Parise Vasco, Juan Marcos
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Parise Vasco, Juan Marcos
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Ambato

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Interpreting Resting Energy Expenditure in Critically Ill Patients with Obesity: Clinical Impact of Weight Adjustment

2026 , Sebastián Chapela , Cagua Ordoñez, Jaen , Parise Vasco, Juan Marcos , Daniel Tettamanti Miranda , Claudia Kecskes , Natalia Llobera , Jesica Asparch , Mariana Rella , María Victoria Peroni , Martha Montalvan , María Jimena Reberendo , Facundo Gutierrez , Mario O. Pozo , Ludwig Álvarez-Córdova , Simancas Racines, Daniel

Accurately estimating resting energy expenditure (REE) in critically ill obese patients remains a significant clinical challenge, as predictive equations are consistently inadequate. Metabolic heterogeneity across obesity classes and the role of substrate utilization are insufficiently characterized. Objective: To evaluate the impact of different weight-normalization methods on the interpretation of REE and to identify independent metabolic determinants of weight-adjusted energy expenditure in critically ill patients with obesity. Methods: Bicentric cross-sectional study of 148 critically ill adults with obesity undergoing indirect calorimetry. REE normalized by actual body weight (REE/kg), ideal body weight (REE/IBW), and adjusted body weight (REE/AdjBW) was calculated. Multivariable models with robust standard errors (HC3), stratified analyses by obesity class (I–III) with a Chow test, and internal validation were performed using 10-fold cross-validation and bootstrap resampling (1000 iterations). Results: Absolute REE did not differ significantly between BMI categories (p = 0.679), while REE/kg progressively decreased from normal weight (27.8 kcal/kg/day) to class III obesity (16.9 kcal/kg/day; p < 0.001). The respiratory quotient (RQ) emerged as the most robust independent correlate of adjusted REE (β = −13 to −15 kcal·kg−1·day−1; p < 0.001), whereas clinical severity scores (SOFA, APACHE II) and comorbidity (Charlson) did not show significant associations. Stratified analyses revealed significant structural heterogeneity between obesity classes (F = 4.545, p = 0.0001), with no significant predictors identified in class III obesity, likely reflecting limited statistical power in this subgroup. Conclusions: Normalizing REE using different weight indices fundamentally alters its metabolic interpretation. RQ surpasses traditional clinical scores as a correlate of adjusted REE, consistent with a phenotype of metabolic inflexibility. The heterogeneity between obesity classes underscores the need for individualized indirect calorimetry rather than reliance on predictive equations.

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Traditional Foods, Oral Microbiome, and Systemic Health: Molecular Pathways Linking Nutrition and Oral Disease Prevention

2026 , Parise Vasco, Juan Marcos , Angamarca Iguago, Jaime , Cagua Ordoñez, Jaen , Beatriz Cabrera , Dolores Jima Gavilanes , Raquel Horowitz , Reytor González, Claudia , Simancas Racines, Daniel

Periodontal disease affects 10–50% of the global population and is associated with various systemic conditions, including diabetes, cardiovascular disease and adverse pregnancy outcomes. Emerging evidence highlights diet as a critical, modifiable factor that influences the composition of the oral microbiome and periodontal health. This narrative review explores the molecular mechanisms through which traditional foods modulate the oral microbiome and contribute to oral and systemic health. A comprehensive literature search was conducted in PubMed/MEDLINE, the Cochrane Library, LILACS and Epistemonikos, prioritizing systematic reviews, meta-analyses and randomized controlled trials. The oral microbiome harbors over 700 bacterial species, and dysbiosis, characterized by pathogen enrichment, drives periodontal inflammation. Anti-inflammatory dietary patterns, including the Mediterranean diet, demonstrate protective effects. Omega-3 fatty acids, vitamins C and D, polyphenols and dietary fiber support periodontal health, whereas refined carbohydrates, saturated fats and pro-inflammatory nutrients can exacerbate disease. Probiotics show promise as an adjunctive therapy. However, the translation to clinical guidelines is impeded by methodological challenges, including the limited number of randomized controlled trials with oral endpoints, confounding by hygiene practices, and the lack of standardized multi-omics approaches. Nutritional counselling should be integrated into periodontal care as a modifiable risk factor. Future research priorities include precision nutrition approaches, the validation of salivary biomarkers, and interprofessional collaboration between dental and nutrition professionals. © 2026 by the authors.

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Sociodemographic Factors and Childhood Growth: Associations with Environmental Sanitation Phases

2026 , Yadira Morejón-Terán , Ana Clara P. Campos , Parise Vasco, Juan Marcos , Leila Denise A. F. Amorim , Laura C. Rodrigues , Mauricio L. Barreto , Sheila Maria Alvim de Matos

Early childhood growth trajectories can influence the risk of chronic diseases in adulthood. Improvements in environmental sanitation may affect child development in low-resource settings. Objective: to examine the associations among socioeconomic factors with nutrition indicators, and trajectories of anthropometric indicators across three epidemiological cohorts that reflect different phases of environmental sanitation implementation. Methods: A longitudinal study was conducted in Salvador, Brazil, from 1997 to 2013. A total of 1429 children were recruited across three epidemiological cohorts, corresponding to the phases of a sanitation program: pre-intervention (n = 299), intervention (n = 1007), and post-intervention (n = 123). Height-for-age (HAZ) and BMI-for-age (BAZ) z-scores were assessed at four time points. Multilevel linear models were used to adjust for socioeconomic factors. Results: A total of 992 children (68.7%) completed follow-up. Post-intervention children showed improved HAZ trajectories, with sex-specific patterns that varied across cohorts. Birth weight is positively associated with HAZ across all cohorts (0.34–0.49 kg increase per z-score). Household overcrowding (>2 persons/room) is consistently associated with lower HAZ (−0.34 to −0.63 z-score reduction). Children who were never exclusively breastfed in the post-intervention phase had a higher BAZ (0.76 z-score increase). Caesarean delivery is associated with higher BAZ in the pre-intervention (0.23) and intervention (0.27) cohorts. Conclusions: Children born in later time periods showed better growth trajectories, which may reflect the combined effects of sanitation improvements, economic development, and other societal changes in Brazil during this period. Further research using experimental or quasi-experimental designs is needed to isolate the specific contribution of sanitation to child growth.

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Natural Products Targeting Key Molecular Hallmarks in Gastric Cancer: Focus on Apoptosis, Inflammation, and Chemoresistance

2026 , Simancas Racines, Daniel , Cagua Ordoñez, Jaen , Angamarca Iguago, Jaime , Parise Vasco, Juan Marcos , Reytor González, Claudia

Natural products have emerged as promising multi-target agents for addressing the complex biology of gastric cancer, a malignancy characterized by marked molecular heterogeneity, late clinical presentation, and frequent resistance to systemic therapies. This narrative synthesis integrates primarily preclinical evidence, with emerging clinical data, on how naturally derived compounds modulate three central molecular processes that drive gastric tumor progression and therapeutic failure: evasion of programmed cell death, persistent tumor-promoting inflammation, and chemoresistance. Compounds such as curcumin, resveratrol, berberine, ginsenosides, quercetin, and epigallocatechin gallate restore apoptotic competence by shifting the balance between pro-survival and pro-death proteins, destabilizing mitochondrial membranes, promoting cytochrome c release, and activating caspase-dependent pathways. These agents also exert potent anti-inflammatory effects by inhibiting nuclear factor kappa B and signal transducer and activator of transcription signaling, suppressing pro-inflammatory cytokine production, reducing cyclooxygenase activity, and modulating the tumor microenvironment through changes in immune cell behavior. In parallel, multiple natural compounds function as chemo-sensitizers by inhibiting drug efflux transporters, reversing epithelial–mesenchymal transition, attenuating cancer stem cell-associated traits, and suppressing pro-survival signaling pathways that sustain resistance. Collectively, these mechanistic actions highlight the capacity of natural products to simultaneously target interconnected hallmarks of gastric cancer biology. Ongoing advances in formulation strategies may help overcome pharmacokinetic limitations; however, rigorous biomarker-guided studies and well-designed clinical trials remain essential to define the translational relevance of these compounds.

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