Parenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines.

Short bowel syndrome is a severe malabsorption disorder, and prolonged parenteral nutrition is essential for survival in some cases. Among the undesirable effects of long-term parenteral nutrition is an increase in proinflammatory cytokines. The aim of the present study was to measure the serum levels of interleukin-6, interleukin-10, tumor necrosis factor alpha, and transforming growth factor beta, in patients with short bowel syndrome on cyclic parenteral nutrition and patients who had previously received but no longer require parenteral nutrition. The study was cross-sectional and observational. Three groups were studied as follows: Parenteral nutrition group, 9 patients with short bowel syndrome that receive cyclic parenteral nutrition; Oral nutrition group, 10 patients with the same syndrome who had been weaned off parenteral nutrition for at least 1 year prior to the study; Control group, 13 healthy adults, matched for age and sex to parenteral and oral groups. The following data were collected: age, tobacco use, drug therapies, dietary intake, body weight, height, blood collection. All interleukins were significantly higher in the parenteral group compared with the control group as follows: interleukin-6: 22 ± 19 vs 1.5 ± 1.4 pg/mL, P= .0002; transforming growth factor ß: 854 ± 204 vs 607 ± 280 pg/mL, P= .04; interleukin-10: 8 ± 37 vs 0.6 ± 4, P= .03; tumor necrosis factor α: 20 ± 8 vs 8 ± 4 pg/mL, P< .0001. We concluded that parenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines.

URINARY LOSS OF MICRONUTRIENTS IN DIABETIC PATIENTS ATTENDING A TERTIARY HOSPITAL SERVICE.

BACKGROUND/AIMS: micronutrient deficiency may contribute to a poorer control of diabetes. Thus, the objective of the present study was to assess the urinary excretion of micronutrients in patients with type 2 diabetes mellitus. METHODS: patients with diabetes and controls were assessed regarding food intake, anthropometry, urinary loss of micronutrients and compared by the nonparametric Mann-Whitney test (p < 0.05). RESULTS: nine diabetic volunteers (52 ± 14 years, BMI 30 ± 11 kg/m² and abdominal circumference (AC) of 99 ± 25 cm) and 9 control individuals (51 ± 16 years, BMI 26 ± 5 kg/m² and AC of 90 ± 13 cm) were studied. Higher iron excretion was observed in the diabetic group and higher magnesium excretion in the control group. CONCLUSIONS: the type 2 diabetic patients here studied did not show increased micronutrient excretion in urine when compared to controls.

Introducción/objetivos: la deficiencia de micronutrientes puede contribuir a un menor control de la diabetes. El objetivo de este estudio fue evaluar la excreción urinaria de micronutrientes en pacientes con diabetes mellitus tipo 2. Métodos: los pacientes con diabetes y los controles fueron evaluados por la ingesta de alimentos, la antropometría, la pérdida urinaria de micronutrientes y comparados por Mann Whitney no paramétrico (p < 0,05). Resultados: fueron evaluados nueve sujetos diabéticos (52 ± 14 años con un IMC de 30 ± 11 kg/m² y la circunferencia de la cintura (CC) de 99 ± 25 cm) y nueve sujetos control (51 ± 16 años, IMC 26 ± 5 kg/m² y CA total de 90 ± 13 cm). La excreción de hierro más alta se observó en el grupo diabético y la mayor excreción de magnesio en el grupo de control. Conclusiones: el tipo 2 de pacientes diabéticos estudiados aquí no mostraron un aumento en la excreción de micronutrientes en la orina en comparación con los controles.

Anthropometric, food intake differences and applicability of low-cost instruments for the measurement of body composition in two distinct groups of individuals with short bowel syndrome.

INTRODUCTION: Short bowel syndrome is associated with weight loss due to nutrient, electrolyte and fluid malabsorption. In view of the pathophysiology of SBS, all patients would be expected to exhibit similar clinical signs and symptoms, whereas many variations occur probably due to the adaptive capacity of the remaining small intestine in order to compensate for the resected area. OBJECTIVE: To determine whether there is a difference in nutritional status and food intake between patients receiving PNT, patients who do not receive PNT but are monitored on an ambulatory basis, and control subjects, and 2) to determine body composition by two different methods, i.e., electrical bioimpedance and skin fold measurement. METHODS: This was a case-control study where the subjects were divided into three groups: parenteral group (PG) - adults with a history of SBS intermittently using PNT; ambulatory group (AG) - adults with a history of SBS who do not receive PNT; control group (CG) - adults with no history of intestinal resections and/or use of PNT. The volunteers were submitted to measurements of body weight, height, body composition by bioimpedance analysis and assessment of food intake using a food frequency questionnaire. Univariate analysis of variance (ANOVA) with the aid of the SAS® 9.2. software, using the PROC GLM feature. The Student t-test was used to compare the instruments for the assessment of body composition, with the aid of the PROC TTEST feature of the SAS® 9.2 software. RESULTS: Thirty-two volunteers, 19 women and 13 men, participated in the study. The PNT group consisted of 9 volunteers, 4 women and 5 men, with a mean (± SD) age of 57 ± 9 years. The nutrition status and food intake were different between the groups. There was no difference in percent body fat measured by anthropometry and bioimpedance analysis. DISCUSSION AND CONCLUSION: Large resections, as well as the resected portions, explain the greater nutritional impairment of PG compared to AG and CG, although no significant difference in food consumption was detected between these three groups. Since the use of PNT can lead to a state of hyperhydration, the results of BIA should be interpreted with caution, in view of the fact that the lean mass determined by this method varies positively with the hydration state of an individual.

INTRODUCCIÓN: El síndrome del intestino corto se asocia con pérdida de peso por la malabsorción de nutrientes, electrolitos y líquidos. A la vista de la fisiopatología del SIC, se esperaría que todos los pacientes exhibieran signos y síntomas clínicos similares, mientras que pueden ocurrir variaciones probablemente por la capacidad de adaptación del intestino delgado restante con el fin de compensar el área resecada. OBJETIVO: Determinar si existen diferencias en el estado nutritivo y en el consumo de alimentos entre pacientes que reciben TNP, aquellos que no reciben TNP pero que están monitorizados de forma ambulatoria e individuos control, y 2) determinar la composición corporal mediante dos métodos distintos: la bioimpedancia eléctrica y la medición del pliegue cutáneo. MÉTODOS: Éste fue un estudio de casos-control en el que se dividió a los sujetos en tres grupos: el grupo de parenteral (GP) ­ adultos con una historia de SIC y con uso intermitente de TNP; grupo ambulatorio (GA) ­ adultos con una historia de SIC que no recibían TNP; grupo control (GC) ­ adultos sin antecedentes de resecciones intestinales ni uso de TNP. Los voluntarios fueron sometidos a mediciones del peso corporal, talla, composición corporal mediante análisis de bioimpedancia y evaluación del consumo de alimentos utilizando un cuestionario de frecuencia de alimentos. Se realizó un análisis de varianza (ANOVA) con la ayuda del programa SAS® 9.2, utilizando la aplicación PROC GLM. Se empleó el test t de Student para comparar los instrumentos de la evaluación de la composición corporal, con la ayuda de la aplicación PROC TTEST del programa SAS® 9.2. RESULTADOS: 32 voluntarios, 19 mujeres y 13 hombres, participaron en el estudio. El grupo TNP estaba compuesto de 9 voluntarios, 4 mujeres y 5 hombres, con una edad media (± DE) de 57 ± 9 años. El estado nutritivo y el consumo de alimentos fueron diferentes entre los grupos. No hubo diferencias en el porcentaje de grasa corporal medida por antropometría y análisis de bioimpedancia. DISCUSIÓN Y CONCLUSIÓN: Las resecciones largas, así como las porciones resecadas, explican la mayor alteración nutricional del grupo GP en comparación con los grupos GA y GC, aunque no se detectaron diferencias significativas en el consumo de alimentos entre los tres grupos. Puesto que el empleo de TNP puede conducir a un estado de hiperhidratación, los resultados del ABI deberían interpretarse con precaución puesto que la masa magra determinada por este método varía positivamente con el estado de hidratación de un individuo.