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In this study we investigate the impact of the dietary ratio of n-6 to n-3 fatty acids (FAs) from postweaning until adult age upon tumor growth, lipid peroxidation in tumor tissue, and metabolic indicators of cancer cachexia in Walker 256 tumor-bearing rats. Weanling male Wistar rats received a normal low-fat (40 g/kg diet) chow diet or high-fat diets (300 g/kg) that included fish oil (FO) or sunflower oil or blends of FO and sunflower oil to yield n-6 to n-3 FA ratios of approximately 6:1, 30:1, and 60:1 ad libitum. After 8 wk, half of each group was inoculated with 1 ml of 2 x 10(7) Walker 256 cells. At the 14th day after tumor inoculation, the animals were killed, and tumors and blood were removed. The different diets did not modify the blood parameters in the absence of tumor bearing, except the high-FO diet, which decreased serum cholesterol and triacylglycerol concentrations. Tumor weight in chow-fed rats was 19 g, and these rats displayed cancer cachexia, characterized by hypoglycemia, hyperlacticidemia, hypertriacylglycerolemia, loss of body weight, and food intake reduction. Tumor weight in FO-fed rats was 7.7 g, and these animals gained body weight (14.6 g) and maintained blood metabolic parameters similar to non-tumor-bearing animals. Tumor weight in rats fed the diet with an n-6 to n-3 FA ratio of 6:1 was similar to tumor-bearing, chow-fed rats, but they gained 2 g in the body weight and blood metabolic parameters were similar to those in non-tumor-bearing rats. However, a further increase in the n-6 FA content of the diet did not change the cachectic state associated with tumor bearing. In this experimental model, a dietary n-6 to n-3 FA ratio of 6:1 was able to increase food intake and body weight, restore the biochemical blood parameters of cachexia, and prevent the development of cancer cachexia. [ABSTRACT FROM AUTHOR]

Household food insecurity (HFI) has been related to adverse maternal-child health outcomes and mental health worsening during pregnancy. Few studies evaluated the temporal association between HFI and anxiety and depressive symptoms in pregnant women, and this association remains not completely understood. This study aimed to systematically review the association between HFI and symptoms of depression and anxiety in pregnant individuals. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022373615). Systematic searches were conducted on 10 electronic databases and grey literature. Two researchers independently conducted the study selection, data extraction process, and the risk of bias assessment. Random-effects meta-analysis models were used, and I 2  > 40% indicated high heterogeneity across studies. Eighteen articles were included for the systematic review, comprising n = 27,882, and a total of 18,987 pregnant individuals aged between 14 and 45 years were included in the meta-analysis. The prevalence of HFI reported in studies ranged from 12.6% to 62.1% (n = 17). The prevalence of depressive and anxiety symptoms ranged from 18% to 49% (n = 11) and 23% to 34% (n = 2), respectively. HFI during pregnancy was associated with increased odds of experiencing symptoms of depression [(OR: 2.52; 95% CI: 2.11-3.02), I 2  = 73.23%]. The quality of evidence was very low due to high heterogeneity. Our findings highlighted the association between HFI and depression symptoms during pregnancy. Findings from this study suggest the importance of assessing HFI and mental health during pregnancy., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Food insecurity (FI) is a critical issue in developing countries, particularly in low-resource settings, where it can worsen women's mental health. Psychosocial factors such as low household income, limited education, multiparity, and vulnerability are linked to depressive symptoms during pregnancy. Additionally, the family environment influences parental practices, which may impact mental health. This study evaluates the association of socioeconomic factors, parental practices, FI risk, and home visit frequency with depressive symptoms in pregnant women enrolled in the Happy Child Program (Programa Criança Feliz-PCF) in the Federal District, Brazil. In this cross-sectional study, 132 pregnant women monitored by PCF from May to July 2023 were assessed using a self-administered questionnaire for socioeconomic data, the two-item Triage for Food Insecurity (TRIA) instrument for FI risk, the Scale of Parental Beliefs and Early Childhood Care Practices, and the Beck Depression Inventory-II for depressive symptoms. Most participants were multiparous (87.9%), had low income (under 200 USD/month; 80.8%), presented depressive symptoms (67.4%) and were at risk of FI (81.8%). About half demonstrated adequate parental practices (50.8%) and received four home visits per month during pregnancy (54.5%). Women who received four PCF home visits had a lower prevalence of depressive symptoms compared to those with fewer visits (PR 0.76, 95% CI 0.59-0.98). No significant association was found between FI or parental practices and depressive symptoms. These findings suggest that the PCF home-visiting program may strengthen vulnerable families, support social networks, and improve mental health during pregnancy. Additionally, the results of this study highlight the need for targeted interventions aimed at reducing food insecurity and promoting mental health during pregnancy, particularly among socially vulnerable populations. Furthermore, they reinforce the importance of expanding access to home-visiting programs as an effective strategy to improve maternal mental health and well-being, while fostering healthier prenatal environments for both mothers and their children.

Background: Obesity is a non-communicable chronic disease which carries a high cost for the Brazilian Unified Health System. Standardized protocols can help primary health care (PHC) professionals manage the disease., Objectives: To describe the validation process of a protocol concerning dietary guidelines for adults with obesity in PHC by non-nutrition professionals., Methods: A validation study of a dietary advice protocol consisting of 6 recommendations was conducted according to Brazilian Dietary Guidelines. The topics incorporated into the recommendations were submitted to a panel of judges for content validity and achieved a Scale Content Validity Index (S-CVI) score >0.80. Subsequently, an online workshop was held and consisted of guiding questions to adequately improve current protocols. Face validity was assessed in a mediation workshop conducted with PHC non-nutrition professionals. Following the validation process, necessary adjustments were made to the eating protocol., Results: The validation process was conducted by a panel of 20 judges and 10 PHC professionals. The content was validated using a 0.98 S-CVI. The online workshop expert panel agreed the instrument provides a trustworthy foundation for appropriate dietary guidelines. Moreover, the judges suggested changes to the flowchart designed to support the professionals' decisions, discussed the absence of quantitative prescription guidelines, and offered additional suggestions to strengthen equity and encourage autonomy in non-nutrition healthcare professionals in PHC., Conclusion: This study describes the validation process of a dietary advice protocol for people with obesity, as well as the importance of its integration into PHC., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I 2  > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I 2 : 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I 2 : 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies., (© 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Investing in early childhood programs such as Brazil's Criança Feliz Program (PCF) to support low-income families in providing a nurturing care environment is critical to ensure that children reach their full developmental potential. We aimed to analyze the influence of the PCF on the nurturing care environment provided by families enrolled in the program in the Federal District, Brazil. A qualitative case study was conducted based on in-depth interviews with a purposive sampling of 22 caregivers enrolled in the PCF for at least six months. Eighteen subthemes emerged from the thematic analysis following the five components of the Nurturing Care Framework (i.e., good health, adequate nutrition, responsive care, early learning, and security and safety). Caregivers recognized the benefits of the PCF on children's mental health (good health) and reported challenges in providing adequate nutrition due to food insecurity (adequate nutrition). A bond between the home visitor and families was identified as critical to promote responsive parenting practices (responsive care). Caregivers appreciated the early stimulation activities provided during PCF home visits (opportunities for early learning). Access to social welfare programs, such as conditional cash transfer and food assistance, were facilitated through PCF multisectoral actions (safety and security). On the other hand, families reported not receiving support from PCF for issues such as breastfeeding, maternal mental health, and disciplinary practices. In summary, PCF enhanced the components of the nurturing care environment provided by families. However, their vulnerabilities and contextual implementation barriers may prevent families from fully benefiting from PCF activities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 dos Santos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Combined deficiencies of nutrients such as iron and folic acid intake during pregnancy are related to nutritional deficiencies risk, such as anemia. The objective of this study was to analyze the association between risk factors (sociodemographic, dietary and lifestyle) and the intake of iron and folate by pregnant women followed up in Primary Health Care (PHC) in the Federal District, Brazil. A cross-sectional observational study was carried out with adult pregnant women of different gestational ages. A semi-structured questionnaire was applied by researchers trained to collect sociodemographic, economic, environmental, and health data. Two nonconsecutive 24-hour recalls (24hr) were carried out to collect data about food consumption. Multivariate linear regression models were used to analyze the association between sociodemographic and dietary risk factors and the consumption of iron and folate. The mean daily energy intake was 1726 kcal (95% CI 1641-1811), with 22.4% (95% CI 20.09-24.66) derived from ultra-processed foods (UPFs). The mean iron and folate intake were 5.28 mg (95% CI 5.09-5.48) and 193.42 µg (95% CI 182.22-204.61), respectively. According to the multivariate model, the highest quintile of ultra-processed foods intake was associated with lower iron (β = -1.15; IC 95%: -1.74; 0.55; p < 0.001) and folate intake (β = -63.23; IC 95%: -98.32; -28.15; p < 0.001). Pregnant women with high school degree presented higher iron intake (β = 0.74; IC 95%: 0.20; 1.28; p = 0.007) and folate intake (β = 38.95; IC 95%: 6.96; 70.95; p = 0.017) compared to pregnant women with elementary school degree. Folate consumption was also associated with the second gestational period (β = 39.44; IC 95%: 5.58; 73.30; p = 0.023) and pregnancy planning (β = 26.88; IC 95%: 3.58; 50.18; p = 0.024). Further research is warranted to enhance evidence on the relationship between the role of processed foods and micronutrients intake to strengthen the nutritional quality of diet of pregnant women attended in Primary Health Care.

Background: To date, there is no protocol providing dietary guidelines to assist health care professionals in counseling Brazilian individuals with Diabetes Mellitus (DM) assisted in primary health care (PHC) according to the Dietary Guidelines for the Brazilian Population (DGBP). Therefore, this study aimed to develop and validate a protocol based on the DGBP for health care, non-nutritionist professionals in counseling adults with DM in PHC., Methods: We systematized the recommendations published in the DGBP, the Diabetes Brazilian Society guidelines, and the scientific literature regarding food and nutrition needs of adults with DM. The clarity and relevance were validated by an expert panel ( n = 19) and the understanding and applicability were validated by PHC professionals ( n = 12). The degree of agreement of the experts was assessed using a Content Validity Index (CVI). Items receiving CVI > 0.8 were considered appropriate., Results: The protocol consisted of six dietary recommendations that encouraged the daily consumption of beans, vegetables, and fruits, advised the avoidance of sugar-sweetened beverages and ultra-processed foods, stimulated eating in appropriate environments, and gave additional guidance addressed to the particularities of DM. The protocol clarity, relevance, and applicability were successfully validated., Conclusion: The protocol supports health care, non-nutritionist professionals in the guidance of dietary recommendations and promoting adequate and healthy eating habits for adults with DM in PHC.

(1) Measuring usual iodine intake is a complex task due to the food consumption variability and its natural concentration in food. Therefore, the use of covariates to adjust statistical methods to estimate usual intake could improve the estimates obtained through dietary surveys. This study aims to evaluate the influence of salt and seasoning usage covariates on the estimates of usual iodine intake and the prevalence of its inadequacy. (2) A cross-sectional study was conducted with Brazilian pregnant women's food consumption data obtained with 24-h recall ( n = 2247). The usual iodine intake was adjusted for intraindividual variability, supplement use, temporal effects, data collection methods, and sociodemographic characteristics with the tool UCD/NCI SIMPLE in the SAS software. Then, salt and seasoning usage covariates were used to adjust the distribution. The harmonized intake reference values for populations were used to assess intake adequacy. (3) The adjustments for salt and seasoning usage yielded a higher mean of usual iodine intakes. The only exception was the adjustment for the "habit of adding salt to meals after preparing/cooking", which produced a lower mean of usual intake and increased the prevalence of insufficient intake. (4) Salt and seasoning usage covariates affect the estimates evaluated. However, more studies are necessary to evaluate the influence observed.

Despite the global tendency of maternal anaemia to decline, the persistence of anaemia in Brazil is an important health problem given its vulnerability to deficiencies and the significant increase in nutritional requirements during pregnancy. The aim of this study was to estimate the prevalence of anaemia in Brazilian pregnant women through a systematic literature review and meta-analysis. The systematic review was carried out according to Systematic Reviews and Meta-Analyses PRISMA checklist recommendations and using the following electronic databases: Medline, Scopus, Embase, Web of Science, Lilacs, Scielo, Google Scholar, and CAPES Catalog of Theses and Dissertations. Studies that presented a prevalence of anaemia data in Brazilian pregnant women, considering all gestational trimesters, were included. The total sample included 12,792 pregnant women covering all gestational trimesters. The pooled prevalence of anaemia in Brazilian pregnant women was 23% (95% CI: 20-27), with the highest prevalence in the Northeast Region at 26% (95% CI 23-29), while the lowest prevalence was observed in the North Region with 17% (95% CI 14-20). Among the subgroups, no statistical difference was observed. The prevalence of anaemia status in Brazil is still classified as a moderate public health problem according to the World Health Organization maternal anaemia classification.

The quality of diet and nutritional status during pregnancy are crucial to optimize maternal and fetal health. Ultra-processed foods (UPFs) are increasingly prevalent in pregnancy groups despite being nutritionally unbalanced and associated with adverse perinatal outcomes. This cross-sectional study, conducted with data from 229 pregnant women, aimed to investigate the association between UPFs consumption and dietary nutrient intake of pregnant women assisted by Primary Health Care (PHC) in Federal District (DF), Brazil. Food consumption was assessed through two non-consecutive 24-h food records and categorized by the extent of processing using the NOVA classification. Multivariate linear regression models were used to analyze the association between the quintiles of UPF consumption and the total energy and nutrients intake. Mean daily energy intake was 1741 kcal, with 22.6% derived from UPFs. Greater UPF consumption was associated with reduced intake of unprocessed and minimally processed food. The highest quintile of UPFs was positively associated with higher total energy, trans fat, and sodium intake; and inversely associated with the diet content of protein, fiber, iron, magnesium, potassium, copper, zinc, selenium, and folate. Greater UPFs intake negatively impacts the nutritional quality of the diet and impoverishes the nutrient intake of pregnant women. Reducing UPF consumption may broadly improve dietary guidelines adherence in pregnant women and promote maternal and neonatal health.

Objective: The objective is to analyze the concentration of iodine in Brazilian drinking water and its possible contribution to iodine intake for different groups., Methods: Water samples collected from primary healthcare units in eight locations distributed across all five macroregions of Brazil were analyzed. The quantification of iodine in the water samples was done by spectrophotometry (leuco crystal violet method). To classify the degree of iodine concentration, the recommendation of the Ministry of Health (China) was followed since Brazil lacks a classification standard. To verify the possible contribution of drinking water to iodine intake for different groups, the recommended water intake for each group according to the United States Institute of Medicine (2004) was considered. The percentage of iodine in drinking water and its contribution to iodine intake for different physiological groups were calculated based on the estimated average requirement (EAR) of iodine. A descriptive statistical analysis was performed using SPSS version 21.0 and Statistical Analysis Systems (SAS) version 9.2., Results: Significant differences were found between the maximum and minimum concentrations of iodine in water samples from the same location. In Pinhais (south region), the difference was 44.32  μ g· L -1 ; in Viçosa (southeast region), it was 27.86  μ g·L -1 ; in Rondonópolis (midwest region), it was 12.66  μ g·L -1 ; in São Luís (northeast region), it was 11.82  μ g·L -1 ; in Brasilian Federal District (midwest region), it was 10.98  μ g·L -1 ; in Macaé (southeast region), it was 10.14  μ g· L -1 ; in Palmas (north region), it was 4.22  μ g·L -1 ; and in Vitória (southeast region), it was 1.69  μ g·L -1 . The maximum concentrations of iodine found in the drinking water of Pinhais and Viçosa can contribute more than 70.0% and 50.0%, respectively, to daily iodine intake for all groups., Conclusion: Monitoring the concentration of iodine in drinking water from different locations in each city or Federal District is a preventive measure against inadequate iodine intake and possible adverse changes in population health., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Carina Aparecida Pinto et al.)

The act of preparing food, especially at home, may be related to improvement in healthy eating patterns. This study analyzed the association between home-prepared meals consumption and the food markers consumption, and weight gain in pregnant women followed up in Primary Health Care in the Federal District (DF), Brazil. This is a cross-sectional study, conducted with pregnant women of all gestational ages. The characteristics of meals preparation and intake, as well as the consumption of food markers, were evaluated through structured questionnaires. Gestational weight gain was evaluated based on data recorded in the pregnant woman's booklet. Variables related to pregnancy, health, lifestyle, and socioeconomic status were analyzed as covariates. A total of 233 pregnant women were included in this study, with a mean age of 28.50 (SD = 6.32) years. Inadequate gestational weight gain was found in 46% of pregnant women. Consumption of soft drinks was 49% lower in pregnant women who prepared all meals at home. Eating home-prepared meals was inversely associated with a high score for unhealthy foods. Home-prepared meals consumption could be an effective health promotion strategy in Primary Health Care, helping to increase the chances of vegetable consumption, and decrease the consumption of soft drinks.

The consumption of ultra-processed food (UPF)-rich diets represents a potential threat to human health. Considering maternal diet adequacy during pregnancy is a major determinant for perinatal health outcomes, this study aimed to systematically review and meta-analyze studies investigating the association between maternal consumption of a UPF-rich diet and perinatal outcomes. Conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and gray literature using Google Scholar and ProQuest Dissertations and Theses Global were searched up to 31 May 2022. No restrictions were applied on language and publication date. Two reviewers independently conducted the study selection and data extraction process. Meta-analysis was conducted according to the random-effects model. In total, 61 studies were included in the systematic review and the overall population comprised 698,803 women from all gestational trimesters. Meta-analysis of cohort studies showed that maternal consumption of UPF-rich diets was associated with an increased risk of gestational diabetes mellitus (odds ratio (OR): 1.48; 95% confidence interval (CI): 1.17, 1.87) and preeclampsia (OR: 1.28; 95% CI: 1.15, 1.42). Neonatal outcomes showed no association. The overall GRADE quality of the evidence for the associations was very low. The findings highlight the need to monitor and reduce UPF consumption, specifically during the gestational period, as a strategy to prevent adverse perinatal outcomes.

Background/objectives: Iodine deficiency in pregnant women is related to impaired foetal growth and development. The objective of this study was to estimate the prevalence of insufficient iodine intake in pregnant women from different regions of the world., Subjects/methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and Google Scholar grey literature were searched until 10 April 2021. Two reviewers independently conducted article selection, data extraction, and assessment of the risk of bias. Meta-analyses with random effects, subgroup analyses, and meta-regressions were performed., Results: In total, 4639 observational articles were found, with 61 eligible for inclusion. The population consisted of 163,021 pregnant women adults and adolescents, and the overall prevalence of insufficient iodine intake was 53% (95% confidence interval [CI]: 47-60; I 2  = 99.8%). Pregnant women who live in insufficient iodine status country had a higher prevalence (86%; 95% CI: 78-93; I² =97.0%) of inadequate iodine nutritional status than to those living in country considered sufficient (51%; 95% IC: 45-57; I² = 99.8%)., Conclusion: Despite the progress in iodine fortification policies and periodic monitoring of the iodine nutritional status of the population worldwide, salt iodination alone may not be sufficient to provide adequate iodine status to pregnant women. Thus, other actions may be necessary to improve the nutritional clinical care of pregnant group., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: Resistance training program (RTP) assist the maintenance of optimal body composition and inflammatory response modulation in individuals in late Roux-en-Y gastric bypass (RYGB). This study aimed to investigate the effect of RTP on body composition and serum inflammatory profile in individuals 2-7 years post-RYGB., Methods: Volunteers were matched on body mass index (BMI), age, sex, and years after surgery, and they were allocated as control or RTP group. Body composition, visceral fat area (VFA), and inflammatory serum markers were measured at baseline and after 12 weeks of RTP., Results: The sample baseline characteristics (n = 63; BMI = 29.7 ± 5.3 kg/m 2 ) were similar between the groups. After intervention, the RTP group presented higher fat-free mass (Δ 1.17 ± 1.12 kg, p = 0.003) and skeletal muscle mass (Δ 0.77 ± 0.66 kg, p = 0.002) and decreased leptin levels (Δ -0.15 ± 0.60 pg/mL, p = 0.028). Ultrasensitive C-reactive protein (CRPus), interleukin-6, adiponectin, and monocyte chemotactic protein-1 showed no significant time-by-group interaction. After the categorization of RTP group individuals by VFA median values (129.8 cm 2 , IQR 90.9; 152.5), participants with VFA values above the median presented a significant decrease in CRPus (Δ -0.20 mg/L, IQR -7.59; -0.03, p = 0.022) when compared to the participants with VFA values below the median., Conclusion: The RTP improved individuals' body composition by a modest but significant enhancing muscle mass and decreasing serum leptin and CRPus levels, especially in individuals with VFA values above the median. RTPs assist in maintaining the adequate body composition as they contribute to a decrease in proinflammatory markers in long-term RYGB., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Dietary n -3 polyunsaturated fatty acids (PUFAs) present beneficial effects on counteracting inflammation status, displaying a critical anti-inflammatory role and maintaining physiological homeostasis in obesity. The primary objective of this systematic review was to evaluate the effect of n -3 PUFAs intake on the eicosanoid profile of people with obesity and overweight. The search strategy on Embase, Scopus, PubMed, Web of Science, Cochrane Library, Google Scholar and ProQuest was undertaken until November 2019 and updated January 2021. The effect size of n -3 PUFAs on prostaglandins was estimated by Glass's, type 1 in a random-effect model for the meta-analysis. Seven clinical trials met the eligible criteria and a total of 610 subjects were included in this systematic review, and four of seven studies were included in meta-analysis. The intake of n -3 PUFAs promoted an overall reduction in serum pro-inflammatory eicosanoids. Additionally, n -3 PUFAs intake significantly decreased the arachidonic acid COX-derived PG eicosanoid group levels (Glass's Δ -0⋅35; CI -0⋅62, -0⋅07, I 2 31⋅48). Subgroup analyses showed a higher effect on periods up to 8 weeks (Glass's Δ -0⋅51; CI -0⋅76, -0⋅27) and doses higher than 0⋅5 g of n -3 PUFAs (Glass's Δ -0⋅46; CI -0⋅72, -0⋅27). Dietary n -3 PUFAs intake contributes to reduce pro-inflammatory eicosanoids of people with obesity and overweight. Subgroup's analysis showed that n -3 PUFAs can reduce the overall arachidonic acid COX-derived PG when adequate dose and period are matched., (© The Author(s) 2021.)

Background/objectives: Cancer patients undergoing radiotherapy (RT) frequently experience weight loss and changes in body composition, which negatively affect their nutritional status, lead to a poor clinical prognosis, and reduce survival rates. This study aimed to evaluate whether changes in body weight, phase angle, and standardized phase angle are associated with longer survival in cancer patients undergoing RT., Methods: This prospective cohort study included 62 cancer patients who underwent RT between 2008 and 2009 and were followed until 2019. Anthropometric and bioelectrical impedance analysis data were assessed before and after RT. The Kaplan-Meier method was used to calculate survival, and mortality risk was assessed using the Cox proportional hazards model., Results: Kaplan-Meier analysis indicated no significant difference in survival time after the 10-year follow-up between patients who had weight loss during RT and those with weight maintenance or weight gain during RT. Mortality risk was associated, in the adjusted multivariate analysis, with age (p = 0.023), site of treatment (p = 0.001), and weight loss during RT (p = 0.044). Every 1 kg lost increased the risk of death by 25% compared with patients who maintained or gained weight during RT. Changes in phase angle and standardized phase angle after RT were not associated with increased mortality risk., Conclusions: Weight loss during RT, site of treatment, and age are associated with a higher risk of death in cancer patients after the 10-year follow-up.

Background: Resistance training (RT) and adequate protein intake are recommended as strategies to preserve fat-free mass (FFM) and resting metabolic demand after bariatric surgery. However, the effect of both interventions combined in the late postoperative period is unclear. This study investigated the effects of RT, isolated and combined with protein supplementation, on body composition and resting energy expenditure (REE) in the late postoperative period of Roux-en-Y gastric bypass (RYGB)., Methods: This controlled trial involved patients who were 2-7 years postRYGB. Participants were partially matched on body mass index (BMI), age, sex, and years after surgery, and divided into four groups, placebo maltodextrin (control [CON]; n = 17), whey protein supplementation (PRO; n = 18), RT combined with placebo (RTP; n = 13), and RT combined with whey protein supplementation (RTP + PRO; n = 15)-considering the participants who completed the protocol. REE was measured by indirect calorimetry and body composition by multifrequency electrical bioimpedance., Results: Participant characteristics (40.3 ± 8.3 years old; average BMI 29.7 ± 5.3 kg/m 2 ; 88.9% females) were similar among groups. The RTP+PRO group showed an increase of 1.46 ± 1.02 kg in FFM and 0.91 ± 0.64 kg in skeletal muscle mass (SMM), which was greater than the equivalent values in the CON group (- 0.24 ± 1.64 kg, p = 0.006 and - 0.08 ± 0.96 kg, p = 0.008, respectively). There was no significant time-by-group interaction for absolute or relative REE., Conclusion: Combined RT and adequate protein intake via supplementation can increase FFM and SMM in the late postoperative period without changing REE. These associated strategies were effective in improving muscle-related parameters and potentially in improving the patients' physical function.

Purpose: Fatty acid synthase (FASN) is a key enzyme in fatty acid biosynthesis that is usually over-expressed in patients with breast cancer, but its relationship with the patient's dietary habit is not clear. A higher intake of n-3 polyunsaturated fatty acids is related to reduced breast carcinogenesis in vitro and in vivo. The aim of this study was to clinically investigate the association between serum FASN levels and fatty acid intake in women newly diagnosed with breast cancer., Methods: In a case-control cross-sectional study, with 18 breast cancer patients and 29 controls, we evaluated nutritional status, dietary intake, and serum FASN levels. Statistical analyses were carried out with parametric and non-parametric tests, according to the sample's normality distribution., Results: The mean age of breast cancer group (n = 18) and control group (n = 29) was 46.8 ± 9.7 y and 44.4. ± 8.6 y, respectively. Mean serum concentration of FASN in breast cancer group was significantly higher (132.51 ± 95.05 ng/mL) than in control group (36.88 ± 20.87 ng/mL) (p < 0.0001). Among breast cancer group, serum FASN levels of premenopausal women were significantly higher than those of postmenopausal women (p = 0.026). There was no significant difference between the early and late disease stages in regard to serum FASN levels in breast cancer group. Mean nutrient intake was similar and n-3 docosahexaenoic acid intake was low in both groups. We observed no association regarding fatty acid intake and serum FASN levels., Conclusion: These data suggest that dietary n-3 fatty acid has no association with serum FASN levels among newly diagnosed breast cancer patients., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Purpose: This systematic review aimed to synthesize the available evidence on the effects of a high-protein diet on appetite sensations in individuals with overweight and obesity., Methods: Two authors independently conducted literature searches, study selection, design of the method, and quality appraisal. The main inclusion criteria were studies involving protocols that present a protein intake greater than 1.2 g/kg/day or 25% of the total daily energy content compared to a normal protein diet, i.e., 0.8-1.2 g/kg/day or 15%-20% of the total energy content. Studies that evaluated test meals or diet within a period of less than 7 days and participants with diabetes, cancer, or other specific conditions were excluded from this review. The literature search was updated until November 2019 using the main databases available., Results: Of a total of 4191 records, ten articles met the inclusion criteria and included a total of 1079 subjects. In six studies, participants experienced enhanced fullness or satiety in response to a high-dietary protein intake, of which four studies had an intervention period of 10-12 weeks., Conclusion: Our results suggest that among individuals with overweight or obesity, higher dietary protein intake may influence appetite sensations by enhancing fullness or satiety. The low level of evidence, due to the heterogeneity of the protocols and the high risk of bias, highlights the need for further studies to confirm these results.

Zika virus (ZIKV) has a strong tropism for the nervous system and has been related to post-infection neurological syndromes. Once neuronal cells are infected, the virus is capable of modulating cell metabolism, leading to neurotoxicity and cellular death. The negative effect of ZIKV in neuron cells has been characterized. However, the description of molecules capable of reversing these cytotoxic effects is still under investigation. In this context, it has been largely demonstrated that docosahexaenoic acid (DHA), an omega-3 polyunsaturated fatty acid, is highly neuroprotective. Here, we hypothesized that DHA's neuroprotective proprieties could have an influence on ZIKV-induced neurotoxicity in SH-SY5Y cells. Our data showed that pre-treatment of SH-SY5Y cells with DHA increased the cell viability and proliferation in ZIKV-infected cells. Moreover, DHA triggered an anti-inflammatory response in those infected cells. Besides, DHA was capable of restoring mitochondria function and number in ZIKV-infected SH-SY5Y cells. In addition, cells pre-treated with DHA prior to ZIKV infection presented a lower viral load at different times of infection. Taking together, these results demonstrated that DHA has a potential anti-inflammatory and neuroprotective effect against ZIKV infection in these neuron-like cells and could be a useful tool in the treatment against this virus.

Omega 3-docosahexaenoic acid (DHA) and vitamin E Delta-tocotrienol (Delta-T3) are extensively studied as protective nutrients against cancer development. Little is known about the biological mechanisms targeted by these bioactive molecules on lipid droplet (LD) biogenesis, an important breast cancer aggressiveness marker, and the occurrence of lipophagy in breast cancer cells. The aim of this study was to investigate the effect of DHA, Delta-T3 and DHA plus Delta-T3 co-treatment in LD biogenesis and lipophagy process in triple negative breast cancer cell line MDA-MB-231. Cells were treated with 50 μM DHA and/or 5 μM Delta-T3. Our results demonstrated that DHA can trigger an increase in LD biogenesis and co-treatment with Delta-T3 was able to reduce this LD biogenesis. In addition, we showed that a higher cytoplasmic LD content is associated with a higher breast cancer cells malignance and proliferation. Reduction of cytoplasmic LD content by silencing ADRP (adipose differentiation-related protein), a structural LD protein, also decreased cell proliferation in MDA-MB-231 cells. Treatment with DHA and Delta-T3 alone or co-treatment did not reduce cell viability. Moreover, we showed here that DHA can trigger lipophagy in MDA-MB-231 cells and DHA plus Delta-T3 co-treatment was able to enhance this lipophagy process. Our findings demonstrated that co-treatment with DHA plus Delta-T3 in MDA-MB-231 cells could reduce LD biogenesis and potentiate lipophagy in these cells, possibly having a positive impact to inhibit breast cancer malignancy. Therefore, suitable doses of DHA and Delta-T3 vitamin E isoform supplementation can be a prominent tool in therapeutic treatments against breast cancer., Competing Interests: The authors declare no conflict of interest.

The implication of inflammation in pathophysiology of several type of cancers has been under intense investigation. Omega-3 fatty acids can modulate inflammation and present anticancer effects, promoting cancer cell death. Pyroptosis is an inflammation related cell death and so far, the function of docosahexaenoic acid (DHA) in pyroptosis cell death has not been described. This study investigated the role of DHA in triggering pyroptosis activation in breast cancer cells. MDA-MB-231 breast cancer cells were supplemented with DHA and inflammation cell death was analyzed. DHA-treated breast cancer cells triggered increased caspase-1and gasdermin D activation, enhanced IL-1β secretion, translocated HMGB1 towards the cytoplasm, and membrane pore formation when compared to untreated cells, suggesting DHA induces pyroptosis programmed cell death in breast cancer cells. Moreover, caspase-1 inhibitor (YVAD) could protect breast cancer cells from DHA-induced pyroptotic cell death. In addition, membrane pore formation showed to be a lysosomal damage and ROS formation-depended event in breast cancer cells. DHA triggered pyroptosis cell death in MDA-MB-231by activating several pyroptosis markers in these cells. This is the first study that shows the effect of DHA triggering pyroptosis programmed cell death in breast cancer cells and it could improve the understanding of the omega-3 supplementation during breast cancer treatment.

Grazing, a type of maladaptive eating behavior, has been associated with poor weight outcomes in bariatric patients. The purpose of this study was to conduct a systematic review of the association between grazing behavior and weight regain post-bariatric surgery. Literature searches, study selection, design of the method, and quality appraisal were carried out by two independent authors. The search strategy was performed until October 2017 in Medline, Embase, Cochrane, Lilacs, Scopus, Web of Science, Google Scholar, ProQuest Dissertation & Theses, and Open Grey. Of a total of 3764 articles, five papers met the inclusion criteria (four original articles and one thesis), comprising 994 subjects, mostly women. The prevalence of grazing behavior ranged from 16.6 to 46.6%, and the highest prevalence of significant weight regain was 47%. The association between grazing and weight regain was observed in four of the five evaluated studies. Our findings support an association between grazing behavior and weight regain after bariatric surgery, regardless of surgery type and contextual concept of grazing. Further studies are needed to confirm the clarity of the real prevalence and interfering factors related to grazing behavior and weight outcomes., Competing Interests: The authors declare no conflict of interest.

Background: We evaluated the effects of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids enriched fish oil (FO) on nutritional and immunological parameters of treatment naïve breast cancer patients., Methods: In a randomized double blind controlled trial, the FO group (FG) patients were supplemented with 2 g/ day of FO concentrate containing 1.8 g of n-3 fatty acids during 30 days. The placebo group (PG) received 2 g/ day of mineral oil. At baseline and after the intervention, plasma levels of n-3 fatty acids, dietary intake, weight, body composition, biochemical and immunological markers were assessed., Results: At the end of the intervention period, no between group differences were observed regarding anthropometric parameters. There was a significant increase in the plasma phospholipid EPA (p = 0.004), DHA (p = 0.007) of the FG patients. In FG patients the percentages of peripheral blood CD4 + T lymphocytes and serum high sensitivity C-reactive protein (hsCRP) levels were maintained while in PG patients there was a significant increase in hsCRP (p = 0.024). We also observed a significant reduction in the percentage of CD4 + T lymphocytes in the peripheral blood (p = 0.042) of PG patients. No changes in serum proinflammatory cytokine and prostaglandin E 2 levels were observed., Conclusions: Supplementation of newly diagnosed breast cancer patients with EPA and DHA led to a significant change in the composition of plasma fatty acids, maintained the level of CD4 + T cells and serum levels of hsCRP, suggestive of a beneficial effect on the immune system and less active inflammatory response., Trial Registration: Brazilian Clinical Trials Registry (REBEC): RBR-2b2hqh. Registered 29 April 2013, retrospectively registered.

Background: Weight regain 24 months after Roux-en-Y gastric bypass (RYGB) and low protein intake in patients without protein supplementation can favor fat-free mass loss and reduce resting energy expenditure (REE). We aimed to assess REE and its association with the body composition of women with weight regain and no protein supplementation in the late postoperative period of RYGB., Methods: We determined the body mass index (BMI), REE by indirect calorimetry, body composition by tetrapolar bioelectrical impedance analysis, and energy intake by two 24-h recalls of 34 patients with at least 5 % of weight regain and no protein supplementation. The software SPSS v.17 analyzed the data calculating measures of central tendency and dispersion and using Pearson's correlation to test the association between the variables and the multivariate linear regression model at a p < 0.05 significance level., Results: Postoperative period was positively associated with weight regain (r = 0.39; p = 0.023). The mean percentages of fat and fat-free masses were 45.1 ± 8.3 % and 54.3 ± 8.1 %, respectively. The mean REE was 1424.7 ± 187.2 kcal (14 kcal/kg of the current weight), mean energy intake was 1258.6 ± 454.3 kcal, and mean protein intake was 0.9 g/kg of the ideal weight ± 0.3. Fat-free mass was positively associated with REE regardless of protein intake and postoperative period., Conclusions: Female bariatric patients with weight regain and no protein supplementation lose fat-free mass, lowering their REE. Health practices that promote maintenance of BMI and body composition may lead to improved outcomes of bariatric surgery.

Many studies have shown that addition of fish oil (FO) to the diet reduces tumor growth but the mechanism(s) of action involved is (are) still unknown. In this study, we examine some possible mechanisms in tumor-bearing rats chronically supplemented with FO. Male Wistar rats (21 days old) were fed with regular chow and supplemented with coconut or FO (1g/kg body weight) until they reached 70 days of age. Then, they were inoculated with a suspension of Walker 256 ascitic tumor cells (2 x 10(7)ml) and after 14 days they were killed. Supplementation with FO resulted in significantly lower tumor weight, greater tumor cell apoptosis, lower ex vivo tumor cell proliferation, a higher tumor content of lipid peroxides, lower expression of cyclooxygenase-2 (COX-2) in tumor tissue and a lower plasma concentration of prostaglandin E2 than observed in rats fed regular chow or supplemented with coconut oil. These results suggest that reduction of tumor growth by FO involves an increase in apoptosis and of lipid peroxidation in tumor tissue, with a reduction in tumor cell proliferation ex vivo, COX-2 expression and PGE2 production. Thus, FO may act simultaneously through multiple effects to reduce tumor growth. Whether these effects are connected through a single underlying mechanism remains to be seen.

Objective: We investigated the effect of the dietary ratio of omega-6 to omega-3 polyunsaturated fatty acids (PUFAs) from postweaning until adulthood on T-lymphocyte proliferation, T-lymphocyte subpopulations (helper and cytotoxic), and production of cytotoxic mediators by macrophages in tumor-bearing rodents., Methods: Weanling male Wistar rats received a normal low-fat (40 g/kg of diet) chow diet or a high-fat (300 g /kg) diet that included fish or sunflower oil or blends of fish and sunflower oils to yield omega-6:omega-3 PUFA ratios of approximately 6:1, 30:1, and 60:1 ad libitum. After 8 wk, 50% of rats in each group were inoculated with 1 mL of 2 x 10(7) Walker 256 cells. Fourteen days after tumor inoculation, animals were killed and lymphocytes and macrophages were obtained for study., Results: The diets richest in omega-6 PUFA resulted in higher proliferation of thymus, spleen, and gut-associated lymphocytes compared with the chow diet irrespective of tumor burden. In contrast, the fish oil diet resulted in lower proliferation of thymus and spleen lymphocytes compared with the chow diet. Diets rich in omega-6 PUFA decreased the proportion of CD8+ lymphocytes. In non-tumor-bearing and tumor-bearing rats, hydrogen peroxide production by macrophages was highest in rats that consumed diets high in omega-3 PUFAs. Superoxide and nitric oxide production were little affected by the dietary ratio of omega-6 to omega-3 PUFAs., Conclusion: Dietary omega-6 and omega-3 PUFA contents alter immune function in non-tumor-bearing and tumor-bearing rats. The omega-3 PUFAs decreased T-cell proliferation but increased hydrogen peroxide production compared with omega-6 PUFAs. Decreased tumor growth and cachexia and increased survival previously reported for fish oil in Walker 256 tumor-bearing rats may be related to improved macrophage function rather than to improved T-cell function.

Weanling female Wistar rats were supplemented with fish oil (1 g/kg body weight) for one generation. The male offspring received the same supplementation until to adult age. Rats supplemented with coconut fat were used as reference. Some rats were inoculated subcutaneously with a suspension (2 x 10(7) cells/mL) of Walker 256 tumor. At day 3, when the tumor was palpable, rats were treated with naproxen (N) (0.1 mg/mL), clenbuterol (Cb) (0.15 mg/kg body weight), and insulin (I) (10 U/kg body weight). At day 14 after tumor inoculation, the animals were killed. Tumor was removed and weighed. Blood, liver, and skeletal muscles were also collected for measurements of metabolites and insulin. In both tumor-bearing untreated rats and tumor-bearing rats supplemented with coconut fat, tumor growth, triacylglycerol, and blood lactate levels were higher, and glycogen content of the liver, blood glucose, cholesterol and HDL-cholesterol levels were lower as compared with the non-tumor-bearing and fish oil supplemented groups. Fish oil supplementation of tumor-bearing rats led to a partial recovery of the glycogen content in the liver and a full reversion of blood glucose, lactate, cholesterol, and HDL-cholesterol levels. The treatment with N plus Cb plus I attenuated cancer cachexia and decreased tumor growth in both coconut fat and fish oil supplemented rats. In conclusion, chronic fish oil supplementation decreased tumor growth and partially recovered cachexia. This beneficial effect of fish oil supplementation was potentiated by treatment with naproxen plus clenbuterol plus insulin.