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Nutrition therapy (NT), defined as the provision of oral, enteral, or parenteral nutrition, should be considered a part of the holistic approach to patient care, while quality assessment of its practices is crucial. The present study aimed to identify variables capable of explaining the reason behind compliance of NTTs with the regulatory requirements.A cross-sectional study focused on assessing the quality of nutritional therapy practices among NTTs who previously stated to be able to comply with requirements of the Brazilian law versus those who were not able to meet these demands. Hospitals were classified as A (teams that had previously reported to be able to meet the requirements) and B (those unable to comply with them). The study was approved by the ethics committees of all participant institutions.Twenty six hospitals met the inclusion criteria. The main hospital features, such as size, classification, service type, and percentage of hospitals providing NT were similar. Hospitals differed on the median number of patients undergoing NT per week: in group B (41.0; IR = 28.0-58.0) and group A (11.0; IR = 5.0-48.0) (p 0.05), but there were no differences regarding personnel expertise. Both hospital groups had low quality control of the NT processes.Lack of quality assurance is responsible for the inadequate services in both type of institutions.

Inflammatory bowel diseases (IBD) are chronic processes involving a deregulated immune response against intestinal microbiota in genetically susceptible individuals. Ulcerative colitis (UC) is an IBD restricted to colonic mucosa and its chronicity is a predisposing factor for colorectal cancer (CRC). Probiotics have been investigated as an adjuvant treatment for UC, and Escherichia coli Nissle 1917 (EcN) was the focus of our investigation. The aim of this study was to investigate the preventive effect of the EcN probiotic in an experimental model of chronic colitis in germ-free (GF) and conventional (CV) mice. CV female mice were used for clinical, immunological and permeability experiments. GF mice were used for a faecal microbiota transplantation assay. To induce colitis, three cycles of 3.0% dextran sulphate sodium (DSS) were administered to the animals. For probiotic treatment, the mice received a daily intragastric gavage of 9.0 log10 cfu of EcN, beginning 10 days before colitis induction and continuing until the end of the experiment. EcN presented beneficial effects when administered preventively. Daily Disease Activity Index (DAI) evolution demonstrated significant difference in remission periods after the first two DSS cycles and during the third one. Reduction in bacterial translocation after probiotic treatment indicated protection of the intestinal barrier. Associated with mucosal preservation, restoration of secretory immunoglobulin A levels and reduction of interleukin (IL)-5, IL-13, tumour necrosis factor and interferon-γ levels were observed in EcN treatment. Finally, when microbiota modification was verified, 16S rRNA-based compositional analysis showed variation of intestinal microbiota between the control and colitis groups. After faecal transplantation using GF mice, it was observed that EcN treatment in CV mice might result in modulated intestinal microbiota. This was observed indirectly in the reduced daily DAI, when colitis was compared with treated group. In conclusion, EcN presented beneficial effects in this model, suggesting its usefulness for treating UC.

Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice per d as a supplement for 15 d. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD < 15) and more (MELD ≥ 15) severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57·4 % and 54·2 % of patients in the WP and CA groups, respectively (P = 0·649). Protein intake was lower at baseline in the WP group than in the CA group (P = 0·035), with no difference after supplementation (P = 0·410). Both the WP and CA MELD < 15 groups increased protein intake after supplementation according to the intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1β and interferon-γ), immunomodulatory proteins (sTNFR1, sTNFR2, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor) or immunomodulatory hormones (adiponectin, insulin and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of interferon-γ-induced protein-10/CXCL10 (P = 0·022), eotaxin-1/CCL11 (P = 0·031) and monocyte chemoattractant protein-1/CCL2 (P = 0·018) and decreased IL-5 (P = 0·027), including among those in the MELD ≥ 15 group, for whom IL-10 was also increased (P = 0·008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared with CA with no impact on nutritional status.

Background Nutrition therapy plays a major role in the perioperative management of surgical patients. Understanding energy metabolism and correctly establishing the adequate energy needs is a crucial step to provide optimal nutrition care. The aim of this study was to assess the resting energy expenditure (REE) after major abdominal procedures and its associated factors. Methods This was a prospective observational study conducted at a single center. REEs of patients admitted for gastrointestinal surgical procedures were measured by indirect calorimetry 24 hours prior to the procedure and reassessed at least once within the fifth postoperative day. Substrate oxidation was calculated according to the Frayn equation. Nutrition status was evaluated using subjective global assessment. Results There were no significant changes in the REEs throughout the study period; however, there was a decrease in the respiratory quotient during the postoperative period, as well as a decrease in carbohydrate oxidation and an increase in lipid oxidation. Only 33.3% of the patients presented a postoperative increase in REE > 10%. Those patients presented higher blood-monocyte levels. Conclusion Postoperative REE is not increased in most of the patients. In patients who had increased REE, associated factors included higher levels of monocytes.

This study evaluated the effects of Bifidobacterium longum 51A on the intestinal mucosa and inflammatory response in experimental colitis. Colitis was induced by administration of 3.5% dextran sodium sulphate (DSS) solution for 7 days. Two periods of administration were performed: treatment (T) group, mice received Bifidobacterium only during disease induction (7 days); total treatment (TT) group, mice received Bifidobacterium for 10 days before and during disease induction. The probiotic effects on intestinal permeability, inflammatory infiltrate, histological analysis, cytokines, chemokines and sIgA were evaluated. Bifidobacterium administration in the T group showed reduction in intestinal permeability and lower IL-1β, myeloperoxidase, and eosinophil peroxidase levels compared to those in the colitis group (P1A treatment modality was more effective than total treatment and reduced the inflammatory response and its consequences on intestinal epithelium.

Dietary fibers, such as fructooligosaccharide (FOS) and partially hydrolyzed guar gum (PHGG) have several gastrointestinal functions. The aims of this study were to evaluate the effect of acute ingestion of FOS and PHGG on the percentage of gastric emptying and small intestinal transit and to evaluate the effect of these dietary fibers on the levels of intestinal hormones-active glucagon-like peptide-1, pancreatic polypeptide, and gastric inhibitory peptide-and their effect on feelings of hunger and satiety and the desire to eat.In this crossover, randomized controlled clinical trial, we compared the effects of these two fibers on gastrointestinal transit. The tests were performed using scintigraphy. On three different days, healthy participants consumed a test meal containing 20 g of digestible maltodextrin (placebo), 20 g of FOS, or 20 g of PHGG.The gastric emptying of the FOS-based diet (84.2 ± 9.4%) within 2 h was statistically increased compared with the placebo and PHGG-based diets (78 ± 10.2% and 74 ± 15.3%, respectively; P0.05). However, a reduction in small intestinal transit was observed after consumption of both FOS- and PHGG-based diets (28.5 ± 15.56% and 24.2 ± 13.7%, respectively) compared with the placebo diet (41.20 ± 15.4%; P0.05). There were no changes in the levels of intestinal hormones, feeling of hunger and satiety, or desire to eat after consuming the three diets (P0.05).The acute intake of FOS increased gastric emptying, whereas both FOS and PHGG reduced small intestine transit without altering the levels of intestinal hormones, hunger feelings and satiety, or the desire to eat.

Inflammatory bowel diseases, irritable bowel syndrome, and mucositis are characterized by intestinal inflammation, but vary according to their pathological mechanisms, severity, location, and etiology. Significant intestinal inflammation that occurs in these diseases induces weight loss, nutritional depletion, and gastrointestinal tract dysfunction. Nutritional support is important in alleviating symptoms and improving patients’ quality of life. In this review, we summarize some nutritional components used to manage intestinal disorders. These include fatty acids, probiotics, parabiotics, postbiotics, prebiotics, synbiotics, and low FODMAP (LFD) diets. These components and LFD diets have been studied and clinical trials have been designed to develop new strategies to alleviate intestinal inflammation and improve the quality of life. Clinical trials on their use in intestinal inflammation do not allow firm conclusions to be drawn mainly because of the heterogeneity of the dose used and the study design or their inconclusive results. However, in the majority of cases, the use of omega-3, probiotics, parabiotics, postbiotics, prebiotics, synbiotics, and LFD improve the health.

Intestinal mucositis (IM) is a common side effect resulting from cancer treatment. However, the management so far has not been very effective. In the last years, the role of the gut microbiota in the development and severity of mucositis has been studied. Therefore, the use of probiotics and paraprobiotics could have a potential therapeutic effect on IM. The aim of our study was to investigate the impact of the administration of Lacticaseibacillus rhamnosus (L. rhamnosus) CGMCC1.3724 and the paraprobiotic on IM in mice. For 13 days, male Balb/c mice were divided into six groups: control (CTL) and mucositis (MUC)/0.1 mL of saline; CTL LrV and MUC LrV/0.1 mL of 108 CFU of viable Lr; CTL LrI and MUC LrI/0.1 mL of 108 CFU of inactivated Lr. On the 10th day, mice from the MUC, MUC LrV, and MUC LrI groups received an intraperitoneal injection (300 mg/kg) of 5-fluorouracil to induce mucositis. The results showed that the administration of the chemotherapeutic agent increased the weight loss and intestinal permeability of the animals in the MUC and MUC LrV groups. However, administration of paraprobiotic reduced weight loss and maintained PI at physiological levels. The paraprobiotic also preserved the villi and intestinal crypts, reduced the inflammatory infiltrate, and increased the mucus secretion, Muc2 gene expression, and Treg cells frequency.

Introduction The implementation of quality assessment in nutrition therapy (NT) is an important strategy, with the potential to contribute to the reduction of malnutrition and improve the cost-effectiveness of NT. Studies on this subject are scarce in the world. Our objective was to evaluate the practice of NT in hospitals located in the third-most-developed state of Brazil. Methods A cross-sectional study, using data collected through interviews with members of the clinical staff/interdisciplinary NT team (NTT) and audits of clinical protocols and medical records, was carried out. Both non-probability and probability sampling techniques were used to select the hospitals. Results Thirty-three hospitals were included (10 public, 10 philanthropic, 9 private, and 4 university). Twenty-six institutions reported to have an NTT. There was no statistically significant difference in the existence and performance of the teams or in the presence of protocols and quality indicators between the types of hospitals. However, the inspection of 172 medical records showed that essential items for the nutrition care of the patient were not fully in agreement with the previous provided information, and this varied according to the type of hospital. Conclusion The majority of hospitals had an NTT as well as protocols and quality indicators. However, patient records were not in accordance with the essential items to guarantee NT quality and safety, indicating a gap between theory and practice.

The beneficial effects of prebiotic, such as fructo-oligosaccharides (FOS), in intestinal inflammation have been demonstrated in several studies. Herein, we evaluate whether joint treatment with FOS, both before and during mucositis, had additional beneficial effects and investigated the mechanisms underlying in the action of FOS on the intestinal barrier. BALB/c mice were randomly divided into five groups: CTR (without mucositis + saline solution), FOS (without mucositis + 6 % FOS), MUC (mucositis + saline solution), PT (mucositis + 6 % FOS supplementation before disease induction), and TT (mucositis + 6 % FOS supplementation before and during disease induction). Mucositis was induced by intraperitoneal injection (300 mg/kg) of 5-fluorouracil (5-FU). After 72 h, the animals were euthanized and intestinal permeability (IP), tight junction, bacterial translocation (BT), histology and morphometry, and immunoglobulin A secretory (sIgA), inflammatory infiltrate, and production of short-chain fatty acids (acetate, butyrate and propionate) were evaluated. The MUC group showed an increase in the IP, BT, and inflammatory infiltrate but a decrease in the tight junction expression and butyrate and propionate levels (P

Background & aims: Chronic liver disease is associated with malnutrition that negatively impacts a patient’s health-related quality of life (HRQoL). We evaluated the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation (LT). Methods: This was a double-blind randomized clinical trial with patients waiting for LT who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40g (20g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance (EB) was calculated as the difference between energy intake (24-hour recall) and total energy expenditure. The chronic liver disease questionnaire (CLDQ) was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9% of patients, and it was directly associated with a poor HRQoL (p0.05). Patients who met protein requirements and had a positive EB demonstrated a higher HRQoL score (4.9) (p

Sarcopenia is a syndrome characterized by loss of muscle mass and strength that impacts clinical outcomes and mortality in cancer patients. Although the molecular pathways involved in sarcopenia are not fully elucidated, the decrease in protein synthesis rate appears to be one of the most important events. The objective of this study was to investigate the relationship between sarcopenia and mTOR signaling pathway in patients undergoing colorectal resection surgery. Three groups of patients were assessed: 1) the control group (no cancer, no sarcopenia), 2) the cancer non-sarcopenic group and 3) the cancer sarcopenic group. All individuals were evaluated in relation to presence of sarcopenia and mTOR signaling pathway. Sarcopenia was evaluated by the combination of low muscle mass and low muscle strength, measured using computerized tomography images, and hand grip strength, respectively. Rectus abdominis muscle biopsy was performed at the time of surgery. mTOR pathway was analyzed by MILLIPLEX Map Kit Phospho/total mTOR 2-Plex Magnetic Bead Panel. Results were presented by phosphor/total mTOR ratio. Independent T test, Kruskal-Wallis test, and Dunn-Bonferroni post hoc were performed for statistical analysis and P 0.05 was considered. Thirty-six patients and five controls were evaluated. A total of 13 cancer patients (36.1%) had sarcopenia. The phospho/total mTOR ratio was different between the control group (0.167 MFI) and the cancer non-sarcopenic group (0.055 MFI) (P = 0.026) as well as between the control group (0.167 MFI) and the cancer sarcopenic group (0.0049 MFI) (P = 0.041). No difference was observed on the median phospho/total mTOR ratio between the cancer groups (P 0.05). More research is needed to extrapolate these results.

This study evaluated the mechanisms action of arginine in experimental model of ulcerative colitis. C57BL/6 mice were randomized into 4 groups: Control group (C): standard diet; Colitis group (Col): standard diet and DSS solution; Pretreated group (PT): diet supplementation with arginine before and during colitis induction; Treated group (T): diet supplementation with arginine during colitis induction. Colitis was induced by administration of 1.5% DSS for 5 days. Parameters such as intestinal permeability (IP), bacterial translocation (BT), histological and morphometric analysis, cytokines, immunoglobulin A, inflammatory infiltrate, oxidative stress, tight junction, iNOS1 Nitric oxide indutase.1 were performed. The Col group showed increased IP, BT, oxidative stress and inflammatory infiltrate in the colon. Arginine decreased IP, BT, oxidative stress and inflammatory infiltrate in the colon. Only, the group T reduced iNOS, cytokine IL-17,2 Interleukine 17.2 and increased collagen area and cytokine TGF-β.3 Transforming growth factor beta.3 These results suggest that arginine can constitute in potential therapy for colitis.

The relationship between inflammatory bowel disease (IBD) and mood disorders is complex and involves overlapping metabolic pathways, which may determine comorbidity. Several studies have been shown that this comorbidity could worsen IBD clinical course. The treatment of ulcerative colitis is complex, and involves traditional therapy to promote the function of epithelial barrier, reducing exacerbated inflammatory responses. Recently, it has been shown that some probiotic strains could modulate gut-brain axis, reducing depressive and anxiety scores in humans, including IBD patients. Accordingly, this study aimed to evaluate the role of Weissella paramesenteroides WpK4 in murine models of ulcerative colitis and chronic stress. It was observed that bacterium ingestion improved health of colitis mice, reducing intestinal permeability, besides improving colon histopathological appearance. In stressed mice, bacterial consumption was associated with a reduced anxiety-like and depressive-like behaviors. In both assays, the beneficial role of W. paramesenteroides WpK4 was related to its immunomodulatory feature. It is possible to state that W. paramesenteroides WpK4 exerted their beneficial roles in gut-brain axis through their immunomodulatory effects with consequences in several metabolic pathways related to intestinal permeability and hippocampal physiology.

Mucositis is a side effect observed in patients undergoing chemotherapy. Besides, this treatment also leads to the imbalance of the intestinal microbiota. This study evaluated the effects of pre and treatment with fructo-oligosaccharides (FOS) in intestinal mucositis induced by 5-fluorouracil (5-FU). Balb/c mice were divided into four groups: CTL (without mucositis + saline), MUC (mucositis + saline), PT (mucositis + 6% FOS before disease induction) and T (mucositis + 6% FOS after disease induction). Mucositis was induced with an intraperitoneal injection of 300 mg/kg 5-FU. After 72 h intestinal permeability (IP), inflammatory infiltrate, oxidative stress, histological analysis, and short-chain fatty acids (SCFA) production were evaluated. The MUC group showed lost weight, intense inflammatory infiltrate, increased oxidative stress and IP (P

Studies have showed the protective effects of conjugated linoleic acid (CLA) on intestinal epithelium, modulating host immune and inflammatory responses on intestinal diseases.To evaluate the preventive effects of CLA on the intestinal mucositis induced by 5-FU in a murine model.Sixty-four BALB/c mice were randomly divided into four groups: Control (CTL), fed a standard chow diet; CLAs, fed a diet supplemented with CLA; Mucositis (5-FU), fed a standard chow diet and underwent mucositis induction and CLAs 5-FU, fed a diet supplemented with CLA and underwent mucositis induction. Mucositis was induced by intraperitoneal injection of 300 mg/kg 5-FU. After 72 h, the animals were euthanized and intestinal permeability, bacterial translocation, inflammatory mediators, and intestinal histology were evaluated.Mice in the CLAs 5-FU group showed reduced weight loss compared to those in the 5-FU group (p 0.005). Furthermore, the results also showed that the treatment with CLA reduced intestinal permeability, bacterial translocation, and biomarkers of inflammatory response besides minor damage to ZO-1 and occludin with maintenance of the integrity of the intestinal epithelium and a favorable balance between the inflammatory and regulatory cytokines.This study suggests that CLA reduced the adverse effects from 5-FU administration on the intestinal mucosa.

BACKGROUND Different nutrition assessment tools in surgical cancer patients are used in clinical practice, which results in different prevalence rates of malnutrition. This may impact the interpretation of the association between nutrition status and clinical outcomes. Reduced standardized phase angle (SPA) values are associated with adverse outcomes in patients with cancer. Thus, it is important to assess the association of SPA with nutrition status and relate it to postoperative clinical outcomes. METHODS This prospective observational study included 121 surgical cancer patients. Bioelectrical impedance analysis, subjective global assessment (SGA), anthropometric measurements, and assessment of muscle strength were used to provide nutrition diagnosis 1 day before surgery. The patients were followed for infectious and noninfectious postoperative complications from the first day after the operation until discharge or death. RESULTS The prevalence of malnutrition was higher according to SGA (63.6%). Patients with an SPA < -1.65 had a greater chance of being diagnosed as malnourished according to the SGA (3.66 [1.35-9.90]), midarm circumference (OR 4.24; CI95%; 1.72-10.43), midarm muscle area (OR 4.38; CI95%; 1.68-11.42), and low handgrip strength (3.84 [1.31-11.25]). Patients with an SPA < -1.65 presented with more infectious complications (OR 4.19; CI95%; 1.52-11.53), but there was no association between SPA and other outcomes or death. SPA was the only significant predictor of infectious complications (AUC, 0.61; 95% CI, 0.51-0.71). CONCLUSION SPA was associated with different nutrition status parameters, and it was able to predict postoperative infectious complications.

Studies on the ‘gut origin of sepsis’ have suggested that stressful insults, such as surgery, can affect intestinal permeability, leading to bacterial translocation. Symbiotics have been reported to be able to improve gut permeability and modulate the immunologic system, thereby decreasing postoperative complications. Therefore we aimed to evaluate the postoperative use of symbiotics in head and neck cancer surgical patients for intestinal function and permeability, as well as the postoperative outcomes. Patients were double-blind randomised into the symbiotic (n18) or the control group (n18). Samples were administered twice a day by nasoenteric tube, starting on the 1st postoperative day until the 5th to 7th day, and comprised 109colony-forming units/ml each ofLactobacillus paracasei,L. rhamnosus,L. acidophilus, andBifidobacterium lactisplus 6 g of fructo-oligosaccharides, or a placebo (6 g of maltodextrin). Intestinal function (day of first evacuation, total stool episodes, stool consistency, gastrointestinal tract symptoms and gut permeability by diamine oxidase (DAO) enzyme) and postoperative complications (infectious and non-infectious) were assessed. Results of comparison of the pre- and postoperative periods showed that the groups were similar for all outcome variables. In all, twelve patients had complications in the symbiotic groupv. nine in the control group (P>0·05), and the preoperative-postoperative DAO activity ranged from 28·5 (sd15·4) to 32·7 (sd11·0) ng/ml in the symbiotic group and 35·2 (sd17·7) to 34·1 (sd12·0) ng/ml in the control group (P>0·05). In conclusion, postoperative symbiotics did not impact on intestinal function and postoperative outcomes of head and neck surgical patients.

Summary Toxoplasmosis represents one of the most common zoonosis worldwide. Its agent, Toxoplasma gondii, causes a severe innate pro-inflammatory response. The indigenous intestinal microbiota promotes host animal homoeostasis and may protect the host against pathogens. Germ-free (GF) animals provide an important tool for the study of interactions between host and microbiota. In this study, we assessed the role of indigenous microorganisms in disease development utilizing a murine toxoplasmosis model, which includes conventional (CV) and GF NIH Swiss mice. CV and GF mice orally inoculated with T. gondii had similar survival curves. However, disease developed differently in the two animal groups. In CV mice, intestinal permeability increased and levels of intestinal pro-inflammatory cytokines were altered. In GF animals, there were discrete epithelial degenerative changes and mucosal oedema, but the liver and lungs displayed significant lesions. We conclude that, despite similar survival curves, CV animals succumb to an exaggerated inflammatory response, whereas GF mice fail to produce an adequate systemic response.

Objective: the development and analysis of the macro and micronutrient composition of homemade enteral diets. Method: A standard homemade enteral diet was developed at three caloric concentrations - 1500, 1800 and 2100 Kcal. After preparation and testing of viscosity, stability, odor and color, plus evaluation of cost, the chemical composition of the nutrients of the diets were analytically determined. Folic acid, vitamin D and vitamin B12 values were calculated using chemical composition tables. The results were compared with recommended nutritional standards for the elderly. Result: The diets exhibited normal macronutrient distribution. The 1500 caloric level presented some mineral and vitamin deficiencies. Suitable values were obtained at the other caloric levels for all minerals except magnesium. There were appropriate levels of all the vitamins in the 2100 Kcal diet, while vitamin E, D and B6 levels were below the recommended dietary allowances in the 1800 Kcal diet. Conclusion: The standard homemade enteral diets studied can contribute to the food and nutritional safety of elderly persons undergoing home care, if all are supplemented with magnesium and the 1800 Kcal diet is supplemented with vitamin E, D and B6. The 1500 Kcal diet was not nutritionally safe in terms of micronutrients.

The aim of this study was to evaluate the association between preoperative nutritional status and health-related quality of life (HRQoL) in patients with gastrointestinal cancer who were admitted for elective surgical treatment.This was a cross-sectional study in which patients with a diagnosis of gastrointestinal cancer were evaluated before a surgical procedure. The nutritional assessment included subjective global assessment (SGA) and measurements of weight loss percentage, bioelectrical impedance, and functional capacity. HRQoL was evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Statistical analyses were performed with a significance level of 5%. The sample size was calculated based on a pilot study.We evaluated 132 patients, the majority of whom were men. The median age of the patients was 62 y, and the most prevalent tumors were in the colon, rectum, and anus (52.3%). The SGA highlighted the high prevalence of malnutrition (69.9%), which was confirmed by the rates of weight loss (73.8%) and the low fat-free mass index (56.8%). Malnourished patients and patients with severe weight loss had worse functional, symptom, global health and quality of life scores (P0.05). Malnutrition, according to the SGA, decreased physical function and role performance scores by 9 and 20 points, respectively (P0.05).Malnutrition, assessed by various tools, was associated with poor HRQoL of surgical patients with gastrointestinal cancer.

BACKGROUND Energy balance (EB) and its relation to nutrition status throughout the perioperative period of liver transplantation (LTx) patients has been poorly reported in the literature, and this is the primary objective of the current study. METHODS A prospective observational study was conducted with patients undergoing LTx, who were assessed before and after the operation. Resting energy expenditure, total energy expenditure (TEE), dietary intake, and EB were evaluated, as well as anthropometry, handgrip strength, and standard phase angle (SPA). The presence of complications after the operation, length of intensive care unit and hospital stay, and death were registered. A P-value

Dietary fiber and prebiotics have been the focus of research and discussion for decades, but there are still pending concepts and definitions, in particular when addressing their use in the prevention and treatment of diarrhea. The purpose of this review is to present the latest advances in the understanding of dietary fiber and prebiotics, to review their proven role in the management of diarrhea, and to postulate the best timings and optimal doses.The use of prebiotics has encompassed not only prevention but also the treatment of distinct types of diarrhea, at different treatment moments, and with regard to various different markers of outcome. Furthermore, the description of soluble fibers claiming to be prebiotics, and vice versa, has too often been the tone in the literature, which has led to misconceptions in classification and, consequently, confusion over the interpretation of results. It remains difficult to establish a consensus about the real impact of fiber and prebiotics on the prevention and therapy of diarrhea.The review highlights the overlapping concepts of fiber and prebiotics, and supports the need for adequate individualization of their use, according to the goal - either prevention or treatment of diarrhea - as well as the optimal timing and dose to be used. Nonetheless, viscous soluble fibers seem to be the best option in treating diarrhea, whereas prebiotics are more important in preventing and avoiding recurrence.

Indigenous microbiota plays a crucial role in the development of several intestinal diseases, including mucositis. Gastrointestinal mucositis is a major and serious side effect of cancer therapy, and there is no effective therapy for this clinical condition. However, some probiotics have been shown to attenuate such conditions. To evaluate the effects of Saccharomyces cerevisiae UFMG A-905 (Sc-905), a potential probiotic yeast, we investigated whether pre- or post-treatment with viable or inactivated Sc-905 could prevent weight loss and intestinal lesions, and maintain integrity of the mucosal barrier in a mucositis model induced by irinotecan in mice. Only post-treatment with viable Sc-905 was able to protect mice against the damage caused by chemotherapy, reducing the weight loss, increase of intestinal permeability and jejunal lesions (villous shortening). Besides, this treatment reduced oxidative stress, prevented the decrease of goblet cells and stimulated the replication of cells in the intestinal crypts of mice with experimental mucositis. In conclusion, Sc-905 protects animals against irinotecan-induced mucositis when administered as a post-treatment with viable cells, and this effect seems to be related with the reduction of oxidative stress and preservation of intestinal mucosa.

When intestinal microbiota is imbalanced, a patient becomes more vulnerable to infectious complications; intervention with beneficial probiotics may help lower risk for infection. The aim of this study was to measure levels of inflammatory cytokine messenger RNA (mRNA) in surgical samples of intestinal mucosal tissues from patients who were given the probiotic Saccharomyces boulardii before undergoing colon surgery.Thirty-three patients undergoing colon resection were randomly assigned to receive at least 7-day preoperative probiotic treatment (n = 15) or conventional (n = 18) treatment. Probiotic treatment consisted of oral lyophilized S boulardii Cytokine mRNA levels (interleukin [IL]-10, IL-1β, IL-23A, tumor necrosis factor [TNF]-α, IL-12B, interferon-γ [INF-γ], and IL-17A) were measured in samples obtained during the operation. Postoperative infections were also assessed.Patients who received probiotics had significantly lower mucosal IL-1β, IL-10, and IL-23A mRNA levels than the control group (P = .001, P = .04, and P = .03, respectively). However, mRNA expression of other cytokines did not differ between the 2 groups (P.05). The incidence of postoperative infectious complications was 13.3% and 38.8% in probiotic and control groups, respectively (P.05). There was no perioperative mortality in either group. The mean total length of hospital stay was similar between the groups (P.05).Probiotic treatment with S boulardii downregulates both pro- and anti-inflammatory cytokines in the intestinal colonic mucosa with no statistical impact on postoperative infection rates.

Gastrointestinal mucositis is a major problem associated with cancer therapy. To minimize these deleterious effects, simultaneous administration of antioxidant components, such as selenium, can be considered. There is a growing interest in the use of yeasts because they are able to convert inorganic selenium into selenomethionine. In the present study, oral administration of Saccharomyces cerevisiae UFMG A-905 enriched with selenium was evaluated as an alternative in minimizing the side effects of 5FU-induced mucositis in mice. Mice body weight, food consumption, faeces consistency and the presence of blood in faeces were assessed daily during experimental mucositis induced by 5-fluorouracil (5FU). Blood was used for intestinal permeability determination, and small intestine for oxidative stress, immunological and histopathological examination. The increased intestinal permeability observed with mucositis induction was partially reverted by S. cerevisiae and selenium-enriched yeast. Both treatments were able to reduce myeloperoxidase activity, but only selenium-enriched yeast reduced eosinophil peroxidase activity. CXCL1/KC levels, histopathological tissue damage and oxidative stress (lipid peroxidation and nitrite production) in the small intestine were reduced by both treatments; however, this reduction was always higher when treatment with selenium-enriched yeast was evaluated. Results of the present study showed that the oral administration of S. cerevisiae UFMG A-905 protected mice against mucositis induced by 5-FU, and that this effect was potentiated when the yeast was enriched with selenium.

Objective The aim of the present study was to identify whether overweight liver recipients are hypometabolic. Methods Liver transplantation (LT) recipients (n = 20), who were 18 to 65 y of age, had a body mass index (BMI) ≥25 kg/m2, and were 1 to 3 y post-transplant. They were matched with healthy controls in terms of sex, age, BMI, and body composition. Dietary intake data were collected using a 3-d food record. The individuals’ daily activities were converted into metabolic equivalents. Resting energy expenditure (REE) was assessed in the morning after an overnight fast (12 h), by indirect calorimetry, using an open-circuit calorimeter. Results Total energy and macronutrient intakes were similar among liver recipients and controls. The majority of the individuals from both groups were sedentary (75%; n = 15/group). Patients who underwent LT showed lower REE (1449.15 ± 101.25 kcal) compared with the control group (1768.45 ± 86.94 kcal). Likewise, the ratio of REE to fat-free mass (FFM) was lower in the LT group (28.9 ± 1.7 kcal/ kg) than in the control group (32.9 ± 0.9 kcal/ kg; P Conclusion The REE of overweight liver recipients is reduced and it might be a risk factor for excessive body weight gain in this population.

Racional: Existe lacuna na literatura em relação à presença de hipercalemia em pacientes submetidos ao transplante hepático. Objetivo: Avaliar a prevalência de hipercalemia após o transplante hepático; e avaliar os fatores de risco associados a essa condição. Métodos: Estudo de coorte retrospectivo, no qual foram avaliados 147 pacientes submetidos ao transplante hepático, com tempo de seguimento de um ano. A coleta de dados compreendeu gênero, idade, valores séricos de potássio, ureia, creatinina, sódio e medicamentos utilizados no tempo de 1, 6 e 12 meses após o transplante. Hipercalemia foi definida como valores de potássio sérico maiores do que 5,5 mEq/l. Resultados: Hipercalemia foi observada em 18,4%, 17,0% e 6,1% dos pacientes no 1º, 6º e 12º meses após o transplante, consecutivamente. Idade avançada (p=0,021), baixos valores de creatinina sérica (p=0,007), valores aumentados de ureia (p=0,010) e hipernatremia (p=0,014) foram fatores associados à hipercalemia, assim como a dose de prednisona no 6º mês após o transplante (p=0,014). Conclusão: Hipercalemia esteve presente em menos de 20% dos pacientes no primeiro mês após o transplante hepático, com diminuição da prevalência ao longo do tempo. Considerando que ela não afeta todos os pacientes, o tratamento dietético deve ser individualizado, com especial atenção à recomendação de administração de potássio de forma rotineira. Background: There is a lack of data regarding hyperkalemia after liver transplantation. Aim: To evaluate the prevalence of hyperkalemia after liver transplantation and its associated factors. Methods: This retrospective cohort study evaluated 147 consecutive post-transplant patients who had at least one year of outpatient medical follow up. The data collection included gender, age, potassium values, urea, creatinine, sodium and medication use at 1, 6 and 12 months after. Hyperkalemia was defined as serum potassium concentrations higher than 5.5 mEq/l. Results: Hiperkalemia was observed in 18.4%, 17.0% and 6.1% of patients 1, 6 and 12 months after tranplantation, respectively. Older age (p=0.021), low creatinine clearance (p=0.007), increased urea (p=0.010) and hypernatremia (p=0.014) were factors associated with hyperkalemia, as well as the dose of prednisone at six months (p=0.014). Conclusion: Hyperkalemia was prevalent in less than 20% of patients in the 1st month after liver transplantation and decreased over time. Considering that hyperkalemia does not affect all patients, attention should be paid to the routine potassium intake recommendations, and treatment should be individualized.

The intestinal epithelium is composed of specialized epithelial cells that form a physical and biochemical barrier to commensal and pathogenic microorganisms. However, dysregulation of the epithelial barrier function can lead to increased intestinal permeability and bacterial translocation across the intestinal mucosa, which contributes to local and systemic immune activation. The increase in these parameters is associated with inflammatory bowel disease, physical exercise under heat stress, intestinal obstruction, ischemia, and mucositis, among other conditions. Lately, there has been growing interest in immunomodulatory nutrients and probiotics that can regulate host immune and inflammatory responses and possibly restore the intestinal barrier. Immunomodulators such as amino acids (glutamine, arginine, tryptophan, and citrulline), fatty acids (short-chain and omega-3 fatty acids and conjugated linoleic acids), and probiotics (Bifidobacterium, Saccharomyces, and Lactobacillus) have been reported in the literature. Here, we review the critical roles of immunomodulatory nutrients in supporting gut barrier integrity and function.

Beneficial effects of L-arginine on immune responses and bowel function have been reported. Mucositis is a side effect of chemotherapy treatment that affects approximately 40% of patients. This complication is characterized by inflammation that affects the gastrointestinal tract, increasing permeability and causing abdominal pain, nausea, vomiting, and diarrhea, which worsen the patient's nutritional status and increases morbimortality. The aim of this study was to evaluate the effect of pretreating with 2% L-arginine supplementation in water on mucositis as induced by 5-fluorouracil (5-FU; a single dose of 200 mg/kg body weight) in Swiss male mice. The effect of L-arginine on weight, intestinal permeability, morphology, and the histopathological score of the small intestine (from 0 to 12), oxidative stress, myeloperoxidase (MPO), and N-acetylglucosaminidase (NAG) activities were evaluated. Intestinal length improvement was observed, in addition to the partial recovery of the mucosal architecture. L-arginine attenuated the histopathological score and MPO activity. There was also an improvement in intestinal permeability, despite weight loss after 5-FU administration. In conclusion, L-arginine can positively impact intestinal mucositis by promoting partial mucosal recovery, reducing inflammation and improving intestinal permeability.

Mucositis is a common complication in patients undergoing radiotherapy and chemotherapy. It is associated with pain, poor quality of life, and malnutrition, leading to an increased number of hospital admissions and prolonged hospitalization. The use of immunonutrients may be an alternative treatment option, which may help to improve patient outcome.Here we assessed the impact of L-citrulline (CIT) on a murine model of 5-fluorouracil (5FU)-induced mucositis.Swiss male mice were randomized into 4 groups: control, CIT, 5FU, and 5FU+CIT. Mice were fed with commercial chow and supplemented with an oral solution of alanine (control and 5FU groups) or CIT (CIT and 5FU+CIT groups). On the seventh day, mice received intraperitoneal phosphate-buffered saline or 5FU (200 mg/kg, single dose) to induce mucositis. On the 10th day, mice were euthanized, and the blood and small intestines were harvested. Body weight, morphology, histopathology score (hematoxylin and eosin) of the small intestine (from 0-12), myeloperoxidase activity, oxidative stress level, and intestinal permeability were assessed.We observed significant weight loss after the administration of 5FU in both treated and control animals. CIT administration contributed to a partial recovery of the mucosal architecture as well as an intermediate reduction of the histopathologic score, and functional intestinal permeability was partially rescued.CIT administration attenuated 5FU-mediated damage to the mucosal architecture of the small intestine, decreasing the size of the injured areas and promoting decreased intestinal permeability.

Patients who need prolonged domiciliary enteral nutritional therapy may benefit from handmade diets. However, the preparation of such diets might cause insecurity with regard to their nutritional composition and physical-chemical properties. Current study analyzes the osmolality and Hydrogen-Ion concentration (pH) on handmade enteral diets. To this purpose, six formulas and two juices, prescribed on discharge from hospital, were analyzed physically and chemically. Osmolality and pH were respectively determined by cryoscopy and potentiometry. Most formulations were classified as isosmolar (with less than 400 mOsm/kg solvent), and only one was classified as slightly hyperosmolar, with rates ranging from 356.7 to 403.5 mOsm/kg solvent. On average, the standard formula presented higher osmolality than similar ones prepared for hyperglycemia. Among the juices, only one registered hyperosmolar concentration of 595.54 mOsm/kg solvent. All formulas presented pH rates classified as low acidity, ranging between 6.1 and 6.6, while the two juices had the lowest results, 4.73 and 4.66 each. The blend of ingredients used in handmade formulas and juices studied presented acceptable osmolality and pH rates for a safe administration and absence of gastrointestinal complications. Data showed here are consistent with an appropriate and healthy diet and contributed towards success in domiciliary enteral nutritional therapy.

Determining the epidemiology of malnutrition is of utmost importance, since it is one of the most prevalent conditions in the community, residential care, and hospital settings. Nutrient imbalance, such as decreased provision of calories, proteins, vitamins, minerals and trace elements, leads to a progressive deficiency status, while the excess is associated with overweight and obesity. Both are considered malnutrition. Furthermore, malnutrition is associated with increased risk of morbidity and mortality, length of hospital stay, hospital readmissions, cost and decreased quality of life. Therefore, a stable nutritional status should be targeted as an integral part of healthcare, and routine nutritional assessment should be carried out as a quality assurance practice. Despite this, healthcare providers, including physicians and medical administrators, often overlook nutritional aspects.

Nutritional diagnosis is essential given that malnutrition negatively affects morbidity and mortality in patients with liver disease. In the absence of a standard method, limited accuracy has been reported in relation to nutritional assessment. The aim of the study was to evaluate the use of subjective global assessment (SGA) and different methods of nutritional assessment, isolated and in combination with SGA to predict clinical outcomes.This was a longitudinal study with patients waiting for liver transplantation. Nutritional status was classified according to SGA. Anthropometric parameters, standard phase angle (SPA), handgrip strength, and 6-min walk test (6MWT) were evaluated. Univariate and multivariate analysis and receiver operator characteristic curve were performed. P 0.05 was statistically significant.Seventy-three patients with an average age of 52.3 ± 11.4 y were evaluated. Of these, 63% were men. Low midarm muscle area (MAMA; P 0.001), malnutrition by SGA + low MAMA (P 0.001), and malnutrition by SGA + low SPA (P 0.001) were independent predictors of clinical features of advanced cirrhosis. SGA + SPA presented the greater area under the curve (AUC: 0.6431). Death was predicted by low midarm circumference (MAC; P = 0.037) and slow gait speed on the 6MWT (GS-6MWT; P = 0.017), with both parameters isolated or concomitantly linked to malnutrition. SGA + GS-6MWT presented the highest predictive power for death (AUC: 0.6673) slightly greater than SGA+MAC (AUC: 0.6346).The results indicate that SGA together with SPA has greater predictive power for features of advanced cirrhosis, and SGA plus gait speed is able to better predict mortality in patients on the waiting list for liver transplant.

The purpose of this study was to assess the effect of arginine supplementation on arginase activity, tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) synthesis in cultured splenic macrophages from a murine model of intestinal obstruction (IO). The effects of nitric oxide synthase (iNOS) inhibition were also studied using iNOS knockout animals.Male C57BL6/J wild-type (WT) and iNOS knockout (iNOS-/-) mice were randomized into 6 groups: Sham and Sham-/- (standard chow), IO and IO-/- (standard chow + IO), and Arg and Arg-/- (standard chow supplemented with arginine + IO). After 7 days of treatment with standard or supplemented chow, IO was induced. Arginase activity as well as TNF-α and IL-10 levels were analyzed in splenic macrophage cultures.Arginine supplementation and the absence of iNOS increased arginase activity in splenic macrophages (Arg, IO-/-, and Arg-/- groups vs the Sham group; P.05). Arginine was also related to a decrease in TNF-α levels (Arg vs IO group, P.05) and maintenance of IL-10 levels (Arg vs other groups, P.05). The inhibition of iNOS did not result in effects on the concentration of cytokines (Sham-/-, IO-/-, and Arg-/- vs other, P.05).Arginine supplementation and iNOS inhibition led to increased arginase activity. Arginine availability decreased plasma TNF-α levels, which may be directly related to nitric oxide derived from arginine.

Glutamine may be a precursor for NO synthesis, which may play a crucial role in bacterial translocation (BT). The goal of the present study was to investigate the potential effects of glutamine on BT and the immunological response in an experimental model of NO synthase inhibition by NG-nitro-L-arginine methyl ester (l-NAME). Mice were randomly assigned to four groups: sham; intestinal obstruction (IO); IO+500 mg/kg per d glutamine (GLN); IO+GLN plus 10 mg/kg per d l-NAME (GLN/LN). The groups were pretreated for 7 d. BT was induced by ileal ligation and was assessed 18 h later by measuring the radioactivity of 99mTc-Escherichiacoli in the blood and organs. Mucosal damage was determined using a histological analysis. Intestinal permeability (IP) was assessed by measuring the levels of 99mTc-diethylenetriaminepentaacetic acid in the blood at 4, 8 and 18 h after surgery. IgA and cytokine concentrations were determined by ELISA in the intestinal fluid and plasma, respectively. BT was increased in the GLN/LN and IO groups than in the GLN and sham groups. IP and intestinal mucosa structure of the sham, GLN and GLN/LN groups were similar. The GLN group had the highest levels of interferon-γ, while IL-10 and secretory IgA levels were higher than those of the IO group but similar to those of the GLN/LN group. The present results suggest that effects of the glutamine pathway on BT were mediated by NO. The latter also interferes with the pro-inflammatory systemic immunological response. On the other hand, IP integrity preserved by the use of glutamine is independent of NO.

The gastrointestinal tract (TGI) has a multitude of functions in addition to digestion. One important function is the ability to serve as a barrier against living organisms and antigens within the lumen, the so-called intestinal barrier function. The breakdown of this barrier may result in the crossing of viable bacteria and their products to mesenteric lymph nodes and more distant sites, a process known as bacterial translocation (BT) (Gatt et al., Aliment Pharmacol Ther 25:741–57, 2007).

O Ângulo de Fase Padronizado (AFP) é medida derivada da Bioimpedância Elétrica (BIA) ajustado por sexo e idade. O AFP é capaz de avaliar a integridade das membranas celulares e tem sido estudado recentemente como possível indicador do estado nutricional (EN) e fator prognóstico em pacientes com câncer. Entretanto, poucos trabalhos avaliaram o comportamento do AFP como indicador do estado nutricional e desfechos clínicos adversos em pacientes oncológicos. Objetivo: Avaliar a associação entre o AFP com as variáveis do estado nutricional no pré-operatório e desfechos clínicos em pacientes cirúrgicos oncológicos. Métodos: Estudo longitudinal-prospectivo realizado com pacientes cirúrgicos oncológicos, admitidos no Instituto Alfa de Gastroenterologia, do Hospital das Clínicas de Belo Horizonte, Minas Gerais. A avaliação do estado nutricional dos pacientes foi realizada antes da cirurgia (pré-operatório) e os desfechos clínicos foram avaliados nos momentos pós-operatório até a alta hospitalar. Os dados sobre o estado nutricional (EN) foram obtidos no pré-operatório imediato, por meio da Avaliação Global Subjetiva (AGS), circunferência do braço (CB), dobra cutânea tricipital (DCT), área muscular do braço (AMB), percentual de perda de peso (PPP) e a funcionalidade, pela dinamometria. O AFP foi obtido por meio da BIA e calculado segundo a seguinte equação: AFP=AF medido - AF médio (para idade e sexo)/desvio-padrão da população, segundo idade e sexo. Dados sobre os desfechos clínicos e glicemia capilar foram coletados em prontuário médico e corridas de leito. Foram realizadas análises descritivas e bivariadas; concordância entre métodos por meio do coeficiente kappa e modelos de regressão logística simples foram utilizados para avaliar a associação entre o AFP, estado nutricional e desfechos clínicos nessa população. Para comparar as médias da glicemia capilar, segundo a categorização do AFP, utilizou-se o Teste Ancova. Para todas as análises foi adotado um nível de significância de 5%; (p0,05). Conclusão: Nossos achados sugerem que o AFP pode ser considerado instrumento útil e mais precoce que parâmetros tradicionais, capaz de auxiliar na avaliação e classificação do estado nutricional de pacientes oncológicos, no ambiente hospitalar. Este também mostrou-se bom indicador prognóstico, capaz de predizer complicações infecciosas e apresentou uma tendência significativa de associação, em relação à hiperglicemia hospitalar avaliada. Futuros estudos poderão confirmar esses achados e se o AFP, utilizado em combinação com outras ferramentas de diagnóstico nutricional nesses pacientes, aumentaria a sensibilidade em detectar estados nutricionais mais debilitados. The Standardized Phase Angle (AFP) is measured derived from electrical bioimpedance (BIA) adjusted for sex and age. AFP is able to assess the integrity of cell membranes and has recently been studied as a possible indicator of nutritional status (NS) and a prognostic factor in patients with cancer. However, few studies have evaluated the AFP's behavior as an indicator of nutritional status and adverse clinical outcomes in cancer patients. Objective: To evaluate the association between the AFP and the variables of the nutritional status preoperatively and clinical outcomes in cancer surgical patients. Methods: A longitudinal-prospective study of cancer surgical patients admitted to the Alfa Institute of Gastroenterology, Hospital das Clinicas in Belo Horizonte, Minas Gerais. The evaluation of the nutritional status of patients was performed before surgery (pre-operative) and clinical outcomes were evaluated postoperatively times until hospital discharge. The data on the nutritional status (NS) were obtained immediately preoperatively through the Subjective Global Assessment (SGA), arm circumference (AC), triceps skinfold (TSF), arm muscle area (AMA), percentage of weight loss (PPP) and functionality, the grip strength. The AFP was obtained by BIA and calculated according to the following equation: measured AFP = AF - AF average (for age and sex) / standard deviation of the population by age and sex. Data on clinical outcomes and blood glucose were collected from medical records and bed races. Descriptive and bivariate analyzes were performed; agreement between methods using the kappa coefficient and simple logistic regression models were used to evaluate the association between AFP, nutritional status and clinical outcomes in this population. To compare the mean blood glucose of the second categorization AFP, we used the ANCOVA. For all analyzes it was adopted a significance level of 5%; (p 0.05). Conclusion: Our findings suggest that the AFP can be considered useful and earlier than traditional parameters, able to assist in the evaluation and classification of the nutritional status of cancer patients in the hospital. This also proved to be good prognostic indicator, capable of predicting infectious complications and showed a significant association tendency in relation to hyperglycaemia evaluated hospital. Future studies will confirm these findings and AFP, used in combination with other diagnostic tools in these patients nutritional, increase the sensitivity to detect more impaired nutritional status.

Probiotic is a preparation containing microorganisms that confers beneficial effect to the host. This work assessed whether oral treatment with viable or heat-killed yeast Saccharomyces cerevisiae strain UFMG 905 prevents bacterial translocation (BT), intestinal barrier integrity, and stimulates the immunity, in a murine intestinal obstruction (IO) model. Four groups of mice were used: mice undergoing only laparotomy (CTL), undergoing intestinal obstruction (IO) and undergoing intestinal obstruction after previous treatment with viable or heat-killed yeast. BT, determined as uptake of (99m)Tc-E. coli in blood, mesenteric lymph nodes, liver, spleen and lungs, was significantly higher in IO group than in CTL group. Treatments with both yeasts reduced BT in blood and all organs investigated. The treatment with both yeasts also reduced intestinal permeability as determined by blood uptake of (99m)Tc-DTPA. Immunological data demonstrated that both treatments were able to significantly increase IL-10 levels, but only viable yeast had the same effect on sIgA levels. Intestinal lesions were more severe in IO group when compared to CTL and yeasts groups. Concluding, both viable and heat-killed cells of yeast prevent BT, probably by immunomodulation and by maintaining gut barrier integrity. Only the stimulation of IgA production seems to depend on the yeast viability.