Cancer patients with COVID-19: does prior nutritional risk associated with cancer indicate a poor prognosis for COVID-19?

OBJECTIVE: To verify whether the presence of related nutritional risk indicators prior to COVID-19 diagnosis is associated with poor survival in patients with cancer. METHODS: We retrospectively analyzed the data of hospitalized cancer patients who tested positive for COVID-19 between March 2020 and February 2021. Nutritional risk was defined as the presence of one of the following characteristics: body mass index <20kg/m 2 , scored Patient-generated Subjective Global Assessment ≥9 points or classification B, albumin level <3.5g/dL, and C-reactive protein level ≥10mg/L, evaluated between 7 and 60 days prior to the date of patient inclusion. The endpoint measure was all-cause mortality within 30 days of COVID-19 diagnosis. RESULTS: A total of 253 patients were included, most of whom were elderly (62.4%) and female (63.6%). Overall, 45.4% of the patients were at nutritional risk. Survival was significantly lower in patients at nutritional risk (8 days; interquartile range [IQR]: 3-29) than in patients not at nutritional risk (16 days; IQR: 6-30) (p<0.001). The presence of prior nutritional risk was associated with increased 30-day mortality (HR: 1.42; 95%CI: 1.03-1.94), regardless of age, gender, tumor site or stage, and other risk factors, and the model had good discrimination accuracy (concordance statistic: 0.744). CONCLUSION: The presence of prior nutritional risk indicators is related to poor prognosis in patients with cancer and COVID-19, emphasizing the importance of nutritional care, notably during this pandemic.

Cancer patients with COVID-19: does prior nutritional risk associated with cancer indicate a poor prognosis for COVID-19?

ABSTRACT Objective To verify whether the presence of related nutritional risk indicators prior to COVID-19 diagnosis is associated with poor survival in patients with cancer. Methods We retrospectively analyzed the data of hospitalized cancer patients who tested positive for COVID-19 between March 2020 and February 2021. Nutritional risk was defined as the presence of one of the following characteristics: body mass index <20kg/m 2 , scored Patient-generated Subjective Global Assessment ≥9 points or classification B, albumin level <3.5g/dL, and C-reactive protein level ≥10mg/L, evaluated between 7 and 60 days prior to the date of patient inclusion. The endpoint measure was all-cause mortality within 30 days of COVID-19 diagnosis. Results A total of 253 patients were included, most of whom were elderly (62.4%) and female (63.6%). Overall, 45.4% of the patients were at nutritional risk. Survival was significantly lower in patients at nutritional risk (8 days; interquartile range [IQR]: 3-29) than in patients not at nutritional risk (16 days; IQR: 6-30) (p<0.001). The presence of prior nutritional risk was associated with increased 30-day mortality (HR: 1.42; 95%CI: 1.03-1.94), regardless of age, gender, tumor site or stage, and other risk factors, and the model had good discrimination accuracy (concordance statistic: 0.744). Conclusion The presence of prior nutritional risk indicators is related to poor prognosis in patients with cancer and COVID-19, emphasizing the importance of nutritional care, notably during this pandemic.

Association of the MC4R rs17782313 polymorphism with plasma ghrelin, leptin, IL6 and TNFα concentrations, food intake and eating behaviors in morbidly obese women.

PURPOSE: The rs17782313 variant of the MC4R gene plays an important role in the obesity phenotype. Studies that evaluate environmental factors and genetic variants associated with obesity may represent a great advance in understanding the development of this disease. This work seeks to assess the association of the polymorphism of MC4R rs17782313 on plasma parameters, including leptin, ghrelin, tumor necrosis factor (TNFα) and interleukin 6 (IL6), and on the eating behaviors of morbidly obese women. METHODS: 70 adult women with BMI between 40 and 60 kg/m2 were recruited. Laboratory and anthropometric data were recorded. Using a visual analog scale (VAS), the feelings of hunger and satiety were evaluated. The presence or absence of binge eating was evaluated through the Binge Eating Scale (BES) questionnaire. Habitual food intake was analyzed using 3-day dietary records. TaqMan® assays were conducted using real-time PCR to assess genotype polymorphism variants from peripheral blood DNA. RESULTS: This study found that female patients with the MC4R rs17782313 polymorphism had high levels of ghrelin and reduced levels of IL6 in the postprandial period. We observed a higher prevalence of severe binge eating in more than 50% of women with at least one risk allele. CONCLUSION: Our hypothesis is that the MC4R rs17782313 polymorphism may influence the release of ghrelin, even without being associated with feelings of hunger and satiety. More than half of women with this polymorphism exhibited severe binge eating. LEVEL OF EVIDENCE: Level III: case-control analytic study.

Modified Nutrition Risk in the Critically ill (mNUTRIC Score) as prognostic marker in critically ill cancer patients

Objetivo: Relacionar o NUTRIC score modificado com os desfechos clínicos de pacientes oncológicos críticos. Métodos: Estudo prospectivo observacional, onde os pacientes foram acompanhados por 28 dias após a admissão na Unidade de Terapia Intensiva (UTI). Os dados foram coletados em prontuário físico e/ou eletrônico e o mNUTRIC score foi realizado em até 48 horas da admissão na UTI. A correlação de Spearman e a regressão logística univariada e multivariada foram utilizadas correlacionando os desfechos clínicos de interesse. Resultados: Trinta e cinco pacientes foram incluídos no estudo. Destes, 62,9% apresentavam alto risco nutricional. Pacientes que obtiveram pontuação mais alta no mNUTRIC score tinham idade mais avançada, pior Performance Status, Proteína C-Reativa maior, maior necessidade de instalação de VM e internação na UTI mais prolongada. Houve correlação forte entre o mNUTRIC score e utilização de ventilação mecânica (VM). O modelo de regressão logística multivariada demonstrou que pacientes com alto risco nutricional apresentavam 97,54 vezes mais chance de utilização de VM do que aqueles com baixo risco nutricional. Conclusão: O mNUTRIC score foi efetivo como preditor de utilização de VM e maior tempo de internação na UTI. Este instrumento demonstrou viabilidade para utilização e identificação inicial dos pacientes oncológicos críticos que necessitam de intervenção nutricional precoce.

Purpose: To relate modified nutritional risk in the critically ill (mNUTRIC score) with the clinical outcomes of critically ill cancer patients. Methods: A prospective observational study, in which they were followed up for 28 days after admission to the Intensive Care Unit (ICU). Data were collected in physical and/or electronic medical records and the mNUTRIC score was performed within 48 hours of admission to the ICU. Spearman's correlation and univariate and multivariate logistic regression were applied by correlating the clinical outcomes of interest. Results: Thirty-five patients were included in the study. Of these, 62.9% presented high nutritional risk. Patients who scored higher on the mNUTRIC score were older, worse Performance Status, higher C-Reactive Protein, greater need for MV installation and longer ICU stay. There was a strong correlation between the mNUTRIC score and the use of mechanical ventilation (MV). The multivariate logistic regression model showed that patients with nutritional risk were 97.54 times more likely to use MV. Conclusion: The mNUTRIC score was effective as a predictor of MV use and longer ICU stay. This instrument demonstrated viability for the initial use and identification of these patients who require early nutritional intervention.

Influence of FTO rs9939609 polymorphism on appetite, ghrelin, leptin, IL6, TNFα levels, and food intake of women with morbid obesity.

BACKGROUND: The fat mass and obesity-related (FTO) gene has a strong relationship with obesity, extreme obesity and inflammatory state, and may also be associated with food intake regulation. OBJECTIVE: The aim of the present study was to evaluate the influence of the rs9939609 single-nucleotide polymorphism of the FTO gene on appetite, ghrelin, leptin, interleukin 6 (IL6), tumor necrosis factor α (TNFα) levels and food intake of morbidly obese women. MATERIALS AND METHODS: The study comprised 70 women, aged between 20 and 48 years, from Rio de Janeiro, Brazil. The participants were selected according to the body mass index between 40 and 60 kg/m2. Anthropometric and biochemical data were measured during fasting. Hormones and inflammatory data were measured before and after the participants ate an isocaloric meal. Dietary records were calculated and analyzed using a nutritional assessment program. Visual analog scales were used for behaviors of the sensations of appetite and food preferences. The FTO rs9939609 variant was genotyped using real-time polymerase chain reaction. RESULTS: Participants with the AA genotype had lower values of ghrelin and IL6 and higher values of leptin than those with TT and TA in the postprandial period. Comparing the plasma concentrations of ghrelin, insulin, IL6 and TNFα intragenotypes, it was observed that those with TT had decreased leptin and increased IL6 at the postprandial period. Subjects with TA showed increased postprandial IL6, and those with AA had decreased postprandial ghrelin. There was no difference in TNFα intra- and intergenotypes. The postprandial sensations of hunger were lower in AA than those with TT. There were differences between genotypes regarding ingested grams of protein by weight, cholesterol, B3, B5, B6 and B12 vitamins, and selenium potassium and sodium minerals. CONCLUSION: These findings suggest that genetics may exert an influence on physiologic factors and might alter eating behavior.

Manejo Nutricional em Paciente com Metástase Gástrica de Câncer de Mama: um Relato de Caso / Nutritional Management in a Patient with Breast Cancer Metastasis to the Stomach: a Case Report / Manejo Nutricional en Paciente con Metástasis Gástrica del Cáncer de Mama: un Informe de Caso

Introdução: O surgimento de metástase gástrica oriunda de neoplasia da mama é raro. Entretanto, o suporte nutricional nesses casos é imprescindível, já que tumores gástricos estão relacionados a complicações nutricionais, favorecendo desfechos clínicos negativos. Relato do caso: Paciente com diagnóstico de adenocarcinoma de mama, com progressão para ossos, ovário e estômago, internada em razão das complicações clínicas. Apresentou perda de peso grave durante a internação, além de diagnóstico de risco de desnutrição pela avaliação subjetiva global produzida pelo paciente. Em virtude do quadro de odinofagia severa, a alimentação via oral tornou-se impossibilitada, sendo optado pelo uso de sonda nasoentérica após discussão com equipe interdisciplinar. Conclusão: A terapia nutricional em pacientes com câncer avançado ainda é um dilema entre os profissionais e sua execução deve ser discutida e decidida por uma equipe interdisciplinar, com participação indispensável do nutricionista, do paciente e de seus familiares. Para isso, os serviços de saúde devem estar preparados para o correto manejo da conduta nutricional, a fim de promover qualidade de vida para esses pacientes.

Introduction: It is uncommon for breast cancer to metastasize to the stomach. However, when it does occur, nutritional support is indispensable, because gastric tumors are associated with nutritional complications, which worsen clinical outcomes. Case report: We report the case of a female patient diagnosed with breast adenocarcinoma that had metastasized to the bones, ovary, and stomach, who was hospitalized because of clinical complications. During hospitalization, she presented severe weight loss and was classified as being at nutritional risk, as determined by the Patient-Generated Subjective Global Assessment. Due to severe odynophagia, oral intake was not possible. Therefore, after consultation with the multidisciplinary team, the decision was made to insert a nasogastric tube. Conclusion: Nutritional therapy in patients with advanced cancer still constitutes a dilemma facing professionals and needs to be discussed by a multidisciplinary team, the participation of the nutritionist, patient, and family being indispensable. Therefore, health care services must be prepared to manage nutritional therapy correctly, in order to promote better quality of life for such patients.

Introducción: El surgimiento de metástasis gástrica proveniente de neoplasia de mama es raro. Sin embargo, el soporte nutricional en estos casos es imprescindible, ya que los tumores gástricos están relacionados a complicaciones nutricionales, favoreciendo los resultados clínicos negativos. Informe de caso: Paciente con diagnóstico de adenocarcinoma de mama, con progresión para huesos, ovario y estómago, internada debido a complicaciones clínicas. Se presentó una pérdida de peso grave durante la internación, además de diagnóstico de riesgo de desnutrición por la evaluación subjetiva global producida por el paciente. Debido a un cuadro de odinofagia severa, la alimentación oral se volvió imposibilitada, siendo optado por el uso de sonda nasoentérica después de la discusión con el equipo interdisciplinario. Conclusión: La terapia nutricional en pacientes con cáncer avanzado sigue siendo un dilema entre los profesionales y su ejecución debe ser discutida y decidida por un equipo interdisciplinario, con participación indispensable del nutricionista, del paciente y de sus familiares. Para ello, los servicios de salud deben estar preparados para el correcto manejo de la co