Evaluación de la técnica de conteo de grasas y ajuste de enzimas pancreáticas en un grupo de pacientes con insuficiencia pancreática secundaria a fibrosis quística con seguimiento en un hospital de alta complejidad / Evaluation of the fat counting technique and pancreatic enzyme adjustment in a group of patients with pancreatic insufficiency secondary to cystic fibrosis followed-up in a tertiary-level hospital

Objetivo: evaluar la efectividad de la técnica de conteo de grasas y ajuste de enzimas pancreáticas en un grupo de pacientes con insuficiencia pancreática secundaria a fibrosis quística (FQ). Materiales y métodos: En un grupo de pacientes con FQ, sin otra patología asociada, mayores de 1 año, con >10 000 UKD (unidades por kilo por día) de lipasa; se realizó educación y aplicación de técnica de conteo de grasas con ajuste enzimático, solicitando Van de Kamer y registro alimentario de 5 días durante la recolección de la muestra con un intervalo de 3 meses entre ambas determinaciones. Se evaluó la efectividad de la misma y las dosis de enzimas utilizadas mediante el porcentaje de excreción grasa (PEG), así como las variaciones en la cantidad de enzimas utilizadas y la ganancia de peso. Los datos se registraron en RED Cap (Research Electronic Data Capture) y se analizaron mediante Stata 12. Resultados: De un total de 21 pacientes, 16 completaron la intervención. El 50% presentó un índice de masa corporal (IMC) mayor del Plo 25 antes y después, un 87% alcanzó adecuación calórica mayor del 120% de la ingestas diarias recomendadas (RDA) al final, logrando un aumento promedio de z score de peso de 0,28 con una media inicial de 17 kg y final de 18,2 kg. En cuanto a la media del requerimiento enzimático fue de 14 800 UKD antes y 10 145 UKD después (z=0,002), asimismo el porcentaje de excreción grasa (PEG) tuvo una disminución del 38% (p=0,1705). Conclusiones: La implementación de la técnica de conteo de grasas y ajuste enzimático, podría ser una estrategia válida para aquellos pacientes con FQ que tienen dosis altas de enzimas e inadecuada ganancia de peso (AU)

Objective: To evaluate the effectiveness of the fat counting technique and pancreatic enzyme adjustment in a group of patients with pancreatic insufficiency secondary to cystic fibrosis (CF). Materials and methods: A group of patients with CF without other associated diseases, older than 1 year of age, lipase dose >10 000 UKD (units per kilo per day), received education on the fat counting technique with enzyme adjustment followed by its implementation of the intervention. Van de Kamer was requested and a 5-day food record was kept during the sample collection with an interval of 3 months between both measurements. The effectiveness of the technique and the enzyme doses used were evaluated based on the percentage of fat excretion (PFE), as well as the variations in the amount of enzymes used and weight gain. Data were recorded in RED Cap (Research Electronic Data Capture) and analyzed using Stata 12. Results: Of a total of 21 patients, 16 completed the intervention. Fifty percent had a body mass index (BMI) greater than Plo 25 before and after the intervention; 87% had achieved a caloric increase greater than 120% of the recommended daily intake (RDA) at the end of the study and an average increase in weight z score of 0.28 with an initial mean of 17 kg and a final mean of 18.2 kg. Mean enzyme requirement was 14 800 UKD before and 10 145 UKD after the intervention (z=0.002). PFE decreased by 38% (p=0.1705). Conclusions: The implementation of the technique of fat counting and enzyme adjustment may be a valid strategy for CF patients with high enzyme doses and inadequate weight gain. (AU)

Dimorfismo sexual de la leptina, resistencia a la insulina y composición corporal en prepúberes normopeso / Leptin sexual dimorphism, insulin resistance, and body composition in normal weight prepubescent

INTRODUCCIÓN: La etapa prepuberal es un periodo crítico del desarrollo de la grasa corporal, en el cual la leptina y la resistencia a la insulina han sido asociados, sin embargo, hay pocos estudios en prepúberes normo- peso. OBJETIVO: Evaluar la relación de leptina con composición corporal y resistencia a la insulina en un grupo de prepúberes normopeso. PACIENTES Y MÉTODO: Estudio transversal analítico en 128 pre púberes saludables, normopeso, entre 6 y 10 años. Se midieron, talla, peso, índice de masa corporal (IMC), porcentaje de grasa corporal (PGC), perímetro abdominal (PA) y perímetro de cadera (PC). Se determinó leptina (ng/ml) e Insulina (μU/L) en plasma por inmunoensayo y glicemia (mmol/L) por método enzimático. Se calculó HOMA-IR. Se hizo análisis de comparación y de correlación por sexo. RESULTADOS: Se confirmó en niñas un mayor nivel de leptina (6,8 ± 5 vs 3,3 ± 3,7; p = 0,000), insulina (7,1 ± 4,5 vs 5,2 ± 2,5; p = 0,016), PGC (22,4 ± 4,3 vs 18,6 ± 3,9; p = 0,000) y PC (67 ± 5,7 vs 65,0 ± 4,5; p = 0,019), y un menor índice cintura/cadera (0,84 ± 0,04 vs 0,88 ± 0,04; p = 0,000) comparado con varones. Las correlaciones de leptina con variables antropométricas fueron signifi cantes en ambos sexos, con mayor asociación en sexo femenino. La asociación del HOMA-IR con la leptina fue similar en ambos sexos. CONCLUSIONES: En prepúberes normopeso de 6 a 10 años, hay diferencias por sexo en adiposidad y en niveles de leptina, no asociadas con diferencias en el IMC ni en la resistencia a la insulina. La mayor asociación de leptina con adiposidad en las niñas podría estar relacionada con una elevada tasa de adipogénesis inducida por esta hormona.

INTRODUCTION: The prepubertal stage is a critical period of body fat development, in which leptin and insulin re sistance has been associated, however, there are few studies in normal-weight prepubescents. OBJECTIVE: To assess the relationship between leptin and body composition and insulin resistance in a group of normal-weight prepubescents. PATIENTS AND METHOD: Analytical cross-sectional study with 128 healthy prepubescents of normal weight, aged between 6 and 10 years. Height, weight, body mass index (BMI), body fat percentage (BFP), waist circumference (WC), and hip circumference (HC) were measured. Plasma leptin (ng/mL) and insulin (mU/L) were evaluated by immunoassay and glycemia (mmol/L) by enzymatic method. HOMA-IR was calculated. A comparison study and correlation analysis by sex were performed. RESULTS: Females presented higher values than males of leptin (6.8 ± 5 vs 3.3 ± 3.7; p = 0.000), insulin (7.1 ± 4.5 vs 5.2 ± 2.5; p = 0.016), BFP (22.4 ± 4.3 vs 18.6 ± 3.9; p = 0.000), and HC (67 ± 5.7 vs 65.0 ± 4.5; p = 0.019), and a lower waist/hip ratio (0.84 ± 0.04 vs 0.88 ± 0.04; p = 0.000). Leptin correlations with anthropometric variables were significant in both sexes, with greater association in females. The association of HOMA-IR with leptin was similar in both sexes. CONCLUSIONS: in normal-weight prepubescents aged between 6-10 years, there are sex differences in adiposity and leptin levels not associated with differences in BMI or insulin resistance. The greater association of leptin with adiposity in girls could be related to a high rate of adipogenesis induced by this hormone.

Quality by design approach for the preparation of fat-soluble vitamins lipid injectable emulsion.

The fat-soluble vitamins lipid injectable emulsion, a parenteral supplement, commonly used for hospitalized patients to meet daily requirements of fat-soluble vitamins. This study attempts to reduce risk, improve the stability and safety of fat-soluble vitamins lipid injectable emulsion using a Quality by Design (QbD) approach. The quality target product profile and critical quality attributes were defined based on a comprehensive understanding of fat-soluble vitamins lipid injectable emulsions. The emulsions were prepared using a high-pressure homogenization method. Critical quality attributes (CQAs) were identified using risk assessment tools such as fishbone diagram and risk estimation matrix. The assay, mean droplet size, polydispersity index, zeta potential, and the volume-weighted percentage of fat greater than 5 µm (PFAT5) were identified as CQAs. Accordingly, three critical formulation and process parameters for the emulsions were the percentage of emulsifier, homogenization pressure, and homogenization recirculation. The design space was obtained via a design of experiment (DoE), and an optimum formulation was successfully prepared. All physicochemical attributes of the optimal formulation were within the design space (i.e., droplet size: 217.2 ±â€¯0.37 nm; polydispersity index: 0.115 ±â€¯0.012; PFAT5: less than 0.05%; zeta potential: -34.6 ±â€¯1.09 mV; and viscosity: 20.95 mPa at 0.1 s-1). The optimal formulation remained acceptable physicochemical stability at 25 ±â€¯2 °C/60% RH ±â€¯5% RH over a 12-month period. Safety of the optimal emulsion was evaluated as acceptable through the determination of lysophospholipid content and an in vitro hemolysis assay. In conclusion, an optimal lipid injectable emulsion for fat-soluble vitamins was successfully prepared using a QbD approach.

Transition period produces changes in blood and body composition in mares / Período de transição produz alterações na composição do sangue e do corpo em éguas

Clinical and metabolic evaluation is necessary for the monitoring of pregnant and lactating mares, as they reflect the health of the animal. The body condition of the mare is an indicator of reproductive efficiency. The study aimed to determine the possible variations in body and metabolic condition in Mangalarga Marchador mares during the transition period. Forty-eight mares distributed in two groups were used: Maintenance Group (MG), composed of non-pregnant and non-lactating mares, and Transition Group (TG), formed by pregnant mares and who after delivery became lactating. Analyzes were performed in the times T-60, T-30 and T-15 before delivery, first six hours (T0) after delivery and T15, T30 and T60 days after delivery. MG was evaluated only at one time (T-60). Body weight and fat-free mass differed (P<0.05) between the groups. The percentage of fat was lower in MG. Mares had a higher fat percentage in TG at T-60 and T-30 times. There was a difference (P<0.05) in the amount of cholesterol between MG and TG (T0, T15 and T30). Triglycerides were different between the groups. TG showed higher concentrations of non-esterified fatty acids (P<0.05). There was a higher amount of glucose in TG (delivery and lactation) when compared to mares in MG. Changes in body condition and metabolic constituents occurred in the animals resulting from physiological adaptations of the transition period. The energetic components are the most affected from the transition period, with intense fat mobilization to supply the body demands.(AU)

Avaliações clínicas e metabólicas são necessárias para o monitoramento de éguas gestantes e lactantes, pois refletem a saúde do animal. A condição corporal da égua pode ser um indicador da eficiência reprodutiva. O estudo objetivou determinar as possíveis variações na condição corporal e metabólica em éguas Mangalarga Marchador durante o período de transição. Foram utilizadas 48 éguas distribuídas em dois grupos: Grupo em Manutenção (GM) composto por éguas não gestantes e não lactantes; Grupo em Transição (GT) formado por éguas gestantes e que após o parto tornaram-se lactantes. As análises foram realizadas nos tempos T-60, T-30 e T-15 antes do parto, primeiras seis horas (T0) após o parto e T15, T30 e T60 dias após o parto. O GM foi avaliado apenas uma vez (T-60). O peso corporal e a massa livre de gordura diferiram (P<0,05) entre os grupos. O percentual de gordura foi menor em GM. As éguas apresentaram maior porcentagem de gordura no GT no T-60 e no T-30. Houve diferença (P<0,05) na quantidade de colesterol entre GM e GT (T0, T15 e T30). Triglicérides foram diferentes entre os grupos. GT apresentou maiores concentrações de ácidos graxos não esterificados (P<0,05). Houve maior quantidade de glicose no GT (parto e lactação) quando comparada às éguas no GM. Mudanças na condição corporal e nos constituintes metabólicos ocorreram nos animais resultantes de adaptações fisiológicas do período de transição. Os componentes energéticos são os mais afetados neste período, existindo intensa mobilização de gordura para suprir demandas corporais.(AU)

Relación entre variables antropométricas respecto antecedentes propioceptivos en deportistas chilenos / Relationship between anthropometric variables regarding propioceptive background in chilean sportsmen

El objetivo es determinar la relación entre variables antropométricas respecto antecedentes propioceptivos en escolares deportistas de Taekwondo. La metodología consiste en un estudio descriptivo correlacional, dentro de un marco cuantitativo, donde la muestra fue no probabilistica intencionada con una cantidad de 72 escolares deportistas masculinos de la ciudad de Santa Cruz, Chile. Las variables y antecedentes evaluados se obtuvieron a través de criterios protocolares antropométricos y corres-pondientes a la variable propiocepción, justificado este ultimo con el test SBAT con una confiabilidad de correlación entre 0.67­0.87. Como conclusión, se verificó la correlación bajo análisis estadístico, a través de un trabajo sistemático, donde los resultados muestran una correlación significativa negativa mayor grasa, menor estado propioceptivo y una correlación significativa positiva mayor masa muscular, mayor estado propioceptivo. Consecuentemente los límites de esta investigación son de orden particular, pudiendo servir como referencia local, mas no se pueden extrapolar, sin embargo la metodología aplicada se puede utilizar con otros grupos de estudio en el trabajo cuantitativo.

The objective of this article is to determine the relationship of the variety of antropometrics respective to background in scholars of Taekwondo. The methodology consists of a descriptive correlation, in a Quantitative framework, where the demonstration was probably not intentional with a quantity of 72 sports male scholars in the city of Santa Cruz, Chile. The variables and backgrounds were obtained and evaluated though the protocols anthropometry critics and correspondence to the variable proportion, justified this last with the SBAT test with a confidential correlation between 0.67-0.87. According to the conclusion of the objectives, verified the correlation under the statistical analysis, through the sys-tematic work, where the results show a correlation significantly negatively higher fat, less Propriocepti-ve state. Consecutively the limits of the investigation are in a particular order, serve as a local reference, more than they cannot be extrapolate, however the applied methodology you can use with other study groups in the quantity of the work.

Leukocyte and Skeletal Muscle Telomere Length and Body Composition in Monozygotic Twin Pairs Discordant for Long-term Hormone Replacement Therapy.

Estrogen-based hormone replacement therapy (HRT) may be associated with deceleration of cellular aging. We investigated whether long-term HRT has effects on leukocyte (LTL) or mean and minimum skeletal muscle telomere length (SMTL) in a design that controls for genotype and childhood environment. Associations between telomeres, body composition, and physical performance were also examined. Eleven monozygotic twin pairs (age 57.6 ± 1.8 years) discordant for HRT were studied. Mean duration of HRT use was 7.3 ± 3.7 years in the user sister, while their co-twins had never used HRT. LTL was measured by qPCR and SMTLs by southern blot. Body and muscle composition were estimated by bioimpedance and computed tomography, respectively. Physical performance was measured by jumping height and grip strength. HRT users and non-users did not differ in LTL or mean or minimum SMTL. Within-pair correlations were high in LTL (r = 0.69, p = .020) and in mean (r = 0.74, p = .014) and minimum SMTL (r = 0.88, p = .001). Body composition and performance were better in users than non-users. In analyses of individuals, LTL was associated with BMI (r 2 = 0.30, p = .030), percentage total body (r 2 = 0.43, p = .014), and thigh (r 2 = 0.55, p = .004) fat, while minimum SMTL was associated with fat-free mass (r 2 = 0.27, p = .020) and thigh muscle area (r 2 = 0.42, p = .016). We found no associations between HRT use and telomere length. Longer LTLs were associated with lower total and regional fat, while longer minimum SMTLs were associated with higher fat-free mass and greater thigh muscle area. This suggests that telomeres measured from different tissues may have different associations with measures of body composition.

Fat mass index performs best in monitoring management of obesity in prepubertal children / Índice de massa gorda apresenta melhor desempenho no monitoramento do tratamento da obesidade em crianças pré-púberes

Abstract Objective An early and accurate recognition of success in treating obesity may increase the compliance of obese children and their families to intervention programs. This observational, prospective study aimed to evaluate the ability and the time to detect a significant reduction of adiposity estimated by body mass index (BMI), percentage of fat mass (%FM), and fat mass index (FMI) during weight management in prepubertal obese children. Methods In a cohort of 60 prepubertal obese children aged 3–9 years included in an outpatient weight management program, BMI, %FM, and FMI were monitored monthly; the last two measurements were assessed using air displacement plethysmography. The outcome measures were the reduction of >5% of each indicator and the time to achieve it. Results The rate of detection of the outcome was 33.3% (95% CI: 25.9–41.6) using BMI, significantly lower (p < 0.001) than either 63.3% using %FM (95% CI: 50.6–74.8) or 70.0% (95% CI: 57.5–80.1) using FMI. The median time to detect the outcome was 71 days using FMI, shorter than 88 days using %FM, and similar to 70 days using BMI. The agreement between the outcome detected by FMI and by %FM was high (kappa 0.701), but very low between the success detected by BMI and either FMI (kappa 0.231) or %FM (kappa 0.125). Conclusions FMI achieved the best combination of ability and swiftness to identify reduction of adiposity during monitoring of weight management in prepubertal obese children.

Resumo Objetivo O reconhecimento precoce e preciso do sucesso no tratamento da obesidade pode aumentar a adesão de crianças obesas e suas famílias a programas de intervenção. Este estudo observacional prospectivo visa a avaliar a capacidade e o tempo de detecção de uma redução significativa na adiposidade estimada pelo índice de massa corporal (IMC) no percentual de massa gorda (% MG) e no índice de massa gorda (IMG) durante o controle de peso em crianças obesas pré-púberes. Métodos Em uma coorte de 60 crianças obesas pré-púberes entre três e nove anos, incluídas em um programa ambulatorial de controle de peso, o IMC, o % MG e o IMG foram monitorados mensalmente e as duas últimas medições avaliadas foram feitas com pletismografia por deslocamento de ar. As medições resultantes foram redução de > 5% de cada indicador e atingir o tempo para tanto. Resultados A taxa de detecção do resultado foi de 33,3% (IC de 95% 25,9-41,6) com o uso de IMC, significativamente menor (p < 0,001) do que 63,3% com % MG (IC de 95% 50,6-74,8) ou 70,0% (IC de 95% 57,5-80,1) com IMG. O tempo médio para detectar o resultado foi de 71 dias com o IMG, menos do que 88 dias com %MG e semelhante a 70 dias com o IMC. A concordância entre o resultado detectado pelo IMG e pelo % MG foi elevada (kappa 0,701), porém muito baixa entre o sucesso detectado pelo IMC e pelo IMG (kappa 0,231) ou %MG (kappa 0,125). Conclusões O IMG atingiu a melhor combinação de capacidade e precocidade para identificar redução na adiposidade durante o monitoramento do controle de peso em crianças obesas pré-púberes.

Milk fat globule membrane coating of large lipid droplets in the diet of young mice prevents body fat accumulation in adulthood.

Epidemiological studies have demonstrated protective effects of breast-feeding on childhood obesity. Differences between human milk and infant milk formula (IMF) in dietary lipid structure may contribute to this effect. In our mouse model, feeding a diet containing large lipid droplets coated with phospholipids (PL) (Nuturis®; PL of milk fat globule membrane (MFGM) fraction origin) in early life protected against excessive body fat accumulation following a diet challenge in adult life. We now set out to determine the relevance of increased droplet size and/or MFGM lipid droplet coating to the observed anti-obesogenic effects in adult life. From day 16 to 42, male mouse pups were exposed to diets with small (S) or large (L) lipid droplets (0·3 v. 2·9 µm average mode diameter, respectively), either without MFGM or with MFGM coating around the lipid droplet, resulting in four groups: S (control diet), L, Scoating and Lcoating (Nuturis® IMF diet). Mice were subsequently challenged with a Western-style diet until dissection at postnatal day 98. A non-challenged group served as reference (REF). We repeatedly determined body composition between postnatal day 42 and 98. At day 98 plasma and gene expression measurements were performed. Only the Nuturis® IMF diet (Lcoating) in early life containing MFGM-coated large lipid droplets reduced body fat mass to a level comparable with the REF group. These data support the notion that the structural aspects of lipids in human milk, for example, both lipid droplet size as well as the MFGM coating, may contribute to its reported protective effect against obesity in later life.

Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis.

OBJECTIVE Little is known about the relationship between sagittal spinal alignment in patients with lumbar spinal canal stenosis (LSS) and objective findings such as spinopelvic parameters, lumbar back muscle degeneration, and clinical data. The purpose of this study was to identify the preoperative clinical and radiological factors that predict improvement in sagittal spinal alignment after decompressive surgery in patients with LSS. METHODS The records of 61 patients with LSS who underwent microendoscopic laminotomy and had pre- and postoperative clinical data collected were retrospectively reviewed. Spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), sacral slope, pelvic tilt, and pelvic incidence (PI), were evaluated. On T2-weighted MRI, the cross-sectional area and the percentage of fat infiltration of the paravertebral muscles (PVMs) before surgery were calculated. For patients with preoperative SVA > 40 mm (n = 30), the correlation between SVA improvement and preoperative clinical and radiographic parameters was calculated. RESULTS SVA improvement correlated with preoperative LL (r = -0.39) and PI -LL (r = 0.54). Multiple regression analysis showed that preoperative PI -LL (beta = 0.62; p < 0.01) and symptom duration (beta = -0.40; p < 0.05) were independently associated with SVA improvement. The percentage of fat infiltration of the PVM at L4-5 was significantly greater in patients with preoperative SVA ≥ 40 mm than in those patients with SVA < 40 mm. CONCLUSIONS Preoperative PI -LL and symptom duration were independently associated with SVA improvement in LSS patients with forward-bending posture. PVM degeneration at the lower lumbar level was significantly greater among patients with preoperative SVA ≥ 40 mm than in patients with SVA < 40 mm.

Fat mass index performs best in monitoring management of obesity in prepubertal children.

OBJECTIVE: An early and accurate recognition of success in treating obesity may increase the compliance of obese children and their families to intervention programs. This observational, prospective study aimed to evaluate the ability and the time to detect a significant reduction of adiposity estimated by body mass index (BMI), percentage of fat mass (%FM), and fat mass index (FMI) during weight management in prepubertal obese children. METHODS: In a cohort of 60 prepubertal obese children aged 3-9 years included in an outpatient weight management program, BMI, %FM, and FMI were monitored monthly; the last two measurements were assessed using air displacement plethysmography. The outcome measures were the reduction of >5% of each indicator and the time to achieve it. RESULTS: The rate of detection of the outcome was 33.3% (95% CI: 25.9-41.6) using BMI, significantly lower (p<0.001) than either 63.3% using %FM (95% CI: 50.6-74.8) or 70.0% (95% CI: 57.5-80.1) using FMI. The median time to detect the outcome was 71 days using FMI, shorter than 88 days using %FM, and similar to 70 days using BMI. The agreement between the outcome detected by FMI and by %FM was high (kappa 0.701), but very low between the success detected by BMI and either FMI (kappa 0.231) or %FM (kappa 0.125). CONCLUSIONS: FMI achieved the best combination of ability and swiftness to identify reduction of adiposity during monitoring of weight management in prepubertal obese children.

Effects of a 5-month football program on perceived psychological status and body composition of overweight boys.

The effects of a 5-month intervention of football instruction and practice on the perceived psychological status and body composition of overweight boys were examined. Twelve boys (8-12 years; body mass index ≥ 85th percentile) participated in a structured 5-month football program, consisting of four weekly 60-90 min sessions with mean heart rate > 80%HRmax [football group (FG)]. A control group (CG) included eight boys of equivalent age from an obesity clinic located in the same area as the school. Both groups participated in two sessions of 45-90-min physical education per week at school. Indicators of perceived psychological status included body image, self-esteem, attraction to participation in physical activity, and perceived physical competence measured with standardized questionnaires. Body composition was evaluated using dual-energy X-ray absorptiometry. From baseline through 5 months, FG improved (P < 0.05) in all indicators of psychological status (%Δ = +11.7 to +29.2%) compared with CG (%Δ = -32.1 to +0.5%). Changes in percentage body fat and lean body mass, however, did not differ between FG and CG. The findings suggest that a 5-month football intervention program was effective in improving the psychological status of overweight boys but did not significantly alter body composition.