International Journal of Nutrology

Relationship between gut microbiota, probiotics, and obesity in the cellular and molecular mechanisms for the activation of regulatory t cells and control of inflammatory processes: a systematic review

Nicoli Donadeli Gomes — 2024-06-25

Introduction: Obesity represents a pandemic represented as a long-term chronic imbalance between calorie intake and energy expenditure, resulting in more than 30% of the world's population (over two billion people) being overweight or obese. Studies show that Tregs regulate inflammatory cells such as macrophages and T lymphocytes by reducing the production of cytokines IL-6, IL-10, etc., and microRNAs can regulate the gene expression of inflammatory cells. Probiotics have been increasingly studied for modulating the gut microbiota. Objective: It was to develop a systematic review to describe the main considerations of the relationship between gut microbiota, probiotics, and obesity, to list the cellular and molecular mechanisms for the activation of regulatory T cells and control of inflammatory processes. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to May 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 122 articles were found, and 40 articles were evaluated in full and 24 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=78.7%>50%. It was concluded that probiotic therapy proved to be an important strategy associated with a nutritional change to improve the composition of the gut microbiota. In this context, the probiotics L. paracasei shirota, Akkermansia muciniphila, and Lactobacillus reuteri V3401 stand out, which are responsible for reducing inflammatory markers. Modulation of the gut microbiota through physical exercise, type of nutrients, and use of prebiotics, and/or probiotics have a positive effect on reducing inflammatory markers. 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. Expression of miR-15a-5p was found to be associated with H. parainfluenzae abundance and insulin levels.

Nutrological modulation of cannabidiol in the inflammatory processes of athletes: a systematic review

Ricardo de Oliveira Carvalho — 2024-06-13

Introduction: The correct interaction between the elements of the endocannabinoid system plays an important role in the development of the central nervous system. Clinical and preclinical studies suggest that cannabidiol (CBD) may be useful for athletes due to its anti-inflammatory, analgesic, anxiolytic, and neuroprotective properties and its influence on the sleep-wake cycle. Furthermore, a series of implications for epigenetic processes were also proven, through changes in the expression of exosomes and microRNAs responsible for modulating the immune and inflammatory systems. Objective: It was to list the main clinical considerations of the nutritional modulation of cannabidiol in inflammatory and immunological processes in athletes through a systematic review. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and AMSTAR-2, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 88 articles were found. A total of 36 articles were evaluated in full and 18 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. CBD has been reported to exert a range of physiological, biochemical, and psychological effects with the potential to benefit human health. For example, there is preliminary supporting evidence for CBD's anti-inflammatory, neuroprotective, analgesic, and anxiolytic actions and the possibility that it may protect against gastrointestinal damage associated with inflammation and promote the healing of traumatic skeletal injuries. The combination of Δ9-THC and CBD can alter the activity of microRNAs responsible for increasing the biosynthesis of inflammatory mediators, leading to a reduction in the inflammatory profile. Despite these findings, there is still a lack of randomized and/or prospective controlled clinical studies with a robust sample size to better understand the safety and effectiveness of the use of cannabidiol by medium to high-performance athletes, as well as better understand the dosages for each type of sports performance.

Gut microbiota and skeletal muscle axis in sports performance through nutrological activation of irisin and microRNAs: a systematic review

Hugo Menezes Lopes — 2024-06-12

Introduction: Several discoveries have accumulated evidence regarding gut microbiota, regenerative nutrition, and skeletal muscle metabolism. Exercise volume and intensity have been shown to influence gastrointestinal health status, including the role of growth factors, signaling pathways, oxidative stress, metabolic factors, irisin, and microRNAs. Objective: To present, through a systematic review, the main approaches and outcomes of clinical studies of the gut microbiota and skeletal muscle axis in sports performance through the nutritional activation of irisin and microRNAs. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from January to April 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: 121 articles were found. A total of 40 articles were evaluated in full and 19 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 16 studies with a high risk of bias and 25 studies that did not meet GRADE. It was concluded that exercise-induced stimulation of irisin (bioactive cytokines), through muscle-bone-fat crosstalk, increases muscle anabolism, bone formation, mitochondrial biogenesis, glucose utilization, and fatty acid oxidation and Attenuates chronic low-grade inflammation. A current focus in the field of sports and metabolism is the investigation of how specific metabolites and nutrients affect the progression and treatment of muscle injuries. Nutrients can also regulate normal homeostatic processes by altering the decisions of muscle stem and satellite cells. MicroRNAs have emerged as important players in the regulation of gene expression, being involved in most of the biological processes examined to date, given that microRNAs are mainly involved in the cell's stress response making them ideal candidates for mediating the skeletal muscle response to changes in contractile activity. Identifying and validating target genes will help understand the molecular mechanism through which microRNAs regulate skeletal muscle in response to exercise.

Consensus of the Brazilian Association of Nutrology and the Brazilian Society for Food and Nutrition on the consumption of cow's milk by humans

Carlos Alberto Nogueira-de-Almeida — 2024-06-06

Obesity and mental disorders: prevalence analysis in a group of employees of a large multinational company in Brazil

Leonardo Benhame Rodrigues Kyrillos — 2024-06-03

Obesity is a 21st-century pandemic that is associated with cognitive and mental health problems, non-communicable diseases, and premature death. Several studies have associated obesity with the occurrence of mental disorders, including depression. Considering the high prevalence of the two comorbidities and the importance of their impact on people's lives, the objective of this work was to analyze the correlation between obesity and mental disorders, including depression, in adult employees of a large multinational company based in Brazil. This study followed a prospective observational longitudinal and comparative model, following the STROBE rules. This study was approved by the Ethics and Research Committee. 3706 electronic medical records of occupational medicine consultations of employees from different regions of Brazil of a large multinational company were evaluated, between the years 2020 and 2021. For the present study, the BMI profile was crossed, according to the BMI classification. Brazilian Association of Nutrology (ABRAN) with data from the assessment of the mental state of employees considering the results of the Self Report Questionnaire (SQR20). The results obtained showed an association between the two variables and allowed us to conclude that overweight/obese employees have a higher incidence of mental disorders; employees with low and normal weight are primarily in the age group under 40; overweight/obese employees are preferably between the ages of 40 and 60; men have a higher incidence of overweight and a lower rate of mental disorders; women have a higher incidence of normal weight and a higher rate of mental disorders; Underweight employees are less likely to suffer from mental disorders.

Individualized parenteral nutrition guideline: the challenge of trace elements

Claudio de Lima Barbosa — 2024-05-31

Parenteral nutrition (PN) is one of the pharmacological therapies that makes it possible to save lives previously condemned to death. PN entered clinical practice in the mid-1960s and was one of the most important advances in medicine after the discovery of anesthetics, antibiotics, and antisepsis methods. PN, however, is not without risks, as it is considered a high-alert medication that involves a significant risk of harm when used incorrectly. PN is the most complex existing pharmacological preparation with 20 to 40 active ingredients, the process of its application being transdisciplinary and its safety dependent on individual competence and reliable performance in each of its stages. The correct, individualized, and safe prescription of trace elements represents one of the biggest challenges in this process.

Enteral and parenteral therapy in the regulation of microRNAs to mitigate inflammatory processes and metabolic disorders in patients with obesity: a systematic review

Monysa Soares Bonfim — 2024-04-24

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 January to March 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 =59.2% >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.

The weight of obesity: a retrospective analysis of the direct costs of hospitalizations due to obesity between 2011 and 2020 for the unified health system in Brazil

Welisson Barbosa Costa — 2024-04-16

Aim: This study aimed to analyze the evolution of obesity-related costs over the past 10 years for Brazil's Unified Health System (SUS) and provide insights for guiding and expanding health management and promotion measures. Methods: An observational and retrospective study was conducted using secondary data from 2011 to 2020, extracted from DataSUS with the ICD-10 code for obesity. Statistical analysis was performed to assess trends in hospitalizations and costs related to obesity. Results: During the analyzed period, there was a substantial increase of 110% in hospitalizations and 167% in obesity-related costs for SUS. Female patients (86%) accounted for the majority of hospitalizations, while males (14%) had lower representation. Predominantly, white individuals (62%) were admitted, whereas indigenous individuals had the lowest representation (0,007%). The Southern region contributed to 46% of total cases, in contrast to the Northern region, which accounted for only 0,9%. Conclusion: The findings of this study indicate a significant rise in hospitalizations and associated costs related to obesity for Brazil's Unified Health System. These results underscore the urgency of implementing health promotion and prevention measures, both in the public and private sectors. There is a need for optimized allocation of human resources, including trained professionals for obesity treatment, to mitigate the burden of obesity-related morbidity and mortality and alleviate the strain on the healthcare system.

Major clinical implications of adequate nutrition in children and adolescents with attention-deficit/hyperactivity disorder: a concise systematic review

Michelle Silva Rocha — 2024-04-14

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inappropriate levels of impulsive behavior, hyperactivity, and/or inattention, with a worldwide prevalence estimated at around 7% in childhood and adolescence, and around 3 % in adulthood, with a higher prevalence in boys than in girls. Objective: It was to present the main clinical implications of adequate nutrition in children and adolescents with attention-deficit/hyperactivity disorder. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from January to March 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, 21 articles were evaluated, and 14 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 19 studies with a high risk of bias and 30 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X²=62.8%>50%. Intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) fatty acids daily for 8 weeks is associated with less impulsive behavior in children with ADHD. Dietary supplementation with omega-3 fatty acids reduces ADHD symptoms in both individuals with ADHD and typically developing children. A Mediterranean diet may improve BIS results, although our results are not conclusive in this population. The daily intake of calories and nutrients in patients taking methylphenidate is generally lower than in a healthy population of similar age. Co-supplementation of vitamin D and magnesium over 8 weeks may improve behavioral function and mental health in children with ADHD.

Action of cannabidiol in interaction with microRNAs and exosomes in modulation of inflammatory and immune processes in athletes: a systematic review

Rafaelle Paes de Barros — 2024-04-12

Introduction: The correct interaction between elements of the endocannabinoid system plays an important role in the development of the central nervous system. Clinical and preclinical studies suggest that cannabidiol (CBD) may be useful for athletes due to its anti-inflammatory, analgesic, anxiolytic, and neuroprotective properties and its influence on the sleep-wake cycle. In addition, a series of implications for epigenetic processes have also been proven, through changes in the expression of microRNAs responsible for modulating the immune and inflammatory systems. Objective: It was to develop a systematic review study to highlight the main aspects of cannabidiol in the interaction with microRNAs and exosomes in the modulation of inflammatory and immunological processes in athletes. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from February to April 2023 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: A total of 228 articles were found, and 84 articles were evaluated in full and 33 were included and developed in this 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 90 studies that did not meet GRADE. CBD has been reported to exert a range of physiological, biochemical, and psychological effects with the potential to benefit human health. For example, there is preliminary supporting evidence for the anti-inflammatory, neuroprotective, analgesic, and anxiolytic actions of CBD and the possibility that it may protect against gastrointestinal damage associated with inflammation and promote the healing of traumatic skeletal injuries. The combination of Δ9-THC and CBD can alter the activity of microRNAs responsible for increasing the biosynthesis of inflammatory mediators, leading to a reduction in the inflammatory profile. However, it is important to recognize that these findings are very preliminary, sometimes inconsistent, and largely derived from preclinical studies. These studies are limited in their generalizability to athletes and often administer high doses of CBD. The central observation is that there is a lack of studies that directly investigate CBD and sports performance.

Tactile and smell/taste sensitivity and accepted foods according to sensory properties: a cross-sectional study with children from a reference center in feeding difficulties

Raquel Ricci — 2024-04-03

Introduction: Children with feeding difficulties are more likely to present sensory sensitivities and detect meaningful changes in the sensory properties of foods and reject new foods. Objective: The aims of the study were to identify the top food sources of energy according to children sensitivity profile, and investigate whether there are differences between children sensitivity profile and number of food categories consumed according to their sensory properties. Methods: This was a cross-sectional study with 65 children recruited from an outpatient clinic for children with feeding difficulties, Brazil. Socio-demographics and weight status were included to characterize the sample. Sensory processing using the adapted and validated Short Sensory Profile (SSP) and included the tactile and smell/taste processing domains. Parents reported the number and sources of foods/preparations accepted/consumed by their children. Foods accepted were classified according to the adapted “What We Eat in Latin American - WWELA” classification system. Four aspects of sensory properties were subjectively evaluated for all foods accepted in taste, color, consistency, and texture. Results: Most of the children with tactile and smell/taste sensitivities were classified as combined probable/definite differences, with 52.3% and 92.3%, respectively. Average number of foods categories accepted was 18.81. Rice, whole milk, and banana were among the top food sources for each of sensory processing domains examined. Only children in smell/taste sensitivity showed significant differences for consuming more fibrous foods, with children under typical performance accepting more foods (28.50 2.12) than combined probable/definite differences (16.86± 5.25). Conclusion: Child sensory processing aspects are important when considering the exposure in relation to child acceptance of foods.

Major considerations of enteral nutritional therapy in patients with congestive heart failure: a systematic review

Alexsandro Pereira de Andrade — 2024-03-18

Introduction: Nutrition in the cardiovascular area has focused on improving lifestylerelated diseases such as hypertension, diabetes, dyslipidemia, obesity, and metabolic syndrome from the point of view of primary and secondary prevention, that is, “nutrition for weight loss ” and nutritional guidance has been required. Congestive heart failure (CHF) is a serious and growing public health problem worldwide. Approximately 25 million people are carriers of this disease and two million new cases are diagnosed each year, and enteral nutrition has been highlighted. Objective: It was to develop a systematic review of the main clinical outcomes that highlight the importance of enteral nutritional therapy in patients with congestive heart failure. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from October to November 2023 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: 143 articles were found. A total of 45 articles were evaluated and 34 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 17 studies that did not meet GRADE and AMSTAR-2. It was concluded enteral nutrition is highly recommended in an attempt to mitigate weight loss in these patients. Enteral diet therapy can be infused continuously or intermittently. Studies have shown that more debilitated and less active patients better accept the diet via continuous tube, slowly and for a long period, even in those with heart disease.

Investigation of regenerative nutrology of cells/molecules to the organism: a systematic review

Alessandra Leal de Oliveira — 2024-03-18

Introduction: In the context of tissue regeneration and nutrology, stem cells from adult tissue mediate homeostasis and regeneration of tissues and organs. These decisions are directly integrated with the body's energy balance and nutritional status. Endogenous metabolites and dietary nutrients can directly influence epigenetic enzymes. Objective: It was to carry out a systematic review of the regenerative nutrology of cells and molecules in the body. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April to June 2023 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: A total of 112 articles were found. A total of 45 articles were evaluated in full and 25 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 18 studies that did not meet GRADE. It was evidenced that the metabolism of stem cells was centered on the central metabolism of carbon and the balance between glycolysis versus oxidative phosphorylation in the regulation of cell destiny. Epigenetic modifications to DNA and histones, proteins that alter cellular fate, control chromatin accessibility and downstream gene expression. In addition to the connection between metabolism and epigenetic pathways, nutrients can impact cellular status by modulating signaling pathway activity. A clear example is through the mechanistic targeting of the rapamycin (mTOR) signaling pathway, and in particular the mTOR 1 complex. Nutritional supplementation accelerated the healing of skin ulcers and reduced the intensity of wound care in non-malnourished patients.

Effectiveness of argon plasma coagulation in the treatment of weight regain after roux-y gastric bypass: a cross-sectional prospective observational study

Keila Regina Matos Cantanhede — 2024-02-28

Introduction: Roux-en-Y Gastric Bypass (RYGB) is one of the most commonly performed surgeries to treat obesity worldwide. However, approximately 20% of patients have a recurrence of obesity, and enlargement of the gastrojejunal anastomosis is one of the associated factors. Endoscopic treatment of anastomosis has been proposed for further weight loss. One of the most commonly used techniques for anastomotic narrowing is argon plasma coagulation (APC). However, no randomized controlled trials have proven that this technique is superior to multidisciplinary follow-up. Objective: To evaluate and investigate the efficacy and safety of the application of argon plasma in the gastrojejunal anastomosis in the relapse of obesity after Gastric Bypass. Methods: Transversal study. Thirty-two patients were selected. More than 50% of The excess body weight regained was lost. Ranging from 6 to 25 kg. Results: A loss of more than 50% of the excess weight regained was observed in 30 % patients. Ranging from 6 to 25 kg. Conclusion: The application of argon plasma coagulation was safe and effective in the treatment of obesity recurrence after gastric bypass.

Nutrological aspects of polyphenols and gut microbiota in sports performance: a systematic review

Lara Souza Crepaldi — 2024-02-16

Introduction: In the context of nutrology and sports performance, the focus for intake in athletes and physically active individuals has been directed to the main class of polyphenols. Interest in a personalized approach is increasing in sports to maximize each individual's athletic ability in endurance and strength sports. Polyphenols represent a heterogeneous class of compounds with marked antioxidant and anti-inflammatory properties. The impact of the gut microbiota on the bioavailability and activity of polyphenols is highlighted. Objective: It was to carry out a systematic review to highlight the main relationships between polyphenols, gut microbiota, and sports performance. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to July 2023 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: A total of 115 articles were found, and 81 articles were evaluated in full and 76 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 6 studies with a high risk of bias and 10 studies that did not meet GRADE. As a result and conclusion, it was shown that the metabolic mechanisms favored by polyphenols improve sports performance, improve cardiometabolic functions, reduce recovery times and post-exercise pain, maintain a low degree of oxidative stress, and avoid unregulated inflammatory processes. Thus, polyphenols are able, through their interaction with the gut microbiota, to favor the proliferation of bacterial genera of great importance for metabolic and cognitive functions, such as Akkermansia, Lactobacilli, and Bifidobacteria. Gut microbiota metabolizes polyphenols in the colon to produce small bioactive molecules that exert epigenetic mechanisms on biochemical pathways modulating gene expression. Polyphenols have multiple biological effects, and future exercise studies should be appropriately and specifically designed to determine the physiological interactions between exercise and the selected supplement, rather than just considering performance.

Clinical approaches to the ketogenic diet in the treatment of obesity and other chronic diseases: a systematic review

Lorenna Lemos de Aquino — 2024-01-31

Introduction: The ketogenic diet, a restrictive diet, is mainly characterized by high fat content, low or absent carbohydrate content, and low or normal amounts of protein. Objective: It was to present the important role of the ketogenic diet in the treatment of obesity and other chronic diseases. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 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 111 articles were found, and 44 articles were evaluated, and 22 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 19 studies with a high risk of bias and 32 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X²=65.7%>50%. It was concluded that the therapeutic use of the ketogenic diet is relevant in the treatment of obesity and metabolic syndrome. Furthermore, this work also showed the benefits of the metabolism of ketone bodies in the adjuvant treatment of cancer, diabetes, and obesity, thus contributing to updating knowledge about the use of the ketogenic diet in the therapy of diseases of great clinical and epidemiological importance. When it comes to obese and diabetic people, it is important to highlight that due to the lower consumption of fiber, and an increased consumption of proteins (mainly of animal origin) and fat, the risk of heart disease, colon cancer, and intestinal constipation increases.

Nutrological and pharmacological approaches to cancer cachexia: a systematic review

Roberto Claudio Correia Filho — 2024-01-27

Introduction: Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by the continuous loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. Cancer cachexia is associated with poor 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 the nutrological and pharmacological treatment of cancer cachexia through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from October a December 2023 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: A total of 127 articles were found. A total of 67 articles were evaluated and 24 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 10 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X²=74.5%>50%. Based on the results, symptoms associated with cancer cachexia are thought to be caused by tumor-induced changes in host metabolism that result in systemic inflammation and abnormal neurohormonal responses. The sarcopenia seen in many patients with cancer cachexia is caused, in part, by increased activation of circulating proteolysis-inducing factor (PIF) and skeletal muscle protein breakdown by the ubiquitin-proteasome pathways. The nutritional consequences of cancer treatments must be identified early with screening and assessment of nutritional status. Nutritional intervention includes screening and appropriate nutritional assessment, which should begin early in the disease course 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 controlled trials of cancer patients. Also noteworthy was the use of corticosteroids and mirtazapine for weight gain and pain control.

Major clinical outcomes of the regulation of metainflammation in patients with obesity in the light of nutrology: a systematic review

Renan Francisco Merloto — 2024-01-26

Introduction: Obesity stands out as a multifactorial disease that can cause several public health problems. There are 2.0 billion overweight and obese people in the world, and Brazil is in fifth place in the world ranking. A healthy nutritional status promotes immune function and can prevent the onset of a serious inflammatory process and severe infections, especially in times of pandemics such as COVID-19. Objective: It was to highlight the main clinical outcomes of the regulation of meta-inflammation in patients with obesity in the light of nutrology. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to September 2023 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: A total of 130 articles were found. A total of 42 articles were fully evaluated and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies at high risk of bias and 21 studies that did not meet the GRADE. Most studies showed homogeneity in their results, with X²=71.7%>50%. Research has shown that unbalanced eating patterns, such as the Western diet, rich in simple sugars, refined carbohydrates, and saturated and trans fatty acids, lead to chronic inflammatory responses, increased adipose deposition, and future comorbidities associated with overweight and obesity. Calorie restriction decreased CRP in obese patients and diet administration over 12 weeks had a beneficial effect. Furthermore, obese patients with antioxidant supplementation had lower values of BMI, waist circumference, fasting blood glucose level, and assessment of the homeostasis model of insulin resistance when compared to the placebo group, as well as having lower levels of total cholesterol, triglycerides, LDL, malondialdehyde and tumor necrosis factor-alpha. n-3 PUFA supplementation can significantly reduce serum C-reactive protein (CRP), tumor necrosis factor α (TNFα), and interleukin 6 (IL-6) concentrations.

Nutritional modulation of gut microbiota in inflammatory bowel disease: a systematic review

Mariana Magalhães Bandeira Gomes — 2024-01-18

Introduction: Inflammatory bowel diseases (IBD) have shown an increase in incidence worldwide. The pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microbiota (dysbiosis) and chronic inflammation develops as a result of poor dietary triggers. Diet plays an important role in modulating the gut microbiota and can be applied as a therapeutic tool to improve the course of the disease. Objective: It was to carry out a systematic review of the main interactions between nutrology, gut microbiota, and inflammatory bowel disease, to elucidate the main clinical outcomes of the disease after nutrological treatment, analyzing the main macro and micronutrients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2023 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: 144 articles were found. A total of 39 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 27 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=59.9%>50%. With nutritional treatment, several micronutrients have the potential to modulate intestinal inflammation. Immunonutrition has demonstrated its importance through vitamins A, C, E, and D, folic acid, beta-carotene, and trace elements such as zinc, selenium, manganese, and iron. The Specific Carbohydrate Diet, fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet, and the Mediterranean diet also appear to show strong anti-inflammatory properties and promise to improve symptoms of inflammatory bowel disease. Diet modulation can control IBD by reducing persistent intestinal symptoms, balancing the gut microbiota, and reducing markers of inflammation. Dietary therapy can improve the quality of life of IBD patients.

Management of enteral/parenteral therapy in patients with obesity in the light of exosomes/microRNAs: a systematic review

Lara Suellen Marinho São Mateus — 2024-01-11

Introduction: Alteration in the homeostasis of the intestinal microbiota is related to the prevalence of obesity, which could reach up to 57.8% of the adult world population by 2030. Likewise, the global incidence rate of type 2 diabetes, which represents 90-95 % of all diabetes cases. Extracellular vesicles (exosomes and microRNAs) have emerged as main vehicles for intercellular and intermolecular communication, including those established between the intestinal microbiota and mammals. Providing adequate nutritional therapy with essential nutrients can help mitigate the consequences of the catabolic response. Objective: It was to bring together the main considerations of enteral/parenteral nutritional therapy in patients with obesity, highlighting the management of inflammatory and metabolic processes through exosomes and microRNAs. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2023 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: 118 articles were found. A total of 44 articles were evaluated in full and 39 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =52.5%>50%. It was concluded that exosomes and miRNAs, through enteral/parenteral nutritional therapy, are involved in the control of weight gain, glucose homeostasis, and lipid metabolism. Some clinical studies have shown that enteral nutritional therapy is effective and safe before bariatric surgery, with ketogenic enteral nutrition leading to better clinical outcomes than hypocaloric enteral nutritional protocols in glycemic and lipid profiles to satisfy better regulation of exosomes. and microRNAs, mainly from the intestinal microbiota, for the control of inflammatory and metabolic processes.

Influences of probiotics and gut microbiota on immunomodulation for the treatment of patients with cancer: a systematic review

Mariana Carolina Braga — 2024-01-09

Introduction: Immunomodulation and immunostimulation are the main mechanisms of action of probiotics in the fight against cancer. Objective: It was to carry out a systematic review of the influences of probiotics and gut microbiota on immunomodulation for the treatment of cancer patients. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 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 125 articles were found, and 35 articles were evaluated in full and 18 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 45 studies with a high risk of bias and 15 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=55.4%>50%. It was concluded that probiotics suppress inflammation by inhibiting several signaling pathways and reducing the global activation of NF-κβ and the production of pro-inflammatory cytokines. Probiotics influence receptor antagonism, receptor expression, binding and expression of adapter proteins, expression of negative regulatory signal molecules, and mainly the induction of microRNAs. These microRNAs can modulate the gene expression of tumor cells together with regulatory T cells that have important functions in the tumor microenvironment, mainly in inducing immune evasion. Some modulatory effects of probiotics include the production of cytokines by epithelial cells, increased mucin secretion and phagocytosis and NK cell activity, activation of T and NKT cells, stimulation of IgA production, and decreased proliferation of T cells. The gut microbiota has a major impact on the systemic immune system. The specific microbiota controls cell differentiation in which CD4+ T cells (Th17 cells) secrete IL-17. The presence of Th17 cells and regulatory T cells is associated with the gut microbiota.

Clinical studies and meta-analysis on the effects of collagen, vitamin, and nutrient supplementation for the rejuvenation of collagenic fibers: a systematic review

Michelle Silva Rocha — 2024-01-05

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) increases the levels of collagenderived peptides in the bloodstream and improves skin properties. Objective: It was to carry out a systematic review to elucidate the main results of clinical studies and meta-analyses of clinical studies on the effects of supplementation of types of collagen, vitamins, and nutrients for the rejuvenation of collagen fibers. Methods: The search was carried out from October to December 2023 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 122 articles were found, and 12 articles were evaluated in full, 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 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. 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.

Obesity and comorbidities in COVID-19: a longitudinal observational retrospective study of the main relationships of life risk

Marina Ribeiro Coutinho Teixeira de Carvalho Almeida — 2023-12-12

Introduction: Currently, around 30% of the world's population is overweight or obese. By 2030, it is estimated that more than 60% of the world's population will be overweight or obese. The COVID19 pandemic has resulted in the worsening of obesity comorbidities. The primary increase in the inflammatory response in obese patients functions as a predictor for the hyperinflammatory state observed in COVID-19. Therefore, this primary increase can be amplified by SARS-CoV-2 infection, increasing the production of cytokines such as TNF-α, IL-1, and IL-6. Objective: It was to carry out a retrospective longitudinal observational study to quantitatively analyze how cardiovascular comorbidities such as diabetes, hypertension, obesity, smoking, and compromised immunity contribute to the increased risk of life of participants affected by COVID-19. Methods: This study followed a longitudinal observational retrospective design (STROBE). A total of 45 public and official documents from Brazil (ANVISA), WHO (World Health Organization), Pan American Health Organization (PAHO), EASO (The European Association for the Study of Obesity - The European Commission/ National Information on COVID-19, Lancet Resource Centre) and scientific articles were subjected to eligibility analysis and, after that, 32 documents dated from 2019 to 2022 were selected. Results: In total, 3,993,857 participants were found from 32 documents. The highest incidence of deaths occurred in participants who were smokers, had compromised immunity, had diabetes, and were obese. The greatest risk of death was observed among participants who smoke (HR=2.5) and those with compromised immunity (HR=2.1). Despite this, other comorbidities such as diabetes, obesity, and hypertension also presented statistically significant results for the risk of life. It was observed that only the difference between the means of the comorbidities “obesity” and “diabetes” was not statistically significant, with p<0.05, that is, both comorbidities have similar impacts on the worsening and death of participants in the presence of COVID-19. Conclusion: Cardiovascular comorbidities such as diabetes, hypertension, obesity, smoking, and compromised immunity contributed to the increased risk of life in participants affected by COVID-19, especially in those of an older age. The endothelial dysfunction caused by SARS-CoV-2 explains why participants with comorbidities related to blood vessels such as cardiovascular disease, hypertension, diabetes, and obesity are more likely to develop severe COVID-19, even death

Major approaches and clinical studies of the relationship of inflammatory bowel diseases with nutrients, gut microbiota, and exosomes/microRNAs: a systematic review

Maria Eduarda Brianez — 2023-11-30

Introduction: Inflammatory bowel diseases (IBDs) are multifactorial diseases characterized by chronic inflammation of the gastrointestinal tract. Nutrients, gut microbiota, exosomes, and microRNAs play crucial roles in the pathophysiology of IBD. Objective: It was to carry out a systematic review of the main approaches and clinical studies on the relationship between inflammatory bowel diseases and nutrients, intestinal microbiota, and exosomes/microRNAs. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2023 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 177 articles were found, and 58 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 06 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=67.7%>50%. It was concluded that inflammatory bowel diseases are associated with various gastrointestinal symptoms and, therefore, affect patients' quality of life. Although intestinal bacteria and the host's immune response are considered important factors in its pathogenesis, a sufficient explanation of their role in its pathophysiological mechanism has not been presented. Exosomes and microRNAs, together with nutrients and gut microbiota, participate in the molecular interactions of inflammatory bowel diseases. Recent studies have confirmed the important role of miRNAs in targeting certain molecules in signaling pathways that regulate intestinal barrier homeostasis, inflammatory reactions, and autophagy of the intestinal epithelium. Several studies have identified specific miRNAs associated with inflammatory bowel diseases in colon tissues. The correlation between the gut microbiota and cytokines suggests that exosomes and microRNAs can modulate intestinal immunity by influencing the gut microbiota.

Impact on quality of life caused by vitamin D deficiency in bariatric patients: a literature review

Aline de Aguiar Dantas Ikoma — 2023-10-26

Introduction: Bariatric surgery is a procedure performed to control obesity and its associated morbidities. Surgeries with malabsorptive and mixed techniques cause a deficit in the absorption of micronutrients, including vitamin D. Objective: The objective of this literature review was to investigate studies that verified the impact of vitamin D deficiency on the preand postoperative quality of life of individuals undergoing bariatric surgery. Methods: The search strategy was carried out in the virtual databases PubMed, Scielo, LILACS, Scopus, Web of Science, Embase, and the Virtual Health Library, in addition to gray literature such as Google Scholar, OpenGrey, Ibict/BDTD (Brazilian digital library of theses and dissertations) and ProQuest using the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) descriptors with Boolean logical operators (AND, OR and NOT. The studies considered potentially eligible were those that presented in the same article the levels of vitamin D in the pre and postoperative period of the individuals, as well as the effect generated on their quality of life from where the data collection and analysis of the main outcomes found were made. Results: The online search resulted in 197 studies located in the virtual bibliographic databases and 115 in the gray literature. After removing the duplicates, 235 articles remained that were read by title and abstract, and 12 articles were chosen for reading the full text, leaving 7 that met the inclusion criteria. In most of the included studies, vitamin D deficiency was higher preoperatively than postoperatively in bariatric individuals. Better levels of 25(OH)D were correlated with reduced body weight, decreased BMI, and improved glycemic profile. Conclusion: Combating obesity remains an important issue in Public Health, with bariatric surgery being a safe way to reduce overweight since vitamin D levels are lower in the postoperative period of bariatric individuals, however, it is suggested to choose the appropriate technique to maintain ideal vitamin indices.

Highlight the major clinical outcomes of vitamins and minerals in healthy aging: a systematic review

José Joaquim Portilla Ramos — 2023-10-23

Introduction: In the context of healthy longevity, aging is a natural phenomenon that promotes a senescent phenotype, with the shortening of telomeres. The main ways to increase a healthy life expectancy include lifestyle modifications and pharmacological manipulations. Vitamins, minerals (as micronutrients), essential amino acids, polyunsaturated fatty acids (PUFA), probiotics, and plant metabolites such as polyphenols and terpenoids are widely recognized for preventing aging. Objective: It was to carry out a systematic review to highlight the main clinical outcomes of vitamins and minerals in healthy aging. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2023 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 122 articles were found, and 40 articles were evaluated in full and 38 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 21 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=72.4%>50%. Zinc and copper govern many functions that characterize the so-called “oxy-aging”. Selenium (Se) is a fundamental cofactor in many redox functions, vitamin C's role in aging has been investigated particularly for skin health and immunity, particularly in inflammatory and degenerative diseases. Retinoids, which represent a synthetic form of vitamin A, appear effective in preventing skin degeneration due to aging. The role of vitamin E in preventing and reducing ROS-induced injuries has been well described. Supplementation with selenium and coenzyme Q10 influenced the biomarkers analyzed to indicate an anti-aging effect. It was concluded that micronutrients such as vitamins and minerals have anti-oxidant, protective, and regenerative properties to promote healthy aging.

Effects of cannabidiol on metabolic modulation and improving sports performance: a systematic review

Franciele da Silva Conter — 2023-10-17

Introduction: In the sports scenario, cannabidiol (CBD) is a phytocannabinoid that has been accumulating important scientific evidence in various metabolic and metabolomic effects. Δ9 tetrahydrocannabinol (Δ9-THC) may be responsible for some adverse effects on sports performance and this makes cannabis unattractive for athletes. Extracellular vesicles (exosomes and microRNAs) induced by exercise emerged as potential mediators of tissue crosstalk. Objective: It was to carry out a systematic review study to highlight the main outcomes of cannabidiol in metabolic modulation and microRNA signaling in increasing sports performance. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from March to May 2023 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: A total of 127 articles were found. A total of 87 articles were evaluated in full and 62 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with a high risk of bias and 11 studies that did not meet GRADE. It has been shown that cannabidiol exerts some physiological, biochemical, and psychological effects with the potential to benefit athletes. For example, there is preliminary supporting evidence for the anti-inflammatory, neuroprotective, analgesic, and anxiolytic actions of cannabidiol and the possibility that it may protect against gastrointestinal damage associated with inflammation and promote healing of traumatic skeletal injuries. However, it is important to recognize that these findings are very preliminary, sometimes inconsistent, and largely derived from preclinical studies. These studies are limited in their generalizability to athletes and often administer high doses of cannabidiol. The central observation is that there is a lack of studies that directly investigate cannabidiol and sports performance. Furthermore, we identified a specific repertoire of microRNAs that are regulated by cannabinoids, at rest (vigilant), and in microglia activated by lipopolysaccharides. Modulated microRNAs and their target genes are controlled by TLR, Nrf2, and Notch cross-signaling and are involved in the immune response, cell cycle regulation, as well as cellular stress and redox homeostasis.

Anais XXVII Congresso Brasileiro de Nutrologia - n. 27, v. 1, 2023

Carlos Alberto Nogueira-de-Almeida — 2023-10-04

O Congresso Nacional de Nutrologia, maior evento da área na América Latina, está na sua 27ª edição.
O CBN 2023 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 gerados pela comunidade acadêmica, envolvidos pela Nutrologia em todo o país, sejam compartilhados.
Dessa forma, além das conferências e palestras, foram selecionados 381 trabalhos, que estão publicados nesses Anais, e 13 foram escolhidos para serem apresentados oralmente durante o evento. Toda esta difusão de conhecimento enriquecerá ainda mais o CBN 2023.

Major considerations in the use of bariatric endoscopic therapy (intragastric balloon) and nutrological therapy in successful weight loss in patients with obesity: a systematic review

Cleanne Martins Silva — 2023-09-11

Introduction: Obesity is a chronic and multifactorial disease that affects more than 2.2 billion people worldwide. Treatment options for obesity have expanded significantly and include lifestyle changes, pharmacotherapy, endoscopic bariatric therapies, and bariatric surgery. Objective: It was to carry out a systematic review to present the main considerations regarding the use of the intragastric balloon as bariatric endoscopic therapy and nutritional therapy in an attempt to achieve successful weight loss in patients with obesity. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to August 2023 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: 129 articles were found. A total of 34 articles were evaluated in full and 24 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 12 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =74.7% >50%. In the challenges against super obesity and comorbidities, the use of endoscopic devices has been reported for many years, with the majority of positive results for patients. These devices are gaining increasing acceptance, and the Food and Drug Administration (FDA) has approved three endoscopic devices for use. Patients should be carefully assessed nutritionally and medication-wise and advised on the most appropriate route. To promote long-term adherence, any dietary intervention must take into account patients' dietary preferences, cultural context, and food availability. Ideally, use a combination of Mediterranean and high-protein diets to promote weight loss based on the patient's preference.

A review of the role of vitamin d in autoimmunity

Danilo Chiaradia Finamor — 2023-08-11

Introduction: The main function of vitamin D is to increase the intestinal absorption of calcium, participating in the stimulation of active transport of this ion in enterocytes. Extra-renal hydroxylation of vitamin D also occurs, originating the vitamin that would act in an autocrine and paracrine manner, with functions of inhibiting cell proliferation, promoting cell differentiation, and immune regulation. Objective: It was to review the scientific literature on the role of vitamin D in autoimmunity. Methods: A search was carried out on scientific articles centered on the proposed theme: “Role of vitamin D in autoimmunity”. Several search engines that carried scientific information in the health area were used to carry out this study, such as Google Scholar and the Medical Publications database (PubMed), and Scientific Electronic Library Online (SCIELO). In collecting the information, the descriptors used to carry out this research were: vitamin D; vitamin D in preventing diseases; vitamin D and autoimmune diseases; vitamin D; autoimmune diseases. The inclusion criteria used in this study were publications of scientific articles available in full and with free electronic access, limited to a period between 2011 and 2022, and selected articles in Portuguese and English. Results and Conclusion: Based on this methodology, it was possible to analyze a population of 58 articles that were selected for the study and constituted the sample used in this review. Several studies point to the effects of vitamin D not related to calcium metabolism, such as antineoplastic activity (particularly concerning breast, colon, and prostate cancers, and lymphoproliferative diseases), antihypertensive and immunomodulatory. Vitamin D deficiency and its use for treatment have been described in various autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, lupus, inflammatory bowel disease, myasthenia gravis, scleroderma, alopecia areata, psoriasis, vitiligo, autoimmune hepatitis, type 1 diabetes mellitus, autoimmune thyroiditis, etc. The effects of vitamin D on the immune system are related to the tolerance of self-antigens, exerting an inhibitory effect on the Th1 and Th17 type lymphocyte pattern, and a promoting effect on the expression of the Th2 and Treg pattern through the action of vitamin D in all cells of the system through the vitamin D receptor. More studies are needed to establish safe and effective doses in the management of these properties of vitamin D.