Effect of a higher protein diet and lifestyle camp intervention on childhood obesity (The COPE study): results from a nonrandomized controlled trail with 52-weeks follow-up.

PURPOSE: In adults, diets rich in protein seem beneficial in relation to satiety, weight loss, and weight management; however, studies investigating dietary protein and weight development in children are scarce and inconsistent. This nonrandomized controlled trial aimed to investigate the effect of a higher protein diet during lifestyle intervention on anthropometry and metabolic biomarkers in children with overweight and obesity. METHODS: Children (n:208) were recruited from two multicomponent lifestyle camps. One camp was assigned as the intervention group. In the intervention group, carbohydrates-rich foods at breakfast and two in-between-meals were replaced with protein-containing foods to increase the amount of protein from ~ 10-15 energy percent (E%) per day to ~ 25E% per day. Other components were similar between groups. Anthropometry and biochemical measurements were collected at baseline, 10 weeks (after camp) and 52 weeks. RESULTS: The intervention group had a non-significant improvement in BMI-SDS (- 0.07 SD (- 0.19; 0.05), p = 0.24) compared to the control group, but in general, there was no effect of a higher protein diet on anthropometry and metabolic biomarkers. Overall, 10 weeks at camp resulted in a more favorable body composition [- 6.50 kg (p < 0.00), - 0.58 BMI-SDS (p < 0.00), and - 5.92% body fat (p < 0.00)], and improved metabolic health, with most changes maintained at 52 weeks. CONCLUSION: A higher protein diet had no significant effect on body composition and metabolic health; however, these lifestyle camps are an efficiatious treatment strategy for childhood obesity. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov with ID: NCT04522921. Preregistered August 21st 2020.

High protein diet-induced metabolic changes are transcriptionally regulated via KLF15-dependent and independent pathways.

High protein diet (HPD) is an affordable and positive approach in prevention and treatment of many diseases. It is believed that transcriptional regulation is responsible for adaptation after HPD feeding and Kruppel-like factor 15 (KLF15), a zinc finger transcription factor that has been proved to perform transcriptional regulation over amino acid, lipid and glucose metabolism, is known to be involved at least in part in this HPD response. To gain more insight into molecular mechanisms by which HPD controls expressions of genes involved in amino acid metabolism in the liver, we performed RNA-seq analysis of mice fed HPD for a short period (3 days). Compared to a low protein diet, HPD feeding significantly increased hepatic expressions of enzymes involved in the breakdown of all the 20 amino acids. Moreover, using KLF15 knockout mice and in vivo Ad-luc analytical system, we were able to identify Cth (cystathionine gamma-lyase) as a new target gene of KLF15 transcription as well as Ast (aspartate aminotransferase) as an example of KLF15-independent gene despite its remarkable responsiveness to HPD. These findings provide us with a clue to elucidate the entire transcriptional regulatory mechanisms of amino acid metabolic pathways.

Feasibility and Efficiency of the BEFORE (Better Exercise and Food, Better Recovery) Prehabilitation Program.

Prehabilitation has been postulated as an effective preventive intervention to reduce postoperative complications, particularly for elderly patients with a relatively high risk of complications. To date, it remains to be determined whether prehabilitation increases physical capacity and reduces postoperative complications. The aim of this study was to assess the feasibility of a 4-week multimodal prehabilitation program consisting of a personalized, supervised training program and nutritional intervention with daily fresh protein-rich food for colorectal cancer patients aged over 64 years prior to surgery. The primary outcome was the feasibility of this prehabilitation program defined as ≥80% compliance with the exercise training program and nutritional intervention. The secondary outcomes were the organizational feasibility and acceptability of the prehabilitation program. A compliance rate of ≥80% to both the exercise and nutritional intervention was accomplished by 6 patients (66.7%). Attendance of ≥80% at all 12 training sessions was achieved by 7 patients (77.8%); all patients (100%) attended ≥80% of the available training sessions. Overall, compliance with the training was 91.7%. Six patients (66.7%) accomplished compliance of ≥80% with the nutritional program. The median protein intake was 1.2 (g/kg/d). No adverse events occurred. This multimodal prehabilitation program was feasible for the majority of patients.

Effects of High and Low Protein Diets on Inflammatory Profiles in People with Morbid Obesity: A 3-Week Intervention Study.

Nutritional interventions in morbidly obese individuals that effectively reverse a pro-inflammatory state and prevent obesity-associated medical complications are highly warranted. Our aim was to evaluate the effect of high (HP) or low (LP) protein diets on circulating immune-inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), interleukin-10 (IL-10), monocyte chemoattractant protein-1 (MCP-1), chemerin, omentin, leptin, total adiponectin, high molecular weight adiponectin, and fetuin-A. With this aim, 18 people with morbid obesity were matched into two hypocaloric groups: HP (30E% protein, n = 8) and LP (10E% protein, n = 10) for three weeks. Biomarkers were measured pre and post intervention and linear mixed-effects models were used to investigate differences. Consuming HP or LP diets resulted in reduced CRP (HP: -2.2 ± 1.0 mg/L, LP: -2.3 ± 0.9 mg/L) and chemerin (HP: -17.9 ± 8.6 ng/mL, LP: -20.0 ± 7.4 ng/mL), with no statistically significant differences by diet arm. Participants following the LP diet showed a more pronounced decrease in leptin (-19.2 ± 6.0 ng/mL) and IL-6 (-0.4 ± 0.1 pg/mL) and an increase in total adiponectin (1.6 ± 0.6 µg/mL). Changes were also observed for the remaining biomarkers to a smaller degree by the HP than the LP hypocaloric diet, suggesting that a LP hypocaloric diet modulates a wider range of immune inflammatory biomarkers in morbidly obese individuals.

Safety of a Combined WB-EMS and High-Protein Diet Intervention in Sarcopenic Obese Elderly Men.

PURPOSE: Whole-body electromyostimulation (WB-EMS) especially in combination with a high-protein supplementation has been established as an efficient treatment against sarcopenia. However, there are several case reports of rhabdomyolysis after WB-EMS application. Thus, we asked if this training could potentially lead to deteriorations of the cardiac as well as the renal function. MATERIALS AND METHODS: One hundred sarcopenic obese men aged 70 years and older were randomly balanced (1-1-1) and allocated to one of the three study arms. During 16 weeks of intervention, these groups either performed WB-EMS and took a protein supplement (WB-EMS&P), solely received the protein supplement (Protein) or served as control group (CG). WB-EMS consisted of 1.5×20 min (85 Hz, 350 µs, 4 s of strain to 4 s of rest) applied with moderate-to-high intensity while moving. We further generated a daily protein intake of 1.7-1.8 g/kg/body mass per day. At baseline and 8-10 days after completion of the intervention, blood was drawn and biomarkers of muscle, cardiac and renal health were assessed. RESULTS: Hereby, we found slight but significant elevations of creatine kinase (CK) levels in the WB-EMS group pointing to minor damages of the skeletal muscle (140 U/l [81-210], p < 0.001). This was accompanied by a significant, low-grade increase of creatine kinase-muscle brain (CK-MB, 0.43 ng/mL [-0.29-0.96], p < 0.01) and high-sensitivity troponin T (hsTnT, 0.001 ng/mL. [0.000-0.003], p < 0.001) but without a higher risk of developing heart failure according to N-terminal prohormone of brain natriuretic peptide (NT-proBNP, -5.7 pg/mL [-38.8-24.6], p = 0.17). Estimated glomerular filtration rate (eGFR) was impaired neither by the high-protein supplementation alone nor in combination with WB-EMS (CG 76.0 mL/min/1.73 m2 [71.9-82.2] vs Protein 73.2 mL/min/1.73 m2 [63.0-78.9] vs WB-EMS&P 74.6 mL/min/1.73 m2 [62.8-84.1], p = 0.478). CONCLUSION: In conclusion, even in the vulnerable group of sarcopenic obese seniors, the combination of WB-EMS with a high-protein intake revealed no short-term, negative impact on the eGFR, but potential consequences for the cardiovascular system need to be addressed in future studies.

Appetite control: hormones or diet strategies?

PURPOSE OF REVIEW: Appetite control results from metabolic, behavioral, and environmental factors that influence hunger and the desire to eat. We summarize the latest advances in the hormonal and nutritional strategies to control appetite and reduce hunger. RECENT FINDINGS: The fed-hunger-state is regulated by central and peripheric hormones, which modulate energy balance. Leptin, insulin, ghrelin, peptide YY (PYY), and other gut-derived peptides represent the main appetite controllers. The role of orexins, obestatin, and liver-expressed antimicrobial peptide 2 has been uncovered recently. New insights have demonstrated the role of hippocampal activity as a possible mechanism of action. Glucagon-like peptide 1 (GLP1) receptor agonists are well known agents controlling appetite. Association of GLP1 receptor agonist, PYY, or glucose-dependent insulinotropic polypeptide agonists have been tested as new approaches. Appetite-control hormones have also risen as factors involved in the efficacy of bariatric procedures. High-protein, ketogenic diet, and intermittent fasting have been described as nutritional strategies to reduce appetite, although the physiological mechanism and long-term safety remains unclear. SUMMARY: Appetite control has been an important target for the treatment of obesity and associated disorders. New studies have demonstrated promising adoption of dietary approaches, hormone-based drugs, and bariatric surgery to control energy intake. Further research will establish a significant association, benefits, and safety of these new therapies.

High Protein Intake Among Preschoolers in Childcare in a Region at Elevated Risk for Obesity.

OBJECTIVES: To compare diet quality of convenience samples of children 2-3 and 4-5 years attending 11 of 75 childcare centers in Hays County, Texas to a nationally representative sample, as part of a needs assessment to inform a childcare center-based intervention. METHODS: Parents completed 24-h recalls of their child's diet in 2014. Usual dietary intake of the regional and age-matched sample from the National Health and Nutrition Examination Survey (2011-2014) was estimated using the National Cancer Institute method. Diet quality was assessed using the Healthy Eating Index. Quantile regression and t-tests compared nutrient intake and Healthy Eating Index scores between the two samples. RESULTS: Children ages 2-3 and 4-5 years in the regional sample (n = 124) consumed a higher percent of calories from protein (19%) than children in the national sample (n = 1613; 14%, P < .0.0001). In the regional sample, 21% of children 2-3 years consumed protein in excess of the AMDR compared to fewer than 1% of children in the national sample. CONCLUSIONS FOR PRACTICE: Assessing regional diet while planning health outreach is important. Among children in childcare in this community, high protein intake may contribute to weight disparity. Workshops with childcare center staff to address center policies, environments, and parent outreach could address replacing some high-protein foods with other nutrient-rich foods.

A high-protein diet, not isolated BCAA, is associated with skeletal muscle mass index in patients with gastrointestinal cancer.

OBJECTIVES: Patients with cancer are susceptible to experiencing the loss of skeletal muscle mass. Thus, the purpose of this study was to evaluate whether a high-protein diet (HPD) or isolated branched-chain amino acid (BCAA) intake is associated with an increased skeletal muscle mass index (SMI) in patients with cancer of the gastrointestinal tract. METHODS: This cross-sectional, observational study included 106 patients with gastrointestinal tract tumors. Food consumption was estimated using 24-h food recall. Patients were divided into two groups: a low-protein diet (LPD) group (≤1.2 g · kg · d-1) and a high-protein diet (HPD) group (>1.2 g · kg · d-1). Appendicular muscle mass (ASM) was calculated using Lee's formula, and its values were divided by the square of the height of the patient to obtain SMI values. Differences were considered significant when the probability they occurred by chance was <5% (P < 0.05). RESULTS: Of 106 patients assessed, 69 (65%) consumed a diet consistent with specifications of the LPD group and 37 (35%) consumed a diet consistent with HPD intake. Logistic regression after adjusting for sex and caloric and carbohydrate consumption showed an association between SMI and HPD (odds ratio, 4.19; 95% confidence interval, 1.06-16.56; P < 0.001) but not with BCAA. Daily total protein intake, but not isolated BCAA or leucine, was able to predict an increase in SMI in 43% of patients considered (P = 0.006). Thus, HPD was associated with SMI, and total protein intake was a better predictor of SMI than BCAAs. CONCLUSION: HPD is a cost-effective way to enhance SMI, rather than focusing on the ingestion of isolated BCAAs.

Effects of plant and animal high protein diets on immune-inflammatory biomarkers: A 6-week intervention trial.

BACKGROUND & AIMS: Pro-inflammatory biomarkers are well-established contributors to insulin resistance and represent valid targets for diabetes management and prevention. Yet, little is known whether nutrition could play a role in modulating various aspects of immune-inflammatory responses. Our aim is to assess the effect of isocaloric animal and plant protein dietary interventions on selected biomarkers representing various immune-inflammatory pathways. METHODS: We enrolled 37 participants with type 2 diabetes (age 64 ± 6 years, body mass index 30.2 ± 3.6 kg/m2, glycated hemoglobin 7.0 ± 0.6%) who underwent an either high-animal protein (AP) or high-plant protein (PP) diet (30 E% protein, 40 E% carbohydrates, 30 E% fat) for 6-weeks. Clinical examinations were performed at beginning and end of the study. Levels of pro-inflammatory adipokines [chemerin, progranulin], cytokines [tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), soluble urokinase-type plasminogen activator receptor (suPAR), transforming growth factor beta 1 (TGF-ß1)], and proteins [calprotectin, lactoferrin and growth differentiation factor 15 (GDF-15)] were determined in blood serum using enzyme-linked immunosorbent assay. RESULTS: Chemerin and progranulin concentrations decreased following AP and PP diets. TGF-ß1 increased in AP and decreased in PP, whereas calprotectin increased in PP and decreased in AP. No statistically significant differences in the concentrations of IL-6, TNF-α, suPAR, lactoferrin and GDF-15 could be seen in either of the protein diet arms. CONCLUSIONS: These results suggest that both AP and PP diets may effectively reduce the levels of the pro-inflammatory adipokines chemerin and progranulin. The effects on the additional immune-inflammatory biomarkers seem to be more complex. CLINICAL TRIAL REGISTRY NUMBER: NCT02402985 (ww.clinicaltrials.gov).

Impact of Early High-protein Diet on Neurofunctional Recovery in Rats with Ischemic Stroke.

BACKGROUND Ischemic stroke, featuring high incidence, morbidity, and mortality, is one of the three major diseases troubling human beings. The purpose of the study was to examine the impact of early high-protein diet on neurofunctional recovery in rats with ischemic stroke as well as their cerebral infarct areas and molecular expressions of oxidative stress. MATERIAL AND METHODS The middle cerebral artery occlusion model (MCAO) was established, and 48 adult, male Sprague Dawley (SD) rats of clean grade aged seven to eight months (250-280 g body weight) were randomized into four groups: the MCAO group with high-protein diet (MH), the MCAO group with standard-protein diet (MS), the sham group with high-protein diet (SH), and the sham group with standard-protein diet (SS). High-protein diet intervention started on the first day of the surgery, and the rats' body weights and their neurological deficit scores were measured on each postoperative day while the scores of motors coordination and balance ability were recorded every other day. In addition, their cerebral infant areas and the molecular expressions of oxidative stress injuries were detected as well. RESULTS Compared to the MS group, the rats in the MH group gained faster weight growth (p<0.05), presented significantly lower neurological impairment scores (p<0.05), remarkably improved motor coordination and balance ability (p<0.05) as well as showed smaller cerebral infarct areas (p<0.05), increased expression of SOD (superoxide dismutase), and reduced expressions of MDA (malondialdehyde) and iNOS (inducible nitric oxide synthase). However, there was no significant difference between the SS group and the SH group (p>0.05). CONCLUSIONS Early high-protein diet facilitates the recovery of body weights and neurological functions as well the reduction of the cerebral infarct areas of rats, thus alleviating ischemic stroke-caused oxidative stress injuries.

Calidad proteica de la dieta en lactantes con desnutrición severa / Protein quality in the diet of infants with severe malnutrition

Introducción: la desnutrición severa infantil constituye un problema vigente en países pobres, porque los requerimientos nutrimentales se proporcionan de manera inadecuada. Las necesidades proteicas relacionadas con la tasa de crecimiento, se reflejan en la cantidad requerida de aminoácidos esenciales; del total de proteínas, la dieta de adultos debe contener 15 por ciento, y la de lactantes entre 33 y 37 por ciento de estos aminoácidos. La calidad proteica se obtiene calculando el escore de aminoácidos, a partir del cual se diseñó el patrón seguro para diferentes grupos de edades, que incluye composición en aminoácidos esenciales, sus proporciones y digestibilidad, y es adecuada cuando estas proporciones satisfacen los requerimientos de nitrógeno para crecimiento, síntesis, y reparación tisular. Objetivos: determinar la calidad proteica de la dieta de lactantes con desnutrición severa, ingresados en el Hospital Francisco Icaza Bustamante de Guayaquil, Ecuador, durante el periodo 2009-2010; y los específicos, diagnosticar el tipo de desnutrición severa de los pacientes, identificar el perfil de aminoácidos en la dieta de los casos de estudio, así como establecer el valor biológico de las proteínas dietéticas que reciben. Métodos: estudio de enfoque cuantitativo, observacional, descriptivo, analítico y de corte transversal, en lactantes con diagnóstico de desnutrición severa. La población incluyó a todos los pacientes con desnutrición severa, menores de 24 meses de edad; la muestra fue de 33 pacientes, basada en criterios de selección. Para evaluar calidad proteica se utilizó el Escore de Aminoácidos Corregido por Digestibilidad Proteica, comparando el perfil dietético con las necesidades del niño(AU)

Introduction: severe childhood malnutrition is a current health problem in poor countries because nutritional requirements are inadequately met. Protein needs related to growth rates are reflected in the volume required of essential amino acids. Of the total proteins, the diet of adults should contain 15 percent and that of infants between 33 and 37 percent of these amino acids. Protein quality was obtained by estimating the score of amino acids, starting from which a safe pattern was designed for different age groups, including the composition as to essential amino acids, their proportions and digestibility. It is considered to be adequate when these proportions meet the nitrogen requirements for growth, synthesis and tissue repair. Objectives: determine the protein quality of the diet of infants with severe malnutrition staying at Francisco Icaza Bustamante hospital in Guayaquil, Ecuador, during the period 2009-2010. Specific objectives are to diagnose the type of severe malnutrition of patients, identify the amino acid profile in the diet of the study cases, and establish the biological value of the diet proteins they receive. Methods: a quantitative cross-sectional analytical descriptive observational study was conducted of infants diagnosed with severe malnutrition. The study population included all the patients with severe malnutrition aged under 24 months. The sample was 33 patients, based on selection criteria. Protein quality was evaluated with the Protein Digestibility Corrected Amino Acid Score, comparing the dietary profile with the needs of the child. Results: statistical analysis showed that all patients had several limiting amino acids in their diet. Conclusions: the diet of infants with severe malnutrition has a poor protein quality, with an amino acid coefficient inadequate for synthesis functions and the consequent negative impact on growth and development(AU)

High-Protein Foods and Physical Activity Protect Against Age-Related Muscle Loss and Functional Decline.

BACKGROUND: Some clinical trials suggest that protein supplementation enhances the effects of resistance exercise on skeletal muscle mass (SMM); fewer studies examine the effects of diets rich in protein-source foods on SMM and functional status among community-dwelling adults. METHODS: Data from the Framingham Offspring study including diet (three-day records, exams 3 and 5), physical activity (exams 2 and 4), percent SMM (%SMM) (exams 6 and 7), and functional performance (exams 5 through 8) were used to evaluate independent and combined effects of physical activity and high-protein foods on adjusted mean %SMM (using analysis of covariance) and risk of functional decline (using Cox proportional hazard's models). Analyses were adjusted for such factors as age, education, height, smoking, and fruit and grain consumption). RESULTS: Higher intakes of protein-source foods (red meat, poultry, fish, dairy, and soy, nuts, seeds and legumes) were associated with higher %SMM over 9 years, particularly among women. Men and women with higher intakes of foods from animal sources had a higher % SMM regardless of activity; beneficial effects of plant-based protein foods were only evident in physically active adults. Active subjects with higher intakes of animal or plant protein-source foods had 35% lowest risks of functional decline. Among less active individuals, only those consuming more animal protein-source foods had reduced risks of functional decline (HR: 0.7l; 95% CI: 0.50-1.01). CONCLUSION: Higher intake of animal-protein foods, alone and especially in combination with a physically active lifestyle, was associated with preservation of muscle mass and functional performance in older adults.

Influência do teor e qualidade da proteína dietética sobre o crescimento corporal e desenvolvimento de órgãos, em três gerações sucessivas de ratos / Influence of content and quality of diet protein in body growing and organ development in three successive rat generations

Cummulative effects of Brazilian Northweast Regional Basic Diet (RBD) on body growth and organ development were evaluated in three successive generations in 159 Sprague Dawley rats. The RDB group (7.83% protein ,predominantly vegetable protein and a Control group (caseine 7.80%).Virgin, 120 day-old, were mated and their first offspring formed the first generation (F1). The subsequent generations (F2 and F3) were obtained from animals from previous generations. As standard, a group receiving22% casein was used. Kruskal-Wallis and Pearson tests were used for statistics (with the level of significance at p<0.05). Comparing the proteic quality of RDB versus Control diet it was observed: a robust reduction of body weight gain, of the tail length, and food intake, as well as the relative weight of the organs in one or more generations. The quality and quantity of proteins inRBD compared to Control diet discloses a major impairement of these parameters. The results showed a perpetuation and worsening of the adverse effects induced by qualitative/quantitative protein deficient diets, throughout successive generations and the possibility of development of organic adaptation mechanisms, in an attempt to insure body growth and development of some organs

Los efectos acumulados de lo consumo de la Dieta Básica Regional (DBR) del Nordeste de Brasil fueron evaluados, em tres generaciones sucessivas en 159 ratones Sprague-Dawley, sobre el crecimento corporal y el desarrollo de órganos. Fue constituído un grupo DBR(un 7,83% de proteínas predominantemente de origem vegetal)y un grupo Control (caseína a un 7,80%). Ratas primíparas de 120 dias de edad, fueron fertilizadas y, com sus proles constituyron la primera generación (Fl). Las generaciones subsiguientes (F2 y F3) fueron obtenidas de ejemplares de las respectivas generaciones anteriores. Como padrón fue utilizado un grupo recibiendo Caseína a un 22%. Los métodos de Krushal-Wallis y de Pearson fueron usados en el tratamento estadístico de los datos (nível designificación de p < 0,05). Comparando se lacalidad de la proteína de la DBR com la de la dieta control se constató; la reducción acentuada de la curva ponderal, de lo ganancia de peso, delo anchura del rabo, de lo consumo alimentar, asi como may or peso relativo de algunos órganos,en una o más generaciones. Al confrontar lacalidad y la cantidade de proteínas de la DBR en relación com la dieta padron (Caseína a un 22%),revela agravamento acentuado de esos. Los resultados muestran perpetuacción y agravamento de los efectos nocivos inducidos porel consumo de dietas cualitativas y ocuantitativamente deficientes en proteínas através de generaciones sucessivas y la posibilidadde desarrollar mecanismos orgánicos de adaptación en el intente de asegurar el crecimento corporal y el desarrollo de algunos órganos

Os efeitos cumulativos do consumo da Dieta Básica Regional (DBR) do Nordeste do Brasil foram avaliados em três gerações sucessivas em 159 ratos Sprague Dawley sobre o crescimento corporal e o desenvolvimento de órgãos. Foi constituído um grupo DBR (7,83% de proteínas, predominantemente de origem vegetal) e um grupo Controle (caseína a 7,80%). Ratas primíparas, de 120 dias de idade, foram fertilizadas e, com suas proles, constituíram a 1ª geração (F1). As gerações subseqüentes (F2 e F3) foram obtidas de exemplares das respectivas gerações anteriores. Como Padrão,foi utilizado um grupo recebendo caseína a 22%. Os métodos de Kruskal-Wallis e de Pearson foram usados no tratamento estatístico dos dados (nível de significância de p < 0,05).Comparando-se a qualidade da proteína da DBR com a da dieta Controle constatou-se: redução acentuada da curva ponderal, de ganho de peso, do comprimento da cauda e do consumo alimentar, assim como maior peso relativo de alguns órgãos, em uma ou mais gerações. O confronto da qualidade e quantidade de proteínas da DBR em relação à dieta Padrão, revela agravamento acentuado desses parâmetros. Os resultados mostram perpetuação e agravamento dos efeitos nocivos induzidos pelo consumo de dietas qualitativa e/ou quantitativamente deficientes em proteínas, através de gerações sucessivas, e a possibilidade de se desenvolverem mecanismos orgânicos de adaptação, na tentativa de assegurar o crescimento corporal e o desenvolvimento de alguns órgãos