International Journal of Nutrology

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

Tiago Lazzaretti Fernandes — 2025-01-13

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

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

Helena Ramalho Arvate — 2025-01-08

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

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

Ana Beatriz Quinzani Baptista — 2025-01-02

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

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

Paloma Salomone — 2024-11-18

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

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

Milena de Souza Vasconcelos — 2024-11-15

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

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

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

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

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

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

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

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

Julian Yin Vieira Borges — 2024-10-17

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

Anorexics and saints

Claudio de Lima Barbosa — 2024-10-16

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

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

Marília de Andrade Salvá — 2024-10-02

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

Importance of melatonin and its supplementation in the treatment of obesity, inflammatory processes, non-alcoholic hepatic steatosis, and hepatocellular carcinoma: a systematic review

Thaysa Andressa Brandão Vilela Teixeira — 2024-09-30

Introduction: There are more than 2.3 billion overweight and obese people in the world. One of the important neurohormones responsible for adipose tissue metabolism is melatonin (N-acetyl-5-methoxytryptamine) (MEL), which can modulate inflammatory processes by eliminating nitric oxide, reducing synthesis or inhibiting other pro-inflammatory mediators, including tumor necrosis factor-alpha (TNF-a), interleukin 6 (IL-6) and interleukin 8 (IL-8). Objective: It was to highlight the main considerations and clinical evidence of the importance of melatonin and its supplementation in the treatment of obesity, inflammatory processes, non-alcoholic fatty liver disease, and hepatocellular carcinoma. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from May to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 115 articles were found. A total of 28 articles were evaluated and 25 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 25 studies that did not meet the GRADE. Most studies presented homogeneity in their results, with X²=85.7%>50%. It was concluded that obesity-related inflammation is related to a state of oxidative stress with high production of reactive oxygen species. Melatonin has been highlighted for its antioxidant and anti-inflammatory properties. The high prevalence of obesity in the world population also confers an increased risk for the development of non-alcoholic fatty liver disease (NAFLD), as well as other liver diseases including hepatocellular carcinoma (HCC). Studies involving drug and molecular therapies are proposed to control the progression of these diseases. It is necessary to perform a molecular analysis involving epigenetic, biochemical, and inflammatory aspects related to melatonin supplementation, clarifying the effect of melatonin supplementation on obesity and liver diseases, including NAFLD and HCC. Thus, it is highlighted that the antioxidant and anti-inflammatory effect of melatonin is essential as a synergistic agent in weight loss and as prophylaxis and/or treatment of liver diseases.

Major outcomes in heart failure and cardiovascular diseases of the use of vitamin D, ubiquinone, and magnesium in nutrological cardiology: a systematic review

Divina Seila de Oliveira — 2024-09-27

Introduction: Heart failure (HF) and cardiovascular diseases (CVD) are the main causes of death in the population. According to data from the World Health Organization for 2023, of the 21.5 million deaths from these diseases. The beneficial metabolic effects of magnesium, vitamin D, and ubiquinone (coenzyme Q10) can be highlighted. Objective: It was to scientifically analyze the influence of the three elements Magnesium, Vitamin D, and ubiquinone (Coenzyme Q10) concerning heart failure, cardiovascular diseases and metabolic syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from June to July 2024 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 154 articles were found, and 80 articles were evaluated and 78 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 26 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I² =96.8% >50%. It was concluded that magnesium plays a fundamental role in glucose metabolism, insulin, and glycemic homeostasis, in the synthesis of adenosine triphosphate, proteins, and nucleic acids. However, further studies are needed to better clarify the role of magnesium in the prevention and treatment of cardiovascular diseases, especially concerning higher concentrations and increased treatment time. Vitamin D plays important roles in innate and adaptive immune responses, cell cycle, and metabolic processes, evidenced by the reported relationship between its deficiency and the prevalence of immune-mediated disorders, cancer, and cardiometabolic diseases. Coenzyme Q10 exerts an important protective antioxidant action. Clinical studies carried out showed that pathologies such as acute myocardial infarction, arterial hypertension, myopathies induced by statins, physical fatigue inherent to physical exercise, male infertility, pre-eclampsia, Parkinson's disease, periodontal diseases, and migraines had low plasma concentrations of Q10. In addition, Coenzyme Q10 reduces the amount of lipid peroxide found in atherosclerotic lesions. Thus, Q10 protects the lipids present in cell membranes, as well as plasma lipoproteins.

Major clinical outcomes of nutrology management and the endocannabinoid system in the performance of paralympic athletes: a systematic review

Vitor Bezerra de Medeiros — 2024-09-26

Introduction: In the Paralympic sports scenario, recent research suggests that the connection between nutrients and the intestinal microbiota may play an important role in athlete health and performance. Exercise-induced extracellular vesicles (exosomes and microRNAs) have emerged as potential mediators of muscle crosstalk. Furthermore, clinical 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. As a corollary of this, a series of implications of cannabidiol in gene expression processes modulated by microRNAs are being evidenced, impacting the immune and inflammatory systems in athletes. Objective: This study aimed to present the main clinical outcomes of nutritional management and the endocannabinoid system in the performance of Paralympic athletes through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The search was realized from June to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 135 articles were found. A total of 28 articles were evaluated and 25 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most of the studies presented homogeneity in their results, with X² = 87.5% >50%. It was concluded that Paralympic athletes should feed, train, and utilize the entire supraorganism, including the intestinal microbiota, implementing gut-centered dietary strategies to achieve optimal performance. Current evidence suggests that the gut microbiota may contribute to sports performance through the production of nutritional metabolites (short-chain fatty acids, secondary bile acids), influence on gastrointestinal physiology (nutrient absorption), and immune modulation (inhibition of pathogens). Intake of adequate dietary fiber, a variety of protein sources, and 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 Paralympic athletes and with potential beneficial effects on performance. Furthermore, there is preliminary evidence supporting 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 the healing of traumatic skeletal injuries. A specific repertoire of microRNAs regulated by cannabinoids in resting (vigilant) and lipopolysaccharide-activated microglia has been identified. The modulated microRNAs and their target genes are controlled by TLR, Nrf2, and Notch cross-talk and are involved in immune response, cell cycle regulation, cellular stress, and redox homeostasis.

Major approaches to endoscopic treatment of gastrojejunal anastomosis post gastric bypass with argon plasma and dietary monitoring: a systematic review

Kennya Medeiros Lopes de Barros Lima — 2024-09-26

Introduction: Obesity is a serious chronic non-communicable disease (NCD) that has several consequences for public health. In this scenario, there are more than 2.2 billion people who are overweight or obese in the world, and the latest census showed that Brazil is in fifth place in the world ranking with 18.0 million obese individuals, tending to reach 70.0 million patients. Roux-en-Y Gastric Bypass (RYGB) is one of the most performed surgeries in the world, however, approximately 20% of patients undergoing this surgery do not lose the desired weight in the first year and 15% of patients regain weight after 18 to 24 months. Anastomotic diameters above 15.0 mm have been associated with a recurrence of obesity and may be associated with complaints of decreased satiety. Thus, the application of argon plasma in gastrojejunal anastomosis has been proposed to reduce weight in patients undergoing RYGB who presented recurrent obesity. Objective: It was to develop current scientific approaches through a systematic review of the main approaches and application of argon plasma and dietary monitoring in the reduction of dilated gastrojejunal anastomosis and the consequent reduction of recurrent weight after gastric bypass. Methods: The research and development of the work were carried out from May to July 2024 in the Scopus, PubMed, Science Direct, and Scielo databases, using the main scientific articles on nutrigenomics, and following the PRISMA rules. The quality of the studies was based on the GRADE and AMSTAR-2 instruments, and the risk of bias by the Cochrane instrument (Funnel Plot). Results and Conclusion: Twentyone studies were included out of a total of 125. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=88.6%>50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 37 studies with a high risk of bias and 25 studies that did not meet the GRADE and AMSTAR-2 criteria. The application of argon plasma in the treatment of dilated gastrojejunal anastomosis and dietary monitoring have been highlighted as effective and safe methods in the treatment of recurrent obesity. The application of argon plasma via an endoscopic approach is very effective in its indications, technically easy to perform, and has numerous advantages over conventional electrocoagulation. Complications are rare. The limit of tissue penetration depth of 2 to 3 mm associated with excellent coagulation allows its application in critical areas such as the duodenum and colon.

Nutritional therapies in patients with obesity in controlling gene expression of microRNAs for reducing inflammatory processes and metabolic disorders: a systematic review

Suzana Viana de Moura Batalha — 2024-09-21

Introduction: In the context of the obesity pandemic, an estimated 3.0 billion patients have excessive reserves of adipose tissue and calories. These patients with excess energy are not classified as overweight or obese. Increasing evidence suggests that obesity promotes the activation of resident T cells and macrophages. MicroRNAs contribute to the maintenance of the immune response and obesity in adipose tissue, and enteral nutritional therapy is essential for the treatment of obesity, as it works as triggers to modulate gene expression through microRNAs. Objective: This study aimed to present the main considerations of enteral nutritional therapy in patients with obesity, in controlling the gene expression of microRNAs in the gut microbiota, adipose tissue, and circulatory systems to reduce inflammatory processes, and metabolic disorders. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found. A total of 38 articles were fully evaluated and 17 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with high risk of bias and 23 studies that did not meet the GRADE. Most studies showed homogeneity in their results, with X²=73.5% >50%. It was concluded that certain miRNAs have been implicated in the control of body weight gain, glucose homeostasis, insulin resistance and lipid metabolism. A single dose of dietary protein has acute effects on hormonal and metabolic regulation and increases the expression of exosomal miRNA in individuals with obesity and insulin resistance. Enteral feeding is an effective and safe treatment in the regulation of these microRNAs. Ketogenic enteral nutrition may lead to better clinical outcomes than hypocaloric enteral nutritional protocols in glycemic and lipid profiles. A diverse range of nutritional interventions have been shown to be effective in the treatment of obesity and its comorbidities, mainly through the modulation of nutritherapy on microRNAs in adipose tissue, intestinal microbiota and circulatory systems.

Major clinical evidence on the use of low-dose naltrexone in the treatment of cancer: a systematic review

Luciene Pereira de Oliveira — 2024-09-20

Introduction: Opioid receptors are groups of receptors (γ-, κ-, δ-, and ζ-opioid receptors) that are widely distributed in nerve cells in the brain, spinal cord, and digestive tract. Naltrexone is a type of general opioid receptor antagonist. It has been used to treat chronic pain syndrome, autoimmune diseases, and cancer at a dose of 5 mg/day, which is generally called low-dose naltrexone (LDN). Objective: It was to analyze the pharmacological functions of low-dose naltrexone, especially in anti-inflammation and immunoregulation, and its therapeutic potential against cancer. Methods: The research and development of the work were carried out from June to July 2024 in the Scopus, PubMed, Science Direct, and Scielo databases, using scientific articles from the last 15 years, following the PRISMA rules. The quality of the studies was based on the GRADE and AMSTAR2 instruments, and the risk of bias was assessed using the Cochrane instrument (Funnel Plot). Results and Conclusion: Fifteen studies were included in the systematic review out of 30. Most studies showed homogeneity in their results, with X²=94.5%>50%. Low-dose naltrexone has immunomodulatory and therapeutic effects. Low-dose naltrexone regulates the production of inflammatory cytokines, influencing the level of endogenous opioid peptides in the body. Furthermore, low-dose naltrexone has an antitumor effect and can modulate the neuroblastoma tumor response, delaying the onset and reducing the incidence rate of tumors, significantly decreasing tumor volume and weight, and DNA synthesis in cancer.

Health promotion through the adoption of the mediterranean diet as a therapeutic proposal in the treatment and prevention of metabolic syndrome: a systematic review

Maria Aparecida Orlando de Moraes Ferreira — 2024-09-20

Introduction: Excessive weight gain generates comorbidities, many of which are characterized as metabolic syndrome (MetS). It is important to highlight the association of MetS with cardiovascular diseases, increasing global mortality by approximately 1.5 times and cardiovascular mortality by approximately 2.5 times. In this sense, the Mediterranean diet presents itself as the main therapeutic proposal in the treatment of MetS, as it corresponds to caloric limitations without altering the patient's adequate nutritional status. Objective: It was to investigate the effects of health promotion through the adoption of the Mediterranean diet as a therapeutic proposal in the treatment and prevention of metabolic syndrome, evaluating the nutritional benefit on quality of life. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from April to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 157 articles were found. A total of 26 articles were evaluated in full and 21 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies with a high risk of bias and 28 studies that did not meet GRADE and AMSTAR-2. It was concluded that the studies showed the beneficial effects of the Mediterranean diet in reducing the prevalence of MetS. Furthermore, the dietary pattern described in the Mediterranean diet combined with physical activities can be used as a useful clinical tool in the treatment of metabolic syndrome. The suggested menu, with foods rich in fiber, is associated with reducing cardiovascular risk and, therefore, the Mediterranean diet is recognized as an agent for promoting health and preventing and treating obesity. In this sense, it appears that dietary factors can play a fundamental role both in the individual components and in the prevention and control of metabolic syndrome. Recent data associate the presence of MetS with lower consumption of whole grains, fruits, and vegetables. Therefore, there is a close relationship between these foods and dietary fiber, and, probably, soluble fiber is more directly related to these effects. A reduced prevalence of MetS was also observed in patients with systemic lupus erythematosus, a result of the good level of adherence to the Mediterranean diet. Furthermore, 25(OH)D status is associated with the composition, diversity, and functionality of the gut microbiota, and lifestyle intervention can modulate both the gut microbiota and 25(OH)D levels, potentially influencing metabolic pathways.

Major evidence of nutritional and metabolic management in the context of bariatric surgery: a systematic review

Ana Angélica Nogueira Lima — 2024-09-17

Introduction: Approximately $315 billion is spent annually on the medical cost of obesity in adult patients in the United States alone. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the rate of bariatric surgery (BS) increased from 158,000 in 2011 to 196,000 in 2015. This increase in invasive techniques does not eliminate unhealthy habits, therefore, lifestyle modifications, such as healthy eating and correct physical activity programs, can improve surgical results. Objective: To establish the main nutritional and metabolic management strategies in the context of bariatric surgery, to modulate and reduce the problems caused by nutrient deficit. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from May to June 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 135 articles were found. 42 articles were fully evaluated 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 22 studies with a high risk of bias and 24 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=79.7%>50%. It was concluded that the recommendations were gathered to assist in individualized clinical practice in the nutritional management of patients with obesity. In general, patients with obesity have significantly lower concentrations of serum iron, folic acid, vitamins A, B6, B12, C, 25-hydroxyvitamin D, and lipid-standardized vitamin E. Before bariatric surgery, nutritional status should be analyzed and preoperative weight loss can be attempted. Very low-calorie diets and very low-calorie ketogenic diets are prescribed in the last months before surgery. It was noted that the recommendations were gathered to assist in individualized clinical practice in the nutritional management of patients with obesity, including nutritional management. Iron status may be affected by adipose tissue inflammation and increased expression of the systemic iron regulatory protein hepcidin. The postoperative recommendation for vitamin B12 (cobalamin) should be 350-500 micrograms/1000 micrograms monthly, and for folate (folic acid) in the postoperative period should be 1000 micrograms per day.

MDPL syndrome (mandibular hypoplasia, deafness, progeroid features, and lipodystrophy) and nutrological management: a rare case report

Limiro Luiz da Silveira Neto — 2024-09-17

Introduction: Congenital lipodystrophies comprise a rare group of heterogeneous disorders that affect adipose tissue distributions and are characterized by varying degrees of body fat loss. Genetic damage, telomere shortening, cellular senescence, and proliferation defects are hallmarks of the aging process. Metabolism and mitochondrial activity play an important role in the pathogenesis of MDPL syndrome (mandibular hypoplasia, deafness, progeroid features, and lipodystrophy). Objective: It was to report the case and diagnosis of a patient with MDPL syndrome and the nutrological management. Case report: The information was obtained during the patient's medical consultation with the author, interview with the patient and family, photographic record, and literature review. This study followed ethics committee compliance and preserved the patient's anonymity, as well as the patient's rights and care, as per the 1964 Declaration of Helsinki. The total fat percentage of 32% (54th percentile), a very low relative musculoskeletal index of 2.56 kg/m², and also a low fat mass index of 3.89 g/m². Laboratory tests showed a low leptin of 1.90 ng/mL, basal insulin of 166.3 μUI/mL, HOMA IR of 38.2, and triglycerides of 205 mg/dL. Analysis of DNA extracted by oral SWAB was positive for alteration in the POLD1 gene, confirming the diagnosis of MDPL. After initiating treatment with a diet adjusted in proteins, calories, index, and glycemic load, metformin, the patient presented new exams with HOMA-IR 8.3, evolving with a gain of 2.5 kilos, now with 33.1 kilograms of weight, reporting improvement. Final considerations: The reported case and raised publications bring to light the discussion of the diagnosis and treatment of a complex syndrome such as MDPL. The absence of a cure, the difficulty in diagnosis, and the unavailability of some of the therapeutic resources make the syndrome of mandibular hypoplasia, deafness, progeroid characteristics, and lipodystrophy an extremely rare syndrome, difficult to diagnose, and difficult to manage. Progress in identifying lipodystrophy genes will help to better understand the role of pathways involved in the complex physiology of fat. Studies have shown mitochondrial dysfunction as well as morphological alterations in mitochondria in patients with MDPL.

Major clinical outcomes of nutrology and lifestyle in the metabolic processes of healthy aging: a systematic review

Sarah Rachel Pereira de Moura Lima — 2024-09-14

Introduction: Centenarians exemplify the concept of healthy aging and therefore provide an invaluable resource for identifying novel host-intestinal microbiota relationships concerning aging. Approximately 18 micronutrients, composed of minerals and vitamins, facilitate the optimal utilization of macronutrients through their role in catalyzing numerous biochemical processes, increasing their bioavailability and absorption, and balancing the microbiome. In the context of aging, a major challenge to maintaining health in old age is unbalanced nutritional intake, resulting in nutritional deficiency or malnutrition. Objective: The main clinical outcomes of nutrology and lifestyle in the metabolic processes of healthy aging were listed through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from July to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 118 articles were found. A total of 39 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 21 studies with a high risk of bias and 15 that did not meet the GRADE and AMSTAR-2 criteria. Most studies showed homogeneity in their results, with X²=82.7%>50%. Zinc and copper govern many functions that characterize the so-called “oxy-aging”. Selenium (Se) is a fundamental cofactor in many redox functions, the role of vitamin C 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 the prevention and reduction of ROS-induced lesions has been well described. Supplementation with selenium and coenzyme Q10 influenced the analyzed biomarkers in a way that indicated an anti-aging effect. It was concluded that an adequate plasma level of trace elements, such as Zn or copper (Cu), promotes an optimal function of the immune response. Selenium (Se) is a key cofactor in many redox functions, which reduces ROS-induced degeneration in the senescent phenotype. The role of vitamin C in aging has been investigated particularly for skin health and immunity, particularly in inflammatory and degenerative diseases. Vitamin A acts in the prevention of skin degeneration due to aging. The role of vitamin E in the prevention and reduction of ROS-induced lesions has been well described, as well as it has been associated with the prevention of cognitive decline during senescence, particularly in Alzheimer's disease. Good fats, vitamins, minerals, or polyphenols can have antioxidant and anti-inflammatory activities, with anti-aging effects. Recent studies have shown that vitamin K is a vital cofactor in the activation of several proteins, which act against age-related syndromes.

Major considerations on the relationship of triple negative breast cancer with microRNAs and nutrological triggers: a systematic review

Márcio do Nascimento Ribeiro — 2024-09-13

Introduction: Triple-negative breast cancer (TNBC) accounts for 15% of all cases. Its incidence is usually higher in young women (under 40 years of age). The classification as triple-negative occurs because, in this case, there are no estrogen, progesterone, and HER2 receptors, which are responsible for controlling tumor growth. Higher levels of physical activity and better diet quality are associated with lower mortality from breast cancer in observational studies. Furthermore, physical activity and optimal nutrition can improve the relative dose intensity of chemotherapy, as they can activate miRNAs that regulate several biological processes. Objective: This was to conduct a systematic review to establish the main considerations of the relationship between triple-negative breast cancer and microRNAs as biomarkers and regulators of gene expression in cancer cells, as well as to show some nutritional triggers of microRNA activation desirable for breast cancer control. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from April to June 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 and AMSTAR-2 instrument and the risk of bias was analyzed appropriately. According to the Cochrane instrument. Results and Conclusion: 112 articles were found, and 40 were evaluated in full and included in this article, 22 of which were included in the systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 15 studies with a high risk of bias and 25 studies that did not reach GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=81.5%>50%. It was concluded that an increasing number of studies have shown that non-coding RNA (ncRNA), including microRNA (miRNA) and long non-coding RNA (lncRNA), play a significant role in tumorigenesis. Although a diet and exercise intervention did not affect relative dose intensity, the intervention was associated with a higher pCR in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy. High expression levels of miR-27a/b, miR-210, and miR-454 were associated with shorter overall survival, whereas high expression levels of miR-454 and miR-374a/b were associated with disease-free survival. The miRNAs associated with triple-negative breast cancer may provide new avenues for early diagnosis and treatment of breast cancer. Furthermore, specific miRNAs may serve as potential prognostic biomarkers in triple-negative breast cancer.

Major types of diets in the management of metabolic syndrome and obesity: a systematic review

Pedro Luiz Ferreira de Siqueira Júnior — 2024-09-10

Introduction: Excessive weight gain generates comorbidities, many of which are characterized as metabolic syndrome (MS), in which the individual, to be diagnosed, must present three or more metabolic or anthropometric changes such as increased waist circumference, systemic arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduced serum HDL levels. It is important to highlight the association of MS with cardiovascular diseases, increasing global mortality by approximately 1.5 times and cardiovascular mortality by approximately 2.5 times. In this sense, of the different types of diets such as the low-carb diet, very low-carb diet, and intermittent fasting diet, the traditional Brazilian diet, the DASH, and the Mediterranean diet stand out, as they present as the main therapeutic proposal in the treatment of MS. Objective: It was to carry out a systematic review to present the main types of diets in the management of metabolic syndrome, evaluating their effectiveness as a nutritional benefit in controlling health and quality of life. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to June 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 and AMSTAR-2 instrument and the risk of bias was analyzed appropriately. according to the Cochrane instrument. Results and Conclusion: 111 articles were found, and 30 were evaluated in full and included in this article, 21 of which were included in the systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 12 studies with a high risk of bias and 21 studies that did not reach GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=79.8%>50%. It was concluded that the traditional Brazilian diet, DASH, and the Mediterranean diet have in common the characteristics of plant-based diet varieties that incorporate natural foods and reduce ultra-processed foods. These diets have shown good results for human health through the prevention and treatment of obesity in its different life cycles, and there is also evidence of a reduction in the risk of cardiovascular diseases and cancer in individuals with obesity. Furthermore, these diets promote a decrease in low-grade inflammation that affects individuals with obesity, having beneficial effects in reducing metabolic syndrome, even more so when added to physical activities. It has been shown that dietary factors can play a fundamental role both in the individual components and in the prevention and control of metabolic syndrome. Recent data associate the presence of metabolic syndrome with lower consumption of whole grains, fruits, and vegetables.

Major relationships among nutrology, gut microbiota and lifestyle change in healthy longevity: a systematic review

Mateus Antunes Nogueira — 2024-08-28

Introduction: In the healthy longevity scenario, individuals over 65 and over 80 years old will be the fastest growing segment of the population. This is associated with the intensification of chronic diseases, such as cardiovascular diseases, diabetes, cancer, sarcopenia, and degenerative diseases (non-communicable diseases). Genetic, epigenetic, and lifestyle factors can determine the longevity of humans. Certain healthy foods are associated with longer telomere lengths. Objective: To describe, through a systematic literature review, the main relationships between nutrology, gut microbiota, and lifestyle changes in healthy longevity. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from May to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 139 articles were found. A total of 51 articles were fully assessed and 22 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 32 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X² =77.5%>50%. It was concluded that nutrients that can modulate epigenetic pathways, positively influence the outcomes associated with healthy longevity. Studies have shown that the gut microbiota in longlived individuals has a high capacity for lipid metabolism, amino acid degradation, and potential signs of a chronic inflammatory state. Probiotics and prebiotics may be effective alternatives, considering the relationship between the microbiome and healthy aging. Furthermore, resveratrol can modulate epigenetic pathways and may affect outcomes associated with aging, exerting favorable metabolic changes, such as reductions in inflammatory markers or low-density lipoprotein. Nutrients and natural substances of human physiology and biochemistry such as melatonin, coenzyme Q10, and selenium control the functions of the immune and metabolic systems. Many metabolic or chronic diseases have been implicated in poor diet and lifestyle. Improving the quality of diet is associated with reduced mortality from all causes, whereas multivitamin and multimineral supplements can improve life expectancy

The role of gut microbiota in the obesity: a literature review

Karen Thalyne Pereira e Silva Domingos — 2024-08-15

Introduction: Obesity is a multifactorial and polygenic condition that, according to the World Obesity Federation, will affect over 1 billion people by 2030. In this regard, research is being conducted regarding gut microbiota influence on the pathogenesis of this disease, such as inflammation and insulin resistance. Therefore, understanding the gut microbiota and the mechanism by which its modulation through diet and/or the use of probiotics can impact the host and contribute to the treatment of obesity is essential. Methods: A systematic review was conducted on the PubMed, Scielo, and ScienceDirect databases, following the PRISMA protocol, from January 2018 to September 2022. Results and Conclusion: 415 articles were found. 36 studies were evaluated, and 20 were included in this review. The use of calorierestricting diets, along with the consumption of grains and cereals, was found to be useful in reducing strains that promote inflammation and insulin resistance, factors that are associated with obesity pathogenesis, leading to weight reduction. Other studies examined probiotics use, which led to lipopolysaccharides and insulin resistance reduction, as well as a decrease in the quantity of pro-inflammatory cytokines associated with obesity and type 2 diabetes mellitus. Therefore, combining diets with probiotic therapies may be a strategy for microbiota modulation, aiming to reduce inflammatory markers and insulin resistance.

Off-label pharmacotherapy of obesity: a systematic review

Roger Rafael Porto ro — 2024-08-13

Introduction: In the context of obesity pharmacotherapy, some anti-obesity medications (monoamine oxidase inhibitors - MAOIs) have been approved by the Federal Drug Administration (FDA). MAOIs is indicated in combination with lifestyle changes to control overweight and obesity. Some drugs used off-label are accumulating evidence for weight management. Objective: It was to carry out a systematic review to present the off-label pharmacotherapy of obesity through the outcomes of clinical studies. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from May to July 2023 and developed based on Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 2002 to 2023. 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 using the Funnel Plot chart. Results and Conclusion: It was found 132 studies that were submitted to the eligibility analysis and, then, 16 of the 48 total studies were selected. Most studies showed homogeneity in their results, with X² =95.1% >50%. The Funnel Plot graph showed a symmetrical behavior, not suggesting a significant risk of bias in the studies. Some drugs used off-label are accumulating evidence for weight management. As an example, tirzepatide is a new drug approved by the FDA in May 2022 for the treatment of type 2 diabetes mellitus and can be used off-label for the treatment of obesity. In 2013, the first published study showed that metformin up to a dose of 2500 mg per day is an effective medication to reduce weight. AMPK2 is one of the possible targets of metformin for the treatment of obesity. Although metformin treatment in participants receiving a placebo appears to result in an initial decrease in BMI and HOMA-IR, there is no evidence of a sustained effect after prolonged use in adolescents. Low-certainty evidence suggests that off-label fluoxetine may decrease weight compared with placebo. Sustained-release bupropion was more effective than placebo in weight loss when combined with a 500 kcal deficit diet. Treatment with pramlinitide (up to 240 mg three times daily) for 16 weeks resulted in a placebo-corrected reduction in body weight of 3.7%, and 31% of subjects treated with pramlinitide achieved ≥5% weight loss vs. 2% with placebo. Oral melatonin replacement increases the volume and activity of brown adipose tissue, promoting thermogenesis and adipose tissue metabolism with consequent weight loss.

Major considerations of nutrological therapy in cancer patients: a systematic review

Roger Rafael Porto Rocha — 2024-08-13

Introduction: Oncological malnutrition is a highly prevalent comorbidity in cancer, limiting patients' quality of life. International and national clinical guidelines recommend supportive nutrition and exercise therapy for cancer patients. Objective: It was to present the main approaches to nutritional therapy in cancer patients. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from August to October 2023 and developed based on Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 2002 to 2023. The low quality of the evidence was attributed to case reports, editorials, and brief communications, according to the GRADE instrument. Results and Conclusion: A total of 81 studies were found that were subjected to eligibility analysis and, subsequently, 16 of the 22 final studies were selected. Most studies showed homogeneity in their results, with X² =78.4% >50%. Current dietary guidelines for cancer patients fail to address adequate dietary intake of macro- and micronutrients that can improve patients' nutritional status. Clinical studies and meta-analyses have shown that there is an important impact of a personalized and specific diet on patients during and after anti-neoplastic treatment. Most studies indicate that cancer patients should receive a nutritional assessment immediately after diagnosis. You need to maintain a healthy body weight, with a body mass index of 20–24.9, preserving your lean mass and avoiding an increase in fat mass. Therefore, after diagnosing nutritional status, a conservative energy restriction of 500-1,000 kcal/day should be considered. Nutritional therapy should be based on the patient's nutritional status, eating habits, schedule, activities, and cultural preferences. Therefore, adequate dietary consumption of dietary macro and micronutrients rich in β-carotene and vitamins A, E, and C can prevent the deterioration of nutritional status, also improving the quality of life of cancer patients.

Nutrology and molecular state of art in muscle recovery and sports performance: a systematic review

Bruno Rocha de Castro — 2024-08-06

Introduction: Nutrition makes it possible to recover from the negative impact of an injury induced by physical exercise. Recent progress has been made regarding gut microbiota, regenerative nutrition, and skeletal muscle metabolism. MicroRNAs (miRs) have emerged as critical regulators of numerous biological processes, modulating gene expression at the post-transcriptional level. Objective: It was to carry out a systematic review to elucidate the main considerations of nutrology and molecular state of art through exosomes, microRNAs, and nutrients in muscle recovery and sports performance. 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 237 articles were found. A total of 107 articles were evaluated in full and 52 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 47 studies with a high risk of bias and 70 studies that did not meet GRADE. Based on the findings, it was concluded that dietary manipulations and metabolites may affect tissue stem cell fate decisions. Self-renewal and differentiation of mesenchymal stem cells can be regulated by manipulating vitamin C, A, or D levels and valine restriction. miRs play an important role as regulatory molecules during the muscle healing process. Myoblasts are known to secrete exosomes enriched with miRs into the inflammatory environment, whereby miR-224 is transferred to macrophages to inhibit M2 polarization. Additional data demonstrate that WNT-9a may be a direct target of miR224 for macrophage polarization. The results showed that miR-122 and myogenic markers were down-regulated in C2C12 cells after TGF-β stimulation, and overexpression of miR-122 can restore myogenesis inhibited by TGF-β. Evidence suggests that the exosome derived from mesenchymal stem cells exhibits functions similar to mesenchymal stem cells with low immunogenicity and without tumorization. High rates of intestinal self-renewal are enabled by intestinal stem cells (LGR5+) at the base of intestinal crypts. LGR5+ activity, including proliferation and differentiation rates, is affected by large shifts in nutrient availability, as occurs on a high-fat diet or fasting. The practice of physical activity, endogenous metabolites, and dietary nutrients can directly influence epigenetic enzymes.

Precise nutrition in the metabolic and nutritional management of bariatric surgery: a systematic review

Nathalia Galindo Cordeiro — 2024-08-02

Introduction: Obesity is a chronic relapsing disease characterized by abnormal or excessive adiposity with health risks. Any nutritional intervention in patients who are candidates for or have already undergone bariatric surgery must be based on a detailed nutritional assessment, including an assessment of personal values, preferences, and social determinants of eating habits. Objective: It was to carry out a systematic review to explore and present nutritional importance before, during, and after bariatric surgery. 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: 122 articles were found. A total of 43 articles were evaluated in full and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 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=64.5%>50%. It was concluded that enteral nutrition strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to the diet prescribed before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects in reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology help provide optimal care to patients, especially nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures, such as RYGB. It is essential to immediately administer thiamine. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. Additionally, serum micronutrient levels should be monitored regularly and additional supplemental measures prescribed as indicated.

Main considerations of off-label drugs in patients with excessive adipose tissue and obesity: a systematic review

Rodrigo Siqueira de Carvalho — 2024-08-01

Introduction: The rise of the obesity pandemic has been underestimated since most assessments do not include perhaps up to 2.7 billion patients with excessive stores of adipose tissue and calories. A variety of classes of anti-obesity drugs approved for other indications have been used off-label in attempts to promote weight loss. Objective: It was to discuss the main off-label drugs for treating excess fatty tissue and obesity through clinical studies and consensus among world societies. 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 115 articles were found, 30 articles were evaluated in full, and 22 were included and developed in the present systematic review study, out of a total of 24 (2 references are on the website and were not included) Considering the Cochrane tool for risk of bias, the overall evaluation resulted in 18 studies with high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=58.6%>50%. It was concluded that the current paradigm for the diagnosis and treatment of obesity is for those with high BMI, however, the paradigm is flawed for patients with lower BMI in the early stages of abnormal adipose tissue accumulation, who are often ignored and left without treatment. This promotes the continuation of obesity worldwide, allowing early-stage patients to accumulate increasingly greater amounts of adipose tissue. Thus, the use of off-label antiobesity drugs has accumulated scientific evidence for a safe and effective treatment. However, it is still necessary to promote more observational studies and medical reports to corroborate the findings so far present in randomized studies.

Major clinical and metabomic approaches to childhood obesity: a systematic review

Mauro Lopes Teixeira Filho — 2024-07-16

Introduction: In the context of childhood obesity, of children under 5 years of age in Brazil, 7% are overweight and 3% meet the criteria for obesity. Globally, according to a report from the World Health Organization (WHO), it is estimated that the total number of overweight and obese children in the world could reach 75 million by the year 2025. Objective: It was to carry out a systematic review to present the main approaches to clinical and metabolomics of childhood obesity. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from February 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: 110 articles were recruited for the initial evaluation. A total of 41 articles were evaluated and 19 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X²=58.7%>50%. It was concluded that miRNAs are potential biomarkers for the development of pathologies, such as obesity. A heterogeneous group of these molecules was found to be associated with obesity in children. miR-15b-5p, miR-486-5p and hsa-miR-122-5p were considered good candidates for childhood obesity biomarkers. MiRNA-dependent mechanisms regulate up to 60% of all human genes. MiRNAs influence multiple pathways, including insulin signaling, immune-mediated inflammation, adipokine expression, adipogenesis, lipid metabolism, and regulation of food intake.

Insulin resistance and metabolic syndrome as a risk factor for Alzheimer's Disease: systematic literature review

Gabriela Fernanda — 2024-07-09

Introduction: It is estimated that worldwide, 65.7 million people will live with the disease in 2030, with Alzheimer's disease being the most prevalent in the world, accounting for 60% of dementia cases. The hypothesis was then raised that through the neuroprotective effect of insulin and insulin resistance in the genesis of Metabolic Syndrome, the hypothetical relationship is made that metabolic syndrome is a risk factor for Alzheimer's disease. Objective: The literature that verifies the impact of vitamin D deficiency on the quality of life of individuals undergoing bariatric surgery was reviewed. Methods: The search strategy was carried out in the virtual databases PubMed, Scielo, LILACS, Scopus, Web of Science, Embase, and Biblioteca Virtual em Saúde, 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 the Boolean logical operators AND, OR and NOT. The studies considered eligible were those that presented metabolic syndrome as a risk factor for the development of Alzheimer's disease. Results: The online search found 216 studies in virtual bibliographic databases and 70 in gray literature. After removing duplicates, 282 articles remained and were read the title and abstract, with 25 articles chosen for full-text reading, leaving 13 that met the inclusion criteria. Most of the studies included corroborated the hypothesis that metabolic syndrome is a risk factor for Alzheimer's disease. Even the two studies that provide some results in which BMI showed a slower decline in cognitive function, stated that the phenotype studied was that of metabolically healthy obese individuals. Conclusion: The results of this study confirmed the idea that there is an interaction between metabolic health and brain health. First, chronic inflammation and oxidative stress associated with metabolic syndrome can cause damage to blood vessels, compromising cerebral blood flow and impairing the supply of essential nutrients to the brain. Additionally, insulin resistance, one of the key components of metabolic syndrome, can hurt brain function by interfering with the absorption of glucose, a vital fuel for the brain. Finally, how changes in blood lipid levels can contribute to the accumulation of beta-amyloid protein plaques in the brain, one of the markers of Alzheimer's disease.