Avaliação da prescrição nutricional e da atividade física no controle da endometriose e na modulação da microbiota intestinal

Abstract

Endometriosis is a debilitating disease characterize by chronic inflammation with repercussions on social, occupational and psychological aspects. It is defined as the presence of functional endometrial glands and stroma outside the uterine cavity. Generally, endometrioses has no cure and clinical treatment aims to reduce endometriotic foci, alleviating pain in an attempt to improve the patient’s quality of life. The immune system alterations identified in women with endometriosis contribute to the understanding of the pathophysiology of inflammation triggered by these lesions and consequently, to the clinical manifestations. Considering the recognized role of the resident microbiota, especially the intestinal resisdent microbiota, as a factor associated with host health, studies have suggested that its diversity and balance may be linked to health and disease conditions. Among various factors, including microbial groups acquired at birth, age, sex physiological and hormonal conditions, host genotype, social behavior and habits linked to geography and diet, the latter is considered a key factor in the diversity of the intestinal microbiota. Several studies suggest that moderate-intensity physical training may also be associated with the modulation of the intestinal microbiota. In physical active individuals and athletes, this microbiota may exhibit greater diversity and species richness compared to sedentary individuals. The aim of the study was to assess the overal structure of the intestinal microbiota in women with symptomatic endometriosis, before and during a clinical protocol for disease management, involving nutritional prescription and physical activity. The sample population consisted of 22 women with a positive clinical diagnosis os endometriosis, from partner gynecology services in Juiz de Fora, MG. The most commonly used diagnostic method for endometriosis among the participants was pelvic magnetic resonance imaging. In the initial consultation following the clinical diagnosis, therapeutic approaches were prescribed, involving nutritional management and physical activity. After 3 months, these patients returned to the clinic for a followup clinical assessment. At both time points, fecal specimens were collected for microbiota analysis and participants clinical and nutritional data were recorded. Sociodemographic characteristics were documented at the firts time point. The analyses conducted up to the present moment included women aged between 18 to 50 years, with a predominant age group od 26 to 35 years. The predominant income range was 1 to 3 minimum wages (77.3%), with 54.5% of participants being non- practitioners of physical activity, and 77.3% had never received professional dietary guidance. Regarding weight, a general decrease was observed between the first and second consultations. The vast majority of participants exhibited a decrease in body fat percentage (skinfold measurements and bioimpedance), with an improvement in lean mass percentage. Metagenomic DNA was extracted from fecal samples, and the analysis of microbial community structure will be conducted subsequently using the REP-PCR technique.