Is there a relationship between the ketogenic diet and sleep disorders?

Sleep disorders are very often underestimated and, consequently, not treated with due priority. Common sleep disorders include insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. The ketogenic diet (KD) is rich in fat, low in carbohydrates (CHO), and adequate in protein. The KD has shown several applications in treating medical conditions, such as epilepsy, neurodegenerative disorders, obesity with its comorbidities, and sleep disorders, with encouraging results. Therefore, the purpose of this review is to address the primary sleep disorders and their respective standard therapeutic approaches, analyse the effect of ketone bodies (KBs) on sleep homeostasis, and the effects of KD on sleep disorders and in particular on obstructive sleep apnoea (OSA) syndrome. The goal is to summarise the evidence existing up to now on the subject, to provide a starting point for further investigations.

"Forever young at the table": metabolic effects of eating speed in obesity.

BACKGROUND: Cardiometabolic diseases (CMD) are recognized as the main causes of morbidity and mortality in developed countries. In recent years eating speed (ES) has been of particular interest since some studies have associated it with the development of obesity and CMD. However, the different impact of the ES at which main meals are eaten on the risk of developing these diseases has not yet been identified. Thus, we aimed to investigate the effect of ES at the main meals (breakfast, lunch, and dinner) on the risk of developing cardiometabolic diseases (type 2 diabetes mellitus, dyslipidaemia and hypertension) in middle-aged Caucasian subjects with obesity. METHODS: For this purpose we carried out a cross-sectional, observational study. One hundred and eighty-seven middle-aged subjects aged 43.6 ± 16 years were enrolled of which anthropometric parameters and lifestyle habits were studied. A dietary interview was performed to collect information about meal duration and eating habits at the main meals. According to median value of meal duration, meals were classified in two groups: fast eating group (FEG) and slow eating group (SEG). RESULTS: The prevalence of dyslipidaemia was more than twice in FEG compared to SEG at lunch and dinner. For all main meals, FEG had a significantly higher risk of dyslipidaemia than SEG (p < 0.05) in unadjusted model. However, when the model was adjusted for age, BMI, physical activity, smoking and alcohol use and medication, the result remained significant for lunch and dinner (p < 0.05). CONCLUSION: The results of our study suggest that fast eating increases at lunch and dinner increase the risk of developing dyslipidaemia in obesity.

Aplicação Clínica de Métodos baseados em indução e captação de fluorescência na detecção de lesões de cárie oclusal / Clinical application of fluorescence-based methods to detect occlusal caries lesions

Os exames visual e radiográfico são comumente utilizados na prática clínica odontológica. Entretanto, são subjetivos, com baixa sensibilidade e alta especificidade. Atualmente, métodos baseados em fluorescência têm sido avaliados como auxiliares na detecção de lesões de cárie, como o DIAGNOdent® (KaVo), o DIAGNOdent pen® (KaVo) e a câmera VistaProof® (Dürr Dental). O objetivo desse trabalho foi avaliar através do relato de dois casos clínicos, a aplicação de métodos baseados em indução e captação de fluorescência como auxiliares na detecção de cárie, comparando-os aos métodos convencionais. No primeiro caso, o dente 46 apresentava um sulco pigmentado com cavitação aparente e, radiograficamente, observou-se imagem radiolúcida profunda envolvendo dentina. No segundo caso, o dente 36 apresentava sulco pigmentado com microcavitação e também imagem radiolúcida profunda em dentina. Em ambos os casos, os valores obtidos pelo DIAGNOdent® e DIAGNOdent pen® corresponderam à lesões em dentina, segundo as tabelas propostas pelo fabricante e por um estudo clínico recente da literatura. Em relação à câmera intraoral VistaProof®, também em ambos os casos, os resultados obtidos apresentaram discordância entre os valores da tabela proposta pelo fabricante, que sugeriu lesão em esmalte, diferente da tabela proposta pelo estudo clínico, que sugeriu lesão em dentina. Pôde-se concluir que o DIAGNOdent® e o DIAGNOdent pen® foram capazes de detectar as lesões de cárie em dentina, assim como os métodos convencionais. Entretanto, a câmera VistaProof® apresentou resultados divergentes, que variaram de acordo com a tabela de interpretação clínica utilizada. Assim, os novos métodos devem ser empregados com cautela na prática clínica e devem ser auxiliares aos métodos convencionais para detecção de lesões de cárie oclusal.

Visual and radiographic examinations are commonly used in dental practice. However, they are subjective methods, with low sensitivity and high specificity. Currently, fluorescence-based methods have been evaluated for caries detection, as DIAGNOdent? (KaVo), DIAGNOdent pen? (KaVo) and VistaProof? fluorescence camera (D�rr Dental). The aim of this study was to evaluate, through reporting two clinical cases, the application of fluorescence-based methods as aids for caries detection, comparing them to the conventional methods. In the first case, tooth 46 showed pigmented pit and fissures with apparent cavitation and a deep radiolucent lesion in dentin observed by radiography. In the second case, tooth 36 presented pigmented pit and fissures with cavitation and also a deep radiolucent image in dentin. In both cases, DIAGNOdent? and DIAGNOdent pen? values corresponded to dentin carious lesions, by the cut-off points proposed by the manufacturer and by a clinical study recently published in the literature. Regarding VistaProof? camera, in both cases, it showed different results between the cut-offs proposed by the manufacturer, which suggested enamel lesion, and the cut-offs proposed by the clinical study, which suggested a dentin carious lesion. We concluded that DIAGNOdent? and DIAGNOdent pen? could detect dentin carious lesions as well as the conventional methods. However, VistaProof? fluorescence camera showed different results, which varied according to the cut-off points used for clinical interpretation. Thus, the new methods should be used with caution in clinical practice and as a supplementary aid for occlusal caries detection.