individualised nutritional intervention. Therefore, nutritional therapy should be adjuvant to any treatment, as it is essential in all stages of the disease: for its development, during the treatment(s) and in the follow-up period. The aim of nutritional intervention is to promote changes in body composition, by maintaining or increasing lean body mass and keeping fat mass in healthy levels, which may have a positive impact on Quality of Life, response to treatment(s), prognosis and reduced health care costs.

[Food for health: primary-care prevention and public health--relevance of the medical role]. / Alimentação para a saúde: a relevância da intervenção dos médicos.

Each individual is unique, with genetic factors that interact with a particular environment. Therefore, the daily energy requirements should be calculated individually and have to consider the several factors which influence them: basal metabolic rate, diet-induced thermogenesis, physical activity, specific diseases, among other factors. Food provides macronutrients: carbohydrates, proteins and lipids, as well as micronutrients: vitamins, minerals and oligoelements, which should be eaten daily in the recommended amounts during the life cycle, e.g. pregnancy, childhood, adolescence, adulthood and aging. Health professionals can use the "Roda dos Alimentos Portuguesa" to teach and guide the population on how to eat, whether they are healthy or ill individuals, in order to meet their nutritional needs. Through this tool it is possible for everyone to understand and to practice a diet that is: 1) complete (eating foods from all groups), 2) balanced (to respect the proportions of each food group, adjusting the recommended portions/amounts for each individual), and 3) diversified (to choose different foods within each group). Some studies show that food marketing and advertising influence the consumers' choices since childhood. There is already some Regulation in this field, especially about nutrition and health claims. However, a permanent supervision of food marketing is necessary, to ensure compliance with the European Regulation from EFSA. It is crucial to teach and to encourage people to carefully read the food labels before purchasing. Health professionals should also be aware, academically and professionally, about the basics principles of Food and Health Promotion. The unique and essential role of the Professionals of Nutrition needs to be valued and recognized, and these professionals have to be integrated in sufficient number, in the multidisciplinary teams of the National Health Service, whether in Hospitals or Health Care Centers for the ambulatory population. These are the interventions and attitudes that make a difference and that are actually effective in preventing and/or treating many chronic diseases. Hence it is possible to improve health and quality of health services provided to the population (public health scope) and that of patients (clinical practice scope) as well as to optimize costs in health.

[What is the relevance of nutrition in oncology?]. / Qual a relevância da nutrição em oncologia?

Cancer has an increasingly significant impact on society, being a highly destabilizing factor in the life of any patient. The disease as well as anti-neoplastic treatments can profoundly alter biological functions and, remarkably, the patients' nutritional status. Thus, Nutrition is a key factor in oncology, by influencing the development of the disease, cancer related symptoms, the response to, and recovery from treatment(s), and therefore determining the patients' Quality of Life and probably prognosis. Therefore, the assessment of Quality of Life in any clinical study is essential because it values physical, psychological and social factors, which often depend on or are related with Nutrition. The aim of this review work, was to explore extent to which individualized nutrition intervention improves nutritional parameters (nutritional status and intake), Quality of Life, and ultimately the prognosis of the disease. Based on clinical research studies conducted until now, early nutritional intervention via individualized nutritional counseling, does significantly improve nutritional parameters and Quality of Life. It was also found that appropriate and individualized nutritional intervention, improves symptoms, reduces morbidity and may have the potential to improve the prognosis of the disease. According to the reviewed data and guidelines, nutritional therapy should be central and adjuvant to any treatment, and should be included in the multidisciplinary approach mandatory in oncology. This will allow for more adequate and efficient results these patients. Multidisciplinary follow-up, with early nutritional intervention, is of major importance in oncology, thus being a key factor for successful treatment and recovery of these patients.

[Research training in nutrition: relevance for medical clinical pratice]. / Estágio de investigação em nutrição: relevância para a prática clínica em medicina.

INTRODUCTION: In oncology, early and individualized nutritional intervention for each patient is essential to improve nutritional intake and status, to reduce morbidity during treatment, enhance tolerance to treatment and improve Quality of Life. OBJECTIVES: For medical students to evaluate nutritional risk and status, analyse the prevalence of undernutrition in a population of patients with diverse types of tumours. We aimed to identify difficulties regarding the use of the MUST tool (Malnutrition Universal Screening Tool) for nutritional risk by the students. METHODS: This study included 35 cancer patients consecutively referenced for Radiotherapy (RT) in the Radiotherapy Department of the University Hospital of Santa Maria. Nutritional risk was evaluated by MUST; nutritional status by Patient Generated-Subjective Global Assessment (PG-SGA) validated and specific for oncology. RESULTS: Students identified 13 patients (36%) at moderate/high risk of undernutrition. According to PG-SGA, 31,5% (11/35) of patients presented moderate or severe undernutrition, of which 77% of patients needed individualized nutritional counselling. Students successfully detected undernourished patients using these specific methods. CONCLUSION: Risk of undernutrition and undernutrition are common in oncology, therefore indicating the critical need to educate all health professionals for risk screening and for the relevance of nutritional intervention in the multidisciplinary context. MUST is a simple and quick tool, that demonstrated to be adequate when applied by medical students, well accepted by these health professionals and effectively used. Nutritional risk evaluation can and must be performed by health professionals such as the medical team, as long as they are involved in patient's treatment. Our methodology may be used as a model allowing for early guidance to individualized intervention, human resources' optimization and education for the importance of nutrition care.

The diversity of nutritional status in cancer: new insights.

OBJECTIVE: Nutritional status in cancer has been mostly biased toward undernutrition, an issue now in dispute. We aimed to characterize nutrition status, to analyze associations between nutritional and clinical/cancer-related variables, and to quantify the relative weights of nutritional and cancer-related features. METHODS: The cross-sectional study included 450 nonselected cancer patients (ages 18-95 years) at referral for radiotherapy. Nutritional status assessment included recent weight changes, body mass index (BMI) categorized by World Health Organization's age/sex criteria, and Patient-Generated Subjective Global Assessment (PG-SGA; validated/specific for oncology). RESULTS: BMI identified 63% as >or=25 kg/m(2) (43% overweight, 20% obese) and 4% as undernourished. PG-SGA identified 29% as undernourished and 71% as well nourished. Crossing both methods, among the 319 (71%) well-nourished patients according to PG-SGA, 75% were overweight/obese and only 25% were well nourished according to BMI. Concordance between BMI and PG-SGA was evaluated and consistency was confirmed. More aggressive/advanced stage cancers were more prevalent in deficient and excessive nutritional status: in 83% (n = 235/282) of overweight/obese patients by BMI and in 85% (n = 111/131) of undernourished patients by PG-SGA. Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; undernutrition was associated with aggressive lung, colorectal, head-neck, stomach, and esophageal cancers (p < .005). Estimates of effect size revealed that overweight/obesity was associated with advanced stage (24%), aggressive breast (10%), and prostate (9%) cancers, whereas undernutrition was associated with more aggressive lung (6%), colorectal (6%), and head-neck (6%) cancers; in both instances, age and longer disease duration were of significance. CONCLUSION: Undernutrition and overweight/obesity have distinct implications and bear a negative prognosis in cancer. This study provides novel data on the prevalence of overweight/obesity and undernutrition in cancer patients and their potential role in cancer histological behavior.