RESUMEN La hemodiálisis, junto con la enfermedad renal crónica (ERC), intensifica el proceso inflamatorio y el estrés oxidativo en los pacientes en tratamiento. En este contexto, la suplementación con vitamina E puede mitigar los efectos nocivos resultantes de estos procesos. Esta es una revisión sistemática cuyo objetivo fue evaluar el efecto de la suplementación con vitamina E sobre biomarcadores inflamatorios y estrés oxidativo en pacientes con ERC en hemodiálisis. La revisión se elaboró según la metodología para revisiones sistemáticas y metanálisis (PRISMA) y la búsqueda se realizó en las bases de datos Pubmed, Cochrane Library, Scopus y Web of Science. El riesgo de sesgo de los estudios incluidos se evaluó con la Herramienta Cochrane de Riesgo de Sesgo (Cochrane Risk of Bias Tool). En esta revisión se incluyeron doce estudios desarrollados entre 2006 y 2020. La mayoría (n= 11) utilizó dosis de vitamina E que oscilaban entre 400 UI y 888 UI y el tiempo de suplementación osciló entre 2 semanas y 12 meses. De los 12 artículos incluidos, 25% (n= 3) analizaba la suplementación en biomarcadores inflamatorios, 50% (n= 6) en biomarcadores de estrés oxidativo y 25% (n= 3) en estos parámetros simultáneamente. Se observó un efecto positivo en 58,4% de los estudios (n= 7). Por lo tanto, la suplementación con vitamina E puede ser efectiva para mitigar el proceso inflamatorio y el estrés oxidativo, sin embargo, vale la pena señalar que el efecto depende de la dosis y el tiempo de suplementación.

ABSTRACT Hemodialysis, along with chronic kidney disease (CKD), intensifies the inflammatory process and oxidative stress in patients undergoing treatment. In this context, Vitamin E supplementation can mitigate the deleterious effects resulting from these processes. This is a systematic review whose objective was to evaluate the effect of Vitamin E supplementation on inflammatory biomarkers and oxidative stress in patients with CKD on hemodialysis. This review was prepared according to the methodology for systematic reviews and meta-analyses (PRISMA) and the search was performed in Pubmed, Cochrane Library, Scopus and Web of Science databases. The risk of bias of the included studies was assessed with the Cochrane Risk of Bias Tool. Twelve studies developed between 2006 and 2020 were included in this review. Most of them (n= 11) used vitamin E doses ranging from 400 IU to 888 IU and the supplementation time ranged from 2 weeks to 12 months. Of all the 12 articles included, 25% (n= 3) analyzed supplementation on biomarkers of oxidative stress and 25% (n= 3) addressed these parameters simultaneously. A positive effect was observed in 58.4% of the studies (n= 7). Thus, Vitamin E supplementation can be effective in mitigating the inflammatory process and oxidative stress, however, it is worth noting that the effect depends on the dose and time of supplementation.

ABSTRACT The main goal of this study was to verify the association between serum and dietary concentrations of calcium, phosphorus and iron, and to determinate whether patients with kidney disease undergoing hemodialysis had inadequacy in dietary intake. We conducted a descriptive cross-sectional study that evaluated 40 patients undergoing hemodialysis. Food consumption was determined by the 24-hour recall. The optical technology method was used to obtain hemoglobin and hematocrit concentrations. Serum levels of iron, calcium and phosphorus were determined by dry chemistry. We observed insufficient consumption of energy, macronutrients and minerals. Energy intake of patients with longer hemodialysis was higher. The sample presented hypocalcemia, hyperphosphatemia (except in the group ≥8 years of hemodialysis), higher iron concentrations and lower hemoglobin and hematocrit values. The serum levels of minerals were not affected by dietary intake. There was a significant correlation between dietary phosphorus and calcium in patients undergoing hemodialysis for more than 8 years, those over 60 years old and, between calcium and phosphorus normal levels in patients over 60 years old. Hemoglobin, hematocrit and mineral serum levels were similar regardless of age and hemodialysis time. It was concluded that inadequacies of minerals reflected deregulation among metabolism and the pathophysiological changes inherent to Chronic Kidney Disease.

RESUMEN El objetivo principal de este estudio fue verificar la asociación entre las concentraciones séricas y dietéticas de calcio, fósforo y hierro, y determinar su ingesta dietética inadecuada en pacientes con enfermedad renal sometidos a hemodiálisis. Se trató de un estudio descriptivo transversal que evaluó a 40 pacientes en hemodiálisis. El consumo de alimentos se determinó mediante el recordatorio de 24 horas. Se utilizó el método de tecnología óptica para obtener concentraciones de hemoglobina y hematocrito. Los niveles séricos de hierro, calcio y fósforo se determinaron mediante química seca. El estudio mostró un consumo insuficiente de energía, macronutrientes y minerales. La ingesta energética de los pacientes con hemodiálisis más prolongada fue mayor. La muestra presentó hipocalcemia, hiperfosfatemia (excepto en el grupo ≥8 años de hemodiálisis), mayor concentración de hierro y menores valores de hemoglobina y hematocrito. Los niveles séricos de minerales no se vieron afectados por su ingesta dietética. Hubo una correlación significativa entre el fósforo dietético y el calcio en los pacientes en hemodiálisis durante más de 8 años y los mayores de 60 años y, también, entre los niveles normales de calcio y fósforo en los pacientes mayores de 60 años. Los niveles séricos de hemoglobina, hematocrito y minerales fueron similares independientemente de la edad y el tiempo de hemodiálisis. Se concluyó que las deficiencias de los minerales parecen reflejarse en la desregulación de su metabolismo y los cambios fisiopatológicos inherentes a la Enfermedad Renal Crónica.

RESUMO Objetivo Investigar a relação entre as concentrações de calcidiol (25(OH)D3) e os parâmetros de ferro em pacientes com doença renal crônica. Métodos É um estudo transversal, descritivo e quantitativo. A amostra foi composta por 86 pacientes, adultos, de ambos os sexos, em terapia dialítica. As concentrações de 25(OH)D3 foram determinadas pelo método de quimioluminescência; o consumo alimentar foi avaliado pela aplicação de Recordatórios de 24 horas e foram avaliados os níveis séricos de hemoglobina, ferro, ferritina e saturação de transferrina. A análise dos dados foi realizada no programa Stata, com nível de significância p<0.05. Resultados Os resultados apontaram para concentrações de 25(OH)D3 compatíveis com suficiência, níveis de ferro compatíveis com a normalidade e ferritina e saturação de transferrina superiores à referência. O consumo de carboidratos e lipídios foi superior no sexo feminino. Não foi verificada relação entre a adequação de 25(OH)D3 e a presença de anemia e parâmetros de ferro. Conclusão Tendo em vista que os níveis médios séricos de ferro e 25(OH)D3 estavam adequados, sugere-se que a resistência à eritropoietina e o processo inflamatório podem ter contribuído para o percentual de anêmicos constatado no estudo.

ABSTRACT Objective To investigate the relationship between calcidiol (25(OH)D3) concentrations and iron parameters in patients with chronic kidney disease. Methods This is a cross-sectional, descriptive, and quantitative study. The sample consisted of 86 adult patients of both sexes undergoing dialysis. 25(OH)D3 concentrations were determined by chemiluminescence; food consumption was assessed using 24-hour recalls, and the serum levels of hemoglobin, iron, ferritin, and transferrin saturation were assessed. Data analysis was performed using the program Stata, with a significance level of p<0.05. Results The results pointed to 25(OH)D3 concentrations compatible with sufficiency, iron levels consistent with normality, and ferritin and transferrin saturation above the reference values. The consumption of carbohydrates and lipids was higher in females. There was no relationship between the adequacy of 25(OH)D3 and the presence of anemia and iron parameters. Conclusion Considering that the mean serum levels of iron and 25(OH)D3 were adequate, it is suggested that resistance to erythropoietin and the inflammatory process may have contributed to the percentage of anemic individuals found in the study.

ABSTRACT Introduction: Recent studies highlight Chronic Kidney Disease (CKD) as responsible for severe damage to clinical-nutritional status and for changes in the lipid profile of its patients, which, together, contribute to the increase in deaths and hospitalization time for these patients. Therefore, this study aimed to determine the protein intake and its association with the lipid and anthropometric profile of chronic renal patients. Methods: Data came from a cross-sectional survey conducted with 95 patients with CKD on dialysis treated at Renal Therapy Centers in the State of Piauí. Anthropometric variables were determined. Protein consumption was obtained by applying two 24hr dietary recalls. Lipid fractions were determined according to the calorimetric enzymatic method and specific calculations. Data were analyzed with Stata®, v.12 software (Statacorp, College Station, Texas, USA), with significance level set at p<0.05. The research received ethical approval, nº 2.527.329. Results: The final sample consisted of 95 patients, with a predominance of male participants (67.4%) and the average age of the total population was 40.8±10.7 years. There was no association between protein consumption and anthropometric variables. However, there was a significant, but negative, correlation between protein intake and total cholesterol concentrations (p= 0.017) and LDL-c (p= 0.025). Conclusion: The mean protein intake identified, 1.30±0.83 g/kg/day, despite meeting the recommendation for chronic renal patients did not appear to influence the anthropometric status, but had significant effects on specific lipid parameters of patients with CKD of this study.

RESUMEN Introducción: Estudios recientes destacan a la enfermedad renal crónica (ERC) como responsable del daño severo en el estado clínico-nutricional y de cambios en el perfil lipídico de sus pacientes, que, en conjunto, contribuyen al aumento del tiempo de hospitalización y mortalidad de estos pacientes. Por tanto, este estudio tuvo como objetivo determinar la ingesta proteica y su asociación con el perfil lipídico y antropométrico de pacientes renales crónicos. Métodos: Se analizaron los datos de la encuesta transversal realizada a 95 pacientes con ERC en diálisis tratados en Centros de Terapia Renal del Estado de Piauí. Se determinaron variables antropométricas. El consumo de proteínas se obtuvo aplicando dos encuestas de alimentación 24HR. Las fracciones lipídicas se determinaron según el método enzimático calorimétrico y cálculos específicos. Los datos se analizaron en Software Stata 12, y se adoptaron como nivel de significancia p<0.05. La investigación recibió la aprobación ética, bajo la opinión del número 2.527.329. Resultados: La muestra final estuvo conformada por 95 pacientes, con predominio de varones (67,4%) y la edad promedio de la población total fue de 40,8±10,7 años. No hubo asociación entre el consumo de proteínas y las variables antropométricas de los pacientes. Sin embargo, hubo una correlación significativa, pero negativa, entre la ingesta de proteínas y las concentraciones de CT (p= 0.017) y LDL-c (p= 0.025). Conclusión: Se concluyó que la ingesta media de proteínas identificada, 1,30±0,83 g/kg/día, a pesar de cumplir con la recomendación para pacientes renales crónicos, no pareció influir en el estado antropométrico, pero tuvo efectos significativos sobre parámetros lipídicos específicos de pacientes con ERC de este estudio.

ABSTRACT The objective of this study was to investigate the association between calcium and phosphorus parameters with serum parathormone concentrations in patients with Chronic Kidney Disease (CKD) undergoing hemodialysis. It is descriptive quantitative cross-sectional study. The sample was composed of 50 individuals distributed in: group with up to 5 years of hemodialysis and group with more than 5 years of hemodialysis. Food consumption was assessed using 24-hour dietary recall. Descriptive analysis of quantitative variables was presented as mean and standard deviation. Data analysis was performed using the SPSS program; Student “T” test, Fisher's exact test and Pearson's chi-square test were used, with significance level p <0.05. The groups presented adequate serum calcium concentrations and high concentrations of phosphorus and parathormone. Patients with more than 5 years of hemodialysis had a statistically higher serum parathormone level (p= 0.034); there was an association between longer hemodialysis time and higher serum phosphorus concentrations (p= 0.039). There was a moderate positive correlation between serum parathormone and phosphorus in the group with up to 5 years of hemodialysis (p= 0.012). It was concluded that the progression of CKD increases serum phosphorus and parathormone concentrations, reflecting the pathophysiological events and altered metabolic demand inherent to the pathology.

RESUMEN El objetivo de este trabajo fue investigar la asociación de los parámetros de calcio y fósforo con las concentraciones séricas de parathormona en pacientes con enfermedad renal crónica (ERC) en hemodiálisis. Se trata de un estudio descriptivo, cuantitativo y transversal. La muestra estuvo constituida por 50 individuos distribuidos en: grupo con hasta 5 años en hemodiálisis y grupo con más de 5 años en hemodiálisis. El consumo de alimentos se evaluó mediante el recordatorio de 24 horas. El análisis descriptivo de las variables cuantitativas se presentó como media y desviación estándar de la media. El análisis de los datos se realizó mediante el programa SPSS; Se utilizó la prueba “T” de Student, la prueba exacta de Fisher y la prueba de chi-cuadrado de Pearson, con un nivel de significancia de p <0.05. Los grupos mostraron concentraciones adecuadas de calcio sérico y altas concentraciones de fósforo y parathormona. Los pacientes con más de 5 años de hemodiálisis tenían un nivel de parathormona sérica estadísticamente más alto (p= 0,034); hubo una asociación entre un mayor tiempo de hemodiálisis y mayores concentraciones de fósforo sérico (p= 0,039). Hubo una correlación positiva moderada entre parathormona sérica y fósforo en el grupo con hasta 5 años de hemodiálisis (p= 0.012). Se concluyó que la progresión de la ERC aumenta las concentraciones séricas de fósforo y parathormona, reflejando los eventos fisiopatológicos y alteración de la demanda metabólica inherente a la patología.

ABSTRACT This study proposes to update knowledge about the relationship between microbiota and Colorectal Cancer (CRC). This is a review carried out using the methodology of the Preferred Report Item for Systematic Analysis and Meta-Analysis (PRISMA) and search for original articles, indexed in the Pubmed, Cochrane and Science Direct databases, published between 2011 and 2019, in English. Ten articles showed changes in bacterial composition and its influence on the development and progression of CRC, and only two addressed changes in the composition of fungi and their relationship with CRC. Most studies have shown that the increase in Fusobacterium nucleatum and bacteroides fragilis is strongly associated with the occurrence of CRC due to inflammatory mechanisms; and that Faecalibacterium prausnitzii is a protective factor through the production of butyrate. Additional research is recommended to assess the relationship of microorganisms with the development of CRC, with an emphasis on fungi.

RESUMEN Este estudio propone actualizar el conocimiento sobre la relación entre la microbiota y el Cancer Colorectal (CCR). Esta es una revisión realizada utilizando la metodología del Elemento de Informe Preferido para el Análisis Sistemático y el Meta-análises (PRISMA) y la búsqueda de artículos originales, indexados en las bases de datos Pubmed, Cochrane y Science Direct, publicados entre 2011 y 2019, en inglés. Diez artículos mostraron cambios en la composición bacteriana y su influencia en el desarrollo y la progresión del CCR, y solo dos abordaron los cambios en la composición de los hongos y su relación con el CCR. La mayoría de los estudios han demostrado que el aumento de Fusobacterium nucleatum y bacteroides fragilis está fuertemente asociado con la aparición de CCR debido a mecanismos inflamatorios; y que Faecalibacterium prausnitzii es un factor protector a través de la producción de butirato. Se recomienda investigación adicional para evaluar la relación de los microorganismos con el desarrollo de CCR, con énfasis en los hongos.

Resumo O aumento da participação de alimentos ultraprocessados na alimentação de crianças e adolescentes está relacionado ao desenvolvimento de agravos não transmissíveis, como dislipidemia. Objetivou-se realizar uma revisão sistemática da literatura sobre a relação do consumo de alimentos ultraprocessados e o perfil lipídico de crianças e adolescentes. Realizou-se uma busca nas bases de dados PubMed, Scopus, Cochrane e LILACS por estudos com desenhos transversais e longitudinais, com ou sem intervenção; em crianças e/ou adolescentes aparentemente saudáveis, que tivessem a ingestão de alimento ultraprocessado como variável de exposição e o perfil lipídico como desfecho. Após triagem, 14 estudos foram incluídos, destes, nove demonstraram que o consumo de ultraprocessados estava relacionado com o aumento do LDL-c, colesterol total, triglicerídeos e diminuição do HDL-c. Três estudos não encontraram nenhuma relação e dois demonstraram que a maior ingestão de cereais prontos estava relacionada com a diminuição de colesterol total e LDL-c. Observou-se elevado consumo de alimentos ultraprocessados e relação positiva com lipídios sanguíneos em crianças e adolescentes o que chama atenção para a realização de intervenções, como educação nutricional, com vistas a reduzir a ingestão desses alimentos.

Abstract The increase in the input of ultra-processed ingredients in the food of children and adolescents is related to the development of noncommunicable diseases such as dyslipidemia. The scope of this study was to conduct a systematic review of the literature on the relationship of consumption of ultra-processed foods in the lipid profile of children and adolescents. A search in the PubMed, Scopus, Cochrane and LILACS databases was carried out to locate cross-sectional and longitudinal studies, with or without intervention, in apparently healthy children and/or adolescents, who had the intake of ultra-processed food as an exposure variable and the lipid profile as an outcome. After screening, 14 studies were included, of which nine demonstrated that ultra-processed food consumption was related to increased LDL-c, total cholesterol, triglycerides and a reduction in HDL-c. Three studies found no relationship and two demonstrated that the increased intake of ready-to-eat cereals was related to the decrease in total cholesterol and LDL-c. There was a high consumption of ultra-processed foods and positive relation with blood lipids among children and adolescents, which calls attention to interventions, such as nutritional education, with a view to reducing the intake of these foods.

Resumo O aumento da participação de alimentos ultraprocessados na alimentação de crianças e adolescentes está relacionado ao desenvolvimento de agravos não transmissíveis, como dislipidemia. Objetivou-se realizar uma revisão sistemática da literatura sobre a relação do consumo de alimentos ultraprocessados e o perfil lipídico de crianças e adolescentes. Realizou-se uma busca nas bases de dados PubMed, Scopus, Cochrane e LILACS por estudos com desenhos transversais e longitudinais, com ou sem intervenção; em crianças e/ou adolescentes aparentemente saudáveis, que tivessem a ingestão de alimento ultraprocessado como variável de exposição e o perfil lipídico como desfecho. Após triagem, 14 estudos foram incluídos, destes, nove demonstraram que o consumo de ultraprocessados estava relacionado com o aumento do LDL-c, colesterol total, triglicerídeos e diminuição do HDL-c. Três estudos não encontraram nenhuma relação e dois demonstraram que a maior ingestão de cereais prontos estava relacionada com a diminuição de colesterol total e LDL-c. Observou-se elevado consumo de alimentos ultraprocessados e relação positiva com lipídios sanguíneos em crianças e adolescentes o que chama atenção para a realização de intervenções, como educação nutricional, com vistas a reduzir a ingestão desses alimentos.

Abstract The increase in the input of ultra-processed ingredients in the food of children and adolescents is related to the development of noncommunicable diseases such as dyslipidemia. The scope of this study was to conduct a systematic review of the literature on the relationship of consumption of ultra-processed foods in the lipid profile of children and adolescents. A search in the PubMed, Scopus, Cochrane and LILACS databases was carried out to locate cross-sectional and longitudinal studies, with or without intervention, in apparently healthy children and/or adolescents, who had the intake of ultra-processed food as an exposure variable and the lipid profile as an outcome. After screening, 14 studies were included, of which nine demonstrated that ultra-processed food consumption was related to increased LDL-c, total cholesterol, triglycerides and a reduction in HDL-c. Three studies found no relationship and two demonstrated that the increased intake of ready-to-eat cereals was related to the decrease in total cholesterol and LDL-c. There was a high consumption of ultra-processed foods and positive relation with blood lipids among children and adolescents, which calls attention to interventions, such as nutritional education, with a view to reducing the intake of these foods.

Resumo Objetivo: Consolidar as informações disponíveis acerca dos efeitos da vitamina B12 sobre a densidade mineral óssea e o risco de fraturas, com destaque para ensaios clínicos, dados observacionais e longitudinais realizados com humanos. Método: Foi realizada uma revisão sistemática da literatura dos últimos dez anos sobre o papel da vitamina B12 na densidade mineral óssea e no risco de fraturas em populações de todas as idades e para ambos os sexos, com busca de artigos nos bancos de dados eletrônicos: PubMed, Science Direct, Medline e SciELO. Como estratégia de busca de dados incluíram-se os descritores: B12 Vitamin and Bone Mineral Density e B12 Vitamin and Risk of Fractures. A qualidade das evidências dos artigos incluídos foi avaliada pelo sistema GRADE. Resultados: Após a análise dos títulos e dos resumos dos artigos, a estratégia de busca resultou em 25 referências, das quais 17 artigos preencheram os critérios de elegibilidade. Esta revisão fornece evidências de que o papel da vitamina B12 sobre a densidade mineral óssea ou o risco de fraturas ainda precisa ser mais bem elucidado. As controvérsias encontram respaldo na heterogeneidade das metodologias utilizadas para o diagnóstico da vitamina B12 e também na variedade de populações presentes entre os estudos. Conclusão: Ainda não está bem estabelecido o real impacto da deficiência de vitamina B12 na saúde dos ossos e sobre os mecanismos associados ao metabolismo ósseo. É de suma importância a realização de mais estudos esclarecedores, principalmente em grupos vulneráveis como as mulheres pós-menopausa e os idosos, grupos estes bastante afetados pela deficiência dessa vitamina.

Summary Objective: To consolidate information available on the effect of vitamin B12 on bone mineral density and fracture risk, with emphasis on clinical trials, observational and longitudinal data conducted in humans. Method: A systematic review of the literature of the past decade on the role of vitamin B12 in bone mineral density and fracture risk in subjects of all ages and both sexes was performed by means of a PubMed, Science Direct, Medline and SciELO database search. Articles included in this review were identified using the search terms: B12 Vitamin and Bone Mineral Density and Vitamin B12 and Risk of Fractures. Evidence quality of the included articles was evaluated by GRADE system. Results: A total of 25 original studies were identified. After reviewing the titles and abstracts of articles, only 17 articles met the inclusion criteria. The present review provides evidence that the role of vitamin B12 on bone mineral density or fracture risk should be further elucidated. Controversies are explained by heterogeneity of methodologies used for the diagnosis of vitamin B12 and also by differences among populations investigated on the studies. Conclusion: A real effect of vitamin B12 deficiency in bone health and the mechanisms associated with bone metabolism is not well established yet. It is extremely important to carry out more clarifying studies about this theme, especially with vulnerable groups such as postmenopausal and elderly women, as is well-known that they are greatly affected by deficiency of this vitamin.