Adriana Garófolo

Dieta e câncer: um enfoque epidemiológico

Epidemiologistas que estudam câncer tem observado que a sua prevalencia no mundo tem aumentado demaneira significativa no ultimo seculo. Acredita-se que este resultado esta relacionado, entre outros aspectos,com a industrializacao e a urbanizacao ocorridas neste periodo. De fato, a morbi-mortalidade associada aocâncer observada em paises desenvolvidos e maior do que em paises em desenvolvimento. Alem disso,algumas formas especificas de câncer, como o de colon e reto, prostata e mama feminina, sao mais frequentesem paises desenvolvidos, enquanto outras, como de estomago, esofago e colo de utero tem maior incidencianos paises em desenvolvimento. Padroes distintos de câncer tambem sao observados entre individuos queemigram para um novo pais ou regiao. Com base em estudos epidemiologicos, analisou-se a relacao entrecâncer e nutricao, e algumas modificacoes na alimentacao que podem prevenir alguns tipos de cânceres.

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

CONTEXT AND OBJECTIVE Malnutrition in cancer patients has many causes. Nutritional status is usually assessed from weight/height indices. These present limitations for the nutritional assessment of cancer patients: their weights include tumor mass, and lean mass changes are not reflected in weight/height indices. The objective was to evaluate differences between two anthropometric methods and compare deficits, in non-hematological tumor patients and hematological disease patients. DESIGN AND SETTING Cross-sectional study at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo. METHODS Children and adolescents were evaluated between March 1998 and January 2000. Traditional anthropometric measurements were obtained in the first month of treatment (induction therapy), by weight-for-height (W/H) using z-scores index for children and body mass index (BMI) for adolescents. Body composition evaluations consisted of specific anthropometric measurements: triceps skinfold thickness (TSFT), mid-upper arm circumference (MUAC) and arm muscle circumference (AMC). Data were analyzed to compare nutritional assessment methods for diagnosing malnutrition prevalence. The chi-squared test was used for comparative analyses between tumor patients and hematological disease patients. RESULTS Analysis was done on 127 patients with complete data. Higher percentages of deficits were found among tumor patients, by W/H z-scores or BMI and by MUAC and AMC. Higher percentages of deficits were shown by TSFT (40.2%) and MUAC (35.4%) than by W/H z-scores or BMI (18.9%). CONCLUSION Non-hematological tumor patients presented higher malnutrition prevalence than did hematological disease patients. Body composition measurements by TSFT and MUAC detected more patients with malnutrition than did W/H or BMI.

Balanço entre ácidos graxos ômega-3 e 6 na resposta inflamatória em pacientes com câncer e caquexia

Emaciation and loss of lean body mass is a frequent phenomenon observed in cancer patients. This condition leads to infection risk and a poor response to treatment, thus reducing the chances of cure. Furthermore, malnutrition is also associated with a poor quality of life. Therefore, therapies have been proposed in attempt to revert the catabolism observed in most of these patients by attenuating the inflammatory response. Among them, omega-3 fatty acid supplementation may be a strategy to reduce the production of pro-inflammatory cytokines and improve metabolic substrate tolerance, decreasing protein catabolism in order to ameliorate the prognosis of cure in cancer patients. However, studies demonstrate some conflicting results of omega-3 supplementation on immune response. On the other hand, clinical trials in cancer patients demonstrate that the inflammatory response decreases and the nutritional status improves. The aim of this paper is to elaborate a strict review of the subject.

Diretrizes para terapia nutricional em crianças com câncer em situação crítica

Este trabalho e constituido de uma revisao de conceitos fundamentais e atualizados relacionados a terapianutricional de criancas com câncer criticamente doentes. O objetivo principal desta revisao e discutir alteracoesnutricionais e metabolicas decorrentes dessa condicao, bem como as indicacoes, recomendacoes,contra-indicacoes e complicacoes da terapia nutricional (nutricao enteral e parenteral) em pacientes comcâncer. Este artigo aborda, de forma objetiva, a aplicacao pratica de alguns conceitos baseados em evidenciascientificas, e propoe algumas diretrizes para auxiliar na decisao da terapia nutricional no âmbito da vivenciaclinica. Conclui-se que ha necessidade de maior incentivo ao desenvolvimento da ciencia da terapia desuporte, como o tratamento das infeccoes, a terapia intensiva e a terapia metabolico-nutricional, para que seampliem as possibilidades de cura de criancas e adolescentes com câncer.

Prevalência de desnutrição em crianças com tumores sólidos

OBJETIVE: To evaluate the malnutrition prevalence in children and adolescents with solid tumors, who received treatment in a Brazilian oncology center. METHODS: 44 patients were evaluated during the first month of the oncology therapy, using anthropometric measures and, according to the World Health Organization criteria, the Z-scores of weight/age, height/age, and weight/height. RESULTS: The Z-scores of weight/age, height/age, and weight/height showed 16%, 7% e 16% of malnutrition, respectively. Prevalence of malnutrition was observed in 27% of patients with cerebral tumors, 25% of those with neuroblastomas, and 11% of those with Wilms tumor. CONCLUSION: The high prevalence of malnutrition in this population, may be associated with the disease, its treatment, and the social and economic factors. Nonetheless, failure to identify nutritional risk, due to the lack of a nutritional protocol, may be another cause of malnutrition in patients with solid tumors.

Suplemento artesanal oral: uma proposta para recuperação nutricional de crianças e adolescentes com câncer

Objective The aim of this study was to evaluate the impact of homemade oral supplements on the nutritional recovery of patients with mild or severe malnutrition or at nutritional risk. Methods Eight recipes of homemade oral supplements containing 30% to 35% of the total energy expenditure were proposed. The patients with severe malnutrition (group B) received the oral supplement for 2 weeks and the others for 4 weeks (group A). Oral supplementation with homemade supplements was compared with oral supplementation with store-bought supplements, investigated earlier with a protocol with the same design. Results Homemade oral supplements contain much lower amounts of certain micronutrients but are five times cheaper than store-bought supplements. In group A, 88% of the patients taking homemade oral supplements and 84% of the patients taking store-bought supplements responded positively to supplementation. In group B, 22% of the patients taking homemade oral supplements and 25% of the patients taking store-bought supplements recovered. The difference was not significant. The impact of store-bought supplementation on the triceps skinfold thicknesses and arm circumferences of the patients in group A was greater than that obtained with homemade supplements. In group B, the effect on triceps skinfold thickness was not significant (p=0.16). Patients taking homemade or store-bought oral supplements presented similar protein and energy intakes and improvements in nutritional status. Only the body composition of patients in group A taking store-bought oral supplements was better. Conclusion The results obtained by this study suggest that the therapeutic use of homemade oral supplements is an alternative capable of promoting the nutritional recovery of cancer patients, especially those who cannot afford store-bought supplements.

Suplementos orais artesanais desenvolvidos para pacientes com câncer: análise descritiva

OBJETIVO: Descrever a elaboracao de oito formulacoes de suplementos artesanais orais desenvolvidos para aumentar o consumo de energia, proteinas e micronutrientes de pacientes com câncer, analisar seu valor nutricional e avaliar a apreciacao do sabor, testando dois tipos de lipideos. METODOS: Os suplementos foram desenvolvidos com base em quatro ingredientes alimentares: leite, ovos, acucares e oleos para recuperacao nutricional. As formulacoes foram calculadas pelo programa de apoio a nutricao NUTWIN e seu valor nutricional foi comparado as recomendacoes para pacientes com câncer para macronutrientes e as Ingestoes Diarias Recomendadas para micronutrientes. Por meio de degustacao, os suplementos foram testados para verificacao do sabor quando preparados com oleo ou margarina. RESULTADOS: A quantidade de energia por mililitro variou de 1,35 a 2,17kcal, tendo 39% a 59% de carboidrato, 11% a 13% de proteina e 30% a 49% de lipideo, fornecendo em media 43% e 77% da recomendacao de energia e proteina, respectivamente. Vitaminas C e K, acido folico e manganes apresentaram 15% de adequacao em relacao as recomendacoes. Com relacao ao sabor, 78% dos pacientes que experimentaram com oleo e 85% dos que experimentaram com margarina relataram sabor bom, sem diferenca estatistica entre os tipos de suplementos. CONCLUSAO: A avaliacao do sabor demonstrou que a maioria dos pacientes considerou o suplemento com sabor bom. Essas taxas foram superiores quando testados com margarina. Os resultados sugerem que o uso de suplementos orais artesanais pode ser uma alternativa viavel em situacoes onde nao ha recursos suficientes para aquisicao dos industrializados.

Avaliação da eficiência da nutrição parenteral quanto à oferta de energia em pacientes oncológicos pediátricos

OBJECTIVE: The objective of this study was to evaluate parenteral nutrition efficiency in supplying energy for pediatric oncology patients, indications and main difficulties in the procedure. METHODS: This was an observational descriptive study done from July 2003 to July 2004 at the Pediatric Oncology Institute of the Universidade Federal de Sao Paulo. Inclusion criteria: hospitalized cancer patients receiving parenteral. Energy adequateness was analyzed by equations that calculated basal energy expenditure adjusted for initial progression. RESULTS: Forty-one (4%) of the 1016 hospitalized patients received parenteral nutrition: 54% were males and received parenteral nutrition for a median of 10 days (1-51). Fifty-six percent of the episodes did not reach the adjusted basal energy expenditure; 26% remained between 100 and 120% and 18% were above 120%. The mean adjusted basal energy expenditure was 106% with a standard deviation of 38% and a median of 96%. The reasons associated with difficulties to achieve the basal energy expenditure were metabolic intolerance, non-exclusive parenteral nutrition, suspension or interruption of its use, prescription without discussing with nutritionist and use of peripheral route. Parenteral nutrition was mainly indicated in gastrointestinal toxicity. The discarded volume of parenteral nutrition was above 10% in 17 of 35 episodes (49%). Protection from room light (cover) assessed in 19 patients during the days of administration detected an absence of 37 of 315 days (12%). CONCLUSION: Energy supply did not meet the demands of a high percentage of the patients, mainly because of the severity of the clinical scenario, interruptions and non-exclusive use, reducing the amount of time available to administer the nutrition. A multidisciplinary team which would improve the efficiency of the procedures could reduce the losses, guaranteeing a more adequate supply and increasing the benefits of parenteral nutrition.