Osteoporosis and Hepatic Steatosis: 2 Closely Related Complications in Short-Bowel Syndrome.

BACKGROUND: Osteoporosis has scarcely been prospectively investigated in short-bowel syndrome (SBS). This prospective study was designed to evaluate incretins, adipokines, bone mass, and lipid deposits from marrow adipose tissue (MAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver (IHLs). METHODS: The study comprised 2 groups matched by gender, height, and age: the control group (CG) (9 males, 9 females) and the SBS group (SBSG) (6 males, 5 females). The SBSG was evaluated twice in an interval of 1 year (SBSG0 and SBSG1 ). The biochemical evaluation included incretins, leptin, and adiponectin. Dual-energy x-ray absorptiometry and magnetic resonance were, respectively, used to measure BMD and lipid deposits. RESULTS: Bone mineral density (BMD) was lower in the SBSG than in the CG, but there was no difference between SBSG0 and SBSG1 . There was no difference in MAT, SAT, and VAT, but IHL was lower in CG than in SBSG0 and SBSG1 . A negative correlation between MAT and third lumbar vertebrae BMD was found in the CG but not in SBSG0 or SBSG1 . There was a negative association between IHL and bone mass considering all participants (CG and SBSG0 ) (R2 = 0.38; P < .05). CONCLUSION: Appropriate nutrition assistance recovers body composition, reverts the relationship of bone mass and MAT, and mitigates bone loss in SBS. In spite of this, osteoporosis seems to be an early and persistent complication in SBS. Curiously, SBS seems to be a highly vulnerable condition for the development of hepatic steatosis and shows an association between bone mass and IHL.

Short bowel syndrome: influence of nutritional therapy and incretin GLP1 on bone marrow adipose tissue.

Energy deprivation leads to a decrease in white adipose tissue and bone mineral density (BMD), while simultaneously inducing the expansion of marrow adipose tissue (MAT). In short bowel syndrome (SBS), parenteral nutrition mitigates the deterioration of nutritional status, including decreases in MAT. Osteoporosis is, however, a frequent complication of SBS. The objective of our study here was to evaluate the association of fat deposit sites (subcutaneous and visceral adipose tissues: intrahepatic lipid (IHL) and MAT) and the incretin glucagon-like peptide 1 (GLP1) with BMD in individuals with SBS. MAT was negatively correlated with lumbar spine BMD in normal individuals, but not in those in the SBS group, who otherwise showed a positive correlation between MAT and GLP1. In addition, in individuals with SBS, IHL was negatively associated with lumbar spine BMD and positively associated with C-terminal telopeptide of type 1 collagen (a serum biomarker of bone turnover). Caloric maintenance in individuals with SBS, therefore, seems to positively affect the relationship between MAT and BMD, which may be modulated, at least in part, by GLP1.

Energy intake in short bowel syndrome: assessment by 24-h dietary recalls compared with the doubly labelled water method.

Short bowel syndrome (SBS) represents a serious intestinal absorption disorder, and patients may be prone to severe malnutrition. Dietetic therapy is critically important both for immediate prognosis and successful long-term rehabilitation. To maintain energy balance, an accurate assessment of energy intake is required. Our objective was to compare energy intake (EI) assessed by 24-h dietary recalls (EIrecall), a standard clinical assessment, with the total energy expenditure measured by the doubly labelled water (TEEdlw) method in SBS patients and matched controls. A total of twenty-two participants (eleven each in the SBS and control groups (CG), six female and five male) were evaluated; CG were matched to SBS patients on the basis of age, BMI and sex. TEE was measured by DLW and compared with EI determined by four 24-h dietary recalls using the USDA Automated Multiple-Pass Method. Bland-Altman plots and paired Student's t test were used to compare EIrecall with TEEdlw (P<0·05). Participants' mean age was 53 (sd 8) years. TEEdlw (7·85 (SD 1·16) MJ/d, 0·14 (SD 0·02) MJ/kg per d) was significantly lower (P=0·014) compared with EIrecall (11·07 (SD 3·45) MJ/d, 0·21 (SD 0·08) MJ/kg per d) in the SBS group. On the other hand, in the CG group TEEdlw (10·02 (SD 1·86) MJ/d, 0·18 (SD 0·03) MJ/kg per d) was significantly higher (P=0·001) compared with EIrecall (7·19 (SD 1·68) MJ/d, 0·13 (SD 0·03) MJ/kg per d). In SBS patients, reported EI is higher than DLW-measured EI. Therefore, providing or prescribing energetic intake based on EIrecall without accounting for potential malabsorption-related losses can compromise the energy needs in SBS patients and affect nutritional status in the long term.

Indice de masa corporal no está asociado con la oxidación de los lípidos y carbohidratos en pacientes hospitalizados / The body mass index is not associated with lipid or carbohydrate oxidation in hospitalized patients

Introducción: El balance de energía se ve influenciado por la oxidación de macronutrientes (proteínas, carbohidratos y lípidos). Objetivo: Caracterizar la utilización de sustratos en sujetos con peso normal y obesos. Metodología: se realizó una impedancia bioeléctrica y una calorimetría indirecta para determinar la oxidación de carbohidratos y lípidos de pacientes hospitalizados. Los sujetos fueron divididos en tres grupos, el grupo 1: IMC 18,5-24,9 kg / m2, grupo 2: IMC 25-29.9 kg / m2 y el grupo 3: IMC> 30 kg / m2. Los grupos de individuos se compararon mediante la prueba de ANOVA y, en algún caso, después de la prueba se aplicó el Dunn (p< 0,05 consi-derado significativo). Resultados: Se estudiaron 38 personas (11 hombres y 27 mujeres) con una edad media de 44,3±16,5 años; 18 normales, 10 con sobrepeso y 10 obesos. Los sujetos obesos tenían un mayor gasto energético en reposo que los individuos normales. Obesos y no obesos oxidan cantidades similares de carbohidratos y lípidos. Conclusiones: El índice de masa corporal no se asoció con la oxidación de los lípidos y carbohidratos en pacientes hospitalizados. La cantidad de masa sin grasa se asocia con la cantidad total de hidratos de carbono y oxidación de lípidos.

Introduction: Energy balance is influenced by the oxidation of macronutrients (proteins, carbohydrates and lipids). Objective: To characterize substrate utilization in normal weight and obese. Subjects and Methods: Bioelectrical impedance analysis and indirect calorimetry were used to determine the oxidation of carbohydrates and lipids in hospitalized patients. Subjects were divided into three groups: group 1: BMI 18.5-24.9 kg/m, group 2: BMI 25-29.9 kg / m and Group 3: BMI> 30 k/m². Groups of individuals were compared using ANOVA and, in some cases, after the Dunn test was applied (p <0.05 were considered significant). Results: 38 individuals (11 men and27 women) with a mean age of 44.3 ± 16.5 years ofwhich 18 were eutrophic, 10 overweightand10 obese. Obese subjects had higher resting energy expenditure than normal individuals. Obese and non-obese individuals oxidized similar amounts of carbohydrates and lipids. Conclusions: BMI was not associated with the oxidation oflipids and carbohydrates in hospitalized patients. The amount offat mass is associated with the total amount of carbohydrate and lipid oxidation.

Perfil do estado de saúde de mulheres climatéricas / Health status profile of climacteric women

Modelo do estudo: Estudo retrospectivo com análise de dados de prontuário. Objetivo: O presente estudo teve por objetivo verificar a freqüência de obesidade, diabetes mellitus, hipertensão arterial e dislipidemia em um grupo de mulheres climatéricas. Metodologia: Estudo das primeiras pacientes atendidas no Ambulatório do Climatério (ACLI) do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto -USP, no período de1983 a 2007. De fevereiro a abril de 2008 foram coletados dados de peso, estatura, Índice de Massa Corporal (IMC), grupo biológico, diagnóstico de hipertensão, diabetes e dislipidemia. Resultados: De 1983 a 2007, 400 pacientes tiveram seguimento no Ambulatório (ACLI), e 272 apresentavam seus prontuários com os dados do presente estudo devidamente registrados. Dessas 272pacientes, foram selecionadas 628 consultas, sendo que, portanto, em média, cada mulher teve trêsretornos. Estas mulheres tinham idade mínima de 29 e máxima de 80 anos, com IMC mediano acimade 25 kg/m2. O diagnóstico de diabetes, hipertensão e dislipidemia foi detectado em, respectivamente:32%, 68% e 54% dos casos.Conclusão: Mulheres climatéricas atendidas em um hospital de nível de atendimento terciário apresentaram um aumento do IMC e da prevalência de doenças crônicas não transmissíveis com o passar dotempo, o que faz urgir um olhar mais atento dos profissionais de saúde a esse grupo populacional.

Study design: Retrospective analysis of medical records.Purpose: This study aimed to determine the prevalence of obesity, diabetes mellitus, hypertension anddyslipidemia in a group of climacteric women.Methods: Study of the first patients treated at the Menopause Clinic (ACLI), Department of Obstetrics andGynecology, School of Medicine of Ribeirão Preto (USP), from 1983 to 2007. Data on weight, height, BMI,biological group, diagnosis of hypertension, diabetes and dyslipidemia was collected from February/2008 until April/2008. Results: From 1983 until 2007, 400 patients were followed up, and 272 had their records registered. Of these 272 patients, 628 were selected queries, and therefore, on average, each woman had three returns. Women over the age of 29 and maximum of 80 years and median BMI above 25kg/m². The prevalence of diabetes, hypertension and dyslipidemia was respectively 32%, 68% and 54%. The prevalence of NCDs and BMI was higher for the later groups. Conclusion: Climacteric women treated at a hospital level care center showed a worsening of the BMI and the prevalence of noncommunicable chronic diseases over time, which is urging a closer look at health professionals in this population group.

Ingestion of ferrous sulfate increases ferremia in patients with short bowel syndrome.

OBJECTIVE: Because short bowel syndrome is associated with iron deficiency, the objective of the present study was to monitor ferremia after the ingestion of different iron compounds and doses in enterectomized patients. METHODS: This was a randomized, double-blind, cross-over study conducted in 13 patients of both sexes in the metabolic unit of Hospital das Clínicas de Faculdade de Medicina de Ribeirão Preto-Universídade de São Paulo and was divided into two stages. Three different iron compounds, ferrous sulfate (FS), sodium iron ethylenediaminetetra-acetic acid (EDTA), and dehydrated cell fraction (DCF), were studied. The patients were randomly assigned to one of four groups receiving high-dose DCF (120mg) and low-dose DCF (5mg) and the two iron compounds. The subjects (n=7) receiving high-dose DCF participated in 2 test days. All patients receiving the physiologic dose (low-dose DCF, n=6) participated in 3 test days with a 1-mo interval between compounds. After an 8-h fast, blood samples were collected at 0.25, 0.5, 1, and 2h. Serum iron curve and the sum of the area under the curve were calculated and adjusted according to a mixed-effect linear model (P<0.05). RESULTS: Serum FS levels were higher in the 120-mg group compared with the others (P<0.005). The mean areas under the curve for FS and EDTA at the doses of 120 and 5mg of elemental iron were 238, 224, 177, and 153 microg/dL, respectively. The mean area under the curve for DCF was 165 microg/dL, with no significant difference between groups. CONCLUSION: Regardless of dose, FS was the compound that resulted in higher ferremia compared with the other doses and compounds.

Gastrointestinal transit, appetite, and energy balance in gastrectomized patients.

BACKGROUND: Alterations in gastrointestinal tract physiology after gastrectomy may affect appetite and energy balance. OBJECTIVE: The objective of this study was to examine energy balance, appetite, and gastrointestinal transit in subjects with gastrectomy. DESIGN: Seven subjects with total gastrectomy (TG) and 14 subjects with partial gastrectomy (PG), who were free from signs of recurrent disease, and 10 healthy control subjects were studied. Resting energy expenditure (REE) was measured by indirect calorimetry and compared with REE predicted by the Harris-Benedict equation (mREE/pREE%). Gastrointestinal transit was measured by scintigraphy. Habitual food intake was assessed, and appetite was measured during scintigraphy after ingestion of a test meal (361 kcal). RESULTS: Body mass index was not different among the groups. mREE/pREE% was higher in patients with PG (P < 0.01) than in control subjects. The TG group showed higher energy intake (P < 0.05) than the PG group and control subjects. Gastric emptying was faster in the PG group than in control subjects, and gastrointestinal transit was accelerated in both PG and TG groups. An intense, precocious postprandial fullness and a relatively early recovery of hunger and prospective consumption sensations were seen in these patients. CONCLUSIONS: Patients with PG or TG have higher than predicted energy expenditure, which in TG seems to be compensated for by increased energy intake. These patients have preserved postprandial appetite responses and precocious postprandial fullness, which seem to be associated with disturbances in gastrointestinal transit of the ingested meal and are likely to be independent of vagal fiber integrity or stomach-released ghrelin.

Influence of meal time on salivary circadian cortisol rhythms and weight loss in obese women.

OBJECTIVE: We aimed to determine the influence of meal time on salivary circadian cortisol rhythms and weight loss in obese women. METHODS: Twelve obese subjects (body mass index >40 kg/m(2)) were hospitalized for 64 d and then randomly assigned to one of three 18-d stages with a 5-d interval between stages. In stage 1, the subjects received a hypocaloric diet (1000 kcal/d) portioned into five meals per day. In stage 2, the subjects received the same diet between 0900 and 1100 h. In stage 3, they received the same diet between 1800 and 2000 h. Between admissions, the subjects were discharged from the hospital and consumed their usual diet at home. Salivary cortisol rhythm (in six samples collected over a 24-h period) was determined during each stage, and anthropometric, bioimpedance, indirect calorimetric, and urinary nitrogen excretion variables were measured. RESULTS: Salivary cortisol circadian rhythms were similar during all stages when measured on day 1 or 18 of treatment. Despite significant reductions in all anthropometric measurements except waist/hip ratio, no significant changes were observed in salivary cortisol rhythm after alteration of the eating hours. Starting on day 4 of treatment, nitrogen ingestion and excretion levels decreased significantly; on day 10, nitrogen balance was negative in all study stages. CONCLUSION: Administration of a hypocaloric diet led to changes in weight, body composition, resting metabolic rate, and nitrogen balance but did not significantly alter salivary circadian cortisol rhythms.

Terapia nutricional no paciente criticamente enfermo / Nutritional therapeutic for the critically ill patients

A Terapia Nutricional tem tido grande impacto na evolução do paciente grave. Sua escolha e manuseio, no entanto, têm sido alvo de dúvidas e erros freqüentes, principalmente no paciente crítico. A escolha da terapia nutricional a ser realizada, bem como sua via de administração deve levar em conta o quadro clínico e as condições gerais do paciente. A via oral/enteral de oferta de nutrientes, mais fisiológica, é a preferível. Portanto, sempre que possível, deve-se utilizar o trato gastrintestinal. Quando este não puder ser utilizado, a via parenteral está indicada, tanto no sentido de suplementar a nutrição enteral, como quando esta não consegue suprir toda a demanda de nutrientes, de que o paciente necessita. Esta revisão tem por objetivo apresentar e difundir a condução da terapia nutricional no paciente crítico, de forma prática e adequada. De maneira geral, a oferta calórica deverá atender às necessidades basais do paciente e a protéica fornecer material plástico para síntese protéica. Minerais, vitaminas e água deverão ser ajustados às necessidades e ao quadro clínico do paciente em questão

Biobehavioral influences on energy intake and adult weight gain.

U.S. adults are now gaining more weight and becoming obese at an earlier age than in previous years. The specific causes of adult weight gain are unknown, but may be attributed to a combination of factors leading to positive energy balance. U.S. food supply data indicate that Americans have had a gradual increase in energy intake since 1970, and that per capita energy intake was 1.42 MJ/d (340 kcal/d) higher in 1994 than that in 1984. In contrast, self-reported physical activity remained constant between 1990 and 1998. Taken together, these data indicate that the increasing trend in U.S. adult weight gain is primarily attributable to overconsumption of energy. Epidemiological and experimental studies in animals and humans provide strong evidence that biobehavioral factors such as dietary variety, liquid (vs. solid) energy, portion size, palatability (taste), snacking patterns, restaurant and other away-from-home food, and dietary restraint and disinhibition influence hunger, satiety and/or voluntary energy intake. When these eating behaviors are consistently experienced either separately or in combination over the long term, they are likely to facilitate overeating. We provide a brief overview of the evidence to date for the role of these biobehavioral factors in contributing to excess energy intake and increases in body weight over time.

Aspectos de enfermagem, nutriçäo, fisioterapia e serviço social no transplante de medula óssea / Nursing, nutrition, physical therapy and social work aspects of bone marrow transplantation

O sucesso do transplante de medula óssea (TMO) depende da açäo entrosada de uma variedade de profissionais, além da equipe médica, para atender as múltiplas e complexas necessidades dos pacientes submetidos ao TMO. Neste revisäo, discute-se a atuaçäo das equipes de enfermagem, nutriçäo, fisioterapia e assistência social na assistência desses pacientes. O papel dos profissionais de saúde mental (psicólogos e psiquiatras) foi tratado em um capítulo separado deste Simpósio.