Cardiometabolic effects of early v. delayed time-restricted eating plus energetic restriction in adults with overweight and obesity: an exploratory randomised clinical trial.

This exploratory study investigated the effects of early v. delayed time-restricted eating (TRE) plus caloric restriction (CR) on body weight, body composition and cardiometabolic parameters in adults with overweight and obesity. Adults (20-40 years) were randomised to one of three groups for 8 weeks: early time-restricted eating (eTRE; 08.00-16.00) plus CR, delayed time-restricted eating (dTRE; 12.00-20.00) plus CR or only CR (CR; 08.00-20.00). All groups were prescribed a 25 % energy deficit relative to daily energy requirements. Thirteen participants completed the study in the eTRE and CR groups and eleven in the dTRE group (n 37). After the interventions, there was no significant difference between the three groups for any of the outcomes. Compared with baseline, significant decreases were observed in the body weight (eTRE group: -4·2 kg; 95 % CI, -5·6, -2·7; dTRE group: -4·8 kg; 95 % CI, -5·9, -3·7; CR: -4·0 kg; 95 % CI, -5·9, -2·1), fat mass (eTRE group: -2·9 kg; 95 % CI, -3·9, -1·9; dTRE group: -3·6 kg; 95 % CI, -4·6, -2·5; CR: -3·1 kg; 95 % CI, -4·3, -1·8) and fasting glucose levels (eTRE group: -4 mg/dl; 95 % CI, -8, -1; dTRE group: -2 mg/dl; 95 % CI, -8, 3; CR: -3 mg/dl; 95 % CI, -8, 2). In a free-living setting, TRE with a energetic deficit, regardless of the time of day, promotes similar benefits in weight loss, body composition and cardiometabolic parameters. However, given the exploratory nature of our study, further investigation is needed to confirm these findings.

Predictive equations for evaluation for resting energy expenditure in Brazilian patients with type 2 diabetes: what can we use?

BACKGROUND: Evaluation of the resting energy expenditure (REE) is essential to ensure an appropriate dietary prescription for patients with type 2 diabetes. The aim of this record was to evaluate the accuracy of predictive equations for REE estimation in patients with type 2 diabetes, considering indirect calorimetry (IC) as the reference method. METHODS: A cross-sectional study was performed in outpatients with type 2 diabetes. Clinical, body composition by electrical bioimpedance and laboratory variables were evaluated. The REE was measured by IC (QUARK RMR, Cosmed, Rome, Italy) and estimated by eleven predictive equations. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients. RESULTS: Sixty-two patients were evaluated [50% female; mean age 63.1 ± 5.2 years; diabetes duration of 11 (1-36) years, and mean A1C of 7.6 ± 1.2%]. There was a wide variation in the accuracy of REE values predicted by equations when compared to IC REE measurement. In all patients, Ikeda and Mifflin St-Jeor equations were that most underestimated REE. And, the equations that overestimated the REE were proposed by Dietary Reference Intakes and Huang. The most accurate equations were FAO/WHO/UNO in women (- 1.8% difference) and Oxford in men (- 1.3% difference). CONCLUSION: In patients with type 2 diabetes, in the absence of IC, FAO/WHO/UNO and Oxford equations provide the best REE prediction in comparison to measured REE for women and men, respectively.

Cirrhosis affects maximal oxygen consumption, functional capacity, quality of life in patients with hepatitis C.

OBJECTIVE: The aim is assess, compare, and correlate maximal oxygen consumption (VO2max. ), functional capacity and quality of life in cirrhotic patients with hepatitis C virus (HCV) and in healthy individuals. METHODS: This case-control study included 36 participants (18 patients with HCV cirrhosis and 18 healthy individuals) matched for sex and age. VO2max was assessed using ergospirometry with an incremental load test on a cycloergometer. Functional capacity was measured by a 6-min walk test (6WT), and quality of life was assessed using the 36-Item Short-Form Health Survey (SF-36). RESULTS: Both the cirrhotic group and the control group had similar results for sex (44.4% male) and age (55.6 ± 8.31 and 55.2 ± 8.85 years, respectively). The cirrhotic group scored lower in all domains of the SF-36, on the VO2max test (cirrhotic group 16.2 [11.6-18.6] ml/kg/min; control group 19.9 [16.28-26.9]; p = 0.007) and on the 6WT (cirrhotic group 521.5 [476.25-544.75] m; control group 618.0 [570.75-643.75] m; p = 0.0001). Correlations were found between the 6WT and the VO2max (r = 0.801, p < 0.0001) and between the 6WT and quality of life (SF-361-functional capacity domain; r = 0.552, p = 0.018) only in the cirrhotic group. CONCLUSION: Patients with cirrhosis due to HCV show changes in VO2max and in functional capacity, which have a significant impact on their quality of life.

Hyperleptinemia independent of body adiposity in women with fibromyalgia.

The prevalence of overweight and obesity in patients with fibromyalgia is high, which makes these patients more likely to trigger metabolic changes. It is also uncertain whether the clinical manifestations of fibromyalgia alter the metabolism in these patients. This study investigates the influence of adiposity indicators and presence of fibromyalgia on leptin and acylated ghrelin levels, which are hormones responsible for controlling energy homeostasis. Seventeen women with fibromyalgia (patients) and fifteen healthy women (controls) were evaluated. Pain intensity, physical activity level characteristics and leptin and acylated ghrelin levels were assessed. General linear models, using a main-effects model, were used to test the effect of fibromyalgia (patients vs. controls) on the relationship of leptin and acylated ghrelin with anthropometric indicators [body mass index, waist circumference (WC) and WC by height]. Patients showed higher leptin levels (controls: 9.1 ± 6.7 vs. patients: 22.4 ± 10.6 ng/mL; p < 0.01) and lower acylated ghrelin levels (controls: 188.7 ± 103.4 vs. patients: 126.7 ± 47.8 pg/mL; p = 0.04). The anthropometric variables, entered into linear models as independent variables, significantly influenced both leptin and acylated ghrelin levels (p < 0.01). The explained variance (R(2)) of the models containing leptin was higher (R(2) = 0.52-0.61) compared to the models containing acylated ghrelin (R(2) = 0.24-0.27). When analyzing the influence of the presence of fibromyalgia (study group: women with fibromyalgia vs. healthy women), only the leptin levels were influenced. High leptin levels independent of adiposity in women with fibromyalgia may be associated with the clinical condition of this syndrome.

Insulin alone or with captopril: effects on signaling pathways (AKT and AMPK) and oxidative balance after ischemia-reperfusion in isolated hearts.

Insulin and the inhibition of the renin-angiotensin system have independent benefits for ischemia-reperfusion injury, but their combination has not been tested. Our aim was to evaluate the effects of insulin+captopril on insulin/angiotensin signaling pathways and cardiac function in the isolated heart subjected to ischemia-reperfusion. Isolated hearts were perfused (Langendorff technique) with Krebs-Henseleit (KH) buffer for 25 min. Global ischemia was induced (20 min), followed by reperfusion (30 min) with KH (group KH), KH+angiotensin-I (group A), KH+angiotensin-I+captopril (group AC), KH+insulin (group I), KH+insulin+angiotensin-I (group IA), or KH+insulin+angiotensin-I+captopril (group IAC). Group A had a 24% reduction in developed pressure and an increase in end-diastolic pressure vs. baseline, effects that were reverted in groups AC, IA, and IAC. The phosphorylation of protein kinase B (AKT) was higher in groups I and IA vs. groups KH and A. The phosphorylation of AMP-activated protein kinase (AMPK) was ∼31% higher in groups I, IA, and IAC vs. groups KH, A, and AC. The tert-butyl hydroperoxide (tBOOH)-induced chemiluminescence was lower (∼2.2 times) in all groups vs. group KH and was ∼35% lower in group IA vs. group A. Superoxide dismutase content was lower in groups A, AC, and IAC vs. group KH. Catalase activity was ∼28% lower in all groups (except group IA) vs. group KH. During reperfusion of the ischemic heart, insulin activates the AKT and AMPK pathways and inhibits the deleterious effects of angiotensin-I perfusion on SOD expression and cardiac function. The addition of captopril does not potentiate these effects.

Cocontraction and economy of triathletes and cyclists at different cadences during cycling motion.

The purpose of this study was to compare the cycling technique of triathletes and cyclists on the basis of the cocontraction of selected muscles of the lower limbs and economy at different cadences. The economy (EC) and percent cocontraction from nine triathletes and eight cyclists were compared at 60, 75, 90 and 105 rpm cadences. Tests were performed on two separate days. The maximal oxygen uptake was measured and the second ventilatory threshold (VO(2VT)) was estimated on the first day using a stationary bicycle. On the second day the four different cadences were tested at approximately 5% below the VO(2VT). The EMG activity of the rectus femoris (RF), biceps femoris (BF) and vastus lateralis (VL) was recorded and the EMG signal was normalized using the 60 rpm dynamic contraction. The percent cocontractions were calculated from RF/BF and VL/BF muscles. The EC was also calculated. The results showed that cyclists were significantly more economic, indicating that they exerted more power with less VO(2), and presented significantly lower percent cocontraction than triathletes (p<0.05). Thus, the results suggest that the cyclists had a better technique than the triathletes. The simultaneous use of the percent cocontraction and economy seems to be a good performance indicator for cyclists and triathletes.

Effective force and economy of triathletes and cyclists.

The effective force applied on the crank, the index of pedalling effectiveness, and the economy of movement at 60, 75, 90, and 105 rev/min cadences were examined in nine cyclists and eight triathletes. Tests were performed on two days. Maximal oxygen uptake was measured and the second ventilatory threshold was estimated on day 1 using a stationary bicycle. On day 2, the four different cadences were tested at about 5% below the second ventilatory threshold. A strain gauge instrumented clip-less pedal mounted on the bicycle enabled us to measure the normal and tangential forces exerted on the pedal, while the pedal and crank angles were monitored with the aid of a video system. Based on this information, the effective force and the index of pedalling effectiveness were calculated. Cyclists produced significantly more effective force and a higher index of pedalling effectiveness at 60 and 75 rev/min and were significantly more economic at all cadences than triathletes. The significant and positive correlation between effective force and economy at all cadences suggests that improvement of the effective force would reflect on economy.