RESUMO
Resumen: Introducción: La caquexia es un síndrome asociado al cáncer avanzado, VIH, pacientes en quimioterapia y quienes tienen seguimiento en cuidados paliativos. La prevalencia es de 25% de los pacientes con diagnóstico de cáncer, 26% en quienes reciben quimioterapia y de 14 a 38% de pacientes con VIH. Un pilar para el manejo es el cannabis debido al efecto del delta-9-tetrahidrocanabinol (THC), del cual se derivó el dronabinol, un fármaco desarrollado para estimular apetito y ganancia de peso. El objetivo de esta revisión bibliográfica es obtener la información sobre los cannabinoides y la evidencia más sólida existente con respecto al uso del dronabinol en pacientes que han presentado pérdida de peso y apetito. Material y métodos: Revisión de la bibliografía con buscador PubMed con las palabras clave Palliative care (cuidados paliativos), Cannabinoids (cannabinoides), cachexia (caquexia), Dronabinol (dronabinol), Appetite (apetito), de 1990 a 2018, limitado a humanos, obteniendo 259 artículos, eliminando 222 por repetirse o tener poca relevancia, dejando 37 artículos para análisis. Resultados: De 37 artículos revisados, nueve fueron estudios experimentales, 10 revisiones sistematizadas, un metaanálisis y 16 artículos de recomendaciones y sugerencias de manejo. Conclusión: El manejo del apetito y pérdida de peso en pacientes en cuidados paliativos, VIH, ancianos o en quimioterapia debe ser multidisciplinario, involucrando nutriólogos, psicólogos y médicos, ajustando el manejo a las características individuales que manifiesten. El dronabinol es un fármaco de primera elección para el manejo de dichos síntomas cuando la historia natural de la enfermedad se acompaña de náusea, vómito o dolor.
Abstract: Introduction: Cachexia is a syndrome associated with advanced cancer, HIV, patients on chemotherapy and those who are followed in palliative care. The prevalence is 25% of patients diagnosed with cancer, 26% in those receiving chemotherapy and 14 to 38% of patients with HIV. A mainstay for management is cannabis, due to the effect of delta-9-tetrahydrocannabinol (THC) from which dronabinol, a drug developed to stimulate appetite and weight gain, was derived. The aim of this literature review is to obtain information on cannabinoids and the strongest existing evidence regarding the use of dronabinol in patients who have presented weight and appetite loss. Material and methods: Literature review with PubMed search engine with the keywords Palliative care, Cannabinoids, cachexia, Dronabinol, Appetite, from 1990 to 2018, limited to humans, obtaining 259 articles, eliminating 222 for repetition or low relevance, leaving 37 articles for analysis. Results: Out of 37 articles reviewed 9 were experimental studies, 10 systematized reviews, 1 meta-analysis and 16 articles of recommendations and management suggestions. Conclusion: The management of appetite and weight loss in palliative care, HIV, elderly or chemotherapy patients should be multidisciplinary, involving nutritionists, psychologists and physicians, adjusting the management to the individual characteristics manifested. Dronabinol is a drug of first choice for the management of these symptoms when the natural history of the disease is accompanied by nausea, vomiting or pain.
RESUMO
BACKGROUND: The effects of non-nutritive sweeteners (NNS) on glucose metabolism and appetite regulating hormones are not clear. There is an ongoing debate concerning NNS use and deleterious changes in metabolism. OBJECTIVES: The aim of this review is to analyze the scientific available evidence regarding the effects of NNS on glucose metabolism and appetite regulating hormones. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA: We identified human observational studies evaluating the relation between NNS consumption and obesity, diabetes, and metabolic syndrome, in addition to clinical trials evaluating the effects of NNS in glucose metabolism and appetite regulating hormones. RESULTS: Fourteen observational studies evaluating the association between NNS consumption and the development of metabolic diseases and twenty-eight clinical trials studying the effects of NNS on metabolism were included. Finally, two meta-analyses evaluating the association between the consumption of NNS-containing beverages and the development of type 2 diabetes were identified. CONCLUSIONS: Some observational studies suggest an association between NNS consumption and development of metabolic diseases; however, adiposity is a confounder frequently found in observational studies. The effects of the NNS on glucose metabolism are not clear. The results of the identified clinical trials are contradictory and are not comparable because of the major existing differences between them. Studies evaluating specific NNS, with an adequate sample size, including a homogeneous study group, identifying significant comorbidities, with an appropriate control group, with an appropriate exposure time, and considering adjustment for confounder variables such as adiposity are needed.
