Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm.

Non celiac gluten sensitivity (NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease (CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as 'foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders (irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by evidence-based agreements.

Nutrition and immune system disorders / Nutrición y trastornos del sistema inmune

INTRODUCTION: Energy and nutrients obtained through food play an important role in the development and preservation of the immune system therefore any nutritional imbalance affects its competence and integrity. OBJECTIVES: Knowing the nutritional approach on different disorders of the immune system. METHODS: A review has been carried out on the most prevalent immunological disorders in developed countries, the nutritional characteristics to which they are associated and their nutritional approach. RESULTS: Nutritional treatment for immune disorders has focused in recent years on the role of PUFA-ω3 and vitamin D. Maintaining body weight, preventing malnutrition and protein catabolism are key strategies for nutritional treatment. This should be adapted to each disease stage because it is a dynamic process. CONCLUSIONS: Nutritional treatment for immunological disorders, especially in autoimmune diseases, is not always clear because they present acute and remission states. Anorexia is one of the most characteristic symptoms derived mainly from pharmacological treatment and inflammatory processes. Diet should be dense in nutrients that prevent deterioration.Nutritional treatment of immunological disorders should aim to maintain an optimal state of nutrition during symptomatic periods, prevent their deterioration during acute episodes and improve during stable periods free of symptoms.

INTRODUCCIÓN: la energía y los nutrientes que obtenemos a través de la alimentación ejercen un papel importante en el desarrollo y preservación del sistema inmune, por lo que cualquier desequilibrio nutricional en el individuo afecta a su competencia e integridad. OBJETIVOS: conocer el abordaje nutricional sobre diferentes trastornos del sistema inmune. MÉTODOS: se ha realizado una revisión sobre los trastornos inmunológicos de mayor prevalencia en países desarrollados, las características nutricionales a los que se encuentran asociados y su abordaje nutricional. RESULTADOS: el abordaje nutricional de los trastornos inmunológicos se ha centrado en los últimos años en los AGP-ω3 y la vitamina D. Mantener el peso corporal, evitar estados de desnutrición y catabolismo proteico, son estrategias clave del tratamiento nutricional. Este debe adecuarse a cada fase de la enfermedad, por lo que se trata de un proceso dinámico. CONCLUSIONES: el abordaje nutricional de los trastornos inmunológicos, sobre todo en las enfermedades autoinmunes, no siempre es del todo claro, debido a los estados agudos y de remisión que presentan. La anorexia es uno de los síntomas más característicos, derivada del tratamiento farmacológico y el proceso inflamatorio. La dieta debe contener una elevada densidad en nutrientes que eviten el deterioro.El abordaje nutricional de los trastornos inmunológicos debe tener como objetivo mantener un estado óptimo de nutrición durante los periodos sintomáticos, prevenir su deterioro durante los episodios agudos y mejorarlo durante los periodos estables libres de sintomatología.

Nutrition and Periodontal Disease.

The identification of inflammatory periodontal disease and education in local and systemic risk factors and their management forms the foundation of the treatment of this disease. Nutrition is potentially a modifiable risk factor that could drive or abrogate the underlying oxidative stress in periodontitis. As research in this area is still in its infancy, clinical guidance on the delivery of dietary advice for susceptible patients is scarce. This paper will explain the possible mechanisms linking nutrition and periodontal disease, as well as the guidelines currently available to the dental profession. CPD/CLINICAL RELEVANCE: With a growing evidence base, an appreciation of the links between nutrition and inflammatory periodontal disease can help guide clinicians in educating patients on this potentially important modifiable risk factor.

XV Congreso SEINAP. Inmunonutrición / XV Congreso SEINAP. Immunonutrition

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Immunonutrition: methodology and applications / Inmunonutrición: metodología y aplicaciones

Immunonutrition is an emergent and interdisciplinary subject, since it comprises several aspects related to Nutrition, Immunity, Infection, Inflammation, and Injury or tissue damage, what is known as Nutrition and 4 'Is'. Within these interactions the endocrine, nervous and immune systems are involved, microbiota being a part of the last one. Nowadays, gut microbiota has been shown to play an essential role, not only in the gastrointestinal tract but also into the nervous system, because of its bilateral connection. There are several methods to study Immunonutrition, which allow measuring different immunological biomarkers to provide information about the nutritional status. However, it should be taken into account that there is not a single gold standard parameter to evaluate the cause-effect relationship between nutrition and the immune system. On the contrary, a combination of biomarkers have to be assessed depending on the different nutritional situations. Since Immunonutrition is a multidisciplinary matter as mentioned above, the study on the interactions between nutrition and the immune system has not been exclusively focused as such, but bearing in mind other systems of the organisms as well as a wide range of confounding factors and determinants coming from idiosyncratic features, genes and lifestyle of each individual. Therefore, Immunonutrition allows to study the following research fields: 1) Evaluation of nutritional status in presumably healthy people with risk of malnutrition (children, adolescents, adults, pregnant women, elderly, and sportspeople); 2) Assessment of the evolution and progress of patients with nutrition and immune-related diseases, such as food allergies, eating and metabolic disorders; 3) Evaluation of the effects of nutrients, bioactive compounds and both conventional and functional foods on the immune system; 4) Evaluation of impact of lifestyle determinants on the immune system, such as diet, food behaviour, physical activity, sedentariness, sleep quality and quantity, and as a key factor, stress (AU)

La Inmunonutrición es una materia emergente e interdisciplinar, ya que abarca distintos aspectos relacionados con la Nutrición, la Inmunidad, la Infección, la Inflamación y la Injuria o daño tisular, lo que se ha denominado como la Nutrición y las 4 'Ies'. En estas interacciones se encuentran implicados los sistemas endocrino, nervioso e inmune, formando parte la microbiota de este último. Actualmente la microbiota intestinal tiene un papel fundamental no solo a nivel del tracto gastrointestinal sino que presenta además un eje de conexión bilateral con el sistema nervioso Para el estudio de la Inmunonutrición existen diferentes biomarcadores del sistema inmune que proporcionan información acerca del estado nutricional del individuo. Sin embargo, se debe tener en cuenta que no existe un solo parámetro para evaluar la relación causa-efecto de la nutrición sobre el sistema inmunitario, sino que es un conjunto de biomarcadores a tener en cuenta dependiendo de los distintas situaciones nutricionales. Si bien está claro que se trata de una materia multidisciplinar, no solo se deben focalizar los estudios sobre las interacciones entre la nutrición y el sistema inmune de manera aislada, sino sobre otros sistemas del organismo teniendo en cuenta un gran abanico de factores de confusión y determinantes derivados de las condiciones idiosincrásicas de cada individuo, su genética y su estilo de vida. Por todo ello, la Inmunonutrición permite llevar a cabo una serie de estudios basados fundamentalmente en cuatro líneas de investigación: 1) Evaluación de poblaciones supuestamente sanas pero con riesgo de malnutrición (niños, adolescentes, adultos, gestantes, lactantes, personas mayores y deportistas), 2) Estudio de la evolución de pacientes con enfermedades relacionadas con la nutrición y el sistema inmunitario, 3) Estudio de los efectos de nutrientes, compuestos bioactivos y alimentos convencionales y funcionales sobre el sistema inmunitario; 4) Estudio del impacto del estilo de vida sobre el comportamiento del sistema inmunitario, teniendo como determinantes principales la dieta, el comportamiento alimentario, la actividad física, el sedentarismo, la calidad y cantidad de sueño, y como factor clave, el estrés (AU)

Inmunonutrición: metodología y aplicaciones / Immunonutrition: methodology and applications

La Inmunonutrición es una materia emergente e interdisciplinar, ya que abarca distintos aspectos relacionados con la Nutrición, la Inmunidad, la Infección, la Inflamación y la Injuria o daño tisular, lo que se ha denominado como la Nutrición y las 4 'Ies'. En estas interacciones se encuentran implicados los sistemas endocrino, nervioso e inmune, formando parte la microbiota de este último. Actualmente la microbiota intestinal tiene un papel fundamental no solo a nivel del tracto gastrointestinal sino que presenta además un eje de conexión bilateral con el sistema nervioso. Para el estudio de la Inmunonutrición existen diferentes biomarcadores del sistema inmune que proporcionan información acerca del estado nutricional del individuo. Sin embargo, se debe tener en cuenta que no existe un solo parámetro para evaluar la relación causa-efecto de la nutrición sobre el sistema inmunitario, sino que es un conjunto de biomarcadores a tener en cuenta dependiendo de las distintas situaciones nutricionales. Si bien está claro que se trata de una materia multidisciplinar, no solo se deben focalizar los estudios sobre las interacciones entre la nutrición y el sistema inmune de manera aislada, sino sobre otros sistemas del organismo teniendo en cuenta un gran abanico de factores de confusión y determinantes derivados de las condiciones idiosincrásicas de cada individuo, su genética y su estilo de vida. Por todo ello, la Inmunonutrición permite llevar a cabo una serie de estudios basados fundamentalmente en cuatro líneas de investigación: 1) Evaluación de poblaciones supuestamente sanas pero con riesgo de malnutrición (niños, adolescentes, adultos, gestantes, lactantes, personas mayores y deportistas), 2) Estudio de la evolución de pacientes con enfermedades relacionadas con la nutrición y el sistema inmunitario, 3) Estudio de los efectos de nutrientes, compuestos bioactivos y alimentos convencionales y funcionales sobre el sistema inmunitario; 4) Estudio del impacto del estilo de vida sobre el comportamiento del sistema inmunitario, teniendo como determinantes principales la dieta, el comportamiento alimentario, la actividad física, el sedentarismo, la calidad y cantidad de sueño, y como factor clave, el estrés (AU)

Immunonutrition is an emergent and interdisciplinary subject, since it comprises several aspects related to Nutrition, Immunity, Infection, Inflammation, and Injury or tissue damage, what is known as Nutrition and 4 'Is'. Within these interactions the endocrine, nervous and immune systems are involved, microbiota being a part of the last one. Nowadays, gut microbiota has been shown to play an essential role, not only in the gastrointestinal tract but also into the nervous system, because of its bilateral connection. There are several methods to study Immunonutrition, which allow measuring different immunological biomarkers to provide information about the nutritional status. However, it should be taken into account that there is not a single gold standard parameter to evaluate the cause-effect relationship between nutrition and the immune system. On the contrary, a combination of biomarkers have to be assessed depending on the different nutritional situations. Since Immunonutrition is a multidisciplinary matter as mentioned above, the study on the interactions between nutrition and the immune system has not been exclusively focused as such, but bearing in mind other systems of the organisms as well as a wide range of confounding factors and determinants coming from idiosyncratic features, genes and lifestyle of each individual. Therefore, Immunonutrition allows to study the following research fields: 1) Evaluation of nutritional status in presumably healthy people with risk of malnutrition (children, adolescents, adults, pregnant women, elderly, and sportspeople); 2) Assessment of the evolution and progress of patients with nutrition and immune-related diseases, such as food allergies, eating and metabolic disorders; 3) Evaluation of the effects of nutrients, bioactive compounds and both conventional and functional foods on the immune system; 4) Evaluation of impact of lifestyle determinants on the immune system, such as diet, food behaviour, physical activity, sedentariness, sleep quality and quantity, and as a key factor, stress (AU)

Inmunonutrición perioperatoria / Perioperative immunonutrition

No disponible

Exploring the influence of the gut microbiota and probiotics on health: a symposium report.

The present report describes the presentations delivered at the 7th International Yakult Symposium, 'The Intestinal Microbiota and Probiotics: Exploiting Their Influence on Health', in London on 22-23 April 2013. The following two themes associated with health risks were covered: (1) the impact of age and diet on the gut microbiota and (2) the gut microbiota's interaction with the host. The strong influence of the maternal gut microbiota on neonatal colonisation was reported, as well as rapid changes in the gut microbiome of older people who move from community living to residential care. The effects of dietary changes on gut metabolism were described and the potential influence of inter-individual microbiota differences was noted, in particular the presence/absence of keystone species involved in butyrate metabolism. Several speakers highlighted the association between certain metabolic disorders and imbalanced or less diverse microbiota. Data from metagenomic analyses and novel techniques (including an ex vivo human mucosa model) provided new insights into the microbiota's influence on coeliac, obesity-related and inflammatory diseases, as well as the potential of probiotics. Akkermansia muciniphila and Faecalibacterium prausnitzii were suggested as targets for intervention. Host-microbiota interactions were explored in the context of gut barrier function, pathogenic bacteria recognition, and the ability of the immune system to induce either tolerogenic or inflammatory responses. There was speculation that the gut microbiota should be considered a separate organ, and whether analysis of an individual's microbiota could be useful in identifying their disease risk and/or therapy; however, more research is needed into specific diseases, different population groups and microbial interventions including probiotics.

Gene expression of peripheral blood mononuclear cells as a tool in dietary intervention studies: What do we know so far?

Peripheral blood mononuclear cells (PBMCs) generally refer to monocytes and lymphocytes, representing cells of the innate and adaptive immune systems. PBMCs are a promising target tissue in the field of nutrigenomics because they seem to reflect the effects of dietary modifications at the level of gene expression. In this review, we describe and discuss the scientific literature concerning the use of gene expression at the mRNA level measured from PBMCs in dietary interventions studies conducted in humans. A search of literature was undertaken using PubMed (last assessed November 24, 2011) and 20 articles were selected for discussion. Currently, results from these studies showed that PBMCs seem to reflect liver environment and complement adipose tissue findings in transcriptomics. PBMC gene expression after dietary intervention studies can be used for studying the response of certain genes related to fatty acid and cholesterol metabolism, and to explore the response of dietary interventions in relation to inflammation. However, PBMC transcriptomics from dietary intervention studies have not resulted yet in clear confirmation of candidate genes related to disease risk. Use of microarray technology in larger well-designed dietary intervention studies is still needed for exploring PBMC potential in the field of nutrigenomics.

[Immunonutrition after trauma]. / Immunonutrition nach Trauma.

Immunonutrition may be superior to standard clinical nutrition in specific clinical situations. After severe trauma, an enteral immuno-enhancing diet, enriched with arginine, omega-3 fatty acids, and nucleotides, decreases infectious complications. During acute respiratory distress syndrome, a continuous enteral diet with high-dose omega-3 fatty acids, gamma-linolenic acid, and antioxidants improved clinical outcome. Glutamine should be administered enterally or parenterally whenever total parenteral nutrition is indicated.

Human intestinal microbiota and healthy ageing.

Earlier studies have indicated a decrease in anaerobes and bifidobacteria and a concomitant increase in enterobacteria in the intestinal microbiota with ageing. However, new data obtained with molecular techniques suggests decreased stability and increased diversity of the gut microbiota with advancing age. Further, no simple marker change in microbiota composition can be identified. Except for the reduced immune function, ageing itself may have relatively little effect on overall gastrointestinal function. Concomitant changes in nutrition, increased incidence of disease and corresponding use of medication with advancing age modify the composition of the microbial community of the gastrointestinal tract. This mini-review will focus on the recent findings on the gut microbiota of the elderly and on the potential benefits of probiotics, prebiotics and synbiotics.

Neuroimmunomodulation by nutrition in stress situations.

Stress has long been suspected to play a role in the etiology of many diseases and may be detrimental to health. Nowadays, the communication between the neuroendocrine and the immune systems is well established and there is enough evidence that the magnitude of stress-associated immune dysregulation is large enough to have health implications. In stress conditions, modulation of the immune system by the central nervous system (CNS) is mediated by a complex network of signals, showing a relationship between stress and resistance to infection. On the other hand, an adequate balanced diet plays a crucial role in the management of stress, and nutrition seems to be a critical determinant in the interactions among CNS and the immune system under stress conditions. Thus, interactions among nutrition, CNS and the immune system could be a key to understand implications in physiological stress situations. The present article will briefly review nutrition approaches on stress-related immune response and CNS communication.

The health impact of polyparasitism in humans: are we under-estimating the burden of parasitic diseases?

Parasitic infections are widespread throughout the tropics and sub-tropics, and infection with multiple parasite species is the norm rather than the exception. Despite the ubiquity of polyparasitism, its public health significance has been inadequately studied. Here we review available studies investigating the nutritional and pathological consequences of multiple infections with Plasmodium and helminth infection and, in doing so, encourage a reassessment of the disease burden caused by polyparasitism. The available evidence is conspicuously sparse but is suggestive that multiple human parasite species may have an additive and/or multiplicative impact on nutrition and organ pathology. Existing studies suffer from a number of methodological limitations and adequately designed studies are clearly necessary. Current methods of estimating the potential global morbidity due to parasitic diseases underestimate the health impact of polyparasitism, and possible reasons for this are presented. As international strategies to control multiple parasite species are rolled-out, there is a number of options to investigate the complexity of polyparasitism, and it is hoped that that the parasitological research community will grasp the opportunity to understand better the health of polyparasitism in humans.

Amino acids and immune function.

A deficiency of dietary protein or amino acids has long been known to impair immune function and increase the susceptibility of animals and humans to infectious disease. However, only in the past 15 years have the underlying cellular and molecular mechanisms begun to unfold. Protein malnutrition reduces concentrations of most amino acids in plasma. Findings from recent studies indicate an important role for amino acids in immune responses by regulating: (1) the activation of T lymphocytes, B lymphocytes, natural killer cells and macrophages; (2) cellular redox state, gene expression and lymphocyte proliferation; and (3) the production of antibodies, cytokines and other cytotoxic substances. Increasing evidence shows that dietary supplementation of specific amino acids to animals and humans with malnutrition and infectious disease enhances the immune status, thereby reducing morbidity and mortality. Arginine, glutamine and cysteine precursors are the best prototypes. Because of a negative impact of imbalance and antagonism among amino acids on nutrient intake and utilisation, care should be exercised in developing effective strategies of enteral or parenteral provision for maximum health benefits. Such measures should be based on knowledge about the biochemistry and physiology of amino acids, their roles in immune responses, nutritional and pathological states of individuals and expected treatment outcomes. New knowledge about the metabolism of amino acids in leucocytes is critical for the development of effective means to prevent and treat immunodeficient diseases. These nutrients hold great promise in improving health and preventing infectious diseases in animals and humans.

Infecção esquistossomótica aguda: produção de citocinas em camundongos desnutridos e deficientes em iNOS / Acute S. mansoni infection: production of citocinas in undernourished and iNOS deficient mice

A esquistossomose está presente em 76 países, dentre eles o Brasil, atingindo 19 estados, estando Pernambuco entre os estados com maior número de casos. Em zonas endêmicas para o Schistosoma mansoni, observa-se, freqüentemente, uma sobreposição de subnutrição e infecção parasitária. Em estudos imunológicos em animais infectados pelo S. mansoni, ocorre um predomínio inicial da resposta Th1 que contribui para a formação do granuloma agudo, com a oviposição e sua deposição nos tecidos do hospedeiro. Essa resposta Th1 sofre uma substituição progressiva por uma resposta Th2. Diante disso, este trabalho teve como objetivo estudar a resposta imune celular em camundongos deficientes em iNOS, desnutridos e com infecção esquistossomótica aguda. Foram utilizados 200 animais subdivididos em C57BL/6 KO iNOS e C57BL/6 controles submetidos às dietas hipoprotéica ou controle e infectados com 30 cercárias de S. mansoni ou não infectados. A metodologia consistiu de análise da carga parasitária, da histopatologia e morfometria do fígado, cultura de células esplênicas para se obter os sobrenadantes e dosar as citocinas (IFN- , IL-4 e IL-10). Os resultados não revelaram diferenças quanto à recuperação dos vermes nos diferentes grupos. A análise histopatológica sugere que relacionado à variável deficiência em iNOS, esta atua inibindo a resposta inflamatória dos granulomas no início da infecção. Ainda em relação a variável deficiência de iNOS, no grupo KO EI, o único parâmetro morfométrico hepático mais elevado foi o volume dos granulomas em relação ao seu controle C57 EI, salientando que a ausência de óxido nítrico sugere um aumento da reação celular em torno dos ovos. O fator dieta não interfere na resposta inflamatória entre os animais deficientes em iNOS, em todos os tempos analisados. Em relação às citocinas de um modo geral, o fator deficiência em iNOS não aumentou a resposta Th2 (IL-4 e IL-10), e por isso a resposta Th1 (IFN-g) permaneceu maior nos grupos com deficiência em iNOS. No entanto, quando a dieta hipoprotéica é associada a essa deficiência ocorre uma diminuição da resposta Th2, no início da infecção. Portanto, o fator dieta e a deficiência em iNOS não parecem atuar sinergicamente e em algumas etapas sugere efeitos conflitantes.

Interactions of malnutrition and immune impairment, with specific reference to immunity against parasites.

1. Clinical malnutrition is a heterogenous group of disorders including macronutrient deficiencies leading to body cell mass depletion and micronutrient deficiencies, and these often coexist with infectious and inflammatory processes and environmental problems. 2. There is good evidence that specific micronutrients influence immunity, particularly zinc and vitamin A. Iron may have both beneficial and deleterious effects depending on circumstances. 3. There is surprisingly slender good evidence that immunity to parasites is dependent on macronutrient intake or body composition.

Manifestações sistêmicas na doença pulmonar obstrutiva crônica / Systemic manifestations in chronic obstructive pulmonary disease

A doença pulmonar obstrutiva crônica é progressiva e está relacionada a uma resposta inflamatória anormal dos pulmões à inalação de partículas e/ou gases tóxicos, sobretudo a fumaça de cigarro. Embora acometa primariamente os pulmões, diversas manifestações extrapulmonares relacionadas a esta enfermidade têm sido descritas. O aumento do número de células inflamatórias, que resulta em produção anormal de citocinas pró-inflamatórias, e o desequilíbrio entre a formação de radicais livres e a capacidade antioxidante, resultando em sobrecarga oxidativa, provavelmente são mecanismos envolvidos na inflamação local e sistêmica. Além disso, a diminuição do condicionamento físico secundária às limitações ventilatórias pode estar envolvida no desenvolvimento de alterações musculares. A doença pulmonar obstrutiva crônica apresenta diversas manifestações sistêmicas que incluem a depleção nutricional, a disfunção dos músculos esqueléticos, que contribui para a intolerância ao exercício, e as manifestações relacionadas a co-morbidades comumente observadas nestes pacientes. Essas manifestações têm sido relacionadas à sobrevida e ao estado geral de saúde dos pacientes. Nesse sentido, esta revisão tem como objetivo discutir os achados da literatura relacionados às manifestações sistêmicas da doença pulmonar obstrutiva crônica, ressaltando o papel da inflação sistêmica, e algumas perspectivas de tratamento.

Intradialytic parenteral nutrition: comparison of olive oil versus soybean oil-based lipid emulsions.

Lipid, oxidative and inflammatory parameters are frequently altered in dialysis patients and may be worsened by intravenous lipid emulsions (ILE). We assessed the efficacy and tolerance of olive as compared with standard soybean oil-based ILE during intradialytic parenteral nutrition (IDPN). IDPN mixtures containing amino acids, glucose, and either olive oil (OO group, n 17) or soybean oil-based ILE (SO group, n 18) were administered in a 5-week randomized, double-blind study. On days 0 and 35, patients' nutritional status was assessed by BMI, normalized protein catabolic rate, predialytic creatinine, serum albumin and transthyretin; lipid metabolism by plasma LDL- and HDL-cholesterol, triacylglycerols, phospholipids, apo A-I, A-II, B, C-II, C-III, E and lipoprotein (a); oxidative status by alpha-tocopherol, retinol, selenium, glutathione peroxidase, malondialdehyde and advanced oxidized protein products; inflammatory status by serum C-reactive protein, orosomucoid, IL-2 and IL-6. No serious adverse event was observed. Significant changes were observed from day 0 to day 35 (P<0.05): nutritional criteria improved (albumin in OO; albumin, transthyretin and creatinine in SO); LDL-cholesterol, apo B, C-II, C-III and apo A-I/A-II ratio increased in both groups. HDL-cholesterol decreased in OO; apo E increased and lipoprotein (a) decreased in SO; alpha-tocopherol/cholesterol ratio increased in OO; malondialdehyde decreased in both groups; IL-2 increased in both groups. The between-group comparison only showed the following differences: alpha-tocopherol/cholesterol increased in OO; lipoprotein (a) decreased in SO. From these data, it was concluded that OO- and SO-based IDPNs similarly improved nutritional status and influenced plasma lipid, oxidative, inflammatory and immune parameters.

Systemic manifestations in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is progressive and is characterized by abnormal inflammation of the lungs in response to inhalation of noxious particles or toxic gases, especially cigarette smoke. Although this infirmity primarily affects the lungs, diverse extrapulmonary manifestations have been described. The likely mechanisms involved in the local and systemic inflammation seen in this disease include an increase in the number of inflammatory cells (resulting in abnormal production of inflammatory cytokines) and an imbalance between the formation of reactive oxygen species and antioxidant capacity (leading to oxidative stress). Weakened physical condition secondary to airflow limitation can also lead to the development of altered muscle function. Chronic obstructive pulmonary disease presents diverse systemic effects including nutritional depletion and musculoskeletal dysfunction (causing a reduction in exercise tolerance), as well as other effects related to the comorbidities generally observed in these patients. These manifestations have been correlated with survival and overall health status in chronic obstructive pulmonary disease patients. In view of these facts, the aim of this review was to discuss findings in the literature related to the systemic manifestations of chronic obstructive pulmonary disease, emphasizing the role played by systemic inflammation and evaluating various therapeutic strategies.