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1.
Artigo em Inglês | MEDLINE | ID: mdl-35383985

RESUMO

Robert G. Martindale has received honoraria from Baxter, Fresenius Kabi, and Nestle, and acted as an advisory board member for Nestle. Stanislaw Klek has received speaker's honoraria from Baxter, Braun, Fresenius Kabi, Nestle, Nutricia, Shire, and Vipharm, and acted as an advisory board member for Fresenius Kabi, Shire, and Tracheron. Zudin Puthucheary has received honoraria for consultancy and speaker fees from Faraday Pharmaceuticals, Baxter, Fresenius Kabi, Nutricia, and Nestle. Martin D. Rosenthal has reported to be on the speaking bureau for Fresenius Kabi, Nestle, Baxter, and Abbott, and has received honoraria from these companies. This article is protected by copyright. All rights reserved.

2.
Nutrition ; 85: 111115, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33545540

RESUMO

Clinical manifestations of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can include gastrointestinal signals and symptoms. Individuals with previous clinical conditions that usually enroll gut dysbiosis have been identified as being at high risk to develop more severe infectious phenotypes. Actually, intestinal dysbiosis has been observed in infected patients and potentially linked to systemic hyperinflammation. These observations suggest that a previous gut dysbiosis may be aggravated by SARS-CoV-2 infection and related to progression of the coronavirus disease 2019 (COVID-19) into more severe stages. While COVID-19's pathophysiology is not fully understood, it seems relevant to consider the interactions of candidate therapeutic drugs with the host, gut microbiota, and SARS-CoV-2. Here we summarize scientific evidence supporting the potential relevance of these interactions and suggest that unfavorable clinical data on hydroxychloroquine administration in COVID-19 may have been influenced by the dose provided and its impact on gut dysbiosis. The proposition is based on preliminary data on gut microbiota composition from individuals with inactive systemic lupus erythematosus under exclusive continuous hydroxychloroquine treatment, displaying a direct correlation between drug doses and markers typically associated with gut dysbiosis.


Assuntos
COVID-19/tratamento farmacológico , Disbiose/induzido quimicamente , Microbioma Gastrointestinal/efeitos dos fármacos , Hidroxicloroquina/efeitos adversos , COVID-19/microbiologia , Humanos , Hidroxicloroquina/uso terapêutico
4.
Nutrition ; 84: 111083, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33418229

RESUMO

OBJECTIVES: The use of easily accessible methods to estimate skeletal muscle mass (SMM) in patients with cirrhosis is often limited by the presence of edema and ascites, precluding a reliable diagnosis of sarcopenia. The aim of this study was to design predictive models using variables derived from anthropometric and/or biochemical measures to estimate SMM; and to validate their applicability in diagnosing sarcopenia in patients with cirrhosis. METHODS: Anthropometric and biochemical data were obtained from 124 male patients (18-76 y of age) with cirrhosis who also underwent dual-energy x-ray absorptiometry (DXA) and handgrip strength (HGS) assessments to identify low SMM and diagnose sarcopenia using reference cutoff values. Univariate analyses for variable selection were applied to generate predictive decision tree models for low SMM. Model accuracy for the prediction of low SMM and sarcopenia (when associated with HGS) was tested by comparison with reference cutoff values (appendicular SMM index, obtained by DXA) and clinical sarcopenia diagnoses. The prognostic value of the models for the prediction of sarcopenia and mortality at 104 wk of follow up was further tested using Kaplan-Meier graphics and Cox models. RESULTS: The models with anthropometric variables, alone and combined with biochemical variables, showed good accuracy (0.89 [0.83; 0.94] and 0.90 [0.84; 0.95], respectively) and sensitivity (0.72 [0.56; 0.85] and 0.74 [0.59; 0.86], respectively) and excellent specificity (0.96 [0.90; 0.99] and 0.97 [0.92; 0.99], respectively) in predicting SMM. Both models showed excellent accuracy (0.94 [0.89; 0.98], good sensitivity (0.68 [0.45; 0.86]), and excellent specificity (1.00 [0.96; 1.00]) in predicting sarcopenia. The models predicted mortality in patients with sarcopenia, with the likelihood of death sixfold greater relative to patients not predicted to have sarcopenia. CONCLUSIONS: Our simple and inexpensive models provided a practical and safe approach to diagnosing sarcopenia patients with cirrhosis along with an estimate of their mortality risk when other reference methods are unavailable.


Assuntos
Força da Mão , Sarcopenia , Absorciometria de Fóton , Composição Corporal , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Masculino , Músculo Esquelético/patologia , Sarcopenia/diagnóstico , Sarcopenia/patologia
5.
Nutrition ; 81: 110900, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738510

RESUMO

The new coronavirus associated with severe acute respiratory syndrome (SARS-CoV-2), surprisingly, does not affect only the lungs. The severe response to SARS-CoV-2 appears to include a "cytokine storm," which indicates a state of hyperinflammation and subsequent dysfunction of multiple organs and tissues in the most severe cases. This could be the reason why populations at the highest risk for death from the SARS-CoV-2 infection-induced disease (coronavirus disease 2019 [COVID-19]) are those suffering from chronic low-grade inflammation, but prone to hyperinflammation. This includes individuals of advanced age and those with obesity, type 2 diabetes, hypertension, and metabolic syndrome. Inflammation resolution is strongly dependent on lipid mediators, the specialized pro-resolution mediators (SPMs). ω-3 polyunsaturated fatty acids (ω-3 PUFAs) are precursors of very potent SPMs, including resolvins, protectins, and maresins. Additionally, they are associated with a less aggressive inflammatory initiation, after competing with ω-6 fatty acids for eicosanoid synthesis. Therefore, it makes sense to consider the use of ω-3 PUFAs for clinical management of COVID-19 patients. ω-3 PUFAs may be given by oral, enteral, or parenteral routes; however, the parenteral route favors faster incorporation into plasma phospholipids, blood cells, and tissues. Here, we discuss these aspects to propose the parenteral infusion of ω-3 PUFAs as adjuvant immunopharmacotherapy for hospitalized patients with COVID-19.


Assuntos
COVID-19/tratamento farmacológico , Óleos de Peixe/administração & dosagem , COVID-19/epidemiologia , COVID-19/imunologia , Quimioterapia Adjuvante , Síndrome da Liberação de Citocina/tratamento farmacológico , Síndrome da Liberação de Citocina/imunologia , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Inflamação/dietoterapia , Inflamação/imunologia , Infusões Parenterais , Modelos Biológicos , Fenômenos Fisiológicos da Nutrição , Pandemias , SARS-CoV-2
6.
Nutrition ; 83: 111066, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33360792

RESUMO

OBJECTIVES: The aim of this study was to contribute to the design of specialized parenteral nutrition protocols in surgery by evaluating the dynamics of polyunsaturated fatty acid (PUFA) concentrations in different body pools after the infusion of fish oil-containing lipid emulsion (FOLE) in rats that had undergone surgical central venous catheterization (CVC). METHODS: After 5-d adaptation in metabolic cages, 78 male Lewis rats (300-450 g) fed a standard diet were sacrificed (baseline control) or had only CVC (surgical control) or also received a 72-h infusion of a parenteral lipid emulsion with or without fish oil. The catheterized animals were sacrificed 0 (T0), 2 (T2), 6 (T6), and 12 h (T12) after the infusion ended. Gas chromatography was used to determine the concentrations of eicosapentaenoic (EPA), docosahexaenoic (DHA), and arachidonic (ARA) acids and the ω-3 to ω-6 ratio in plasma, liver, and blood leukocytes. Kruskal-Wallis and Wilcoxon tests were applied to plasma and liver data and descriptive analysis to leukocyte data. RESULTS: Plasma, liver, and leukocytes exhibited almost undetectable EPA and DHA and detectable ARA concentrations at baseline. Immediately after FOLE infusion (T0), these PUFAs changed in all pools, resulting in a higher ratio of ω-3 to ω-6 compared with rats with no FOLE infusion (P < 0.05). All these changes decreased over time, with residual effects remaining until T6 in plasma, T12 in liver, and only until T2 in leukocytes. CONCLUSION: Data from this study suggest that ω-3 PUFAs are cleared early after the end of FOLE infusion, mainly in leukocytes. This should be considered when FOLEs are applied for immunomodulatory purposes in surgery.


Assuntos
Ácidos Graxos Ômega-3 , Óleos de Peixe , Animais , Ácidos Docosa-Hexaenoicos , Ácido Eicosapentaenoico , Emulsões Gordurosas Intravenosas , Masculino , Nutrição Parenteral , Ratos , Ratos Endogâmicos Lew
7.
JPEN J Parenter Enteral Nutr ; 44(7): 1169-1170, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32463483

RESUMO

In this letter we discuss the proposition of Bristian BR (2020) to use the intravenous administration of fish-oil emulsions in critically ill patients with Coronavirus Disease 2019 (COVID-19). We consider that immune-modulatory properties of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, rapidly provided in high amounts by fish-oil emulsions, may be important to change the course of COVID-19's death pathway. Prescriptions should be based on body weight (eg, 0.2-g pure fish-oil lipid emulsion/kg body weight/d) and also should consider combining the parenteral administration of fish-oil emulsions with low oral aspirin intake to trigger resolvin synthesis from EPA and DHA.


Assuntos
COVID-19 , Óleos de Peixe , Animais , Estado Terminal , Ácidos Docosa-Hexaenoicos , Ácido Eicosapentaenoico , Emulsões , Emulsões Gordurosas Intravenosas , Humanos , SARS-CoV-2
8.
JPEN J Parenter Enteral Nutr ; 44 Suppl 1: S7-S20, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32049392

RESUMO

BACKGROUND: The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). METHODS: The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. RESULTS: The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence-based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω-3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. CONCLUSIONS: This article provides a set of expert consensus statements to complement formal PN guideline recommendations.


Assuntos
Emulsões Gordurosas Intravenosas , Nutrição Parenteral , Consenso , Óleos de Peixe , Humanos , Nutrição Parenteral Total , Óleo de Soja
9.
JPEN J Parenter Enteral Nutr ; 44 Suppl 1: S21-S27, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32049394

RESUMO

Lipid emulsions are an integral part of parenteral nutrition, and traditionally have been regarded as an energy-dense source of calories and essential fatty acids. For many years, lipids used in parenteral nutrition have been based on vegetable oils (eg, soybean-oil emulsions). However, soybean-oil emulsions may not have an optimal fatty-acid composition under some circumstances when used as the only lipid source, as soybean oil is particularly abundant in the ω-6 polyunsaturated fatty acid (PUFA), linoleic acid. Hence, a progressive series of more complex lipid emulsions have been introduced, typically combining soybean oil with 1 or more alternative oils, such as medium-chain triglycerides (MCTs) and/or olive oil and/or fish oil. The wide range of lipid emulsions now available for parenteral nutrition offers opportunities to alter the supply of different fatty acids, which potentially modifies functional properties, with effects on inflammatory processes, immune response, and hepatic metabolism. Fish oil has become an important component of modern, composite lipid emulsions, in part owing to a growing evidence base concerning its biological effects in a variety of preclinical models. These biological activities of fish oil are mainly attributed to its ω-3 PUFA content, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA and EPA have known mechanisms of action, anti-inflammatory, immunomodulatory, and antioxidative properties. Specialized proresolving mediators, such as resolvins, protectins, and maresins, are synthesized directly from DHA and EPA, are key for the resolution of inflammation, and improve outcomes in many cell- and animal-based models and, recently, in some clinical settings.


Assuntos
Emulsões Gordurosas Intravenosas , Nutrição Parenteral , Animais , Ácidos Graxos Ômega-6 , Óleos de Peixe , Azeite de Oliva , Óleo de Soja
10.
Nutrients ; 12(2)2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31973130

RESUMO

Gut microbiota composition is influenced by environmental factors and has been shown to impact body metabolism. OBJECTIVE: To assess the gut microbiota profile before and after Roux-en-Y gastric bypass (RYGB) and the correlation with food intake and postoperative type 2 diabetes remission (T2Dr). DESIGN: Gut microbiota profile from obese diabetic women was evaluated before (n = 25) and 3 (n = 20) and 12 months (n = 14) after RYGB, using MiSeq Illumina-based V4 bacterial 16S rRNA gene profiling. Data on food intake (7-day record) and T2Dr (American Diabetes Association (ADA) criteria) were recorded. RESULTS: Preoperatively, the abundance of five bacteria genera differed between patients with (57%) and without T2Dr (p < 0.050). Preoperative gut bacteria genus signature was able to predict the T2Dr status with 0.94 accuracy ROC curve (receiver operating characteristic curve). Postoperatively (vs. preoperative), the relative abundance of some gut bacteria genera changed, the gut microbial richness increased, and the Firmicutes to Bacteroidetes ratio (rFB) decreased (p < 0.05) regardless of T2Dr. Richness levels was correlated with dietary profile pre and postoperatively, mainly displaying positive and inverse correlations with fiber and lipid intakes, respectively (p < 0.05). CONCLUSIONS: Gut microbiota profile was influenced by RYGB and correlated with diet and T2Dr preoperatively, suggesting the possibility to assess its composition to predict postoperative T2Dr.


Assuntos
Diabetes Mellitus Tipo 2/microbiologia , Ingestão de Alimentos/fisiologia , Derivação Gástrica , Microbioma Gastrointestinal/fisiologia , Obesidade Mórbida/microbiologia , Adulto , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Microbioma Gastrointestinal/genética , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Período Pós-Operatório , RNA Ribossômico 16S/análise , Indução de Remissão , Resultado do Tratamento
12.
Clin Nutr ; 38(6): 2906-2912, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30799193

RESUMO

OBJECTIVE: To assess the influence of Roux-en-Y gastric by-pass (RYGB) on fecal bile acid (BA) profile and its relationship with postoperative remission of type 2 diabetes (T2D). METHODS: Fecal samples were collected 3 and 12 months after RYGB from diabetic obese women who were responsive (n = 12) and non-responsive (n = 8) to postoperative remission of T2D. Fecal BA profile was accessed by liquid chromatography coupled to tandem mass spectrometry in a targeted approach. RESULTS: Relative to pre-operative levels, a total of 10 fecal BA profiles decreased after RYGB (ANOVA, p ≤ 0.05) with significant fold-changes for glycochenodeoxycholic, glycocholic, taurocholic, and taurochenodeoxycholic acids at 3-months postoperatively, and for glycochenodeoxycholic, glycocholic and taurocholic acids at 12 months postoperatively (Benjamini-Hochberg, p ≤ 0.05). Postoperative changes in fecal BA were different between responsive and non-responsive women, with a significant reduction in more sub-fractions of BA in responsive women than in non-responsive women, and a marked difference in the temporal behavior of cholic acid (CA) and chenodeoxycholic acid (CDCA), thus reflecting changes in CA/CDCA ratio, and tauroursodeoxycolic (TUDCA) levels between these responsiveness groups (ANOVA, p ≤ 0.05). CONCLUSION: RYGB induces a marked reduction in the concentration of fecal BA, which is heterogeneous according to T2D responsiveness.


Assuntos
Ácidos e Sais Biliares/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Derivação Gástrica , Obesidade/cirurgia , Adolescente , Adulto , Fezes , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/metabolismo , Período Pós-Operatório , Indução de Remissão/métodos , Adulto Jovem
13.
JPEN J Parenter Enteral Nutr ; 43(1): 32-40, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30175461

RESUMO

BACKGROUND: This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS: A 2-step approach for the malnutrition diagnosis was selected, that is, first screening to identify at risk status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSIONS: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.


Assuntos
Consenso , Desnutrição/diagnóstico , Programas de Rastreamento , Avaliação Nutricional , Estado Nutricional , Guias de Prática Clínica como Assunto , Adulto , Idoso , Índice de Massa Corporal , Caquexia/diagnóstico , Feminino , Humanos , Liderança , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Músculos , Fenótipo , Sarcopenia/diagnóstico , Sociedades Científicas , Perda de Peso
14.
BMC Obes ; 5: 25, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30288293

RESUMO

Background: Body mass index (BMI) has been used to assess body adiposity, but it cannot adequately reflect body fat (BF) amount. The body adiposity index (BAI) has been shown a better performance than BMI for this purpose, but it can be inaccurate to estimate BF under extreme amounts of fat. Here, we propose a new anthropometric index, the Belarmino-Waitzberg (BeW) index, for specific estimation of BF in severely obese patients. Methods: In 144 adult patients with severe obesity, BF was estimated by air displacement plethysmography (ADP), as the reference method, along with the follow anthropometric measurements: height, abdominal circumference (AC), hip circumference (HC), weight, BMI (weight/ height2) and BAI ([HC(cm) / height (m)1.5) - 18] × 100). Patients were proportionately distributed into two distinct databases, the building model database (BMD) and the validation model database (VMD), which were applied to develop and validate the BeW index, respectively. The BeW index was tested for gender and ethnicity adjustment as independent variables. The agreement of BF% values obtained by the new index and by BAI with ADP was also assessed. Results: The BF% was 52.05 ± 5.42 for ADP and 59.11 ± 5.95 for the BeW index (all results are expressed as the mean ± standard deviation). A positive Pearson correlation (r = 0.74), a good accuracy (Cb = 0.94), and a positive Lin's concordance correlation (CCC = 0.70) were observed between the two groups. The 95% limits of individual agreement between the BeW index and ADP were 6.8 to 7.9%, compared to - 7.5 to 14.8% between the BAI and ADP. The new index, called the Belarmino-Waitzberg (BeW) index, showed an improvement of 2.1% for the R2 value and a significant gender effect, therefore resulting in two different indexes for females and males, as follows: Female BeW = - 48.8 + 0.087 × AC(cm) + 1.147 × HC(cm) - 0.003 × HC(cm)2 and Male BeW = - 48.8 + 0.087 × AC(cm) + 1.147 × HC(cm) - 0.003 × HC(cm)2-7.195. Conclusions: The new BeW index showed a good performance for BF estimation in patients with severe obesity and can be superior to the BAI for this purpose.

15.
Nutrition ; 51-52: 60-65, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29605765

RESUMO

OBJECTIVES: Patients with head and neck cancer have changes in body composition and resting energy expenditure (REE) related to significant inflammatory processes. We investigated REE and body composition in a population of patients with head and neck cancer, comparing the measured REE with predicted energy expenditure and deriving an equation of anthropometric values and body composition. METHODS: This retrospective, observational, descriptive study of a single center included patients with head and neck cancer. We evaluated nutritional status by body mass index (BMI) and Patient-Generated Subjective Global Assessment (PG-SGA), body composition by electric bioimpedance, and REE by indirect calorimetry (IC). RESULTS: We included 140 patients, most of whom were men (80.7%), 60 y or older (58.6%), and had advanced disease (77.9%). Most were malnourished by BMI standards (77.9%) and severely malnourished according to the PG-SGA (49.3%), with a fat-free mass below the ideal values (82.9%) associated with sarcopenia (92.1%). Hypermetabolism was 57%. When comparing REE with the Harris-Benedict formula, we found the agreement limits from -546 613 to 240 708, the mean difference was -152 953 (95% confidence interval [CI], -185 844 to -120 062) and Pitman's variance test was r = -0.294 (P = 0.001). When we included the activity factor and the thermogenesis factor in REE and compared with Harris-Benedict, we found the agreement limits from -764.423 to 337.087, a mean difference of -213.668 (95% CI -259.684 to -167.652), and the Pitman's variance text at r = -0.292 (P = 0.001). CONCLUSION: Predictive equations, generally recommended by guidelines, are imprecise when compared with IC measures. Therefore, we suggest a new predictive equation.


Assuntos
Composição Corporal/fisiologia , Metabolismo Energético/fisiologia , Neoplasias de Cabeça e Pescoço/metabolismo , Neoplasias de Cabeça e Pescoço/fisiopatologia , Adulto , Peso Corporal , Calorimetria Indireta , Impedância Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Descanso , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
16.
Curr Opin Clin Nutr Metab Care ; 21(4): 246-251, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29697537

RESUMO

PURPOSE OF REVIEW: The current review provides an overview of recent literature on new findings related to bariatric surgery and gut gene expression. RECENT FINDINGS: Bariatric surgery modulates the expression of intestinal genes. Experimental and clinical investigations have demonstrated the association of gut rearrangement with changes in intestinal expression of genes related to glucose metabolism. Recent data suggest that bariatric surgery also affects expression of genes belonging to other pathways, including nutrient transporters and metabolism of vitamin B12, decreasing pathway-encoding genes that may contribute to vitamin B12 deficiency in the postoperative period. SUMMARY: Bariatric surgery is an effective intervention strategy against severe obesity, resulting in sustained weight loss and reduction of comorbidities. Nutritional genomic changes appear in response to bariatric surgery, possibly due to adaptive gut response. Improved understanding of the molecular pathways modulated by this intervention may facilitate weight and comorbidities management.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Glicemia/metabolismo , Trato Gastrointestinal/metabolismo , Expressão Gênica , Obesidade Mórbida/cirurgia , Deficiência de Vitamina B 12/etiologia , Glicemia/genética , Humanos , Intestinos , Deficiência de Vitamina B 12/genética
17.
JPEN J Parenter Enteral Nutr ; 42(1): 24-36, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28402708

RESUMO

BACKGROUND: Ascites in cirrhotic patients interfere with accurate assessment of skeletal muscle when diagnosing sarcopenia. We hypothesized measurement of appendicular skeletal muscle index (ASMI) with dual-energy x-ray absorptiometry (DXA) improves the diagnosis of sarcopenia in cirrhotic patients as ASMI does not include the fluid-filled abdominal compartment. OBJECTIVE: To evaluate if ASMI is influenced by ascites, lower limb edema (LLE) and predicts mortality alone or combined with handgrip strength (HGS) in cirrhotic patients. DESIGN: ASMI, HGS, and 36-month mortality were obtained in 144 men with cirrhosis. ASMI was compared before and after paracentesis in 20 men with ascites and to results from 20 matched controls. The prognostic value of ASMI alone and with HGS was tested in a survival. Survival probabilities were obtained for sarcopenia diagnosed by standard ASMI and HGS European Working Group on Sarcopenia in Older People (EWGSOP) cutoffs and a new cutoff calculated from our ASMI + HGS tertiles. RESULTS: ASMI did not change after paracentesis, was lower in patients than in controls (P < .001), and was not influenced by LLE (D = 0.30 kg/m2, P = .068; R2 = 2.40%). Mortality was influenced by ASMI and HGS (Pinteraction = 0.028). Sarcopenia diagnosed by EWGSOP was also diagnosed by our new cutoff; both predicted mortality with the latter more sensitive for mortality risk prediction (P = .011). CONCLUSIONS: DXA-measured ASMI is not influenced by ascites or LLE in cirrhotic patients; can diagnose low skeletal muscle/sarcopenia; and predicts mortality, particularly when combined with HGS.


Assuntos
Absorciometria de Fóton/métodos , Cirrose Hepática/complicações , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Reprodutibilidade dos Testes
18.
Clin Nutr ; 37(5): 1474-1484, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29249532

RESUMO

BACKGROUND & AIMS: Currently there is no FDA-approved therapy for nonalcoholic steatohepatitis (NASH). Increased n-6/n-3 polyunsaturated fatty acids (PUFA) ratio can induce endoplasmic reticulum (ER) stress and mitochondrial dysfunction that characterize NASH. Our recent study with n-3 PUFA showed improvement in individual histologic parameters like steatosis, ballooning and lobular inflammation. We hypothesized that n-3 PUFA therapy mediated improvement in histologic parameters is modulated by lipidomic and proteomic changes. METHODS: We therefore evaluated hepatic proteomic and plasma lipidomic profiles before and after n-3 PUFA therapy in subjects with NASH. In a double-blind, randomized, placebo-controlled trial, patients with NASH received 6-month treatment with n-3 PUFA (0.945 g/day [64% alpha-linolenic (ALA), 21% eicosapentaenoic (EPA), and 16% docosahexaenoic (DHA) acids]). Paired liver biopsy and plasma collected before and after-n-3 PUFA therapy were assessed using mass spectrometry and gas chromatography for hepatic proteomics and plasma lipidomics. Data were matched to UniProt and LIPID MAPS database, respectively. Cytoscape software was used to analyze functional pathways. Twenty-seven NASH patients with paired liver histology and plasma before and after n-3 PUFA treatment were studied. RESULTS: Treatment with n-3 PUFA significantly increased ALA, EPA, and glycerophospholipids, and decreased arachidonic acid (p < 0.05 for all). Further, proteomic markers of cell matrix, lipid metabolism, ER stress and cellular respiratory pathways were also modulated. Interestingly, these alterations reflected functional changes highly suggestive of decreased cellular lipotoxicity potential; reduced ER proteasome degradation of proteins and induction of chaperones; and a shift in cell energy homeostasis towards mitochondrial beta-oxidation. CONCLUSION: Six-month treatment with omega-3 PUFAs significantly improved hepatic proteomic and plasma lipidomic markers of lipogenesis, endoplasmic reticulum stress and mitochondrial functions in patients with NASH.


Assuntos
Estresse do Retículo Endoplasmático/efeitos dos fármacos , Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-3/uso terapêutico , Lipogênese/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Biomarcadores/sangue , Método Duplo-Cego , Feminino , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Fígado , Masculino , Pessoa de Meia-Idade , Proteômica
19.
Front Microbiol ; 8: 2010, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29089934

RESUMO

Background and aims: Non-alcoholic fatty liver disease (NAFLD) is characterized by the presence of fat in hepatocytes because of decreased ß-oxidation and increased lipogenesis. Prebiotics, probiotics, and synbiotic have modulatory effects on intestinal microbiota and may influence the gut-liver axis. Our aim was to evaluate the effects of prebiotic, probiotics, and synbiotic on liver histopathology and gene expression related to ß-oxidation and lipogenesis after hypercholesterolemia. Methods: Wistar male adult rats (n = 40) were submitted to hypercholesterolemic conditions (HPC) (60 days). On Day 30 of HPC, rats were subdivided in 5 groups: negative control (NC): without HPC + Gv (distilled water); positive control (PC): with HPC + Gv (distilled water); prebiotic (PRE): HPC + Gv with prebiotic (Fiber FOS®); probiotic (PRO): HPC + Gv with probiotic strains Gv (Probiatop®); and synbiotic (SYN): HPC + Gv with synbiotic (Simbioflora®). All rats were sacrificed on Day 30 post-treatment. Blood was collected to verify total serum cholesterol, and liver tissue was sampled to verify histopathological changes and gene expression. Gene expression related to ß-oxidation (PPAR-α and CPT-1) and lipogenesis (SREBP-1c, FAS and ME) was evaluated in liver tissue using RT-qPCR. Results: PC had higher cholesterol levels when compared to NC. PRE and SYN rats had lower cholesterol levels than PC. PC rats showed more histopathological changes than NC rats; PRE and SYN rats showed fewer alterations than PC rats. PPAR-α was expressed at higher levels in SYN and PC rats compared with PRE and PRO rats. CPT-1 expression was similar in all groups. SREBP-1c was expressed at higher levels in PC rats compared with NC rats; levels were lower in SYN rats compared with PRO rats; levels were lower in PRE rats compared with PC and PRO rats. FAS was expressed at lower levels in PRE rats compared with SYN rats. ME expression was lower in PC rats compared with NC rats. Conclusion: Prebiotic and synbiotic supplementation improve hepatic alterations related to hypercholesterolemia. These changes appear to be mediated by altered expression of genes related to ß-oxidation and lipogenesis.

20.
Nutr. hosp ; 34(4): 969-975, jul.-ago. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-165361

RESUMO

Introduction: Malnutrition in hospitalized patients is not evaluated frequently. However, it is a critical issue given that it has been related to a high rate of infectious complications and increased mortality rates. There is a high prevalence of patients with nutritional impairment in the home environment, which favors their clinical worsening, the increase of re-hospitalizations and, consequently, the increase in public health expenditures. Objective: Nutrition experts have thoroughly discussed and written this positioning paper on hospital and homecare malnutrition to describe the prevalence of malnutrition in Brazil. Best practice recommendations for nutrition therapy of patients in hospital and homecare, in particular the use of oral nutritional supplements (ONS), to those who are at risk of malnutrition or malnourished were evaluated, and the impact on clinical and economic data were assessed. In addition, they emphasize that investments in oral nutritional supplementation are also important in the homecare environment (home or nursing homes). Materials and methods: Selected scientific articles on disease-related malnutrition, especially those carried out in Brazil, were assessed. Data on prevalence, clinical outcomes, and economic burdens were reviewed. Results and conclusion: Several studies have shown the importance of in-hospital nutritional assessment for early detection of malnutrition and early intervention with nutrition therapy, in particular with oral nutritional therapy. Unfortunately, hospital malnutrition remains high in Brazil, with severe consequences for patients. The implementation of universal nutritional screening and diagnosis as well as the therapeutic approach of malnutrition, particularly with the use, when possible, of oral nutrition supplements as the first step to address this condition is still low, and demands the investment in educational resources to change practices. Routine use of nutritional therapy in hospital and homecare settings improves clinical outcomes, is cost effective, and would be expected to help reduce healthcare costs (AU)


Introducción: la desnutrición en pacientes hospitalizados no se evalúa con frecuencia. Sin embargo, es un problema crítico dado que se ha relacionado con una alta tasa de complicaciones infecciosas y con el incremento de la mortalidad. Se observa una alta prevalencia de pacientes desnutridos en el entorno domiciliario, lo que favorece su deterioro clínico, el aumento de las rehospitalizaciones y, como consecuencia, el aumento del gasto sanitario público. Objetivo: expertos en nutrición realizaron una revisión detallada de los estudios para redactar un posicionamiento sobre la situación en Brasil respecto a la prevalencia de la desnutrición hospitalaria y domiciliaria. Se identificaron las mejores prácticas recomendadas para la terapia nutricional de los pacientes hospitalarios y en domicilio en riesgo de desnutrición o desnutridos y se evaluó la utilidad de los suplementos nutricionales orales (SNO) a través de datos clínicos y económicos. Adicionalmente, se evidenció que las inversiones en suplementos nutricionales orales son también importantes en el entorno domiciliario (domicilio o residencia). Materiales y métodos: se evaluaron artículos científicos seleccionados, especialmente los realizados en Brasil, sobre la desnutrición relacionada con enfermedades. Se revisaron los datos sobre la prevalencia, los resultados clínicos y las cargas económicas. Resultados y conclusión: varios estudios han demostrado la importancia de la evaluación nutricional en el hospital para la detección precoz de la desnutrición y la intervención temprana con terapia nutricional oral, siempre que sea posible, como estrategia inicial para abordar el problema. Desafortunadamente, la desnutrición hospitalaria continúa siendo elevada en Brasil, con consecuencias graves para los pacientes. La identificación del estado nutricional deficiente a través del cribado y el inicio de la terapia nutricional, particularmente con el uso, cuando es posible, de suplementos nutricionales orales, como primera etapa para combatir la desnutrición no está aún establecida y requiere una inversión en recursos educativos para cambiar las prácticas actuales. El uso rutinario de la terapia nutricional en el entorno hospitalario y domiciliario mejora los resultados clínicos y tiene un impacto positivo en la disminución de los costes asociados y, de esta forma, se espera que contribuya a la reducción de los costes de atención sanitaria (AU)


Assuntos
Humanos , Desnutrição/dietoterapia , Doenças Transmissíveis/dietoterapia , Doenças Transmissíveis/epidemiologia , Nutrição Enteral/métodos , Diagnóstico Precoce , Hospitais/normas , Doenças Transmissíveis/mortalidade , Brasil/epidemiologia
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