High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: Results of a Brazilian multicenter study.

BACKGROUND: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The objective of this study was to evaluate the prevalence of malnutrition across different age groups in patients with cancer in Brazil and to identify associations with nutrition impact symptoms (NIS). METHODS: In this observational, cross-sectional, multicenter study, the authors evaluated 4783 patients with cancer aged ≥20 years who were admitted to 45 public hospitals in Brazil. Nutritional status, nutritional risk, and NIS were evaluated using the Patient-Generated Subjective Global Assessment. RESULTS: More than one-fourth (25.5%) of all participants were aged ≥65 years. In patients aged ≥65 years, the prevalence of moderate/suspected and severe malnutrition was 55%, it was 45.4% in those aged 51 to 64 years, and it was 36.1% in those aged ≤50 years. Among the NIS with a higher risk of occurrence in patients aged ≥65 years were no appetite (odds ratio [OR], 1.90; 95% CI, 1.62-2.22; P < .05) and dry mouth (OR, 1.40; 95% CI, 1.1-1.67; P < .05). In patients between ages 51 and 64 years, compared with those aged ≤50 years, the NIS with a higher risk of occurrence were no appetite (OR, 1.45; 95% CI, 1.23-1.69; P < .05), dry mouth (OR, 1.22; 95% CI, 1.02-1.45; P < .05), and problems with swallowing (OR, 1.56; 95% CI, 1.25-1.96; P < .05). CONCLUSIONS: The prevalence of malnutrition and the occurrence of NIS are high in hospitalized Brazilian patients aged ≥65 years who have cancer. The occurrence of NIS was higher in the population aged >50 years than in those aged ≤50 years. Nutritional screening and assessment should be performed immediately after hospitalization to enable early diagnosis and multidisciplinary or interdisciplinary intervention(s).

Olive Oil, Palm Oil, and Hybrid Palm Oil Distinctly Modulate Liver Transcriptome and Induce NAFLD in Mice Fed a High-Fat Diet.

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. The most severe form is nonalcoholic steatohepatitis (NASH). Among risk factors for the development of NAFLD is excessive lipid intake. Since palm (P) oil is the most consumed oil in the world, we aimed to investigate the effects of high-fat diets made with P oil, hybrid palm (HP) oil, or olive (O) oil in liver. Twenty-four male mice (C57Bl/6J) were fed a high-fat diet (41% fat) containing P, HP, or O oils for 8 weeks and compared to a control (C) group fed a chow diet. Adiposity was measured with computed tomography. Body, adipose tissue, and liver weights, as well as liver fat (Bligh⁻Dyer), blood lipid profile, glucose, and liver enzymes were measured. Liver histology (hematoxylin⁻eosin) and transcriptome (microarray-based) were performed. ANOVA tests with Newman⁻Keuls were used. Body weight was increased in the P group (p < 0.001) and body fat in the O group (C vs. O p ≤ 0.01, P vs. O p ≤ 0.05, HP vs. O p ≤ 0.05). All high-fat diets disturbed the blood lipid profile and glucose, with marked effects of HP on very low-density lipoprotein cholesterol (VLDL), triglycerides, and alkaline phosphatase (p ≤ 0.001). HP had the highest liver fat (42.76 ± 1.58), followed by P (33.94 ± 1.13). O had a fat amount comparable to C (16.46 ± 0.34, 14.71 ± 0.70, respectively). P and HP oils induced hepatocyte ballooning. Transcriptome alterations of the O group were related to amino acid metabolism and fatty acid (FA) metabolism, the P group to calcium ion homeostasis, and HP oil to protein localization. Both P and HP oils induced NASH in mice via disturbed hepatocyte transcription. This raises concerns about the content of these oils in several industrialized foods.

Energy Expenditure in Critically Ill Elderly Patients: Indirect Calorimetry vs Predictive Equations.

BACKGROUND: Predictive equations (PEs) are used for estimating resting energy expenditure (REE) when the measurements obtained from indirect calorimetry (IC) are not available. This study evaluated the degree of agreement and the accuracy between the REE measured by IC (REE-IC) and REE estimated by PE (REE-PE) in mechanically ventilated elderly patients admitted to the intensive care unit (ICU). METHODS: REE-IC of 97 critically ill elderly patients was compared with REE-PE by 6 PEs: Harris and Benedict (HB) multiplied by the correction factor of 1.2; European Society for Clinical Nutrition and Metabolism (ESPEN) using the minimum (ESPENmi), average (ESPENme), and maximum (ESPENma) values; Mifflin-St Jeor; Ireton-Jones (IJ); Fredrix; and Lührmann. Degree of agreement between REE-PE and REE-IC was analyzed by the interclass correlation coefficient and the Bland-Altman test. The accuracy was calculated by the percentage of male and/or female patients whose REE-PE values differ by up to ±10% in relation to REE-IC. RESULTS: For both sexes, there was no difference for average REE-IC in kcal/kg when the values obtained with REE-PE by corrected HB and ESPENme were compared. A high level of agreement was demonstrated by corrected HB for both sexes, with greater accuracy for women. The best accuracy in the male group was obtained with the IJ equation but with a low level of agreement. CONCLUSIONS: The effectiveness of PEs is limited for estimating REE of critically ill elderly patients. Nonetheless, HB multiplied by a correction factor of 1.2 can be used until a specific PE for this group of patients is developed.

Hepatic, renal and inflammatory biomarkers are positively associated with blood pressure changes in healthy pregnant women: a prospective cohort.

This article evaluates the association of hepatic, renal, and inflammatory biomarkers with changes in systolic (SBP) and diastolic (DBP) blood pressure (BP) during healthy pregnancies.A prospective cohort study with 225 healthy pregnant women was conducted in Rio de Janeiro, Brazil. SBP and DBP were evaluated throughout pregnancy (5th-13th, 20th-26th, and 30th-36th gestational weeks) and were the outcomes. The following biomarkers were measured at the first trimester and analyzed according to tertiles of the sample distribution and were considered the main independent predictors: alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA), creatinine (Cr), and C-reactive protein (CRP) concentrations. The statistical analysis included 3 stages of modeling with the longitudinal linear mixed-effects procedures: Model 1 was adjusted for gestational age and quadratic gestational age; Model 2 included interactions between the biomarkers and gestational age; and Model 3 was adjusted for self-reported skin color, education, parity, early-pregnancy body mass index (BMI) (under/normal <25; overweight/obese ≥25 kg/m), smoking habit, and leisure-time physical activity. Additional models were performed for CRP and UA with the inclusion of interaction terms between the biomarkers and BMI.Women classified in the third tertile of the ALP (≥61.1 U/L; ßSBP = 3.474; 95% confidence interval [CI]: 0.955-5.992; ßDBP = 3.291; 95% CI: 1.098-5.485), ALT (≥14.3 U/L; ßSBP = 2.232; 95% CI: 0.221-4.242; ßDBP = 2.355; 95% CI: 0.721-3.989), and Cr values (≥48.6 µmol/L; ßDBP = 1.927; 95% CI: 0.347-3.508) presented higher BP levels during pregnancy compared to those in the first and second tertiles. Women in the highest tertile of the ALP concentration distribution presented a lower rate of change in SBP and DBP during pregnancy (interaction term with gestational age ßSBP = -0.004; 95% CI: -0.007 to -0.001; P = 0.02; ßDBP = -0.003; 95% CI: -0.006 to -0.001; P = 0.01). Higher UA concentrations were associated with higher SBP levels only in overweight/obese women (ß = 3.878; 95% CI: 0.687-7.068), whereas higher CRP concentrations (≥2.6 mg/L) were associated with higher DBP in under/normal weight women (ß =2.252; 95% CI: 0.267-4.236).ALP, ALT, and Cr concentrations were positively associated with BP levels, whereas ALP was associated with a lower rate of change in BP. The associations of UA and CRP with BP differ according to the early-pregnancy BMI.

Ethanol intake inhibits growth of the epithelium in the intestine of pregnant rats.

The effects of ethanol ingestion on jejunal and ileal epithelial cells were studied in pregnant rats by measuring crypt and villus cell population, crypt cell proliferation, and crypt cell cycle time as parameters. Timed-pregnancy female rats were fed a liquid diet containing either ethanol [designated as ethanol-fed group (EFG)] or an isocaloric amount of carbohydrate [designated as pair-fed group (PFG)] from gestational day 2 up to delivery. Daily diet ingestion, body weight, nitrogen balance, and nitrogen digestibility were assessed during the gestational period. Crypt and villus cell population, crypt cell proliferation, and crypt cell cycle time were measured in the maternal small intestine at the time animals were killed, just after delivery. Ethanol consumption resulted in ileal hypoplasia of the crypt and villus, but only the villus showed hypoplasia in the jejunum. In addition, crypt cell proliferation was markedly decreased, whereas crypt cell cycle time was longer, both in the jejunum and ileum of the EFG. Ethanol ingestion had no significant effect on body weight gain, nitrogen balance, and nitrogen digestibility. According to our expectations, the offspring from the EFG had significantly lower body weight. In conclusion, chronic ethanol ingestion during pregnancy inhibited the maternal intestinal epithelium growth, more extensively in the ileum.