Carla Alberici Pastore

Obesity paradox in cancer: new insights provided by body composition

BACKGROUND Obesity, defined by body mass index (BMI), appears to have a paradoxical protective effect in several chronic diseases. OBJECTIVE We investigated the obesity paradox in cancer patients by using body composition. DESIGN The study was an observational study of 175 cancer patients assessed before chemotherapy. Obesity was defined as BMI (in kg/m(2)) ≥30 or fat mass index (FMI; fat mass divided by the square of height) ≥5.2 (men) and ≥8.2 (women) measured by using a bioelectrical impedance analysis. Low muscle mass (sarcopenia) was defined as fat-free mass index (fat-free mass divided by the square of height) <17.5 (men) and <15.1 (women). RESULTS Most patients were women (65.7%) and had a mean (±SD) age of 56.9 ± 12.8 y. According to BMI criteria, 60% of patients were overweight or obese. The median survival time for overweight (2.64 y; range: 0.23-3.16 y) and obese (2.61 y; range: 0.26-3.20 y) patients was significantly higher than for patients with a normal (2.04 y; range: 0.06-3.05 y) or low (0.52 y; range: 0.19-0.98 y) BMI (P < 0.001). Sarcopenic patients had shorter survival, regardless of their FMI. Obesity predicted higher survival rates only when sarcopenia was absent. In a multivariate Cox regression model, sarcopenia was an independent predictor of higher mortality (HR: 5.19; 95% CI: 2.58, 10.43) after we controlled for BMI, age, and tumor stage. CONCLUSIONS The obesity paradox is present in cancer patients only when obesity is defined by BMI. Patients with sarcopenic obesity had the poorest prognosis. Cancer patients with high mortality risk can be identified by a body-composition assessment.

Association between an inflammatory-nutritional index and nutritional status in cancer patients

INTRODUCTION Cachexia is a multifatorial syndrome characterized by loss of body weight, fat and muscle, increasing morbidity and mortality. The use of an index accounting for both serum albumin and C Reactive Protein levels could make early identification of cachexia easier. OBJECTIVE To evaluate the variation of an inflammatory nutritional index related to nutritional status in cancer patients. METHODS Cross sectional study including patients with gastrointestinal and lung cancer of a public chemotherapy service in Brazil. Serum albumin and C Reactive Protein were measured and the nutritional status was defined by Subjective Global Assessment. Statistical analyses were performed using Stata 9.2(TM). RESULTS A total of 74 patients were evaluated, 58.1% of them were male, mean age 63.4 ± 11.9 years old. Gastrointestinal cancer was the most prevalent type (71.6%). Only 13.7% of the patients were well nourished and 21.9% were severely malnourished. C Reactive Protein significantly increased according to nutritional status decline (p=0.03). When the albumin from patients with systemic inflammation was evaluated, there was no significant variation in relation to nutritional status (p=0.06). The Inflammatory Nutritional Index significantly varied in relation to nutritional status independent of the systemic inflammation (p=0.02). CONCLUSIONS Inflammatory Nutritional Index can be an adjuvant way for biochemical nutritional assessment and follow up in cancer patients with systemic inflammation.

Nutritional status, muscle mass and strength of elderly in Southern Brazil

AIMS to assess and compare nutritional status and functional capacity of elderly goers of groups for guided physical activity or for guided recreational activities. METHODS Cross-sectional study with 210 elderly (60 years old or more) of coexistence groups (for physical or recreational activities). Nutritional status was assessed by the Mini Nutritional Assessment and Body Mass Index. Muscle mass was estimated by calf circumference (cut point of 31cm for both genders) and strength was evaluated by hydraulic dynamometer, which measures the opponents finger maximal strength. The study was approved by Research Ethics Committee. RESULTS Were enrolled 106 elderly in recreational group and 104 in physical activity group. Most of the sample (86.7%) were female. The mean age was 69.3 years old. Body Mass Index showed 82.9% of seniors with excessive weight (87.7% in recreational and 77.9% in physical activity group, p=0.04). When assessed by Mini Nutritional Assessment, 22.9% was classified as malnourished or at risk of malnutrition, with no difference between groups. The mean calf circumference was 37.3 ± 4.1 cm, decreasing significantly with aging (p=0.05) and being higher in elderly with higher BMI (p=0.001). Calf circumference was also greater in physical activity group. Muscle strengths mean was 6.77 (IQR: 5.83, 7.90) kg, with significantly higher values among men. There was no significant variation between age, nutritional status or between groups. CONCLUSIONS This study presented as its main findings that most seniors showed no nutritional risk, with high prevalence of overweight. The practice of physical activities was associated with greater CP and greater functionality of the opposing finger muscles, which indicates the importance of maintaining physical activity in the aging process, in order to prevent frailty and disability.

The Inflammatory-Nutritional Index: assessing nutritional status and prognosis in gastrointestinal and lung cancer patients

OBJECTIVE To evaluate the prognostic capacity of the Inflammatory-Nutritional Index (INI) in gastrointestinal and lung cancer patients. METHODS Longitudinal study, including patients from a chemotherapy service in Brazil, between July 2008 and May 2010. INI (Albumin/CRP) and nutritional status (by Subjective Global Assessment - SGA) were evaluated. Risk INI was defined as lower than 0.35. The mean follow-up of survival was 1.6 year. Statistical analyses were performed using Stata 11.1™. RESULTS 74 patients participated in the study, mean age 63.4, most of them male (58%) and presenting gastrointestinal cancer (71%). Malnutrition was identified in 87% of the patients (22% severely malnourished). The mean INI was 2.67 and 54% of the patients had INI levels considered as risk. During the follow-up there were 49 deaths (66%). The median survival time for INI risk patients was significantly shorter than for normal INI ones (p = 0,002). It took 0.78 year for the INI risk subsample to decline 50%, while it took 2.78 year for the normal INI subsample. INI risk and severe malnutrition were independent predictors for poor survival. CONCLUSION The INI showed prognostic capacity in this sample and may be a useful tool, based on routinely available blood tests, to assess cancer patients.

Intenção de amamentar e de introdução de alimentação complementar de puérperas de um Hospital-Escola do sul do Brasil

O objetivo deste artigo e analisar a intencao de puerperas de amamentar e as perspectivas de introducao de alimentos complementares no primeiro ano de vida da crianca. Estudo transversal descritivo, realizado no Hospital Escola da Universidade Federal de Pelotas (RS), de Setembro a Dezembro de 2010. Os dados foram obtidos atraves de um questionario padronizado, contemplando perguntas sobre fatores socioeconomicos, amamentacao e alimentacao complementar. Participaram 170 puerperas com idade media de 26,5 ± 5,8 anos. Dentre elas, 99% realizaram pre-natal, mas apenas 49% referiram ter recebido informacao sobre aleitamento materno e/ou alimentacao complementar nestas consultas. Todas as maes informaram pretender amamentar, sendo a media do aleitamento exclusivo pretendido de 5,5 ± 1,6 meses. As variaveis associadas a maior tempo de intencao de amamentacao foram maior escolaridade, nao trabalhar fora do lar, menor idade materna e ter recebido informacoes sobre amamentacao durante o pre-natal. Quanto a alimentacao complementar, caldo de feijao foi o alimento mais pretendido pelas maes para o primeiro ano de vida, com 99,41% de aceitacao, enquanto cha foi o de intencao mais precoce. O tempo de amamentacao exclusiva foi aquem do preconizado pela OMS e a alimentacao complementar mostrou-se equivocada.

Introduction of an Omega-3 Enriched Oral Supplementation for Cancer Patients Close to the First Chemotherapy: May It Be a Factor for Poor Compliance?

The present study aims to evaluate compliance of cancer patients to EPA-enriched supplementation at the beginning of chemotherapy, and its effects on inflammation. Gastrointestinal and lung cancer patients were randomly assigned to receive nutritional supplement enriched with 2.2 g EPA or standard isocaloric one. Supplements were introduced 72 h before the first chemotherapy and continued for 4 wk. Serum C-reactive protein was measured and its variation was analyzed according to tumor location and treatment group. Compliance was assessed by phone contact and counting of supplement bottles returned after treatment. Sixty-nine patients were assessed, mean aged 65.5 yr old, most of them (59%) men. Gastrointestinal cancer was more prevalent and lung cancer had the highest C-reactive protein values (P = 0.009). Twenty-four patients interrupted treatment (trend for more interruption in EPA group), mainly because of gastrointestinal intolerance. No difference was found in C-reactive protein variation between EPA and control groups after treatment. Lung tumors showed higher inflammation than gastrointestinal ones. A short intervention with EPA was insufficient to reduce inflammation, which may be caused by the frequent abandoning of treatment. The beginning of chemotherapy may not be the optimal time point to initiate EPA supplementation because uncomfortable effects of both treatments may lead to poor adherence.