Rastreio da sarcopenia e avaliação dos efeitos da suplementação de cúrcuma em pacientes ambulatoriais com tumores do aparelho digestivo
Data
2024-06-10
Autores
Almeida, Pamela Simões de 
Orientadores
Forones, Nora Manoukian
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A sarcopenia é uma síndrome caracterizada pela diminuição da força e quantidade da massa muscular esquelética. Quando associada ao câncer está relacionada à piores desfechos clínicos. Os tumores do aparelho digestivo (TAD) podem comprometer a ingestão alimentar, e por isso é fundamental a avaliação e detecção do risco nutricional, e intervenção precoces. A cúrcuma e/ou curcumina mostraram efeitos benéficos em indivíduos com câncer, na diminuição da depleção e do estresse oxidativo muscular, e na melhora de fatores relacionados a sarcopenia. Para aumentar a biodisponibilidade da curcumina algumas tecnologias foram adicionadas a sua composição, como a Polar-Nonpolar-Sandwich (PNS) utilizada no Cureit®. A suplementação de curcumina em pacientes sarcopênicos com TAD, pode ser uma possível estratégia nutricional adjuvante ao tratamento convencional, evitando a progressão da sarcopenia. Objetivo: Avaliar a prevalência de sarcopenia em indivíduos com TAD a nível ambulatorial e verificar os efeitos da suplementação de curcumina nesta população. Métodos: Estudo conduzido entre maio/2022 e novembro/2023, realizado em duas etapas. A primeira caracterizada como prospectiva, transversal e observacional obtida da triagem nutricional de pacientes novos ou em início de tratamento, com diagnóstico de câncer do aparelho digestivo, atendidos nos ambulatórios de oncologia do Hospital São Paulo- UNIFESP e da Irmandade Santa Casa de Misericórdia de São Paulo. A segunda etapa foi um ensaio clínico, randomizado, triplo-cego, controlado por placebo. O grupo A realizou a suplementação com 500mg de Cureit®, e o grupo B com 500mg de amido de milho (Placebo), uma vez ao dia, por 90 dias. Foram realizadas três avaliações ao longo do estudo (antes da intervenção, durante e após), que analisaram o estado nutricional (Avaliação Subjetiva Global- Produzida Pelo Paciente- ASG-PPP), composição corporal (Bioimpedância- BIA), sarcopenia (Sarc-CalF; Força do Aperto de Mão (FAM); Teste de Levantar da Cadeira; Timed Up and Go (TUG); Massa Muscular Esquelética Total (MMET) da BIA) e qualidade de vida (questionário EORTC QLQ C30). O estudo seguiu as recomendações dos Padrões Consolidados de Relatórios de Ensaios Clínicos (CONSORT) e possui número de Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-8jmj76b. Resultados: A primeira etapa foi composta por 76 indivíduos, em sua maioria homens (59,2%), com média de idade de 62 anos. O câncer colorretal esteve presente em 32,9%, assim como o carcinoma hepatocelular/biliopancreático (32,9%), em estádio avançado (73,7%). O risco de sarcopenia foi positivo em 43,4%, destes, 20% tiveram confirmação. Na segunda etapa houve melhora, em ambos os grupos entre as avaliações, da FAM (p=0,029), teste de levantar da cadeira (p <,001), TUG (p <,001), porcentagem de perda de peso (p <,001) e da qualidade de vida (Domínio 1, p=0,01 e Domínio 2, p=0,006). O grupo intervenção não obteve resultados com diferenças significativas. Conclusão: Foi encontrada prevalência de 20% de sarcopenia na população estudada. Apesar do grupo suplementado, demonstrar melhores resultados para sintomas e qualidade de vida, não houve diferença significante em relação ao grupo placebo. Os pacientes de ambos os grupos, apresentaram melhora significante das variáveis relacionadas a sarcopenia, estado nutricional e qualidade de vida entre as avaliações realizadas durante tratamento oncológico.
Introduction: Sarcopenia is a syndrome characterized by decreased strength and quantity of skeletal muscle mass. When associated with cancer, it is related to worse clinical outcomes. Digestive system tumors (DST) can compromise food intake, so assessment and detection of nutritional risk and early intervention are essential. Turmeric and/or curcumin have shown beneficial effects in individuals with cancer, reducing muscle depletion and oxidative stress, and improving factors related to sarcopenia. To increase the bioavailability of curcumin, some technologies were added to its composition, such as Polar-Nonpolar-Sandwich (PNS) used in Cureit®. Curcumin supplementation in sarcopenic patients with DST may be a possible nutritional strategy as an adjuvant to conventional treatment, preventing the progression of sarcopenia. Objective: To evaluate the prevalence of sarcopenia in individuals with DST on an outpatient basis and verify the effects of curcumin supplementation in this population. Methods: The study was conducted between May/2022 and November/2023, and carried out in two stages. The first characterized as prospective, cross-sectional, and observational obtained from the nutritional screening of new patients or those beginning treatment, diagnosed with DST, treated at the oncology outpatient clinics of Hospital São Paulo - UNIFESP and Irmandade Santa Casa de Misericórdia de São Paulo. The second stage was a randomized, triple-blind, placebo-controlled clinical trial. Group A was supplemented with 500mg of Cureit®, and Group B was supplemented with 500mg of corn starch (Placebo), once a day, for 90 days. Three assessments were carried out throughout the study (before the intervention, during and after), which analyzed nutritional status (Subjective Global Assessment - Produced by the Patient - ASG-PPP), body composition (Bioimpedance - BIA), sarcopenia (Sarc-CalF; Hand Grip Strength (HGM); Chair Standing Test; Timed Up and Go (TUG); Total Skeletal Muscle Mass (MMET) through the BIA) and quality of life (EORTC QLQ C30). The study followed the recommendations of the Consolidated Standards for Reporting Clinical Trials (CONSORT) and has the Brazilian Clinical Trials Registry (ReBEC) number: RBR-8jmj76b. Results: The first stage consisted of 76 individuals, mostly men (59.2%), with an average age of 62 years. Colorectal cancer was present in 32.9%, as well as hepatocellular/biliopancreatic carcinoma (32.9%), at an advanced stage (73.7%). The risk of sarcopenia was positive in 43.4%, of which 20% were confirmed. In the second stage, there was an improvement, in both groups between assessments, in FAM (p=0.029), chair stand test (p <.001), TUG (p <.001), percentage of weight loss (p <. .001) and quality of life (Domain 1, p=0.01 and Domain 2, p=0.006). The intervention group did not obtain results with significant differences. Conclusion: A 20% prevalence of sarcopenia was found in the studied population. Although the supplemented group demonstrated better results for symptoms and quality of life, there was no significant difference from the placebo group. Patients in both groups showed significant improvement in variables related to sarcopenia, nutritional status, and quality of life between the assessments carried out during cancer treatment.
Introduction: Sarcopenia is a syndrome characterized by decreased strength and quantity of skeletal muscle mass. When associated with cancer, it is related to worse clinical outcomes. Digestive system tumors (DST) can compromise food intake, so assessment and detection of nutritional risk and early intervention are essential. Turmeric and/or curcumin have shown beneficial effects in individuals with cancer, reducing muscle depletion and oxidative stress, and improving factors related to sarcopenia. To increase the bioavailability of curcumin, some technologies were added to its composition, such as Polar-Nonpolar-Sandwich (PNS) used in Cureit®. Curcumin supplementation in sarcopenic patients with DST may be a possible nutritional strategy as an adjuvant to conventional treatment, preventing the progression of sarcopenia. Objective: To evaluate the prevalence of sarcopenia in individuals with DST on an outpatient basis and verify the effects of curcumin supplementation in this population. Methods: The study was conducted between May/2022 and November/2023, and carried out in two stages. The first characterized as prospective, cross-sectional, and observational obtained from the nutritional screening of new patients or those beginning treatment, diagnosed with DST, treated at the oncology outpatient clinics of Hospital São Paulo - UNIFESP and Irmandade Santa Casa de Misericórdia de São Paulo. The second stage was a randomized, triple-blind, placebo-controlled clinical trial. Group A was supplemented with 500mg of Cureit®, and Group B was supplemented with 500mg of corn starch (Placebo), once a day, for 90 days. Three assessments were carried out throughout the study (before the intervention, during and after), which analyzed nutritional status (Subjective Global Assessment - Produced by the Patient - ASG-PPP), body composition (Bioimpedance - BIA), sarcopenia (Sarc-CalF; Hand Grip Strength (HGM); Chair Standing Test; Timed Up and Go (TUG); Total Skeletal Muscle Mass (MMET) through the BIA) and quality of life (EORTC QLQ C30). The study followed the recommendations of the Consolidated Standards for Reporting Clinical Trials (CONSORT) and has the Brazilian Clinical Trials Registry (ReBEC) number: RBR-8jmj76b. Results: The first stage consisted of 76 individuals, mostly men (59.2%), with an average age of 62 years. Colorectal cancer was present in 32.9%, as well as hepatocellular/biliopancreatic carcinoma (32.9%), at an advanced stage (73.7%). The risk of sarcopenia was positive in 43.4%, of which 20% were confirmed. In the second stage, there was an improvement, in both groups between assessments, in FAM (p=0.029), chair stand test (p <.001), TUG (p <.001), percentage of weight loss (p <. .001) and quality of life (Domain 1, p=0.01 and Domain 2, p=0.006). The intervention group did not obtain results with significant differences. Conclusion: A 20% prevalence of sarcopenia was found in the studied population. Although the supplemented group demonstrated better results for symptoms and quality of life, there was no significant difference from the placebo group. Patients in both groups showed significant improvement in variables related to sarcopenia, nutritional status, and quality of life between the assessments carried out during cancer treatment.
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Citação
ALMEIDA, Pamela Simões de. Rastreio da sarcopenia e avaliação dos efeitos da suplementação de cúrcuma em pacientes ambulatoriais com tumores do aparelho digestivo. 2024. Dissertação (Mestrado em gastroenterologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.