Acute intake of fructooligosaccharide and partially hydrolyzed guar gum on gastrointestinal transit: A randomized crossover clinical trial.

OBJECTIVES: Dietary fibers, such as fructooligosaccharide (FOS) and partially hydrolyzed guar gum (PHGG) have several gastrointestinal functions. The aims of this study were to evaluate the effect of acute ingestion of FOS and PHGG on the percentage of gastric emptying and small intestinal transit and to evaluate the effect of these dietary fibers on the levels of intestinal hormones-active glucagon-like peptide-1, pancreatic polypeptide, and gastric inhibitory peptide-and their effect on feelings of hunger and satiety and the desire to eat. METHODS: In this crossover, randomized controlled clinical trial, we compared the effects of these two fibers on gastrointestinal transit. The tests were performed using scintigraphy. On three different days, healthy participants consumed a test meal containing 20 g of digestible maltodextrin (placebo), 20 g of FOS, or 20 g of PHGG. RESULTS: The gastric emptying of the FOS-based diet (84.2 ± 9.4%) within 2 h was statistically increased compared with the placebo and PHGG-based diets (78 ± 10.2% and 74 ± 15.3%, respectively; P < 0.05). However, a reduction in small intestinal transit was observed after consumption of both FOS- and PHGG-based diets (28.5 ± 15.56% and 24.2 ± 13.7%, respectively) compared with the placebo diet (41.20 ± 15.4%; P < 0.05). There were no changes in the levels of intestinal hormones, feeling of hunger and satiety, or desire to eat after consuming the three diets (P > 0.05). CONCLUSION: The acute intake of FOS increased gastric emptying, whereas both FOS and PHGG reduced small intestine transit without altering the levels of intestinal hormones, hunger feelings and satiety, or the desire to eat.

SHORT-TERM EFFECT OF WHEY PROTEIN SUPPLEMENTATION ON THE QUALITY OF LIFE OF PATIENTS WAITING FOR LIVER TRANSPLANTATION: A DOUBLE BLINDED RANDOMIZED CLINICAL TRIAL.

BACKGROUND: Chronic liver disease is associated with malnutrition that negatively impacts a patient's health-related quality of life (HRQoL). AIM: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. METHODS: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. RESULTS: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. CONCLUSION: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

Critical analysis of factors affecting the efficiency of nutrition therapy teams.

BACKGROUND: Nutrition therapy (NT), defined as the provision of oral, enteral, or parenteral nutrition, should be considered a part of the holistic approach to patient care, while quality assessment of its practices is crucial. The present study aimed to identify variables capable of explaining the reason behind compliance of NTTs with the regulatory requirements. METHODS: A cross-sectional study focused on assessing the quality of nutritional therapy practices among NTTs who previously stated to be able to comply with requirements of the Brazilian law versus those who were not able to meet these demands. Hospitals were classified as A (teams that had previously reported to be able to meet the requirements) and B (those unable to comply with them). The study was approved by the ethics committees of all participant institutions. RESULTS: Twenty six hospitals met the inclusion criteria. The main hospital features, such as size, classification, service type, and percentage of hospitals providing NT were similar. Hospitals differed on the median number of patients undergoing NT per week: in group B (41.0; IR = 28.0-58.0) and group A (11.0; IR = 5.0-48.0) (p < 0.05), but there were no differences regarding personnel expertise. Both hospital groups had low quality control of the NT processes. CONCLUSION: Lack of quality assurance is responsible for the inadequate services in both type of institutions.

Preoperative and Postoperative Resting Energy Expenditure of Patients Undergoing Major Abdominal Operations.

BACKGROUND: Nutrition therapy plays a major role in the perioperative management of surgical patients. Understanding energy metabolism and correctly establishing the adequate energy needs is a crucial step to provide optimal nutrition care. The aim of this study was to assess the resting energy expenditure (REE) after major abdominal procedures and its associated factors. METHODS: This was a prospective observational study conducted at a single center. REEs of patients admitted for gastrointestinal surgical procedures were measured by indirect calorimetry 24 hours prior to the procedure and reassessed at least once within the fifth postoperative day. Substrate oxidation was calculated according to the Frayn equation. Nutrition status was evaluated using subjective global assessment. RESULTS: There were no significant changes in the REEs throughout the study period; however, there was a decrease in the respiratory quotient during the postoperative period, as well as a decrease in carbohydrate oxidation and an increase in lipid oxidation. Only 33.3% of the patients presented a postoperative increase in REE > 10%. Those patients presented higher blood-monocyte levels. CONCLUSION: Postoperative REE is not increased in most of the patients. In patients who had increased REE, associated factors included higher levels of monocytes.

Prophylactic and therapeutic supplementation using fructo-oligosaccharide improves the intestinal homeostasis after mucositis induced by 5- fluorouracil.

The beneficial effects of prebiotic, such as fructo-oligosaccharides (FOS), in intestinal inflammation have been demonstrated in several studies. Herein, we evaluate whether joint treatment with FOS, both before and during mucositis, had additional beneficial effects and investigated the mechanisms underlying in the action of FOS on the intestinal barrier. BALB/c mice were randomly divided into five groups: CTR (without mucositis + saline solution), FOS (without mucositis + 6 % FOS), MUC (mucositis + saline solution), PT (mucositis + 6 % FOS supplementation before disease induction), and TT (mucositis + 6 % FOS supplementation before and during disease induction). Mucositis was induced by intraperitoneal injection (300 mg/kg) of 5-fluorouracil (5-FU). After 72 h, the animals were euthanized and intestinal permeability (IP), tight junction, bacterial translocation (BT), histology and morphometry, and immunoglobulin A secretory (sIgA), inflammatory infiltrate, and production of short-chain fatty acids (acetate, butyrate and propionate) were evaluated. The MUC group showed an increase in the IP, BT, and inflammatory infiltrate but a decrease in the tight junction expression and butyrate and propionate levels (P < 0.05). In the PT and TT groups, FOS supplementation maintained the IP, tight junction expression, and propionate concentration within physiologic levels, increased butyrate levels, and reduced BT and inflammatory infiltrate (P < 0.05). Total treatment with FOS (TT group) was more effective in maintaining histological score, morphometric parameters, and sIgA production. Thus, total treatment (prophylactic and therapeutic supplementation) with FOS was more effective than pretreatment alone, in reducing 5-FU-induced damage to the intestinal barrier.

Short-term effect of whey protein supplementation on the quality of life of patients waiting for liver transplantation: a double blinded randomized clinical trial / Efeito a curto prazo da suplementação com proteína do soro do leite sobre a qualidade de vida de pacientes em fila de espera para o transplante hepático: ensaio clínico randomizado

ABSTRACT Background: Chronic liver disease is associated with malnutrition that negatively impacts a patient's health-related quality of life (HRQoL). Aim: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. Methods: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. Conclusion: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

RESUMO Racional: A doença hepática crônica está associada à desnutrição que afeta negativamente a qualidade de vida relacionada à saúde (QVRS). Objetivo: Avaliar o efeito da suplementação aguda de proteína do soro de leite na QVRS e no estado nutricional e funcional dos pacientes em lista de espera para o transplante hepático. Métodos: Ensaio clínico randomizado com pacientes à espera do transplante hepático que foram randomizados em dois grupos: PS (suplementação com proteína do soro de leite) e Controle (suplementação com caseína). Ambos os grupos receberam 40 g das proteínas (20 g pela manhã e 20 g à noite) por 15 dias. O estado nutricional e funcional foi avaliado. O balanço energético foi calculado como a diferença entre a ingestão energética (recordatório de 24 horas) e o gasto energético total (avaliado por calorimetria indireta). O questionário de doença hepática crônica (CDLQ) foi utilizado para avaliar a QVRS. Todas as medidas foram realizadas antes e após a intervenção. Resultados: Cinquenta e seis pacientes foram avaliados. A desnutrição esteve presente em 56,9% e, diretamente associada à baixa QVRS (p<0,05). A suplementação, com ambas as proteínas, não alterou o estado nutricional e funcional dos pacientes (p>0,05). Entretanto, a QVRS melhorou após a suplementação com PS e caseína, sem diferenças entre os grupos (p>0,05). Pacientes que alcançaram as necessidades proteicas e com balanço energético positivo tiveram maior escore de QVRS (4,9; p<0,05), sem diferenças entre os grupos (p>0,05). Conclusão: A desnutrição reduz substancialmente a QVRS. A suplementação aguda com PS ou caseína melhorou de forma similar a QVRS.

Malnutrition is associated with poor health-related quality of life in surgical patients with gastrointestinal cancer.

OBJECTIVE: The aim of this study was to evaluate the association between preoperative nutritional status and health-related quality of life (HRQoL) in patients with gastrointestinal cancer who were admitted for elective surgical treatment. METHODS: This was a cross-sectional study in which patients with a diagnosis of gastrointestinal cancer were evaluated before a surgical procedure. The nutritional assessment included subjective global assessment (SGA) and measurements of weight loss percentage, bioelectrical impedance, and functional capacity. HRQoL was evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Statistical analyses were performed with a significance level of 5%. The sample size was calculated based on a pilot study. RESULTS: We evaluated 132 patients, the majority of whom were men. The median age of the patients was 62 y, and the most prevalent tumors were in the colon, rectum, and anus (52.3%). The SGA highlighted the high prevalence of malnutrition (69.9%), which was confirmed by the rates of weight loss (73.8%) and the low fat-free mass index (56.8%). Malnourished patients and patients with severe weight loss had worse functional, symptom, global health and quality of life scores (P < 0.05). Malnutrition, according to the SGA, decreased physical function and role performance scores by 9 and 20 points, respectively (P < 0.05). CONCLUSION: Malnutrition, assessed by various tools, was associated with poor HRQoL of surgical patients with gastrointestinal cancer.

Hypometabolism as a potential risk factor for overweight and obesity in liver recipients.

OBJECTIVE: The aim of the present study was to identify whether overweight liver recipients are hypometabolic. METHODS: Liver transplantation (LT) recipients (n = 20), who were 18 to 65 y of age, had a body mass index (BMI) ≥25 kg/m2, and were 1 to 3 y post-transplant. They were matched with healthy controls in terms of sex, age, BMI, and body composition. Dietary intake data were collected using a 3-d food record. The individuals' daily activities were converted into metabolic equivalents. Resting energy expenditure (REE) was assessed in the morning after an overnight fast (12 h), by indirect calorimetry, using an open-circuit calorimeter. RESULTS: Total energy and macronutrient intakes were similar among liver recipients and controls. The majority of the individuals from both groups were sedentary (75%; n = 15/group). Patients who underwent LT showed lower REE (1449.15 ± 101.25 kcal) compared with the control group (1768.45 ± 86.94 kcal). Likewise, the ratio of REE to fat-free mass (FFM) was lower in the LT group (28.9 ± 1.7 kcal/ kg) than in the control group (32.9 ± 0.9 kcal/ kg; P < 0.05). The correlation between the FFM and the REE was strong in control participants (r = 0.73; P < 0.01), whereas it was moderate in the LT group (r = 0.45). CONCLUSION: The REE of overweight liver recipients is reduced and it might be a risk factor for excessive body weight gain in this population.

Development of enteral homemade diets for elderly persons receiving home care and analysis of macro and micronutrient composition / Desenvolvimento de dietas enterais semiartesanais para idosos em atenção domiciliar e análise da composição de macro e micronutrientes

Abstract Objective: the development and analysis of the macro and micronutrient composition of homemade enteral diets. Method: A standard homemade enteral diet was developed at three caloric concentrations - 1500, 1800 and 2100 Kcal. After preparation and testing of viscosity, stability, odor and color, plus evaluation of cost, the chemical composition of the nutrients of the diets were analytically determined. Folic acid, vitamin D and vitamin B12 values were calculated using chemical composition tables. The results were compared with recommended nutritional standards for the elderly. Result: The diets exhibited normal macronutrient distribution. The 1500 caloric level presented some mineral and vitamin deficiencies. Suitable values ​​were obtained at the other caloric levels for all minerals except magnesium. There were appropriate levels of all the vitamins in the 2100 Kcal diet, while vitamin E, D and B6 levels were below the recommended dietary allowances in the 1800 Kcal diet. Conclusion: The standard homemade enteral diets studied can contribute to the food and nutritional safety of elderly persons undergoing home care, if all are supplemented with magnesium and the 1800 Kcal diet is supplemented with vitamin E, D and B6. The 1500 Kcal diet was not nutritionally safe in terms of micronutrients. AU

Resumo Objetivo: Desenvolver e analisar a composição de macro e micronutrientes de dietas enterais semiartesanais para uso domiciliar. Método: Foi desenvolvida uma receita de dieta enteral semiartesanal padrão, com três concentrações calóricas, de 1500, 1800 e 2100 Kcal. Após o preparo e teste de viscosidade, estabilidade, odor, cor e custo as dietas tiveram a composição química de macro e micronutrientes analisada. O folato e vitamina D e B12 tiveram seus valores estimados por meio de tabelas de composição química. Os resultados encontrados foram comparados com as recomendações nutricionais para idosos. Resultado: As dietas apresentaram distribuição normal de macronutrientes. A dieta de 1500 Kcal apresentou diversas deficiências de minerais e vitaminas. Nos demais níveis calóricos, obteve-se valores adequados para todos os minerais exceto o magnésio. As vitaminas estavam todas adequadas no nível calórico de 2100 Kcal e no de 1800 Kcal, a vitamina E, D e B6 não alcançaram as recomendações dietéticas diárias. Conclusão: A dietas padrões desenvolvidas podem contribuir para segurança alimentar e nutricional de idosos em terapia nutricional domiciliar, desde que todas suplementadas com magnésio, e a de 1800 Kcal com vitamina E, D e B6. A fórmula de 1500 Kcal não se mostrou segura nutricionalmente no que tange aos micronutrientes. AU

Sala de espera: diálogo entre extensão universitária e educação alimentar e nutricional com pacientes pré e pós-transplante hepático / Waiting room: dialogue between university extension and food and nutritional education with patients pre- and post-liver transplantation

Introdução: A Educação Alimentar e Nutricional (EAN) deve estar inserida em diversos setores públicos, dentre esses a Sala de Espera, que consiste em área física com pessoas que aguardam atendimento profissional. Esse espaço pode ser utilizado para ajudar pacientes e familiares, em situações que exijam maior atenção de cuidados de saúde, incluindo a nutrição. Pacientes candidatos ou já submetidos ao transplante hepático são grupo vulnerável que deve compreender o tratamento e aprender a manejar os cuidados necessários por toda a vida, especialmente os dietéticos. Método: Estudo descritivo com abordagem quanti-qualitativa, cujas atividades desenvolvidas consistiram em oficinas com diferentes temáticas. O público-alvo foi de pacientes candidatos ou já submetidos ao transplante hepático e que aguardavam atendimento médico na Sala de Espera. A efetividade das oficinas foi avaliada por meio de testes de conhecimento pré e pós-oficina, utilizando-se o teste t Student para verificar a média de acertos obtidos antes e após as oficinas, considerando-se 5% como valor de significância. Ademais, foram analisados comentários e sugestões deixadas pelos participantes de forma a avaliar as representações dos pacientes em relação às oficinas. Resultados: A amostra foi composta por 62 pacientes (23 pré-transplante e 39 pós-transplante hepático). A idade média foi 45,7 anos, sendo 32 pacientes do sexo masculino e 30 do sexo feminino. Verificou-se que, após as oficinas, os participantes, tanto pré como póstransplante, tiveram melhor desempenho nos testes de conhecimento (p<0,05). Conclusões: A Sala de Espera revelou-se como espaço de construção de conhecimento, compartilhamento de experiências, sentimentos, dúvidas e socialização dos saberes técnico-científico e popular.

Introduction: The Food and Nutrition Education must be inserted in various public sectors, among others, the Waiting Room, consisting of physical area with people waiting for a professional service. This space can be used to help patients and families, in situations that require greater attention to health care, including nutrition. Patient candidates or already undergoing liver transplantation are vulnerable group that should understand the treatment and learn how to handle the necessary care for life, especially dietary. Methods: A descriptive study with quantitative and qualitative approach developed whose activities consisted of workshops with different themes. The audience was patient candidates or already undergoing liver transplantation and waiting for medical care in the Waiting Room. The effectiveness of the workshops was assessed by pre-and post-workshop knowledge tests, using the student t test to verify the mean score obtained before and after the workshops, considering 5% significance level. In addition, we analyzed comments and suggestions left by participants to assess the representations of patients in relation to the workshops. Results: The sample consisted of 62 patients (23 pre-transplant and 39 post-liver transplantation). The mean age was 45.7 years, 32 male and 30 females. It was found that after the workshops, participants from both pre-and post-transplant showed better performance in the knowledge tests (p<0.05). Conclusions: The Waiting Room proved as a space to build knowledge, share experiences, feelings, doubts, and socialization of scientific-technical and popular knowledge.

Effect of Conjugated Linoleic Acid-enriched Butter After 24 hours of Intestinal Mucositis Induction.

Mucositis is the most common side effect due to chemotherapy or radiotherapy. It refers to the inflammation of intestinal mucous membranes, and it is associated with complications such as diarrhea, weight loss, and increased intestinal permeability (IP). This study was designed to evaluate the effect of diet containing conjugated linoleic acid (CLA)-enriched butter on intestinal damage and inflammatory response after 24 h of 5-fluorouracil (5-FU)-induced mucositis. Mice were divided into four groups: CTL; CLA; 5-FU, and CLA 5-FU, and they were fed for 31 days. On the 30th experimental day, mucositis was induced by unique injection of 300 mg/kg of 5-FU. After 24 h (31st experimental day), IP was evaluated; ileum and fecal material were collected to determine cytokine level and myeloperoxidase (MPO) activity and secretory immunoglobulin A (sIgA). The 5-FU group showed an increase in IP and MPO activity (CTL vs. 5-FU: P < 0.05). Additionally, increased levels of IP and MPO were observed in CLA 5-FU group compared to those in the test groups (P < 0.05). Animals in the CLA 5-FU group showed reduced concentrations of sIgA (CTL vs. CLA 5-FU: P < 0.05). CLA-enriched butter exacerbating the 5-FU-induced intestinal damage. Safety concerns regarding the use of CLA require further investigation.

Osmolality and pH in handmade enteral diets used in domiciliary enteral nutritional therapy

Patients who need prolonged domiciliary enteral nutritional therapy may benefit from handmade diets. However, the preparation of such diets might cause insecurity with regard to their nutritional composition and physical-chemical properties. Current study analyzes the osmolality and Hydrogen-Ion concentration (pH) on handmade enteral diets. To this purpose, six formulas and two juices, prescribed on discharge from hospital, were analyzed physically and chemically. Osmolality and pH were respectively determined by cryoscopy and potentiometry. Most formulations were classified as isosmolar (with less than 400 mOsm/kg solvent), and only one was classified as slightly hyperosmolar, with rates ranging from 356.7 to 403.5 mOsm/kg solvent. On average, the standard formula presented higher osmolality than similar ones prepared for hyperglycemia. Among the juices, only one registered hyperosmolar concentration of 595.54 mOsm/kg solvent. All formulas presented pH rates classified as low acidity, ranging between 6.1 and 6.6, while the two juices had the lowest results, 4.73 and 4.66 each. The blend of ingredients used in handmade formulas and juices studied presented acceptable osmolality and pH rates for a safe administration and absence of gastrointestinal complications. Data showed here are consistent with an appropriate and healthy diet and contributed towards success in domiciliary enteral nutritional therapy.

Fiber, prebiotics, and diarrhea: what, why, when and how.

PURPOSE OF REVIEW: Dietary fiber and prebiotics have been the focus of research and discussion for decades, but there are still pending concepts and definitions, in particular when addressing their use in the prevention and treatment of diarrhea. The purpose of this review is to present the latest advances in the understanding of dietary fiber and prebiotics, to review their proven role in the management of diarrhea, and to postulate the best timings and optimal doses. RECENT FINDINGS: The use of prebiotics has encompassed not only prevention but also the treatment of distinct types of diarrhea, at different treatment moments, and with regard to various different markers of outcome. Furthermore, the description of soluble fibers claiming to be prebiotics, and vice versa, has too often been the tone in the literature, which has led to misconceptions in classification and, consequently, confusion over the interpretation of results. It remains difficult to establish a consensus about the real impact of fiber and prebiotics on the prevention and therapy of diarrhea. SUMMARY: The review highlights the overlapping concepts of fiber and prebiotics, and supports the need for adequate individualization of their use, according to the goal - either prevention or treatment of diarrhea - as well as the optimal timing and dose to be used. Nonetheless, viscous soluble fibers seem to be the best option in treating diarrhea, whereas prebiotics are more important in preventing and avoiding recurrence.

Pretreatment With L-Citrulline Positively Affects the Mucosal Architecture and Permeability of the Small Intestine in a Murine Mucositis Model.

BACKGROUND: Mucositis is a common complication in patients undergoing radiotherapy and chemotherapy. It is associated with pain, poor quality of life, and malnutrition, leading to an increased number of hospital admissions and prolonged hospitalization. The use of immunonutrients may be an alternative treatment option, which may help to improve patient outcome. OBJECTIVE: Here we assessed the impact of L-citrulline (CIT) on a murine model of 5-fluorouracil (5FU)-induced mucositis. METHODS: Swiss male mice were randomized into 4 groups: control, CIT, 5FU, and 5FU+CIT. Mice were fed with commercial chow and supplemented with an oral solution of alanine (control and 5FU groups) or CIT (CIT and 5FU+CIT groups). On the seventh day, mice received intraperitoneal phosphate-buffered saline or 5FU (200 mg/kg, single dose) to induce mucositis. On the 10th day, mice were euthanized, and the blood and small intestines were harvested. Body weight, morphology, histopathology score (hematoxylin and eosin) of the small intestine (from 0-12), myeloperoxidase activity, oxidative stress level, and intestinal permeability were assessed. RESULTS: We observed significant weight loss after the administration of 5FU in both treated and control animals. CIT administration contributed to a partial recovery of the mucosal architecture as well as an intermediate reduction of the histopathologic score, and functional intestinal permeability was partially rescued. CONCLUSIONS: CIT administration attenuated 5FU-mediated damage to the mucosal architecture of the small intestine, decreasing the size of the injured areas and promoting decreased intestinal permeability.

Functional status and heart rate variability in end-stage liver disease patients: association with nutritional status.

OBJECTIVES: Muscle dysfunction and reduced heart rate variability (HRV) are common in patients with advanced liver disease, and both are related to poor outcomes. Malnutrition is also highly prevalent in these patients, however, the association between the malnutrition and HRV has not yet been assessed. The aim of this study was to evaluate the short-term HRV, functional and nutritional statuses in patients with advanced liver disease. METHODS: The nutritional and functional statuses were determined by subjective global assessment, handgrip strength (dynamometer, JAMAR) and gait speed during a 6-minute walk text (6MWT), respectively. The cardiac workload index (CWI) was used to evaluate the cardiac response to the 6MWT. The time domain (SD of all normal-to-normal intervals [SDNN]) and very-low, low-, and high-frequency domains of short-term HRV were evaluated with RS800 CX (Polar, Finland) and Cardioseries software (Brazil). RESULTS: The study evaluated 42 patients with liver disease (62% men) and malnutrition was found in 62% of this population. The malnourished participants presented with reduced functional status, 41% decreased SDNN, and 14% greater CWI compared with well-nourished individuals (P < 0.05). Additionally, the CWI was negatively associated to SDNN (r = 0.414; P < 0.05) and gait speed (r = 0.598; P < 0.05), especially in malnourished individuals (r = 0.650; P < 0.05). These data indicate that malnourished patients with liver disease have higher cardiovascular risk related to reduced functional status, which may be associated to poor outcomes during the course of the disease before and after transplant. Another relevant aspect is that the 6MWT associated to HRV could be a useful tool to screen liver disease patients who have a higher risk for cardiovascular complications.

Dietary supplementation with omega-3 fatty acid attenuates 5-fluorouracil induced mucositis in mice.

BACKGROUND: Studies showed the positive effects of omega-3 fatty acid (n-3 FA) for the treatment of inflammatory bowel disease as it alleviated the symptoms and promoted better mucosal integrity. The objective of this study was to determine whether a diet with the addition of n-3 FA helps control the inflammation observed in 5-fluorouracil (5-FU) induced mucositis. METHODS: BALB/c mice were randomly divided into four groups as follows: 1: control (CTL), fed a standard chow diet; 2: CTL + n-3 FA - n-3 FA, fed a diet with n-3; 3: mucositis (MUC), fed a standard chow diet and subjected to mucositis; and 4: MUC+ n-3 FA, fed a diet with n-3 FA and subjected to mucositis. On the 8th day, the animals of the MUC and MUC + n-3 FA groups received an intraperitoneal injection of 300 mg/kg 5-FU for mucositis induction. After 24 h or 72 h, all mice were euthanized and evaluated for intestinal permeability, bacterial translocation, intestinal histology and apoptosis. RESULTS: Mice that received the diet with n-3 FA and a 5-FU injection showed less weight loss compared to the animals of the MUC group (p < 0.005). Decreased intestinal permeability and bacterial translocation were also observed in animals fed n-3 FA, and these mice underwent mucositis compared to the MUC group (p < 0.005). These data were associated with mucosal integrity and a reduced number of apoptotic cells in the ileum mucosa compared to the mice that received the control diet and 5-FU injection. CONCLUSION: Together, these results show that omega-3 fatty acid decreases the mucosal damage caused by 5-FU-induced mucositis.

The role of immunomodulators on intestinal barrier homeostasis in experimental models.

The intestinal epithelium is composed of specialized epithelial cells that form a physical and biochemical barrier to commensal and pathogenic microorganisms. However, dysregulation of the epithelial barrier function can lead to increased intestinal permeability and bacterial translocation across the intestinal mucosa, which contributes to local and systemic immune activation. The increase in these parameters is associated with inflammatory bowel disease, physical exercise under heat stress, intestinal obstruction, ischemia, and mucositis, among other conditions. Lately, there has been growing interest in immunomodulatory nutrients and probiotics that can regulate host immune and inflammatory responses and possibly restore the intestinal barrier. Immunomodulators such as amino acids (glutamine, arginine, tryptophan, and citrulline), fatty acids (short-chain and omega-3 fatty acids and conjugated linoleic acids), and probiotics (Bifidobacterium, Saccharomyces, and Lactobacillus) have been reported in the literature. Here, we review the critical roles of immunomodulatory nutrients in supporting gut barrier integrity and function.

Subjective global assessment: a reliable nutritional assessment tool to predict outcomes in critically ill patients.

BACKGROUND & AIMS: Nutritional assessment of critically ill patients has created controversy. However, it is well established that malnourished patients who are severely ill have worse outcomes than well-nourished patients. Therefore, assessing patients' nutritional status may be useful in predicting which patients may experience increased morbidity and mortality. METHOD: One hundred eighty-five consecutively admitted patients were followed until discharge or death, and their nutritional status was evaluated using Subjective Global Assessment (SGA) as well as anthropometric and laboratory methods. Agreement between the methods was measured using the Kappa coefficient. RESULTS: Malnutrition was highly prevalent (54%), according to SGA. Malnourished patients had significantly higher rates of readmission to the intensive care unit (ICU) (OR 2.27; CI 1.08-4.80) and mortality (OR 8.12; CI 2.94-22.42). The comparison of SGA with other tests used to assess nutritional status showed that the correlation between the methods ranged from poor to superficial. CONCLUSION: SGA, an inexpensive and quick nutritional assessment method conducted at the bedside, is a reliable tool for predicting outcomes in critically ill patients.

The role of L-arginine-nitric oxide pathway in bacterial translocation.

This study investigated the nitric oxide (NO) role as a mediator of arginine on bacterial translocation (BT) and gut damage in mice after intestinal obstruction (IO). The effects of pretreatment with arginine with or without NO inhibition on the systemic and local immunological response were also assessed. Mice were categorized into four groups. Group ARG received chow containing 2 % arginine, while group ARG + L-NAME received the same diet plus L-NAME (N-nitro-L-arginine methyl ester) by gavage. The IO and Sham groups were fed standard chow. After 7 days, animals were gavaged with radiolabeled Escherichia coli, anesthetized and subjected to IO, except the Sham group. Animals were euthanized after 18 h, and BT was evaluated in the mesenteric lymph nodes, blood, liver, spleen and lungs. In another experiment, the intestinal injury was assessed regarding intestinal permeability and ileum histological analyses. Intestinal secretory immunoglobulin A (sIgA) levels, serum IFN-γ and IL-10 cytokines were assessed. Arginine reduced BT, but NO inhibition enhanced BT compared with the ARG group (p < 0.05). Intestinal permeability in the ARG and ARG + L-NAME groups was similar but decreased when compared with the IO group (p < 0.05). Histological preservation was observed. Arginine treatment increased IL-10 and sIgA levels when compared with the Sham and IO groups (p < 0.05). The cytokines and sIgA concentrations were similar in the ARG + L-NAME and Sham groups. Arginine appeared to reduce BT and its effects on the modulation of cytokines and secretory IgA in mice after IO are mediated by NO production.