Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora

Detalhes bibliográficos
Autor(a) principal: Rodrigues, Viviane Dias
Data de Publicação: 2015
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
Texto Completo: http://www.bdtd.uerj.br/handle/1/8635
Resumo: Supplementation with immunomodulatory diet is recommended preoperatively for major cancer surgery in order to reduce infectious complications and length of stay. The aim of this study was to evaluate the effect of high-protein diet and immunomodulatory diet in nutritional status, inflammatory and immune response in gastric cancer patients in the preoperative and postoperative period.This is a prospective cohort study, with intervention in patients of the National Cancer Institute (INCA). After admission all patients received polymeric high-protein diet to correct protein-calorie intake during the median of 96 days at preoperative period. Five to seven days before surgery, high-protein diet was stopped and started immunomodulatory diet. On admission, after high-protein diet after immunomodulatory diet and postoperatively were collected nutritional parameters such as patient-generated subjective global assessment (PG-SGA), body weight, height, body mass index (BMI), midarm circumference (MC), midarm muscle circumference (MMC), triceps skinfold thickness (TSF), weight loss percentage (% PP), albumin, prealbumin; inflammatory parameters were listed as C-reactive protein (CRP) interleukins 1 and 6 (IL-1, IL-6), tumor necrosis factor-&#61537; (TNF-&#61537;), PCR/albumin ratio and Glasgow Prognostic Score (GPS); of immune parameters were collected: CD4, CD8, and Natural killer cells. In addition, the postoperative outcome within 30 days was observed, as the complications rates and death. Thirty-seven patients were included 59.5% male, 56.8% elderly (&#8805; 60 years), 43.2% eutrophic according PG-SGA and 81.1% with advanced cancer stage, 48.6% underwent total gastrectomy. Overall, 29.4% had complications and 11.8% died. Complications occurred particularly in those patients with higher IL-6 levels, with lower CD4/CD8 ratio and lower protein-calorie intake preoperatively, according t test. Patients who had IL-6 levels above 2,1pg / mL showed an 11.0 times greater risk of developing complications and/or death in the postoperative period, according to logistic regression adjusted for preoperative time (p=0.013; 95% CI = 1.7- 72.8). The presence of death was higher in individuals with CPR/albumin ratio <0.2 (p=0.021) and GPS 1 and 2 (p=0.011), according to chi-square test. We conclude that patients who consumed more than 80% of immunomodulatory diet had higher postoperative CD4, although it was not found reduced complications rate or length of stay. The high protein and immunomodulatory diet was able to maintain the nutritional and immune status of patients with gastric cancer in pre- and postoperative period, but in relation to inflammatory parameters there was no decrease after immunomodulatory diet.
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spelling Martucci, Renata Brumhttp://lattes.cnpq.br/2694712471212390Avesani, Carla Mariahttp://lattes.cnpq.br/3561058635341668Neves, Mário Fritsch Toroshttp://lattes.cnpq.br/4057939698550381Peres, Wilza Arantes Ferreirahttp://lattes.cnpq.br/0609700701164944http://lattes.cnpq.br/2680771020795705Rodrigues, Viviane Dias2021-01-05T19:39:29Z2018-11-122015-04-30RODRIGUES, Viviane Dias. Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora. 2015. 88 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2015.http://www.bdtd.uerj.br/handle/1/8635Supplementation with immunomodulatory diet is recommended preoperatively for major cancer surgery in order to reduce infectious complications and length of stay. The aim of this study was to evaluate the effect of high-protein diet and immunomodulatory diet in nutritional status, inflammatory and immune response in gastric cancer patients in the preoperative and postoperative period.This is a prospective cohort study, with intervention in patients of the National Cancer Institute (INCA). After admission all patients received polymeric high-protein diet to correct protein-calorie intake during the median of 96 days at preoperative period. Five to seven days before surgery, high-protein diet was stopped and started immunomodulatory diet. On admission, after high-protein diet after immunomodulatory diet and postoperatively were collected nutritional parameters such as patient-generated subjective global assessment (PG-SGA), body weight, height, body mass index (BMI), midarm circumference (MC), midarm muscle circumference (MMC), triceps skinfold thickness (TSF), weight loss percentage (% PP), albumin, prealbumin; inflammatory parameters were listed as C-reactive protein (CRP) interleukins 1 and 6 (IL-1, IL-6), tumor necrosis factor-&#61537; (TNF-&#61537;), PCR/albumin ratio and Glasgow Prognostic Score (GPS); of immune parameters were collected: CD4, CD8, and Natural killer cells. In addition, the postoperative outcome within 30 days was observed, as the complications rates and death. Thirty-seven patients were included 59.5% male, 56.8% elderly (&#8805; 60 years), 43.2% eutrophic according PG-SGA and 81.1% with advanced cancer stage, 48.6% underwent total gastrectomy. Overall, 29.4% had complications and 11.8% died. Complications occurred particularly in those patients with higher IL-6 levels, with lower CD4/CD8 ratio and lower protein-calorie intake preoperatively, according t test. Patients who had IL-6 levels above 2,1pg / mL showed an 11.0 times greater risk of developing complications and/or death in the postoperative period, according to logistic regression adjusted for preoperative time (p=0.013; 95% CI = 1.7- 72.8). The presence of death was higher in individuals with CPR/albumin ratio <0.2 (p=0.021) and GPS 1 and 2 (p=0.011), according to chi-square test. We conclude that patients who consumed more than 80% of immunomodulatory diet had higher postoperative CD4, although it was not found reduced complications rate or length of stay. The high protein and immunomodulatory diet was able to maintain the nutritional and immune status of patients with gastric cancer in pre- and postoperative period, but in relation to inflammatory parameters there was no decrease after immunomodulatory diet.A suplementação com dieta imunomoduladora é recomendada no pré-operatório de cirurgias oncológicas de grande porte visando à redução das complicações infecciosas e tempo de internação. O objetivo do presente trabalho foi avaliar o efeito da suplementação hiperproteica ou imunomoduladora na resposta nutricional, inflamatória e imune no pré-operatório e pós- operatório de pacientes com câncer gástrico. Trata-se de um estudo de coorte prospectiva, com intervenção, em pacientes do Instituto Nacional de Câncer (INCA). Após a admissão todos os pacientes receberam dieta polimérica hiperprotéica para correção da ingestão proteico-calórica, durante a mediana de 96 dias no período pré-operatório. Cinco a sete dias antes da cirurgia, a dieta hiperproteica foi interrompida e iniciada dieta imunomoduladora. Na admissão, após dieta hiperproteica, após dieta imunomoduladora e no pós-operatório foram coletados parâmetros nutricionais, como: avaliação subjetiva global produzida pelo paciente (ASG-PPP), peso corporal, altura, índice de massa corporal (IMC), circunferência do braço (CB), circunferência muscular do braço (CMB), prega cutânea tricipital (PCT), percentual de perda de peso (%PP), albumina, pré-albumina; como parâmetros inflamatórios foram coletados: proteína C reativa (PCR) interleucinas 1 e 6 (IL-1; IL-6), fator de necrose tumoral-&#61537; (TNF-&#61537;), relação PCR/albumina e Glasgow Prognostic Score (GPS); dos parâmetros imunes foram coletados: linfócitos CD4, CD8 e células Natural Killer. Além disso, foi observado o desfecho até 30 dias no pós-operatório, quanto às taxas de complicações e óbito. Foram incluídos 37 pacientes sendo 59,5% do sexo masculino, 56,8% idosos (&#8805; 60 anos), 43,2% eutróficos segundo ASG-PPP e 81,1% com estadiamento avançado do câncer, 48,6% realizaram gastrectomia total, 29,4% apresentaram complicações e 11,8% foram a óbito. As complicações ocorreram principalmente naqueles pacientes, com maiores níveis de IL-6, com menor relação CD4/CD8 e menor ingestão proteico-calórica no pré-operatório, segundo teste t. Os pacientes que tiveram níveis de IL-6 acima de 2,1pg/mL apresentaram um risco 11,0 vezes maior de apresentarem complicações e/ou óbito no pós-operatório, segundo regressão logística ajustada por tempo pré-operatório (p=0,013; IC 95%=1,7 72,8). A presença de óbito foi maior naqueles indivíduos com relação PCR/albumina <0,2 (p=0,021) e GPS 1 e 2 (p=0,011), segundo teste Qui-quadrado. Conclui-se que os pacientes que consumiram mais de 80% da dieta imunomoduladora apresentaram maior CD4 no pós-operatório, embora não foi encontrado diminuição das complicações e tempo de internação. A suplementação hiperprotéica e imunomoduladora foi capaz de manter o estado nutricional e imune dos pacientes com câncer gástrico no período pré e pós-operatório, porém em relação aos parâmetros inflamatórios não houve diminuição após a suplementação imunomoduladora.Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:39:29Z No. of bitstreams: 1 Viviane Dias Rodrigues Dissertacao completa.pdf: 1306212 bytes, checksum: 5b204bb47f284cfb347839a638b81c42 (MD5)Made available in DSpace on 2021-01-05T19:39:29Z (GMT). No. of bitstreams: 1 Viviane Dias Rodrigues Dissertacao completa.pdf: 1306212 bytes, checksum: 5b204bb47f284cfb347839a638b81c42 (MD5) Previous issue date: 2015-04-30application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBRCentro Biomédico::Faculdade de Ciências MédicasGastric cancerNutritional therapyImmunonutritionNeoplasia gástricaTerapia nutricionalImunonutriçãoEstômago CâncerNeoplasias gástricasTerapia nutricionalAlimentação enteralCâncer Aspectos nutricionaisAgentes antiinflamatóriosCNPQ::CIENCIAS DA SAUDE::NUTRICAOResposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladoraInflammatory and immune response of gastric cancer patient submitted to enteral nutrition and immunomodulatory therapyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALViviane Dias Rodrigues Dissertacao completa.pdfapplication/pdf1306212http://www.bdtd.uerj.br/bitstream/1/8635/1/Viviane+Dias+Rodrigues+Dissertacao+completa.pdf5b204bb47f284cfb347839a638b81c42MD511/86352024-02-26 15:59:58.904oai:www.bdtd.uerj.br:1/8635Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T18:59:58Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false
dc.title.por.fl_str_mv Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
dc.title.alternative.eng.fl_str_mv Inflammatory and immune response of gastric cancer patient submitted to enteral nutrition and immunomodulatory therapy
title Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
spellingShingle Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
Rodrigues, Viviane Dias
Gastric cancer
Nutritional therapy
Immunonutrition
Neoplasia gástrica
Terapia nutricional
Imunonutrição
Estômago Câncer
Neoplasias gástricas
Terapia nutricional
Alimentação enteral
Câncer Aspectos nutricionais
Agentes antiinflamatórios
CNPQ::CIENCIAS DA SAUDE::NUTRICAO
title_short Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
title_full Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
title_fullStr Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
title_full_unstemmed Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
title_sort Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora
author Rodrigues, Viviane Dias
author_facet Rodrigues, Viviane Dias
author_role author
dc.contributor.advisor1.fl_str_mv Martucci, Renata Brum
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/2694712471212390
dc.contributor.referee1.fl_str_mv Avesani, Carla Maria
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/3561058635341668
dc.contributor.referee2.fl_str_mv Neves, Mário Fritsch Toros
dc.contributor.referee2Lattes.fl_str_mv http://lattes.cnpq.br/4057939698550381
dc.contributor.referee3.fl_str_mv Peres, Wilza Arantes Ferreira
dc.contributor.referee3Lattes.fl_str_mv http://lattes.cnpq.br/0609700701164944
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/2680771020795705
dc.contributor.author.fl_str_mv Rodrigues, Viviane Dias
contributor_str_mv Martucci, Renata Brum
Avesani, Carla Maria
Neves, Mário Fritsch Toros
Peres, Wilza Arantes Ferreira
dc.subject.eng.fl_str_mv Gastric cancer
Nutritional therapy
Immunonutrition
topic Gastric cancer
Nutritional therapy
Immunonutrition
Neoplasia gástrica
Terapia nutricional
Imunonutrição
Estômago Câncer
Neoplasias gástricas
Terapia nutricional
Alimentação enteral
Câncer Aspectos nutricionais
Agentes antiinflamatórios
CNPQ::CIENCIAS DA SAUDE::NUTRICAO
dc.subject.por.fl_str_mv Neoplasia gástrica
Terapia nutricional
Imunonutrição
Estômago Câncer
Neoplasias gástricas
Terapia nutricional
Alimentação enteral
Câncer Aspectos nutricionais
Agentes antiinflamatórios
dc.subject.cnpq.fl_str_mv CNPQ::CIENCIAS DA SAUDE::NUTRICAO
description Supplementation with immunomodulatory diet is recommended preoperatively for major cancer surgery in order to reduce infectious complications and length of stay. The aim of this study was to evaluate the effect of high-protein diet and immunomodulatory diet in nutritional status, inflammatory and immune response in gastric cancer patients in the preoperative and postoperative period.This is a prospective cohort study, with intervention in patients of the National Cancer Institute (INCA). After admission all patients received polymeric high-protein diet to correct protein-calorie intake during the median of 96 days at preoperative period. Five to seven days before surgery, high-protein diet was stopped and started immunomodulatory diet. On admission, after high-protein diet after immunomodulatory diet and postoperatively were collected nutritional parameters such as patient-generated subjective global assessment (PG-SGA), body weight, height, body mass index (BMI), midarm circumference (MC), midarm muscle circumference (MMC), triceps skinfold thickness (TSF), weight loss percentage (% PP), albumin, prealbumin; inflammatory parameters were listed as C-reactive protein (CRP) interleukins 1 and 6 (IL-1, IL-6), tumor necrosis factor-&#61537; (TNF-&#61537;), PCR/albumin ratio and Glasgow Prognostic Score (GPS); of immune parameters were collected: CD4, CD8, and Natural killer cells. In addition, the postoperative outcome within 30 days was observed, as the complications rates and death. Thirty-seven patients were included 59.5% male, 56.8% elderly (&#8805; 60 years), 43.2% eutrophic according PG-SGA and 81.1% with advanced cancer stage, 48.6% underwent total gastrectomy. Overall, 29.4% had complications and 11.8% died. Complications occurred particularly in those patients with higher IL-6 levels, with lower CD4/CD8 ratio and lower protein-calorie intake preoperatively, according t test. Patients who had IL-6 levels above 2,1pg / mL showed an 11.0 times greater risk of developing complications and/or death in the postoperative period, according to logistic regression adjusted for preoperative time (p=0.013; 95% CI = 1.7- 72.8). The presence of death was higher in individuals with CPR/albumin ratio <0.2 (p=0.021) and GPS 1 and 2 (p=0.011), according to chi-square test. We conclude that patients who consumed more than 80% of immunomodulatory diet had higher postoperative CD4, although it was not found reduced complications rate or length of stay. The high protein and immunomodulatory diet was able to maintain the nutritional and immune status of patients with gastric cancer in pre- and postoperative period, but in relation to inflammatory parameters there was no decrease after immunomodulatory diet.
publishDate 2015
dc.date.issued.fl_str_mv 2015-04-30
dc.date.available.fl_str_mv 2018-11-12
dc.date.accessioned.fl_str_mv 2021-01-05T19:39:29Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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dc.identifier.citation.fl_str_mv RODRIGUES, Viviane Dias. Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora. 2015. 88 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2015.
dc.identifier.uri.fl_str_mv http://www.bdtd.uerj.br/handle/1/8635
identifier_str_mv RODRIGUES, Viviane Dias. Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora. 2015. 88 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2015.
url http://www.bdtd.uerj.br/handle/1/8635
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dc.publisher.none.fl_str_mv Universidade do Estado do Rio de Janeiro
dc.publisher.program.fl_str_mv Programa de Pós-Graduação em Ciências Médicas
dc.publisher.initials.fl_str_mv UERJ
dc.publisher.country.fl_str_mv BR
dc.publisher.department.fl_str_mv Centro Biomédico::Faculdade de Ciências Médicas
publisher.none.fl_str_mv Universidade do Estado do Rio de Janeiro
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