RESUMO CONTEXTO: Considerando a alta incidência de óbitos devido ao câncer coloretal (CCR), estudos investigaram variáveis que podem afetar a sobrevida, com objetivo de prolongar a sobrevida. O estado nutricional desses pacientes também pode predizer a sobrevida. OBJETIVO: O objetivo do presente estudo foi avaliar se o índice de massa corporal (IMC), a porcentagem de gordura, os níveis séricos de adiponectina e de vitamina D são relevantes para a caracterização e diferenciação de pacientes com CCR avançado e pacientes com histórico de CCR. MÉTODOS: O estudo foi realizado por pacientes com câncer colorretal avançado (Grupo 1) e pacientes em acompanhamento após o tratamento do CCR (Grupo 2). O estado nutricional foi avaliado por meio do IMC, percentual de gordura corporal, ângulo de fase da bioimpedância elétrica, escore de Avaliação Global Subjetiva Gerada pelo Paciente. As concentrações de adiponectina foram determinadas por ELISA e os níveis de vitamina D foram medidos por meio de cromatografia líquida de alta performance. RESULTADOS: Os grupos 1 e 2 consistiram de 23 e 27 pacientes, respectivamente. O IMC, percentual de gordura corporal, ângulo de fase, níveis de vitamina D e adiponectina não foram significativamente diferentes entre os grupos. O escore médio da Avaliação Global Subjetiva Gerada pelo Paciente foi significativamente maior no grupo 1 em comparação com o Grupo 2, e foi significativamente correlacionado com o risco de mortalidade a longo prazo. CONCLUSÃO: Entre os indicadores do estado nutricional, apenas o escore da Avaliação Global Subjetiva Gerada pelo Paciente foi significativamente diferente entre os grupos e foi um importante preditor de sobrevida em pacientes com câncer colorretal avançado.

ABSTRACT BACKGROUND: Considering the high incidence of colorectal cancer (CRC) related deaths, many studies have investigated variables that can affect survival, with the aim of prolonging survival. The nutritional status can also be predict survival in patients with CRC. OBJECTIVE: The aim of the present study was to evaluate if BMI, %FAT, PhA, PG-SGA, adiponectin levels, and vitamin D levels are relevant to the characterization and differentiation of patients with advanced CRC and patients with a history of CRC. METHODS: The study was carried out by patients with advanced colorectal cancer (Group 1) and patients in follow-up after colorectal cancer treatment (Group 2). Nutritional status was assessed using the body mass index, body fat percentage, phase angle from bioelectrical impedance, Patient-Generated Subjective Global Assessment score. Adiponectin concentrations were determined using an enzyme-linked immunosorbent assay, and vitamin D levels were measured using high performance liquid chromatography. RESULTS: Groups 1 and 2 consisted of 23 and 27 patients, respectively. The body mass index, body fat percentage, phase angle, vitamin D and adiponectin levels were not significantly different between the groups. The mean Patient-Generated Subjective Global Assessment score was significantly higher in group 1 compared with group 2, and was significantly correlated with the long-term mortality risk. CONCLUSION: Among the nutritional status parameters, only the Patient-Generated Subjective Global Assessment score was significantly different between the groups and was an important predictor of survival in patients with advanced colorectal cancer.

Background: The aim of this study was to evaluate the association between adiponectin and tumor necrosis factor-α (TNF-α) serum levels in colorectal cancer (CRC) patients and compare these levels to clinical stage and nutritional status. Methods: A total of 79 patients were enrolled in the study (39 with CRC and 40 in the control). Nutritional status was assessed by Patient-Generated Subjective Global Assessment (PG-SGA), body mass index (BMI), and phase angle (PhA). Adiponectin and TNF-α serum concentrations were determined using an enzyme-linked immunosorbent assay. Results: Serum adiponectin levels were higher among CRC patients (p = 0.001). TNF-α serum levels were not significantly different between the groups, but patients with stage III or IV CRC had higher levels of TNF-α than those with lower stage disease (p = 0.037). The three tools used for the assessment of nutritional status (BMI, PhA, and PG-SGA) demonstrated that patients with a more severe nutritional deficit had higher adipocytokine levels, although these differences were significant only to TNF-α, when distributed PhA in tertiles. Conclusions: Adiponectin levels were higher among CRC patients. Although TNF-α serum levels from CRC patients did not differ significantly to the control group, CRC patients with stage III or IV had higher levels compared to those with stage I and II tumors. Nutritional status, as determined by BMI, PhA, and PG-SGA, demonstrated that patients with a greatest nutritional deficit, had higher levels of adipocytokines; however, these differences were significant only for TNF-α, when distributed PhA in tertiles.

Antecedentes: El propósito de este estudio fue evaluar la asociación entre las concentraciones séricas de adiponectina y de factor de necrosis tumoral-α (TNF-α) en paciente con cáncer colorrectal (CCR) y comparar estas concentraciones con el estadio clínico y el estado nutritivo. Métodos: Se reclutó a un total de 79 pacientes en el estudio (39 con CCR y 40 en el grupo control). Se evaluó el estado nutritivo mediante la Evaluación Global Subjetiva Generada por el Paciente (PG-SGA), el índice de masa corporal (IMC) y el ángulo de fase (AF). Se determinaron las concentraciones séricas de adiponectina y de TNF-α mediante un inmunoensayo de absorción ligado a enzima. Resultados: Las concentraciones séricas de adiponectina fueron superiores en los pacientes con CCR (p = 0,001). Las concentraciones séricas de TNF-α no fueron significativamente distintas entre los grupos pero los pacientes con CC en estadios III o IV tuvieron mayores concentraciones de TNF-α que aquellos con un menor estadio de la enfermedad (p = 0,037). Las tres herramientas empleadas para evaluar el estado nutritivo (IMC, AF y PG-SGA) demostraron que los pacientes con un déficit nutricional más pronunciado presentaban mayores concentraciones de adipocitocina, aunque algunas diferencias sólo fueron significativas para el TNF-α cuanto se distribuyó el AF en terciles. Conclusiones: Las concentraciones de adiponectina fueron superiores en pacientes con CCR. Aunque las concentraciones séricas de TNF-α de los pacientes con CCR no diferían significativamente de las del grupo control, los pacientes con CCR en estadios III o IV tuvieron concentraciones superiores en comparación con aquellos con tumores en estadios I y II. El estado nutritivo, determinado por IMC, AF y PG-SGA, demostró que los pacientes con un mayor déficit nutricional tenían concentraciones superiores de adipocitocinas; sin embargo, estas diferencias sólo fueron significativas para el TNF-α cuando el AF se distribuyó en terciles.

Objective: To evaluate methods for the identification of nutrition risk and nutritional status in outpatients with colorectal (CRC) and gastric cancer (GC), and to compare the results to those obtained for patients already treated for these cancers. Methods: A cross-sectional study was conducted on 137 patients: group 1 (n = 75) consisting of patients with GC or CRC, and group 2 (n = 62) consisting of patients after treatment of GC or CRC under follow up, who were tumor free for a period longer than 3 months. Nutritional status was assessed in these patients using objective methods ; nutritional screening tools [Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Nutritional Risk Index (NRI)], and subjective assessment [Patient-Generated Subjective Global Assessment (PG-SGA)]. The sensitivity and specificity of each method was calculated in relation to the PG-SGA used as gold standard. Results: One hundred thirty seven patients participated in the study. Stage IV cancer patients were more common in group 1. There was no difference in BMI between groups (p = 0.67). Analysis of the association between methods of assessing nutritional status and PG-SGA showed that the nutritional screening tools provided more significant results (p < 0.05) than the objective methods in the two groups. PG-SGA detected the highest proportion of undernourished patients in group 1. The nutritional screening tools MUST, NRI and MST were more sensitive than the objective methods. Phase angle measurement was the most sensitive objective method in group 1. Conclusion: The nutritional screening tools showed the best association with PG-SGA and were also more sensitive than the objective methods. The results suggest the combination of MUST and PG-SGA for patients with cancer before and after treatment.