Plasma obestatin concentrations are negatively correlated with body mass index, insulin resistance index, and plasma leptin concentrations in obesity and anorexia nervosa.

BACKGROUND: Obestatin is a recently identified ghrelin gene product that was reported to inhibit appetite and gastric motility in contrast to ghrelin. We investigated fasting obestatin and ghrelin levels in patients with obesity and anorexia nervosa. METHODS: Fasting plasma obestatin, acyl-ghrelin, desacyl-ghrelin, leptin, glucose serum adiponectin, and insulin were measured in 10 obese subjects, 11 restricting-type anorexics, and 11 control subjects. RESULTS: Obese group had significantly lower levels of obestatin (p < .01), while anorexic group had significantly higher levels (p < .01). Obestatin was negatively correlated with body mass index (BMI) (r = -.74), glucose (r = -.56), insulin (r = -.55), leptin (r = -.66), and also with the homeostasis model assessment of insulin resistance (HOMA-R) (r = -.49) and was positively correlated with acyl-ghrelin (r = .65) and desacyl-ghrelin (r = .60). No correlation was seen between obestatin and adiponectin, but the latter was negatively correlated with both acyl-ghrelin and desacyl-ghrelin. Desacyl-ghrelin to acyl-ghrelin ratio was significantly different between anorexic and control groups (p < .05), while no difference was seen between obese and control groups. CONCLUSIONS: Both obestatin and ghrelin are increased in anorexic and decreased in obesity. We suggest that obestatin is a nutritional marker reflecting body adiposity and insulin resistance.

[Effect of vitamin C administration on gastric colonization by Helicobacter pylori]. / Efeito da administração de vitamina C sobre a colonização do estômago por Helicobacter pylori.

BACKGROUND: The conventional treatment of Helicobacter pylori infection consists on antibiotics, to which a small but significant number of patients are non-responders. Alternative treatments to the infection have been suggested, including the use of antioxidants. There has been such increasing interest upon vitamin C since it was demonstrated vitamin C concentrations in the stomach of infected patients are significant lower compared to healthy subjects. Pharmacological doses of vitamin C have been investigated for eradication of H. pylori, with controversial results. AIM: To evaluate the effect of oral administration of vitamin C on H. pylori colonization in the stomach of patients with chronic gastritis and patients with peptic ulcer who had experienced antimicrobial treatment failures. MATERIAL AND METHODS: Protocol I: randomized, double-blinded, placebo controlled study, with patients with chronic gastritis, with no previous treatment for eradication. Protocol II: open, uncontrolled study, with patients with peptic ulcer, with at least two previous treatments for eradication. Treatment consisted of 5 g vitamin C for 28 consecutive days. The effect of the treatment was evaluated by 14C-urea breath test concerning eradication rate, radioactivity variation and infection suppression. RESULTS: In Protocol I, 38 patients completed the study--21 received vitamin C and 17 received placebo 28 consecutive days. Eradication rates per-protocol analysis with vitamin C were 0, with 95% confidence interval of 0-15%. In Protocol II, eight patients completed treatment. Eradication rate was 0%, with 95% confidence interval of 0-12%. H. pylori load was not decreased. CONCLUSION: Administration of vitamin C, in a 5 g/day dosage during 28 days is neither effective for H. pylori eradication nor quantitatively alters the bacteria load in the stomach of infected patients.

Efeito da administração de vitamina C sobre a colonização do estômago por Helicobacter pylori / Effect of vitamin C administration on gastric colonization by Helicobacter pylori

RACIONAL: O tratamento convencional de Helicobacter pylori consiste na utilização de antimicrobianos, aos quais uma minoria expressiva de pacientes não responde. Tratamentos alternativos para a infecção têm sido propostos, incluindo o uso de antioxidantes. Destaque crescente tem sido atribuído à vitamina C ao se demonstrar que concentrações da mesma no estômago de indivíduos infectados com H. pylori são substancialmente menores do que as de indivíduos saudáveis. Doses farmacológicas de vitamina C foram investigadas na erradicação de H. pylori com resultados controversos. OBJETIVO: Avaliar o efeito da administração via oral de vitamina C sobre a colonização de estômago por H. pylori em pacientes infectados, com gastrite crônica ou com úlcera péptica cujos tratamentos convencionais não resultaram em erradicação. MATERIAL E MÉTODOS: Protocolo I: estudo aleatório, duplo-cego, controlado por placebo em pacientes com gastrite crônica, sem tratamento prévio para a infecção. Protocolo II: estudo aberto, não controlado em pacientes com úlcera péptica e pelo menos dois tratamentos prévios de erradicação. O tratamento consistiu em vitamina C 5 g/dia durante 28 dias consecutivos. Seu efeito foi avaliado pelo teste respiratório com 14C-uréia quanto à taxa de erradicação, à variação de radioatividade e à supressão da infecção. RESULTADOS: No protocolo I, 38 pacientes completaram o estudo, 21 recebendo vitamina C e 17 recebendo placebo durante 28 dias. A taxa de erradicação "por protocolo" com vitamina C foi zero, intervalo de confiança de 95 por cento: 0 por cento-15 por cento. No protocolo II, oito pacientes completaram o tratamento. A taxa de erradicação foi zero, com intervalo de confiança de 95 por cento: 05-32 por cento. Não houve diminuição da carga bacteriana. CONCLUSÕES: A administração de vitamina C na dosagem diária de 5 g durante 28 dias não é eficaz na erradicação de infecção por H. pylori, nem altera quantitativamente sua carga no estômago dos pacientes infectados.

[Features of Chagas' disease patients with emphasis on digestive form, in a tertiary hospital of Ribeirão Preto, SP]. / O perfil dos portadores de doença de Chagas, com ênfase na forma digestiva, em hospital terciário de Ribeirão Preto, SP.

In order to characterize the demographic and clinical profile of patients with digestive manifestations of Chagas' disease, the medical records were reviewed of patients (n = 377) currently attended at Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto with positive serologic reaction for Chagas' disease and admitted from January 2002 to March 2003. Median age was 67 years and 210 (56%) were women. Megaesophagus and/or megacolon were present in 135 patients, 59% of these had cardiopathy. For 49% of patients with digestive disease, at least two medical prescriptions of medicines for the treatment of cardiovascular diseases were found. In 66 patients, chronic comorbidities were detected. The population with digestive manifestation of Chagas' disease referred to HCFMRP is mostly geriatric, with an elevated frequency of cardiopathy, which may indicate a high risk for surgical approach to the treatment of chagasic megaesophagus and megacolon.

O perfil dos portadores de doença de Chagas, com ênfase na forma digestiva, em hospital terciário de Ribeirão Preto, SP / Features of Chagas' disease patients with emphasis on digestive form, in a tertiary hospital of Ribeirão Preto, SP

Para caracterizar o perfil clínico e demográfico dos portadores da forma digestiva da doença de Chagas atualmente atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, foram revistos 377 prontuários de pacientes com resultado positivo para reação sorológica para a doença de Chagas atendidos entre janeiro de 2002 a março de 2003. A idade mediana dos pacientes era de 67 anos e 210 (56 por cento) eram mulheres. Megaesôfago e/ou megacólon chagásicos estavam presentes em 135 pacientes, dos quais, 59 por cento apresentavam cardiopatia. Para 49 por cento dos pacientes com doença digestiva, havia prescrição de pelo menos dois medicamentos para tratamento de doença cardiovascular. Em 66 pacientes, foram detectadas comorbidades crônicas. A população de portadores da forma digestiva da doença de Chagas do HCFMRP é majoritariamente geriátrica e apresenta freqüência elevada de doenças cardiovasculares, o que sugere risco elevado das modalidades de tratamento cirúrgico do megaesôfago e megacólon.

Estado nutricional e avaliaçäo dietética de pacientes gastrectomizados / Nutritional status and dietary assessment of patients with gastrectomy

RACIONAL: O aspecto nutricional é crucial na cirurgia de gastrectomia e a reconstruçäo mais adequada do canal alimentar deve ser considerada para se reduzir o risco de desnutriçäo. A causa da desnutriçäo pós-gastrectomia näo é bem determinada, mas os mecanismos que levam à desnutriçäo säo evidentemente multifatoriais. OBJETIVO: Avaliar o estado nutricional de pacientes submetidos a diferentes tipos de reconstruçäo cirúrgica após gastrectomia total ou subtotal. PACIENTES E MÉTODOS: Foram avaliados 50 pacientes submetidos a gastrectomia 0,5-39 anos antes, 7 com reconstruçäo a Billroth I, 26 a Billroth II, 3 a Henley e 14 a Y-de-Roux, e indicaçäo cirúrgica de câncer em 21 dos pacientes. Foram utilizadas avaliaçäo nutricional subjetiva e antropométrica, e avaliaçäo dietética pelo recordatório alimentar. RESULTADOS: Segundo a avaliaçäo nutricional subjetiva, 6 dos 50 pacientes eram desnutridos moderados. O índice de massa corporal médio dos pacientes foi de 22 ± 4,75 kg/m2, a ingestäo média diária de 1624 ± 477 quilocalorias. Entre os pacientes operados por câncer, os submetidos a gastrectomia subtotal e Y-de-Roux apresentaram os maiores índices de massa corporal. Näo houve relaçäo do tempo decorrido desde a cirurgia com o índice de massa corporal ou com a ingestäo calórica. CONCLUSÕES: Entre os pacientes operados por câncer, gastrectomia subtotal com reconstruçäo Y-de-Roux se associa com melhor estado nutricional. Outros fatores, que näo a baixa ingestäo de calorias, causam a perda de peso nos pacientes submetidos a gastrectomia

[Nutritional status and dietary assessment of patients with gastrectomy]. / Estado nutricional e avaliação dietética de pacientes gastrectomizados.

BACKGROUND: Nutrition is a crucial factor in gastric resection surgery and the most suitable alimentary canal reconstruction method must be considered in order to reduce the risk of malnutrition. The cause of postgastrectomy malnutrition has not been clearly determined, but the mechanisms behind malnutrition are evidently multifactorial. AIM: To evaluate the nutritional status of patients who underwent different reconstructive procedures after total or subtotal gastrectomy. PATIENTS AND METHODS: Fifty patients who have undergone gastrectomy for 0.5-39 years were assessed. The surgical procedures used were Billroth I in 7, Billroth II in 26, Henley in 3 and Roux-en-Y in 14 of the patients. Twenty one of them have followed gastrectomy for cancer. The nutritional status was evaluated by subjective global assessment, dietary recall and anthropometry. RESULTS: According to subjective global assessment, 6 of 50 patients were mild malnourished. The mean body mass index was 22 4.75 kg/m2, the average daily calorie intake was 1624 477 Kcal. Of the patients operated for cancer, those who underwent subtotal gastrectomy followed by Roux-en-Y presented higher body mass index. No relationship between the period of time since surgery with body mass index or with calorie intake was found. CONCLUSIONS: Among patients operated for cancer, subtotal gastrectomy with Roux-en-Y reconstruction is associated with better nutritional status. Factors other than low calorie intake are the cause of weight loss in patients with gastrectomy.