Chemotherapy and Anticancer Drugs Adjustment in Obesity: A Narrative Review.

BACKGROUND: Obese individuals have higher rates of cancer incidence and cancer- related mortality. The worse chemotherapy outcomes observed in this subset of patients are multifactorial, including the altered physiology in obesity and its impact on pharmacokinetics, the possible increased risk of underdosing, and treatment-related toxicity. AIMS: The present review aimed to discuss recent data on physiology, providing just an overall perspective and pharmacokinetic alterations in obesity concerning chemotherapy. We also reviewed the controversies of dosing adjustment strategies in adult and pediatric patients, mainly addressing the use of actual total body weight and ideal body weight. METHODS: This narrative review tried to provide the best evidence to support antineoplastic drug dosing strategies in children, adolescents, and adults. RESULTS: Cardiovascular, hepatic, and renal alterations of obesity can affect the distribution, metabolism, and clearance of drugs. Anticancer drugs have a narrow therapeutic range, and variations in dosing may result in either toxicity or underdosing. Obese patients are underrepresented in clinical trials that focus on determining recommendations for chemotherapy dosing and administration in clinical practice. After considering associated comorbidities, the guidelines recommend that chemotherapy should be dosed according to body surface area (BSA) calculated with actual total body weight, not an estimate or ideal weight, especially when the intention of therapy is the cure. CONCLUSION: The actual total body weight dosing appears to be a better approach to dosing anticancer drugs in both adults and children when aiming for curative results, showing no difference in toxicity and no limitation in treatment outcomes compared to adjusted doses.

Prevalencia de sobrepeso y obesidad. Problema de salud en la comunidad universitaria y politécnica ecuatoriana / Prevalence of overweight and obesity. Health problem in the Ecuadorian university and polytechnic community

RESUMEN Objetivo: Analizar investigaciones relacionados con la prevalencia de bajo peso, sobrepeso y obesidad en el ámbito universitario para determinar los indicadores de la determinación de este problema de salud. Método: Revisión descriptiva, la búsqueda bibliográfica se realizó a partir de las bases de datos como Scielo, Dialnet, Lilacs, Scopus. PubMed y Portal Regional de la BVS. Que permitió seleccionar 33 artículos científicos. Resultados y conclusiónes: A partir de las investigaciones consultadas los investigadores determinar que, en la mayoría de estas, se da a conocer resultados sobre la prevalencia de obesidad y sobrepeso, sin tener en cuenta el bajo peso y normopeso. Además, en las investigaciones abordadas para determinar la prevalencia de la obesidad y sobrepeso, se realiza a partir del IMC con los datos de la talla y peso corporal de los sujetos investigados y factores los factores sociodemográficos de la población investigada.

ABSTRACT Objective: To analyze research related to the prevalence of underweight, overweight and obesity in the university setting in order to determine the indicators of the determination of this health problem. Method: Descriptive review, the bibliographic search was carried out using databases such as Scielo, Dialnet, Lilacs, Scopus. PubMed and Regional Portal of the VHL. Which allowed the selection of 33 scientific articles. Results and conclusions: From the researches consulted, the researchers determined that, in most of these, results on the prevalence of obesity and overweight are reported, without taking into account underweight and normal weight. In addition, in the researches approached to determine the prevalence of obesity and overweight, it is done from the BMI with the data of the height and body weight of the investigated subjects and the sociodemographic factors of the investigated population.

Current Medical Treatment for Alcohol-Associated Liver Disease.

Alcohol-associated liver disease is one of the main causes of chronic liver disease. It comprises a clinical-histologic spectrum of presentations, from steatosis, steatohepatitis, to different degrees of fibrosis, including cirrhosis and severe necroinflammatory disease, called alcohol-associated hepatitis. In this focused update, we aim to present specific therapeutic interventions and strategies for the management of alcohol-associated liver disease. Current evidence for management in all spectra of manifestations is derived from general chronic liver disease recommendations, but with a higher emphasis on abstinence and nutritional support. Abstinence should comprise the treatment of alcohol use disorder as well as withdrawal syndrome. Nutritional assessment should also consider the presence of sarcopenia and its clinical manifestation, frailty. The degree of compensation of the disease should be evaluated, and complications, actively sought. The most severe acute form of this disease is alcohol-associated hepatitis, which has high mortality and morbidity. Current treatment is based on corticosteroids that act by reducing immune activation and blocking cytotoxicity and inflammation pathways. Other aspects of treatment include preventing and treating hepatorenal syndrome as well as preventing infections although there is no clear evidence as to the benefit of probiotics and antibiotics in prophylaxis. Novel therapies for alcohol-associated hepatitis include metadoxine, interleukin-22 analogs, and interleukin-1-beta antagonists. Finally, granulocyte colony-stimulating factor, microbiota transplantation, and gut-liver axis modulation have shown promising results. We also discuss palliative care in advanced alcohol-associated liver disease.

Equations for calculating ideal body weight in patients on mechanical ventilation in adult intensive care units in Latin America: exploratory review / Ecuaciones para calcular el peso ideal en pacientes con ventilación mecánica en unidades de cuidado intensivo adulto en Latinoamérica: revisión exploratoria

Abstract Introduction Ideal body weight calculation is used in critical medicine for drug dosing and setting ventilation parameters. However, the suggested and used equations were designed on the basis of anthropometric variables that do not represent the Latin American population. Objective To map and present the current evidence on the equations used to calculate ideal weight in patients on mechanical ventilation in intensive care units in Latin America. Material and Methods Exploratory review using the Joanna Briggs Institute method conceived by Arskey / O'Malley. A search was performed in the BVS, LILLACS, REDALYC, Ovid, Google Scholar and Scielo databases using keywords and MeSH terms in Spanish, English, and Portuguese, with no time limitation. The results are presented in descriptive tables. Results Overall, 1126 studies were identified and 1120 were excluded; 6 studies were reviewed and 3 additional studies were identified through a manual search. The studies were published in Chile, Brazil, Mexico, Ecuador, and Peru. In 89%, the ARDS Network equation was used to calculate tidal volume. Acute respiratory distress syndrome was the most reported pathology (33%). Conclusions Adult intensive care units in Latin America use the equation suggested by the ARDS Network, which was designed in a population with different anthropometric characteristics.

Resumen Introducción El cálculo del peso ideal se utiliza en medicina crítica para dosificación de medicaciones y programación de parámetros ventilatorios; sin embargo, las ecuaciones sugeridas y usadas fueron diseñadas con variables antropométricas que no representan la población latinoamericana. Objetivo Mapear y presentar la evidencia actual de las ecuaciones utilizadas para calcular el peso ideal en pacientes con ventilación mecánica en unidades de cuidado intensivo de Latinoamérica. Material y métodos Revisión exploratoria con el método del Instituto Joanna Briggs concebido por Arskey y O'Malley. Se realizó una búsqueda en las bases de datos BVS, LILACS, Redalyc, Ovid, Google Scholar y SciELO con el uso de palabras clave y términos MeSH en idiomas español, inglés y portugués, sin límites de tiempo. Los resultados se presentan de forma descriptiva. Resultados Se identificaron 1.126 estudios, se excluyeron 1.120, se revisaron seis y se encontraron tres adicionales mediante búsqueda manual. Los estudios fueron publicados en Chile, Brasil, México, Ecuador y Perú. En el 89 % se usó la ecuación del ARDS Network para calcular volumen corriente. El síndrome de dificultad respiratoria aguda fue la patología más informada (33 %). Conclusiones En las unidades de cuidado intensivo adulto de Latinoamérica se usa la ecuación sugerida por el ARDS Network diseñada en población con características antropométricas diferentes.

Dataset for the estimation of a new body fat measurement method.

Due to the increasing prevalence of obesity and its negative consequences worldwide on public health, body composition analysis is a central pillar to assess the nutritional status. Scientists could use datasets to develop a new body fat measurement formula. Using bioelectrical impedance analysis, we analyzed the total body composition of 345 patients (234 men and 111 women) aged between 18 and 60 years residing in the metropolitan area of Barranquilla, Colombia. They have the potential for predictive formula analysis enhancing the cooperation among scientists. Due to the obesity pandemic, new datasets from other populations are needed to develop a body fat basic mathematical equation formula that could be used worldwide to determine the prevalence of overweight and obesity in a specific population group predisposed to develop metabolic syndrome or death, secondary to high cardiovascular risk.

Estimación del agua corporal total y del peso seco, usando impedancia bioeléctrica tetrapolar de multifrecuencia (BIA-4) en pacientes en hemodiálisis / Total body water and dry weight estimation by using multi-frequency tetrapolar bioelectrical impedance

Antecedentes. La medición del "peso seco" en pacientes renales se ha tornado difícil por el sinnúmero de variables que en él intervienen, dada la importancia de conocerlo por cuanto con él se determina el tratamiento diálitico, farmacólogico y nutricional se ha trabajado en diferentes ecuaciones y métodos para obtenerlo. Objetivo. Describir la composición corporal, el agua corporal total y el peso seco de pacientes con enfermedad renal en Hemodiálisis Materiales y Métodos. Se realizó un estudio descriptivo transversal en seis fases, desde el año 2001 al 2010. Con el método de BIA-1 Y BIA-4 (bioimpedancia de unifrecuencia y tetrapolar) y la ecuación Ramírez-Almanza. Para la determinación del peso seco se utilizaron los valores de normovolemia e hipervolemia y se utilizó un nuevo instrumento para diagnóstico nutricional VGS-MIS. Resultados. El 50% de los pacientes estudiados tenían un diagnóstico de Diabetes e Hipertensión, el 87% con riesgo leve de desnutrición, solo el 3% sin riesgo de desnutrición. El punto de cohorte de la Resistencia dada por la bioimpedancia de 550 permite determinar que pacientes con valores por debajo de éste son sintomáticos con una alta sensibilidad 73% y una especificidad de 50%. Para el agua total corporal es posible utilizar la ecuación Ramirez-Almanza pues tiene una buena correlacion mediana (0.76)con el índice de impedancia de Kushner. La VGS-MIS es el mejor método de valoración encontrada hasta ahora para paciente renal porque involucra diferentes parámetros físicos, nutricionales, clìnicos y bioquímicos. Conclusión. El uso de la Bioimpedancia en paciente en hemodiálisis ha permitido una mayor exactitud en el cálculo del agua corporal total, peso seco y estado nutricional de los pacientes en hemodiálisis.

Background. Dry weight assessment in renal patients has got difficult because of many variables which are taken into account to do it. Because it is used to determine the dialytic, pharmacological and nutritional treatment in such patients, it has worked on different equations and methods in order to obtain it. Objetive. To describe body composition, total body water and dry weight of patiens who suffer from renal disease and are under hemodialysis. Materials and methods. A transversal descriptive study was carried out by six phases from the year 2001 to 2010. It was used the Unifrequency Tetrapolar Bioimpedance (BIA-1), the Multifrequency Tetrapolar Bioimpedance (BIA-4) and the Ramírez-Almanza equation. Normovolemia and hipervolemia values were used to establish dry weight and a new instrument was used in nutritional diagnosis to global subjective valuation in renal patient under hemodialysis, the Malnutrition Inflammation Score (MIS). Results. 50% of the studied patients had a diabetes and hipertension diagnosis, 87% were in a low risk of desnutrition, just 3% without any risk of desnutrition. The Resistance cohort point given by the bioimpedance of 550 allows to determine who patients with values under of this are somatics with 73% a hight sensibility and a 50% specificity. To total water weight it is possible to use the Ramirez-Almanza equation due to it has a good mediana correlation (0.76) with the Kushner Impedance Index. VGS-MIS is the best assessment method used until know on renal patient because it involves different physic, nutritional, clinic and biochemic parameters. Conclusion. Bioimpedance use on patient under hemodialysis has led a higher precision in the total body water, dry weight and nutritional state in such patients.

Nutritional assessment of pregnant adolescents: comparison of two popular classification systems.

The objective of this study was to assess the degree of concordance between two popular classification systems [the Centers for Disease Control and Prevention (CDC)-2000 and the Institute of Medicine (IOM)-2009] used to categorise the nutritional status of pregnant adolescents. This cross-sectional study involved 327 pregnant adolescents (10-19 years) booking for antenatal care at a single public maternity in São Paulo, Brazil. Participants were classified into one of four categories, by both systems according to their pre-pregnancy body mass index and age. The CDC-2000 system classified significantly fewer pregnant adolescents as underweight (3.7% vs. 12.5%, P < 0.0001) and significantly more adolescents as normal-weight (86.8% vs. 75.6%, P = 0.0003) than the IOM-2009 system. The distribution of the adolescents in the two systems differed significantly. The global rate of discordance was 13.5%. The overall concordance between the two systems was marginally good (K = 0.63), being moderate for younger (<16 years) adolescents (K = 0.52). Approximately one in every seven pregnant adolescent would be classified in a non-corresponding category if the IOM-2009 classification was used instead of the CDC-2000 classification. The IOM-2009 nutritional classification, which does not take into account age and gender, tends to overestimate the proportion of underweight adolescents, especially in the younger-age group. The use of this classification system can lead to recommendations of higher gestational weight gain in a substantial proportion of pregnant adolescents, which could predispose to post-partum weight retention and future obesity.