ABSTRACT
OBJECTIVE: To evaluate the effectiveness and side-effect profile of the modified Atkins diet (MAD) compared to the usual diet (UD) in reducing seizure frequency among patients with drug-resistant epilepsy (DRE). METHODS: In February 2023, we conducted an extensive search in PubMed, EMBASE, and Cochrane databases to find randomized controlled trials (RCTs) comparing MAD to UD in patients with drug-resistant epilepsy (DRE) on standard anti-seizure medication (ASM). We used random-effects meta-analyses and the Risk of Bias 2 tool to evaluate treatment effects and assess the quality of the included RCTs, respectively. RESULTS: Six studies were evaluated in the meta-analysis, including 575 patients, of whom 288 (50.1 %) were randomized to the MAD. Average follow-up period was 12 weeks. MAD plus standard drug therapy was associated with a higher rate of 50 % or greater reduction in seizure frequency compared to UD plus drug therapy (RR 6.28; 95 % CI 3.52-10.50; p<0.001), both in children (RR 6.28; 95 % CI 3.43-11.49; p<0.001) and adults with DRE (RR 6.14; 95 % CI 1.15-32.66; p = 0.033). MAD was also associated with a higher seizure freedom rate compared to UD (RR 5.94; 95 % CI 1.93-18.31; p = 0.002). Five studies reported adverse events with MAD; constipation was reported in 17 % of patients (95 % CI 5-44 %), lethargy in 11 % (95 % CI 4-25 %), and anorexia in 12 % (95 % CI 8-19 %). Due to limited information about the ASM regimens, we were unable to further analyze the interaction between MAD and ASM. SIGNIFICANCE: This meta-analysis, comprising 575 patients from 6 RCTs, revealed that MAD led to higher rates of seizure freedom and underscored its role in seizure frequency reduction by 50 % or more in both adults and children, with no significant adverse events concerns.
Subject(s)
Diet, High-Protein Low-Carbohydrate , Diet, Ketogenic , Drug Resistant Epilepsy , Adult , Child , Humans , Randomized Controlled Trials as Topic , Drug Resistant Epilepsy/drug therapy , Diet, Ketogenic/adverse effects , Seizures/drug therapy , Seizures/chemically induced , Anticonvulsants/adverse effectsABSTRACT
Based on the data of employment and food demand of urban migrant workers, this paper empirically analyzed the impact of urban pension insurance on the nutritional intake structure of migrant workers. The results showed that participating in urban pension insurance can change the nutritional intake structure of migrant workers. Additionally, fat and protein replace carbohydrate as the main nutrition sources for migrant workers. After controlling the income and labor intensity of migrant workers and other factors, urban pension insurance has a positive effect on the intake of fat and protein of migrant workers for they increase by 13.5% and 8.8% respectively. There is no significant effect on the intake of carbohydrates of migrant workers. The calorie intake of migrant workers increases by 6.8% accounting for the change of nutritional intake structure. Endogenous and robustness tests showed that the above conclusions are robust. Heterogeneity analysis showed that there is no significant difference in the effect of urban pension insurance on calorie intake of migrant workers in different income levels and age groups.(AU)
Este artigo usa os dados da pesquisa de Emprego e demanda alimentar dos trabalhadores migrantes urbanos para analisar empiricamente o impacto do seguro patrimonial urbano na estrutura de ingestão nutricional dos trabalhadores migrantes. O estudo constatou que: o seguro-pensão urbano mudou a estrutura de ingestão nutricional dos trabalhadores migrantes. Gordura e proteína substituíram os carboidratos e se tornaram a principal fonte de nutrição dos trabalhadores migrantes. Depois de controlar fatores como a renda e a intensidade do trabalho dos trabalhadores migrantes, o seguro de pensão urbana aumentou significativamente a ingestão de gordura e proteína dos trabalhadores migrantes em 13,5% e 8,8%, respectivamente, enquanto a ingestão de carboidratos dos trabalhadores migrantes não foi afetada. Significativamente afetado. A transformação da estrutura de ingestão nutricional dos trabalhadores migrantes aumentou sua ingestão calórica em 6,8%. Os testes de endogenia e robustez mostram que as conclusões acima são robustas. A análise de heterogeneidade mostra que não há diferença significativa no efeito do seguro previdenciário urbano sobre o aumento da ingestão de calorias para trabalhadores migrantes de diferentes níveis de renda e diferentes grupos etários.(AU)
Subject(s)
Humans , Nutritional Requirements , Diet , Diet, High-Protein Low-Carbohydrate/economics , Dietary Fats/economicsABSTRACT
Based on the data of employment and food demand of urban migrant workers, this paper empirically analyzed the impact of urban pension insurance on the nutritional intake structure of migrant workers. The results showed that participating in urban pension insurance can change the nutritional intake structure of migrant workers. Additionally, fat and protein replace carbohydrate as the main nutrition sources for migrant workers. After controlling the income and labor intensity of migrant workers and other factors, urban pension insurance has a positive effect on the intake of fat and protein of migrant workers for they increase by 13.5% and 8.8% respectively. There is no significant effect on the intake of carbohydrates of migrant workers. The calorie intake of migrant workers increases by 6.8% accounting for the change of nutritional intake structure. Endogenous and robustness tests showed that the above conclusions are robust. Heterogeneity analysis showed that there is no significant difference in the effect of urban pension insurance on calorie intake of migrant workers in different income levels and age groups.
Este artigo usa os dados da pesquisa de Emprego e demanda alimentar dos trabalhadores migrantes urbanos para analisar empiricamente o impacto do seguro patrimonial urbano na estrutura de ingestão nutricional dos trabalhadores migrantes. O estudo constatou que: o seguro-pensão urbano mudou a estrutura de ingestão nutricional dos trabalhadores migrantes. Gordura e proteína substituíram os carboidratos e se tornaram a principal fonte de nutrição dos trabalhadores migrantes. Depois de controlar fatores como a renda e a intensidade do trabalho dos trabalhadores migrantes, o seguro de pensão urbana aumentou significativamente a ingestão de gordura e proteína dos trabalhadores migrantes em 13,5% e 8,8%, respectivamente, enquanto a ingestão de carboidratos dos trabalhadores migrantes não foi afetada. Significativamente afetado. A transformação da estrutura de ingestão nutricional dos trabalhadores migrantes aumentou sua ingestão calórica em 6,8%. Os testes de endogenia e robustez mostram que as conclusões acima são robustas. A análise de heterogeneidade mostra que não há diferença significativa no efeito do seguro previdenciário urbano sobre o aumento da ingestão de calorias para trabalhadores migrantes de diferentes níveis de renda e diferentes grupos etários.
Subject(s)
Humans , Diet , Diet, High-Protein Low-Carbohydrate/economics , Dietary Fats/economics , Nutritional RequirementsABSTRACT
O objetivo do presente estudo foi avaliar, por meio de uma revisão da literatura, evidências da utilização de dietas com restrição de carboidratos no manejo do diabetes mellitus (DM). As buscas eletrônicas e manuais foram até abril de 2019, e incluíram trabalhos publicados a partir de 2008. Foram excluídos estudos de pesquisas in vitro e em animais, revisões de literatura, livros, monografias, dissertações, teses, estudos de caso e relatos de caso. Os artigos remanescentes foram submetidos à análise de sua qualidade metodológica pela Escala JADAD cinco pontos. Um total de 19 estudos randomizados e com qualidade média de três pontos foram selecionados e analisados quanto aos tipos de dieta utilizadas, adesão, tipo de DM, tempo de intervenção, consumo reportado de carboidratos e resultados observados para os grupos controle e intervenção. Dentre os parâmetros escolhidos para mensurar os possíveis efeitos das dietas, destacaram-se alteração de peso e IMC, Hb1Ac, variabilidade ou controle glicêmico, perfil lipídico e alteração nas doses de insulina ou medicação utilizadas. Em quatro estudos não foram observadas vantagens significativas de uma dieta restrita em carboidratos, e 15 trabalhos relataram melhoras em um ou mais parâmetros. Tais resultados podem representar uma grande vantagem na adoção desta estratégia alimentar no manejo do DM e na prevenção de complicações da doença. Contudo, existem limitações nos estudos, que precisam ter suas hipóteses verificadas no longo prazo, e pesquisas adicionais devem ser realizadas para configurar uma estratégia oficial no controle do DM. (AU)
This study aimed to evaluate, through a literature review, evidence of the use of diets with carbohydrate restriction in the management of diabetes mellitus (DM). Electronic and manual searches were conducted until April 2019, including works published from 2008 onwards. Studies on in vitro and animal research, literature reviews, books, monographs, dissertations, theses, case studies and case reports were excluded. The remaining articles were submitted to analysis of their methodological quality by the five-point JADAD Scale. Nineteen randomized studies with an average quality of three points were selected and analyzed regarding the types of diet used, adherence, type of DM, time of intervention, reported consumption of carbohydrates and results observed for the control and intervention group. Among the parameters chosen to measure the possible effects of diets, weight and BMI changes, Hb1Ac, variability or glycemic control, lipid profile and changes in insulin doses or medication used stood out. In four studies, no significant advantages were observed from a carbohydraterestricted diet, and 15 studies reported improvements in one or more parameters. Such results can represent a great advantage in adopting this dietary strategy in the management of DM and in preventing complications of the disease. However, there are limitations in the studies, which need to have their hypotheses verified in the long term, and additional research must be carried out to configure an official strategy in the control of DM. (AU)
Subject(s)
Carbohydrates , Diabetes Mellitus , Diet, High-Protein Low-Carbohydrate , Dietary Carbohydrates , Diet, Fat-Restricted , Diet Therapy , Diet, Carbohydrate-RestrictedABSTRACT
The ketogenic diet is an established, effective and well-tolerated treatment in refractory epilepsy. This paper provides practical information on the administration of ketogenic diet. It goes over the standardized protocols and the new ones that allow to broaden the scope regarding the clinical management of the ketogenic diet. It addresses issues such as the implementation, counseling and follow-up as well as the application and how to proceed in special situations such as anesthesia or acute illness. Finally, the aim of this paper is to highlight the relevance of the multidisciplinary teamwork and the family support throughout this laborious but interesting treatment.
La dieta cetogénica se considera un tratamiento eficaz y bien tolerado para la epilepsia refractaria. Nuestro trabajo suministra información práctica sobre el uso de la dieta cetogénica, realizando una revisión acerca de las indicaciones clásicas y las nuevas que permiten ampliar el uso de la misma. Detallamos cómo implementar la dieta, los controles médicos en el seguimiento y la forma de actuar en situaciones especiales, tales como la anestesia o la enfermedad aguda. Se enfatiza la i mportancia del trabajo de los profesionales de las distintas especialidades y la familia como equipo, detallando los roles que ocupa cada uno en este interesante pero laborioso tratamiento.
Subject(s)
Diet, Ketogenic , Drug Resistant Epilepsy/diet therapy , Drug Resistant Epilepsy/therapy , Diet, High-Protein Low-Carbohydrate , Diet, Ketogenic/adverse effects , Diet, Ketogenic/classification , Humans , Interdisciplinary StudiesABSTRACT
La dieta cetogénica se considera un tratamiento eficaz y bien tolerado para la epilepsia refractaria. Nuestro trabajo suministra información práctica sobre el uso de la dieta cetogénica, realizando una revisión acerca de las indicaciones clásicas y las nuevas que permiten ampliar el uso de la misma. Detallamos cómo implementar la dieta, los controles médicos en el seguimiento y la forma de actuar en situaciones especiales, tales como la anestesia o la enfermedad aguda. Se enfatiza la i mportancia del trabajo de los profesionales de las distintas especialidades y la familia como equipo, detallando los roles que ocupa cada uno en este interesante pero laborioso tratamiento.
The ketogenic diet is an established, effective and well-tolerated treatment in refractory epilepsy. This paper provides practical information on the administration of ketogenic diet. It goes over the standardized protocols and the new ones that allow to broaden the scope regarding the clinical management of the ketogenic diet. It addresses issues such as the implementation, counseling and follow-up as well as the application and how to proceed in special situations such as anesthesia or acute illness. Finally, the aim of this paper is to highlight the relevance of the multidisciplinary teamwork and the family support throughout this laborious but interesting treatment.
Subject(s)
Humans , Diet, Ketogenic/classification , Diet, Ketogenic/adverse effects , Drug Resistant Epilepsy/diet therapy , Drug Resistant Epilepsy/therapy , Interdisciplinary Studies , Diet, High-Protein Low-CarbohydrateABSTRACT
BACKGROUND: Despite the well-documented importance of nutrition in optimizing performance and health, the dietary intake of soccer players has attracted little attention. AIM: We aimed to assess the pre-season dietary intake of professional soccer players and its adequacy in macro and micronutrients. METHODS: The pre-season dietary intake of 19 male athletes was assessed using a semi-structured 3-day food record. To determine dietary adequacy and excess, energy and macronutrient intake were compared with the Brazilian dietary reference values for athletes, and micronutrients were compared with the Estimated Average Requirement - EAR (minimum recommendation) and Tolerable Upper Intake Level - UL (maximum recommendation). RESULTS: Mean daily energy intake (40.74±12.81 kcal/kg) was adequate. However, there was a low carbohydrate intake (5.44±1.86 g/kg/day) and a high amount of protein and fat (1.91±0.75 and 1.27±0.50 g/kg/day, respectively). Sodium intake (3141.77±939.76 mg/day) was higher than UL (2300 mg/day), while the majority of players showed daily intake of vitamin A (74%), vitamin D (100%), folate (58%), calcium and magnesium (68%) below the EAR (625, 10 and 320 µg/day, 800 and 330 mg/day, respectively). CONCLUSION: The dietary intake of professional soccer players was adequate in energy, but inadequate in macro and micronutrients, which suggests the need to improve nutritional practices to sustain the physical demands of soccer during pre-season.
Subject(s)
Athletes , Diet, Healthy , Patient Compliance , Sports Nutritional Physiological Phenomena , Adolescent , Adult , Brazil/epidemiology , Deficiency Diseases/epidemiology , Deficiency Diseases/etiology , Deficiency Diseases/physiopathology , Deficiency Diseases/prevention & control , Diet Records , Diet, High-Protein Low-Carbohydrate/adverse effects , Energy Intake , Humans , Male , Prevalence , Recommended Dietary Allowances , Risk , Seasons , Severity of Illness Index , Soccer , Young AdultABSTRACT
BACKGROUND: Excessive weight gain is commonly observed within the first year after kidney transplantation and is associated with negative outcomes, such as graft loss and cardiovascular events. The purpose of this study is to evaluate the effect of a high protein and low glycemic-index diet on preventing weight gain after kidney transplantation. METHODS: We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3-1.4 g/kg/day) and low-glycemic index diet versus a conventional diet (0.8-1.0 g/kg/day of protein) on preventing weight gain after kidney transplantation. A total of 120 eligible patients 2 months after transplantation will be recruited. Patients with an estimated glomerular filtration rate through the modification of diet of renal disease (MDRD) formula < 30 mL/min/1.73 m2 or urinary albumin excretion > 300 mg/24 h will be excluded. Patients' diets will be allocated through simple sequential randomization. Patients will be followed-up for 12 months with nine clinic appointments with a dietitian and the evaluations will include nutritional assessment (anthropometrics, body composition, and resting metabolic rate) and laboratory tests. The primary outcome is weight maintenance or body weight gain under 5% after 12 months. Secondary outcomes include body composition, resting metabolic rate, satiety sensation, kidney function, and other metabolic parameters. DISCUSSION: Diets with higher protein content and lower glycemic index may lead to weight loss because of higher satiety sensation. However, there is a concern about the association of high protein intake and kidney damage. Nevertheless, there is little evidence on the impact of high protein intake on long-term kidney function outcome. Therefore, we designed a study to test if a high protein diet with low-glycemic index will be an effective and safe nutritional intervention to prevent weight gain in kidney transplant patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT02883777 . Registered on 3 August 2016.
Subject(s)
Glycemic Index , Kidney Transplantation , Kidney/surgery , Transplant Recipients , Weight Loss , Body Composition , Brazil , Clinical Protocols , Diet, High-Protein Low-Carbohydrate/adverse effects , Glomerular Filtration Rate , Humans , Kidney/physiopathology , Kidney Transplantation/adverse effects , Nutritional Status , Prospective Studies , Research Design , Satiety Response , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Epilepsy is a brain disorder that affects both children and adults. From the 1920s the ketogenic diet has gained prestige as another treatment option for patients with refractory epilepsy. SUBJECTS AND METHODS: A summary of the evidence will be made through a systematic review of randomized clinical trials that have compared a single ketogenic diet with other diet for the management of these patients. AIM: To determine the effectiveness of the ketogenic diet in reducing episodes of seizures in patients with refractory epilepsy. The search strategy included randomized controlled trials and controlled clinical trials. Databases used were Medline, LILACS, Central and CINAHL. RESULTS: Six articles that met our elegibility criteria. CONCLUSIONS: There is limited evidence that the ketogenic diet compared to the medium-chain triglyceride diet is more effective in reducing the frequency of seizures. There is also moderate evidence that classical ketogenic diet compared to the gradual diet (2.5:1 and 3:1) is more effective in reducing seizures. There is moderate evidence that classical ketogenic diet compared to Atkins diet is more effective in reducing the frequency of seizure. The decision to apply this type of diet should also be based on costs, preferences and safety of treatment. It should also take into account the likelihood that studies have indexing problems have been left out of the review.
TITLE: Efectividad de la dieta cetogenica en niños con epilepsia refractaria: revision sistematica.Introduccion. La epilepsia es una patologia cerebral que afecta tanto a niños como a adultos. Desde los años veinte, la dieta cetogenica ha ganado prestigio como otra opcion de tratamiento en pacientes con epilepsia refractaria. Sujetos y metodos. Se realiza una sintesis de la evidencia a traves de una revision sistematica de ensayos clinicos aleatorizados que hayan comparado una dieta cetogenica sola con otros tipos de dieta para el tratamiento de estos pacientes. Objetivo. Determinar la efectividad de la dieta cetogenica en la disminucion de los episodios de convulsiones en pacientes con epilepsia refractaria. La estrategia de busqueda incluyo ensayos clinicos aleatorizados y ensayos clinicos controlados. Las bases de datos usadas fueron: Medline, LILACS, Central y CINAHL. Resultados. Se obtuvieron seis articulos que cumplian con los criterios de elegibilidad. Conclusiones. Existe evidencia limitada de que la dieta cetogenica en comparacion con la dieta de trigliceridos de cadena media es mas efectiva en disminuir la frecuencia de las convulsiones. Existe evidencia moderada de que la dieta cetogenica clasica en comparacion con la dieta gradual (2,5:1 y 3:1) es mas efectiva para disminuir las crisis epilepticas. Existe evidencia moderada de que la dieta cetogenica clasica en comparacion con la dieta Atkins es mas efectiva para disminuir la frecuencia de convulsiones en tres meses. La decision de aplicar este tipo de dietas tambien debe basarse en costes, preferencias y seguridad del tratamiento. Ademas, debe considerarse la probabilidad de que algunos estudios, por problemas de indizacion, hayan quedado fuera de la revision.
Subject(s)
Diet, Ketogenic , Drug Resistant Epilepsy/diet therapy , Seizures/diet therapy , Child , Controlled Clinical Trials as Topic , Diet, High-Protein Low-Carbohydrate , Humans , Randomized Controlled Trials as TopicABSTRACT
Introdução: A dismorfia muscular produz mudanças na alimentação. Com ela a dieta passa a ser hiperprotéica e hipolipídica, acompanhada de diversos suplementos alimentares. Objetivos: Analisar as características da alimentação de sujeitos com dismorfia muscular. Métodos: Pesquisa transversal, descritiva interpretativa, de abordagem quali-quantitativa. Resultados: As modificações na rotina alimentar objetivam aumentar a massa muscular e/ou reduzir a gordura corporal. Houve recusas de convites à restaurantes, reuniões ou jantares, em razão das exigências dietéticas especiais. Os suplementos consumidos são hiperprotéicos, aminoácidos e termogênicos. A dieta e o consumo de suplementos alimentares são incentivados por amigos, comerciantes, professores de educação física e pelos familiares. Conclusão: o consumo excessivo e descontrolado de proteínas e a drástica redução na ingestão de lipídeos, como consequência do excessivo desejo de modificação estética entre os sujeitos com dismorfia muscular, reflete em grave problema de saúde que demanda medidas oficiais, além de uma postura adequada nas diferentes áreas da saúde, especialmente a Educação Física.
Introduction: Muscle dysmorphia produces changes in diet. With her diet becomes protein and hipolipidic, accompanied by various dietary supplements. Objectives: To analyze the characteristics of feed of subjects with muscle dysmorphia. Methods: Transversal, descriptive, interpretive, qualitative and quantitative approach. Results: Changes in dietary practices aimed at increasing muscle mass and / or reduce body fat. Been refused calls for restaurants, meetings or dinners, because of special dietary requirements. Supplements consumed are high in protein, amino acids and thermogenic. The diet and consumption of dietary supplements are encouraged by friends, businessmen, teachers of physical education and the family. Conclusion: The excessive and uncontrolled consumption of protein and a drastic reduction in dietary fat as a consequence of the excessive desire for aesthetic change between subjects with muscle dysmorphia, reflects a serious health problem that requires official action, and proper posture in different health, especially physical education.