International Journal of Nutrology

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.

Vitamin D deficiency and preterm birth: a comprehensive review

Cristiane Fadel Bearzi — 2023-08-10

Introduction: Pregnancy and its prognosis are highly influenced by maternal nutritional status before and during pregnancy. We know the importance of adequate macronutrient intake and micronutrient supplementation in the preconception period, during pregnancy and in the puerperium. Objective: This literature review aimed to study the relationship between preterm birth and hypovitaminosis D. Methods: Literature review carried out in the Google Scholar, Virtual Health Library (VHL), SciELO and PubMed databases in period of last 5 year- 2017-2022 (june). Results and Conclusion: recent evidence supports that vitamin D deficiency during pregnancy is associated with an increased risk of preterm birth. It is known that hypovitaminosis D during pregnancy can be a risk factor for preterm birth and all its complications for the newborn. But its isolated supplementation during pregnancy is still not a preventive action with statistically significant benefits in preterm birth. Researchers and physicians should be made aware of this issue to improve prenatal care. Strategies adopted to prevent preterm birth are scarce, and it is hoped that in the posterity the evidence mentioned in this article on the role of vitamin D may help to reduce its incidence and, consequently, mortality and, as such, improve the health of women pregnant women and their respective descendants.

Healthy longevity: a systematic review of nutrological and lifestyle aspects

Rodrigo Augusto Carvalho Junqueira — 2023-08-03

Introduction: In the context of healthy longevity, quality of life, genetic, environmental, and lifestyle factors can determine the life expectancy of human beings. Nutrition is a key component affecting our health, and several studies show that nutrition also has the potential to increase lifespan. Objective: It was to carry out a systematic review of the impacts of nutrology and lifestyle on the longevity of human beings, as well as to point out the main dietary and lifestyle care based on the results of clinical studies. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April 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 311 articles were found, and 147 articles were evaluated and 47 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies with a high risk of bias and 51 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =87.3%>50%. There is scientific evidence that nutrients and natural substances of human physiology and biochemistry such as melatonin and coenzyme Q10 control the functions of the immune system. Many metabolic or chronic diseases have been implicated with poor diet and lifestyle. Improved diet quality is associated with reduced all-cause mortality, whereas multivitamins and multimineral supplements can improve life expectancy. Overall well-being is improved when sedentary but sufficiently physically active adults reduce sedentary time and increase physical activity levels. The results of the pandemic indicate there have been a variety of lifestyle changes, physical inactivity, and psychological issues. Still, adults over 40 years old, with children, unemployed, and those living in a macroeconomic region were shown to be more exposed to unhealthy behaviors. The maintenance of dietary intervention through telemedicine can reduce the negative impact of eating habits and physical activity patterns.

Pmma body injection and hypercalcemia correlation: a cross-sectional observational study on the comprehensive analysis of variables

Fernanda Bortolozo — 2023-07-27

Introduction: Hypercalcemia related to aesthetic intramuscular implants exclusively made of PMMA (polymethylmethacrylate) is a very rare condition. Late complications of these implants are related to poorly understood inflammatory triggers, which may reactivate stabilized implants, increase calcitriol production, and lead to hypercalcemia. Methods: Records of patients seen between 2022 and 2023 with a PMMA microsphere body implant and a subsequent diagnosis of hypercalcemia were searched. Medical history, medication use, data on PMMA implantation, and laboratory tests related to calcium metabolism were described and subjected to variable correlation analysis. The instituted treatments were described. Results: A total of 17 female patients with exclusive body PMMA implants confirmed by ultrasonography or MRI (Magnetic Resonance Image) developed hypercalcemia between 2017 and 2022. Prior renal disease, COVID-19 infection, vitamin D use, and anabolic steroid use correlated with laboratory changes in hypercalcemia. Larger PMMA implant volumes led to parathyroid hormone suppression. Conclusion: Patients with PMMA body implants may rarely present with hypercalcemia when variables such as renal disease before implantation, high doses of vitamin D or anabolic steroids are present. Based on the data presented and the available scientific literature, recommendations for patient investigation, implant volume limit, and patient follow-up after the procedure were made.

The use of assistance dogs in the detection of hypoglycemic episodes in type 1 diabetes: a descriptive and comprehensive review

Anna Luiza Alves Boldrin de Siqueira — 2023-07-13

Introduction: Type 1 diabetes mellitus (T1DM) is a disease of autoimmune and polygenic origin, characterized by the destruction of the beta cells of the pancreatic islets and, consequently, the absence of insulin production. The treatment aims at imitating the physiological secretion of insulin in individuals without comorbidity, using insulin therapy. Hypoglycemia is defined as any event of abnormally low blood glucose, putting the person at potential risk. Tachycardia, tremors, pallor, cold sweating, lingual paresthesia, and blurred vision, possibly leading to coma, are its main signs and symptoms. The recognition of serious clinical conditions transmitted by both visual and olfactory signals can be understood and elaborated by the dog's cognitive system, allowing the rapid detection of a hypoglycemic episode and, thus, allowing adequate conduct before a serious episode. Objective: To analyze the advances, both in studies and in professional practices, in the use of assistance dogs to identify hypoglycemia in diabetics 1, as well as to seek to understand the consequences of unidentified and untreated hypoglycemia. Methods: The most relevant studies searched using the keywords "hypoglycemia AND diabetes", in addition to "diabetes alert dogs" in Google Scholar, were analyzed, with 4 corresponding to the objectives of the current research. Finally, pathology books and official documents from the Ministry of Health and the Brazilian Society of Diabetes were used to build a theoretical explanation. Results and Discussion: Dogs are conditioned to respond with specific alert behaviors, such as barking or licking, when levels of their owner's blood sugar levels are below the ideal range, as identified by the amount of isoprene released in the individual's breath. This attitude causes the patient to measure his plasma glucose level, helping him to carry out the appropriate measures to keep the levels back to normal. The hesitation of the occurrence of hypoglycemia causes some type 1 diabetic to contain their lifestyle to try to reduce the probability of the occurrence of a hypoglycemic episode, negatively affecting their quality of life and psychological well-being. In addition, they can intentionally maintain hyperglycemia to avoid a sudden drop in glucose, however, this practice results in late problems such as nephropathy, neuropathy, and cardiopathy. Conclusions: Hypoglycemia is one of the main threats for people with diabetes, as it results in severe symptoms that can lead to coma if not treated quickly. Possibly, dogs perceive plasma glycemic variations using, in addition to the olfactory apparatus, perceptions captured through other senses, mainly vision, but the scarcity of studies carried out with dogs trained to support people with diabetes problems, mainly in Brazil, makes the efficiency of these animals to detect alterations of glucose in the blood remains debatable.

Colostro bovino e suas aplicações na saúde humana: uma revisão narrativa

Carlos Alberto Nogueira-de-Almeida — 2023-07-10

Introdução: o colostro bovino é a secreção produzida pela glândula mamária da vaca nos primeiros dias após o parto. Trata-se de um alimento rico em proteínas, lipídios, além de enzimas, vitaminas, minerais, fatores de crescimento, oligossacarídeos, nucleotídeos e citocinas. Objetivo: Foi revisar a literatura em relação aos benefícios do consumo de colostro bovino para a saúde humana. Métodos: Revisão narrativa, conduzida por meio de busca nas bases de dados Pubmed, Medline, Scielo, Cochrane, Lilacs e Crossref, usando como palavra-chave “colostro bovino”. Resultados: foram encontrados estudos que envolvem potenciais benefícios para imunidade, desempenhos físico e muscular e saúde gastrointestinal. Conclusão: O colostro bovino é um produto alimentar e nutricional. Seu uso pode ser feito diretamente como alimento ou como componente de alguns alimentos, mas, atualmente, tem sido mais utilizado como suplemento. Os conhecimentos científicos relativos à segurança de uso e também aos benefícios à saúde de seus componentes, individuais ou associados, têm se acumulado nos últimos anos, permitindo graus crescentes de evidências que podem embasar sua utilização clínica.

Tissue regeneration and gut microbiota-skeletal muscle axis via microRNAs and nutrition: a systematic review

Rodrigo Augusto Carvalho Junqueira — 2023-07-10

Introduction: In the scenario of muscle regeneration in athletes, maintenance of skeletal muscle function is the prerequisite for tissue homeostasis and increased performance. MicroRNAs play a positive role in expanding our understanding of the controlling factors for skeletal muscle function. Recent progress has been made regarding gut microbiota, regenerative nutrition, and skeletal muscle metabolism. Objective: It was to carry out a systematic review of the main relations of regeneration of skeletal muscle-gut microbiota through nutrological functions, cells, and microRNAs. 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 217 articles were found. A total of 97 articles were fully evaluated and 49 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 54 studies at high risk of bias and 34 studies that did not meet the GRADE. It was concluded that miRNAs are widely present in skeletal muscle and play an irreplaceable tuning role in the proliferation, differentiation, apoptosis, development, and other physiological processes of skeletal muscle cells. The proposal that miRNAs are primarily involved in the cell's stress response makes miRNAs ideal for mediating the skeletal muscle response to changes in contractile activity. Research has accumulated evidence that confirms that miRNAs have played an important regulatory role in cell proliferation and differentiation, thus regulating skeletal muscle growth as highlighted in the small intestine by intestinal stem cells (LGR5+). The ketogenic or high-glucose diet regulates the self-renewal balance of LGR5+. Self-renewal and HSC differentiation can be regulated by manipulating vitamin C, A, or D levels and valine restriction. The composition of each athlete's microbiome influences sports performance.

Clinical and nutrological aspects of celiac disease: a case report

Mayelin Abreu Jorrin — 2023-07-04

Celiac Disease is an autoimmune enteropathy triggered by gluten intake in genetically predisposed individuals. The prevalence varies by country and it is estimated to be 1% of the population. Diagnosis can be made at any age, and may manifest in a typical manner with diarrhea, abdominal pain, malabsorption, malnutrition; or with atypical symptoms and extra intestinal manifestations such as metabolic diseases, and neurological symptoms. The interest in its diagnosis results in the regression of symptoms with the dietary exclusion of gluten, the recovery of adequate nutritional status, and the reduction of the risk of the appearance of more serious complications (refractory disease, lymphoma, and intestinal adenocarcinoma). A case is reported of a patient with Hashimoto's thyroiditis, with dyspeptic symptoms, ferropenia, and chronic fatigue who after an etiological investigation was diagnosed with celiac disease, in addition to reviewing current clinical, nutrological, and therapeutic aspects of the disease.

Major roles of the gut microbiota and microRNAs in cardiovascular disease events: a systematic review

Vanessa Piovesan Freitas Assumpção — 2023-07-03

Introduction: Gut microbiota (GM) is an essential mediator in the health of GM and has been identified as the origin of several diseases by influencing cell signaling and T cell receptor pathways in the central nervous system. Several microRNAs participate in signaling networks through GM intervention. The interaction between GM and miRNAs plays a crucial role in vascular dysfunction. GM can metabolize L-carnitine, choline, and phosphatidylcholine and produce vascular-toxic metabolites such as trimethylamine-Noxide (TMAO), which is associated with the atherosclerotic process. Nutrology and dietary therapy represent important strategies, especially with the use of plant-derived miRNAs to modify GM. Objective: To carry out a systematic review to highlight the main roles of the gut microbiota and microRNAs in cardiovascular disease events. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from March to May 2023 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 2002 to 2022. The low quality of evidence was attributed to reports of cases, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: The total of 126 studies were found for eligibility analysis, and then 42 of the 64 total studies were selected for this systematic review. According to the GRADE instrument, most studies showed homogeneity in their results, with X² =88.7%>50%. It was concluded that the gut microbiota can be influenced by diet, genetics, and environmental factors. Changes in the microbial population can lead to multiple diseases, including cardiovascular disease. miRNAs have been known as important regulators of several biological functions, and are also involved in the pathogenesis of cardiovascular diseases. There is evidence that disturbances in the gut microbiota and derived metabolites impair the development of atherosclerotic cardiovascular disease. Studies have shown that YRNAs belonging to extracellular vesicles and their fragments play important roles in the initiation, progression, and diagnosis of atherosclerosis.

Effects of melatonin in the prevention of cardiovascular diseases: a systematic review

Marcelo Melo Martins — 2023-06-30

Introduction: Obesity represents a multifactorial disease that causes major public health problems. There are about 2.0 billion overweight and obese people in the world, represented by 39.6% of adults. Melatonin may provide cardioprotection at low pharmacological doses. Melatonin's ability to improve cardiovascular function and its hypotensive effect because of its direct and receptor-dependent antioxidant actions suggest that melatonin may have some beneficial effects in controlling diabetic vascular complications. Objective: It was to carry out a systematic review of the main effects of melatonin in the treatment of obesity and diabetes mellitus, as well as in the prevention of cardiovascular diseases. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from April to May 2023 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles until 2023. The low quality of evidence was attributed to case reports, editorials, and short communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 168 studies were found for eligibility analysis, and so 46 of a total of 68 studies were selected for this systematic review. According to the GRADE instrument, most studies showed homogeneity in their results, with X² =90.4%>50%. The Funnel Plot showed a symmetrical behavior, not suggesting a significant risk of bias in studies with smaller sample sizes. It was concluded that melatonin can reduce body weight and fat mass and regulate energy expenditure, glucose/lipid metabolism, and insulin secretion; therefore, it can play an effective role in weight management. There is a growing consensus that the antioxidant and anti-inflammatory properties of melatonin are of great importance in preserving the body's function and homeostasis. In adulthood, disturbances in melatonin production negatively impact the progression of cardiovascular risk factors and promote cardiovascular and neurodegenerative diseases. The consumption of melatonin supplements can be effective in controlling blood pressure and anthropometric indices (as predictors of obesity) in patients with T2DM. Furthermore, melatonin has significant effects on ischemia-reperfusion injury, myocardial injury, pulmonary hypertension, hypertension, vascular diseases, valvular heart diseases, and lipid metabolism. As an inexpensive and well-tolerated drug, melatonin could be a new therapeutic option for cardiovascular diseases.

Major considerations of cardiometabolic nutrients in heart failure: a systematic review

Marcelo Melo Martins — 2023-06-29

Introduction: Heart failure (HF) is one of the main causes of hospitalizations in the world. In Brazil, about 7.0 million Brazilians suffer from this syndrome. The clinical evolution of patients with HF evidence variable conditions of malnutrition. This can occur due to inadequate intake, altered metabolism, pro-inflammatory state, increased oxidative stress, and greater loss of nutrients, even due to drug interactions. Objective: It was to demonstrate, through a systematic review of the literature, the main considerations of cardiometabolic nutrients in heart failure. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from April to May 2023 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles until 2023. The low quality of evidence was attributed to case reports, editorials, and short communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 136 studies were found for eligibility analysis, and so 75 of a total of 84 studies were selected for this systematic review. According to the GRADE instrument, most studies showed homogeneity in their results, with X² =92.2% >50%. The Funnel Plot showed a symmetrical behavior, not suggesting a significant risk of bias in studies with smaller sample sizes. The presence of malnutrition is an important predictive factor for reduced survival in patients with HF, highlighting inadequate food intake, altered metabolism, pro-inflammatory state, increased oxidative stress, greater loss of nutrients, and drug interactions. Patients with HF have anabolism/catabolism imbalance. Providing nutritional support significantly increased dietary adherence above 90%. Therefore, malnutrition and inflammation are important predictors for assessing the prognosis of the disease in patients with HF.

Major aspects of cannabidiol in the interaction with microRNAs and exosomes in the modulation of inflammatory and immunological processes in athletes: a systematic review

Aline Isabela Tiemi Ichikawa — 2023-06-20

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 60 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.

Influences of mindset and lifestyle on sports performance: a systematic review

Giovanna Maria Gontijo — 2023-06-19

Introduction: In the scenario of the mindset and performance of athletes, the athlete's lifestyle becomes an integral part of this development. e need to focus on the mindset of athletes, exploring the perspectives of elite athletes through a qualitative approach, in order to understand the lifestyle and other factors to which they attribute their success. Objective: It was to carry out a systematic review to present the main studies on the influence of mindset (mindset) on the performance of athletes, as well as the entire lifestyle scenario for this development. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from January to March 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 118 articles were found, and 32 articles were evaluated in full and 29 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 52 studies with a high risk of bias and 14 studies that did not meet GRADE. It was concluded that mindsets such as believing in yourself after failure (called the constructive mental code) are very beneficial for athletes' perseverance, motivation, and performance improvement. Still, a positive mindset can positively influence the performance of athletes, showing that mental skills training can lead to better performance in competition. Thus, champion athletes attribute their good mindset as the main predictor of competitive success. However, it is necessary to inform and encourage these practices in coaches and support staff in the area of the psychological skills of athletes. Mindfulness can benefit athletes' mindsets and performance. Cognitive variables, such as coping with stress, are significantly correlated with performance. Highperformance strategies include using honed mental rehearsal skills and practicing recovery.

Major nutrological approaches to macronutrients in the performance and body composition of highly trained athletes: a systematic review

Rosângela da Silva Castanho — 2023-06-19

Introduction: Findings around nutrient timing require appropriate context because factors such as age, gender, fitness level, previous fueling status, diet status, training volume, training intensity, program design, and time before upcoming training or competition can influence the extent to which timing can play a role in the adaptive response to exercise. Thus, nutrient timing is a feeding strategy that in almost all situations can be useful for promoting recovery and training adaptations. Objective: A systematic review was carried out to elucidate the importance of macronutrient consumption by highly trained athletes on performance and body composition. Methods: The present study followed a systematic review model (PRISMA). The search strategy was carried out in PubMed, Cochrane Library, Web of Science, Scopus, and Google Scholar databases, using scientific articles from 2009 to 2021. The low quality of evidence was attributed to case reports, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: After the study eligibility process, a total of 42 scientifically favorable articles were found to compose the systematic review. Biases did not compromise the scientific basis of the studies. The amount depends on the mode and intensity of exercise, the quality of protein ingested, and the individual's energy and carbohydrate status. However, it should be noted that there is preliminary evidence that consuming much higher amounts of protein (>3 g/kg/d) may confer a benefit concerning body composition. Concerns that protein intake within this range is unhealthy are unfounded in healthy, exercising individuals. One should try to consume whole foods that contain high-quality protein sources. Timing of protein intake in the period spanning the exercise session can provide several benefits, including improved recovery and greater gains in lean body mass. Essential amino acids and leucine supplements are beneficial for the exercising individual by increasing muscle protein synthesis rates, decreasing muscle protein breakdown, and possibly aiding exercise recovery.

Major clinical outcomes of vitamin D deficiency in inflammatory bowel diseases: a systematic and integrative review

Matheus Prudente Nabuth — 2023-06-18

Introduction: Clinical studies have proven the direct correlation of vitamin D deficiency in patients suffering from inflammatory bowel diseases, such as Crohn's disease, with an average age of 41 years and more frequently in women. Vitamin D seems to interact with the immune system through its action on the regulation and differentiation of cells such as lymphocytes, macrophages, and natural killer (NK) cells, in addition to interfering with the production of cytokines. Objective: It was to present, through a systematic review, the main clinical outcomes of the correlation of vitamin D deficiency and inflammatory bowel diseases, highlighting Crohn's disease. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to October 2022 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 207 articles were found, and 142 articles were evaluated and 117 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 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with R² =95.7% >50%. It was shown that the highest prevalence of low serum levels of vitamin D is among patients suffering from Crohn's disease and other inflammatory bowel diseases when compared to a control group. However, more comprehensive studies are still needed, especially those that aim to evaluate serum vitamin D in values related to clinical treatment and also the effects of vitamin D supplementation on disease activity and mucosal healing. Thus, it will be possible to evaluate in a relevant way, the replacement of vitamin D in the remission of Crohn's disease, optimizing the treatment of patients and corroborating the improvement in quality of life.

Major metabolic and metabolomic aspects of nutrition in the gut microbiota and sports performance: a systematic review

Vanessa Nishi Ishikawa — 2023-06-16

Introduction: In the context of sports performance, nutrition has been used to improve the health of the brain, bones, muscles, and cardiovascular system of athletes. However, recent research suggests that the gut microbiota (GM) may also play a role in athlete health and performance. Objective: It was to carry out a systematic review of the main clinical findings, involving the metabolic and metabolomic aspects, of the relationship between gut microbiota and sports performance under control and nutrological modulation. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from January to March 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 328 articles were found, and 132 articles were evaluated in full and 108 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 52 studies with a high risk of bias and 74 studies that did not meet GRADE. It was concluded that athletes must feed, train and utilize the entire supraorganism, including the GM, implementing gut-centered dietary strategies to achieve optimal performance. Current evidence suggests that the GM may contribute to sports performance through the production of dietary metabolites (short-chain fatty acids, secondary bile acids), influence on gastrointestinal physiology (e.g. nutrient absorption), and immune modulation (inhibition of pathogens). Dietary strategies common in athletes, such as a high intake of protein and simple carbohydrates and a low intake of nondigestible carbohydrates, may adversely affect the GM and predispose athletes to gastrointestinal problems and thus impair performance. However, adequate dietary fiber intake, a variety of protein sources, and an emphasis on unsaturated fats, especially ɷ-3 fatty acids, as well as supplementation with pre, pro, and synbiotics, have shown promising results in optimizing the health of the athletes and their GM with potential beneficial effects on performance.

Gut-Skin axis and healthy skin: a systematic review

Fernanda Soubhia Liedtke — 2023-06-15

Introduction: The skin has a multifactorial aging process, both by intrinsic and extrinsic predictors. Skin diseases contributed almost 2.0% to the global burden of 308 diseases and injuries in recent years. The role of the gut microbiota (GM) in human aging is important. GM directly affects aging through the gastrointestinal system. The microbial impact on the skin is still not fully understood. Objective: The present study analyzed the major scientific evidence on the relationship between gut microbiota and the skin, emphasizing the importance of intestinal health for aesthetically healthy skin. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from February 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 137 articles were found. A total of 47 articles were fully evaluated and 27 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 studies at high risk of bias and 13 studies that did not meet the GRADE. It was concluded that current scientific evidence reveals the existence of an important Skin-GM axis, highlighting the management of dermatoses through probiotics and prebiotics, as well as lifestyle changes. To establish aesthetically healthy skin, it is imperative to manipulate the gut microbiota to achieve balance. Thus, treatments that elevate or repair a bowel are essential as adjunctive therapy in the management of inflammatory skin diseases and may contribute to the effectiveness of standard dermal therapy.

Major approaches to the skin-gut microbiota axis under the light of the nutrology of probiotics and prebiotics: a systematic review

Juliana Baldo de Oliveira Lima — 2023-06-08

Introduction: Skin conditions contributed with about 2.0% to the global burden of 306 diseases and injuries in recent years. The microbiota compositions of lesional skin in atopic dermatitis and psoriasis showed distinct differences compared to healthy skin, as well as healthy skin presented a healthy gut microbiota in the light of nutrology. Objective: It was to analyze, through a systematic review, the main considerations on the Skin-Gut microbiota axis, presenting the importance of intestinal health through nutrology, probiotics and prebiotics. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to October 2022 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: A total of 255 articles were found. A total of 76 articles were evaluated in full and 20 articles were included. Current scientific evidence reveals the existence of an important Skin-Gut microbiota axis in the presence of nutrients responsible for this, highlighting the management of dermatoses through probiotics and prebiotics, as well as changes in lifestyle. Conclusion: Management of aesthetically healthy skin includes manipulation of bowel function. Treatments that augment or repair a leaky gut barrier may become important as adjunctive therapy in the management of inflammatory skin conditions and may help to enhance the effectiveness of standard dermal therapy.

Major considerations of nutrological aspects, gut microbiota, and regulation (down or up-regulation) of microRNAs/exosomes in inflammatory bowel diseases: a systematic review

Mayelin Abreu Jorrin — 2023-05-23

Introduction: Inflammatory bowel diseases (IBD) are multifactorial, chronic, continuous, relapsing, and immune-mediated diseases of the gastrointestinal tract. The pathogenesis of IBD is linked to genetically susceptible individuals, dysregulated gut microbiota (dysbiosis), chronic inflammation, and poor dietary patterns. Diet and microRNAs/exosomes play an important role in modulating the intestinal microbiota, and can be applied as a therapeutic tool to improve the course of IBD. Objective: It was to carry out a systematic review of the main considerations of nutrological aspects, intestinal microbiota, and the regulation (Down or Up-regulation) and modulation of microRNAs/exosomes in inflammatory bowel diseases. Methods: The present study followed the international model of systematic review and meta-analysis (PRISMA). Clinical studies were included, involving randomized controlled, prospective, and retrospective studies, as well as pre-clinical studies, published in previous years as gold standard articles until 2023. Results and Conclusion: A total of 154 articles were found. A total of 78 articles were fully evaluated and 55 were included in this systematic review. Considering the Cochrane tool for risk of bias, 22 studies with a high risk of bias and 24 studies that did not meet the GRADE were removed. Most studies showed homogeneity in their results, with X² =93.5% >50%. The present study analyzed the main interactions between dietary therapy, intestinal microbiota, microRNAs, exosomes, and inflammatory bowel disease, elucidating the main clinical outcomes of the disease after nutrological treatment. As a corollary, important randomized controlled clinical studies were found in the last ten years that showed the important role of diet modulation in the control and even in the remission of inflammatory bowel disease, revealing important reductions in persistent intestinal symptoms, in the balance of the intestinal microbiota, in the regulatory role of microRNAs, reducing inflammation markers and improving quality of life. Recognition of the need for additional data from clinical trials, the inherent uncertainty of efficacy for all inflammatory bowel disease therapies, and the potential for benefit with dietary interventions will help guide progress toward a better understanding of the usefulness of dietary therapy for individuals with inflammatory bowel disease.

Medical Ethics in Nutrology

Claudio de Lima Barbosa — 2023-05-18

Few medical specialties have aroused as much interest as Nutrology in these post-modern times of beauty and slimming at any cost. Medical Schools need to make an effort to raise the awareness of future physicians on this issue, which is so sensitive today: Ethics in Medicine.

Nutritional therapy in celiac disease: a review of the gluten-free diet as a modulator of cardiovascular risk factors

Kaique Flávio Xavier Cardoso Filardi — 2023-05-18

Introduction: Celiac Disease (CD) is a chronic immune-mediated enteropathy precipitated by dietary exposure to gluten in genetically predisposed individuals. The CD has been reported as a rare disease, with an estimated prevalence of 0.3 to 2% worldwide. Objective: This study aimed to review the literature on the role of a gluten-free diet in cardiovascular risk factors in patients with celiac disease, specifically related to lipid profile, body mass index, and diabetes mellitus. Methods: This is a non-systematic literature review study, carried out from July to October 2017. Relevant publications available in the PubMed and BIREME databases were identified. The literature review included randomized controlled trials, cohort studies, casecontrol studies, and cross-sectional analyses. Results and Conclusion: CD it is a disease of special interest due to its association with other autoimmune disorders, intestinal malabsorption, with specific comorbidities, and because its main control mechanism is dietary therapy: the Gluten-Free Diet. Bearing in mind the increase in the worldwide prevalence of celiac disease and its relationship with cardiovascular risk, which may be attributable both to the pathophysiological role of the disease and to the therapeutic plan (dietary), scientific investment in this sphere of public health becomes more than necessary. The influence of gluten-free diet on the cardiovascular risk parameters studied in this review is still not entirely clear. Some studies have suggested that gluten-free diet may have a beneficial effect on the lipid profile of celiac patients, while others have shown that the diet probably does not change or induce atherosclerosis by raising the lipid profile of these patients. In addition, by altering caloric and glycemic intake, the reviewed studies demonstrated a greater tendency towards hyperglycemia and the development of insulin resistance in celiac patients on gluten-free diet. As well as there was a trend towards an increase in body mass index after the introduction of gluten-free diet. However, some authors report that based on these available data, it is not possible to state whether there is a better or worse cardiovascular risk profile after the introduction of gluten-free diet, and therefore, continuity with clinical studies is necessary.

Family hypercholesterolemia and LDLR mutations in communities of european origin in southern Brazil: a prospective observational cohort study

C. A. Werutsky — 2023-05-15

Familial hypercholesterolemia (FH) is an autosomal dominant disease characterized by high levels of circulating low-density lipoprotein (LDL) and premature coronary heart events. A quarter of the population of Southern Brazil is affected by hypercholesterolemia and the region has the highest mortality rates due to cardiovascular disease in the country. The aim of this study was to describe LDLR mutations in European descendants with FH living in Southern Brazil. Ten mL of venous blood were taken from 40 patients and used for DNA extraction and subsequent Polymerase Chain Reaction (PCR). The DNA fragments were sequenced and analyzed and the data obtained were compared to reference values from the University of California Santa Cruz (UCSC) Genome Browser. A total of 15 mutations were identified in 38 patients (95% of the total samples). These mutations were located in exons 11 (P518L) and 15 (D727G) in Italian, Portuguese and Spanish descendants and the *105T>G mutation, still undescribed, should be critically evaluated by means of mRNA alteration studies. The present study demonstrated for the first time the presence of the P518L mutation located in exon 11 of the LDLR gene in European descendants living in southern Brazil. This mutation has a high potential to be pathogenic since it is located in a domain responsible for LDLR release from the endoplasmic reticulum (ER).

Assessment of the quality of life of patients with chronic kidney disease: a prospective observational crosssectional cohort study

Yasser Nader Abed — 2023-05-11

Chronic kidney disease (CKD) is defined as changes in glomerular filtration rate and/or the presence of parenchymal damage, which are maintained for at least three months. When in advanced stages of evolution, renal replacement therapies are necessary, and the most widespread is hemodialysis, indispensable for the stability of the patient. However, such a therapeutic measure has a great influence on the patient's quality of life, interfering with their habits, as well as their physical conditions and social and occupational functioning. Thus, when evaluating the quality of care provided to 204 participants with CKD attending the nephrology and hemodialysis clinic, aimed at recognizing the quality of life, through the validated WHOQOL-BREF questionnaire, a causal relationship between the data obtained from each domain addressed in the questionnaire (physical, environmental, psychological and social relationships) and their quality of life profile. Those younger, males, with higher socioeconomic and educational levels, showed a significant increase in their quality of life. In addition, among the analyzed domains, the physical one, which deals with conditions such as pain, sleep quality, and physical and psychological capacity to perform functions showed to have the greatest impact, unfavorably. The opposite was observed in the environmental domain, which stood out positively among the others, allowing us to conclude that even though the participants had ideal conditions to carry out the procedure, the effects generated by this in the body, contribute to the reduction of significantly on the quality of life.

Prevalence of food allergies in students of a medicine course: a prospective observational cross-sectional cohort study

Marina Batistela — 2023-05-11

Food allergy can be defined as an adverse reaction to a food antigen mediated by fundamentally immunological mechanisms. It is a nutritional problem that has grown in recent decades, probably due to the greater exposure of the population to a greater number of available food allergens. It is becoming a worldwide health problem, associated with a significant negative impact on quality of life. Therefore, the assessment of the prevalence of food allergies in medical students in UNIFIPA is to identify the foods with the highest incidence of allergy and their clinical manifestations.

The employment of the nutrigenomic tool in the prevention and reduction of obesity problems: a review

Daniel Fadul Bitar — 2023-05-09

Introduction: The use of the nutrigenomics tool in the prevention and reduction of obesity problems. Objective: To discuss, through the literature, the interaction between genes, nutrient, and their association with obesity, to convey to the health professional a broader and more detailed and understandable view of the advantages of using nutrigenomics in the prevention or aggravation of this morbidity condition. Methods: Exploratory bibliographic research for its development, articles found in the scientific electronic databases Scielo, Medline, Bireme, and Latin American Literature in Health Sciences (LILACS) in the area of nutrigenomics indexed in the years 2012 to 2018 were selected. Results: Concerning obesity, several studies prove that the control of the need for food intake is affected by polymorphisms in genes encoding peripheral signaling peptides, such as insulin, leptin, and adiponectin. In addition, it is also affected by energy homeostasis that involves changes in PLIN and UCPs genes. Diets based on nutritional needs, nutritional status, and genotype are factors in the prevention and control of obesity and several chronic diseases. Conclusion: Nutrigenomics represents the latest in nutrition science. Health professionals need to know and scientifically debate this new science, showing the health benefits it grants and directing actions that enable the future insertion of this practice in the context of population programs based on public policies for the construction of new paradigms related to the treatment of obesity.

Management of weight loss in a patient with Prader-Willi syndrome with satietogenics: a case report

José Marques Pina Neto — 2023-05-04

Objective: To report the evolution and therapeutic approach in a patient with PraderWilli Syndrome (PWS) associated with literature data assessment with a focus on the pharmacological treatment of obesity in patients with this pathology, since there are currently not many studies that contribute or name a strategy with the use of satietogenics. Methods: The present study was elaborated according to the rules of CARE case report. Due to the cognitive impairment present in the syndrome, the patient’s mother was first contacted about the writing of this paper and was given consent through the signing of the Free and Informed Assent Term for this paper. The patient was treated at a hospital-adjacent Nutrology outpatient clinic in 2019. Case Description: YSP, 20 years old, diagnosed with PWS and Grade III obesity (initial BMI of 55.4kg/m², 140kg) attended the Nutrology outpatient clinic of Adriano Jorge Hospital Foundation – FHAJ in 2019 under referral from a third party, and his companion (relative) reporting hyperphagia and poor school performance, initially without a nutrition plan, during follow-up, nutritional guidance and multi-professional care have been initiated. Results: During the follow-up of the years 2019-2021, resulting from the SARS-CoV-2 pandemic in Brazil and the consequent confinement, the patient presented worsening anxiety and hyperphagia, evolving with increased binge eating and discontinuation of physical activities and diet adherence. During the follow-up in the same period, there were 03 returns denoting weight maintenance, later (2021) the use of on-label (Sibutramine), off-label (Fluoxetine), and Metformin medications were associated with the therapeutic regimen for obesity, due to evidence of insulin resistance. Final considerations: The patient evolved with progressive weight loss and better adherence to the food plan and physical activities.

Major considerations of clinical findings of eye aesthetic and skin treatment with the use of dietary therapy, plasma, and coenzyme Q10: a systematic review

Isabela Rombaldi Costa — 2023-05-03

Introduction: A balanced diet plays an important role in the skin. Bioactive substances, i.e. vitamins, minerals, fatty acids, polyphenols, and carotenoids, with a particular focus on their effects on skin condition. The spotlight is on the skin regeneration technique using plasma. Plasma sublimation leaves an intact and dehydrated epidermis layer that acts as a natural biological dressing. Coenzyme Q10 (CoQ10) is a natural constituent of foods and is also often used in functional foods and supplements. Objective: It was to present a systematic review highlighting the main considerations of clinical findings of ocular aesthetic skin treatment such as blepharoplasty with the use of dietary therapy, plasma, and coenzyme Q10. Methods: The systematic review rules (PRISMA) were followed. The search was carried out from February to March 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using scientific articles from 2003 to 2023. 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 154 articles were found. A total of 58 articles were fully evaluated and 52 were included in this systematic review. Considering the Cochrane tool for risk of bias, 42 studies with a high risk of bias and 24 studies that did not meet the GRADE were removed. Most studies showed homogeneity in their results, with X² =95.7% >50%. The symmetrical funnel plot does not suggest a risk of bias between small sample-size studies. Results and Conclusion: It was concluded that promoting healthy eating habits can benefit the appearance of the skin, delay aging processes and reduce the risk of skin cancer. It is necessary to differentiate the substances that protect and restore the epidermal barrier, ensuring an adequate level of skin hydration and protecting against external factors and damage induced by inflammation (omega-3 and omega-6 fatty acids). Antioxidants and other phytonutrients that scavenge reactive oxygen species and alleviate oxidative damage to the skin also play an important role in preventing and caring for skin aging. It was inferred that the plasma technique enabled the modeling of the eyelids that should be sculpted, reducing excess skin, improving the appearance of the eyelids, rejuvenating the eyes, and reducing eyelid weight, mainly with the concomitant use of coenzyme Q10. Longwave plasma radiofrequency ablation is an effective treatment for non-surgical blepharoplasty. Plasma application has great potential in ocular aesthetics, however, more clinical and histopathological studies are needed to support previous findings and address some safety and efficacy issues.

NutrUgraft - preoperative supplementation in ultra HD liposuction with ultrasound-guided rectus abdominis fat transfer: a prospective longitudinal cohort clinical study

Paloma Salomone — 2023-04-25

Liposuction triggers an inflammatory response as a result of surgical trauma. Preoperative dietary supplementation has been implemented to enhance recovery. The purpose of this study was to evaluate patients’ perceptions of the use of preoperative dietary supplementation through a questionnaire. We conducted a prospective study of 80 healthy patients, 2 men, and 78 women, with a mean age of 34.8 years. Thirty days before surgery, all patients have prescribed the NutrUgraft protocol: CoQ10 200 mg, Dimpless 40 mg, Biointestil 300 mg, and IBS Care 100 mg. The Impact® dietary supplement was also prescribed, 1 unit daily for 7 days. On postoperative day 30, patients answered 5 objective questions: (1) How do you rate your healing? Good, fair, or poor; (2) Did you feel safer by receiving preoperative supplementation? Yes, no, or indifferent; (3) Postoperatively, your bowel: functioned normally, constipated, or had diarrhea; (4) Postoperatively, did you develop fibrosis? Yes, no, or I don’t know; and (5) If undergoing another surgery in the future, would you like to receive preoperative supplementation again? Yes, no, or indifferent. Of 80 patients evaluated, 80% classified their healing as good, 90% reported feeling safer by receiving preoperative supplementation, 85% reported that their bowel functioned normally postoperatively, 80% reported not developing fibrosis, and 91.25% would like to receive supplementation again if undergoing another surgery. Based on the results, patients had a positive perception of all topics evaluated, thus highlighting the importance of dietary supplementation in the preoperative period of plastic surgery.

Major evidence of the GLP-1 analog (liraglutide) in the treatment of obesity: a systematic review

Fabrício Bastos Fernandes — 2023-04-19

Introduction: Obesity is a chronic disease that affects a significant portion of the population. In Brazil, in the surveillance survey of risk and protective factors for diseases, more than half of the Brazilian population, 55.7% are overweight. Objective: A systematic review of the literature was carried out with the primary objective of verifying the effectiveness of weight loss of liraglutide in obesity, the secondary objective is the evaluation and clinical benefits secondary to the medication. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from September to October 2022 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: A total of 84 articles were found, 52 articles were evaluated and 20 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 =96.9% >50%. In this context of a serious disease with a high prevalence in the population, a literature review was carried out to verify the effectiveness of weight loss of liraglutide 3.0mg in obesity. A total of 781 works were found, of which all titles and abstracts were individually evaluated and sixteen related to the clinical question and PICOS were selected. Primary studies show the superiority of liraglutide over placebo and orlistat in weight loss and improvements in clinical outcomes. Conclusion: Liraglutide 3.0mg proved to be a safe and effective option in the treatment of obesity.