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7. Quality of life in gastrointestinal cancer : what is the impact of nutrition?

Author

Ravasco, Paula, Monteiro Grillo, isabel, Marques-Vidal, Pedro, Camilo, Maria Ermelinda, and Repositório da Universidade de Lisboa

Subjects
Gastrointestinal cancer, Nutritional status, Kcalories, Protein, Quality of Life, Nutrition
Abstract

Copyright © Ordem dos Médicos, Introduction: Nutrition and Quality of Life (QoL) are key issues. Aims: 1) to evaluate Quality of Life (QoL), nutritional status and dietary intake, taking into account the stage of disease and therapeutic interventions, 2) to determine potential inter-relations, 3) to quantify the relative contributions of cancer/nutrition/treatments on QoL. Methods: In 184 oesophagus, stomach and colon/rectum cancer patients, the following were evaluated: QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), nutritional status (% weight loss over the previous 6 months), usual diet (diet history), current diet (24 hr recall) and a range of clinical variables. Results: Stage III/IV patients showed a significant reduction from their usual energy/protein intake (p=0.001), worse in oesophagus (p=0.02), while current intakes were lower than in stage I/II patients (p=0.0002). Weight loss was greater in stage III/IV (p=0.001). Different diagnoses and cancer stages presented different patterns of QoL function scales (p=0,03), significantly and independently associated with nutritional factors (p=0,05). Patients in stage III/IV had increased symptomatology (p=0,003); symptom scales and single items were strongly associated with stage III/IV (p=0,04). Patients with stomach cancer presented the worst global QoL not significantly different from oesophagus, vs colon/rectum, p=0,02. Conclusions: In oesophageal, stomach and colon/rectum cancer, nutritional deterioration depends of diet intake, the latter is mainly determined by cancer location and stage. Patients' QoL was determined by cancer or nutrition-related factors with distinct relative weights. Due to this multidimensional construct, in which nutrition plays a major role, nutritional therapy must be integrated in early stages of the overall treatment., Introdução: a Nutrição e a Qualidade de Vida (QV) são essenciais. Objectivos: em doentes com cancro gastrintestinal: 1) avaliar a QV, estado e ingestão nutricionais, tendo em conta o estádio da doença e intervenções terapêuticas prévias2) determinar potenciais inter-relações e, 3) quantificar as contribuições relativas de factores decorrentes da doença, das terapêuticas e da nutrição na QV. Métodos: em 184 doentes com tumores do esófago, estômago e cólon/recto foram avaliados: QV (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), estado nutricional (% perda peso últimos seis meses), ingestão habitual (história dietética), ingestão actual (inquérito 24-horas anteriores), e registadas diversas variáveis clínicas. Resultados: No estádio I/II, a ingestão habitual e actual não diferiam, ao contrário dos doentes com estádio III/IV que apresentavam um decréscimo da ingestão habitual(p=0,001), mais acentuado no esófago (p=0,02). A ingestão actual era inferior no estádio III/IV (p=0,0002). A perda de peso era superior nos doentes com estádio III/IV (p=0,001).Os diferentes diagnósticos e estádios da doença apresentavam padrões distintos nas escalas funcionais de QV (p=0,03), significativa e independentemente associadas com factores nutricionais (p≤0,05). Os doentes com estádio III/IV tinham mais sintomatologia (p=0,003); as escalas de sintomas e itens individuais estavam fortemente associadas com o estádio III/IV (p≤0,04). Os doentes com tumores do estômago apresentavam a pior QV global, não significativamente diferente do esófago, vs cólon/recto (p=0,02).Conclusões: nos tumores do esófago, estômago e cólon/recto, a deterioração nutricional depende da ingestão esta sobretudo determinada pela localização e estádio do tumor. A QV dos doentes é determinada por todos estes factores decorrentes da doença ou associados à nutrição, que exercem influências relativas distintas. Esta multidimensionalidade, em que a nutrição exerce um efeito major, torna obrigatória a integração precoce do tratamento nutricional destes doentes

Published
2006

8. ESTÁGIO DE INVESTIGAÇÃO EM NUTRIÇÃO.

Author

CORONHA, Ana Lúcia, LOURENÇO, Cláudia, FERREIRA, Marlene, REIS, Nélia, ALMEIDA, Raquel, BOLÉO-TOMÉ, Carolina, MONTEIRO-GRILLO, Isabel, CAMILO, Maria Ermelinda, and RAVASCO, Paula

Published
2011

9. Ângulo de fase : indicador do estado nutricional do doente oncológico?

Author

Silva, Inês de Sousa Miranda Mendes da and Ravasco, Paula

Subjects
Cancro gastrointestinal, Estado nutricional, Ciências Médicas [Domínio/Área Científica], Nutrição, Ângulo de fase
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019 Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2020-04-22T10:24:03Z No. of bitstreams: 1 InesMSilva.pdf: 696597 bytes, checksum: 24442d1f4ce0c75493ec421c201c1315 (MD5) Made available in DSpace on 2020-04-22T12:36:00Z (GMT). No. of bitstreams: 1 InesMSilva.pdf: 696597 bytes, checksum: 24442d1f4ce0c75493ec421c201c1315 (MD5) Previous issue date: 2019

Published
2019

10. Perfil Nutricional em Doentes com Cancro Colo-retal Submetidos a Radioterapia: Que Perspetivas?

Author

Santos, Ana Rita Xavier dos, Ravasco, Paula, and Duarte, Maria Paula

Subjects
Acompanhamento Nutricional Radioterapia, Nutrição, PG-SGA, Engenharia e Tecnologia::Outras Engenharias e Tecnologias [Domínio/Área Científica], Desnutrição, Estado Nutricional, Cancro
Abstract

O cancro colo-retal é uma das principais causas de morte na população portuguesa e grande parte das mortes que causa não se deve diretamente aos sintomas e complicações causados pela doença, mas sim à desnutrição que, muitas vezes, resulta deste tipo de tumor. Por esta razão é importante considerar o acompanhamento nutricional individualizado dos pacientes, garantindo o seu aconselhamento durante todo o processo de tratamento da doença e assegurando o melhoramento dos sintomas que causam a falta de apetite e intolerância a certos alimentos. O objetivo deste trabalho residiu na observação da evolução e melhoria dos doentes, aquando acompanhados por consultas de nutrição durante o tratamento radioterapêutico realizado em doentes com cancro colo-retal. Esta análise é fundamental não só para compreender a importância da nutrição na área da oncologia, como também para confirmar que uma alimentação equilibrada e variada poderá favorecer o estado de saúde dos doentes. Durante seis meses, acompanharam-se 50 doentes com cancro colo-retal que se encontravam a fazer tratamentos de radioterapia e que realizaram consultas de nutrição clínica no serviço de Radioterapia do Hospital de Santa Maria. O estado nutricional destes doentes foi avaliado antes e no final dos tratamentos através de diferentes metodologias: estudo da perda de peso médio percentual, avaliação do Índice de Massa Corporal (IMC) e avaliação através do método Patient Generated Subjective Global Assessment (PG-SGA). Foram ainda avaliados parâmetros antropométricos e dados obtidos com base nas características do tumor diagnosticado (histologia, estadio, sintomas). Através de todas as metodologias utilizadas foi possível observar que a intervenção nutricional realizada contribuiu para a melhoria do estado nutricional dos doentes. O acompanhamento efetuado permitiu concluir que as consultas de nutrição não só ajudaram a que os doentes se tornassem fisicamente mais capazes de enfrentar os tratamentos, como foi possível observar um aumento do ânimo psíquico dos mesmos em relação à doença.

Published
2017

11. Nutrição e suplementação no desporto

Author

Ferreira, Duarte André Sousa and Ravasco, Paula

Subjects
Ergogénico, Aminoácidos de cadeia ramificada, Ingestão energética, Aminoácidos essenciais, Ciências Médicas [Domínio/Área Científica], Nutrição
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2018-01-30T13:26:11Z No. of bitstreams: 1 DuarteAFerreira.pdf: 1330536 bytes, checksum: 2f9443827813df2ef8989d27407ca4f2 (MD5) Made available in DSpace on 2018-01-30T16:31:54Z (GMT). No. of bitstreams: 1 DuarteAFerreira.pdf: 1330536 bytes, checksum: 2f9443827813df2ef8989d27407ca4f2 (MD5) Previous issue date: 2017

Published
2017

12. Efeitos da dieta paleolítica nas doenças ocidentais mais prevalentes

Author

Sousa, Gonçalo Nuno Ramalho de and Ravasco, Paula

Subjects
Dieta Paleolítica, Obesidade, Diabetes, Ciências Médicas [Domínio/Área Científica], Nutrição
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2018-02-02T13:40:56Z No. of bitstreams: 1 GoncaloRSousa.pdf: 955752 bytes, checksum: 514b26f7da5b025e3a97d78bc6ff8c80 (MD5) Made available in DSpace on 2018-02-02T15:59:35Z (GMT). No. of bitstreams: 1 GoncaloRSousa.pdf: 955752 bytes, checksum: 514b26f7da5b025e3a97d78bc6ff8c80 (MD5) Previous issue date: 2017

Published
2017

13. Obesidade, sedentarismo e atividade física em estudantes universitários de cursos de saúde : que prevalência?

Author

Domingues, Catarina Maria dos Santos, 1991 and Ravasco, Paula Cristina, 1975

Subjects
Teses de mestrado - 2017, Estado nutricional, Actividade física, Estudantes universitários, Ciências Médicas [Domínio/Área Científica], Composição corporal, Nutrição
Abstract

Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2017 Submitted by Fernando João Machado (fjmachado@fm.ul.pt) on 2018-05-08T13:20:53Z No. of bitstreams: 1 11374_Tese.pdf: 1119787 bytes, checksum: c27847a492b4c0dd9e3b660556fc61cc (MD5) Made available in DSpace on 2018-05-08T13:21:05Z (GMT). No. of bitstreams: 1 11374_Tese.pdf: 1119787 bytes, checksum: c27847a492b4c0dd9e3b660556fc61cc (MD5) Previous issue date: 2017

Published
2017

14. Cirurgia ortopédica e ortotraumatológica : factor de risco nutricional?

Author

Miranda, Joana de Oliveira and Ravasco, Paula

Subjects
Desnutrição hospitalar, MUST, Estado nutricional, Malnutrição, Doentes cirúrgicos, Ciências Médicas [Domínio/Área Científica], Risco nutricional
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-04-11T13:13:20Z No. of bitstreams: 1 JoanaOMiranda.pdf: 888380 bytes, checksum: 583c1a6b80e1406b1aa4a71a9fd10336 (MD5) Made available in DSpace on 2017-04-11T15:11:11Z (GMT). No. of bitstreams: 1 JoanaOMiranda.pdf: 888380 bytes, checksum: 583c1a6b80e1406b1aa4a71a9fd10336 (MD5) Previous issue date: 2016

Published
2016

15. Composição corporal em neoplasia da mama : relevante?

Author

Chaves, Jéssica Eliana Vieira, Ravasco, Paula, and João, Dina

Subjects
Oncologia, Avaliação nutricional, Histologia, Ciências Médicas [Domínio/Área Científica], Composição corporal, Cancro de mama
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-04-10T13:53:34Z No. of bitstreams: 1 JessicaEVChaves.pdf: 425290 bytes, checksum: 9006358681185f9f6ba49a69ebc2b124 (MD5) Made available in DSpace on 2017-04-10T15:53:21Z (GMT). No. of bitstreams: 1 JessicaEVChaves.pdf: 425290 bytes, checksum: 9006358681185f9f6ba49a69ebc2b124 (MD5) Previous issue date: 2016

Published
2016

16. Triagem nutricional em pacientes idosos oncológicos : um estudo multicêntrico luso-brasileiro

Author

Vieira, Vânia Salomé Lopes, 1988, Ravasco, Paula, 1975, and Pinho, Nivaldo Barroso de

Subjects
Teses de mestrado - 2016, Idoso, Ciências Médicas::Ciências da Saúde [Domínio/Área Científica], Desnutrição, MNA-SF, Antropometria, Cancro
Abstract

Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2016 Submitted by Lucília Mateus (luciliamateus@fm.ul.pt) on 2016-11-09T15:51:59Z No. of bitstreams: 2 11110_Tese.pdf: 878385 bytes, checksum: df59cb81abb408098ec51095a45eae0b (MD5) 11110-Errata.pdf: 57617 bytes, checksum: f1962e78d950978f6191f08e0e7a12fd (MD5) Made available in DSpace on 2016-11-17T11:52:01Z (GMT). No. of bitstreams: 2 11110_Tese.pdf: 878385 bytes, checksum: df59cb81abb408098ec51095a45eae0b (MD5) 11110-Errata.pdf: 57617 bytes, checksum: f1962e78d950978f6191f08e0e7a12fd (MD5) Previous issue date: 2016

Published
2016

17. A gravidez, o aumento de peso e o acompanhamento nutricional : custos e benefícios

Author

Abecasis, Mariana Pavão, 1986, Martins, Henrique, and Ravasco, Paula, 1975

Subjects
Teses de mestrado - 2016, Ganho de peso, Obesidade, Estado nutricional, Gravidez, Nutrição pré-natal, Ciências Médicas::Ciências da Saúde [Domínio/Área Científica]
Abstract

Tese de mestrado, Nutrição, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Lucília Mateus (luciliamateus@fm.ul.pt) on 2016-04-28T07:45:36Z No. of bitstreams: 1 11004_Tese.pdf: 1845334 bytes, checksum: 528f4893c70ed3c47998e7711ecb907a (MD5) Made available in DSpace on 2016-04-28T17:17:56Z (GMT). No. of bitstreams: 1 11004_Tese.pdf: 1845334 bytes, checksum: 528f4893c70ed3c47998e7711ecb907a (MD5) Previous issue date: 2016

Published
2016

18. Qual a relevância da nutrição em doentes cirúrgicos? Estudo longitudinal no Serviço de Ortopedia do HSM-CHLN

Author

Apolinário, João Pedro Carvalhão and Ravasco, Paula

Subjects
Complicações cirúrgicas, Ingestão, Outcomes cirúrgicos, Ciências Médicas [Domínio/Área Científica], Cirurgia ortopédica, NutritionDay
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-04-21T15:04:34Z No. of bitstreams: 1 JoaoCApolinário.pdf: 796243 bytes, checksum: 4eba22fbe5d2dbf05aa194a7b946598f (MD5) Made available in DSpace on 2017-04-21T15:16:32Z (GMT). No. of bitstreams: 1 JoaoCApolinário.pdf: 796243 bytes, checksum: 4eba22fbe5d2dbf05aa194a7b946598f (MD5) Previous issue date: 2016

Published
2016

19. Dieta vegetariana : relevância na prevalência e outcomes em doenças crónicas

Author

Ramalho, Francisco Barros and Ravasco, Paula

Subjects
Doença crónica, Dieta vegetariana, Ciências Médicas [Domínio/Área Científica], Dieta vegan
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2016-12-15T15:58:51Z No. of bitstreams: 1 Francisco Ramalho.pdf: 790626 bytes, checksum: aff39bbcadda93ad843eb35389f68009 (MD5) Made available in DSpace on 2016-12-15T17:09:03Z (GMT). No. of bitstreams: 1 Francisco Ramalho.pdf: 790626 bytes, checksum: aff39bbcadda93ad843eb35389f68009 (MD5) Previous issue date: 2015

Published
2015

20. Estilos de vida, adiposidade, hormonas e inflamação : influência na incidência e progressão em cancro da mama, próstata e cólon-recto

Author

Ribas, Alda Sofia Delgado Ribeiro, 1980 and Ravasco, Paula, 1975

Subjects
Obesidade, Teses de mestrado - 2013, Hormonas, Estilo de vida, Cancro
Abstract

Tese de mestrado, Nutrição, Faculdade de Medicina, Universidade de Lisboa, 2013 Submitted by Lucília Mateus (luciliamateus@fm.ul.pt) on 2013-06-19T10:19:16Z No. of bitstreams: 1 674716_Tese.pdf: 775477 bytes, checksum: 4e941c4c74eb7bab747a5139dcf84e6c (MD5) Made available in DSpace on 2013-06-19T10:20:51Z (GMT). No. of bitstreams: 1 674716_Tese.pdf: 775477 bytes, checksum: 4e941c4c74eb7bab747a5139dcf84e6c (MD5) Previous issue date: 2012

Published
2013

21. O que sabe a população sobre factores de risco da diabetes tipo 2

Author

Parreira, Cláudia Alexandra Marinho da Silva Alves, 1974, Martins, Henrique, and Ravasco, Paula, 1975

Subjects
Factores de risco, Teses de mestrado - 2012, Características, Diabetes, Conhecimento, População
Abstract

Tese de mestrado, Nutrição, Faculdade de Medicina, Universidade de Lisboa, 2012 Submitted by Lucília Mateus (luciliamateus@fm.ul.pt) on 2012-11-14T10:22:33Z No. of bitstreams: 1 657913_Tese.pdf: 623114 bytes, checksum: eb9926d1418b9848ba239b5ee8bcb1fc (MD5) Made available in DSpace on 2012-11-15T11:58:25Z (GMT). No. of bitstreams: 1 657913_Tese.pdf: 623114 bytes, checksum: eb9926d1418b9848ba239b5ee8bcb1fc (MD5) Previous issue date: 2012

Published
2012

22. Avaliação da composição corporal e ingestão nutricional em crianças com perturbações de hiperactividadee déficite de atenção medicadas com metilfenidato

Author

Roldão, Rita Margarida Ascenso, 1979, Ravasco, Paula, 1975, and Teles, Luísa

Subjects
Desequilíbrios nutricionais, Teses de mestrado - 2011, Composição corporal, Ingestão nutricional, Peso, Metilfenidato, Antropometria
Abstract

Tese de mestrado, Dietética e Nutrição, Faculdade de Medicina, Universidade de Lisboa, 2011 Submitted by Fernando João Machado (fjmachado@fm.ul.pt) on 2011-12-22T12:36:56Z No. of bitstreams: 1 630692_Tese.pdf: 1023548 bytes, checksum: bc841e518a8c360b1e37526822e751dc (MD5) Made available in DSpace on 2011-12-22T12:37:26Z (GMT). No. of bitstreams: 1 630692_Tese.pdf: 1023548 bytes, checksum: bc841e518a8c360b1e37526822e751dc (MD5) Previous issue date: 2011

Published
2011

23. Nutrição e Oncologia: a investigação e seu impacto na clínica e ensino

Author

Sousa, Carla and Ravasco, Paula, 1975

Abstract

Relatório de projecto no âmbito de Bolsa Universidade de Lisboa/Fundação Amadeu Dias (2010/2011). Universidade de Lisboa. Faculdade de Medicina Submitted by amelia Janeiro (ajaneiro@reitoria.ul.pt) on 2011-12-29T14:21:33Z No. of bitstreams: 1 ulsd_re_Carla_Sousa_2010_2011.pdf: 2031374 bytes, checksum: aa2386a6da1df3380fbfe336515fe4bc (MD5) Made available in DSpace on 2011-12-29T15:49:12Z (GMT). No. of bitstreams: 1 ulsd_re_Carla_Sousa_2010_2011.pdf: 2031374 bytes, checksum: aa2386a6da1df3380fbfe336515fe4bc (MD5) Previous issue date: 2011

Published
2011

24. Factores associados à variação de peso em doentes com depressão

Author

Raposo, Jerónima Isabel Carvalho Correia, 1975 and Ravasco, Paula, 1975

Subjects
Variação ponderal, Psicofármacos, Actividade física, Nutrição, Ingestão alimentar, Depressão, Teses de mestrado - 2010
Abstract

Tese de mestrado, Dietética e Nutrição, Faculdade de Medicina, Universidade de Lisboa, 2010 Submitted by Fernando João Machado (fjmachado@fm.ul.pt) on 2010-12-09T16:00:31Z No. of bitstreams: 2 596898_Anexos.pdf: 107172 bytes, checksum: 139f99945109c515df2ccc43cb471b80 (MD5) 596898_Tese.pdf: 1027691 bytes, checksum: 1d9d9f5d4c19f7cb790c06baccd0637d (MD5) Made available in DSpace on 2010-12-09T16:00:48Z (GMT). No. of bitstreams: 2 596898_Anexos.pdf: 107172 bytes, checksum: 139f99945109c515df2ccc43cb471b80 (MD5) 596898_Tese.pdf: 1027691 bytes, checksum: 1d9d9f5d4c19f7cb790c06baccd0637d (MD5) Previous issue date: 2010

Published
2010

25. [What is the relevance of nutrition in oncology?].

Author

de Carvalho G, Camilo ME, and Ravasco P

Subjects
Humans, Malnutrition etiology, Malnutrition prevention & control, Quality of Life, Neoplasms complications, Neoplasms physiopathology, Neoplasms therapy, Nutritional Status
Abstract

Cancer has an increasingly significant impact on society, being a highly destabilizing factor in the life of any patient. The disease as well as anti-neoplastic treatments can profoundly alter biological functions and, remarkably, the patients' nutritional status. Thus, Nutrition is a key factor in oncology, by influencing the development of the disease, cancer related symptoms, the response to, and recovery from treatment(s), and therefore determining the patients' Quality of Life and probably prognosis. Therefore, the assessment of Quality of Life in any clinical study is essential because it values physical, psychological and social factors, which often depend on or are related with Nutrition. The aim of this review work, was to explore extent to which individualized nutrition intervention improves nutritional parameters (nutritional status and intake), Quality of Life, and ultimately the prognosis of the disease. Based on clinical research studies conducted until now, early nutritional intervention via individualized nutritional counseling, does significantly improve nutritional parameters and Quality of Life. It was also found that appropriate and individualized nutritional intervention, improves symptoms, reduces morbidity and may have the potential to improve the prognosis of the disease. According to the reviewed data and guidelines, nutritional therapy should be central and adjuvant to any treatment, and should be included in the multidisciplinary approach mandatory in oncology. This will allow for more adequate and efficient results these patients. Multidisciplinary follow-up, with early nutritional intervention, is of major importance in oncology, thus being a key factor for successful treatment and recovery of these patients.

Published
2011

26. [The relevance of body composition in cancer patients: what is the evidence?].

Author

Coronha AL, Camilo ME, and Ravasco P

Subjects
Humans, Quality of Life, Body Composition, Neoplasms metabolism, Neoplasms physiopathology, Neoplasms therapy
Abstract

In the past few years, there has been a growing interest on body composition changes of cancer patients. Muscle mass and fat mass are pointed out as the most important compartments from a physiological point of view, as their changes are the ones with the most impact on disease. The excess of fat mass is related with increased risk of incidence and recurrence of some types of cancer, and some studies identify it as a major contributing factor for increased morbidity and mortality in cancer patients. Weight loss in cancer is frequent and is associated with symptoms, circulating pro-cachectic substances produced by the tumour, and/or hypermetabolism states, not compensated with adequate intake. Muscle mass depletion is the most worrying, and has been associated with decreased functional capacity, increased toxicity of anti-neoplastic treatments, longer length of stay and higher risk of nosocomial infections. In end stage disease, some patients may develop cancer cachexia, an irreversible condition highly associated with mortality. Of note that, lean body mass depletion may occur with excess fat mass (sarcopenic obesity), a condition that combines the health risks of obesity and those of sarcopenia. The high prevalence of malnutrition in cancer patients justifies its relevance. Many patients point it as a cause for the reduction of physical, cognitive, emotional and social functions, as well as anorexia, fatigue, dyspnoea, insomnia, gastrointestinal symptoms and worse Quality of Life. Additionally, body composition may be affected by nutrition, lifestyles and physical activity; therefore, any approach to the patient should include all these dimensions, with special emphasis on individualised nutritional intervention. Therefore, nutritional therapy should be adjuvant to any treatment, as it is essential in all stages of the disease: for its development, during the treatment(s) and in the follow-up period. The aim of nutritional intervention is to promote changes in body composition, by maintaining or increasing lean body mass and keeping fat mass in healthy levels, which may have a positive impact on Quality of Life, response to treatment(s), prognosis and reduced health care costs.

Published
2011

27. [What is the nutrition and lifestyle profile in oncology patient? Cross-sectional study].

Author

Rolão A, Monteiro-Grillo I, Camilo ME, and Ravasco P

Subjects
Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pilot Projects, Prospective Studies, Risk Factors, Life Style, Motor Activity, Neoplasms, Nutritional Status
Abstract

Background: Cancer aetiology is multifactorial and risk factors include: obesity, central adiposity, sedentarism, excessive or deficient intake of foods and/or nutrients with pro-carcinogenic effects vs protective ones., Objectives: To evaluate the pattern of nutritional status, life styles, physical activity and diet in a cohort of cancer patients., Methods: This pilot cross-sectional study was conducted in 64 patients referred for radiotherapy at the Radiotherapy Department of the University Hospital of Santa Maria (CHLN). Evaluations were: waist circumference associated with potential cardio-metabolic risk, body composition by Tetrapolar Bioimpedance Analysis (XITRON®), Body Mass Index, dietary intake pattern with a short food frequency questionnaire, physical activity with Jackson questionnaire., Results: The most frequent diagnosis were breast and colorectal cancers; 53% of patients were overweight/obese, and there was a significant correlation between this nutritional pattern and weight gain in comparison with usual weight (p<0.005). There were 78% of patients with a waist circumference above the maximum cut-off limit, indicating moderate/ high cardio-metabolic risk, and most were female patients (87%). The great majority of patients (61%) had excessive fat mass highly above the maximum recommended cut-off value, especially male patients (74%). The dietary pattern was poor in vegetables (55%) and excessive in meat and simple carbohydrates (78%); physical activity was low with a high prevalence of sedentarism., Conclusions: This population presented excessive body weight, excessive fat mass, high cardio-metabolic risk, sedentarism and an unbalanced diet poor in protective foods/nutrients. This population's life styles and nutritional pattern, may be considered of risk in oncology disease. The elevated and growing incidence of cancer in Portugal, reinforces the need for further research in order to identify nutritional factors involved in the etiology/evolution and probably prognosis of cancer.

Published
2011

28. [Food for health: primary-care prevention and public health--relevance of the medical role].

Author

Ravasco P, Ferreira C, and Camilo ME

Subjects
Humans, Primary Prevention, Diet, Health Promotion, Primary Health Care, Public Health
Abstract

Each individual is unique, with genetic factors that interact with a particular environment. Therefore, the daily energy requirements should be calculated individually and have to consider the several factors which influence them: basal metabolic rate, diet-induced thermogenesis, physical activity, specific diseases, among other factors. Food provides macronutrients: carbohydrates, proteins and lipids, as well as micronutrients: vitamins, minerals and oligoelements, which should be eaten daily in the recommended amounts during the life cycle, e.g. pregnancy, childhood, adolescence, adulthood and aging. Health professionals can use the "Roda dos Alimentos Portuguesa" to teach and guide the population on how to eat, whether they are healthy or ill individuals, in order to meet their nutritional needs. Through this tool it is possible for everyone to understand and to practice a diet that is: 1) complete (eating foods from all groups), 2) balanced (to respect the proportions of each food group, adjusting the recommended portions/amounts for each individual), and 3) diversified (to choose different foods within each group). Some studies show that food marketing and advertising influence the consumers' choices since childhood. There is already some Regulation in this field, especially about nutrition and health claims. However, a permanent supervision of food marketing is necessary, to ensure compliance with the European Regulation from EFSA. It is crucial to teach and to encourage people to carefully read the food labels before purchasing. Health professionals should also be aware, academically and professionally, about the basics principles of Food and Health Promotion. The unique and essential role of the Professionals of Nutrition needs to be valued and recognized, and these professionals have to be integrated in sufficient number, in the multidisciplinary teams of the National Health Service, whether in Hospitals or Health Care Centers for the ambulatory population. These are the interventions and attitudes that make a difference and that are actually effective in preventing and/or treating many chronic diseases. Hence it is possible to improve health and quality of health services provided to the population (public health scope) and that of patients (clinical practice scope) as well as to optimize costs in health.

Published
2011

29. [Research training in nutrition: relevance for medical clinical pratice].

Author

Coronha AL, Lourenço C, Ferreira M, Reis N, Almeida R, Boléo-Tomé C, Monteiro-Grillo I, Camilo ME, and Ravasco P

Subjects
Adult, Clinical Medicine, Female, Humans, Male, Middle Aged, Malnutrition diagnosis, Nutritional Sciences education, Research education
Abstract

Introduction: In oncology, early and individualized nutritional intervention for each patient is essential to improve nutritional intake and status, to reduce morbidity during treatment, enhance tolerance to treatment and improve Quality of Life., Objectives: For medical students to evaluate nutritional risk and status, analyse the prevalence of undernutrition in a population of patients with diverse types of tumours. We aimed to identify difficulties regarding the use of the MUST tool (Malnutrition Universal Screening Tool) for nutritional risk by the students., Methods: This study included 35 cancer patients consecutively referenced for Radiotherapy (RT) in the Radiotherapy Department of the University Hospital of Santa Maria. Nutritional risk was evaluated by MUST; nutritional status by Patient Generated-Subjective Global Assessment (PG-SGA) validated and specific for oncology., Results: Students identified 13 patients (36%) at moderate/high risk of undernutrition. According to PG-SGA, 31,5% (11/35) of patients presented moderate or severe undernutrition, of which 77% of patients needed individualized nutritional counselling. Students successfully detected undernourished patients using these specific methods., Conclusion: Risk of undernutrition and undernutrition are common in oncology, therefore indicating the critical need to educate all health professionals for risk screening and for the relevance of nutritional intervention in the multidisciplinary context. MUST is a simple and quick tool, that demonstrated to be adequate when applied by medical students, well accepted by these health professionals and effectively used. Nutritional risk evaluation can and must be performed by health professionals such as the medical team, as long as they are involved in patient's treatment. Our methodology may be used as a model allowing for early guidance to individualized intervention, human resources' optimization and education for the importance of nutrition care.

Published
2011

30. [Quality of life in gastrointestinal cancer: what is the impact of nutrition?].

Author

Ravasco P, Monteiro-Grillo I, Marques Vidal P, and Camilo ME

Subjects
Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Diet, Female, Humans, Male, Middle Aged, Gastrointestinal Neoplasms therapy, Nutritional Status, Quality of Life
Abstract

Introduction: Nutrition and Quality of Life (QoL) are key issues., Aims: 1) to evaluate Quality of Life (QoL), nutritional status and dietary intake, taking into account the stage of disease and therapeutic interventions, 2) to determine potential inter-relations, 3) to quantify the relative contributions of cancer/nutrition/treatments on QoL., Methods: In 184 oesophagus, stomach and colon/rectum cancer patients, the following were evaluated: QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), nutritional status (% weight loss over the previous 6 months), usual diet (diet history), current diet (24 hr recall) and a range of clinical variables., Results: Stage III/IV patients showed a significant reduction from their usual energy/protein intake (p=0.001), worse in oesophagus (p=0.02), while current intakes were lower than in stage I/II patients (p=0.0002). Weight loss was greater in stage III/IV (p=0.001). Different diagnoses and cancer stages presented different patterns of QoL function scales (p=0,03), significantly and independently associated with nutritional factors (p=0,05). Patients in stage III/IV had increased symptomatology (p=0,003); symptom scales and single items were strongly associated with stage III/IV (p=0,04). Patients with stomach cancer presented the worst global QoL not significantly different from oesophagus, vs colon/rectum, p=0,02., Conclusions: In oesophageal, stomach and colon/rectum cancer, nutritional deterioration depends of diet intake, the latter is mainly determined by cancer location and stage. Patients' QoL was determined by cancer or nutrition-related factors with distinct relative weights. Due to this multidimensional construct, in which nutrition plays a major role, nutritional therapy must be integrated in early stages of the overall treatment.

Published
2006

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