Los efectos del ayuno intermitente en pacientes con Diabetes Mellitus tipo 2. Revisión sistemática / The effects of intermittent fasting in patients with type 2 Diabetes Mellitus. Systematic review

Introducción: La enfermedad de Diabetes Mellitus (DM)es considerada una de las enfermedades no transmisibles quecausa mayor morbimortalidad a nivel mundial y requiere deun elevado volumen de recursos y costes. Puesto que laforma de presentación más común es la diabetes mellitus tipo2 (DM2), se plantean nuevas estratégicas terapéuticas, comoes el uso de la dieta de ayuno intermitente como forma deafrontamiento de la enfermedad. Objetivo: Determinar los efectos del ayuno intermitenteen los pacientes con DM2, así como identificar los riesgos ybeneficios de la práctica de dicha dieta. Material y métodos: Se ha realizado una búsqueda bibliográfica en 6 bases de datos (Pubmed, Dialnet, Cochrane,Cinahl, Embase y Scopus), sobre los efectos que produce lapráctica del ayuno intermitente en personas con DM2. Se seleccionaron 16 artículos, que han sido analizados mediante lalectura crítica con el programa FLC 3.0. Resultados: Sedestacaron cambios positivos y estadísticamente significativos en los niveles de hemoglobina glicosilada (HbA1c), disminución de peso, disminución de los niveles de la glucosa en ayunas, así como los niveles de lípidosplasmáticos, el índice de masa corporal (IMC) y la circunferencia de la cintura. Como efectos adversos se observaron loseventos de hipoglucemia, pero no se vieron vinculados a lapráctica del ayuno, sino a las características personales decada paciente. Conclusiones: La dieta del ayuno intermitente en los pacientes con DM2 puede ser una herramienta eficaz que aportabeneficios a la salud de las personas siempre y cuando éstossean controlados y asesorados por profesionales adecuados. No obstante, se necesitan más estudios en humanos, con unamayor muestra de personas y más prolongados en el tiempopara obtener unos resultados más sólidos y concluyentes.(AU)

Introduction: The disease known as diabetes mellitus(DM) is generally considered one of the non communicablediseases worldwide and requires a high number of resourcesand costs for its treatment. Given that the most common formof diabetes mellitus type 2 (DM2), new therapeutical strategies are to be implemented, for instance the intermittent fasting as a way to deal with it.Objective: Determine the effects of the intermittent fasting on diagnosed DM2 patients as well as to identify the risksand benefits of carrying out this diet. Material and methods: Pubmed, Dialnet, Cochrane,Cinahl, Embase and Scopus were all used in the bibliographical research and documentation in regard with the effects produced by the implementation of the intermittentfasting on diagnosed DM2 patients. In addition, sixteen articles have been thoroughly analysed and examined throughthe FLC 3.0 Platform. Results: Positive and statistically significant changes stoodout on the levels of glycosylated haemoglobin (HbA1c),weight loss, lowering of the glucose and plasma lipids levelsduring the fasting period, a reduction of the body mass index(BMI) and the circumference of the waistline. On the contrary,hypoglycaemic events appeared as an adverse effect,nonetheless they were not associated with the practice of thefasting, but for the individual characteristics of the patients. Conclusions: The intermittent fasting on diagnosed DM2patients may suppose an efficient tool which brings healthbenefits as long as the patients are being under an adequate professional control and assessment. However, there is aneed of more longterm investigation and research on humans on a bigger scale with a larger sample in order to obtain more solid and conclusive results.(AU)

Efeito da restrição calórica e do treinamento resistido em marcadores de resistência à insulina de ratas ovariectomizadas / Effect of calorie restriction and strength training on markers of insulin resistance in ovariectomized rats

Neste estudo, avaliamos o efeito da restrição calórica e do treinamento resistido na massa corporal e na sensibilidade à insulina de ratas ovariectomizadas. 80 ratas fêmeas da linhagem Holtzman foram distribuídas em 8 grupos (n=10 cada): ovariectomizado (OVX), ovariectomizado com restrição calórica (OVX RC), ovariectomizado com treinamento resistido (OVX TR), ovariectomizado com restrição calórica e treinamento resistido (OVX TR+RC), Sham operado (SHAM), Sham com restrição calórica (SHAM RC), sham com treinamento resistido (SHAM TR), sham com restrição calórica e treinamento resistido (SHAM TR+RC). Após 13 semanas de intervenção, foram analisados: massa corporal, gordura corporal; concentrações sanguíneas de glicose, insulina e adiponectina; conteúdo de AKT total e fosforilada, pi3k e Glut 4 (nos tecidos adiposos subcutâneo e retroperitoneal). As ratas ovariectomizadas (OVX, OVX RC, OVX TR e OVX TR+RC) apresentaram maior massa corporal e gordura corporal quando comparadas ao grupo SHAM. As concentrações de glicose e insulina foram semelhantes em todos os grupos experimentais, porém a concentração de adiponectina foi menor nos grupos ovariectomizados (OVX, OVX RC, OVX TR e OVX TR+RC), quando comparados ao grupo SHAM. A RC e o TR aumentaram a concentração de adiponectina quando comparado ao grupo OVX. Não houve diferença entre os grupos em relação à via de sinalização da insulina nos tecidos adiposos subcutâneo e retroperitoneal. Concluímos que a ovariectomia causa aumento de massa e gordura corporal, levando à menor concentração de adiponectina, e que a RC e o TR alteram estas modificações

In this study, we evaluated the effect of calorie restriction and strength training on the body weight and insulin sensitivity of ovariectomized rats. Eighty female Holtzman rats were divided into eight groups (n=10 per group): ovariectomized (OVX), ovariectomized plus calorie restriction (OVX-CR), ovariectomized plus strength training (OVX-ST), ovariectomized plus strength training and calorie restriction (OVX-ST+CR), sham operated (SHAM), sham plus calorie restriction (SHAM-CR), sham plus strength training (SHAM-ST), and sham plus strength training and calorie restriction (SHAM-ST+CR). The following variables were analyzed after 13 weeks of intervention: body weight; body fat; blood concentrations of glucose, insulin and adiponectin; total and phosphorylated AKT content; pi3k and Glut 4 (in subcutaneous and retroperitoneal adipose tissues). Ovariectomized rats (OVX, OVX-CR, OVX-ST, and OVX-ST+CR) had a higher body weight and body fat than SHAM animals. Glucose and insulin concentrations were similar in all experimental groups, but adiponectin concentration was lower in the ovariectomized groups (OVX, OVX-CR, OVX-ST, and OVX-ST+CR) when compared to the SHAM group. Calorie restriction and ST increased the concentration of adiponectin when compared to the OVX group. There was no difference between groups in terms of insulin signaling in subcutaneous or retroperitoneal adipose tissue. We conclude that ovariectomy increases body weight and body fat, reducing adiponectin concentration, and that CR and ST alter these modifications

Prevalencia de enfermedad celíaca en niños y adolescentes diabéticos / Prevalence of celiac disease in diabetic children and adolescents

Background: Celiac disease is more common in patients with insulindependent diabetes than in the general population. Aim: To detect celiac disease in diabetic children and adolescent. Patients and methods: Iga antigliadin, IgG antireticulin and IgG antiendomysium antibodies were measured in 67 diabetic children (35 female), aged between 4 and 18 years old. Results : Only one male adolescent, aged years old, without gastrointestinal symptoms, had a significant elevation of antirecticulin and antiendomysium antibodies. His intestinal biopsy showed subtotal villous atrophy, consisten with celiac disease. Conclusions: The prevalence of celiac disease in these diabetic children is 1:67 (1.5 percent). Similar figures have been reported elsewhere

Diet as a risk factor for diabetes

Diabetes is not a single disease entity. It is a heterogenous group of disorders characterized by metabolic abnormalities primarily of glucose but also of lipid and protein, and long-term complications involving multiple organs. Not all forms of diabetes have a relationship with diet. Among the major forms, diet has not been to be an underlying cause of Insulin-dependent and Gestational Diabetes Mellitus. In a small percentage of cases which are classified as malnutrition-related diabetes, protein-energy malnutrition is suspected to be causally related. The majority of cases of diabetes (80-90 percent) are of the noninsulin-dependent type. Diet has been suspected as a risk factor since the disease was recognized hundreds of years ago but it has been diffucult to prove even now. Contrary to the long held belief, there is no evidence that excess consumption of carbohydrate, particularly simple sugar causes diabetes. On the contrary vegetarians appear to have a lower risk of diabetes. Among the nutrients, fat particularly saturated fat still remains a suspect. A high fat diet also assumes added importance because of the higher incidence of diseases such as coronary artery disease, hypertension, stroke and peripheral vascular disease in individuals with diabetes. While no specific nutrient has been shown as a definite risk factor for diabetes, there is little doubt that obesity, particularly upper body obesity, is causally related to diabetes. A defect in insulin receptors in the cell membrane as well as post receptor events associated with obesity are the most likely causes of insulin's ineffectiveness. Thus the reduction of obesity through proper diet and regular physical exercise is the best preventive measure for reducing the incidence of diabetes. Physical activity, in addition to being a potent method of reducing obesity, helps regulate glucose metabolism. Because diabetes is associated with several other chronic diseases, the diet recommended for the control of other chronic diseases is suitable for the prevention of diabetes as well. It has been recommended, that such a diet should derive 60-70 percent of calories from complex carbohydrate, less than 30 percent from fat and not more than 10 percent from saturated fat. Increase in the consumption of fruits, vegetables, grains and legumes and decrease in meat, particularly red meat, and fat appear to meet this dietary goal. (Summary)