International Journal of Nutrology

Scientific evidence of teduglutide in parenteral support in patients with short bowel syndrome: a systematic review

Lucila Maria de Almeida Lopes — 2025-04-28

Introduction: Short bowel syndrome (SBS) is a heterogeneous condition in which patients suffer from impaired intestinal absorption due to absolute loss of the intestine. Approximately 75% of SBS cases develop after a single massive bowel resection. Patients with SBS with intestinal failure (II) [SBS-II] experience decreased quality of life and increased morbidity and mortality due to their dependence on parenteral support (PS). Teduglutide is a degradation-resistant peptide 2 (GLP-2) analog that increases the functional and structural capacity of the intestine. Objective: To analyze the scientific evidence for teduglutide in parenteral support in patients with short bowel syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to August 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 91 articles were found. 29 articles were fully evaluated and 07 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=82.7%>50%. It was concluded that teduglutide can restore intestinal structural and functional integrity, promote mucosal growth, reduce gastric emptying and secretion, and increase nutrient absorption and enteral independence from parenteral nutrition. The 24-week treatment time with teduglutide was generally well tolerated in patients with short bowel syndrome with intestinal failure. The clinical studies showed that teduglutide treatment reduced the volumes and number of days of parenteral support for patients with short bowel syndrome with intestinal failure.

Clinical outcomes and guidelines for nutrological therapy and palliative medicine in cancer patients: a systematic review

Ricardo de Oliveira Carvalho — 2025-04-28

Introduction: Nutritional support for cancer patients in palliative care is still a controversial topic. Dietary counseling, providing nutritional support, and alleviating diet-related issues should be an essential components of a holistic approach to palliative and end-of-life care. Objective: It was to carry out a systematic review to explore and discuss the main approaches to nutritional therapy in palliative care in cancer patients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 141 articles were found. A total of 46 articles were evaluated in full and 21 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 28 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=84.5%>50%. It was concluded that the use of the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to assist in clinical decision-making regarding the indication of enteral nutrition in patients with incurable cancer undergoing palliative care. There are not enough quality studies that provide evidence of the improvement in health status and quality of life when using enteral nutrition through NGT in patients receiving palliative care. For this reason, decision-making in this field must be carried out on an individual basis, weighing up the benefits and harms that can be caused to patients' quality of life. The guidelines recommend that, if oral food intake remains inadequate despite counseling and oral nutritional supplements, enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition (supplemental or total) should be considered.

Nutrological and pharmacological therapy in patients with neoplasms and cachexia: a systematic review

Karlla Gabrielly Claudino Santos — 2025-04-28

Introduction: Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by continuous loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. Cancer cachexia is associated with low tolerance to antitumor treatments, reduced quality of life, and a negative impact on survival. Unintentional weight loss has been associated with a negative impact on multiple outcomes in cancer patients, including survival and quality of life. Objective: It was to present the main evidence of nutritional and pharmacological therapy for cachectic cancer patients through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 105 articles were found. 51 articles were assessed and 14 were included in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 11 studies with a high risk of bias and 22 studies that did not meet the GRADE criteria. It was concluded that the nutritional consequences of cancer treatments should be identified early with screening and assessment of nutritional status. Nutritional intervention includes screening and appropriate nutritional assessment, which should begin early in the course of the disease to reduce or delay negative effects on therapy and quality of life. Liquid nutritional supplements may be useful to help increase caloric intake. Numerous investigations have reported orexigenic activity associated with progestational agents, such as megestrol acetate and medroxyprogesterone. Megestrol acetate has received the most attention in randomized clinical trials of cancer patients. The use of corticosteroids and mirtazapine for weight gain and pain control was also highlighted. Enteral immunonutrition is an effective nutritional intervention that improves immune function in patients undergoing gastric cancer surgery.

Relationship among nutrients, gut microbiota, and microRNAs for healthy weight loss: a systematic review

Luiz Gustavo Brandão de Proença — 2025-04-22

Introduction: In the context of chronic noncommunicable diseases, obesity represents a pandemic represented as a long-term chronic imbalance between calorie intake and energy expenditure, resulting in more than 2.0 billion overweight and obese people worldwide. Objective: It was to present the major considerations and results of clinical studies on the relationship between nutrients, gut microbiota, and microRNAs for healthy weight loss through a systematic review. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 142 articles were found, and 35 articles were evaluated in full and 28 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=72.4%>50%. It was concluded that diet is a determining factor for a healthy colonization of the gut microbiota. Adipose tissue hypertrophy causes metabolic and hemodynamic disorders through the production of several adipokines that play a role in the genesis of insulin resistance and atherosclerosis. Studies in humans with obesity have also found a lower proportion of Bacteroidetes compared to eutrophic individuals. Furthermore, when they lose weight, the proportion of Firmicutes decreases and becomes more similar to that of lean individuals. Maintaining a healthy metabolism depends on a symbiotic consortium between bacteria and other intestinal microorganisms. Furthermore, microRNAs regulate gene expression in adipose tissue, impact the regulation of metabolism and energy homeostasis, and regulate adipogenesis signaling pathways in white, beige, and brown adipose tissue. For example, microRNA (miR-143) promotes thermogenesis in brown adipose tissue and inhibits adipogenesis in white adipose tissue. Some miRNAs have been implicated in the control of body weight gain, glucose homeostasis, insulin resistance, and lipid metabolism, with crosstalk with the gut microbiota. Furthermore, an association was found between B. eggerthi abundance, miR-183-5p expression, and adiponectin levels. miR-15a-5p expression was found to be associated with H. parainfluenza abundance and insulin levels.

Nutrological importance in bone loss recovery for the efficiency of dental implant process: a systematic review

Guilherme Augusto Lima Garcia — 2025-04-18

Introduction: The global dental implant market generated approximately 13 billion dollars in 2023, with an annual growth of 6%. It is prioritized that the nutritional status significantly influences the osseointegration process. Objective: It was to conduct a systematic review to discuss the nutritional importance of optimizing the dental implant osseointegration process. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 123 articles were found, 25 articles were evaluated in full and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 32 studies that did not meet GRADE. Most studies did not show homogeneity in their results, with X²=81.2%>50%. It was concluded that a specific dietary regimen and micronutrients may play a key role in the different phases of dental implant osseointegration. Some micronutrient deficiencies increase oxidative stress and inflammation, in addition to affecting collagen structure and bone mineralization. However, data are lacking for many micronutrients that may modulate bone metabolism. There is evidence for the role of vitamin D as well as vitamin C supplementation in facilitating the success of dental implant surgery.

Investigation of clinical outcomes on the oral or injectable use of semaglutide and cardiovascular risks: a systematic review

Barbara Vanzelli de Oliveira — 2025-04-15

Introduction: In the context of GLP-1 analogs and cardiovascular risks, both subcutaneous and oral formulations of semaglutide have undergone extensive phase 3 clinical trials. Objective: It was to analyze, through a systematic review, the main clinical findings of the oral or injectable use of semaglutide and its relationship with cardiovascular risks. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from November 2024 to January 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 132 articles were found. A total of 35 articles were fully evaluated and 25 articles were included. According to the GRADE instrument, most of the studies presented homogeneity in their results, with X² = 87.5%> 50%. It was concluded that subcutaneous injection is more likely to result in endocrine-related adverse events. Oral administration is more likely to induce gastrointestinal adverse events. Furthermore, it significantly accelerates the onset of adverse reactions. As one of the newer agents in the class, the safety of semaglutide in both subcutaneous and oral formulations has been examined in phase 3 and CVOT programs. However, no major safety concerns have emerged to date, although definitive conclusions for pancreatic cancer, thyroid cancer, and complications of polycystic kidney disease cannot be drawn at this time. Compared with the beneficial effects of these drugs on glucose metabolism, blood pressure, body weight, and cardiovascular (and potentially even renal) outcomes, these agents have an overall beneficial risk/benefit profile for treating patients with T2DM. GLP-1RAs are safe, well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underutilized by cardiologists and require therapy management in patients with T2DM and established atherosclerotic cardiovascular disease or high risk for established atherosclerotic cardiovascular disease.

Major clinical, nutrological and immunological considerations and treatments of vulvar lichen sclerosus: an integrative systematic review

Maria Claudia Tessari Ferreira — 2025-04-14

Introduction: Vulvar Lichen Sclerosus (VLS) is characterized by being a chronic progressive inflammatory skin disease, mediated by lymphocytes, which mainly affects the anogenital area. Its prevalence is higher in the female population (10:1), especially in postmenopausal women, and is associated with autoimmune diseases, although it can affect both sexes. It is one of the diseases that most causes structural damage to the vulva and consequent physical and mental suffering. The diagnosis of vulvar lichen sclerosus is clinical. Biopsy is indicated only in cases of non-typical lesions. Objective: This was to conduct an integrative systematic review to present the main clinical, nutrological, and immunological considerations of vulvar lichen sclerosus, as well as the treatment challenges. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from September to October 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. 38 articles were fully evaluated and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=90.7%>50%. It was concluded that the exact cause of VLS is not fully understood. Still, it is believed that nutritional factors, dysbiosis of the intestinal microbiota, genetics, autoimmunity, and hormonal imbalance may play an important role in its development. The main risk factor for vulvar cancer associated with VLS is delayed diagnosis, so controlling symptoms and preventing complications is crucial, and regular follow-up is necessary to monitor response to treatment and disease recurrence.

Nutrological therapy and control of inflammatory processes and metabolic disorders in patients with obesity: a systematic review

Sarah Bernardon de Oliveira — 2025-04-09

Introduction: Obesity establishes a long-term chronic imbalance between calorie intake and energy expenditure, which causes serious comorbidities. MicroRNAs stand out, which are a class of small non-coding RNAs that regulate gene expression. Changes in their expression and functions have been associated with several diseases, including metabolic disorders and obesity. Enteral and parenteral nutrition therapy functions as an important regulator of microRNAs against inflammatory and metabolic processes. Objective: It was to carry out a systematic review of the main approaches to enteral and parenteral nutrition therapy in patients with obesity, to regulate the gene expression of microRNAs to mitigate inflammatory processes and metabolic disorders. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found. A total of 41 articles were evaluated in full and 30 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 24 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =75.2% >50%. It was concluded that studies accumulate evidence that circulating miRNAs are associated with obesity. Some microRNAs have been implicated in the control of body weight gain, glucose homeostasis, insulin resistance, and lipid metabolism. In this sense, enteral feeding is an effective and safe treatment before bariatric surgery, with ketogenic enteral nutrition leading to better clinical results than hypocaloric enteral nutritional protocols in glycemic and lipid profiles. A diverse range of nutritional interventions are effective in treating obesity and its comorbidities, mainly through nutrotherapy triggers on microRNAs.

Effects of supplementation of collagen types, vitamins, nutrients and exosome modulations for the rejuvenation of collagen fibers and improvement of skin aesthetics: a systematic review

Mauricio Fernando Cuadrado Berrones — 2025-04-08

Introduction: Collagen prevails in connective tissues, constituting 80% of the dry weight of human skin. Aging induces a decline in enzymes involved in the post-translational processing of collagen, reducing the number of fibroblasts that synthesize collagen and the vessels that irrigate the skin. Oral ingestion of hydrolyzed collagen together with vitamins and nutrients (especially apple exosomes/microRNAs) increases the levels of collagen-derived peptides in the bloodstream and improves skin properties. Objective: A systematic review was carried out to elucidate the main results of clinical studies and meta-analyses of clinical studies on the effects of supplementation of types of collagens, vitamins, nutrients and modulations of exosomes/microRNAs for the rejuvenation of collagen fibers and improvement of skin aesthetics. Methods: The search was carried out from November 2024 to January 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 122 articles were found, and 12 articles were evaluated in full, and 08 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=62.4%>50%. Oral nutritional supplements containing collagen peptides can reduce skin vulnerability in the elderly and thus prevent conditions such as skin lesions. Thus, microRNA (miR-181b) may negatively regulate the proliferation of HEKs in psoriasis by targeting TLR4. The direct effects of collagen peptides on fibroblasts, M2-like macrophages, and mechanisms related to oral tolerance are the possible mechanisms for the beneficial effects of collagen supplementation. Special collagen peptides together with acerola extract, vitamin C, vitamin E, biotin, and zinc showed a significant improvement in the skin's collagen structure. The proven positive nutritional effect on collagen structure was fully consistent with the quality of healthy skin. Finally, apple-derived nanovesicles (exosomes) also reduce the degradation of the extracellular matrix, increasing collagen synthesis (COL3A1, COL1A2, COL8A1, and COL6A1) and negatively regulating the production of metalloproteinases.

Major considerations of parenteral nutrological therapy in short bowel syndrome: a systematic review

Ana Angélica Nogueira Lima — 2025-04-02

Introduction: Short bowel syndrome (SBS) is a result of surgical resection or destruction of the bowel associated with the disease. Patients with SBS with intestinal failure (II) (SBS-II) experience decreased quality of life (QOL) and increased morbidity and mortality due to their dependence on parenteral support (PS). Patients treated with teduglutide have been able to reduce and even discontinue PS with varying degrees of success. Objective: To analyze the scientific evidence for teduglutide in parenteral support in patients with short bowel syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from August to October 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 91 articles were found. 29 articles were fully evaluated and 07 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=91.5%>50%. It was concluded that teduglutide can restore intestinal structural and functional integrity, promote mucosal growth, reduce gastric emptying and secretion, and increase nutrient absorption and enteral independence from parenteral nutrition. The 24-week treatment time with teduglutide was generally well tolerated in patients with short bowel syndrome with intestinal failure. The clinical studies showed that teduglutide treatment reduced the volumes and number of days of parenteral support for patients with short bowel syndrome with intestinal failure.

Benefits of implementing a Multi-Professional Nutritional Therapy Team (MNTT) in hospital services: a literature review

Vittor Cândido Soares — 2025-03-27

Introduction: The management of nutritional diseases in the nosocomial context, especially malnutrition, has raised considerable concern. Objective: In this context, the multi-professional nutritional therapy team (MNTT) emerged, aiming to provide a prompt diagnosis and effective treatment for these conditions. Methods: To assess the benefits of implementing MNTT in hospital services, a review was conducted, gathering articles and legislation related to the proposed topic. The search terms used included “nutritional therapy,” “nutritional therapy costs,” “MNTT,” “multidisciplinary nutritional therapy team,” “enteral nutrition,” and “parenteral nutrition.” Discussion: The presence of MNTT leads to reduced mortality, shorter hospital stays, fewer complications, lower hospital expenses, and improved nutritional support for patients compared to services without MNTT. Conclusion: The multitude of benefits from investing in MNTT implementation is evident, as they play a fundamental role in diagnosing, treating, and primarily preventing nutritional diseases, ultimately resulting in better patient care.

Major outcomes of clinical studies and guidelines on nutrological therapy and palliative care in critically ill patients: a systematic review

Hugo Menezes Lopes — 2025-03-21

Introduction: Adequate nutritional therapy is often a missing factor in the treatment of patients receiving end-of-life palliative care. The American Academy of Hospice and Palliative Care defined palliative care as comprehensive and specialized care. The main concerns are nutritional, pain, and symptom management, information sharing and advance care planning, psychosocial and spiritual support, and care coordination. Objective: It was to list the main outcomes of clinical studies and guidelines on enteral/parenteral nutritional therapy and palliative care in critically ill patients. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 93 articles were found. A total of 44 articles were evaluated in full and 16 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 13 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=85.9%>50%. It was concluded that palliative nutritional care plans for critically ill patients should be managed by a nutritionist together with patients and family members. The benefits and risks of artificial nutrition and hydration should be discussed with the patient and/or caregiver when palliative care is initiated. The main goal of palliative care is to preserve the patient's quality of life. This includes defending freedom of choice and allowing the patient to determine their level of nutritional intervention. The results suggest that providing nutritional support ( 12 g of protein, 300 kcal) daily prevents the loss of active tissue mass in palliative cancer patients. Based on these results, we recommend the inclusion of this simple nutritional support to prevent malnutrition in cancer patients in palliative care. Furthermore, severe malnutrition is a predictor of reduced survival in patients with advanced gastrointestinal cancer. Information on nutritional status should be considered to individualize the palliative care plan for these patients and, therefore, improve their quality of life. Using the modified Glasgow Prognostic Score to identify the existence and severity of cancer cachexia has the potential to aid clinical decision-making regarding the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Nutrological triggers of muscle regeneration in athletes under modulation and gene expression of microRNAs and exosomes: a systematic review

Frederico Teixeira Izidorio — 2025-03-21

Introduction: In the context of regenerative nutrological processes, nutrition makes it possible to recover from muscle injuries in athletes. Muscle wasting results in reductions in basal muscle protein synthesis and muscle resistance to anabolic stimulation. Therefore, higher protein intakes (2-2.5 g/kg/day) are necessary. Regular physical training associated with nutritional health has broad benefits to the health of the gut microbiota. MicroRNAs (miRs) and exosomes have emerged as critical regulators of numerous biological processes, modulating gene expression at the post-transcriptional level. Objective: A systematic review was conducted to demonstrate, through scientific studies, the nutrological triggers of muscle regeneration in athletes under the modulation and gene expression of microRNAs and exosomes. Methods: The systematic review rules of the PRISMA Platform and the methodological quality of AMSTAR were followed. The research was carried out from June to August 2024 in the Web of Science, Scopus, PubMed, Lilacs, Ebsco, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 134 articles were found, and 62 articles were evaluated in full and 52 were included and developed in this systematic review study. Clinical studies showed homogeneity in their results, with Chi-Square X² =72.4%>50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 20 studies that did not meet GRADE. miRs play an important role as regulatory molecules during the muscle healing process. Myoblasts are known to secrete exosomes enriched with miRs into the inflammatory environment, whereby miR-224 is transferred to macrophages to inhibit M2 polarization. Additional data demonstrate that WNT-9a may be a direct target of miR224 for macrophage polarization. The results showed that miR-122 and myogenic markers were down-regulated in C2C12 cells after TGF-β stimulation, and overexpression of miR-122 can restore myogenesis inhibited by TGF-β. Evidence suggests that the exosome derived from mesenchymal stem cells exhibits functions similar to mesenchymal stem cells with low immunogenicity and without tumorization. High rates of intestinal self-renewal are enabled by intestinal stem cells (LGR5+) at the base of intestinal crypts. LGR5+ activity, including proliferation and differentiation rates, is affected by large shifts in nutrient availability, as occurs on a high-fat diet or fasting. The practice of physical activity, endogenous metabolites, and dietary nutrients can directly influence epigenetic enzymes. Dietary manipulations and metabolites can affect tissue stem cell fate decisions. Self-renewal and differentiation of mesenchymal stem cells can be regulated by manipulating vitamin C, A, or D levels and valine restriction.

The impact of macro- and micronutrients on metformin anti-diabetic activity: a systematic review

Asif Jan — 2025-03-06

Introduction: Type 2 Diabetes Mellitus (T2DM) affects over 537 million individuals worldwide, with cases expected to rise to 783 million by the year 2045. Metformin is the primary treatment, but its efficacy varies due to dietary influences. Growing evidence suggests that macro- and micronutrients interact with metformin, influencing its therapeutic effects. However, these interactions remain poorly understood. This review aims to bridge this knowledge gap by synthesizing recent findings on metformin-nutrient interactions to inform optimized therapeutic and dietary strategies. Objective: The objective of this systemic review is to investigate the impact of macro- and micronutrients on metformin anti-diabetic activity. Methods: This systematic review adheres to PRISMA guidelines, focusing on systematic reviews, meta-analyses, and experimental studies from PubMed, Scopus, and Web of Science. The research was carried out from September to October 2024. The studies were evaluated for quality using the GRADE tool and the risk of bias was assessed using the Cochrane tool. Results and conclusion: 132 research studies were identified and subjected to an eligibility assessment. After a careful evaluation, 33 studies were included in this systematic review. The Cochrane tool used for assessing the risk of bias revealed that 22 studies had a high risk of bias, while 24 studies failed to meet the GRADE criteria. Most of the studies showed homogeneity in their findings, with X²=85.7%>50%. It was concluded that high saturated fat intake reduces metformin’s effect alternatively, nutrients like leucine enhance metformin efficacy through mechanisms involving the AMPK pathway, promoting lipid oxidation and glycemic improvements. Micronutrients such as calcium, magnesium, and potassium play essential roles in glucose metabolism and insulin signaling. These minerals are absorbed through OCT1 transporters, the same transport pathway used by metformin for cellular uptake. Clinical trials have demonstrated that adequate dietary intake of these micronutrients stabilizes blood glucose levels when combined with metformin. In conclusion, it is suggested that dietary composition should be an integral component of T2DM management for patients on metformin therapy.

Major clinical studies on the relationship between testosterone levels and aging in men: a systematic review

Jeffeson Alexandre Azevedo de Araujo — 2025-02-12

Introduction: After 30 years of age, testosterone levels decline at a rate of 1-2% per year, which correlates with an increased incidence of late-onset hypogonadism diagnosed in middle-aged and elderly men. Testosterone replacement therapy (TRT) is emerging as a promising solution for aging-related problems. Objective: This study aimed to present the main clinical studies on the relationship between testosterone levels and aging in men, as well as an analysis of the reduction in physical and metabolic comorbidities. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 86 articles were found. A total of 23 articles were fully evaluated, and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=77.4%>50%. It was concluded that in the setting of aging in men, late-onset hypogonadism is the clinical entity characterized by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in elderly men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased risk of cardiovascular morbidity and mortality. Although testosterone replacement therapy reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of testosterone replacement therapy in older men is debatable. In middle-aged and older men with hypogonadism and low libido, testosterone replacement therapy for 2 years improved sexual activity, hypogonadal symptoms, and sexual desire, but not erectile function. Furthermore, men with low testosterone, elevated luteinizing hormone, or deficient estradiol concentrations had increased all-cause mortality. Testosterone treatment aimed at achieving physiological concentrations in middle-aged and older men may improve lean body mass, while exercise training improves lean body mass, aerobic fitness, and strength.

Metabolic significance of nutritional treatment before and after bariatric surgery: a systematic review

Renata Cristina Taveira Azevedo — 2025-02-03

Introduction: According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the rate of bariatric surgery (BS) increased from 158 thousand in 2011 to 196 thousand in 2015. Lifestyle modifications, such as healthy eating and correct physical activity programs, can improve surgical results. Thus, the most important aspect in the medical management of bariatric patients refers to nutritional management. Objective: It was to carry out a systematic review to list the main approaches and significance of nutritional treatment before and after bariatric surgery, to mitigate the metabolic damage caused by nutrient deficits. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 127 articles were found. A total of 45 articles were evaluated in full and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=62.5%>50%. It was concluded that the most important aspects of the medical management of bariatric patients refer to nutritional management. Before bariatric surgery, nutritional status should be checked and preoperative weight loss may be attempted. Very low-calorie diets and very low-calorie ketogenic diets are often prescribed in the last few months before surgery. It was observed that the recommendations were gathered to assist in individualized clinical practice in the nutritional management of patients with obesity, including nutritional management. Iron status can be affected by inflammation of adipose tissue and increased expression of the systemic iron-regulating protein hepcidin. The postoperative recommendation for vitamin B12 (cobalamin) should be 350-500 micrograms/1000 micrograms monthly, and postoperative folate (folic acid) should be 1,000 micrograms per day.

Exploring the Relationship Between Fatigue Severity and Clinical Parameters in Hemodialysis Patients Utilizing FACIT-F Scale: A Cross-sectional Study in West Bank Hospitals

Abdalla Qawasmeh — 2025-01-30

Fatigue is one of the most common symptoms experienced by patients with End-Stage Renal Disease (ESRD) and it can be defined as weakness, exhaustion, incapacitating, and disorder. The purpose of this cross-sectional study is to determine the correlation between fatigue severity and key clinical parameters in hemodialysis patients in West Bank hospitals. 62 adult dialysis patients were evaluated for fatigue severity using the Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-F). Demographic information, health behaviors, and clinical characteristics were gathered. The findings demonstrated a strong negative association between fatigue severity and hemoglobin levels (r=-0.319, p=0.023), emphasizing the role of low hemoglobin levels in increasing fatigue. There were no significant relationships between weariness and serum creatinine, phosphorus, or calcium levels. These findings emphasize the necessity of monitoring and treating hemoglobin levels in dialysis patients' tiredness management, pointing to further research and viable therapies.

Impacts of obesity and comorbidities on sexual dysfunction in men and women: a systematic review

Deangelo Cláudio Gomes de Lima — 2025-01-30

Introduction: Obesity, with more than 2.0 billion people worldwide, is associated with numerous comorbidities, affecting male and female sexual and reproductive function. Objective: This study explored the main clinical studies on the impacts of obesity on sexual dysfunction in men and women, as well as treatment proposals in an attempt to mitigate or resolve this condition. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from September to October 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 95 articles were found. A total of 30 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=72.5%>50%. It was concluded that obesity is associated with substantial and significant impairments in quality of life. Weight loss has been shown to improve sexual function in men and women with obesity. The impact of weight loss medications and the long-term effect of bariatric surgery on sexual function require further studies. Higher visceral adiposity index is independently related to the risk of erectile dysfunction and that early intervention is necessary to reduce the progression of erectile dysfunction with high levels of visceral adiposity index. It was shown that BMI, age, smoking, diabetes and hypertension were associated with higher odds of reporting decreased sexual function.

Action of probiotics and nutrients in the management of tregs cells in patients with obesity and cancer: a systematic review

Rafael Tinoco Alves — 2025-01-30

Introduction: In the context of immunomodulation in patients with obesity and cancer, Bifidobacterium is one of the most commonly used probiotics and activates the anti-CTLA-4 antibody, a checkpoint inhibitor that frequently causes autoimmunity in humans undergoing cancer treatment. Immunotherapy enhances the host's immune system to produce antitumor effects, primarily by stimulating Treg cells. Objective: It was to highlight how probiotics and nutrients can stimulate regulatory T cells in patients with obesity and cancer, to immunomodulate and treat these patients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 137 articles were found, and 39 articles were evaluated in full, and 31 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=68.9%>50%. It was concluded that oral administration of butyrate, propionate, and acetate, individually or in combination, led to an increase in the number of Treg cells in the colon. Also, all-trans retinoic acid (atRA), a bioactive form of vitamin A stimulates Treg cells in the human intestine. Probiotics, together with gut microbiota, have been increasingly proposed to improve immune checkpoint blockade treatments against cancer by activating Treg cells.

Importance of nutrological management and gut microbiota in alzheimer's disease: a systematic review

Márcia Cavalheiro Alves — 2025-01-24

Introduction: In the context of neurodegenerative diseases, Alzheimer's disease (AD) is the most common form of dementia. It is estimated that more than 46 million people are affected worldwide. Several factors contribute to the risk of developing late-onset Alzheimer's disease, including advanced age, genetic factors, family history, history of head trauma, hypertension in midlife, obesity, diabetes, and hypercholesterolemia. Studies have shown the important role of the gut microbiota in controlling this condition, together with adequate nutrition. Objective: It was to analyze the relationship between dietary patterns, gut microbiota, micro and macronutrients, and cognitive disorders in Alzheimer's disease. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from May to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 140 articles were found. 75 articles were fully assessed and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=89.5%>50%. It was concluded that several antioxidants found in a healthy natural diet can efficiently attenuate free radical attacks and neutralize dysregulated pro-oxidants, reducing oxidative stress and the induction of degenerative diseases such as Alzheimer's disease. Studies have found that plasma lipopolysaccharide levels in patients with Alzheimer's disease were three times higher than in healthy controls. Thus, increased concentrations of plasma lipopolysaccharide and fecal calprotectin indicate an altered intestinal barrier function and increased inflammation and intestinal permeability in patients with Alzheimer's disease.

Clinical evidence on nutrological management and gut microbiota in inflammatory bowel diseases: a systematic review

Cristiane Reis e Lopes Telles — 2025-01-24

Introduction: The main risk factor for inflammatory bowel disease (IBD) is a positive family history. Crohn's disease (CD) can affect individuals aged 15 to 40 and 50 to 80 years, with a higher percentage in women. Ulcerative colitis (UC) can start at any age. Metabolism encompasses the interactions between diet, the microbiome, and cellular enzymatic processes that generate the chemical pathways necessary to sustain life. Endogenous metabolites and dietary nutrients can directly influence epigenetic enzymes. Epigenetic modifications to DNA and histone proteins alter cell fate by controlling chromatin accessibility and downstream gene expression patterns. Objective: It was to highlight the main interactions between nutrition and gut microbiota in the treatment of inflammatory bowel diseases. Methods: The present study followed the international systematic review model (PRISMA). This study was carried out from July to September 2024. It included randomized controlled, prospective, and retrospective studies published from 2013 to 2023. The Cohen test was performed to calculate the Effect Size and the inverse error standard (precision or sample size) for the risk of bias (Funnel Plot). Results and Conclusion: A total of 30 articles were found, and 17 clinical studies on the modulation of diet to control IBD were included in this study. These studies have shown reductions in persistent gut symptoms, improved gut microbiota, reduced markers of inflammation, and improved quality of life. Diet has an important role in controlling and even remitting IBD. The studies were homogeneous in results, with X² = 82.5%, which increases the reliability of clinical results on the importance of diet in modulating IBD.

Recommendations and guidance on Cobalamin (Vitamin B12) based on the Delphi method

Tiago Lazzaretti Fernandes — 2025-01-13

Introduction: Vitamins are essential micronutrients for the body to function. Cobalamins (Cbls) are watersoluble compounds, acting as cofactors in enzymatic reactions. However, the use of Cbls in the clinical environment is still controversial. Objective: It was to discuss the topic and help guide different professionals, experts were brought together to discuss criteria concerning the diagnosis, indications, and use of cobalamin. Methods: The study was carried out using the Delphi method. Topics were initially created to direct the discussion and initial contributions. In the first meeting with the panelists, questions were formulated. The questions were distributed to all panelists. With the contributions, a text with the answers was created, and a third round to review the contributions and agree with the text was carried out. Results: The main topics related to the use of cobalamin were identified. Conclusion: The main topics related to this topic include risk groups of deficiency of ingestion or absorption by the gastrointestinal tract. The deficiency diagnosis must be made through laboratory tests, and early indication must be made when a significant cobalamin deficiency is identified, to avoid irreversible clinical conditions. A recommended practice is monitoring between 2 and 6 months after starting cobalamin replacement. Evidence Level:6.

Major clinical outcomes of the action of the co-agonist tirzepatide to liraglutide and semaglutide in the treatment of obesity and type 2 diabetes mellitus: a systematic review

Helena Ramalho Arvate — 2025-01-08

Introduction: Obesity is a chronic disease that affects a significant portion of the population. In Brazil, in surveillance research on risk and protective factors for diseases, more than half of the Brazilian population, 56% are overweight. In this scenario, liraglutide and semaglutide are medication for the treatment of type 2 diabetes mellitus (T2DM) and obesity. Tirzepatide is the first dual GLP1/GIP receptor co-agonist that has been approved for the treatment of T2DM and obesity. Objective: It was to present the major clinical outcomes of the action of the co-agonist tirzepatide to liraglutide and semaglutide in the treatment of obesity and type 2 diabetes mellitus. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 84 articles were found, and 52 articles were evaluated and 23 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 8 studies with a high risk of bias and 19 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =79.8% >50%. It was concluded that in people without diabetes, 5 to 15 mg of tirzepatide once weekly for the treatment of obesity (SURMOUNT-1) resulted in substantial reductions in body weight (16.5% to 22.4%) over some time. 72 weeks. Furthermore, liraglutide (3.0 mg) as a medication for the treatment of obesity, in association with lifestyle changes, in patients with and without diabetes proved to be a good therapeutic option with a response about weight loss and maintenance, in addition to benefits secondary to clinical comorbidities associated with obesity.

Analysis of the frequency of consumption of dairy foods as a source of calcium in women in the age group of 19 to 30 years: a prospective observational and cross-sectional study

Ana Beatriz Quinzani Baptista — 2025-01-02

Throughout a woman's life, the amount of calcium needed by her body changes, and in adulthood, this value is relatively lower than in adolescence and post-menopause. Even so, considering that bones are stores of calcium, consumption of the nutrient in adulthood is essential to avoid future problems such as osteoporosis and osteopenia. The objective of this study was to assess the frequency of consumption of dairy products rich in calcium, by adult women between 19 and 30 years old in the city of Catanduva, Brazil. A descriptive cross-sectional observational study was carried out with 114 volunteers. The frequency of consumption of milk and dairy products in the last 12 months was measured through an anonymous questionnaire via “google forms”. It was found that among the most consumed dairy foods are cheese, but most calcium-rich foods are never eaten by the women in the study. The low calcium intake can be explained by the increase in the financial cost of dairy products on the market and by the presence of women who are lactose intolerant. Therefore, the consumption of dairy foods must be encouraged among women, while alternatives must be thought of so that the consumption of calcium, of medicinal importance, is not affected by the prices of dairy products on the market or by the presence or absence of diseases related to lactose.

Assessment of the knowledge on nutrology among medical course students: an observational cross-sectional study

Paloma Salomone — 2024-11-18

Introduction: An unbalanced diet is responsible for more deaths than any other risk factor, including smoking. By definition, Nutrology is the medical specialty whose function is to prevent, diagnose and treat nutroneurometabolic diseases. As it is a relatively new specialty, it has not yet become part of the basic curriculum as a mandatory subject in most medical schools. This fact means that students have little or no contact with the specialty during their academic training. Objective: The objective of this study was to evaluate the knowledge on Nutrology among medical students. Methods: An observational and cross-sectional study was conducted to assess the knowledge of students enrolled in the Ugraft Journey of the Plastic Surgery Leagues of Rio Grande do Sul. Data collection took place through the application of an online questionnaire comprising 14 questions. Results: A total of 170 participants spanning across all semesters of the course, representing 7 universities (UFSM, UFCSPA, UFN, UFAL, Unoeste, Univates, and Unijuí). The participants were aged between 18 and 43 years old, 114 were female and 56 were male. In regard to the question of which course Nutrology is a part of, 84.1% answered Medicine, 14.7% answered Nutrition, and 1.2% answered another course. Additionally, 67.6% stated that they do not know or are not sure about the area of activity of Nutrology, while only 17.6% have already consulted a Nutrologist. Concerning the significance of dietary guidance and supplementation during the pre- and post-operative phases of surgery, 98.2% deemed it advantageous for the patient. When it came to distinguishing between the various indications for oral dietary supplementation, enteral, or parenteral therapy, 74.7% did not know how to differentiate them. Regarding the safety of prescribing a food supplement, 90% do not feel able to do so. As for the meaning of the acronym MNTT, 93% are unaware. Regarding obesity being a chronic disease, 92.4% agreed. Regarding the desire to undertake a residency in Nutrology, 12.9% expressed interest. Finally, regarding the importance of the subject of Nutrology in the curriculum, 94% considered it important. Conclusion: Despite the increasing prevalence of nutrition-related diseases and the evidence showing that poor diet is responsible for more deaths than any other risk factor, studies have observed that the majority of medical students feel unprepared regarding the subject. The findings of this study could serve as motivation for institutions to reconsider the significance of incorporating the discipline of Nutrology into the medical curriculum.

Adequate nutrological treatment for patients with chronic kidney disease: a systematic review

Milena de Souza Vasconcelos — 2024-11-15

Introduction: In the scenario of chronic kidney disease (CKD), data from the World Health Organization show that CKD affects approximately 10% of the world population, particularly in low- and middle-income countries. In the USA alone, approximately 37 million adults are affected, given that diagnosis is late due to the lack of apparent symptoms in the early stages. Due to limited access to diagnosis and treatment, CKD has become the 12th leading cause of death in the world, making adequate nutritional therapy necessary as the main treatment. Objective: It was to highlight the importance of adequate nutrological treatment for patients with chronic kidney disease. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to September 2024 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 124 articles were found. 22 articles were evaluated and 18 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =84.6% >50%. It was concluded that chronic kidney disease is a growing health crisis in the world, accompanying the increase in the number of patients with obesity. Diabetes and hypertension are the main causes of the development of chronic kidney disease. Lifestyle changes, adequate nutritional therapy, and lipid-lowering medications can contribute to improving the clinical outcome of patients with chronic kidney disease. Medical nutritional therapy is fundamental and vital for the treatment of chronic kidney disease, as it can delay disease progression and prevent comorbidities and mortality.

Anais do XXVIII Congresso Brasileiro de Nutrologia - n. 28, v. 1, 2024

Carlos Alberto Nogueira-de-Almeida — 2024-11-14

O Congresso Brasileiro de Nutrologia, maior evento da área na América Latina e do mundo, está na sua 28ª edição.

O CBN 2024 tem como missão prover articulação entre os mais renomados palestrantes nacionais e internacionais, juntamente com os profissionais da saúde - acadêmicos, médicos, nutricionistas, psicólogos - com o objetivo de transmitir conhecimento e atualização sobre os mais variados temas que envolvem nossa especialidade.

Nesse contexto, é de grande valia que os novos conhecimentos científicos que estão sendo produzido pela comunidade acadêmica, envolvidos pela Nutrologia em todo o país, sejam compartilhados.

Dessa forma, além das conferências e palestras, foram selecionados 363 trabalhos, que estão publicados nesses Anais, e 10 foram escolhidos para serem apresentados oralmente durante o evento. Toda esta difusão de conhecimento enriquecerá ainda mais o CBN 2024.

Major clinical outcomes and discussions of the impacts of religiousity/spirituality in patients with palliative care and nutrology therapy: a concise systematic review

Julian Yin Vieira Borges — 2024-10-17

Introduction: In the scenario of nutritional therapy and religiosity/spirituality (R/S), several factors can impact the nutritional status of patients in palliative care. These include knowledge of nutrition, the level of emotional support required for the patient, their motivation, and the nature, impact, and severity of the illness. A diet suitable for weight stabilization provides patients with the energy necessary to meet physical, psychological, social, and R/E aspects. Objective: It was to carry out a concise systematic review to present the main clinical outcomes and discussions about the impacts of religiosity/spirituality in patients with palliative care undergoing nutritional therapy. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 91 articles were found, and 24 articles were evaluated in full, and 17 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=72.8%>50%. It was concluded that when the natural oral intake of food and liquids is disturbed, the role of caregivers is to assist the patient in covering the individual's nutritional needs through nutritional therapy and religiosity and spirituality as metabolic and immunological stimuli. Nutritional therapy requires indication to achieve a treatment goal and informed consent from the patient. The suspension and withdrawal of nutritional therapy and artificial hydration must be evaluated in specific situations (terminally ill, palliative care, dementia, elderly patients) and always on a case-by-case basis, according to the cultural and spiritual needs of the patients. Caregivers must emphasize the right to self-determination and therefore respect the patient's autonomy, and also the particular vulnerability of the patient who suffers from or is at risk of malnutrition.

Anorexics and saints

Claudio de Lima Barbosa — 2024-10-16

In the Middle Ages, some Catholic saints fasted frequently. The specialized literature invariably has a critical bias, as if they suffered from a psychopathology. This article counters this view based on Theology, Catholic Doctrine, and Nutrology.

Clinical evidence of low-calorie and ketogenic nutrological therapy before, during and after bariatric surgery: a systematic review

Marília de Andrade Salvá — 2024-10-02

Introduction: Obesity is a multifactorial disease that causes serious comorbidities. There are more than 2.2 billion overweight and obese people in the world. Obese patients tend to be predisposed to micronutrient deficiency even before bariatric surgery, therefore, it is imperative to supplement nutrients orally, enterally, or parenterally, according to the indications of each patient. Objective: It was highlighted the importance of low-calorie and ketogenic nutritional therapy before, during, and after bariatric surgery through the systematic analysis of clinical studies. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 119 articles were found. A total of 40 articles were fully evaluated and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 27 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=76.5%>50%. It was concluded that nutrological therapy strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to following the prescribed diet before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects on reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology are useful to provide optimal care to patients, especially in nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures such as RYGB. Immediate administration of thiamine is essential. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and a multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. In addition, serum micronutrient levels should be monitored regularly and additional supplementation should be prescribed as indicated.