The Anabolic Response to Protein Ingestion During Recovery From Exercise Has No Upper Limit in Magnitude and Duration In Vivo in Humans: A Commentary.

A comprehensive recent study by Trommelen et al. demonstrated that muscle tissue exhibits a greater capacity to incorporate exogenous exogenous protein-derived amino acids into bound muscle protein than was previously appreciated, at least when measured in "anabolically sensitive," recreationally active (but not resistance-trained), young men following resistance exercise. Moreover, this study demonstrated that the duration of the postprandial period is modulated by the dose of ingested protein contained within a meal, that is, the postexercise muscle protein synthesis response to protein ingestion was more prolonged in 100PRO than 25PRO. Both observations represent important scientific advances in the field of protein metabolism. However, we respectfully caution that the practical implications of these findings may have been misinterpreted, at least in terms of dismissing the concept of protein meal distribution as an important factor in optimizing muscle tissue anabolism and/or metabolic health. Moreover, based on emerging evidence, this idea that the anabolic response to protein ingestion has no upper limit does not appear to translate to resistance-trained young women.

Leading Edge Technologies and Perspectives in Industrial Oilseed Extraction.

With the increase in the world's population and per capita wealth, oil producers must not only increase edible oil production but also meet the demand for a higher quality and variety of products. Recently, the focus has shifted from single processing steps to the entire vegetable oil production process, with an emphasis on introducing innovative technologies to improve quality and production efficiency. In this review, conventional methods of oilseed storage, processing and extraction are presented, as well as innovative processing and extraction techniques. Furthermore, the parameters most affecting the products' yields and quality at the industrial level are critically described. The extensive use of hexane for the extraction of most vegetable oils is undoubtedly the main concern of the whole production process in terms of health, safety and environmental issues. Therefore, special attention is paid to environmentally friendly solvents such as ethanol, supercritical CO2, 2-methyloxolane, water enzymatic extraction, etc. The state of the art in the use of green solvents is described and an objective assessment of their potential for more sustainable industrial processes is proposed.

Dietary macronutrient regulation of acyl and desacyl ghrelin concentrations in children with Prader-Willi syndrome (PWS).

BACKGROUND: The effects of dietary macronutrients on orexigenic and anorexigenic hormones in children are poorly understood. OBJECTIVE: To explore effects of varying dietary macronutrients on appetite-regulating hormones [acyl ghrelin (AG) and desacyl ghrelin (DAG), glucagon-like peptide 1 (GLP-1), peptide tyrosine tyrosine (PYY) and insulin] in children with PWS and healthy children (HC). DESIGN: Randomized, cross-over experiments compared two test diets [high protein-low carbohydrate (HP-LC) and high protein-low fat (HP-LF)] to a STANDARD meal (55% carbohydrate, 30% fat, 15% protein). Experiment 1 included ten children with PWS (median age 6.63 years; BMI z 1.05); experiment 2 had seven HC (median age 12.54 years; BMI z 0.95). Blood samples were collected at baseline and at 60-minute intervals for 4 hours. Independent linear mixed models were adjusted for age, sex and BMI z-score. RESULTS: Fasting and post-prandial AG and DAG concentrations are elevated in PWS children; the ratio of AG/DAG is normal. Food consumption reduced AG and DAG concentrations in both PWS and HC. GLP-1 levels were higher in PWS after the HP-LC and HP-LF meals than the STANDARD meal (P = .02-0.04). The fasting proinsulin to insulin ratio (0.08 vs 0.05) was higher in children with PWS (P = .05) than in HC. Average appetite scores in HC declined after all three meals (P = .02) but were lower after the HP-LC and HP-LF meals than the STANDARD meal. CONCLUSION: Altered processing of proinsulin and increased GLP-1 secretion in children with PWS after a high protein meal intake might enhance satiety and reduce energy intake.

The effect of pistachio by-product extracts treatment in protecting soybean meal and canola meal protein from rumen microbial degradation.

BACKGROUND: The industrial de-hulling of fresh pistachio generates a large quantity of pistachio by-products (PBP). The present study aimed to investigate the effects of treating soybean meal (SBM) and canola meal (CM) with tannin extracts derived from PBP on the protein fractions according to the Cornell Net Carbohydrates and Protein System (CNCPS), rumen degradability, and ruminal and post-ruminal crude protein (CP) disappearance in an in situ trials using three fistulated steers. The extracts of PBP were obtained via different solvents and then added to SBM and CM, so that the final concentrations of added tannins were 0, 5 and 10 g kg-1 dry matter. RESULTS: The CNCPS soluble proteins (fractions A + B1 ) of CP and B1 fraction of CP were lower (P < 0.01) in SBM and CM treated with PBP extracts than untreated meals. Treating SBM with different PBP extracts (except 5 g kg-1 tannin water extract) and CM with 5 g kg-1 tannin water extract and 10 g kg-1 tannin ethanol extract decreased (P < 0.01) ruminal disappearance of CP. From the in situ results, the rapidly degradable fraction (a) of CP decreased (P < 0.01) by treating SBM with different PBP extracts and CM with 5 and 10 g kg-1 tannin water extracts, whereas the slowly degradable fraction (b) of CP remained unchanged in SBM. Treatment of SBM and CM with PBP extracts decreased (P < 0.01) the effective degradability of crude protein estimated with different outflow rates. CONCLUSION: Some of the tannin extracts derived from PBP by water, ethanol and methanol could be effective with respect to protein protection of SBM and CM from degradation in the rumen; however, the use of tannin from water extracts can be more economical and practical. © 2020 Society of Chemical Industry.

The midgut transcriptome of Aedes aegypti fed with saline or protein meals containing chikungunya virus reveals genes potentially involved in viral midgut escape.

BACKGROUND: The mosquito Aedes aegypti is the primary vector for medically important arthropod-borne viruses, including chikungunya virus (CHIKV). Following oral acquisition, an arbovirus has to persistently infect several organs in the mosquito before becoming transmissible to another vertebrate host. A major obstacle an arbovirus has to overcome during its infection cycle inside the mosquito is the midgut escape barrier, representing the exit mechanism arboviruses utilize when disseminating from the midgut. To understand the transcriptomic basis of midgut escape and to reveal genes involved in the process, we conducted a comparative transcriptomic analysis of midgut samples from mosquitoes which had received a saline meal (SM) or a protein meal (PM) (not) containing CHIKV. RESULTS: CHIKV which was orally acquired by a mosquito along with a SM or PM productively infected the midgut epithelium and disseminated to secondary tissues. A total of 27 RNA-Seq libraries from midguts of mosquitoes that had received PM or SM (not) containing CHIKV at 1 and 2 days post-feeding were generated and sequenced. Fewer than 80 genes responded differentially to the presence of CHIKV in midguts of mosquitoes that had acquired the virus along with SM or PM. SM feeding induced differential expression (DE) of 479 genes at day 1 and 314 genes at day 2 when compared to midguts of sugarfed mosquitoes. By comparison, PM feeding induced 6029 DE genes at day 1 and 7368 genes at day 2. Twenty-three DE genes encoding trypsins, metalloproteinases, and serine-type endopeptidases were significantly upregulated in midguts of mosquitoes at day 1 following SM or PM ingestion. Two of these genes were Ae. aegypti late trypsin (AeLT) and serine collagenase 1 precursor (AeSP1). In vitro, recombinant AeLT showed strong matrix metalloproteinase activity whereas recombinant AeSP1 did not. CONCLUSIONS: By substituting a bloodmeal for SM, we identified midgut-expressed genes not involved in blood or protein digestion. These included genes coding for trypsins, metalloproteinases, and serine-type endopeptidases, which could be involved in facilitating midgut escape for arboviruses in Ae. aegypti. The presence of CHIKV in any of the ingested meals had relatively minor effects on the overall gene expression profiles in midguts.

Effect of high-protein meal replacement on weight and cardiometabolic profile in overweight/obese Asian Indians in North India.

The aim of the present study was to evaluate the impact of a high-protein meal replacement (HPMR) on weight and metabolic, lipid and inflammatory parameters in overweight/obese Asian Indians. In this 12-week open-label, parallel-arm randomised controlled trial, 122 overweight/obese men and women were administered either a HPMR or a control diet after 2 weeks of diet and exercise run-in. Body weight, waist circumference (WC), percentage body fat (%BF), fasting blood glucose, post-oral glucose tolerance test (post-OGTT) blood glucose, fasting and post-OGTT serum insulin, lipid profile, high-sensitivity C-reactive protein (hs-CRP), kidney function and hepatic aminotransferases were assessed before and after the intervention. Additional improvement in mean values for the following parameters in the HPMR group compared with the control group was observed: body weight, 4·9 % (95 % CI 3·8, 6·1; P<0·001); WC, 3·8 % (95 % CI 2·5, 5·1; P<0·001); %BF, 6·3 % (95 % CI 4·3, 8·2; P<0·001); systolic blood pressure, 2·8 % (95 % CI 0·4, 5·1; P=0·002); diastolic blood pressure, 3·5 % (95 % CI 0·7, 6·3; P= 0·01); post-OGTT blood glucose, 7·3 % (95 % CI 1·4, 13·1; P=0·02); total cholesterol, 2·5 % (95 % CI 1·6, 3·5; P<0·001); LDL-cholesterol, 7·3 % (95 % CI 1·7, 12·9; P<0·01); alanine aminotransferase, 22·0 % (95 % CI 2·1, 42; P=0·03) and aspartate aminotransferase, 15·2 % (95 % CI 0·9, 29·5; P=0·04). The absolute reduction in BMI was 0·9 units in the intervention arm compared with the control arm (-0·9 %, 95 % CI -1·4, -0·5; P<0·001) and in serum TAG was 11·9 mg/dl (-11·9 mg/dl, 95 % CI -21·1, -2·7; P<0·01). The reduction in fasting serum insulin in the intervention v. the control arm was 3·8 v. 0 % (P=0·002); post-OGTT serum insulin was 50·3 v. 77·3 mU/l (P=0·005); and hs-CRP, 16·7 % v. 0 % (P=0·002). These findings show that intervention with HPMR may lead to significant weight loss and improvement in obesity measures, metabolic, lipid and inflammatory parameters and hepatic transaminases in overweight/obese Asian Indians.

The additional dose of insulin for high-protein mixed meal provides better glycemic control in children with type 1 diabetes on insulin pumps: randomized cross-over study.

BACKGROUND: Delivery of insulin for high-protein low-fat meals with carbohydrates on the basis of carbohydrates leads to higher late postprandial glycemia. Studies with mixed meals demonstrated lower blood glucose level after dual wave bolus. The objective of our study was to assess the impact of additional dose of insulin in dual wave bolus for high-protein mixed meal on the postprandial glycemia. MATERIALS AND METHODS: We performed a randomized, double-blind, two-way cross-over study, including 58 children with type 1 diabetes, aged 14.7 ± 2.2 years. Participants were randomly assigned into two treatment orders: NORMAL-DUAL or DUAL-NORMAL BOLUS. They consumed standardized high-protein, low-fat meals with carbohydrates. The primary outcome was postprandial glycemia (PPG) based on capillary blood glucose measurements (CBGM). The secondary outcomes were the frequency of hypoglycemia, area under glucose curve, mean amplitude of glycemic excursion (MAGE) and glycemic rise. RESULTS: PPG assessed at 180 min was significantly lower when dual wave bolus was delivered (NORMAL 162 mg/dL [9 mmol/L] vs DUAL 130.0 mg/dL [7.22 mmol/L]; P = .004). There were no differences in CBGM between both groups at 60 and 120 min. We found differences between the groups in MAGE at 120 min (NORMAL 82.86 mg/dL [4.6 mmol/L] versus DUAL 54.76 mg/dL [3.04 mmol/L]; P = .0008). We observed no differences in the number of hypoglycemic episodes in both groups. CONCLUSION: Applying an additional dose of insulin in dual wave bolus for high-protein mixed meal improved PPG. We observed no statistically significant increase in the number of hypoglycemic episodes associated with this intervention.

Effect of meal composition on postprandial glucagon-like peptide-1, insulin, glucagon, C-peptide, and glucose responses in overweight/obese subjects.

BACKGROUND: Glucagon-like peptide-1 (GLP-1), an incretin hormone, is released in response to food intake. It is unclear how meals high in protein (HP) and monounsaturated fat (HMF) affect GLP-1 response. PURPOSE: To examine the effect of a HP versus a HMF meal on GLP-1 response. METHODS: Twenty-four overweight/obese participants consumed two meals (HP: 31.9 % energy from protein; HMF: 35.2 % fat and 20.7 % monounsaturated fat) in a random order. Both meals contained the same energy and carbohydrate content. GLP-1, insulin, glucagon, C-peptide, and glucose were assessed from blood drawn in the fasting and postprandial states. The effect of meal condition on hormone and glucose responses and appetite ratings were assessed by repeated measures analysis. RESULTS: Statistically significant (p < 0.01) time by meal condition effect was observed on active GLP-1, total GLP-1, insulin, C-peptide, and glucagon, but not glucose (p = 0.83). Area under the curve was significantly higher during the HP versus the HMF meal conditions for active GLP-1 (23.7 %; p = 0.0007), total GLP-1 (12.2 %; p < 0.0001), insulin (54.4 %; p < 0.0001), C-peptide (14.8 %; p < 0.0001), and glucagon (40.7 %; p < 0.0001). Blood glucose was not different between the HP versus HMF conditions (-4.8 %; p = 0.11). Insulin sensitivity was higher during the HMF versus HP conditions (Matsuda index mean difference: 16.3 %; p = 0.007). Appetite ratings were not different by meal condition. CONCLUSIONS: GLP-1 and insulin responses were higher during the HP condition. However, no difference was found in blood glucose between conditions, and insulin sensitivity was higher during the HMF condition, indicating that a HMF meal may be optimal at regulating blood glucose in overweight/obese individuals without type 2 diabetes.

An automatically progressed computer-controlled simulated digestion system to predict digestible and metabolizable energy of unconventional plant protein meals for growing pigs.

The objective of this experiment was to develop a new computer-controlled simulated digestion system to predict the digestible energy (DE) and metabolizable energy (ME) of unconventional plant protein meals for growing pigs. Nine meals tested included 1 source of rapeseed meal, 4 sources of cottonseed meal, 2 sources of sunflower meal, and 2 sources of peanut meal. Twenty growing pigs (Duroc × [Landrace × Large White]) with an initial body weight (BW) of 41.7 ± 2.6 kg were allotted to a replicated 10 × 3 incomplete Latin square design to determine the DE and ME of 1 basal diet and 9 experimental diets formulated with 9 unconventional plant protein meals. The DE and ME values of unconventional plant protein meals were calculated by the difference method. The in vitro digestible energy (IVDE) of 1 basal diet, 9 experimental diets, and 9 unconventional plant protein meals were determined with 5 replicates of each sample in a complete randomized arrangement. The IVDE/DE or IVDE/ME ranged from 0.96 to 0.98 or 1.00 to 1.01, and the correlation coefficient between IVDE and DE or ME was 0.97 or 0.98 in 10 experimental diets. Accordingly, the IVDE/DE or IVDE/ME ranged from 0.86 to 1.05 or 0.96 to 1.20, and the correlation coefficient between IVDE and DE or ME was 0.92 or 0.91 in 9 unconventional plant protein meals. The coefficient of variation (CV) of IVDE was less than that of DE and ME in the experimental diets (0.43%, 0.80%, and 0.97% for CV of IVDE, DE and ME, respectively) and unconventional plant protein meals (0.92%, 4.84%, and 6.33% for CV of IVDE, DE and ME, respectively). The regression equations to predict DE from IVDE in 10 experimental diets and 9 unconventional plant protein meals were DE = 0.8851 × IVDE +539 (R 2 = 0.9411, residual standard deviation [RSD] = 23 kcal/kg DM, P < 0.01) and DE = 0.9880 × IVDE + 166 (R 2 = 0.8428, RSD = 182 kcal/kg DM, P < 0.01), respectively. There was no statistical difference in the slopes (P = 0.82) or intercepts (P = 1.00) of these 2 equations. Thus, 10 diets and 9 unconventional plant protein meals were pooled to establish the regression equation of DE on IVDE as: DE = 0.9813 × IVDE +187 (R 2 = 0.9120, RSD = 118 kcal/kg DM, P < 0.01). The regression equations to predict ME from IVDE in 10 experimental diets and 9 unconventional plant protein meals were ME = 0.9559 × IVDE +146 (R 2 = 0.9697, RSD = 18 kcal/kg DM, P < 0.01) and ME = 0.9388 × IVDE + 3 (R 2 = 0.8282, RSD = 182 kcal/kg DM, P < 0.01), respectively. There was no statistical difference in slopes (P = 0.97) but significant difference between the intercepts (P = 0.02) of these 2 equations. Our results indicate IVDE has similar response to the DE but different response to the ME in 10 experimental diets and 9 unconventional plant protein meals. Therefore, IVDE is more suitable to predict DE than ME of diets and unconventional plant protein meals for growing pigs.

Effect of Rice Protein Meal Replacement of Fish Meal on Growth, Anti-Oxidation Capacity, and Non-Specific Immunity for Juvenile Shrimp Litopenaeus vannamei.

This study assessed the effect of rice protein meal replacement for fish meal on the growth, nonspecific immunity, and disease resistance on juvenile shrimp Litopenaeus vannamei. Six groups of iso-nitrogenous and iso-lipid feeds named FM, R10, R20, R40, R60, and R80 were prepared by replacing 0%, 10%, 20%, 40%, 60%, and 80% in FM protein with RPM, respectively, and then fed to the shrimps (0.54 ± 0.01 g). An amount of 720 healthy and evenly sized shrimps were allocated to six groups (three replicates per group) and fed four times a day (7:00, 11:00, 17:00 and 21:00) for eight weeks. Results revealed no significant differences in WG, FCR, and SGR of shrimps after replacing FM with 10% RPM (p > 0.05). In the R10 and R20 groups, SOD and T-AOC activities were significantly higher than those in the FM group, whereas the opposite was observed for MDA content (p < 0.05). CAT, ACP, and LZM were all significantly higher in the R10, R20, and R40 groups than in the FM group (p < 0.05). GSH-Px activity in the R10 group was significantly higher than the activity in the FM group (p < 0.05). AKP, PO, TYS, GPT, and GOT activities were significantly higher in the R10 group than in the FM group (p < 0.05). Compared to the FM group, the eukaryotic translation initiation factor 3K (eif3k) gene was significantly up-regulated in the R10 group, whereas the penaiedin 3a (pen 3a) and anti-lipopolysaccharide factor (alf) genes were significantly up-regulated in the R10 and R20 groups (p < 0.05). The crustin a (cru a), immune deficiency (imd), and lysozyme (lzm) mRNA levels were significantly higher in the R10, R20, and R40 groups than in the other groups (p < 0.05). The prophenoloxidase (PO) mRNA levels in the R20 group were significantly higher than those in the FM group (p < 0.05). The replacement of 10−40% of FM with RPM improved the gut flora composition of shrimps, increasing beneficial bacteria (Bacteroidetes) abundance and reducing harmful bacteria (Aspergillus and Vibrio) abundance. After the challenge test of Vibrio parahaemolyticus (7 days), the cumulative mortality in the R10 group significantly decreased (p < 0.05). In conclusion, replacement of 10% FM by RPM significantly improved digestibility, protein synthesis, antioxidant capacity, and disease resistance in L. vannamei.

Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt.

BACKGROUND AND AIMS: To determine the effect of high protein and high fat meals on post prandial glycemia in patients with type 1 diabetes. METHODS: This study included 51 children and adolescents with type 1 diabetes who were following up at Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Abo Elrish Children's hospital, Cairo University. Post prandial blood glucose levels were recorded and compared following three breakfast meals with varying protein and fat content (standard carbohydrate meal, high fat meal, and high protein meal) over a period of 5 hours on 3 consecutive days. RESULTS: High protein meal resulted in hyperglycemia with the peak level at 3.5 hours and continued for 5 hours post prandial while high fat meal caused early hyperglycemia reached the peak at 2 hours then declined towards 5 hours. Comparison of the three different breakfast meals revealed statistically significant difference regarding the postprandial glycemia at 30, 60, 90,120, 180, 210, 240, 270, 300 min. CONCLUSION: Meals high in protein caused sustained increase in postprandial glucose levels over a period of 5 h. However, high fat meals caused early postprandial hyperglycemia. Protein and fat content of meals affect the timing and values of the peak blood glucose as well as the duration of postprandial hyperglycemia. Therefore, fat/protein unit should be taken in consideration while calculating the bolus insulin dose and anticipating the postprandial glucose response.

Growth Performance, Growth-Related Genes, Digestibility, Digestive Enzyme Activity, Immune and Stress Responses of de novo Camelina Meal in Diets of Red Seabream (Pagrus major).

A 60-day experiment was designed to assess the effect of different ratios of fish meal (FM): camelina meal plant protein (CM) on growth response and relative gene expression of growth-promoting factors, feed utilization potency, digestive enzymes activities, apparent digestibility (ADC), stress response, non-specific immunity of Pagrus major. Four isonitrogenous (490.7 g/kg of crude protein) and isolipidic (91.5 g/kg total lipid) experimental diets were formulated and designated as camelina meal (CM0), soyabean meal (SBM20.5), CM20.5, and CM33 based on protein contents. At the end of the feed trial, significantly higher (p < 0.05) weight gain, specific growth rate, and feed intake but lower feed conversion ratio were recorded in fish fed CM0, SBM20.5, and CM20.5 than fish fed CM33. The lowest growth, feed utilization, enzyme activity, and digestibility were recorded in fish fed CM33. Significantly higher pepsin, amylase, and protease activities were observed in fish fed CM0, SBM20.5, and CM20.5 diets than fish fed CM33. The highest ADC of protein was recorded in fish fed CM0, SBM20.5, and CM20.5 diets. Hematocrit levels were depressed CM33 while total serum protein, total cholesterol, triglyceride, blood urea nitrogen, total bilirubin, aspartate aminotransferase, and alanine aminotransferase were not significantly changed by the inclusion of CM. Non-specific immune variables (lysozyme activity, peroxidase activity in serum and nitro blue tetrazolium) in fish fed CM0, SBM20.5, and CM20.5 were significantly higher than in fish fed CM33 diet. The superoxide dismutase of fish fed CM20.5 was not significantly different from CM0 and SBM20.5 (p > 0.05). Catalase and low salinity stress test show that CM0, SBM20.5, and CM20.5 were not significantly (p > 0.05) different, while CM33 was significantly lower than the rest of the diets. TBARs show that CM20.5 and CM33 diets were significantly different (p < 0.05), but CM20.5 was not significantly different from SBM20.5. Significantly higher hepatic IGF-1 and IGF-2 mRNA expression was found in fish-fed diet groups CM0, SBM20.5, and CM20.5 than fish fed CM33. The present study indicated that the addition of CM up 205 kg/kg to diet maintains growth, digestive enzymes, nutrient digestibility, immunity, stress resistance, and feed utilization efficiency of red sea bream.

A High-Protein Meal during a Night Shift Does Not Improve Postprandial Metabolic Response the Following Breakfast: A Randomized Crossover Study with Night Workers.

The aim of this study was to compare the acute effect of a high-protein/moderate carbohydrate (HP-MCHO) versus low-protein/high-carbohydrate (LP-HCHO) meal served at night on the postprandial metabolic response of male night workers the following breakfast. A randomized crossover study was performed with 14 male night workers (40.9 ± 8.9 years old; 29.1 ± 5.3 kg/m2). Participants underwent two different isocaloric dietary conditions at 1:00 h of the night shift: HP-MCHO (45 en% carbohydrate, 35 en% protein and 20 en% fat) and LP-HCHO (65 en% carbohydrate, 15 en% protein and 20 en% fat). Postprandial capillary glucose levels were determined immediately before the intake of the test meal and 30, 60, 90 and 120 min after the end of the meal. At the end of the work shift (6:30 h), participants received a standard breakfast and postprandial levels of glucose, insulin and triglycerides were determined immediately before and then every 30 min for 2 h (30, 60, 90 and 120 min). Higher values of capillary glucose were found after the LP-HCHO condition compared to the HP-MCHO condition (area under the curve (AUC) = 119.46 ± 1.49 mg/dL × min and 102.95 ± 1.28 mg/dL × min, respectively; p < 0.001). For the metabolic response to standard breakfast as the following meal, no significant differences in glucose, insulin, triglyceride, and HOMA-IR levels were found between interventions. A night meal with a higher percentage of protein and a lower percentage of carbohydrate led to minor postprandial glucose levels during the night shift but exerted no effect on the metabolic response of the following meal. This trial was registered at ClinicalTrials.gov as NCT03456219.

Rapid-acting and Regular Insulin are Equal for High Fat-Protein Meal in Individuals with Type 1 Diabetes Treated with Multiple Daily Injections.

INTRODUCTION: The fat and protein content can impact late postprandial glycemia; therefore, prolonged insulin boluses for high-fat/-protein meals are recommended for patients with type 1 diabetes on insulin pump therapy. It is not clear how to translate these findings to multiple daily injection (MDI) therapy. We hypothesized that regular insulin with a slower onset and a longer duration of action might be advantageous for such meals. METHODS: Twenty-five patients with well-controlled type 1 diabetes (mean HbA1c 6.8%, 51 mmol/mol, no episodes of hypoglycemia) on MDI therapy, aged 27.9 ± 4.3 years and well trained in flexible intensive insulin therapy, were given three test breakfasts with the same carbohydrate (CHO) content. The amount of fat and protein was low (LFP) or high (HFP). For LFP meals, patients received a rapid-acting insulin; for HFP meals, a rapid-acting or regular insulin was given in individual doses according to the CHO content and individual insulin-CHO ratios. Postprandial glycemia was determined by 6-h continuous glucose monitoring. RESULTS: Acute postprandial glucose levels measured for 2 h were similar after LFP and two HFP meals (7.8 ± 2.0, 8.1 ± 2.1, 8.0 ± 1.9 mmol/l). Late postprandial glycemia measured from 2 to 6 h was significantly lower after the LFP meal (6.7 ± 1.8 mmol/l, p < 0.05) than after the HFP meals, but there was no difference between the rapid-acting or regular insulin on HFP days (8.6 ± 2.6 and 8.9 ± 2.8 mmol/l, NS). CONCLUSION: The preliminary results of this study indicate no benefit to cover fat-protein meals with regular insulin in individuals with type 1 diabetes treated with MDI.

Impact of phenylketonuria type meal on appetite, thermic effect of feeding and postprandial fat oxidation.

BACKGROUND: Dietary management of phenylketonuria (PKU) requires the replacement of natural protein-containing foods with special low protein foods. The effect of a PKU type diet on factors contributing to energy balance requires investigation. OBJECTIVE: To investigate the impact of a PKU type meal on appetite ratings, gut appetite hormones, thermic effect of feeding (TEF) and fat oxidation. METHODS: Twenty-three healthy adults (mean ± SD age: 24.3 ± 5.1 years; BMI: 22.4 ± 2.5 kg/m2) participated in a randomized, crossover design study. Each participant conducted two (PKU and Control) experimental trials which involved consumption of a PKU type meal and protein substitute drink or an isocaloric and weight matched ordinary meal and protein-enriched milk. Appetite, metabolic rate, fat oxidation measurements and blood collections were conducted for the duration of 300 min. On the completion of the measurements ad libitum buffet dinner was served. RESULTS: Responses of appetite ratings, plasma concentrations of GLP-1 and PYY (P > 0.05, trial effect, two-way ANOVA) and energy intake during ad libitum buffet dinner (P > 0.05, paired t-test) were not significantly different between the two trials. The TEF (PKU, 10.2 ± 1.5%; Control, 13.2 ± 1.0%) and the total amount of fat oxidized (PKU, 18.90 ± 1.10 g; Control, 22.10 ± 1.10 g) were significantly (P < 0.05, paired t-tests) lower in the PKU than in the Control trial. The differences in TEF and fat oxidation were significant (P < 0.05, paired t-tests) for the post-meal period. CONCLUSIONS: Consumption of a meal composed of special low protein foods has no detrimental impact on appetite and appetite hormones but produces a lower TEF and postprandial fat oxidation than an ordinary meal. These metabolic alterations may contribute to the increased prevalence of obesity reported in patients with PKU on contemporary dietary management. CLINICAL TRIAL REGISTRATION: The trial has been registered in ClinicalTrials as NCT02440932.

The Effect of Food on Cysteamine Bitartrate Absorption in Healthy Participants.

OBJECTIVES: Treatment with cysteamine reduces the rate of progression to end-stage kidney disease in cystinosis. Although food is often taken with cysteamine to reduce associated gastrointestinal symptoms, this may alter the bioavailability of cysteamine. METHODS: This is a prospective, randomized, 3-treatment study to determine the effects of fasting and high-fat/calorie and high-protein meals on cysteamine absorption in healthy adult controls. On 3 separate days, serial plasma cysteamine levels were measured after cysteamine bitartrate 500 mg was ingested while fasting and also 30 minutes after high-fat/calorie and high-protein diets. Gastrointestinal (GI) symptoms were also monitored. RESULTS: Eight participants (5 men) were enrolled. Cysteamine absorption, as measured by area under the cysteamine concentration-time curve (AUC0-∞ ) while fasted and following high-fat/calorie and high-protein meals, was 3618 ± 372 min·µM, 2799 ± 405 min·µM (P = .04 vs fasted), and 2457 ± 353 min·µM (P = .005), respectively, and the mean Cmax values for participants were 26.3 ± 3.5 µM, 22.4 ± 5.6 µM (P = .16 vs fasted), and 17.2 ± 2.6 µM (P = .036 vs fasted), respectively. Mild GI symptoms were reported in 3 participants. CONCLUSIONS: Cysteamine absorption may be decreased by 30% when taken with food as compared with the fasting state. Food causes wide variation in tmax and Cmax for cysteamine.

Avaliação nutricional e o uso da levodopa com refeições proteicas em pacientes com doença de Parkinson do município de Macaé, Rio de Janeiro / Nutritional assessment and the use of levodopa with protein meals among patients with Parkinson's disease in the city of Macaé, Rio de Janeiro, Brazil

Resumo A doença de Parkinson (DP) é caracterizada pela redução da dopamina no sistema nervoso central. Apresenta progressão gradativa e é conhecida, principalmente, por tremores e dificuldade em realizar movimentos. Estudos demonstram que há significativa alteração do estado nutricional nos pacientes com DP. O principal medicamento utilizado no tratamento dos pacientes é a levodopa e a sua administração, sem respeitar o intervalo de no mínimo 30 minutos antes ou uma hora após as refeições, pode diminuir o efeito farmacológico da substância devido à interação droga-nutriente. Este estudo objetivou identificar, no município de Macaé-RJ, pacientes com DP em risco nutricional e o consumo proteico associado ao uso da levodopa. Trata-se de um estudo transversal, quantitativo e descritivo.Os instrumentos utilizados foram a Mini Avaliação Nutricional (MAN) e o registro alimentar estimado de três dias. A análise foi descritiva. Para compor a amostra, foi realizado um levantamento do número de pacientes com diagnóstico de DP de dois programas da Secretaria de Saúde e da Associação Parkinson de Macaé. Foram avaliados 40 indivíduos, desses, 57,5% eram do sexo masculino. Apresentaram risco de desnutrição ou desnutrição pela MAN 62,5% dos pacientes, caracterizando déficit nutricional. A ingestão proteica da população foi de 1,4g/Kg/dia. A maior ingestão de proteínas foi no período do dia, considerando as refeições compreendidas entre o café da manhã e o lanche da tarde. O consumo pela população nesse período foi de 74,7% da proteína total. Dos idosos, 75,0% ingeriam seus medicamentos compostos de levodopa simultaneamente às refeições ou não, seguindo o intervalo recomendado pela ANVISA. O estudo verificou que a maioria dos indivíduos apresentou risco nutricional, a maior parte realizava uma ingestão diária total hiperproteica, sendo o conteúdo proteico mal distribuído nas refeições ao longo do dia, além do não cumprimento ao intervalo recomendado da levodopa.

Abstract Parkinson's disease (PD) is characterized by a reduction in dopamine in the central nervous system. It has a gradual progression, and is mainly known for causing tremors and difficulty in performing movements. Studies have shown that there is a significant change in the nutritional status of patients with PD. The main medication used in the treatment of patients is levodopa, and its use, without respecting the minimum intervals of 30 minutes before or one hour after meals, may diminish the pharmacological effect of the drug because of drug-nutrient interactions. The present study aimed to identify PD patients at nutritional and protein consumption risk associated with the use of levodopa in the city of Macaé. A cross-sectional quantitative and descriptive study was performed. The instruments used were the Mini Nutritional Assessment (MNA) and an estimated 3-day dietary record. The analysis was descriptive. To form the sample population a survey was performed of patients diagnosed with PD in two Department of Health programs and from the Parkinson's Association of Macaé. A total of 40 individuals were evaluated, of whom 57.5% were male. Of these, 62.5% presented a risk of malnutrition or MNA defined malnutrition, with nutritional deficit. The protein intake of the study population was 1.4 g/kg/day. The highest protein intake was during the day, including the meals between breakfast and the afternoon snack. A total of 74.7% of total protein was consumed by the population during this period. Overall, 75.0% of the elderly persons consumed their medications containing levodopa simultaneously with meals or did not follow the interval recommended by ANVISA. The study found that the total daily intake of most individuals was hyper-proteic, with proteic content being poorly distributed among meals throughout the day, and that they did not follow the recommended levodopa interval.