Association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy

To analyse the association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy. A prospective cohort study was conducted with 100 pregnant women. Data collection occurred once during each gestational trimester. The assessment of sleep quality and duration was performed using the Pittsburgh Sleep Quality Index. Food intake was assessed using three 24-h recalls in each trimester. Body weight was measured during the three trimesters, and height was measured only once to calculate the BMI. Linear regression analyses were performed to associate sleep duration and quality with food consumption and weight gain variables. Longer sleep duration was associated with a later dinner in the first trimester (β = 0·228, P = 0·025) and earlier in the third trimester (β = -0·223, P = 0·026), in addition to a later morning snack in the second trimester (β = 0·315, P = 0·026). Worse sleep quality was associated with higher total energy intake (β = 0·243, P = 0·044), total fat (β = 0·291, P = 0·015) and the chrononutrition variables such as a higher number of meals (β = 0·252, P = 0·037), higher energetic midpoint (β = 0·243, P = 0·044) and shorter fasting time (β = -0·255, P = 0·034) in the third trimester. Sleep quality was also associated with a higher BMI in the first trimester of pregnancy (β = 0·420, P = < 0·001). Most of the associations found in the present study show that poor sleep is associated with higher energy and fat intake and higher BMI. Longer sleep duration was associated with a later dinner in early pregnancy and an earlier dinner in late pregnancy, as well as with a later morning snack in the second trimester of pregnancy.

Is the Caloric Midpoint Associated with Food Cravings and Food Intake in Pregnant Women?

Objective: The field of chrononutrition suggests that mealtime can influence food intake. Previous studies have linked the caloric midpoint - defined as the time at which 50% of the daily energy is consumed - with different aspects of food consumption. However, its relationship with food craving remains unexplored. This cross-sectional study aimed to investigate the association between caloric midpoint, food craving, and food consumption in pregnant women.Methods: The study comprised 233 pregnant women classified as early eaters (caloric midpoint ≤ 1:00pm) and late eaters (caloric midpoint >1:00pm). Food craving were assessed using Food Craving Trait and State Questionnaires. Energy and nutrient intake, as well as mealtimes, were assessed using a 24-h food recall.Results: No association between caloric midpoint and food craving was found. However, late eaters consumed more calories (2039.47 kcal vs 1843.44 kcal; p < 0.001), carbohydrates (255.06 g vs 211.12 g; p = 0.002), total fat (73.1 g vs 64.8 g; p = 0.003), monounsaturated fat (21.33 mg vs 18.59 mg; p = 0.002) and saturated fat (24.37 mg vs 22.21 mh; p = 0.01) and had higher consumption of calories and macronutrients in the first (calories: 275.63 vs 213.41, p = 0.007; carbohydrate: 170.42 vs 142.54, p = 0.01; total fat: 56.49 vs 50.17, p = 0.04) and second (calories: 213.21 vs 151.59, p = 0.04; carbohydrate: 130.44 vs 96.6, p = 0.04; protein: 15.17 vs 13.71, p = 0.03) afternoon snack, dinner (calories: 576.89 vs 412.4, p < 0.001; carbohydrate: 230.76 vs 169.45, p < 0.001; protein: 80.48 vs 68.9, p = 0.02; total fat: 212.77 vs 147.12, p < 0.001) and late-night snack (calories: 135.75 vs 68.3, p = 0.04; total fat: 13.23 vs 22.45, p = 0.04) than early eaters.Conclusion: Pregnant women who concentrate their meals at later times consumed more calories, macro and micronutrients throughout the day and in the night meals when compared to early eaters.

Health-Related quality of life by 31-item Cervantes scale in breast cancer survivors undergoing adjuvant endocrine therapy

INTRODUCTION

Instruments to manage adverse effects of endocrine therapy with Aromatase inhibitors (AI) may improve adherence and persistence to treatment and Health-Related Quality of Life (HRQL). The 31-item Cervantes Scale (CS-31) is an HRQL questionnaire with particularities of the perimenopausal and postmenopausal period that could be an appropriate instrument to assess HRQL in Breast Cancer (BC) survivors.

OBJECTIVE

This study aimed to perform additional validation of the CS-31 for BC survivors undergoing adjuvant endocrine therapy.

METHODS

This prospective study was performed at three time points named T0, T1, and T2: initial, intermediate, and final follow-up period, respectively, totaling 24 months of follow-up. At each time point, the participants completed the CS-31, Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F), and Hospital Anxiety and Depression Scale (HADS). The internal consistency, construct validity, responsiveness analyses, and known-group validity of CS-31 were evaluated.

RESULTS

This study included 89 postmenopausal women diagnosed with hormone receptor-positive early BC in adjuvant endocrine therapy with AI. The internal consistency was good (Cronbach's alpha = 0.89). Construct validity received a positive rating, with 100% of results consistent with prior hypotheses. A prospective improvement in HRQL was identified for the CS-31 Global Score and FACIT-F Total Score and for most of their domains. Furthermore, women with anxiety and depression by HADS presented worse HRQL by CS-31.

CONCLUSION

The authors identified that the CS-31 seems to be appropriate for use in oncology medical routine and may help to monitor adverse effects and HRQL of BC survivors during adjuvant endocrine therapy.

Influence of fasting during the night shift on next day eating behavior, hunger, and glucose and insulin levels: a randomized, three-condition, crossover trial

AIMS

To investigate the influence of fasting during the night shift on eating behavior, hunger, glucose and insulin levels the following day.

METHODS

Study with 10 male police officers who have been working at night. Participants were tested under three different conditions separated by at least 6 days of washout in a randomized, crossover design: "Night Shift Fasting" (NSF)-two nights of fasting during the night shift; "Night Shift Eating" (NSE)-two nights with the consumption of a standardized meal during the night shift (678 ± 42 kcal consumed at ~ 0200 h); and "Nighttime Sleep" (NS)-two nights of sleep. The morning after, blood glucose and insulin and hunger ratings were assessed, and food intake was assessed with an ad libitum test meal. Food intake was also assessed throughout the remainder of the day using a food record. Generalized Estimating Equations were used to analyze the effect of experimental condition.

RESULTS

Food intake during the test meal, especially of proteins and fats, was higher after fasting during the night shift compared to the other conditions (p < 0.05), whereas desire to eat scores were lower after the NSF compared to NSE condition (p = 0.043). Hunger levels were lower after the NSF compared to the NS condition (p = 0.012). Insulin and HOMA-IR were also lower in the morning after NSF (p < 0.001).

CONCLUSION

Fasting during the night shift leads to not only a higher intake of energy and macronutrients both in the early morning after work and throughout the next day, but also lower insulin levels and HOMA-IR in the morning.

REGISTRATION NUMBER OF CLINICAL TRIAL

NCT03800732. Initial release: 01/09/2019. Last release: 02/23/2022.

Impact of Chemotherapy Regimens on Body Composition of Breast Cancer Women: A Multicenter Study across Four Brazilian Regions

This study aimed to investigate the effect of chemotherapy (CT) and its different types of regimens on the anthropometry and body composition of women with breast cancer. Three-hundred-and-four women with breast cancer were enrolled in this multicenter study. The participants were evaluated before the infusion of the first cycle of CT (pre-CT), and until two weeks after CT completion (post-CT), regarding body weight, body mass index (BMI); waist circumference (WC); waist-to-height ratio (WHtR); conicity index (C-index); fat mass index (FMI); and fat-free mass index (FFMI). CT regimens were classified as anthracycline-based (AC—doxorubicin or epirubicin); anthracyclines and taxane (ACT); cyclophosphamide, methotrexate, and 5-fluorouracil (CMF); or isolated taxanes (paclitaxel or docetaxel). Women significantly increased BMI and FMI post-CT (p < 0.001 and p = 0.007, respectively). The ACT regimen increased FMI (p < 0.001), while FFMI increased after AC (p = 0.007). It is concluded that the CT negatively impacted body composition and the type of regime had a strong influence. The ACT regimen promoted an increase in FMI compared to other regimens, and the AC increased FFMI. These findings reinforce the importance of nutritional monitoring of breast cancer patients throughout the entire CT treatment.

Serum 25-hydroxyvitamin D and cancer-related fatigue: associations and effects on depression, anxiety, functional capacity and health-related quality of Life in breast cancer survivors during adjuvant endocrine therapy

Background

The adjuvant treatment with Aromatase Inhibitor (AI) is considered standard of care for postmenopausal breast cancer (BC) women with hormone receptor-positive (HR +), however, it often causes adverse effects such as cancer-related fatigue (CRF). The high prevalence of vitamin D deficiency in postmenopausal women who start adjuvant AI supports the hypothesis that hypovitaminosis D would be one of the biological explanations for toxicity of AI. This study aimed to identify the relationship between 25-hydroxyvitamin D [25(OH)D] and CRF, and to analyze their associations and effects on depression, anxiety, functional disability, muscle/joint aches and HRQL.

Methods

This prospective study included 89 postmenopausal women diagnosed with HR + early BC in adjuvant endocrine therapy with AI. Anthropometric and body composition assessments were performed, as well as dietary assessments by application of 24-h dietary recall, at three time points, totaling 24 months of follow-up. The women completed the Cervantes Scale (CS), Hospital Anxiety and Depression Scale (HADS) and Health Assessment Questionnaire (HAQ). The CRF was determined from the Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F). The serum 25(OH)D was determined by electrochemiluminescence, with cut-off point above 75 nmol/L adopted as sufficiency. Generalized Linear Model (GLzM) and Generalized Mixed Model (GMM) analysis were used.

Results

At baseline, 36% (n = 32) of the women presented CRF and 39.3% (n = 35) had 25(OH)D below 75 nmol/L. None of the women reached the Estimated Average Requirements (EAR) of vitamin D. The causality between 25(OH)D and CRF was not significant. Longitudinally, lower levels of 25(OH)D had a negative effect on anxiety (p = 0.020), Menopause and Health (p = 0.033) and Vasomotor scores (p = 0.007). Also, the CRF had a negative effect on anxiety (p = 0.028); depression (p = 0.027); functional disability (p = 0.022); HRQL (p = 0.007); Menopause and Health (p = 0.042), Psychological (p = 0.008) and Couple Relations (p = 0.008) domains; and on Health (p = 0.019) and Aging (p = 0.036) subdomains. Vasomotor subdomain (β = -2.279, p = 0.045) and muscle/joint aches (β = -0.779, p = 0.013) were significant with CRF only at baseline.

Conclusions

This study found negative effect of body adiposity on CRF. Still, the clinical relevance of 25(OH)D and CRF is highlighted, especially that of CRF, considering the consistent impact on several adverse effects reported by BC survivors during adjuvant endocrine therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09962-x.

Eosinophilic esophagitis auxiliary diagnosis based on a peptide ligand to eosinophil cationic protein in esophageal mucus of pediatric patients

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus characterized by increased number of eosinophils. Currently, EoE diagnosis is based on endoscopic procedures for histopathological examination, eosinophils' counting and, often, in clinical practice, the challenge is the differentiation between EoE and gastroesophageal reflux disease (GERD). Our aim was to develop novel peptide ligand to Eosinophil cationic protein (ECP) present in EoE biopsies of patients with potential to be used for detection. We performed a comparative proteomic analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS) of esophageal biopsies from pediatric patients with eosinophilic esophagitis, gastroesophageal reflux disease and control individuals. Then, phage display technology was used to select peptides against specific up-regulated protein from EoE patients. Twelve phage clones were selected after three biopanning rounds, and the best phage clone reactivity was evaluated by phage-ELISA assay using esophageal mucus samples from 94 pediatric patients. Mass spectrometry showed that eosinophil cationic protein (ECP) was one of the most up-regulated proteins in EoE patients, which is an eosinophil granule protein usually deposited on tissues to mediate remodeling, but in excess may cause fibrosis and hypertrophy, especially in allergic responses. A highly reactive ECP-ligand peptide (E5) was able to distinguish reactive mucus of EoE patients from GERD and the control individuals by Phage-ELISA, achieving a sensitivity of 84.62%, and a specificity of 82.72%. This is the first study that successfully demonstrated an antibody-like peptide targeting ECP at the esophagus mucus as a useful auxilliary tool for EoE diagnosis with a significant association with atopic disorders and dysphagia.ClinicalTrials.gov no.: NCT03069573.

Time-Related Eating Patterns Are Associated with the Total Daily Intake of Calories and Macronutrients in Day and Night Shift Workers

The aim of the study was to investigate whether time-related eating patterns are associated with the daily intake of calories and macronutrients in Brazilian male military police officers (n = 81; 29-day and 52-night workers; mean age: 36.4 ± 0.9 and 38.5 ± 0.7 years, respectively). Energy and macronutrient intake were determined by a non-consecutive 3-day food recall. Time-related eating patterns, such as the time of the first and the last meals, eating duration, and caloric midpoint, were evaluated. Individuals were classified as “early” or “late” eaters according to the median caloric midpoint. Night shift workers showed a later eating time for the last meal (p < 0.001), longer eating duration (p < 0.001), and later caloric midpoint (p = 0.037) than day workers. Late eaters from both workgroups consumed more 24 h energy (p = 0.028), fat in calories (p = 0.006) and protein (calories: p < 0.001; percentage of total calories: p = 0.042), and less carbohydrates in calories (p = 0.010) intake than early eaters. The time of the first meal was negatively correlated with 24 h energy (p = 0.024) and carbohydrate (p = 0.031) intake only in day workers. The time of the last meal was positively correlated with 24 h energy (day workers: β = 0.352; p = 0.044; night workers: β = 0.424; p = 0.002) and protein (day workers: β = 0.451; p = 0.013; night workers: β = 0.536; p < 0.001) intake for both shift workers, and with carbohydrate (β = 0.346; p = 0.016) and fat (β = 0.286; p = 0.042) intake only in night workers. Eating duration was positively correlated with energy (day workers: β = 0.473; p = 0.004; night workers: β = 0.320; p = 0.023) and carbohydrate (day workers: β = 0.418; p = 0.011; night workers: β = 0.364; p = 0.010) intake in both groups. Thus, time-related eating patterns indicative of intake later at night are associated with increased daily energy and macronutrient intake.

Is chronotype associated with dietary intake and weight gain during pregnancy? A prospective and longitudinal study

OBJECTIVES

The effects of chronotype on dietary intake and weight gain during pregnancy have not been addressed in the literature. The aim of this study was to analyze the effect of chronotype on eating patterns, energy, and macronutrient intake and distribution, as well as weight gain during pregnancy.

METHODS

This was a prospective cohort study carried out with 100 pregnant women in the first, second, and third gestational trimesters. Dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine recalls. Energy and macronutrient intake and distribution were evaluated at meals throughout the day. Chronotype was derived from midsleep time on free days, and the scores obtained were categorized into tertiles. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of chronotype and gestational trimester on eating patterns, daily energy, macronutrient distribution, and weight gain.

RESULTS

Pregnant women with values for midsleep time on free days indicative of eveningness have breakfast later and also have higher energy and carbohydrate intake at dinner than "morning" women. Pregnant "morning" women showed better diet quality in terms of milk and dairy and saturated fat. Also, despite the tendency for all tertiles to gain excess weight during pregnancy, we found that pregnant women with a tendency to eveningness had worse adequacy of gestational weight gain in the third trimester than "morning" women (2.24 ± 0.25 versus 1.22 ± 0.14, P < 0.001).

CONCLUSION

Pregnant women with a tendency to eveningness consume breakfast later in the day and exhibit greater consumption of energy and carbohydrates in the evening, as well as a worse standard of gestational weight gain in the third trimester. Our results emphasize the importance of considering chrononutrition variables in prenatal nutritional guidelines to promote maternal and fetal health.

Circadian misalignment measured by social jetlag from early to late pregnancy and its association with nutritional status: a longitudinal study

A mismatch between circadian and social clocks leads to a circadian misalignment, which has been widely measured by social jetlag (SJL). There are several studies measuring SJL, but it has not been studied in pregnant women. Therefore, this study aimed to identify the occurrence of SJL throughout pregnancy and to verify whether there is an effect of pre-pregnancy body mass index (BMI) on SJL throughout pregnancy. The baseline of the present study was conducted with 205 1st trimester pregnant women of whom 100 were followed in their 2nd and 3rd trimester. SJL was calculated based on the absolute difference between mid-sleep time on workdays versus work-free days. The pre-pregnancy BMI and current BMI (kg/m²) were calculated. Linear regression and Generalised Estimating Equation (GEE) adjusted for confounders were used to determine the association between SJL and the gestational trimesters (time), and anthropometric variables. Most of the pregnant women (54.5%) presented SJL > 1 h in the first gestational trimester. We also found an isolated effect of the gestation trimester on the SJL mean. In this sense, pregnant women had a decrease in SJL from the second to the third trimester (1.33 ± 0.08 versus 1.12 ± 0.07, respectively; p = 0.012). GEE analyzes showed that pregnant women of a normal weight showed a decrease in SJL from the second to the third trimester (1.29 ± 0.11 and 0.93 ± 0.08, respectively, p = 0.032), but this was not found in the other groups of nutritional status (underweight, overweight and obesity). In addition, a positive association between SJL and pre-gestational BMI in the third trimester (β = 0.200, p = 0.046) was found. SJL is quite prevalent during the gestational period and excessive BMI both before and during pregnancy is associated with an increased risk of having SJL > 1 h in the third and second trimesters, respectively. In addition, pregnant women of normal weight—but not underweight or overweight—had decreased SJL from the second to the third trimester.

Health-related quality of life became worse in short-term during treatment in head and neck cancer patients: a prospective study

BACKGROUND

Quality of life (QoL) is influenced in head and neck cancer (HNC) patients by a set of factors related to diagnosis, treatment and tumor impacts. The aim of this study was to evaluate the Quality of Life (QoL) changes in Head and Neck cancer (HNC) patients during treatment (radiotherapy and/or chemoradiotherapy).

METHODS

QoL was evaluated prospectively in 63 HNC patients during radiotherapy and/or chemoradiotherapy at three moments: before or at beginning (T0), in the middle (T1 ~ four weeks) and immediately at the end (T2 ~ eight weeks) of treatment. The differences between the scores at different time points was verified using Friedman's non-parametric test. Negative changes between time points were evaluated, with differences (delta) of ±10 points being considered to be clinically significant.

RESULTS

The total mean age was 59.1 ± 9.5y, and 82.5% were male. The oral cavity and larynx were more frequent tumors. The functional score for 'role' was decreased at time points T1 and T2 as compared to T0, while an improvement in scores was observed for cognitive function. Several physical symptoms also worsened over time, such as: fatigue, nausea and vomiting, dry mouth and sticky saliva, swallowing and skin symptoms, senses and teeth problems. A high frequency of altered and clinically meaningful values were observed for most of domains, ranging from 6 to 74%.

CONCLUSIONS

The QoL became worse at approximately one month after treatment beginning in HNC patients, and this remained until the end of therapy. Protocols directing to early nutritional counseling and management of symptoms of nutritional impact are important to improve clinical outcomes. This is part of preventive actions aiming to make the exhausting treatment process less traumatic and easier to complete.

Oral Nutritional Supplementation Affects the Dietary Intake and Body Weight of Head and Neck Cancer Patients during (Chemo) Radiotherapy

Considering the symptoms of (chemo) radiotherapy and the reduction in food intake in head and neck cancer (HNC) patients, this study aimed to investigate the association between treatment time points and oral nutritional supplementation (ONS) on dietary intake to estimate the frequency of energy and nutrient inadequacy, and also to evaluate body weight changes (BWC). Dietary intake data of 65 patients were obtained from 24-h dietary recalls and prevalence of inadequacy was calculated before or at the beginning (T0), in the middle (T1), and at the end of treatment (T2). BWC were calculated as the weight difference considering the previous weight reported and/or measured. Energy and macronutrient intake decreased in T1 and then improved in T2 (p < 0.001 for both). Micronutrient intake increased during treatment due to ONS use, but still presented a high probability of inadequate intake. In particular, calcium, magnesium, and vitamin B6 showed almost 100% of probability of inadequacy for those who did not use ONS. Finally, overweight patients suffered a higher weight accumulated deficit with a delta of −15 kg compared to other BMI (body mass index) categories. Therefore, we strongly recommend initiating nutritional counseling in conjunction with prophylactic ONS prescription from diagnosis to adjust nutrient intake and minimize weight loss.

Higher energy intake at night effects daily energy distribution and contributes to excessive weight gain during pregnancy

OBJECTIVE

The aim of this study was to analyze the effect of nighttime energy intake on daily energy and macronutrient distribution and weight gain during pregnancy.

METHODS

This was a prospective cohort study carried out with 100 pregnant women and the data collection occurred once per trimester. A dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine dietary recalls. The distribution of energy and macronutrient intake was evaluated at meals throughout the day in each trimester and overall pregnancy. Women were classified as having "lower" or "higher" nighttime intake (1900 to 0559) if consumption in this period were below or above the median of the population, respectively, for at least two trimesters. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of nighttime intake and gestational trimesters on daily energy distribution and weight gain.

RESULTS

In overall pregnancy, the higher group consumed a higher percentage of energy and macronutrients in the evening meals, and less energy, proteins, and lipids in morning meals when compared with the lower group. Also, women in the higher group had greater excessive weight gain in the third trimester compared with the lower group.

CONCLUSION

Pregnant women with a higher energy intake at night had a lower percentage of energy, protein, and lipid intake in morning meals and a higher percentage of energy and macronutrient intake in the evening meals during pregnancy. A worse standard of gestational weight gain in the third trimester was also observed in pregnant women with a higher energy intake at night.

The Impact of Radiodermatitis on Breast Cancer Patients' Quality of Life During Radiotherapy: A Prospective Cohort Study

CONTEXT

In the oncology field, quality of life (QoL) is recognized as an essential component. However, few studies have evaluated radiotherapy (RT) and its adverse events, specifically radiodermatitis.

OBJECTIVES

The objective of this study was to investigate the influence of radiodermatitis severity on QoL of women with breast cancer (BC) throughout RT.

METHODS

A prospective cohort study was conducted with 100 BC patients evaluated weekly during RT. The Dermatology Life Quality Index questionnaire and the Radiation Therapy Oncology Group scale were used. The generalized estimated equations were used to examine the association between the total score of QoL and their domains, time of RT, and the radiodermatitis score, controlled by confounding factors. Estimated marginal means and 95% CIs were compared pairwise by applying Sequential Sidak.

RESULTS

The total QoL score and their domains (work/school, leisure, daily activities, symptoms, and feelings) were significantly associated with the evaluation times of RT (P < 0.001), the radiodermatitis score (P ≤ 0.002), and the interaction between timing (T) of treatment and radiodermatitis score (P < 0.001). When assessing post hoc, it was identified that the worst QoL scores were in the presence of Grade 3 (mean = 6.00) in T3 and Grade 4 (6.50; 7.00) in T5 and T6, respectively, and this difference was statistically significant.

CONCLUSIONS

RT negatively influenced the QoL of women with BC, with the greatest impact resulting from severe radiodermatitis. Actions aimed at minimizing the impairment on QoL need to be adopted to make this exhausting process less traumatic and easier to complete.

Is there agreement between evaluators that used two scoring systems to measure acute radiation dermatitis?

To analyze the agreement between the nurses evaluating radiodermatitis that used the Radiation Therapy Oncology Group (RTOG) and the World Health Organization (WHO) scales.A prospective and longitudinal study conducted in 2016 to 2017, in a university hospital. We analyzed 855 images of irradiated sites of 100 breast cancer women during radiotherapy. In order to evaluate the agreement between 3 observers that evaluated theses irradiated sites Krippendorff's alpha and weighted kappa were obtained and analyzed.The pairwise agreement among the evaluators was fair and moderate (RTOG scale: 0.408, 95% confidence interval, CI 0.370-0.431; WHO scale: 0.559, 95% CI 0.529-0.590). In addition, the general agreement rates were 10.2% and 29.2%, respectively. When assessing the overall absolute agreement between the evaluators according with different phototypes and types of surgery, there was a fair agreement according to the RTOG scale when evaluating patients with phototype V or VI and mastectomy (3.7% and 8.8%, respectively).The RTOG and WHO scales should be used with caution in clinical practice to identify the prevalence of radiodermatitis and the severity. Another point of caution is that skin phototype and the type of surgery may influence the analysis outcome. An illustrative scale was designed and proposed, by our group, aiming to improve accuracy and agreement between evaluators that will be tested in subsequent clinical studies.

Relationship between food perceptions and health-related quality of life in a prospective study with breast cancer patients undergoing chemotherapy

OBJECTIVE

To correlate the perceptions related to dietary intake with the domains and subscales of health-related quality of life (HRQL) in women with breast neoplasms receiving chemotherapy.

METHODS

In this prospective study, 55 women with breast cancer were followed up during chemotherapy at three different times (T0, T1, T2). Before chemotherapy, perceptions related to food consumption were evaluated. HRQL was analyzed with the EORTC QLQ-C30 and Br23 instruments 21 days after each investigated cycle. The differences (T2-T0) in the subscales and HRQL domains were correlated with the differences (T2-T0) in the appetite scores. Spearman's correlation was used to verify a possible correlation between differences in functional and overall HRQL domains (T2-T0) and differences in appetite scores for certain foods and between the differences in some subscales of EORTC QLQ-C30 and Br23 (T2-T0) and differences in appetite scores for certain food groups (T2-T0).

RESULTS

Correlations between pain and appetite for bitter taste and between an increased appetite for juices and pain intensification or fatigue were identified, and pain was correlated with an appetite for starchy foods. An appetite for vegetables, legumes and meat/eggs was correlated with physical function. The only significant correlation with social functions occurred between the appetite for sweet foods and these functions. We found a correlation between overall health, emotional function, social function and physical function and the appetite for juices.

CONCLUSION

Chemotherapy alters the individual's relationship with food and, consequently, the individual's HRQL.

Longer Times of Receipt of Adjuvant Endocrine Therapy Correspond to Improved Functional Capacity and Lower Adiposity in Women Receiving Adjuvant Therapy

PURPOSE

To study the use of functional capacity (FC) level and duration of aromatase inhibitor (AI) therapy with adiposity parameters in women with breast cancer.

PATIENTS AND METHODS

FC was evaluated through the Health Assessment Questionnaire, which was assessed by classification and divided into 3 groups: G1 = mild to moderate difficulty, G2 = moderate to severe disability, and G3 = severe or very severe disability. Body mass, height, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Bioelectrical impedance analysis was used to calculate body fat (BF) and fat-free mass. The women were divided into 2 time groups (T1 and T2), which were determined by the median months of AI use (T1 ≤ 29.5 and T2 > 29.5 months).

RESULTS

Impaired FC and adiposity parameters were significantly positively correlated. In addition, physical exercise was significantly lower in women assessed as G2 and G3 compared to those assessed as G1. The effect of FC on BMI, BF, and WC was also verified, as was the effect of the duration of AI receipt on BMI and BF. Women at T1 had significantly greater functional disability, BMI, and BF values. In addition, although not statistically significant, women in T1 who were assessed as G3 presented higher BMI, WC, and BF values than those in T2.

CONCLUSION

Adiposity above the recommended parameters and impaired FC were associated with the shortest time of receipt of adjuvant endocrine therapy with AI.

Time-related eating patterns and chronotype are associated with diet quality in pregnant women

Animal studies strongly suggest that timed feeding can have beneficial physiological effects, including protection against the obesogenic and metabolic consequences of a high-fat diet. However, the relationship between variables related to the timing of eating and diet quality in pregnancy women, which is considered as a period of nutritional vulnerability, is still poorly described in the literature. Therefore, the aim of the present study was to investigate the associations between time-related eating patterns and chronotype with diet quality of pregnant women. This cross-sectional study was conducted with 100 pregnant women in the first gestational trimester (≤12 weeks of gestation). The information regarding food intake was obtained by three 24-Hour Dietary Recall (24HR). Time-related eating patterns, i.e., the interval between the first and the last meal (eating duration), nightly fasting, time of the first and last meals, and number of meals eating on a day were determined. Chronotype was derived using the mid-sleep time on free days on weekends, with a further correction for calculated sleep debt. Diet quality was evaluated using the Brazilian Healthy Eating Index-Revised (BHEI-R), validated for the Brazilian population. Linear regression modeling analyses adjusted for confounders were used to investigate the association between time-related eating patterns and chronotype with diet quality. The BHEI-R total score was negatively associated with time of the first meal (β =  -0.355; p = 0.002; r² adjusted = 0.141), and positively associated with eating duration (β = 0.262; p = 0.024; r² adjusted = 0.086) and number of meals (β = 0.273; p = 0.019; r² adjusted = 0.091). In addition, the score of total fruit component was negatively associated with chronotype (β = -0.236; p = 0.033; r² adjusted = 0.078), time of the first meal (β = -0.393; p = 0.001; r² adjusted = 0.171), and positively associated with eating duration (β = 0.259; p = 0.022; r² adjusted = 0.087) and number of meals (β = 0.376; p = 0.001; r² adjusted = 0.159). The score for whole fruit component was negatively associated with time of the first meal (β = -0.388; p = 0.001; r² adjusted = 0.152), and positively associated with number of meals (β = 0.403; p = 0.001; r² adjusted = 0.164). A longer eating duration, earlier time of the first meal, higher number of meals and morningness tendency are associated with a better diet quality in the first gestational trimester - higher scores of the total BHEI-R and/or fruit components. We suggest that nutritional guidelines should consider time-related eating patterns and chronotype to ensure good diet quality of pregnant women since the beginning of gestation, contributing on prevention of metabolic-nutritional complications.

Food intake and the nutritional status of women undergoing chemotherapy

The objective behind this study was the analysis of food intake and the nutritional status of women with breast cancer (BC) undergoing chemotherapy (CT). The quantitative dietary evaluation was performed in accordance with Dietary Reference Intakes (DRI), whereas the qualitative evaluation was performed through the Brazilian Healthy Eating Index - Revised (BHEI-R).From among the total number of patients (n = 20), 60% (n = 12) presented waist circumference, equal to or higher than 88cm. It was noted that 75% (n = 15) individuals were overweight. The average intake for calcium, copper, iron, dietary fiber, magnesium, potassium, vitamin A, niacin, vitamin B6 and zinc, were found to be below adequate intake levels, while the intake of vitamin C, phosphorus, manganese, sodium and thiamine were all found to be above DRIs recommendations. As for the analysis of the BHEI-R, 80% (n = 16) of the patients presented a "diet that needs modifications", while 20% (n = 4) presented a "healthy diet". Noted from these observations was the presence of a high overweight rate, a discrepancy in the intake of micronutrients and a diet that needed improvements. In this manner, the establishment and use of a nutritional intervention protocol are very important when it comes to the improvement of the diet in patients with BC and who are undergoing CT.

Impact of chemotherapy on perceptions related to food intake in women with breast cancer: A prospective study

Breast cancer (BC) treatment includes mostly chemotherapy (CT), which can cause side effects like nausea, taste changes, early satiety, slow gastric emptying and xerostomia. In this way, the individual’s relationship with food may change during the treatment. The aim of this study was to evaluate the impact of chemotherapy on perceptions related to food intake of women with BC. Fifty-five women with BC were followed, and data were collected at three periods during first-line CT: beginning (T0), intermediate (T1) and end (T2). A visual analogue scale (VAS) (0 to 10 cm) for hunger, appetite for various food categories and meal enjoyment was investigated. The frequency and intensity of side effects were evaluated using a 4 cm scale. The results showed a higher prevalence of taste changes in T1 (p = 0.044) and more nausea in T1 and T2 (p = 0.018). Furthermore, the intensity of nausea was higher in T2 (p = 0.01) than in the other periods. We observed moderate hunger in T0, T1 and T2 (p = 0.113), but the overall appetite increased between T0 and T2 (p = 0.003). Meal enjoyment was reduced from T0 to T1and returned back to the initial value in T2 (p = 0.021). The appetite for salty (p = 0.004) and spicy (p = 0.03) foods was increased in T1. There was an increase of body weight (p = 0.008), body mass index (BMI) (p = 0.009) and waist circumference (WC) (p = 0.03) during CT. CT changes food hedonism, increasing the overall appetite and the appetite for salty and spicy foods. Moreover, we observed the negative impact of CT on meal enjoyment and an increase in side effects and anthropometric parameters.

Impact of Chemotherapy on Diet and Nutritional Status of Women with Breast Cancer: A Prospective Study

Certain food groups are often rejected during chemotherapy (CT) due to the side effects of treatment, which may interfere with adequate diet and nutritional status. The aim of this study was to evaluate the treatment impact on the diet and nutritional status of women with breast cancer (BC). In this prospective longitudinal study, conducted in 2014-2015, 55 women diagnosed with BC, with a mean age 51.5±10.1 years, were followed and data were collected at three different times. Anthropometric and dietary assessments were performed, the latter by applying nine 24h dietary recalls, by using the Brazilian Healthy Eating Index Revised (BHEI-R), and calculating the prevalence of inadequacy by the EAR cut-off point method. Regarding the BHEI-R analysis, the majority of women had a "diet requires modification', both at the beginning (T0, 58.2%, n = 32) and during treatment (T1, 54.5%, n = 30). However, after the end of the CT, the greater percentage of patients (T2, 49.1%, n = 27) were classified as having an "inadequate diet", since the Total Fruit consumption as well as the Dark Green and Orange Vegetable and Legume consumption decreased significantly during treatment (p = 0.043 and p = 0.026, respectively). There was a significant reduction in the intake of macro and micronutrients, with a high prevalence of inadequacy, of up to 100%, for calcium, iron, phosphorus, magnesium, niacin, riboflavin, thiamin, vitamin B6, vitamin C and zinc. Assessment of the nutritional status indicated that 56% (n = 31) of patients were overweight at these three different times. Weight, BMI and Waist Circumference increased significantly, indicating a worse nutritional status, and there was a correlation between poor diet quality and higher values for BMI, Waist-Hip Ratio and Waist-to-Height Ratio. Chemotherapy interferes in the patients' diet generating a negative impact on the quality and intake of micro and macronutrients, as well as an impact on their nutritional status, with an increase in anthropometric measurements.

A pilot study addressing the impact of religious practice on quality of life of breast cancer patients during chemotherapy

The aim of this preliminary study was to investigate whether religious practice can modify quality of life (QoL) in BC patients during chemotherapy. QoL and religion practice questionnaire (RPQ) scores were evaluated in a sample of BC patients in different moments. Before chemotherapy initiation, women with lower physical and social functional scores displayed higher RPQ scores. On the other hand, low RPQ patients worsened some QoL scores over time. Body image acceptance was positively correlated with religious practice and specifically praying activity. This preliminary study suggests the importance of religion in coping with cancer chemotherapy.