13 results on '"Ravasco, Paula"'
Search Results
2. Protein intake and muscle mass maintenance in patients with cancer types with high prevalence of sarcopenia: a systematic review
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Capitão, Carolina, Coutinho, Diana, Neves, Pedro Miguel, Capelas, Manuel Luís, Pimenta, Nuno M., Santos, Teresa, Mäkitie, Antti, and Ravasco, Paula
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- 2022
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3. Nutrition Information in Oncology — Extending the Electronic Patient-Record Data Set
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Maranhão, Priscila A., Pereira, Ana Margarida, Calhau, Conceição, Ravasco, Paula, Bozzetti, Federico, Laviano, Alessandro, Isenring, Liz, Bandera, Elisa V., B. Huhmann, Maureen, Vieira-Marques, Pedro, and Cruz-Correia, Ricardo J.
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- 2020
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4. Oncology-Led Early Identification of Nutritional Risk: A Pragmatic, Evidence-Based Protocol (PRONTO).
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Muscaritoli, Maurizio, Bar-Sela, Gil, Battisti, Nicolo Matteo Luca, Belev, Borislav, Contreras-Martínez, Jorge, Cortesi, Enrico, de Brito-Ashurst, Ione, Prado, Carla M., Ravasco, Paula, and Yalcin, Suayib
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THERAPEUTIC use of antineoplastic agents ,PROFESSIONAL practice ,NUTRITIONAL assessment ,SARCOPENIA ,EVIDENCE-based medicine ,ANTINEOPLASTIC agents ,RISK assessment ,MEDICAL protocols ,CANCER patients ,TREATMENT effectiveness ,MALNUTRITION ,HEALTH care teams ,CACHEXIA ,DECISION making in clinical medicine ,TUMORS ,EARLY diagnosis ,ONCOLOGY ,ALGORITHMS ,IMMUNOTHERAPY ,DISEASE risk factors - Abstract
Simple Summary: Early identification of patients on antineoplastic therapy who are at risk for or already malnourished is critical for optimizing treatment success. Malnourished patients are at increased risk for being unable to tolerate the most effective 'level' and 'duration' of treatment, with grave implications for both the short- (during treatment) and long-term outcomes. Herein, we provide a practical PROtocol for NuTritional risk in Oncology (PRONTO) to enable oncologists to identify patients with or at risk of malnutrition for further evaluation and follow-up with members of the multidisciplinary care team (MDT). Additional guidance is included on the oncologist-led provision of nutritional support if referral to a dietary service is not available. Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient's ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian's role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Protein intake and muscle mass maintenance in patients with cancer types with high prevalence of sarcopenia: a systematic review
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Capitão, Carolina, Coutinho, Diana, Neves, Pedro Miguel, Capelas, Manuel Luís, Pimenta, Nuno, Santos, Teresa, Mäkitie, Antti, Ravasco, Paula, and Repositório da Universidade de Lisboa
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Protein intake ,Body composition ,Muscle wasting ,Cancer ,Nutrition - Abstract
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021, Rationale: Cancer is associated with muscle wasting. However, optimal protein intake has not been determined, limiting the efficacy of nutritional interventions. This systematic review aims to assess the effect of protein intake on muscle mass of patients with cancer types with high prevalence of sarcopenia during treatment, in longitudinal studies. Methods: MEDLINE, CINAHL, and Scopus databases were searched following PRISMA guidelines. Longitudinal studies written in English, including adults with high sarcopenia prevalence cancer diagnosis, submitted to (chemo)radiotherapy, with assessment of protein intake and muscle changes during treatment, published until 4 October 2020 were included. Studies including supplementation with substances, such as n-3 fatty acids, specific amino acids, or proteins, were excluded. Study appraisal was independently conducted by two reviewers, and a qualitative research synthesis was performed. Results: Overall, 575 records were identified, of which, eight studies were included (one randomized clinical trial and seven uncontrolled before and after studies). Patients with head and neck (n = 5), lung (n = 2), and esophageal cancer (n = 1) were included, comprising a total of 554 participants. The studies presented heterogeneous methodologies, objectives, and methods to assess body composition. Overall, participant groups with a mean protein intake below 1.2 g/kg presented muscle wasting, with one exception, while those reporting a mean intake above 1.4 g/kg, maintained muscle during treatment. Conclusions: Our findings show that protein intakes below 1.2 g/kg, even when within the recommendations, have been associated with muscle wasting during treatment. Only intakes above 1.4 g/kg have been associated with muscle maintenance. High-quality research is needed to establish an optimal dose response.
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- 2021
6. Nutrition in cancer patients
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Ravasco, Paula and Veritati - Repositório Institucional da Universidade Católica Portuguesa
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medicine.medical_specialty ,Sarcopenia ,Cachexia ,Survival ,030309 nutrition & dietetics ,lcsh:Medicine ,Review ,Cochrane Library ,03 medical and health sciences ,Nutritional therapy ,0302 clinical medicine ,Quality of life (healthcare) ,medicine ,Medical nutrition therapy ,Intensive care medicine ,Nutritional support ,Wasting ,Cancer ,Nutrition ,0303 health sciences ,business.industry ,lcsh:R ,Malnutrition ,General Medicine ,medicine.disease ,Clinical trial ,030220 oncology & carcinogenesis ,medicine.symptom ,business - Abstract
Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using “OR” as a Boolean function and the results of the four components were combined by utilizing the “AND” Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1−2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.
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- 2019
7. Quality of life in gastrointestinal cancer : what is the impact of nutrition?
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Ravasco, Paula, Monteiro Grillo, isabel, Marques-Vidal, Pedro, Camilo, Maria Ermelinda, and Repositório da Universidade de Lisboa
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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
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- 2006
8. Weight changes in Portuguese patients with depression: which factors are involved?
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Correia, Jerónima and Ravasco, Paula
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MENTAL depression , *OBESITY risk factors , *PHYSIOLOGICAL aspects of body weight , *PHYSICAL activity , *PSYCHIATRIC drugs , *INGESTION , *PORTUGUESE people , *HEALTH , *PHYSIOLOGY - Abstract
Background &Aims Depression may lead to obesity, just as obesity can contribute to the disease; yet, changes in the dietary pattern and food habits in depressive syndromes have been scantily investigated. We aimed to identify possible associations between nutritional factors and depressive disorder. Methods This cross sectional study included 127 consecutive ambulatory adult patients with depression (DSM-IV), under psychiatric treatment. All study parameters were classified according to sex & age: BMI, waist circumference, %fat mass, food intake & physical activity. Results Patients' mean age was 48 ± 13 (18-81) yrs, 94% were women. Overweight/obesity was found in 72% of the cohort, 72% had excessive fat mass & 69% had a waist circumference above the maximum cut-off value. Longer disease was associated with higher BMI +%fat mass, p < 0.003. Weight gain during illness was registered in 87%; just 12% lost weight, though undernutrition did not occur. Weight gain and greater fat mass were related with higher BMI, p = 0.002. The pattern of food intake was poor, monotonous and inadequate in 59% of patients; there was also a regular consumption of hypercaloric foods by 78% pts. Overall, the usual diet was associated with weight gain, p = 0.002. Antidepressants (75%) and benzodiazepines (72%) were prevalent; these drugs were associated with weight gain, p = 0.01; 80% pts did not practice any physical activity. Conclusions There was a positive association with overweight/obesity: a striking & clinically worrying prevalence of high fat mass, abdominal fat, weight gain, poor nutritional intake and sedentarism. This unhealthy pattern points towards the need of a multidisciplinary approach to promote healthy lifestyles that may help depressive disorder management. [ABSTRACT FROM AUTHOR]
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- 2014
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9. How Relevant Are Cytokines in Colorectal Cancer Wasting?
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Ravasco, Paula, Monteiro-Grillo, Isabel, and Camilo, Maria
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COLON cancer ,RADIOTHERAPY ,WEIGHT loss ,NUTRITION ,HISTOLOGY ,CYTOKINES - Abstract
Purpose: The purpose of this article was to investigate the influence of inflammatory cytokines, pro-cachectic (interleukin [IL]-1 receptor agonist [IL-1ra], IL-6, and tumor necrosis factor-or [TNF-a]), immunomodulatory (IL-10 and interferon-3, [IFN-3,]), and pro-angiogenic (vascular endothelial growth factor [VEGF]), on resting energy expenditure (REE), weight, and nutritional intake and to explore potential interactions between their circulating concentrations and colorectal cancer stage/histologic differentiation and response to radiotherapy (RT). Patients and Methods: This was a prospective longitudinal study in 101 patients evaluated before and after neoadjuvant RT, including REE (indirect calorimetry), percent weight loss, usual/current diet (diet history and 24-hour recall), serum concentrations of cytokines (enzyme-linked immunosorbent assay), and RT response. Results: Stages III/IV were often associated with histologic grades 2/3 (P < 0.01), albeit both characteristics independently were associated with higher concentrations of IL-1ra (P ≤ 0.05), IL-6 (P ≤ 0.02), TNF-α (P ≤ 0.05), IFN-γ, (P ≤ 0.05), and VEGF (P < 0.03). Before and after RT, higher REE, weight loss ≥5%, and intake reduction ≥25% were associated with advanced stage, histologic grades 2/3, higher IL-1ra, IL-6, TNF-α, IFN-γ, and VEGF, and nonresponse to RT (P = 0.003). A general linear model analysis showed that stages IIUIV, histologic grades 2/3, and higher IL-1ra, IL-6, TNF-α, IFN-γ, and VEGF were major determinants of REE increase, weight loss, and intake reduction. In predictive value analyses, higher baseline pro-cachectic cytokines (IL-1ra + IL-6 + TNF-α) by themselves predicted increased REE (hazard ratio [HR]: 8.25; 95% CI: 2.74-26.47; P < 0.002), greater weight loss (HR: 8.15; 95% CI: 2.22-25.40; P < 0.002), and intake reductions (HR: 7.15; 95% CI: 2.25-16.11; P < 0.004) aider RT. Conclusion: This study confirms the fact that wasting in colorectal cancer is correlated with tumor burden and histologic aggressiveness and suggests that both characteristics lead to overproduction of IFN-γ VEGF, and pro-cachectic cytokines, all of which may cause higher metabolic rates, poor intake, and non-response to RT. [ABSTRACT FROM AUTHOR]
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- 2007
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10. Does nutrition influence quality of life in cancer patients undergoing radiotherapy?
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Ravasco, Paula, Monteiro-Grillo, Isabel, and Camilo, Maria Ermelinda
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RADIOTHERAPY , *PATIENTS - Abstract
Purpose: To investigate in cancer patients referred for radiotherapy (RT): (1) quality of life (QoL), nutritional status and nutrient intake, at the onset and at the end of RT; (2) whether individualised nutritional counselling, despite symptoms, was able to enhance nutrient intake over time and whether the latter influenced the patient''s QoL; and (3) which symptoms may anticipate poorer QoL and/or reduced nutritional intake.Material and methods: One hundred and twenty-five patients with tumours of the head–neck/gastrointestinal tract (high-risk: HR), prostate, breast, lung, brain, gallbladder, uterus (low-risk: LR) were evaluated before and at the end of RT. Nutritional status was evaluated by Ottery''s Subjective Global Assessment, nutritional intake by a 24-h recall food questionnaire and QoL by two instruments: EUROQOL and the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30.Results: Baseline malnutrition was prevalent in HR vs. LR (
P=0.02 ); nutritional intake was associated with nutritional status (P=0.007 ); the latter did not change significantly during RT. In LR, baseline energy intake was higher than EER (P=0.001 ), and higher than HR’ intake (P=0.002 ); the latter increased (P<0.03 ), in spite of symptom increase anew and/or in severity (P=0.0001 ). According to both instruments, QoL was always better in LR vs. HR (P=0.01 ); at the end of RT, QoL improvement in HR was correlated with increased nutritional intake (P=0.001 ), both remained stable in LR.Conclusions: Individualised nutritional counselling accounting for nutritional status and clinical condition, was able to improve nutritional intake and patients’ QoL, despite self-reported symptoms. [Copyright &y& Elsevier]- Published
- 2003
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11. Nutritional approaches in cancer: Relevance of individualized counseling and supplementation.
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Ravasco, Paula
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MALNUTRITION diagnosis , *AGE distribution , *COUNSELING , *DECISION making , *DIETARY supplements , *MEDICAL care , *NUTRITION , *NUTRITIONAL assessment , *PATIENTS , *LEGAL status of patients , *SERIAL publications - Abstract
Intensive individualized nutritional counseling requires nutrition professionals with specific experience in oncology. If the patient is unable to achieve his or her nutritional requirements via regular foods, nutritional supplements may be prescribed, the composition of which is based on detection of dietary deficits as well as a detailed intake questionnaire. Any nutritional intervention must be based on the need for an adequate intake and also must take into consideration other relevant factors such as digestive and absorptive capacity, the need for alleviation or arrest of symptoms, and any psychological issues. [ABSTRACT FROM AUTHOR]
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- 2015
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12. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism.
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Pappalardo, Giulia, Almeida, Ana, and Ravasco, Paula
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TUMOR treatment , *EICOSANOIDS , *BODY composition , *BODY weight , *METABOLISM , *NUTRITION , *SERIAL publications , *THERAPEUTICS - Abstract
Objectives: The objective of this review article is to present the most recent intervention studies with EPA on nutritional outcomes in cancer patients, e.g. nutritional status, weight & lean body mass. Methods: For this purpose a PubMed® and MedLine®search of the published literature up to and including January 2014 that contained the keywords: cancer, sarcopenia, EPA,ω-3 fatty acids, weight, intervention trial, muscle mass was conducted. The collected data was summarized and written in text format and in tables that contained: study design, patient' population, sample size, statistical significance and results of the intervention. The paper will cover malignancy, body composition, intervention with EPA, physiological mechanisms of action of EPA, effect of EPA on weight and body composition, future research. Results: In cancer patients deterioration of muscle mass can be present regardless of body weight or Body Mass Index (BMI). Thus, sarcopenia in cancer patients with excessive fat mass (FM), entitled sarcopenic obesity, has gained greater relevance in clinical practice; it can negatively influence patients' functional status, tolerance to treatments & disease prognosis. The search for an effective nutritional intervention that improves body composition (preservation of muscle mass and muscle quality) is of utmost importance for clinicians and patients. The improvement of muscle quality is an even more recent area of interest because it has probable implications in patients' prognosis. Eicosapentaenoic acid (EPA) has been identified as a promising nutrient with the wide clinical benefits. Several mechanisms have been proposed to explain EPA potential benefits on body composition: inhibition of catabolic stimuli by modulating pro-inflammatory cytokines production and enhancing insulin sensitivity that induces protein synthesis; also, EPA may attenuate deterioration of nutritional status resulting from antineoplastic therapies by improving calorie and protein intake as well. Conclusions: Indeed, cancer-related sarcopenia/cachexia is a multifactorial syndrome characterized by inflammation, anorexia, weight loss, and muscle/adipose tissue loss mediated by proin-flammatory cytokines, e.g. TNF-α and IL-6, resulting in increased chemotherapy toxicity, costs, morbidity and mortality. With this review we found that EPA can reduce inflammation and has the potential to modulate nutritional status/body composition. In view of the modest survival benefits of chemotherapy/radiotherapy in some cancers, important issues for physicians are to optimize well-being, Quality of Life via nutritional status and adequate body composition. Thus, improvement in nutritional status is a central outcome. [ABSTRACT FROM AUTHOR]
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- 2015
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13. P-181 Head and Neck in Squamous Cell Carcinomas concurrent chemoradiotherapy: is there a relationship between nutrition and therapeutic response?
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de Sousa, M. João, Bento, Carolina, Zorrinho, Inês, Magalhães, Joana, Basto, Raquel, Garcia, Ana Rita, Khouria, Leila, Pires, Isonda, Ravasco, Paula, and Teixeira, Margarida
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SQUAMOUS cell carcinoma , *CHEMORADIOTHERAPY , *NECK , *NUTRITION , *HEAD - Published
- 2021
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