RAQUEL SUSANA MATOS DE MIRANDA TORRINHAS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
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- Effect of synbiotic in constipated adult women - A randomized, double-blind, placebo-controlled study of clinical response(2013) WAITZBERG, Dan L.; LOGULLO, Luciana C.; BITTENCOURT, Amanda E.; TORRINHAS, Raquel S.; SHIROMA, Glaucia M.; PAULINO, Natalia P.; TEIXEIRA-DA-SILVA, Maria L.Background & aims: Synbiotic intake may selectively change microbiota composition, restore microbial balance in the gut and improve gastrointestinal functions. We have assessed the clinical response of chronically constipated women to a commercially available synbiotic, combining fructooligosaccharides with Lactobacillus and Bifidobacterium strains (LACTOFOS (R)). Methods: Following 1 week of non-interventional clinical observation, 100 constipated adult women, diagnosed by ROME III criteria, were randomized to receive two daily doses (6 g) of synbiotic or maltodextrin (placebo group), for 30 days. Treatment response was evaluated by patient's daily record of evacuation (stool frequency, consistency and shape, according to Bristol scale), abdominal symptoms (abdominal pain, bloating and flatulence) and constipation intensity (Constipation Scoring System AGACHAN). Results: Patients treated with synbiotic had increased frequency of evacuation, as well as stool consistency and shape nearer normal parameters than the placebo group, with significant benefits starting during the second and third weeks, respectively (interaction group/time, P < 0.0001). There were no significant differences in abdominal symptoms, but AGACHAN score was better in the synbiotic than in the placebo group. Conclusions: Dietary supplementation with a synbiotic composed of fructooligosaccharides with Lactobacillus and Bifidobacterium improved evacuation parameters and constipation intensity of chronically constipated women, without influencing abdominal symptoms. NCT01286376 (C) 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
- Letter to the Editor(2011) TORRINHAS, Raquel; WAITZBERG, Dan
- Is There an Advantage in Enriching Parenteral Lipid Emulsions Containing Fatty Acids From Fish Oil With Medium-Chain Triglycerides? A Study on Body Pool Concentrations of omega-3 Fatty Acids in Lewis Rats(2021) TESSER, Alweyd; TORRINHAS, Raquel S. M. M.; GARLA, Priscila C.; OLIVEIRA-FILHO, Ronaldo S.; APROBATO, Felipe G. G.; TAMANAHA, Erika M.; ANTUNES, Marcia S.; SAMPAIO, Geni R.; TORRES, Elizabeth; CALDER, Philip C.; WAITZBERG, Dan LinetzkyBackground The addition of medium-chain triglycerides (MCTs) into parenteral lipid emulsions rich in fatty acids from fish oil (FOLEs) has been shown to improve their clearance and extrahepatic uptake. We assessed whether this effect could favor the leukocyte uptake of omega-3 polyunsaturated fatty acids (PUFAs) for immunomodulatory purposes Methods Following 5-day adaptation in metabolic cages, 42 male Lewis rats fed with AIN-93M chow were killed (baseline control group [BC]) or submitted to central venous catheterization and distributed into (1) surgical control group without parenteral infusion (chow group), (2) test emulsion (MCT/LCT/FO) group with the parenteral infusion of a FOLE containing 40% MCT, and (3) control emulsion group (LCT/FO) with the parenteral infusion of an FOLE without MCT. The 2 FOLEs had similar omega-3 PUFA contents and omega-6/omega-3 PUFA ratios and were infused during 48 and 72 hours. Concentrations of omega-3 and omega-6 PUFAs in plasma, liver, and blood mononuclear and polymorphonuclear leukocytes were assessed by gas chromatography Results In both FOLE groups, leukocyte concentrations of omega-3 PUFAs peaked after 48 hours' infusion (vs BC). At this time point, plasma concentrations of omega-3 PUFAs were higher in MCT/LCT/FO group than in LCT/FO group and the opposite was found in the liver (P<.05), but no differences in PUFA concentrations were observed between these groups in leukocytes (P>.05) Conclusion The omega-3 PUFAs provided by FOLEs rich in MCT were less incorporated by liver and remained more available for extrahepatic cell delivery, but this did not result in a clear benefit in increasing their incorporation by peripheral leukocytes.
- Cell activation state influences the modulation of HLA-DR surface expression on human monocytes/macrophages by parenteral fish oil lipid emulsion(2011) TORRINHAS, R. S.; JACINTHO, T.; GOTO, H.; GIDLUND, M.; SALES, M. M.; OLIVEIRA, P. A.; WAITZBERG, D. L.Abnormal surface expression of HLA-DR by leukocytes is associated with a poor prognosis in critical care patients. Critical care patients often receive total parenteral nutrition with lipid emulsion (LE). In this study we evaluated the influence of fish oil LE (FO) on human monocyte/macrophage (M phi) expression of surface HLA-DR under distinct activation states. Mononuclear leukocytes from the peripheral blood of healthy volunteers (n=18) were cultured for 24 hours without LE (control) or with 3 different concentrations (0.1, 0.25, and 0.5%) of the follow LE: a) pure FO b) FO in association (1:1-v/v) with LE composed of 50% medium-chain trygliceride and 50% soybean oil (MCTSO), and c) pure MCTSO. The leukocytes were also submitted to different cell activation states, as determinate by INF-g addition time: no INF-gamma addition, 18 hours before, or at the time of LE addition. HLA-DR expression on MO surface was evaluated by flow cytometry using specific monoclonal antibodies. In relation to controls (for 0.1%, 0.25%, and 05%: 100) FO decreased the expression of HLA-DR when added alone in simultaneously-activated M., for 0.1%: 70 (59 +/- 73); for 0.25%: 51 (48 +/- 56); and for 05%: 52.5 (50 +/- 58)1 or in association with MCTSO [in simultaneously-activated MO, for 0.1%: 50.5 (47 +/- 61); for 25%: 49 (45 +/- 52); and for 0.5%: 51 (44 54) and in previously-activated Mf, for 1.0%: 63 (44 +/- 88); for 0.25%: 70 (41 +/- 88); and for 0.5%: 59.5 (39 +/- 79)1 in culture medium (Friedman p < 0.05). In relation to controls (for 0.1%, 0.25%, and 0.5%: 100), FO did not influence the expression of these molecules on non-activated M phi [for 0.1%: 87.5(75 +/- 93); for 0.25%: 111 (98 +/- 118); and for 0.5%: 101.5 (84 +/- 113)]. Results show that parenteral FO modulates the expression of HLA-DR on human MO surface accordingly to leukocyte activation state. Further clinical studies evaluating the ideal moment of fish oil LE infusion to modulate leukocyte functions may contribute to a better understanding of its immune modulatory properties.
- Understanding the gut microbiota in cancer cachexia(2023) ROCHA, Ilanna Marques; FONSECA, Danielle Cristina; TORRINHAS, Raquel Susana Matos; WAITZBERG, Dan LinetzkyPurpose of reviewCachexia is a complex, multifactorial syndrome primarily characterized by weight loss, muscle wasting, anorexia, and systemic inflammation. It is prevalent in cancer patients and is associated with a poor prognosis, including lower resistance to intervention toxicity, quality of life, and survival, compared to patients without the syndrome. The gut microbiota and its metabolites have been shown to influence host metabolism and immune response. Our article reviews the current evidence suggesting a role of gut microbiota in the development and progression of cachexia, while discussing the potential mechanisms involved. We also describe promising interventions targeting gut microbiota aiming to improve outcomes related to cachexia.Recent findingsDysbiosis, an imbalance in gut microbiota, has been associated with cancer cachexia through pathways involving muscle wasting, inflammation, and gut barrier dysfunction. Interventions targeting gut microbiota, such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have shown promising results in managing this syndrome in animal models. However, evidence in humans is currently limited.Mechanisms linking gut microbiota and cancer cachexia need to be further explored, and additional human research is necessary to evaluate the appropriate dosages, safety, and long-term outcomes of prebiotic and probiotic use in microbiota management for cancer cachexia.
- Human Leukocyte Death After a Preoperative Infusion of Medium/Long-Chain Triglyceride and Fish Oil Parenteral Emulsions: A Randomized Study in Gastrointestinal Cancer Patients(2012) CURY-BOAVENTURA, Maria Fernanda; TORRINHAS, Raquel Susana Matos de Miranda; GODOY, Andre Borella Pereira de; CURI, Rui; WAITZBERG, Dan LinetzkyBackground: Parenteral lipid emulsions (LEs) can influence leukocyte functions. The authors investigated the effect of 2 LEs on leukocyte death in surgical patients with gastrointestinal cancer. Material and Methods: Twenty-five patients from a randomized, double-blind clinical trial (ID: NCT01218841) were randomly included to evaluate leukocyte death after 3 days of preoperative infusion (0.2 g fat/kg/d) of an LE composed equally of medium/long-chain triglycerides and soybean oil (MCTs/LCTs) or pure fish oil (FO). Blood samples were collected before (t0) and after LE infusion (t1) and on the third postoperative day (t2). Results: After LE infusion (t1 vs t0), MCTs/LCTs did not influence cell death; FO slightly increased the proportion of necrotic lymphocytes (5%). At the postoperative period (t2 vs t0), MCTs/LCTs tripled the proportion of apoptotic lymphocytes; FO maintained the slightly increased proportion of necrotic lymphocytes (7%) and reduced the percentage of apoptotic lymphocytes by 74%. In the postoperative period, MCT/LCT emulsion increased the proportion of apoptotic neutrophils, and FO emulsion did not change any parameter of apoptosis in the neutrophil population. There were no differences in lymphocyte or neutrophil death when MCT/LCT and FO treatments were compared during either preoperative or postoperative periods. MCT/LCTs altered the expression of 12 of 108 genes related to cell death, with both pro- and antiapoptotic effects; FO modulated the expression of 7 genes, demonstrating an antiapoptotic effect. Conclusion: In patients with gastrointestinal cancer, preoperative MCT/LCT infusion was associated with postoperative lymphocyte and neutrophil apoptosis. FO has a protective effect on postoperative lymphocyte apoptosis. (JPEN J Parenter Enteral Nutr. 2012; 36: 677-684)
- High Prevalence of Energy and Nutrients Inadequacy among Brazilian Older Adults(2023) MAGALHAES, Natalia Vieira; WAITZBERG, Dan Linetzky; LOPES, Natalia Correia; VICEDOMINI, Ana Carolina Costa; PRUDENCIO, Ana Paula Aguiar; JACOB-FILHO, Wilson; BUSSE, Alexandre Leopold; FERDINANDO, Douglas; ALVES, Tatiana Pereira; PEREIRA, Rosa Maria Rodrigues; TORRINHAS, Raquel Susana; BELARMINO, GilianePoor nutrition increases the risk of diseases and adverse health outcomes in older adults. We evaluated the potential inadequacy of nutrient intake among older adults in Brazil and its association with body anthropometry and composition outcomes. Dietary intake was obtained from 295 community-living older adults (>60 years old), of both genders, using a seven-day food record. Nutrient inadequacy was further identified based on the Dietary Reference Intakes and European Guidelines. Skeletal muscle mass (SM), strength and performance, and the diagnosis of sarcopenia were assessed using reference methods. Nutritional inadequacy was high, with energy, dietary fiber, and six micronutrients exhibiting the greatest inadequacy levels (>80%). Energy intake was correlated with SM strength (p = 0.000) and performance (p = 0.001). Inadequate energy, fiber, and protein intakes influenced BMI, while inadequate intake of vitamin B6 directly affected the diagnosis of sarcopenia (p & LE; 0.005). Further research is required to investigate whether these inadequacies can be associated with other clinical health outcomes.
- Nutritional guidance, monitoring, and supplementation before and after bariatric surgery - Are we doing this correctly?(2021) SILVA, Mariane Marques da; WAITZBERG, Dan Linetzky; DIPPPOLITO, Regiane Macedo Silva; SALA, Priscila; BARCELOS, Samira; SANTO, Marco Aurelio; MARTINEZ, Ana Cristina; TORRINHAS, Raquel SusanaBackground and aims: minimizing nutritional depletions after a Roux-en-Y gastric bypass (RYGB) may improve clinical results in the treatment of obesity. We evaluated nutritional aspects of obese women undergoing RYGB at a reference university hospital with a department specialized in bariatric surgery. Method: based on the Dietary Reference Intakes developed by the Food and Nutrition Council, Institute of Medicine, and the guidelines issued by the American Society for Metabolic and Bariatric Surgery, we assessed the quantitative and qualitative adequacy of nutritional intake, supplementation, and biochemical monitoring of 20 women both before and 3 and 12 months after a RYGB. Data on nutritional intake was obtained by applying different food surveys, quantitatively interpreted by the Virtual Nutri Plus (R) software and using reference nutritional databases. Results: nutritional intake deficits were already found before the RYGB (p <= 0.05). These worsened postoperatively (p <= 0.05), a period also marked by a qualitatively poor diet. The nutritional supplementation prescribed did not fully achieve the reference recommendations, and was poorly complied with by patients. Furthermore, nutritional monitoring was not carried out in all patients, recommended biochemical markers were not screened, and vitamin D depletions occurred. Conclusion: our data suggest that institutions specialized in bariatric patient care may not be adequately adhering to well known guidelines, or applying efficient strategies to improve compliance.
- Partial Replacement of omega-6 Fatty Acids With Medium-Chain Triglycerides, but Not Olive Oil, Improves Colon Cytokine Response and Damage in Experimental Colitis(2012) BERTEVELLO, Pedro L.; NARDI, Leticia De; TORRINHAS, Raquel S.; LOGULLO, Angela F.; WAITZBERG, Dan L.Background: Soybean oil is rich in omega-6 fatty acids, which are associated with higher incidence and more severe cases of inflammatory bowel diseases. The authors evaluated whether partial replacement of soybean oil by medium-chain triglycerides (MCTs) or olive oil influenced the incidence and severity of experimental ulcerative colitis by using different parenteral lipid emulsions (LEs). Methods: Wistar rats (n = 40) were randomized to receive parenteral infusion of the following LE: 100% soybean oil (SO), 50% MCT mixed with 50% soybean oil (MCT/SO), 80% olive oil mixed with 20% soybean oil (OO/SO), or saline (CC). After 72 hours of infusion, acetic acid experimental colitis was induced. After 24 hours, colon histology and cytokine expression were analyzed. Results: SO was not significantly associated with overall tissue damage. MCT/SO was not associated with necrosis (P < .005), whereas OO/SO had higher frequencies of ulcer and necrosis (P < .005). SO was associated with increased expression of interferon-gamma (P = .005) and OO/SO with increased interleukin (IL)-6 and decreased tumor necrosis factor-alpha expression (P < .05). MCT/SO appeared to decrease IL-1 (P < .05) and increase IL-4 (P < .001) expression. Conclusions: Parenteral SO with high concentration of omega-6 fatty acids was not associated with greater tissue damage in experimental colitis. SO partial replacement with MCT/SO decreased the frequency of histological necrosis and favorably modulated cytokine expression in the colon; however, replacement with OO/SO had unfavorable effects. (JPEN J Parenter Enteral Nutr. 2012; 36: 442-448)
- Body adiposity index performance in estimating body fat in a sample of severely obese Brazilian patients(2015) BELARMINO, Giliane; HORIE, Lilian Mika; SALA, Priscila Campos; TORRINHAS, Raquel S.; HEYMSFIELD, Steven B.; WAITZBERG, Dan L.Background/objectives: The body adiposity index (BAI) estimates the amount of body fat (BF) in humans. In Mexican-American and African-American populations, BAI has performed better than body mass index (BMI). The aim of this study was to evaluate the performance of BAI in estimating percentage (BF%) in severely obese Brazilian patients, with air displacement plethysmography (ADP) used as the reference method. Subjects/methods: Estimation of BF% by ADP, anthropometric measurements (height, abdominal and hip circumferences, body weight, and BMI) and BAI calculation were performed in 72 obese subjects (BMI >= 30 kg/m(2)) aged 30-55 years. Results: The mean BF% estimates +/- standard deviation were 52.1 +/- 5.7 % for ADP and 47.7 +/- 7.4 % for BAI, with a positive Pearson correlation (r(p) = 0.66) and a positive Lin's concordance correlation (r(c) = 0.479) observed between these methods. The 95 % limits of individual agreement between BAI and ADP ranged from -5.769 % to 16.036 %, with BAI exhibiting an average positive bias of 5.13 % compared to the reference method. For each studied variable, BAI exhibited a systematic bias, as evidenced by a tendency for low BF% values to be overestimated. Conclusion: For Brazilian patients with severe obesity, BAI does not provide an accurate estimate of BF%.