b rColoproctology Renata Costa Fortesa,b, ∗, Jhuly Amado Souzab, Maria Rita Carvalho Garbi Novaesc aCurso de Nutric¸ão, Instituto de Ciências da Saúde, Universidade Paulista UNIP, Brasíl
Trang 1w w w j c o l o r g b r
Coloproctology
Renata Costa Fortesa,b, ∗, Jhuly Amado Souzab, Maria Rita Carvalho Garbi Novaesc
aCurso de Nutric¸ão, Instituto de Ciências da Saúde, Universidade Paulista (UNIP), Brasília, DF, Brazil
bPrograma de Residência em Nutric¸ão Clínica, Hospital Regional da Asa Norte, Secretaria de Estado de Saúde do Distrito Federal
(HRAN/SES/DF), Brasília, DF, Brazil
cCurso de Medicina, Escola Superior de Ciências da Saúde (ESCS), Fundac¸ão de Ensino e Pesquisa em Ciências da Saúde (FEPECS), Secretaria de Estado de Saúde do Distrito Federal (HRAN/SES/DF), Universidade de Brasília (UnB), Brasília, DF, Brazil
a r t i c l e i n f o
Article history:
Received22February2014
Accepted27July2014
Availableonline28January2015
Keywords:
Anthropometry
Colorectalcancer
Agaricus sylvaticusfungi
a b s t r a c t
Introduction:Colorectalcancerisadiseaseinfluencedbygeneticandenvironmentalfactors Medicinalfungiand/oritsextractshavebeenusedintheadjuvanttherapyofcancerbecause
oftheirpharmacological,nutritionalandimmunomodulatoryproperties
Objective:Toevaluatetheanthropometricprofileofcolorectalcancerwomenafterdietary supplementationwithAgaricus sylvaticusfungus
Methods:Randomized,double-blind,placebo-controlledclinicaltrialwasconductedina publichospitalintheFederalDistrict–Brazilforsixmonths.Sampleof32patientswith colorectalcancer,female,wasseparatedintotwogroups:supplementedwithAgaricus syl-vaticus(30mg/kg/day)andplacebo.Weconductedanthropometry(weight,height,bodymass index,armcircumference,tricepsskinfold,armmusclecircumferenceandfatpercentage) duringthetreatment.Theresultswereanalyzedatthreedifferenttimes(beforethestartof treatment,threemonthsandaftersixmonthssupplementation)usingtheMicrosoftExcel
2007andSPSS19.0,usingStudent’st-testandF,withsignificanceforp≤0.05
Results:TheAgaricus sylvaticusgroupshowedasignificantincreaseinbodymassindex,arm circumference,percentbodyfatandtricepsskinfold,andnon-significantincreaseinarm musclecircumferenceaftersixmonthsofsupplementation.Theseresultswerenotobserved
intheplacebogroup
Conclusion:TheresultssuggestthatdietarysupplementationwithAgaricus sylvaticusis capa-bletohavebenefitsinanthropometricparametersofwomenwithcolorectalcancer
©2015SociedadeBrasileiradeColoproctologia.PublishedbyElsevierEditoraLtda.All
rightsreserved
∗ Corresponding author at:CursodeNutric¸ão,InstitutodeCiênciasdaSaúde,UniversidadePaulista(UNIP),Brasília,DF,Brazil
E-mail:fortes.rc@gmail.com(R.C.Fortes)
http://dx.doi.org/10.1016/j.jcol.2015.01.001
2237-9363/©2015SociedadeBrasileiradeColoproctologia.PublishedbyElsevierEditoraLtda.Allrightsreserved
Trang 2Ensaio clínico duplo cego, randomizado e placebo controlado com fungos
Agaricus sylvaticus no perfil antropométrico de mulheres com câncer colorretal
Palavras-chave:
Antropometria
Câncercolorretal
FungosAgaricus sylvaticus
r e s u m o
Introduc¸ão: Ocâncercolorretaléumadoenc¸ainfluenciadaporfatoresgenéticose ambi-entais Autilizac¸ão de fungos medicinais e/oude seus extratostem sidoutilizada no adjuvantetratamentodocâncerdevidoàssuaspropriedadesfarmacológicas,nutricionais
eimunomoduladoras
Objetivo: Avaliar o perfil antropométrico de mulheres com câncer colorretal após suplementac¸ãodietéticacomfungosAgaricussylvaticus
Métodos:Ensaioclínicorandomizado,duplo-cego,placebo-controladorealizadoemum hos-pitalpúblicodoDistritoFederalBrasilporseismeses.Amostraconstituídapor32pacientes comcâncercolorretal,sexofeminino,separadosemdoisgrupos:suplementadocom Agar-icussylvaticus(30mg/kg/dia)eplacebo.Realizou-seaantropometria(peso,estatura,índice
demassacorporal,circunferênciadobrac¸o,dobracutâneatricipital,circunferência muscu-lardobrac¸oepercentualdegordura)aolongodotratamento.Osresultadosforamanalisados
emtrêsmomentosdistintos(antesdoiníciodotratamento,comtrêsmeseseapósseis mesesdesuplementac¸ão),utilizandoosprogramasMicrosoftExcel2007eSPSS19.0,por meiodostestesT-studenteF,comsignificânciaparap≤0,05
Resultados:OgrupoAgaricussylvaticusapresentouaumentosignificativodeíndicedemassa corporal,circunferênciadobrac¸o,percentualdegorduracorporaledobracutânea tricip-tale,aumentonãosignificativodecircunferênciamusculardobrac¸oapósseismesesde suplementac¸ão.Essesresultadosnãoforamobservadosnogrupoplacebo
Conclusão: Osresultadossugeremqueasuplementac¸ãodietéticacomAgaricussylvaticus
écapazdeexercerbenefíciosnosparâmetrosantropométricosdemulherescomcâncer colorretal
©2015SociedadeBrasileiradeColoproctologia.PublicadoporElsevierEditoraLtda
Todososdireitosreservados
Introduction
Nowadays,duetoitsincreasingincidence,cancerhasbecome
apublichealthproblemworldwide,1pari passuwiththe
pro-gressive aging of the population, as a consequence of an
increasedlifeexpectancy.2
Colorectalcancerisacommonanddeadlydisease,
influ-encedbygeneticandenvironmentalfactorsandalsobythe
mutualinfluenceofboth.Geneticpredispositionisa
predom-inantriskfactorforsomeindividuals;however,environmental
factors,includingdiet,physicalactivity,smokingandobesity,
arealsoincludedamonghigh-riskfactors.2
Asfortheriskofdevelopingcolorectalcancer,patientscan
bedividedasfollows:thoselessthan50yearsandno
fam-ilyhistoryofcolorectalcancerareatlowrisk;thoseaged50or
moreandwithnootherriskfactorsareincludedintheaverage
riskgroup;patientswithpersonalhistoryofpolypsor
colorec-talcancer,orwithafamilyhistoryofcolorectalcancerorwith
first-degreerelativesdiagnosedwithpolypsareclassifiedas
high-riskpeople;andfinally,theveryhigh-riskclassification
comprisesthosepatientswithpolypoidsyndromes,orwho
aresufferingfrominflammatoryboweldisease.3
Most often, a diagnosis of cancer leads to a phase of
muchanxietyand distress, possiblytriggering a picture of
depression.Inturn,thedepressioncomesinassociationwith
somaticsymptomssuchaslossofappetiteandfatigue,which
mayalsobeassociatedwiththecatabolismand/ortreatment
ofthedisease.4
The use of medicinal fungi and/or their extracts as dietary supplements hasincreased considerably, thanksto itsanti-tumor,anticarcinogenic,antiviral,anti-inflammatory, hypoglycemic,hypocholesterolemicandhypotensiveeffects, amongothers,andtheseproductsmayberecommendedas adjuvantsinthetreatmentofmalignantneoplasms.5
Considering the prominence of this theme, this study aimedtoevaluatetheanthropometricprofileofwomenwith colorectalcancerafterdietarysupplementationwiththe fun-gusAgaricus sylvaticus.
Methods
Study design
Thestudy consistsofarandomized,double-blind, placebo-controlledstudy,whichwasapprovedbytheEthicsCommittee
onHumanResearch,StateSecretariatofHealth,Distrito Fed-eral(CEP/SES/DF)underProtocol051/04.Thepatients’freeand informedconsent(FIC)wasobtained,andtheirparticipation was voluntary.The study was conductedatthe Proctology OutpatientClinic,HospitaldeBasedoDistritoFederal,Brazil, betweenNovember2004andJuly2006
Trang 3numbersrandomlygeneratedbycomputer,whereeach
ran-domnumber correspondedtoagroupreceiving thefungus
(GroupA)orplacebo(GroupB).Thesenumberswereinserted
intoopaque,nottranslucentandclosedenvelopes,withthe
generationofthenumbersequenceperformedbyaresearcher
blindedtothestudy,afterselectionofpatientswithinclusion
andexclusioncriteria.Theenvelopeswere opened
sequen-tiallyasthepatientswereconsecutivelyrecruitedforthestudy
andcontainedthegrouptowhichthepatientwouldbelong
Onlyafterperformingthestatisticalanalysis,itwasrevealed
whichgrouphadreceivedplaceboandwhichreceivedAgaricus
sylvaticus.
Patients
The sample consisted of patients with colorectal cancer
divided into two groups: those who received placebo and
those supplementedwithAgaricus sylvaticus. Thefollowing
inclusioncriteriashouldbefulfilled:femalepatientswitha
confirmed diagnosis of colorectal cancer inthe
postopera-tivephase,from threemonthstotwoyearsofsurgery,and
olderthan20years.Exclusioncriteriawere:pregnantwomen,
breastfeedingmothers,bedriddenindividuals,physically
dis-abledpeople,patients usinganalternative therapyor with
otherchronicnon-communicablediseases,andinmetastasis
process
Agaricus sylvaticus extract
With awidespread geographical distribution and naturally
occurringinBrazil,Agaricus sylvaticuswasfirstdescribed in
Switzerland.ItsidentificationwasconfirmedbytheLondon
RoyalBotanicGardens,whosedocumentationwasprovided
bytheInstituto deBotânica,EnvironmentStateSecretariat,
SãoPaulo,inNovember10,1995.TheAgaricus sylvaticusfungus
(Family:Agaricaceae),whosepopularnameisSunMushroom,
wasobtainedfromaproducerdulyaccreditedbytheEmpresa
BrasileiradePesquisaAgropecuária–Embrapa,fromTapiraí,
StateofSaoPaulo,Brazil.Thefungusextractwasobtainedby
soakingthedehydratedmaterialinhotwaterduring30min;
then,the materialwasliquified,sievedand driedina
des-iccator.Theanalysis ofAgaricus sylvaticus compositionwas
performedbytheJapanFoodResearchLaboratoriesCenterand
revealedthepresenceofcarbohydrates(18.51g/100g),lipids
(0.04g/100g),ergosterol(624mg/100g),proteins(4.99g/100g),
amino acids (arginine – 1.14%; lysine – 1.23%, histidine –
0.51%,phenylalanine–0.92%,tyrosine–0.67%,leucine–143%
methionine–0.32%,valine–1.03%,alanine–1.28%glycine–
0.94%,proline–0.95%,glutamicacid–3.93%,serine–096%,
threonine–0.96%,asparticacid–1.81%,tryptophan–0.32%
cysteine–0.25%)andtraceamountsofmicronutrients
Thedryextractwastransformedintotablets,inaccordance
withpharmacotechnicalprocedure.Thedosageofthefungus
administeredtopatientsfromthesupplementedgroupwas
equivalentto30mg/kg/day,dividedintotwodailydoses(six
tabletsaday,threeinthemorningandthreeintheafternoon,
inbetweenmeals),consideringthemeanweightofthestudy
populationoveraperiodofsixmonths.Asforthegroupof
patientswhoreceivedplacebo,thetabletswereadministered
inthesamequantities,withthesameexcipientsandenergy, butwithouttheextractofAgaricus sylvaticus(initsplace,the placebogroupreceivedstarch)
Clinical evolution
Patientswerefollowedforsixmonths.Duringthefirstthree months,the visitswere heldfortnightlyforclinical assess-mentand,inthelastthreemonths,thevisitswereheldevery
30days
Thefoodanamnesis(semiquantitativeand24-hrecallfood consumptionfrequencyquestionnaire)washeldonthefirst and last days ofconsultation However, the patients were instructedtoremainwiththeusualdiet,inordernotto inter-ferewith theintervention, althoughduringtreatmentthey havereceivedguidelinesonhowtomaintainahealthydiet Aftera6-month follow-up, anindividualizeddietwas sug-gested forall patients,who,whennecessary, werereferred
tootherhealthprofessionals
The anthropometric assessment was performed using bodymassindex(BMI),tricepsskinfoldthickness(TSF),arm circumference (AC), arm muscle circumference (AMC) and bodyfatpercent(%BF).However,forstatisticalpurposes,we extractedtheaverageoftheresultsobtainedinthreedifferent times:beforestartingsupplementation,afterthreemonthsof treatmentandaftersixmonthsoftreatment
Allpatientswerefollowedweeklybyresearcherstoclarify anydoubts,checkontheproperuseofthemushroomandfor confirmationoftheschedule,ensuringgreateradherenceto treatmentandcontrolonthecontinuityofthestudy
We considered as dropouts those patients who did not attendtheconsultationsduringthefullperiodofsixmonths Thosepatientswho died beforetheend oftreatment were excludedfromthesample
Anthropometric assessment
Aspecialformofanthropometricassessment,tobefilledinall theconsultations,wasused.Weightdeterminationwas per-formedwiththepatientbarefooted,wearinglightclothingand withoutjewelleryinterferingwiththemeasurementresults Thepatientshouldremainstandinginthecenterofthescale, withherbodyweightequallydistributedbetweenbothfeet.6
In ordertoobtainthis variable,aPlenna® –Resolvedigital scale(MEA-02500model)withbioimpedance(BIA),capacityof
150kg,with0.1kgvariationandproperlycalibratedwasused For heightmeasurement, the barefooted patient should stayuprightandinanerectposition,withherbodyliftedat maximumextension,headup,lookingforward,inaFrankfurt position,withherbackandthebackofherkneestouchingthe wallandwithfeettogether.6TheFrankfurtanatomicalplane extendsfromthebottommarginoftheeyesockettothetop borderoftheauditorycanal.7Patients’heightwasmeasured onlyonce,incentimeters(cm),witha150-cmlonginelastic measuringtapeattachedtoaflatwallwithoutbaseboardand fixedat50cmfromtheground.Awoodsquarewasplacedon topoftheheadofthepatient;withthis,weobtainedameasure with0.1-cmaccuracy
After data acquisition (weight and height), BMI was obtainedbydividingthepatient’sweightinkilogramsbyher
Trang 4char-acterizethinness;≥18,5kg/m2and<25kg/m2,normalweight;
≥25kg/m2and<30kg/m2,overweight;and≥30kg/m2,obesity,
accordingtotheclassificationrecommendedbyWorldHealth
Organization.8
TSFwas measuredusingaCescorf® quick-reading
com-pass,witharangeupto60mmandaccuracyof±1mm.Three
consecutivemeasurementswereobtainedfromTSF,andthe
arithmeticaverageofthemeasuredvalueswasconsidered
As for AC measurement, an inextensible-material,150-cm
length,1-cmscalemeasuringtapewasused.TheAMCvalue
wasobtainedbytheformula:AMC=AC–(0.314×TSF).8
TSF, AC and AMC measures were compared to a
Frisancho’s9 referencestandard,and theadequacywas
cal-culatedbydividingthevaluesobtainedbythe50thpercentile
andmultiplyingtheresultby100.Astothenutritionalstatus
classification,thefollowingvalueswereconsidered:obesity:
>120%,overweight:110–120%,normalweight:90–110%,mild
malnutrition: 80–90%, moderate malnutrition: 70–80% and
severemalnutrition:<70%.10
Thebodyfatpercentage(%BF)wasobtainedalsousingthe
Plenna®digitalscale
Statistical analysis
Thepresentedvalueswerecomparedandanalyzedapplying
t-Studentand F statisticaltests,using MicrosoftExcel2007
andSPSS(StatisticalPackagefortheSocialSciences,SPSSInc,
Chicago,USA)forWindows,version19.0.Theaccepted
statis-ticalsignificanceprobabilitywasp<0.05
Results
Afterafollow-upofsixmonthsintheProctologyOutpatient
Clinic,HospitaldeBasedoDistritoFederal,atotalof40women
withcolorectalcancerwhomettheinclusionandexclusion
criteriaagreed toparticipateinthe research,and, ofthese
patients,twodiedandsixdroppedoutforvarious reasons
Thefinalsampleconsistedof32patientswithameanageof
56.66±14.07years,atstagesI(n=4),II(n=12)andIII(n=16),
separatedintogroupsreceivingplacebo(n=16)andAgaricus
sylvaticus (n=16).Themeanageswere57.67±13.42yearsand
55.87±15.11 years for placebo and Agaricus sylvaticus
sup-plementedgroups,respectively,withnodifferencebetween
groups(p=0.39)
As for the body mass index, we observed that the
placebogrouphad aninitialBMIof24.25±5.33kg/m2;after
three months, a significant increase in BMI was noted
(from 24.25±5.33kg/m2 to 24.40±5.15kg/m2, p=0.01) and
in the sixth month, there was a further increase (from
24.25±5.33kg/m2to24.71±4.73kg/m2,p=0.06),butthislast
resultwasnotstatisticallysignificant(Fig.1
The supplemented group showed an initial BMI of
24.44±4.59kg/m2;afterthreemonths,asignificantincrease
to 24.91±4.18kg/m2 (p=0.02) was observed, and after six
months a further significant increase to 25.16±3.92kg/m2
occurred,comparedtobaseline(p=0.02)(Fig.1
Regardingarmcircumference(AC),intheplacebogroupan
initialvalueof28.68±5.80cmforthisvariablewasobserved;
Follow-up 23.6
23.8 24 24.2 24.4 24.6 24.8 25 25.2
2)
sylvaticus: p= 0.02 andp= 0.02, after three and six months,
after three months, this value had suffered a significant decline, to 27.88±4.56cm (p=0.05) and, after six months,
a non-significant increase, to 28.39±4.39cm (p=0.31), was observed(Fig.2
The Agaricus sylvaticus group presented initialvaluesof 28.66±4.19cmforAC,withasignificantincreaseoverthree (29.47±4.10cm,p=0.01)andsix(29.68±3,74cm; p=0.0001) monthsofsupplementation(Fig.2
As fortricipitalskinfoldthickness, it was observedthat theplacebogrouphadaninitialmeanof19.53±8.27mmfor
26.5 27 27.5 28 28.5 29 29.5 30
Follow-up
sylvaticus: p= 0.01 andp= 0.0001, after three and six
Trang 5Start
3 months
6 months
Tricipital skin fold (mm) Placebo Agaricus
sylvaticus: p= 0.16 andp= 0.05, after three and six months,
TSF.Afteranintervalofthreemonths,therewasanincrease
to20.43±9.14mm(p=0.14)and aftersixmonths,afurther
increaseto20.42±8.33mm(p=0.19).Butthesechangeswere
notstatisticallysignificant(Fig.3
Withinthreemonthsofsupplementation,theAgaricus
syl-vaticusgroupshowedanon-significantincreaseinTSF(from
21.41±7.44mm to 22.38±5.95mm; p=0.16), followed after
sixmonthsbyasignificantincrease(from21.41±7.44mmto
23.66±5.62mm,p=0.05)(Fig.3
In the placebo group, after arm muscle circumference
measurement,anon-significantdecreaseafterthreemonths
(from 23.44±4.42cm to 22.82±3.16cm, p=0.14) and a
sig-nificant decrease after sixmonths (from 23.44±4.42cm to
22.30±3.29cm,p=0.03)wereobserved(Fig.4
These findings were not found in the Agaricus
syl-vaticus group, which increased its AMC after three (from
21.94±2.61m to 22.45±2.44cm, p=0.10) and six (from 21,
94±2.61cmto22.28±2.65cm,p=0.22)monthsof
supplemen-tation,althoughthesechangeswerenotsignificant(Fig.4
Astothepercentageofbodyfat,the placebogroup
pre-sentedinitiallya%BFof36.33±8.44%.Afterthreemonths,this
variable had increased(from36.33±8.44%to 36.46±7.25%,
p=0.44)andinthe sixth month,anewincreasewasagain
noted(from36.33±8.44%to37.60±8.07%,p=0.19).Butthese
changeswerenotstatisticallysignificant(Fig.5
TheAgaricus sylvaticusgrouppresentedaninitial%BFof
36.88±7.33%.Afterthreemonths,anon-significantincrease
to37.88±6.60%(p=0.09)wasfound,andaftersixmonthsa
significant increase to 39.56±8.68% (p=0.04) was observed
(Fig.5
Discussion
Inthisstudy,thesamplewasconvenientlycomposedof100%
ofwomenwithcolorectalcancer.Scientificevidencesuggests
21 21.5 22 22.5 23 23.5 24
Follow-up
sylvaticus: p= 0.10 andp= 0.22, after three and six months,
thatcolorectalcancerismoreprevalentinwomen,affecting moreandmoreoftentheleftcolon.11InBrazil,theInstituto Nacional do Câncer (INCA) registry for 2012estimated the occurrenceof14,180newcasesofcolorectalcancerinmen andof15,960casesinwomen,correspondingtoanestimated riskof15newcasesper100,000menand16newcasesoutof every100,000women.12
The mean age of our patients was 55 and 57 years for placeboandAgaricus sylvaticusgroups,respectively.Inthese groups, the minimum andmaximum ages were 32 and 77 years,respectively.AccordingtoCozerattolinietal.,13more than90%ofcolonandrectalcancersrelatetoindividualsolder than 50 years,and 75% ofcasesaffect individuals without otherriskfactors,besidesage
40 39.5 39 38.5 38 37.5 37 36.5 36 35.5 35 34.5
Follow-up Placebo Agaricus sylvaticus
sylvaticus: p= 0.09 andp= 0.04, after three and six months,
Trang 6Inthisstudy,bothplaceboandAgaricus sylvaticusgroups
had aninitialBMIwithinthenormalweight range,with a
tendencytobeoverweight.Scientificstudieshaveshown a
positivecorrelationbetweenoverweight,obesityandriskof
developingseveraltypesofcancer,aswellasinmortalityfrom
thisdisease.Itisexpectedthatthe probablemechanism is
interconnectedwithhyperinsulinemiaandwithahighlevel
ofinsulin-dependentgrowthfactor(IGF-1)andofthose
pro-teinsthatbindtoIGF-1,aswellaswiththepracticeofdiets
characterizedbytoomuchenergyconsumption.13
Thereisahighercorrelationbetweenexcessweightand
riskofcolorectalcancer,inwhichtheabdominalorcentral
distributionofbodyfatisthemaincomponentofincreasing
thisrisk,asthisoccurrenceisrobustlylinkedtoinsulin
resis-tanceandhyperinsulinemia.13However,inthisstudy,visceral
fatwasnotevaluated
Clinicalandexperimentalstudiesshowthatthediet
sup-plementedwithAgaricus sylvaticusandotherfungipromotes
positive effects with respect to nutritional, medicinal and
pharmacologicaleffects,andthatthesesupplementscanbe
usedasadjuvantsincancertreatment.14Medicinalfungiexert
anaboliceffects,becausetheycontainalltheessentialamino
acids,plusimmunonutrientslikearginineandglutaminethat,
intimesofmetabolicstress,becomeconditionallyessential,
contributingtoimprovementsinnitrogenbalance.1,15
Inthis study,theAgaricus sylvaticus groupobtained
bet-teranthropometricresults(BMI,AC,TSF,%BF)versusplacebo,
includingin relationtoleanbody mass,despiteno
signifi-cantfinding.Scientificevidencesuggeststhatmedicinalfungi
havebioactivecompoundsabletopreventthemuscleprotein
catabolismcommonlypresentinthesepatients,explainingin
parttheresultsobserved.15–17
Themechanismsofactionofexistingbioactivecompounds
in fungi are not yet fully explained in the literature, but
scientificstudies suggestthat thesesubstances can
modu-latecarcinogenesis,notonlyintheearlystages,butalsoin
advancedphasesintheprogressionofthedisease,especially
bystimulatingtheimmunesystem.14
Wefoundnoscientificpapersintheliteraturethat
eval-uatedanthropometryand/orthenutritionalstatusofcancer
patientsafterdietarysupplementationwithmedicinalfungi,
including those of the Agaricaceae family, species
Agari-cus sylvaticus.However,clinicalstudiesshowthatmedicinal
fungiareabletomodulatethemetabolismofcarbohydrates,
proteins and lipids, besides exerting beneficial effects on
the hematopoietic, immune and gastrointestinal systems,
with positive repercussions on the quality of life ofthese
patients.15–24
Majormetabolicalterationsinducedbyadvancedtumors
include glucose intolerance, decreased insulin secretion,
peripheral insulin resistance, increased synthesis and
glucose turnover, increased activity of the Cori cycle,
increased protein turnover, increased hepatic protein
synthesis, increased muscle protein catabolism, reduced
plasma concentration of branched chain amino acids,
depletion of lipid deposits, increased lipolysis, increased
glycerolandfreefattyacidturnover,reducedlipogenesisand
hyperlipidemia.4,5,15,16,20,21,23
The depletion of adipose tissue is responsible, in large
part,bytheweightlossobservedincancerpatients.Thisis
due tothe different changes infatty acid metabolism and alsototheoccurrenceoflipolysis,increasedlipidoxidation, reductionoflipogenesisandoflipoproteinlipaseactivity,and increased release of lipolytic tumor factors and hormone-sensitivelipase,resultinginhyperlipidemia.15,16,19,20,22
The beneficial effects ofthese fungihave been demon-strated,withinhibitionofanti-tumoractivityandproliferation
ofcancercells,expansionofnaturalkillercellfunctionand
ofotherimmunologicalparameters,suchasthesecretionof immunoglobulinsIgA,IgMandIgE,andaprogressionof mono-cyteandmacrophagefunctions.5,16,21,22
Itisnoteworthythat,inadditiontohighbiologicalvalue proteinsandofimmunomodulatoraminoacids(suchas argi-nineand glutamine)thathelpinmuscleproteinanabolism
of cancer patients, other substances present in medicinal fungistandout:glucans,proteoglucans,lectins,ergosteroland triterpenes– all withthe abilityofmodulatingthe various metabolicandimmuneactionsinthesepatients.5,15,16,22,23
Conclusion
Ourresultssuggestthatdietarysupplementationwith Agar-icus sylvaticus fungus has the ability to bring benefit for anthropometricparametersofwomenwithcolorectalcancer However,controlledand randomizedclinicaltrials, in addi-tiontothoseperformedinthisstudy,areneededtoelucidate themechanismsofactionofthebioactiveprinciplespresent
inAgaricus sylvaticus,aswellasothermedicalconditionsthat couldbenefitthroughthissupplementation
Theauthorsdeclarenoconflictsofinterest
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