Electrolyte beverage consumption alters electrically induced cramping threshold.

BACKGROUND: Recent investigations have questioned the role of hydration and electrolytes in cramp susceptibility and thus the efficacy of consuming electrolyte-rich carbohydrate beverages (EB) to control/prevent cramping. METHODS: Nine euhydrated, cramp-prone participants had their cramp susceptibility assessed by measuring the nerve stimulation threshold frequency at which cramping occurs (TF) before and after consumption of an EB (kCal: 120, Na: 840 mg, K: 320 mg, Mg: 5 mg) and placebo beverage (PB: kCal: 5, Na: 35 mg). Cramp intensity was assessed using a verbal pain scale and poststimulation electromyography (EMG). RESULTS: TF was greater in EB (14.86 ± 7.47 Hz) than PB (14.00 ± 5.03 Hz; P = .038) and reported pain was lower in EB (2.0 ± 0.6) than PB (2.7 ± 0.8; P = .025) while EMG was similar (P = .646). DISCUSSION: EB consumption decreased cramp susceptibility and pain but did not prevent cramping in any participants. These results suggest that electrolyte consumption independent of hydration can influence cramp susceptibility in young people.

Response to oral sucrosomial iron supplementation in patients undergoing bariatric surgery. The BARI-FER study / Respuesta a la suplementación oral con hierro sucrosomado en pacientes sometidos a cirugía bariátrica. Estudio BARI-FER

Background: Chronic intravenous iron administration is often required after bariatric surgery. Oral sucrosomial iron has a particular form of absorption and may represent an alternative treatment. Objective: To assess the effect of switching to oral sucrosomial iron in patients receiving intravenous iron supplementation after bariatric surgery. Patients and methods: A case-control study was conducted on 40 women of childbearing age, of whom 20 were switched to oral sucrosomial iron, while 20 patients continued on intravenous iron sucrose every three months. Results: No significant differences were seen in Hb, ferritin, and TSI levels before and after three months of treatment with sucrosomial iron. Conclusion: Oral sucrosomial iron could be an alternative in patients who require parenteral treatment with iron after bariatric surgery (AU)

Antecedentes: A menudo es necesaria la administración intravenosa crónica de hierro después de la cirugía bariátrica. El hierro sucrosomado oral tiene una forma especial de absorción y es un posible tratamiento alternativo. Objetivo: Valorar el efecto del cambio al hierro sucrosomado oral en los pacientes que reciben suplementos de hierro por vía intravenosa después de cirugía bariátrica. Pacientes y métodos: Se realizó un estudio de casos y controles que incluyó a 40 mujeres en edad fértil, de la que 20 se cambiaron a hierro sucrosomado oral, mientras que las 20 restantes siguieron recibiendo hierro sacarosa cada tres meses. Resultados: No se observaron diferencias importantes en los niveles de Hb, ferritina ni TSI hallados antes y después de tres meses de tratamiento con hierro sucrosomado. Conclusión: El hierro sucrosomado oral puede ser una alternativa en los pacientes que necesitan tratamiento parenteral con hierro después de cirugía bariátrica (AU)

Dietary sugars versus glucose tablets for first-aid treatment of symptomatic hypoglycaemia in awake patients with diabetes: a systematic review and meta-analysis.

BACKGROUND: While glucose tablets have been advocated for treating symptomatic hypoglycaemia in awake patients, dietary sugars may be more convenient. We performed a systematic review to compare the impact of these treatment options on the relief of symptomatic hypoglycaemia, time to resolution of symptoms, blood glucose levels, complications and hospital length of stay. METHOD: We searched PubMed, Embase and the Cochrane Library through 28 June 2016 and assessed the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach. Reference lists from a subset of the resulting articles were mined for additional, potentially eligible papers. We calculated the risk ratio (RR) of each treatment option for the preselected outcomes of interest. RESULTS: Of the 1774 identified papers, four studies met the inclusion criteria; three randomised controlled trials totalling 502 hypoglycaemic events treated with dietary sugars and 223 with glucose tablets and one observational study with 13 events treated with dietary sugars and 9 with glucose tablets. The dietary forms of sugar included sucrose, fructose, orange juice, jelly beans, Mentos, cornstarch hydrolysate, Skittles and milk. In the pooled analysis, patients treated with dietary sugars had a lower resolution of symptoms 15 min after treatment compared with glucose tablets (RR 0.89, 95% CI 0.83 to 0.95). CONCLUSIONS: When compared with dietary sugars, glucose tablets result in a higher rate of relief of symptomatic hypoglycaemia 15 min after ingestion and should be considered first, if available, when treating symptomatic hypoglycaemia in awake patients.

Overproduction of altered VLDL in an insulin-resistance rat model: influence of SREBP-1c and PPAR-X / Sobreproducción de VLDL alteradas en un modelo de insulinorresistencia de rata: influencia de SREBP-1c y PPAR-x

Background: In insulin-resistance, VLDL presents alterations that increase its atherogenic potential. The mechanism by which insulin-resistance promotes the production of altered VLDL is still not completely understood. The aim of this study was to evaluate the relationship between the expression of sterol regulatory element binding protein 1c (SREBP-1c) and of peroxisome proliferator-activated receptor-α (PPAR-α), with the features of composition and size of VLDL in an insulin-resistance rat model induced by a sucrose rich diet (SRD). Methods: The study was conducted on 12 male Wistar rats (180 g) receiving SRD (12 weeks) and 12 controls. Lipid profile, free fatty acids, glucose, and insulin were measured. Lipid content in liver and visceral fat were assessed. Isolated VLDL (d < 1.006 g/ml) was characterized by its chemical composition and size by HPLC. The respective hepatic expression of SREBP-1c and PPAR-α was determined (Western blot). Results: As expected, SRD had elevated triglycerides (TG), free fatty acids and insulin levels, and decreased HDL-cholesterol (p < 0.05), together with augmented hepatic and visceral fat (p < 0.05). SRD showed higher VLDL total mass - with increased TG content - and predominance of large VLDL (p < 0.05). SRD showed an increase in SREBP-1c (precursor and mature forms) and decreased PPAR-α expression (p < 0.045). SREBP-1c forms were positively associated with VLDL total mass (p < 0.04), VLDL-TG% (p < 0.019), and large VLDL% (p < 0.002). On the other hand, PPAR-α correlated negatively with VLDL total mass (p = 0.05), VLDL-TG% (p = 0.005), and large VLDL% (p = 0.002). Conclusions: Insulin-resistance, by coordinated activation of SREBP-1c and reduction of PPAR-α, could promote the secretion of larger and TG over-enriched VLDL particles, with greater atherogenic capacity

Introducción: En la insulinorresistencia, la VLDL presenta alteraciones que aumentan su potencial aterogénico. El mecanismo por el cual la insulinorresistencia promueve la producción de VLDL alteradas aún no se comprende completamente. Objetivo: evaluar la relación entre la expresión de la proteína ligadora de elementos reguladores de esteroles-1c (SREBP-1c) y de los receptores activados por factores de proliferación peroxisomal-α (PPAR-α) con las características de composición y tamaño de VLDL en un modelo animal de insulinorresistencia inducida por dieta rica en sacarosa (DRS). Métodos: Estudiamos 12 ratas macho Wistar (180 g) que recibieron DRS (12 semanas) y 12 controles. Se midieron el perfil lipídico, los ácidos grasos libres, la glucosa y la insulina. Se cuantificaron el contenido lipídico hapático y la grasa visceral. Se caracterizó la VLDL aislada (d < 1,006 g/ml) en composición química y tamaño (HPLC). Se determinó la expresión hepática de SREBP-1c y PPAR-α (Western-blot). Resultados: Esperadamente, el grupo DRS presentó elevación de triglicéridos (TG), ácidos grasos libres e insulina y disminución de colesterol-HDL (p < 0,05), junto con incremento de grasa hepática y visceral (p < 0,05). La DRS mostró una mayor masa total de VLDL —con mayor contenido de TG— y predominio de VLDL grandes (p < 0,05). DRS presentó expresión incrementada de SREBP-1c (precursor y maduro) y disminuida de PPAR-α (p < 0,045). Ambas formas de SREBP-1c se correlacionaron positivamente con masa total de VLDL (p < 0,04), TG%-VLDL (p < 0,019) y VLDL-grande % (p < 0,002). Mientras que PPAR-α se correlacionó negativamente con masa total de VLDL (p = 0,05), TG %-VLDL (p = 0,005) y VLDL-grande % (p = 0,002). Conclusiones: La insulinorresistencia, mediante una coordinada activación de SREBP-1c y reducción de PPAR-α, promovería la secreción de partículas de VLDL grandes y sobreenriquecidas en TG, con mayor capacidad aterogénica

Cardiovascular responses to the ingestion of sugary drinks using a randomised cross-over study design: Does glucose attenuate the blood pressure-elevating effect of fructose?

Overconsumption of sugar-sweetened beverages has been implicated in the pathogenesis of CVD. The objective of the present study was to elucidate acute haemodynamic and microcirculatory responses to the ingestion of sugary drinks made from sucrose, glucose or fructose at concentrations similar to those often found in commercial soft drinks. In a randomised cross-over study design, twelve young healthy human subjects (seven men) ingested 500 ml tap water in which was dissolved 60 g of either sucrose, glucose or fructose, or an amount of fructose equivalent to that present in sucrose (i.e. 30 g fructose). Continuous cardiovascular monitoring was performed for 30 min before and at 60 min after ingestion of sugary drinks, and measurements included beat-to-beat blood pressure (BP) and impedance cardiography. Additionally, microvascular endothelial function testing was performed after iontophoresis of acetylcholine and sodium nitroprusside using laser Doppler flowmetry. Ingestion of fructose (60 or 30 g) increased diastolic and mean BP to a greater extent than the ingestion of 60 g of either glucose or sucrose (P< 0.05). Ingestion of sucrose and glucose increased cardiac output (CO; P< 0.05), index of contractility (P< 0.05) and stroke volume (P< 0.05), but reduced total peripheral resistance (TPR; P< 0.05), which contrasts with the tendency of fructose (60 and 30 g) to increase resistance. Microvascular endothelial function did not differ in response to the ingestion of various sugary drinks. In conclusion, ingestion of fructose, but not sucrose, increases BP in healthy human subjects. Although sucrose comprises glucose and fructose, its changes in TPR and CO are more related to glucose than to fructose.

Chronic osteomyelitis management in austere environments: the International Committee of the Red Cross experience.

BACKGROUND: Chronic osteomyelitis (COM) causes major physical disability. In situations of limited resources and war zones, western world treatments are neither affordable nor sustainable. The International Committee of the Red Cross has established a COM treatment project in the Democratic Republic of Congo, with emphasis on affordability and sustainability. METHODS: One hundred and sixty-eight patients were treated for COM. The protocol focused on surgical excision of necrotic bone, physiotherapy and an open wound dressing method using granulated brown sugar. RESULTS: Seventy-one patients could be reviewed with a mean follow-up of 13.7 months (5-28 months). 46 patients (63.4%, 95% CI 52.5-75.6) had excellent/good results in terms of clinical cure of the infection, and 36 patients (50.7%, 95% CI 38.7-62.7) had seen excellent/good improvement in their functional status compared with before treatment. CONCLUSIONS: The above-mentioned treatment protocol has shown encouraging results: almost two-thirds of the patients had their infection clinically cured, and half the patients saw significant functional improvement.

Type 2 diabetes and impaired glucose tolerance are associated with word memory source monitoring recollection deficits but not simple recognition familiarity deficits following water, low glycaemic load, and high glycaemic load breakfasts.

BACKGROUND: It has been established that type 2 diabetes, and to some extent, impaired glucose tolerance (IGT), are associated with general neuropsychological impairments in episodic memory. However, the effect of abnormalities in glucose metabolism on specific retrieval processes such as source monitoring has not been investigated. The primary aim was to investigate the impact of type 2 diabetes and IGT on simple word recognition (familiarity) and complex source monitoring (recollection). A secondary aim was to examine the effect of acute breakfast glycaemic load manipulations on episodic memory. METHOD: Data are presented from two separate studies; (i) 24 adults with type 2 diabetes and 12 controls aged 45-75years, (ii) 18 females with IGT and 47 female controls aged 30-50years. Controls were matched for age, IQ, BMI, waist circumference, and depression. Recognition of previously learned words and memory for specifically which list a previously learned word had appeared in (source monitoring) was examined at two test sessions during the morning after consumption of low glycaemic load, high glycaemic load and water breakfasts according to a counterbalanced, crossover design. RESULTS: Type 2 diabetes (p<0.05) and IGT (p<0.01) were associated with significant source monitoring recollection deficits but not impairments in familiarity. Impairments were only observed in the late postprandial stage at the second test session. These impairments were not attenuated by the breakfast glycaemic load manipulations. CONCLUSIONS: Isolated source monitoring recollection deficits indicate that abnormalities in glucose metabolism are not detrimental for global episodic memory processes. This enhances our understanding of how metabolic disorders are associated with memory impairments.

[Consensus on the diagnostic and therapeutic approach to pain and stress in the newborn]. / Consenso sobre el abordaje diagnóstico y terapéutico del dolor y el estrés en el recién nacido.

Pain and stress experienced by the newborn have not been addressed adequately. Infants in neonatal intensive care units often undergo painful and stressful invasive procedures, and inappropriate treatment increases morbidity and mortality. At the 5th Clinical Consensus of the Ibero-American Society of Neonatology, 32 neonatologists from the region were invited to establish recommendations for the diagnosis and treatment of neonatal pain and stress. Key themes were explored based on the best scientific evidence available in indexed databases. All attendees participated actively in a meeting in Santiago, Chile, with the objective of reaching a consensus on recommendations and conclusions. Pain and neonatal stress affect neurological development and long-term behavior and require timely diagnosis and appropriate management and treatment, including the use of drugs with an appropriate balance between effectiveness and toxicity. The Consensus emphasized the importance of assessing pain in the newborn from a multidimensional viewpoint, and provided recommendations on the indications and limitations for an individualized pharmacological therapy. The use of analgesics has precise indications but also important limitations; there is a lack of randomized studies in newborns, and adverse effects need to be considered. Nonpharmacological measures to mitigate pain were proposed. Stress management should begin in the delivery room, including maternal contact, stimulus reduction and the implementation of intervention reduction protocols. Recommendations for improving clinical practices related to neonatal pain and stress are presented.

Refeeding syndrome in a patient with advanced kidney failure due to nephronophthisis.

Refeeding syndrome (RS) is a serious and potentially fatal disorder. It is caused by a shift of fluids, sodium, potassium, magnesium and phosphorus as well changes in the metabolism of glucose, protein, fat and vitamins following the refeeding of malnourished patients, whether enterally or parenterally. RS has rarely been reported in patients with advanced kidney disease probably due to the pre-existing hyperphosphatemia, hypermagnesemia and hyperkalemia in these patients. In the following report, we present a patient with nephronophthisis type 1 deletion syndrome in whom her main previous nutrition was limited to simply rehydration to avoid renal replacement therapy. On presentation, she was cachectic and dehydrated with advanced kidney failure. She was treated with medical nephrectomy using non-steroidal anti-inflammatory drugs and then placed on maintenance hemodialysis. Percutaneous endoscopic gastrostomy was used for her initial feeding. Care was exercised during her early refeeding with regard to correction of fluids and essential electrolytes, viz. potassium, phosphorus and magnesium, as well as multivitamins to avoid the cardiovascular and neurological complications of RS. However, the changes in the gut, pancreas and liver as well as her hyperlipidemia were a clear obstacle. Fortunately, the ileus and pancreatitis she developed on refeeding improved dramatically with a decrease of the feeding dose to half; however, the liver abnormalities and hyperlipidemia were severe and slow to recover. These improved after addition of ursodeoxycholic acid and permitted successful increase of the dose of feeding subsequently.

Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention.

Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition. In the present study, we investigated the effects of micronutrients and sugar, alone and in combination, in a beverage on growth and cognition in schoolchildren. In a 2 × 2 factorial design, children (n 414, 6-11 years) were randomly allocated to consume beverages containing (1) micronutrients with sugar, (2) micronutrients with a non-nutritive sweetener, (3) no micronutrients with sugar or (4) no micronutrients with a non-nutritive sweetener for 8.5 months. Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II (KABC-II) subtests and the Hopkins Verbal Learning Test (HVLT). Micronutrients decreased the OR for Fe deficiency at the endpoint (OR 0.19; 95% CI 0.07, 0.53). Micronutrients increased KABC Atlantis (intervention effect: 0.76; 95% CI 0.10, 1.42) and HVLT Discrimination Index (1.00; 95% CI 0.01, 2.00) scores. Sugar increased KABC Atlantis (0.71; 95% CI 0.05, 1.37) and Rover (0.72; 95% CI 0.08, 1.35) scores and HVLT Recall 3 (0.94; 95% CI 0.15, 1.72). Significant micronutrient × sugar interaction effects on the Atlantis, Number recall, Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone. Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls (micronutrients - 0.08; 95% CI - 0.15, - 0.01; sugar - 0.07; 95% CI - 0.14, - 0.002), but in combination, this effect was attenuated. The beverages with micronutrients or added sugar alone had a beneficial effect on cognition, which was attenuated when provided in combination.

Food restriction-induced hyperactivity: addiction or adaptation to famine?

Increased physical activity is present in 30-80% of anorexia nervosa patients. To explain the paradox of low food intake and excessive exercise in humans and other animals, it has been proposed that increased physical activity along with food restriction activates brain reward circuits and is addictive. Alternatively, the fleeing-famine hypothesis postulates that refusal of known scarce energy-low food sources and hyperactivity facilitate migration towards new habitats that potentially contain new energy-rich foodstuffs. The use of rewarding compounds that differ in energy density, such as the energy-free sweetener saccharin and the energy rich sucrose makes it possible to critically test the reward-addiction and fleeing-famine hypotheses. The aims of the present work were to study if sucrose and/or saccharin could attenuate food restriction-induced hyperactivity, weight loss, increased plasma corticosterone, and activation of brain structures involved in neuroendocrine control, energy balance, physical activity, and reward signaling in rats. Its major findings are that access to sucrose, but not to saccharin, attenuated food restriction-induced running wheel activity, weight loss, rises in plasma corticosterone, and expression of the cellular activation marker c-Fos in the paraventricular and arcuate hypothalamus and in the nucleus accumbens. These findings suggest that the energy-richness and easy availability of sucrose interrupted a fleeing-famine-like hyperactivity response. Since corticosterone mediates food restriction-induced wheel running (Duclos et al., 2009), we propose that the attenuating effect of sucrose consumption on plasma corticosterone plays a role in reduced wheel running and weight loss by lowering activation of the nucleus accumbens and arcuate hypothalamus in these animals.

Consumption of palatable food decreases the anorectic effects of serotonergic, but not dopaminergic drugs in baboons.

We examined the effects of periodic access to a palatable, high sugar content food (candy) in 8 male baboons on the anorectic response to d-amphetamine, which increases dopamine, and dexfenfluramine, which increases serotonin. During candy access, up to 200 candies containing 75% of energy as sugar were available during the morning on Mondays, Wednesdays and Fridays; food pellets (19% of energy as sugar) were available in the afternoon and throughout the remaining days of the week. During candy access, baboons consumed a mean of 177 pieces of candy containing 696 kcal (2.91 MJ) in the morning compared to 44 food pellets and 150 kcal (0.63 MJ) in the morning on non-candy days. Food pellet intake was lower during candy access. Complete dose-response functions for the effects of the drugs on food pellet intake on days that candy was not available were determined before, during, and after the period of access to candy. Dexfenfluramine and amphetamine produced dose-dependent decreases in food pellet intake and increases in latency to eat food pellets before, during, and after candy access. During access to candy, the dose-response function for dexfenfluramine was shifted to the right indicating the development of tolerance, while that for amphetamine was shifted to the left indicating sensitization. Only the dose-response function for dexfenfluramine returned to baseline after candy access suggesting that the difference was specific to concurrent palatable food consumption. We hypothesize that tolerance to the effects of dexfenfluramine reflects a decrease in the satiating effect of serotonin release due to repeatedly eating large amounts of palatable food.

Sugar-sweetened beverages and hypertension.

Consumption of sugar-sweetened beverages has been associated with the development and maintenance of obesity, as well as the risk for multiple obesity-related comorbidities. Some experts have hypothesized that the effect is entirely associated with excess caloric intake, while others suggest that a component of sweeteners may have a physiologic impact on the development of hypertension, insulin resistance and nonalcoholic fatty liver disease. Chen et al. have presented the first, large-scale clinical trial, assessing the direct effect of modest changes in sweetened drink consumption on blood pressure in a racially diverse population. The study team utilized data from the PREMIER: Lifestyle Interventions for Blood Pressure Control trial, in which 810 adult subjects were randomized to three groups: advice only; comprehensive lifestyle modification aimed at weight loss, increased exercise and dietary sodium reduction; or comprehensive lifestyle modification with incorporation of the Dietary Approach to Stop Hypertension (DASH) diet. Sweetened drink intake was estimated from 24-h subject recall, assessed by unscheduled phone calls to subjects at baseline, 6 months and 18 months. Over the duration of the study, a reduction of one 12-oz serving of sugar-sweetened beverages per day was associated with an average of 1.8 mmHg reduction in systolic blood pressure and an average of 1.1 mmHg reduction in diastolic blood pressure.

Effect of honey on serum cholesterol and lipid values.

Small studies have suggested that honey benefits patients with high cholesterol concentrations. The present study aimed to confirm this finding in a larger group of subjects. Sixty volunteers with high cholesterol, stratified according to gender and hydroxymethylglutaryl-coenzyme A reductase inhibitor (statin) treatment (yes/no), were randomized to receive 75 g of honey solution or a honey-comparable sugar solution once daily over a period of 14 days. Baseline measurements, including body mass index (BMI) and lipid profile, were obtained, and subjects also completed dietary questionnaires and the Inventory for the Assessment of Negative Bodily Affect-Trait form (INKA-h) questionnaire. Measurements were repeated 2 weeks later. BMI and high-density lipoprotein (HDL) cholesterol values were significantly correlated (r = -0.487; P < .001) as were BMI and a lower ratio of low-density lipoprotein (LDL) cholesterol to HDL cholesterol (r = 0.420; P < .001), meaning that subjects with a high BMI had a lower HDL cholesterol value. INKA-h scores and LDL cholesterol values were also significantly correlated (r = 0.273, P = .042). Neither solution influenced significantly cholesterol or triglyceride values in the total group; in women, however, the LDL cholesterol value increased in the sugar solution subgroup but not in the women taking honey. Although ingesting honey did not reduce LDL cholesterol values in general, women may benefit from substituting honey for sugar in their diet. Reducing the BMI lowers the LDL cholesterol value, and psychological interventions also seem important and merit further investigation.

Nutritional supplementation in monochorionic diamniotic twin pregnancies: impact on twin-twin transfusion syndrome.

Twin-to-twin transfusion syndrome (TTTS) has been related to unbalanced unidirectional arteriovenous anastomoses in the placenta of monochorionic diamniotic (DiMo) twin gestations. As maternal malnutrition accounting for hypoproteinemia and anemia has been detected in severe cases of TTTS, the purpose of this study was to evaluate the impact of early diet supplementation on TTTS. Fifty-one DiMo twin pregnancies were given commercially available oral nutritional diet supplements and then compared in a retrospective cohort study to 52 twin gestations with the same chorionicity but not subjected to nutritional supplementation. Diet supplementation was associated with lower overall incidence of TTTS (20/52 versus 8/51, P = 0.02) and with lower prevalence of TTTS at delivery (18/52 versus 6/51, P = 0.012) when compared with no supplementation. Nutritional intervention also significantly prolonged the time between the diagnosis of TTTS and delivery (9.4 +/- 3.7 weeks versus 4.6 +/- 6.5 weeks; P = 0.014). The earlier nutritional regimen was introduced, the lesser chance of detecting TTTS ( P = 0.001). Although not statistically significant, dietary intervention was also associated with lower Quintero stage, fewer invasive treatments, and lower twin birth weight discordance. Diet supplementation appears to counter maternal metabolic abnormalities in DiMo twin pregnancies and improve perinatal outcomes in TTTS when combined with the standard therapeutic options.

[Diet composition along the evolution of type 1 diabetes mellitus]. / Características da dieta nas diferentes fases da evolução do diabetes melito tipo 1.

The importance of nutrition therapy in treating diabetes mellitus has been emphasized since it was first identified, being the only effective intervention then. In Type 1 diabetes, its importance is even more pronounced due to its association with the use of exogenous insulin. Appropriate caloric ingestion in order to attain normal body weight maintains anabolism, warranting growth and development and decreases insulin resistance. The correct use of micronutrients and macronutrients is vitally important. The knowledge of carbohydrate metabolism and its association with glycemic elevation, in qualitative and quantitative aspects, is emphasized since it enables good control, especially during the postprandial period. The correct use of proteins to prevent or treat nephropathies and lipids or to avoid dyslipidemia, obesity, and cardiovascular disease are also addressed. Sucrose and artificial sweeteners should be used with care. Compliance with treatment, however, is the key to reach the desired goals.

Características da dieta nas diferentes fases da evolução do diabetes melito tipo 1 / Diet composition along the evolution of type 1 diabetes mellitus

A importância da terapia nutricional no tratamento do diabetes melito tem sido enfatizada desde os primórdios de seu conhecimento, quando era a única intervenção efetiva. No diabetes tipo 1, a dieta adequada é fundamental em conseqüência de sua conjugação com a utilização da insulina exógena. A ingestão energética adequada, para obtenção de peso normal mantém o anabolismo, assegurando crescimento e desenvolvimento, assim como diminui a resistência à insulina. O uso correto dos micro e macronutrientes é de fundamental importância. O conhecimento do metabolismo dos carboidratos e sua relação com a elevação glicêmica, em seus aspectos qualitativos e quantitativos é enfatizada por possibilitar um bom controle, principalmente no período pós-prandial. É comentada também a correta utilização de proteínas para prevenir ou tratar nefropatia e gorduras para evitar a dislipidemia, obesidade e doença cardiovascular. Sacarose e edulcorantes artificiais devem ser utilizados com critérios. A aderência ao tratamento, entretanto, é fundamental para obtenção das metas desejadas.

The importance of nutrition therapy in treating diabetes mellitus has been emphasized since it was first identified, being the only effective intervention then. In Type 1 diabetes, its importance is even more pronounced due to its association with the use of exogenous insulin. Appropriate caloric ingestion in order to attain normal body weight maintains anabolism, warranting growth and development and decreases insulin resistance. The correct use of micronutrients and macronutrients is vitally important. The knowledge of carbohydrate metabolism and its association with glycemic elevation, in qualitative and quantitative aspects, is emphasized since it enables good control, especially during the postprandial period. The correct use of proteins to prevent or treat nephropathies and lipids or to avoid dyslipidemia, obesity, and cardiovascular disease are also addressed. Sucrose and artificial sweeteners should be used with care. Compliance with treatment, however, is the key to reach the desired goals.

L-alanin-L-glutamine supplementation improves the outcome after colorectal surgery for cancer.

OBJECTIVE: To investigate the effect of l-alanine-l-glutamine (Gln) on postoperative complication rate and duration of hospitalization in patients operated for colorectal cancer. METHOD: A total of 109 patients operated with the diagnosis of colorectal cancer and given enteral nutrition between January 2001 and January 2005 were prospectively analysed. The patients were randomized and analysed in two groups; Gln group (n = 57): patients were given parenteral Gln (1 g/kg/day, Dipeptiven, Fresenuis Kabi, Germany) together with enteral nutrition (Ensure; Abbott, Zwolle, The Netherlands) and the control group (n = 52) only received enteral nutrition (Ensure; Abbott), which was a standard isonitrogenous and isocaloric formula. The supplemental enteral nutrition was provided for at least 5 days pre- and postoperatively according to the nutritional status of the patients. Age, gender, subjective global assessment (SGA), body mass index (BMI), serum albumin, protein, associated disorders, localization of pathology, techniques of anastomosis, postoperative complications and length of hospital stay were analysed for each patient. RESULTS: The duration of nutritional support in the Gln group was 6 +/- 2 and 5 +/- 1 days pre- and postoperatively; while it was 7 +/- 1 and 6 +/- 1 days for the control group, and there were no significant difference among the groups (P > 0.05). Age, gender, SGA, BMI, levels of serum albumin and protein, localization of pathology and techniques of anastomosis were also similar (P > 0.05). Wound infection (P = 0.038), intraabdominal abcess formation (P = 0.044) and wound dehiscence (P = 0.044) were significantly higher in the control group than in the Gln group. There was no significant difference in terms of anastomotic leakage and other complications between both groups (P > 0.05). Hospital stay was significantly shorter in the Gln group (P < 0.001). CONCLUSION: Supplementation of parenteral Gln decreased the postoperative complications and hospital stay and in the patients undergoing the colorectal surgery for cancer.