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1.
BMC Med Genet ; 21(1): 239, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33261563

RESUMO

BACKGROUND: Early-onset chronic diarrhoea often indicates a congenital disorder. Mutation in diacylglycerol o-acyltransferase 1 (DGAT1) has recently been linked to early-onset chronic diarrhoea. To date, only a few cases of DGAT1 deficiency have been reported. Diarrhoea in those cases was severe and developed in the neonatal period or within 2 months after birth. CASE PRESENTATION: Here, we report a female patient with DGAT1 mutations with delayed-onset chronic diarrhoea. The patient had vomiting, hypoalbuminemia, hypertriglyceridemia, and failure to thrive at early infancy. Her intractable chronic diarrhoea occurred until she was 8 months of age. A compound heterozygous DGAT1 mutation was found in the patient, which was first found in the Chinese population. Her symptoms and nutrition status improved after nutritional therapy, including a fat restriction diet. CONCLUSIONS: This case expanded our knowledge of the clinical features of patients with DGAT1 mutations. Intractable diarrhoea with delayed onset could also be a congenital disorder.


Assuntos
Diacilglicerol O-Aciltransferase/genética , Diarreia/genética , Insuficiência de Crescimento/genética , Hipertrigliceridemia/genética , Hipoalbuminemia/genética , Mutação , Vômito/genética , Idade de Início , Sequência de Bases , Diacilglicerol O-Aciltransferase/deficiência , Diarreia/dietoterapia , Diarreia/metabolismo , Diarreia/fisiopatologia , Dieta com Restrição de Gorduras , Insuficiência de Crescimento/dietoterapia , Insuficiência de Crescimento/metabolismo , Insuficiência de Crescimento/fisiopatologia , Feminino , Expressão Gênica , Heterozigoto , Humanos , Hipertrigliceridemia/dietoterapia , Hipertrigliceridemia/metabolismo , Hipertrigliceridemia/fisiopatologia , Hipoalbuminemia/dietoterapia , Hipoalbuminemia/metabolismo , Hipoalbuminemia/fisiopatologia , Lactente , Índice de Gravidade de Doença , Vômito/dietoterapia , Vômito/metabolismo , Vômito/fisiopatologia
2.
JAMA Netw Open ; 3(11): e2025454, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33252690

RESUMO

Importance: Excess body weight and insulin resistance lead to type 2 diabetes and other major health problems. There is an urgent need for dietary interventions to address these conditions. Objective: To measure the effects of a low-fat vegan diet on body weight, insulin resistance, postprandial metabolism, and intramyocellular and hepatocellular lipid levels in overweight adults. Design, Setting, and Participants: This 16-week randomized clinical trial was conducted between January 2017 and February 2019 in Washington, DC. Of 3115 people who responded to flyers in medical offices and newspaper and radio advertisements, 244 met the participation criteria (age 25 to 75 years; body mass index of 28 to 40) after having been screened by telephone. Interventions: Participants were randomized in a 1:1 ratio. The intervention group (n = 122) was asked to follow a low-fat vegan diet and the control group (n = 122) to make no diet changes for 16 weeks. Main Outcomes and Measures: At weeks 0 and 16, body weight was assessed using a calibrated scale. Body composition and visceral fat were measured by dual x-ray absorptiometry. Insulin resistance was assessed with the homeostasis model assessment index and the predicted insulin sensitivity index (PREDIM). Thermic effect of food was measured by indirect calorimetry over 3 hours after a standard liquid breakfast (720 kcal). In a subset of participants (n = 44), hepatocellular and intramyocellular lipids were quantified by proton magnetic resonance spectroscopy. Repeated measure analysis of variance was used for statistical analysis. Results: Among the 244 participants in the study, 211 (87%) were female, 117 (48%) were White, and the mean (SD) age was 54.4 (11.6) years. Over the 16 weeks, body weight decreased in the intervention group by 5.9 kg (95% CI, 5.0-6.7 kg; P < .001). Thermic effect of food increased in the intervention group by 14.1% (95% CI, 6.5-20.4; P < .001). The homeostasis model assessment index decreased (-1.3; 95% CI, -2.2 to -0.3; P < .001) and PREDIM increased (0.9; 95% CI, 0.5-1.2; P < .001) in the intervention group. Hepatocellular lipid levels decreased in the intervention group by 34.4%, from a mean (SD) of 3.2% (2.9%) to 2.4% (2.2%) (P = .002), and intramyocellular lipid levels decreased by 10.4%, from a mean (SD) of 1.6 (1.1) to 1.5 (1.0) (P = .03). None of these variables changed significantly in the control group over the 16 weeks. The change in PREDIM correlated negatively with the change in body weight (r = -0.43; P < .001). Changes in hepatocellular and intramyocellular lipid levels correlated with changes in insulin resistance (both r = 0.51; P = .01). Conclusions and Relevance: A low-fat plant-based dietary intervention reduces body weight by reducing energy intake and increasing postprandial metabolism. The changes are associated with reductions in hepatocellular and intramyocellular fat and increased insulin sensitivity. Trial Registration: ClinicalTrials.gov Identifier: NCT02939638.


Assuntos
Dieta com Restrição de Gorduras , Dieta Vegana , Fígado/metabolismo , Músculo Esquelético/metabolismo , Obesidade/dietoterapia , Absorciometria de Fóton , Adulto , Idoso , Glicemia/metabolismo , Composição Corporal , Peso Corporal , Peptídeo C/metabolismo , Colesterol/metabolismo , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , Ingestão de Energia , Metabolismo Energético , Feminino , Hemoglobina A Glicada/metabolismo , Hepatócitos/metabolismo , Humanos , Insulina/metabolismo , Resistência à Insulina , Gordura Intra-Abdominal/diagnóstico por imagem , Metabolismo dos Lipídeos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fibras Musculares Esqueléticas/metabolismo , Músculo Esquelético/diagnóstico por imagem , Obesidade/metabolismo , Sobrepeso/dietoterapia , Sobrepeso/metabolismo , Período Pós-Prandial , Espectroscopia de Prótons por Ressonância Magnética , Triglicerídeos/metabolismo
3.
Am J Physiol Endocrinol Metab ; 319(6): E1084-E1100, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33017221

RESUMO

Central and peripheral mechanisms are both required for proper control of energy homeostasis. Among circulating plasma proteins, C1q/TNF-related proteins (CTRPs) have recently emerged as important regulators of sugar and fat metabolism. CTRP4, expressed in brain and adipose tissue, is unique among the family members in having two tandem globular C1q domains. We previously showed that central administration of recombinant CTRP4 suppresses food intake, suggesting a central nervous system role in regulating ingestive physiology. Whether this effect is pharmacological or physiological remains unclear. We used a loss-of-function knockout (KO) mouse model to clarify the physiological role of CTRP4. Under basal conditions, CTRP4 deficiency increased serum cholesterol levels and impaired glucose tolerance in male but not female mice fed a control low-fat diet. When challenged with a high-fat diet, male and female KO mice responded differently to weight gain and had different food intake patterns. On an obesogenic diet, male KO mice had similar weight gain as wild-type littermates. When fed ad libitum, KO male mice had greater meal number, shorter intermeal interval, and reduced satiety ratio. Female KO mice, in contrast, had lower body weight and adiposity. In the refeeding period following food deprivation, female KO mice had significantly higher food intake due to longer meal duration and reduced satiety ratio. Collectively, our data provide genetic evidence for a sex-dependent physiological role of CTRP4 in modulating food intake patterns and systemic energy metabolism.


Assuntos
Adipocinas/genética , Adipocinas/fisiologia , Adiposidade/genética , Ingestão de Alimentos/genética , Adipocinas/farmacologia , Animais , Contagem de Células Sanguíneas , Colesterol/sangue , Dieta com Restrição de Gorduras , Dieta Hiperlipídica , Feminino , Intolerância à Glucose/genética , Intolerância à Glucose/metabolismo , Masculino , Camundongos , Camundongos Knockout , Camundongos Obesos , Obesidade/metabolismo , Resposta de Saciedade , Caracteres Sexuais , Ganho de Peso/genética
4.
PLoS Med ; 17(9): e1003282, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32903262

RESUMO

BACKGROUND: Endothelial dysfunction is a crucial step in atherosclerosis development, and its severity is determinant for the risk of cardiovascular recurrence. Diet may be an effective strategy to protect the endothelium, although there is no consensus about the best dietary model. The CORonary Diet Intervention with Olive oil and cardiovascular PREVention (CORDIOPREV) study is an ongoing prospective, randomized, single-blind, controlled trial in 1,002 coronary heart disease (CHD) patients, whose primary objective is to compare the effect of 2 healthy dietary patterns (low-fat versus Mediterranean diet) on the incidence of cardiovascular events. Here, we report the results of one secondary outcome of the CORDIOPREV study: to evaluate the effect of these diets on endothelial function, assessed by flow-mediated dilation (FMD) of the brachial artery. METHODS AND FINDINGS: From the total participants taking part in the CORDIOPREV study, 805 completed endothelial function study at baseline and were randomized to follow a Mediterranean diet (35% fat, 22% monounsaturated fatty acids [MUFAs], and <50% carbohydrates) or a low-fat diet (28% fat, 12% MUFAs, and >55% carbohydrates), with endothelial function measurement repeated after 1 year. As secondary objectives and to explore different underlying mechanisms in the modulation of endothelial function, we quantified endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) and evaluated, in 24 preselected patients, in vitro cellular processes related to endothelial damage (reactive oxygen species, apoptosis, and senescence) and endothelial repair (cell proliferation and angiogenesis), as well as other modulators (micro-RNAs [miRNAs] and proteins). Patients who followed the Mediterranean diet had higher FMD (3.83%; 95% confidence interval [CI]: 2.91-4.23) compared with those in the low-fat diet (1.16%; 95% CI: 0.80 to 1.98) with a difference between diets of 2.63% (95% CI: 1.89-3.40, p = 0.011), even in those patients with severe endothelial dysfunction. We observed higher EPC levels (group difference: 1.64%; 95% CI: 0.79-2.13, p = 0.028) and lower EMPs (group difference: -755 EMPs/µl; 95% CI: -1,010 to -567, p = 0.015) after the Mediterranean diet compared with the low-fat diet in all patients. We also observed lower intracellular reactive oxygen species (ROS) production (group difference: 11.1; 95% CI: 2.5 to 19.6, p = 0.010), cellular apoptosis (group difference: -20.2; 95% CI: -26.7 to -5.11, p = 0.013) and senescence (18.0; 95% CI: 3.57 to 25.1, p = 0.031), and higher cellular proliferation (group difference: 11.3; 95% CI: 4.51 to 13.5, p = 0.011) and angiogenesis (total master segments length, group difference: 549; 95% CI: 110 to 670, p = 0.022) after the Mediterranean diet than the low-fat diet. Each dietary intervention was associated with distinct changes in the epigenetic and proteomic factors that modulate biological process associated with endothelial dysfunction. The evaluation of endothelial function is a substudy of the CORDIOPREV study. As in any substudy, these results should be treated with caution, such as the potential for false positives because of the exploratory nature of the analyses. CONCLUSIONS: Our results suggest that the Mediterranean diet better modulates endothelial function compared with a low-fat diet and is associated with a better balance of vascular homeostasis in CHD patients, even in those with severe endothelial dysfunction. CLINICAL TRIAL REGISTRATION: URL, http://www.cordioprev.es/index.php/en. clinicaltrials.gov number NCT00924937.


Assuntos
Doença das Coronárias/dietoterapia , Endotélio/metabolismo , Idoso , Doenças Cardiovasculares/prevenção & controle , Dieta com Restrição de Gorduras , Dieta Mediterrânea , Gorduras na Dieta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Azeite de Oliva , Estudos Prospectivos , Proteômica , Método Simples-Cego
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(7): 431-437, ago.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194699

RESUMO

OBJETIVO: Explorar a través Google Trends las tendencias del interés de la población española sobre información relacionada con diferentes tipos de dietas, focalizadas en las más populares y con estudios de evidencia, a lo largo de los últimos 10 años. MATERIAL Y MÉTODO: Se analizaron las tendencias de búsqueda de los términos «dieta mediterránea», «dieta cetogénica», «dieta baja en grasas», «ayuno intermitente» y «dieta vegana». El volumen relativo de búsqueda (VRB) de cada término fue comparado. La dirección de la tendencia se estudió mediante la correlación de Spearman (CS). RESULTADOS: El término «dieta mediterránea» fue el más buscado, con una mediana de VRB de 16 (rango intercuartil [RI] 6; rango 8-100), aunque siguió una tendencia cronológica decreciente (CS = -0,216). Le siguieron «dieta cetogénica», con VRB de 8 (RI 9; rango 1-57); «dieta vegana», con VRB de 4 (RI 5; rango 0-16); «ayuno intermitente», con VRB de 2 (RI 5; rango 0-27), y «dieta baja en grasas», con VRB de 1,16 (RI 0; rango 0-2). El término con mejor correlación a lo largo del tiempo fue «ayuno intermitente» (CS = 0,96), seguido de «dieta cetogénica» (CS = 0,91) y «dieta vegana» (CS = 0,85). CONCLUSIÓN: En España, el interés de la población sobre la información acerca de la dieta mediterránea es mayor que para otras dietas. Sin embargo, en los últimos años se ha producido un incremento progresivo en el interés, medido como VRB, en otras dietas, como la dieta cetogénica, la dieta vegana o el ayuno intermitente, y se ha producido una reducción en el interés por la dieta mediterránea. La dieta baja en grasas no genera interés en la población española


OBJECTIVE: To use Google Trends to explore the trends of interest of the Spanish population regarding information related to different types of diets, focused on those that are popular and with evidence-based studies, over the last 10 years. MATERIAL AND METHODS: The search trends referred to the terms «Mediterranean diet», «ketogenic diet», «low fat diet», «intermittent fasting» and «vegan diet» were analyzed. The relative search volumes (RSV) of the terms were compared. The direction of the trend was studied using the Spearman's correlation coefficient (SC). RESULTS: «Mediterranean diet» was the most widely searched term, with a median RSV of 16 (interquartile range [IQR] 6; range 8-100), though it exhibited a decreasing chronological trend (SC = -0.216). It was followed by «ketogenic diet», with an RSV of 8 (IQR 9; range 1-57); «vegan diet», with an RSV of 4 (IQR 5; range 0-16); «intermittent fasting», with an RSV of 2 (IQR 5; range 0-27), and «low fat diet», with an RSV of 1.16 (IQR 0; range 0-2). The term with the best correlation over time was «intermittent fasting» (SC = 0.96), followed by «ketogenic diet» (SC = 0.91) and «vegan diet» (SC = 0.85). CONCLUSIONS: In Spain, the interest of the population in information about the Mediterranean diet is greater than for other diets. However, in recent years there has been a progressive increase in interest (measured as RSV) in other diets such as the ketogenic diet, vegan diet or intermittent fasting, and there has been a decrease in interest in the Mediterranean diet. The low fat diet does not generate interest in the Spanish population


Assuntos
Humanos , Acesso à Internet/tendências , Dieta/métodos , Dietoterapia/métodos , Informação Nutricional , Dieta/estatística & dados numéricos , Dieta/classificação , Dieta Mediterrânea , Dietoterapia/classificação , Dieta Cetogênica , Dieta com Restrição de Gorduras , Jejum , Dieta Vegana
6.
Animal ; 14(12): 2523-2534, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32638696

RESUMO

Sub-acute ruminal acidosis (SARA) is sometimes observed along with reduced milk fat synthesis. Inconsistent responses may be explained by dietary fat levels. Twelve ruminally cannulated cows were used in a Latin square design investigating the timing of metabolic and milk fat changes during Induction and Recovery from SARA by altering starch levels in low-fat diets. Treatments were (1) SARA Induction, (2) Recovery and (3) Control. Sub-acute ruminal acidosis was induced by feeding a diet containing 29.4% starch, 24.0% NDF and 2.8% fatty acids (FAs), whereas the Recovery and Control diets contained 19.9% starch, 31.0% NDF and 2.6% FA. Relative to Control, DM intake (DMI) and milk yield were higher in SARA from days 14 to 21 and from days 10 to 21, respectively (P < 0.05). Milk fat content was reduced from days 3 to 14 in SARA (P < 0.05) compared with Control, while greater protein and lactose contents were observed from days 14 to 21 and 3 to 21, respectively (P < 0.05). Milk fat yield was reduced by SARA on day 3 (P < 0.05), whereas both protein and lactose yields were higher on days 14 and 21 (P < 0.05). The ruminal acetate-to-propionate ratio was lower, and the concentrations of propionate and lactate were higher in the SARA treatment compared with Control on day 21 (P < 0.05). Plasma insulin increased during SARA, whereas plasma non-esterified fatty acids and milk ß-hydroxybutyrate decreased (P < 0.05). Similarly to fat yield, the yield of milk preformed FA (>16C) was lower on day 3 (P < 0.05) and tended to be lower on day 7 in SARA cows (P < 0.10), whereas yield of de novo FA (<16C) was higher on day 21 (P < 0.01) in the SARA group relative to Control. The t10- to t11-18:1 ratio increased during the SARA Induction period (P < 0.05), but the concentration of t10-18:1 remained below 0.5% of milk fat, and t10,c12 conjugated linoleic acid remained below detection levels. Odd-chain FA increased, whereas branched-chain FA was reduced during SARA Induction from days 3 to 21 (P < 0.05). Sub-acute ruminal acidosis reduced milk fat synthesis transiently. Such reduction was not associated with ruminal biohydrogenation intermediates but rather with a transient reduction in supply of preformed FA. Subsequent rescue of milk fat synthesis may be associated with higher availability of substrates due to increased DMI during SARA.


Assuntos
Leite , Amido , Ração Animal/análise , Animais , Bovinos , Dieta/veterinária , Dieta com Restrição de Gorduras/veterinária , Ácidos Graxos/metabolismo , Feminino , Lactação , Metaboloma , Leite/metabolismo , Rúmen/metabolismo , Amido/metabolismo
7.
Am J Physiol Endocrinol Metab ; 319(3): E472-E484, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32691631

RESUMO

Obesity and its metabolic sequelae are implicated in dysfunction of the somatosensory, sympathetic, and hypothalamic systems. Because these systems contribute to integrative regulation of energy expenditure (EE) and energy intake (EI) in response to ambient temperature (Ta) changes, we hypothesized that diet-induced obesity (DIO) disrupts Ta-associated EE-EI coupling. C57BL/6N male mice were fed a high-fat diet (HFD; 45% kcal) or low-fat diet (LFD; 10% kcal) for ∼9.5 wk; HFD mice were then split into body weight (BWT) quartiles (n = 8 each) to study DIO-low gainers (Q1) versus -high gainers (Q4). EI and indirect calorimetry (IC) were measured over 3 days each at 10°C, 20°C, and 30°C. Responses did not differ between LFD, Q1, and Q4; EI and BWT-adjusted EE increased rapidly when transitioning toward 20°C and 10°C. In all groups, EI at 30°C was not reduced despite lower EE, resulting in positive energy balance and respiratory exchange ratios consistent with increased de novo lipogenesis, energy storage, and relative hyperphagia. We conclude that 1) systems controlling Ta-dependent acute EI/EE coupling remained intact in obese mice and 2) rapid coupling of EI/EE at cooler temperatures is an important adaptation to maintain energy stores and defend body temperature, but less critical at thermoneutrality. A post hoc analysis using digestible EI plus IC-calculated EE suggests that standard IC assumptions for EE calculation require further validation in the setting of DIO. The experimental paradigm provides a platform to query the hypothalamic, somatosensory, and sympathetic mechanisms that drive Ta-associated EI/EE coupling.


Assuntos
Regulação da Temperatura Corporal/fisiologia , Ingestão de Energia , Metabolismo Energético , Obesidade/metabolismo , Temperatura , Tecido Adiposo Marrom/metabolismo , Animais , Glicemia/metabolismo , Composição Corporal , Peso Corporal , Dieta com Restrição de Gorduras , Dieta Hiperlipídica , Ingestão de Líquidos , Insulina/sangue , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Obesos , Obesidade/etiologia
8.
Am J Gastroenterol ; 115(10): 1596-1603, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32558690

RESUMO

Bile acids (BAs) are the central signals in enterohepatic communication, and they also integrate microbiota-derived signals into enterohepatic signaling. The tissue distribution and signaling pathways activated by BAs through natural receptors, farsenoid X receptor and G protein-coupled BA receptor 1 (GPBAR1, also known as Takeda G-coupled receptor 5), have led to a greater understanding of the mechanisms and potential therapeutic agents. BA diarrhea is most commonly encountered in ileal resection or disease, in idiopathic disorders (with presentation similar to functional diarrhea or irritable bowel syndrome with diarrhea), and in association with malabsorption such as chronic pancreatitis or celiac disease. Diagnosis of BA diarrhea is based on Se-homocholic acid taurine retention, 48-hour fecal BA excretion, or serum 7αC4; the latter being a marker of hepatic BA synthesis. BA diarrhea tends to be associated with higher body mass index, increased stool weight and stool fat, and acceleration of colonic transit. Biochemical markers of increased BA synthesis or excretion are available through reference laboratories. Current treatment of BA diarrhea is based on BA sequestrants, and, in the future, it is anticipated that farsenoid X receptor agonists may also be effective. The optimal conditions for an empiric trial with BA sequestrants as a diagnostic test are still unclear. However, such therapeutic trials are widely used in clinical practice. Some national guidelines recommend definitive diagnosis of BA diarrhea over empirical trial.


Assuntos
Ácidos e Sais Biliares/metabolismo , Diarreia/metabolismo , Diarreia/terapia , Dieta com Restrição de Gorduras , Sequestrantes/uso terapêutico , Benzotiazóis/uso terapêutico , Ácido Quenodesoxicólico/análogos & derivados , Ácido Quenodesoxicólico/uso terapêutico , Colestenonas/sangue , Resina de Colestiramina/uso terapêutico , Doença Crônica , Cloridrato de Colesevelam/uso terapêutico , Colestipol/uso terapêutico , Fezes/química , Humanos , Mucosa Intestinal/metabolismo , Síndrome do Intestino Irritável/metabolismo , Isoxazóis/uso terapêutico , Fígado/metabolismo , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/tratamento farmacológico , Síndromes de Malabsorção/metabolismo , Receptores Citoplasmáticos e Nucleares/agonistas , Ácido Taurocólico/análogos & derivados
9.
Obesity (Silver Spring) ; 28(7): 1235-1244, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475085

RESUMO

OBJECTIVE: This study aimed to compare two energy-restricted, nutrient-dense diets at the upper or lower ends of the dietary fat recommendation range (lower fat [20% energy from fat] versus moderate fat [35%]) on weight loss using behavioral theory-based nutrition education. METHODS: A total of 101 premenopausal women with overweight or obesity were randomized to an energy-restricted lower-fat or moderate-fat diet for 1 year. Interventions included 28 behavioral theory-based nutrition education sessions plus weekly exercise sessions. RESULTS: Both treatment groups experienced weight loss (-5.0 kg for lower fat and -4.3 kg for moderate fat; P < 0.0001), but there was no difference in weight loss or fat intake between groups. Total and low-density lipoprotein cholesterol decreased (-3. 4 mg/dL and -3.8 mg/dL; P < 0.05), and high-density lipoprotein cholesterol increased (1.9 mg/dL; P < 0.05) in both groups at 12 months. Diet quality, assessed by the Healthy Eating Index, increased significantly at 4 months versus baseline (70.8 [0.9] vs. 77.8 [1.0]) and was maintained through 12 months. Higher Healthy Eating Index scores were associated with greater weight loss at 4 months (r = -0.2; P < 0.05). CONCLUSIONS: In the context of a well-resourced, free-living weight-loss intervention, total fat intake did not change; however, theory-based nutrition education underpinned by food-based recommendations resulted in caloric deficits, improvements in diet quality, and weight loss that was sustained for 1 year.


Assuntos
Manutenção do Peso Corporal/fisiologia , Estilo de Vida , Política Nutricional , Obesidade/dietoterapia , Perda de Peso , Adulto , Restrição Calórica , Dieta com Restrição de Gorduras , Dieta Saudável , Exercício Físico/fisiologia , Feminino , Humanos , Obesidade/terapia
10.
Am J Clin Nutr ; 112(2): 293-302, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32520346

RESUMO

BACKGROUND: Dietary Guidelines for Americans recommend the consumption of 3 servings/d of low-fat/nonfat dairy. The effects of higher dairy consumption and its fat content are unknown in patients with type 2 diabetes. OBJECTIVE: Evaluate the impact of higher consumption of high- compared with low-fat dairy on glycated hemoglobin (HbA1c), body weight, and cardiovascular disease risk factors in patients with type 2 diabetes. METHODS: We enrolled 111 subjects with type 2 diabetes (aged 58.5 ± 8.9 y, 47% females, diabetes duration 13.2 ± 8.3 y, HbA1c 8.09 ± 0.96%) who consumed <3 servings of dairy/d. We randomly assigned them into 3 groups: control group maintained baseline dairy intake, low-fat (LF) group incorporated ≥3 servings/d of LF dairy, and the high-fat (HF) group incorporated ≥3 servings/d of HF dairy. We evaluated HbA1c, body weight, BMI, body composition parameters, blood pressure (BP), lipid parameters, homeostatic model assessment of insulin resistance (HOMA-IR), and total energy and macronutrient intake at baseline, and after 12 and 24 wk. RESULTS: At 24 wk, percent energy from saturated fat increased from baseline in the HF group by 3.6%, (95% CI: 2.2, 5.1) and decreased in the LF group by -1.9% (95% CI: -3.3, -0.4). The LF group increased their percent energy from protein by 4.5% (95% CI: 2.6, 6.4), whereas the HF group decreased their percent energy from carbohydrates by -3.4% (95% CI: -0.2, -6.7). There were no differences in the mean changes in HbA1c, body weight, BMI, body composition or lipid parameters, or BP between the 3 groups at 24 wk. CONCLUSION: In patients with type 2 diabetes, increased dairy consumption to ≥3 servings/d compared with <3 servings/d, irrespective of its fat content, while maintaining energy intake has no effect on HbA1c, body weight, body composition, lipid profile, or BP. This trial was registered at clinicaltrials.gov as NCT02895867.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Gorduras , Adulto , Idoso , Glicemia/metabolismo , Pressão Sanguínea , Peso Corporal , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Gorduras na Dieta/análise , Gorduras na Dieta/metabolismo , Ingestão de Energia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
11.
Cochrane Database Syst Rev ; 6: CD013636, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32476140

RESUMO

BACKGROUND: The ideal proportion of energy from fat in our food and its relation to body weight is not clear. In order to prevent overweight and obesity in the general population, we need to understand the relationship between the proportion of energy from fat and resulting weight and body fatness in the general population. OBJECTIVES: To assess the effects of proportion of energy intake from fat on measures of body fatness (including body weight, waist circumference, percentage body fat and body mass index) in people not aiming to lose weight, using all appropriate randomised controlled trials (RCTs) of at least six months duration. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) to October 2019. We did not limit the search by language. SELECTION CRITERIA: Trials fulfilled the following criteria: 1) randomised intervention trial, 2) included adults aged at least 18 years, 3) randomised to a lower fat versus higher fat diet, without the intention to reduce weight in any participants, 4) not multifactorial and 5) assessed a measure of weight or body fatness after at least six months. We duplicated inclusion decisions and resolved disagreement by discussion or referral to a third party. DATA COLLECTION AND ANALYSIS: We extracted data on the population, intervention, control and outcome measures in duplicate. We extracted measures of body fatness (body weight, BMI, percentage body fat and waist circumference) independently in duplicate at all available time points. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity, funnel plot analyses and GRADE assessment. MAIN RESULTS: We included 37 RCTs (57,079 participants). There is consistent high-quality evidence from RCTs that reducing total fat intake results in small reductions in body fatness; this was seen in almost all included studies and was highly resistant to sensitivity analyses (GRADE high-consistency evidence, not downgraded). The effect of eating less fat (compared with higher fat intake) is a mean body weight reduction of 1.4 kg (95% confidence interval (CI) -1.7 to -1.1 kg, in 53,875 participants from 26 RCTs, I2 = 75%). The heterogeneity was explained in subgrouping and meta-regression. These suggested that greater weight loss results from greater fat reductions in people with lower fat intake at baseline, and people with higher body mass index (BMI) at baseline. The size of the effect on weight does not alter over time and is mirrored by reductions in BMI (MD -0.5 kg/m2, 95% CI -0.6 to -0.3, 46,539 participants in 14 trials, I2 = 21%), waist circumference (MD -0.5 cm, 95% CI -0.7 to -0.2, 16,620 participants in 3 trials; I2 = 21%), and percentage body fat (MD -0.3% body fat, 95% CI -0.6 to 0.00, P = 0.05, in 2350 participants in 2 trials; I2 = 0%). There was no suggestion of harms associated with low fat diets that might mitigate any benefits on body fatness. The reduction in body weight was reflected in small reductions in LDL (-0.13 mmol/L, 95% CI -0.21 to -0.05), and total cholesterol (-0.23 mmol/L, 95% CI -0.32 to -0.14), with little or no effect on HDL cholesterol (-0.02 mmol/L, 95% CI -0.03 to 0.00), triglycerides (0.01 mmol/L, 95% CI -0.05 to 0.07), systolic (-0.75 mmHg, 95% CI -1.42 to -0.07) or diastolic blood pressure(-0.52 mmHg, 95% CI -0.95 to -0.09), all GRADE high-consistency evidence or quality of life (0.04, 95% CI 0.01 to 0.07, on a scale of 0 to 10, GRADE low-consistency evidence). AUTHORS' CONCLUSIONS: Trials where participants were randomised to a lower fat intake versus a higher fat intake, but with no intention to reduce weight, showed a consistent, stable but small effect of low fat intake on body fatness: slightly lower weight, BMI, waist circumference and percentage body fat compared with higher fat arms. Greater fat reduction, lower baseline fat intake and higher baseline BMI were all associated with greater reductions in weight. There was no evidence of harm to serum lipids, blood pressure or quality of life, but rather of small benefits or no effect.


Assuntos
Tecido Adiposo , Adiposidade , Gorduras na Dieta/administração & dosagem , Ingestão de Energia , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Peso Corporal , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dieta com Restrição de Gorduras , Dieta Rica em Proteínas , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Triglicerídeos/sangue , Circunferência da Cintura
13.
Curr Atheroscler Rep ; 22(6): 20, 2020 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-32468247

RESUMO

PURPOSE OF REVIEW: Carbohydrate (CHO)-restricted dietary patterns (very-low-CHO < 25-50 g CHO/day; low CHO 50-130 g CHO/day) and physical activity are used for weight loss and type 2 diabetes (T2D) prevention and management. This review discusses evidence for effects of these lifestyle therapies on body weight and glycemic control. RECENT FINDINGS: Evidence supports the view that CHO-restricted interventions may be more effective than high-CHO, low-fat (HCLF) interventions in the short term for weight loss and glycemic control, but both produced similar levels of weight loss and glycemic control by 12 months. CHO-restricted dietary patterns resulted in a decreased use of diabetes medications. Benefits of CHO restriction were achieved at intakes that did not induce ketosis. Physical activity increases insulin sensitivity and reduces pancreatic beta-cell load, enhancing the effect of weight loss to delay or prevent T2D. A CHO-restricted dietary pattern may be a reasonable option for weight loss and T2D management for some individuals. Physical activity enhances weight management and cardiometabolic health.


Assuntos
Peso Corporal , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta com Restrição de Carboidratos/métodos , Carboidratos da Dieta , Exercício Físico , Dieta da Carga de Carboidratos/métodos , Dieta com Restrição de Gorduras/métodos , Intolerância à Glucose , Humanos , Resistência à Insulina , Resultado do Tratamento , Perda de Peso
14.
Ann Intern Med ; 172(12): 786-794, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32423348

RESUMO

BACKGROUND: The DASH diet has been found to lower blood pressure (BP) and low-density lipoprotein cholesterol levels. OBJECTIVE: To compare diets rich in fruits and vegetables with a typical American diet in their effects on cardiovascular injury in middle-aged adults without known preexisting cardiovascular disease (CVD). DESIGN: Observational study based on a 3-group, parallel-design, randomized trial conducted in the United States from 1994 to 1996. (ClinicalTrials.gov: NCT00000544). SETTING: 3 of the 4 original clinical trial centers. PARTICIPANTS: 326 of the original 459 trial participants with available stored specimens. INTERVENTION: Participants were randomly assigned to 8 weeks of monitored feeding with a control diet typical of what many Americans eat; a diet rich in fruits and vegetables but otherwise similar to the control diet; or the DASH diet, which is rich in fruits, vegetables, low-fat dairy, and fiber and has low levels of saturated fat and cholesterol. Weight was kept constant throughout feeding. MEASUREMENTS: Biomarkers collected at baseline and 8 weeks: high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP). RESULTS: The mean age of participants was 45.2 years, 48% were women, 49% were black, and mean baseline BP was 131/85 mm Hg. Compared with the control diet, the fruit-and-vegetable diet reduced hs-cTnI levels by 0.5 ng/L (95% CI, -0.9 to -0.2 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.1 pg/mL). Compared with the control diet, the DASH diet reduced hs-cTnI levels by 0.5 ng/L (CI, -0.9 to -0.1 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.04 pg/mL). Levels of hs-CRP did not differ among diets. None of the markers differed between the fruit-and-vegetable and DASH diets. LIMITATION: Short duration, missing specimens, and an inability to isolate the effects of specific foods or micronutrients. CONCLUSION: Diets rich in fruits and vegetables given over 8 weeks were associated with lower levels of markers for subclinical cardiac damage and strain in adults without preexisting CVD. PRIMARY FUNDING SOURCE: National Institutes of Health, National Heart, Lung, and Blood Institute.


Assuntos
Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/tratamento farmacológico , Dieta com Restrição de Gorduras/métodos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Adulto , Biomarcadores/sangue , Pressão Sanguínea , Doenças Cardiovasculares/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Precursores de Proteínas , Estudos Retrospectivos
15.
PLoS One ; 15(5): e0233447, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442194

RESUMO

The food industry is currently shown the concern with low-fat products. This study aims to evaluate the properties of oat ß-glucan(OG)-marine collagen peptide (MCP) mixed gels induced by high pressure at different ratios, pressures, pH levels and the superiority of application in the sausage. The results indicated that the typical gel with high levels of hardness, cohesiveness, springiness, and chewiness, as well as high water holding and oil adsorption capacities was formed using the OG/MCP ratio of 10:1 under 400 MPa at pH 6.0. The mixed gel replacing with 50% fat significantly increased the springiness and chewing(P<0.05), and sausages with 80% mixed gel were significantly juicier than that of the control sausage(P<0.05). Therefore, OG-MCP mixed gel could be used in the reformulation of low-fat meat products to enhance their safety and nutritional value.


Assuntos
Avena/química , Colágeno/química , Gorduras na Dieta/análise , Produtos da Carne/análise , beta-Glucanas/química , Animais , Cor , Culinária , Dieta com Restrição de Gorduras , Manipulação de Alimentos , Indústria Alimentícia , Géis , Humanos , Reologia , Sus scrofa , Paladar
16.
Cochrane Database Syst Rev ; 5: CD004192, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32428983

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system. Although the exact pathogenesis remains unknown, the leading theory is that it results from immune system dysregulation. Approved disease-modifying therapy appears to modulate the immune system to improve MS-related outcomes. There is substantial interest in the ability of dietary interventions to influence MS-related outcomes. This is an update of the Cochrane Review 'Dietary interventions for multiple sclerosis' (Farinotti 2003; Farinotti 2007; Farinotti 2012). OBJECTIVES: To assess the effects of dietary interventions (including dietary plans with recommendations for specific whole foods, macronutrients, and natural health products) compared to placebo or another intervention on health outcomes (including MS-related outcomes and serious adverse events) in people with MS. SEARCH METHODS: On 30 May 2019, we searched CENTRAL, MEDLINE, Embase, and Web of Science. We also searched ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform (ICTRP), and Networked Digital Library of Theses and Dissertations (NDLTD). We checked reference lists in identified trials and requested information from trial authors to identify any additional published or unpublished data. SELECTION CRITERIA: We included any randomized controlled trial (RCT) or controlled clinical trial (CCT) examining the effect of a dietary intervention versus placebo or another intervention among participants with MS on MS-related outcomes, including relapses, disability progression, and magnetic resonance imaging (MRI) measures. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Planned primary outcomes were number of participants experiencing relapse and change in disability progression, according to a validated disability scale at the last reported follow-up. Secondary outcomes included MRI activity, safety, and patient-reported outcomes. We entered and analysed data in Review Manager 5. MAIN RESULTS: We found 41 full-text articles examining 30 trials following full-text review. Participants were adults with MS, defined by established criteria, presenting to MS clinics in Europe, North America, and the Middle East. Study design varied considerably, although all trials had at least one methodological issue leading to unknown or high risk of bias. Trials examined: supplementation to increase polyunsaturated fatty acids (PUFAs) (11 trials); a variety of antioxidant supplements (10 trials); dietary programmes (3 trials); and other dietary supplements (e.g. acetyl L-carnitine, biotin, creatine, palmitoylethanolamide, probiotic, riboflavin) (6 trials). In three trials comparing PUFAs with monounsaturated fatty acids (MUFAs), the evidence was very uncertain concerning difference in relapses (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.88 to 1.20; 3 studies, 217 participants; 75% in the PUFA group versus 74% in the MUFA group; very low-certainty evidence). Among four trials comparing PUFAs with MUFAs, there may be little to no difference in global impression of deterioration (RR 0.85, 95% CI 0.71 to 1.03; 4 studies, 542 participants; 40% in the PUFA group versus 47% in the MUFA group; low-certainty evidence). In two trials comparing PUFAs with MUFAs (102 participants), there was very low-certainty evidence for change in disability progression. None of the PUFA versus MUFA trials examined MRI outcomes. In one trial comparing PUFAs with MUFAs (40 participants), there were no serious adverse events; based on low-certainty evidence. In two trials comparing different PUFAs (omega-3 versus omega-6), there may be little to no difference in relapses (RR 1.02, 95% CI 0.62 to 1.66; 2 studies, 129 participants; 30% in the omega-3 versus 29% in the omega-6 group; low-certainty evidence). Among three trials comparing omega-3 with omega-6, there may be little to no difference in change in disability progression, measured as mean change in Expanded Disability Status Scale (EDSS) (mean difference (MD) 0.00, 95% CI -0.30 to 0.30; 3 studies, 166 participants; low-certainty evidence). In one trial comparing omega-3 with omega-6, there was likely no difference in global impression of deterioration (RR 0.99, 95% CI 0.51 to 1.91; 1 study, 86 participants; 29% in omega-3 versus 29% in omega-6 group; moderate-certainty evidence). In one trial comparing omega-3 with omega-6 (86 participants), there was likely no difference in number of new T1- weighted gadolinium-enhancing lesions, based on moderate-certainty evidence. In four trials comparing omega-3 with omega-6, there may be little to no difference in serious adverse events (RR 1.12, 95% CI 0.38 to 3.31; 4 studies, 230 participants; 6% in omega-3 versus 5% in omega-6 group; low-certainty evidence). In four trials examining antioxidant supplementation with placebo, there may be little to no difference in relapses (RR 0.98, 95% CI 0.59 to 1.64; 4 studies, 345 participants; 17% in the antioxidant group versus 17% in the placebo group; low-certainty evidence). In six trials examining antioxidant supplementation with placebo, the evidence was very uncertain concerning change in disability progression, measured as mean change of EDSS (MD -0.19, 95% CI -0.49 to 0.11; 6 studies, 490 participants; very low-certainty evidence). In two trials examining antioxidant supplementation with placebo, there may be little to no difference in global impression of deterioration (RR 0.99, 95% 0.50 to 1.93; 2 studies, 190 participants; 15% in the antioxidant group versus 15% in the placebo group; low-certainty evidence). In two trials examining antioxidant supplementation with placebo, the evidence was very uncertain concerning difference in gadolinium-enhancing lesions (RR 0.67, 95% CI 0.09 to 4.88; 2 studies, 131 participants; 11% in the antioxidant group versus 16% in the placebo group; very low-certainty evidence). In three trials examining antioxidant supplementation versus placebo, there may be little to no difference in serious adverse events (RR. 0.72, 95% CI 0.17 to 3.08; 3 studies, 222 participants; 3% in the antioxidant group versus 4% in the placebo group; low-certainty evidence). AUTHORS' CONCLUSIONS: There are a variety of controlled trials addressing the effects of dietary interventions for MS with substantial variation in active treatment, comparator, and outcomes of interest. PUFA administration may not differ when compared to alternatives with regards to relapse rate, disability worsening, or overall clinical status in people with MS, but evidence is uncertain. Similarly, at present, there is insufficient evidence to determine whether supplementation with antioxidants or other dietary interventions have any impact on MS-related outcomes.


Assuntos
Antioxidantes/administração & dosagem , Suplementos Nutricionais , Ácidos Graxos Insaturados/administração & dosagem , Esclerose Múltipla/dietoterapia , Adulto , Dieta com Restrição de Gorduras , Dieta Paleolítica , Dieta Vegetariana , Progressão da Doença , Ácidos Graxos Monoinsaturados/uso terapêutico , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-6/administração & dosagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva
17.
Am J Physiol Endocrinol Metab ; 318(6): E856-E865, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32315211

RESUMO

Obesity is associated with several chronic comorbidities, one of which is type 2 diabetes mellitus (T2DM). The pathogenesis of obesity and T2DM is influenced by alterations in diet macronutrient composition, which regulate energy expenditure, metabolic function, glucose homeostasis, and pancreatic islet cell biology. Recent studies suggest that increased intake of dietary carbohydrates plays a previously underappreciated role in the promotion of obesity and consequent metabolic dysfunction. Thus, in this study, we utilized mouse models to test the hypothesis that dietary carbohydrates modulate energetic, metabolic, and islet adaptions to high-fat diets. To address this, we exposed C57BL/6J mice to 12 wk of 3 eucaloric high-fat diets (>60% calories from fat) with varying total carbohydrate (1-20%) and sucrose (0-20%) content. Our results show that severe restriction of dietary carbohydrates characteristic of ketogenic diets reduces body fat accumulation, enhances energy expenditure, and reduces prevailing glycemia and insulin resistance compared with carbohydrate-rich, high-fat diets. Moreover, severe restriction of dietary carbohydrates also results in functional, morphological, and molecular changes in pancreatic islets highlighted by restricted capacity for ß-cell mass expansion and alterations in insulin secretory response. These studies support the hypothesis that low-carbohydrate/high-fat diets provide antiobesogenic benefits and suggest further evaluation of the effects of these diets on ß-cell biology in humans.


Assuntos
Dieta Hiperlipídica , Dieta Cetogênica , Carboidratos da Dieta , Metabolismo Energético , Hiperglicemia/metabolismo , Resistência à Insulina , Células Secretoras de Insulina/metabolismo , Obesidade/metabolismo , Adaptação Fisiológica , Tecido Adiposo , Animais , Diabetes Mellitus Tipo 2/metabolismo , Dieta com Restrição de Gorduras , Sacarose na Dieta , Teste de Tolerância a Glucose , Secreção de Insulina , Camundongos
18.
Nutrients ; 12(4)2020 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-32235325

RESUMO

Many postmenopausal women individually experience varying degrees of climacteric symptoms. Among the many influencing factors, body weight and diet are recognized as important contributors to the incidence and severity of these symptoms. This study was performed to investigate the interaction effect of BMI (body mass index) and dietary consumption on the risk of climacteric symptoms among Korean women. Approximately half of the subjects (48.8%) experienced climacteric symptoms. After adjusting for the covariates, the subjects who are overweight or obese showed significantly greater total scores of climacteric symptoms (p = 0.010) and subscales of symptoms (p = 0.027 for physical climacteric symptoms and p = 0.007 for psychological climacteric symptoms), except for urogenital climacteric symptoms (p = 0.085), than those subjects at a normal weight. When subjects were divided into groups according to dietary macronutrient consumption, those who are overweight or obese were 2.84-fold (adjusted odds ratio, 95% CI = 1.18-6.80, p = 0.019) more likely to experience climacteric symptoms than those at a normal weight among the subjects with high fat consumption. However, the BMI category did not affect the adjusted odds ratio for experiencing climacteric symptoms among subjects who consumed a low-fat diet.


Assuntos
Índice de Massa Corporal , Climatério , Dieta , Menopausa/metabolismo , Nutrientes/administração & dosagem , Nutrientes/metabolismo , Fenômenos Fisiológicos da Nutrição , Saúde da Mulher , Peso Corporal , Dieta com Restrição de Gorduras , Dieta Hiperlipídica/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/metabolismo , Obesidade/fisiopatologia
19.
Nutr. hosp ; 37(2): 313-320, mar.-abr. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-190596

RESUMO

INTRODUCTION: dietary fat has been reported as one of the significant risk factors in the development of cardiovascular diseases (CVD). OBJECTIVE: this study aimed at assessing the possible association between fat intake and CVD. METHODS: the present case-control study was conducted in the center of coronary angiography. Three-hundred and ninety nine patients who referred for elective coronary angiography with clinical suspicion of coronary artery disease were enrolled. Dietary data were collected from each patient using an interview-based food frequency questionnaire. RESULTS: the findings of the present study revealed no significant differences between cases and controls regarding the intake of all types of fat either before or after energy adjustment. For both cases and controls the percentage of fat intake from total energy and the intakes of polyunsaturated and monounsaturated fats, cholesterol, omega-6 and omega-3 were within the recommended amounts. The intake of all fat types (except trans-fat) was not associated with the risk of developing CVD. Trans-fat intake in the second and third quartile increased the risk of CVD by OR 1.86 (95 % CI: 1.03-3.34) and 2.01 (95 % CI: 1.12-3.60), respectively. CONCLUSIONS: while trans-fats may be significantly associated with the development of CVD in the first two quartiles, no association has been detected with other fat types


INTRODUCCIÓN: se ha establecido que la grasa en la dieta es uno de los factores de riesgo significativos en el desarrollo de enfermedades cardiovasculares (ECV). OBJETIVO: este estudio tuvo como objetivo evaluar la posible asociación entre la ingesta de grasa y la ECV. MÉTODOS: el presente estudio de casos y controles se realizó en el centro de la angiografía coronaria. Se inscribieron 399 pacientes que fueron remitidos para una angiografía coronaria electiva con sospecha clínica de enfermedad coronaria. Los datos dietéticos se obtuvieron de cada paciente mediante un cuestionario de frecuencia de alimentos basado en entrevistas. RESULTADOS: los hallazgos del presente estudio no revelaron diferencias significativas entre los casos y los controles con respecto a la ingesta de todos los tipos de grasa, ya sea antes o después del ajuste de energía. Para ambos casos y controles, el porcentaje de ingesta de grasas de la energía total y las ingestas de grasas poliinsaturadas y monoinsaturadas, colesterol, omega-6 y omega-3 se encuentran dentro de las cantidades recomendadas. La ingesta de todos los tipos de grasa (excepto las grasas trans) no se asoció con el riesgo de desarrollar ECV. La ingesta de grasas trans en el segundo y tercer cuartil aumentó el riesgo de ECV en OR 1,86 (IC 95 %: 1,03-3,34) y 2,01 (IC 95 %: 1,12-3,60), respectivamente. CONCLUSIONES: si bien las grasas trans pueden estar asociadas significativamente con el desarrollo de ECV en los dos primeros cuartiles, no se ha detectado asociación con otros tipos de grasa


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dieta Hiperlipídica/efeitos adversos , Doença das Coronárias/complicações , Gorduras na Dieta/efeitos adversos , Doença das Coronárias/diagnóstico , Gorduras na Dieta/administração & dosagem , Doença das Coronárias/prevenção & controle , Fatores de Risco , Dieta com Restrição de Gorduras/métodos , Inquéritos Nutricionais
20.
BMJ ; 369: m696, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32238384

RESUMO

OBJECTIVE: To determine the relative effectiveness of dietary macronutrient patterns and popular named diet programmes for weight loss and cardiovascular risk factor improvement among adults who are overweight or obese. DESIGN: Systematic review and network meta-analysis of randomised trials. DATA SOURCES: Medline, Embase, CINAHL, AMED, and CENTRAL from database inception until September 2018, reference lists of eligible trials, and related reviews. STUDY SELECTION: Randomised trials that enrolled adults (≥18 years) who were overweight (body mass index 25-29) or obese (≥30) to a popular named diet or an alternative diet. OUTCOMES AND MEASURES: Change in body weight, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, systolic blood pressure, diastolic blood pressure, and C reactive protein at the six and 12 month follow-up. REVIEW METHODS: Two reviewers independently extracted data on study participants, interventions, and outcomes and assessed risk of bias, and the certainty of evidence using the GRADE (grading of recommendations, assessment, development, and evaluation) approach. A bayesian framework informed a series of random effects network meta-analyses to estimate the relative effectiveness of the diets. RESULTS: 121 eligible trials with 21 942 patients were included and reported on 14 named diets and three control diets. Compared with usual diet, low carbohydrate and low fat diets had a similar effect at six months on weight loss (4.63 v 4.37 kg, both moderate certainty) and reduction in systolic blood pressure (5.14 mm Hg, moderate certainty v 5.05 mm Hg, low certainty) and diastolic blood pressure (3.21 v 2.85 mm Hg, both low certainty). Moderate macronutrient diets resulted in slightly less weight loss and blood pressure reductions. Low carbohydrate diets had less effect than low fat diets and moderate macronutrient diets on reduction in LDL cholesterol (1.01 mg/dL, low certainty v 7.08 mg/dL, moderate certainty v 5.22 mg/dL, moderate certainty, respectively) but an increase in HDL cholesterol (2.31 mg/dL, low certainty), whereas low fat (-1.88 mg/dL, moderate certainty) and moderate macronutrient (-0.89 mg/dL, moderate certainty) did not. Among popular named diets, those with the largest effect on weight reduction and blood pressure in comparison with usual diet were Atkins (weight 5.5 kg, systolic blood pressure 5.1 mm Hg, diastolic blood pressure 3.3 mm Hg), DASH (3.6 kg, 4.7 mm Hg, 2.9 mm Hg, respectively), and Zone (4.1 kg, 3.5 mm Hg, 2.3 mm Hg, respectively) at six months (all moderate certainty). No diets significantly improved levels of HDL cholesterol or C reactive protein at six months. Overall, weight loss diminished at 12 months among all macronutrient patterns and popular named diets, while the benefits for cardiovascular risk factors of all interventions, except the Mediterranean diet, essentially disappeared. CONCLUSIONS: Moderate certainty evidence shows that most macronutrient diets, over six months, result in modest weight loss and substantial improvements in cardiovascular risk factors, particularly blood pressure. At 12 months the effects on weight reduction and improvements in cardiovascular risk factors largely disappear. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015027929.


Assuntos
Dieta com Restrição de Carboidratos , Dieta com Restrição de Gorduras , Dieta Mediterrânea , Nutrientes , Obesidade/dietoterapia , Comportamento de Redução do Risco , Pressão Sanguínea , Índice de Massa Corporal , Peso Corporal , Doenças Cardiovasculares/prevenção & controle , HDL-Colesterol , LDL-Colesterol , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Perda de Peso
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