Post-transplant diabetes mellitus: Findings in nutritional status and body composition.

INTRODUCTION: Weight gain and changes in body composition are associated with the onset of diabetes after kidney transplantation, and detailing these changes can help prevent this situation. The study aimed to assess the prevalence of diabetes mellitus after kidney transplantation and changes in the nutritional status and body composition in patients with diabetes one year from surgery. MATERIALS AND METHODS: This survey was a single-center, prospective cohort study. Twenty-nine patients over 18 years old who underwent isolated kidney transplantation, without diabetes, were included and followed up for one year. At hospital discharge after transplantation and one year later, anthropometric (weight, height and abdominal circumference), body composition (electrical bioimpedance), routine biochemical and dietary intake assessments were performed. RESULTS: Most of the patients were male (75%), and the mean age was 48.0±11.8 years old. In the first-year post-surgery 27.6% of patients had DM and the diagnosis was made, on average, 4 months after transplantation. The group with diabetes had, from the beginning to the end of the study, greater weight and body fat, especially abdominal fat. The non-diabetic group, after one year, showed an increase in phase angle, body weight and body masses, more pronounced of fat-free mass, when compared with fat mass gain. CONCLUSIONS: Both groups showed weight gain, but in the non-diabetic group these changes can be interpreted as an improvement in the nutritional profile. Metabolic abnormalities associated with immunosuppression and eating habits, combination that maintains increased the risk for diabetes for long time, keeping this group with priority in nutritional care.

Alkaline Diet and Metabolic Acidosis: Practical Approaches to the Nutritional Management of Chronic Kidney Disease.

The kidneys play an extremely important role in maintaining the body acid-base balance by excreting nonvolatile acids and regenerating and reabsorbing bicarbonate in the kidney tubules. As the individual loses their kidney function, renal excretion of nonvolatile acid produced by metabolism of the diet is impaired, resulting in low-grade metabolic acidosis. With this in mind, it is relevant to better understand the dietary aspects related to the acid-base balance in chronic kidney disease metabolic acidosis and try to provide possible strategies for the nutritional management of these cases. The type of diet can deeply affect the body by providing acid or base precursors. Generally speaking, foods such as meat, eggs, cheese, and grains increase the production of acid in the organism, whereas fruit and vegetables are alkalizing. On the other hand, milk is considered neutral as well as fats and sugars, which have a small effect on acid-base balance. The modern Western-type diet is deficient in fruits and vegetables and contains excessive animal products. Thus metabolic acidosis may be exacerbated by a contemporary Western diet, which delivers a high nonvolatile acid load. The remaining acid is neutralized or stored within the body. Bone and muscle are lost to neutralize the acid and serum bicarbonate falls. Early studies suggest that lowering the dietary acid load with a reduced protein content and vegetable proteins replacements, associated with an increase in fruits and vegetables intake can improve the metabolic parameters of acidosis, preserve bone and muscle, and slow the glomerular filtration rate decline. More studies focusing on the effects of controlled dietary interventions among chronic kidney disease patients are needed to determining the optimal target for nutritional therapy.

Late referral for chronic kidney disease patients: nutritional point of view.

UNLABELLED: The prevalence of late referral of patients with chronic kidney disease (CKD) is high and has been associated with a worse CKD prognosis, however few studies have been conducted from a nutritional perspective. OBJECTIVE: Characterize the nutritional status of patients with CKD at first attendance in a nephrology service, with early (ER) and late referral (LR). METHODOLOGY: It was a cross-sectional study with patients older than 18 years referred to the Nephrology service of a University Hospital. The referral groups were classified according to estimated glomerular filtration rate (eGFR) as: LR (eGFR15 ml/min/1.73m2) based on the Kidney Disease Outcomes Quality Initiative. Nutritional evaluation included subjective global assessment (SGA), anthropometric, laboratory and bioelectrical impedance data. The SAS software was used for statistical analysis. RESULTS: Seventy-five patients were evaluated, 29% of them belonging to the LR group. This group showed a greater previous weight loss (-7.0 ± 3.5 versus -2.8 ± 7.0 Kg) and lower values for all anthropometric and body composition variables. In general, the laboratory results of the LR group also were worse. According to the SGA, all LR patients had some degree of malnutrition (50% with severe malnutrition against 28.8% in ER), showing significantly lower results for GFR (21.4 + 12.2 ml/ min/1.73 m2), albumin (3.9 + 0.3 g/dL), serum bicarbonate (22.8 + 5.1 mmol/L) and phase angle (5.3+ 0.6 θ). Renal function was positively correlated with percent adequacy of arm circumference (r=0,40; p<0,01) and albumin (r=0,45; p<0,01). CONCLUSION: The LR group showed a worse nutritional status showing that, for the nutritional point of view, the delayed referral brings substantial losses that can make difference in future treatment, thus demonstrating the importance of early nutritional monitoring for this population.

La prevalencia de la referencia tardía de los pacientes con enfermedad renal crónica (ERC) es alta y se ha asociado con un pronóstico peor ERC, sin embargo pocos estudios se han llevado a cabo desde una perspectiva nutricional. Objetivo: Caracterizar el estado nutricional de los pacientes con ERC con la primera cita en un servicio de nefrología, con temprana (ER) y la remisión tardía (LR). Metodología: Se realizó un estudio transversal con pacientes mayores de 18 años a que se refiere el servicio de Nefrología del Hospital Universitario. Los grupos de referencia se clasificaron de acuerdo a la tasa estimada de filtración glomerular (TFG) como: LR (TFG 15 ml / min / 1.73m2), basado en la Kidney Disease Outcomes Quality Initiative. Evaluación nutricional incluyó la evaluación subjetiva global (SGA), antropométricas, de laboratorio y los datos de impedancia bioeléctrica. El software de SAS ® se utilizó para el análisis estadístico. Resultados: Fueron evaluados setenta y cinco pacientes, el 29% de ellos pertenece al grupo LR. Este grupo mostró una pérdida mayor de peso anterior (-7,0 ± 3,5 frente a -2,8 ± 7,0 Kg) y los valores más bajos para todas las variables antropométricas y de composición corporal. En general, los resultados de laboratorio del grupo LR también eran peores. De acuerdo con el SGA, todos los pacientes tenían LR algún grado de desnutrición (50% con desnutrición severa contra 28,8% en ER), que muestra resultados significativamente más bajos de la TFG (21,4 + 12,2 ml / min / 1,73 m2), albúmina (3,9 + 0,3 g / dL), bicarbonato sérico (22,8 + 5,1 mmol / L) y ángulo de fase (5.3+ 0,6 ). La función renal se correlacionó positivamente con el porcentaje de adecuación de la circunferencia del brazo (r=0,40; p.

Study of Protein Oxidative Stress, Antioxidant Vitamins and Inflammation in Patients Undergoing either Hemodialysis or Peritoneal Dialysis.

BACKGROUND: The influence of dialysis modality on oxidative stress (OS) and inflammation is not yet clear. Elucidating this influence could provide novel therapy concepts for cardiovascular diseases. AIM: To compare protein OS, antioxidant vitamins and inflammation in patients undergoing either hemodialysis (HD) or peritoneal dialysis (PD). METHODS: A cross-sectional study was performed with 19 PD and 21 HD patients treated for ≥ 6 months. The control group was composed of 17 healthy individuals. Advanced oxidation protein products (AOPP), advanced glycation end products (AGEs), vitamins C, A and E, C-reactive protein and interleukin 6 were measured in plasma samples. RESULTS: OS was higher in the dialysis group when compared with controls, but HD patients showed higher AOPP compared with PD (HD:141.9 ± 75.2 µmol/L; PD: 112.5 ± 69.3 µmol/L, P< 0.01) and AGEs (HD: 32.2 ± 10.6 AU x10³; PD: 26.6 ± 4.9 AUx10³, P< 0.05). There was no difference in inflammation and vitamin levels among dialysis patients. In HD patients, AGEs correlated moderately with serum vitamin C (r = 0.46; P< 0.05). CONCLUSION: The dialysis modality adopted influences protein OS, but it has no effect on antioxidant status or inflammation. Hemodialysis probably exacerbates OS due to the increased bioincompatibility of the dialysis procedure, and this scenario seems to be related to the intravenous supplementation of vitamin C. Peritoneal dialysis allows for a better oxidative balance, which may reduce cardiovascular risk.

Treatment for weight loss of grade iii obese patients in the hospital environment: comparative study between hospitalization and ambulatory programs / Tratamiento para la pérdida de peso en pacientes con obesidad grado iii en ambiente hospitalario: estudio comparativo entre programas de internación y ambulatorio

Introduction: Obesity is a disease characterized by excessive accumulation of body fat with health damaging effects. Objective: To assess the impact of two programs for the treatment of grade III obesity, hospitalization and ambulatory care, on weight loss and body composition. Methods: This was a retrospective study based on the analysis of the medical records ofpatients submitted to the above programs between 1990 and2005, with evaluation of weight evolution, body circumferences (abdominal, hip and arm), fat mass (FM, kg) and fat-free mass (FFM, kg). Results: A total of 50 medical records were evaluated, 54% of them concerning patients of the hospitalization program (HP). Both programs were efficient in promoting weight loss, however, it was greater for HP. HP led to reduction of all body circumferences and of FM but its cost was 80 times higher than the ambulatory program. Conclusion: On the basis of the data evaluated, despite its much higher cost, the HP yielded more effective results in terms of weight loss and change of body composition.

Introducción: La obesidad es una enfermedad caracterizada por la acumulación excesiva de grasa corporal, con efectos nocivos para la salud. Objetivo: Evaluar el impacto de dos programas para el tratamiento de la obesidad grado III: hospitalización y ambulatorio, en la pérdida de peso y composición corporal. Método: Se realizó un estudio retrospectivo basado en el análisis de las historias clínicas de los pacientes sometidos a los dos programas, entre 1990 y 2005, con la evaluación de la evolución del peso, circunferencias corporales (cadera, abdominal, y del brazo), la masa grasa (MG, kg) y masa libre de grasa (MLG, kg). Resultados: Un total de 50 historias clínicas fueron evaluadas, siendo la mayoría (54%), de los pacientes del programa de hospitalización (PH). Los dos programas fueron eficaces en la promoción de la pérdida de peso, pero esta pérdida fue mayor para el PH; que llevó a una reducción de todas las medidas de las circunferencias corporales y de la MG. Sin embargo, su costo fue 80 veces mayor que el del programa de ambulatorio. Conclusión: Sobre la base de los datos evaluados, a pesar de su costo mucho más alto, el HP dió resultados más eficaces en términos de pérdida de peso y en el cambio de la composición corporal.

Short-term carbohydrate-restricted diet for weight loss in severely obese women.

BACKGROUND: Weight loss in bariatric pre-surgery period reduces surgical complications, surgery time, blood loss, and length of hospital stay. Carbohydrate-restricted diets have been used as an alternative for weight loss. We tested the efficacy of a low-calorie carbohydrate-restricted diet (RD) for short-term weight loss in women with severe obesity and evaluate its metabolic effects in relation to a conventional low-calorie diet (CD). METHODS: The subjects received a 1,200-kcal diet with or without carbohydrate restriction for a period of 1 week in the hospital. Nineteen obesity class III women were distributed into two groups: experimental (n = 10) and control (n = 9). The following variables were assessed at the beginning and end of the study: anthropometric measurements, body composition, resting energy expenditure, substrate oxidation, and biochemical tests. RESULTS: Compared with CD, RD led to larger weight loss (2.6 and 4.4 kg, respectively; p = 0.01) and waist circumference reduction (p < 0.01). Among the assessed biochemical indicators, only plasma and urine acetone levels were different (p < 0.01); higher values were found in the experimental group with no symptoms and other diet-related complaints. There was also a significant decrease in triglycerides and carbohydrate oxidation, as well as a significant enhancement in lipid oxidation in the RD group. CONCLUSION: Short-term RD was more efficient than CD regarding quick weight loss and waist circumference reduction, which may favor gastroplasty. Also, RD did not lead adverse metabolic effects.

Intestinal permeability and oxidative stress in patients with alcoholic pellagra.

BACKGROUND & AIMS: Increased intestinal permeability is one of the grastointestinal changes observed in alcoholic patients. However, there are no objective definitions as yet of how alcohol induces pathological changes in the various organs. The action of oxygen-free radicals during ethanol metabolism has been considered a determinant factor of these alterations. The present study was undertaken to determine the effect of niacin supplementation on intestinal permeability and oxidative stress in patients with alcoholic pellagra. METHODS: The study was divided into two phases: in Phase 1 we studied ten patients with pellagra before treatment with niacin, and in Phase 2 we studied the same patients after 27 days of treatment with niacin. Intestinal permeability was assessed by the (51)CrEDTA test and the antioxidant action of niacin supplementation was assessed by the determination of lipid peroxidation (plasma malondialdehyde, MDA), protein oxidation (plasma carbonyl group) and of the antioxidants plasma vitamin E and erythrocyte glutathione peroxidase. RESULTS: Comparison of intestinal permeability by the (51)CrEDTA test before and after niacin treatment showed a significant decrease in permeability from 4.29+/-1.92% to 1.90+/-1.19% (P<0.05). Assessment of oxidative stress showed a significant decrease (P<0.05) in lipid and protein peroxidation (MDA: 1.19+/-0.40-0.89+/-0.27 micromol/l; carbonyl groups: 2.22+/-0.36-1.84+/-0.40 nmol/mg protein). CONCLUSIONS: The results suggest that niacin and vitamin E deficiency in patients with pellagra could be important factors in increased intestinal permeability and decreased antioxidant conditions, recovering to normal values after treatment with niacin, associated to alcohol abstinence and a balanced diet.