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1.
Nat Commun ; 12(1): 3377, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099716

RESUMO

Animal models of human diseases are classically fed purified diets that contain casein as the unique protein source. We show that provision of a mixed protein source mirroring that found in the western diet exacerbates diet-induced obesity and insulin resistance by potentiating hepatic mTORC1/S6K1 signaling as compared to casein alone. These effects involve alterations in gut microbiota as shown by fecal microbiota transplantation studies. The detrimental impact of the mixed protein source is also linked with early changes in microbial production of branched-chain fatty acids (BCFA) and elevated plasma and hepatic acylcarnitines, indicative of aberrant mitochondrial fatty acid oxidation. We further show that the BCFA, isobutyric and isovaleric acid, increase glucose production and activate mTORC1/S6K1 in hepatocytes. Our findings demonstrate that alteration of dietary protein source exerts a rapid and robust impact on gut microbiota and BCFA with significant consequences for the development of obesity and insulin resistance.


Assuntos
Proteínas na Dieta/efeitos adversos , Ácidos Graxos/metabolismo , Microbioma Gastrointestinal/fisiologia , Resistência à Insulina , Obesidade/etiologia , Ração Animal/efeitos adversos , Animais , Linhagem Celular Tumoral , Dieta Hiperlipídica/efeitos adversos , Dieta Ocidental/efeitos adversos , Sacarose na Dieta/efeitos adversos , Modelos Animais de Doenças , Transplante de Microbiota Fecal , Vida Livre de Germes , Gluconeogênese , Hepatócitos , Humanos , Fígado/metabolismo , Fígado/patologia , Masculino , Alvo Mecanístico do Complexo 1 de Rapamicina/metabolismo , Camundongos , Obesidade/metabolismo , Obesidade/patologia , Ratos , Proteínas Quinases S6 Ribossômicas 90-kDa/metabolismo , Transdução de Sinais
2.
Nutrients ; 13(4)2021 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-33916669

RESUMO

BACKGROUND: Diets have been a central component of lifestyle modification for decades. The Low-Carbohydrate Diet (LCD), originally conceived as a treatment strategy for intractable epilepsy (due to its association with ketogenesis), became popular in the 1970s and since then has risen to prominence as a weight loss strategy. OBJECTIVE: To explore the efficacy, limitations and potential safety concerns of the LCD. DATA SOURCES: We performed a narrative review, based on relevant articles written in English from a Pubmed search, using the terms 'low carbohydrate diet and metabolic health'. RESULTS: Evidence supports the efficacy of the LCD in the short-term (up to 6-months) for reduction in fat mass and remission of Type 2 Diabetes Mellitus (T2D). However, the longer-term efficacy of the LCD is disappointing, with diminishment of weight loss potential and metabolic benefits of the LCD beyond 6-months of its adoption. Furthermore, practical limitations of the LCD include the associated restriction of food choices that restrict the acceptability of the LCD for the individual, particularly over the longer term. There are also safety concerns of the LCD that stem from nutritional imbalances (with a relative excess of dietary fat and protein intake with associated dyslipidaemia and increased risk of insulin resistance and T2D development) and ketotic effects. Finally, the LCD often results in a reduction in dietary fibre intake, with potentially serious adverse consequences for overall health and the gut microbiota. CONCLUSIONS: Although widely adopted, the LCD usually has short-lived metabolic benefits, with limited efficacy and practicality over the longer term. Dietary modification needs tailoring to the individual, with careful a priori assessments of food preferences to ensure acceptability and adherence over the longer term, with avoidance of dietary imbalances and optimization of dietary fibre intake (primarily from plant-based fruit and vegetables), and with a posteriori assessments of the highly individual responses to the LCD. Finally, we need to change our view of diets from simply an excipient for weight loss to an essential component of a healthy lifestyle.


Assuntos
Carboidratos/deficiência , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos/efeitos adversos , Carboidratos da Dieta/metabolismo , Obesidade/dietoterapia , Diabetes Mellitus Tipo 2/metabolismo , Dieta com Restrição de Carboidratos/métodos , Carboidratos da Dieta/administração & dosagem , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/efeitos adversos , Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/efeitos adversos , Humanos , Obesidade/metabolismo , Indução de Remissão/métodos , Fatores de Tempo , Resultado do Tratamento , Perda de Peso
3.
Nutrients ; 13(4)2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33917381

RESUMO

Multi-factors, such as anorexia, activation of renin-angiotensin system, inflammation, and metabolic acidosis, contribute to malnutrition in chronic kidney disease (CKD) patients. Most of these factors, contributing to the progression of malnutrition, worsen as CKD progresses. Protein restriction, used as a treatment for CKD, can reduce the risk of CKD progression, but may worsen the sarcopenia, a syndrome characterized by a progressive and systemic loss of muscle mass and strength. The concomitant rate of sarcopenia is higher in CKD patients than in the general population. Sarcopenia is also associated with mortality risk in CKD patients. Thus, it is important to determine whether protein restriction should be continued or loosened in CKD patients with sarcopenia. We may prioritize protein restriction in CKD patients with a high risk of end-stage kidney disease (ESKD), classified to stage G4 to G5, but may loosen protein restriction in ESKD-low risk CKD stage G3 patients with proteinuria <0.5 g/day, and rate of eGFR decline <3.0 mL/min/1.73 m2/year. However, the effect of increasing protein intake alone without exercise therapy may be limited in CKD patients with sarcopenia. The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia. In the case of loosening protein restriction, it is safe to avoid protein intake of more than 1.5 g/kgBW/day. In CKD patients with high risk in ESKD, 0.8 g/kgBW/day may be a critical point of protein intake.


Assuntos
Proteínas na Dieta/administração & dosagem , Terapia por Exercício/métodos , Desnutrição Proteico-Calórica/prevenção & controle , Insuficiência Renal Crônica/terapia , Sarcopenia/prevenção & controle , Terapia Combinada/métodos , Proteínas na Dieta/efeitos adversos , Taxa de Filtração Glomerular/fisiologia , Humanos , Desnutrição Proteico-Calórica/epidemiologia , Desnutrição Proteico-Calórica/etiologia , Recomendações Nutricionais , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Sarcopenia/epidemiologia , Sarcopenia/etiologia
4.
Nutrients ; 13(2)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33530399

RESUMO

Deficiencies in fruit and vegetable intake have been associated with oral cancer (oral cavity and oropharyngeal). Salivary rinses contain measurable biomarkers including soluble CD44 (solCD44) and total protein, which are known markers of oral cancer risk. This study investigates the effect of nutritional factors on solCD44 and protein levels to evaluate oral cancer risk and survival. We evaluated solCD44 and protein levels from 150 patients with oral and oropharyngeal squamous cell carcinoma and 150 frequency-matched controls. We subsequently characterized the effect of food group consumption and these biomarkers on progression-free survival (PFS) and overall survival (OS). Patients reported eating fewer servings of salad (p = 0.015), while controls reported eating fewer servings of potatoes (p < 0.001). Oral cancer patients who consumed at least one serving per week of green salad were found to have significantly lower CD44 levels than those who ate salad less frequently (mean of log2[solCD44]1.73 versus 2.25, p = 0.014). Patients who consumed at least one serving per week of "salad or other vegetables" had significantly longer PFS (median 43.5 versus 9.1 months, p = 0.003, adjusted hazard ratio (HR) = 0.39 p = 0.014) and OS (median 83.6 versus 10 months, p = 0.008, adjusted HR = 0.04 p = 0.029). These findings suggest that dietary factors, namely greater green salad and vegetable intake, may be associated with lower CD44 levels and better prognosis in oral cancer patients.


Assuntos
Receptores de Hialuronatos/metabolismo , Neoplasias Bucais/dietoterapia , Saladas , Idoso , Biomarcadores Tumorais , Estudos de Casos e Controles , Proteínas na Dieta/efeitos adversos , Feminino , Frutas , Neoplasias de Cabeça e Pescoço/dietoterapia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prognóstico , Intervalo Livre de Progressão , Saliva , Inquéritos e Questionários , Sobrevida , Verduras
5.
Nutrients ; 13(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33578699

RESUMO

There is accumulating evidence that early protein intake is related with weight gain in childhood. However, the evidence is mostly limited to the first year of life, whereas the high-weight-gain-velocity period extends up to about 2 years of age. We aimed to investigate whether protein intake during the second year of life is associated with higher weight gain and obesity risk later in childhood. We conducted a systematic review with searches in both PubMed®/MEDLINE® and the Cochrane Central Register of Controlled Trials. Ten studies that assessed a total of 46,170 children were identified. We found moderate-quality evidence of an association of protein intake during the second year of life with fat mass at 2 years and at 7 years. Effects on other outcomes such as body mass index (BMI), obesity risk, or adiposity rebound onset were inconclusive due to both heterogeneity and low evidence. We conclude that higher protein intakes during the second year of life are likely to increase fatness in childhood, but there is limited evidence regarding the association with other outcomes such as body mass index or change in adiposity rebound onset. Further well-designed and adequately powered clinical trials are needed since this issue has considerable public health relevance.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Proteínas na Dieta/efeitos adversos , Obesidade/epidemiologia , Ganho de Peso , Tecido Adiposo , Adiposidade , Índice de Massa Corporal , Peso Corporal , Criança , Pré-Escolar , Ensaios Clínicos como Assunto , Proteínas na Dieta/administração & dosagem , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Masculino , Obesidade/etiologia , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etiologia , Fatores de Risco
6.
Nutrients ; 13(2)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33572843

RESUMO

BACKGROUND: A previous randomized dietary intervention in pregnant women from the 1970s, the Harlem Trial, reported retarded fetal growth and excesses of very early preterm births and neonatal deaths among those receiving high-protein supplementation. Due to ethical challenges, these findings have not been addressed in intervention settings. Exploring these findings in an observational setting requires large statistical power due to the low prevalence of these outcomes. The aim of this study was to investigate if the findings on high protein intake could be replicated in an observational setting by combining data from two large birth cohorts. METHODS: Individual participant data on singleton pregnancies from the Danish National Birth Cohort (DNBC) (n = 60,141) and the Norwegian Mother, Father and Child Cohort Study (MoBa) (n = 66,302) were merged after a thorough harmonization process. Diet was recorded in mid-pregnancy and information on birth outcomes was extracted from national birth registries. RESULTS: The prevalence of preterm delivery, low birth weight and fetal and neonatal deaths was 4.77%, 2.93%, 0.28% and 0.17%, respectively. Mean protein intake (standard deviation) was 89 g/day (23). Overall high protein intake (>100 g/day) was neither associated with low birth weight nor fetal or neonatal death. Mean birth weight was essentially unchanged at high protein intakes. A modest increased risk of preterm delivery [odds ratio (OR): 1.10 (95% confidence interval (CI): 1.01, 1.19)] was observed for high (>100 g/day) compared to moderate protein intake (80-90 g/day). This estimate was driven by late preterm deliveries (weeks 34 to <37) and greater risk was not observed at more extreme intakes. Very low (<60 g/day) compared to moderate protein intake was associated with higher risk of having low-birth weight infants [OR: 1.59 (95%CI: 1.25, 2.03)]. CONCLUSIONS: High protein intake was weakly associated with preterm delivery. Contrary to the results from the Harlem Trial, no indications of deleterious effects on fetal growth or perinatal mortality were observed.


Assuntos
Dieta Rica em Proteínas/efeitos adversos , Proteínas na Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição Materna , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Dinamarca/epidemiologia , Inquéritos sobre Dietas , Suplementos Nutricionais , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Noruega/epidemiologia , Razão de Chances , Mortalidade Perinatal , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Cuidado Pré-Natal/métodos , Prevalência , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
8.
Am J Clin Nutr ; 113(3): 706-715, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33381804

RESUMO

BACKGROUND: Metabolic syndrome (MetS) is associated with increased mortality independent of BMI, resulting in discordant metabolic phenotypes, such as metabolically healthy obese and metabolically unhealthy normal-weight individuals. Studies investigating dietary intake in MetS have reported mixed results, due in part to the limitations of self-reported measures. OBJECTIVES: To investigate the role of biomarker-calibrated estimates of energy and protein in MetS and metabolic phenotypes. METHODS: Postmenopausal participants from the Women's Health Initiative (WHI) study who were free of MetS at baseline, had available data from FFQs at baseline, and had components of MetS at Year 3 (n = 3963) were included. Dietary energy and protein intakes were estimated using biomarker calibration methods. MetS was defined as 3 or more of the following: elevated serum triglycerides (≥150 mg/dL), low HDL cholesterol (<50 mg/dL), hypertension [systolic blood pressure (BP) ≥130 or diastolic BP ≥85 mmHg], elevated serum glucose (>100 mg/dL), and abdominal adiposity (waist circumference > 89 cm). Models were adjusted for age, WHI study component, race/ethnicity, education, income, smoking, recreational physical activity, disease history, and parity. RESULTS: For every 10% increment in total calibrated energy intake, women were at a 1.37-fold elevated risk of MetS (95% CI, 1.15-1.63); a 10% increment in calibrated total protein intake was associated with a 1.21-fold elevated risk of MetS (95% CI, 1.00-1.47). Specifically, animal protein intake was associated with MetS (OR, 1.08; 95% CI, 1.02-1.14), whereas vegetable protein intake was not (OR, 0.99; 95% CI, 0.95-1.03). No differences were seen when examining metabolic phenotypes. CONCLUSIONS: We found that higher calibrated total energy, total protein, and total animal protein intakes were strongly associated with MetS. If replicated in clinical trials, these results will have implications for the promotion of energy and animal protein restrictions for the reduction of MetS risks.


Assuntos
Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/efeitos adversos , Ingestão de Energia/fisiologia , Síndrome Metabólica/etiologia , Idoso , Biomarcadores/sangue , Feminino , Humanos , Síndrome Metabólica/sangue , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade
9.
Nutrients ; 12(11)2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33172198

RESUMO

Few studies have examined the relationship of protein intake by food source with metabolic syndrome in Korean adults, even though animal food intake has increased. This study examined the association between plant and animal protein intake and metabolic syndrome among middle-aged Korean adults. A total of 13,485 subjects aged 30-64 years were selected from the 2013-2018 Korea National Health and Nutrition Examination Survey. Protein intake was assessed using 24-h dietary recall data and divided into quintiles. Men had a higher percentage of energy intake from animal protein (7.4%) than plant protein (6.9%). Men in the highest quintile group of animal protein intake had a higher prevalence of abdominal obesity (OR: 1.30, 95% CI: 1.00-1.70), reduced high-density lipoprotein cholesterol (HDL-C) (OR: 1.43, 95% CI: 1.07-1.90), and elevated fasting glucose (OR: 1.32, 95% CI: 1.01-1.74), after adjusting for covariates. Furthermore, stronger associations of animal protein intake with abdominal obesity were shown in men who consumed less than estimated energy requirements (OR: 1.60, 95% CI: 1.11-2.31). Plant protein intake was negatively associated with increased blood pressure in men. Neither animal nor plant protein intakes were significantly associated with any of the metabolic syndrome risk factors in women. The results imply that lower animal protein intake may be a beneficial factor for metabolic syndrome management in middle-aged Korean men.


Assuntos
Proteínas na Dieta/efeitos adversos , Síndrome Metabólica/epidemiologia , Adulto , Intervalos de Confiança , Ingestão de Energia , Feminino , Alimentos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Proteínas de Plantas , República da Coreia/epidemiologia , Fatores de Risco
10.
J Agric Food Chem ; 68(42): 11710-11725, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33034193

RESUMO

The responses of gut microbiota to dietary proteins have been studied previously. However, the effects of dietary proteins supplemented with a high-fat diet (HFD) on the metabolite biomarkers associated with non-alcoholic fatty liver disease (NAFLD) are not well understood. To understand the underlying mechanisms, C57BL/6J mice were fed with either a low-fat diet with casein (LFC) or an HFD with casein (HFC), fish (HFF), or mutton proteins (HFM), and their cecal microbiota and liver metabolites were analyzed. At the phylum level, the HFD group had a relatively higher abundance of Firmicutes compared to the LFC-diet group. At the genus level, the HFF-diet group had the highest abundance of Lactobacillus and Akkermansia compared to the HFC- and HFM-diet groups. Furthermore, mice fed with the HFF diet had significantly reduced levels of hepatic metabolites involved in oxidative stress and bile acid metabolism. Thus, meat proteins in HFD interact in the host to create distinct responses in the gut microbiota and its metabolites.


Assuntos
Proteínas na Dieta/efeitos adversos , Endotoxemia/imunologia , Microbioma Gastrointestinal , NF-kappa B/imunologia , Receptor 4 Toll-Like/imunologia , Animais , Bactérias/classificação , Bactérias/genética , Bactérias/crescimento & desenvolvimento , Bactérias/isolamento & purificação , Ácidos e Sais Biliares/metabolismo , Dieta Hiperlipídica/efeitos adversos , Proteínas na Dieta/metabolismo , Endotoxemia/etiologia , Endotoxemia/metabolismo , Endotoxemia/microbiologia , Humanos , Fígado/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/genética , Estresse Oxidativo , Receptor 4 Toll-Like/genética
11.
Saudi Med J ; 41(10): 1041-1046, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33026043

RESUMO

Food containing gluten and casein could play a role in autism spectrum disorders (ASD) symptoms. The present review aimed to update the evidence about the role of the gluten- and casein-free diet (GCFD) on the management of ASD. Web of Science, Science Direct, Google Scholar, and PubMed databases were used to search for randomized controlled trials (RCT) conducted between January 2000 and February 2020. In total, 9 RCT were included (521 participants) with age range between 2 to 18 years. Four of these studies did not show a significant improvement regarding the symptoms of ASD. The rest of these studies (n=5) showed improvement in communication, stereotyped movements, aggressiveness, language, hyperactivity, tantrums, and signs of attention deficit hyperactivity disorder compared to control group. Hence, the data remains insu cient to support the use of GCFD to improve the symptoms of ASD in children.


Assuntos
Transtorno do Espectro Autista/dietoterapia , Caseínas/administração & dosagem , Caseínas/efeitos adversos , Dieta Livre de Glúten , Dieta com Restrição de Proteínas , Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/efeitos adversos , Adolescente , Transtorno do Espectro Autista/etiologia , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Humanos , Masculino
12.
Ecotoxicol Environ Saf ; 206: 111380, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33011511

RESUMO

Duckweed is a potential alternative protein source for food and feed. However, little is known about the nitrate accumulation in this plant. A high nitrate level in vegetables can indirectly lead to an elevated intake of nitrites and N-nitroso compounds, increasing the risk of diseases for humans and animals. This research hypothesizes that the nitrate accumulation of Lemna minor differs between growing media. Additionally, it evaluates whether legal safety levels of nitrate for human and animal intake are exceeded. The duckweed was grown on (i) rainwater, and (ii) three synthetic media containing different nutrient levels. Furthermore, (iii) biological effluent of swine manure treatment and (iv) aquaculture effluent from pikeperch production were used, as these are potential media for closing nutrient loops in the agriculture sector. It was found that nitrate levels increased with the increasing availability of macronutrients in the water, and pH showed a particularly strong negative correlation with the nitrate levels in the plant. Nevertheless, nitrate content never exceeded 530 mg NO3 kg-1 fresh weight. To conclude, Lemna minor's nitrate content was below safety limits for human consumption in all tested growing media; however, a potential risk for ruminants was observed as these are more sensitive to nitrate conversions in their gastro-intestinal track.


Assuntos
Araceae/metabolismo , Proteínas na Dieta/análise , Nitratos/metabolismo , Verduras/metabolismo , Agricultura , Animais , Meios de Cultura/química , Meios de Cultura/metabolismo , Proteínas na Dieta/efeitos adversos , Humanos , Concentração de Íons de Hidrogênio , Nitratos/análise , Águas Residuárias/química
13.
Allergol. immunopatol ; 48(5): 490-455, sept.-oct. 2020.
Artigo em Inglês | IBECS | ID: ibc-201841

RESUMO

INTRODUCTION AND OBJECTIVES: Methemoglobinemia has been reported to be associated with severe food protein-induced enterocolitis syndrome (FPIES). However, no reports have evaluated methemoglobin (MHb) levels in FPIES without symptomatic methemoglobinemia or the usefulness of MHb measurement for the diagnostic prediction of FPIES. To evaluate the MHb levels of patients with neonatal-onset FPIES and determine whether MHb levels are higher in FPIES than in other gastrointestinal diseases. PATIENTS AND METHODS: Eleven neonates with severe acute FPIES (FPIES group) and 139 neonates with other gastrointestinal diseases (non-FPIES group) were included in this study. Patient characteristics, symptoms, and venous blood test values (MHb, pH, HCO3-, and C-reactive protein) were evaluated. RESULTS: The median age at onset was 16 days vs. 1 day; males comprised 64% vs. 46%, the median gestational age was 38 weeks vs. 38 weeks, the median birth weight was 2710g vs. 2880g, and the median hospitalization duration was 31 days vs. 6 days for the FPIES vs. non-FPIES groups, respectively. MHb (%) was higher in the FPIES group than in the non-FPIES group [median (range), 1.1 (0.6-10.9) and 0.6 (0.3-1.2), respectively, p < 0.001]. There were no differences in terms of pH, HCO3-, and C-reactive protein (p > 0.05). In the receiver operating characteristic analysis for FPIES diagnosis based on MHb (%), the area under the curve was 0.885, specificity was 97.1%, and sensitivity was 72.7% at a MHb cutoff of 1.0. CONCLUSION: High MHb levels may help diagnose severe acute FPIES in neonates, but careful evaluation is needed


No disponible


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Enterocolite/etiologia , Enterocolite/sangue , Metemoglobinemia/complicações , Proteínas na Dieta/efeitos adversos , Hipersensibilidade Alimentar/complicações , Gastroenteropatias/etiologia , Curva ROC , Síndrome
14.
BMC Cancer ; 20(1): 696, 2020 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-32723394

RESUMO

BACKGROUND: Between 30 and 50% of colon tumors have mutations in the Kirsten-ras (KRAS) gene, which have a large nutritional attributable risk. Despite its high frequency in colorectal cancer (CRC), data to support specific associations between KRAS mutations in CRC and diet are sparse. Here, we conducted a systematic review to summarize the current epidemiological evidence on the association between various dietary factors and KRAS mutations. METHODS: PubMed, Science Direct, and Cochrane databases were searched for relevant studies published until December 31, 2019, using inclusion and exclusion criteria in accordance with PRISMA guidelines. We analyzed the studies to find associations between nutritional factors and CRC tumors with KRAS mutations in humans. RESULTS: We identified 28 relevant studies to include in this systematic review. In-depth analyses showed unclear associations between nutritional factors and KRAS mutations in CRC. Most epidemiological studies in the same nutrient or food often reported conflicting and/or inconclusive findings, whereas for some dietary factors, the results were homogeneous. CONCLUSIONS: Further research using a more robust prospective cohort study is needed to lend more credence to the epidemiological associations found between KRAS mutations and dietary factors.


Assuntos
Neoplasias Colorretais/genética , Dieta/efeitos adversos , Alimentos/efeitos adversos , Genes ras , Mutação , Acrilamida/efeitos adversos , Bebidas/efeitos adversos , Laticínios/efeitos adversos , Gorduras na Dieta/efeitos adversos , Fibras na Dieta , Proteínas na Dieta/efeitos adversos , Frutas , Humanos , Nutrientes/efeitos adversos , Verduras
16.
Nutrients ; 12(7)2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32674427

RESUMO

Non-immunoglobulin E-mediated gastrointestinal food allergic disorders (non-IgE-GI-FA) include food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE) and food protein-induced allergic proctocolitis (FPIAP), which present with symptoms of variable severity, affecting the gastrointestinal tract in response to specific dietary antigens. The diagnosis of non-IgE-GI-FA is made clinically, and relies on a constellation of typical symptoms that improve upon removal of the culprit food. When possible, food reintroduction should be attempted, with the documentation of symptoms relapse to establish a conclusive diagnosis. Management includes dietary avoidance, nutritional counselling, and supportive measures in the case of accidental exposure. The prognosis is generally favorable, with the majority of cases resolved before school age. Serial follow-up to establish whether the acquisition of tolerance has occurred is therefore essential in order to avoid unnecessary food restriction and potential consequent nutritional deficiencies. The purpose of this review is to delineate the distinctive clinical features of non-IgE-mediated food allergies presenting with gastrointestinal symptomatology, to summarize our current understanding of the pathogenesis driving these diseases, to discuss recent findings, and to address currents gaps in the knowledge, to guide future management opportunities.


Assuntos
Antígenos/imunologia , Dietoterapia/métodos , Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/imunologia , Enterocolite/imunologia , Enterocolite/terapia , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/terapia , Trato Gastrointestinal/imunologia , Proctocolite/imunologia , Proctocolite/terapia , Criança , Pré-Escolar , Aconselhamento , Enterocolite/diagnóstico , Feminino , Hipersensibilidade Alimentar/diagnóstico , Humanos , Imunoglobulina E/imunologia , Masculino , Proctocolite/diagnóstico , Síndrome
17.
Cochrane Database Syst Rev ; 6: CD003959, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32573771

RESUMO

BACKGROUND: The ideal quantity of dietary protein for formula-fed low birth weight infants is still a matter of debate. Protein intake must be sufficient to achieve normal growth without leading to negative effects such as acidosis, uremia, and elevated levels of circulating amino acids. OBJECTIVES: To determine whether higher (≥ 3.0 g/kg/d) versus lower (< 3.0 g/kg/d) protein intake during the initial hospital stay of formula-fed preterm infants or low birth weight infants (< 2.5 kilograms) results in improved growth and neurodevelopmental outcomes without evidence of short- or long-term morbidity. Specific objectives were to examine the following comparisons of interventions and to conduct subgroup analyses if possible. 1. Low protein intake if the amount was less than 3.0 g/kg/d. 2. High protein intake if the amount was equal to or greater than 3.0 g/kg/d but less than 4.0 g/kg/d. 3. Very high protein intake if the amount was equal to or greater than 4.0 g/kg/d. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 8), in the Cochrane Library (August 2, 2019); OVID MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R) (to August 2, 2019); MEDLINE via PubMed (to August 2, 2019) for the previous year; and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (to August 2, 2019). We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-randomized trials. SELECTION CRITERIA: We included RCTs contrasting levels of formula protein intake as low (< 3.0 g/kg/d), high (≥ 3.0 g/kg/d but < 4.0 g/kg/d), or very high (≥ 4.0 g/kg/d) in formula-fed hospitalized neonates weighing less than 2.5 kilograms. We excluded studies if infants received partial parenteral nutrition during the study period, or if infants were fed formula as a supplement to human milk. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We identified six eligible trials that enrolled 218 infants through searches updated to August 2, 2019. Five studies compared low (< 3 g/kg/d) versus high (3.0 to 4.0 g/kg/d) protein intake using formulas that kept other nutrients constant. The trials were small (n = 139), and almost all had methodological limitations; the most frequent uncertainty was about attrition. Low-certainty evidence suggests improved weight gain (mean difference [MD] 2.36 g/kg/d, 95% confidence interval [CI] 1.31 to 3.40) and higher nitrogen accretion in infants receiving formula with higher protein content (3.0 to 4.0 g/kg/d) versus lower protein content (< 3 g/kg/d), while other nutrients were kept constant. No significant differences were seen in rates of necrotizing enterocolitis, sepsis, or diarrhea. We are uncertain whether high versus low protein intake affects head growth (MD 0.37 cm/week, 95% CI 0.16 to 0.58; n = 18) and length gain (MD 0.16 cm/week, 95% CI -0.02 to 0.34; n = 48), but sample sizes were small for these comparisons. One study compared high (3.0 to 4.0 g/kg/d) versus very high (≥ 4 g/kg/d) protein intake (average intakes were 3.6 and 4.1 g/kg/d) during and after an initial hospital stay (n = 77). Moderate-certainty evidence shows no significant differences in weight gain or length gain to discharge, term, and 12 weeks corrected age from very high protein intake (4.1 versus 3.6 g/kg/d). Three of the 24 infants receiving very high protein intake developed uremia. AUTHORS' CONCLUSIONS: Higher protein intake (≥ 3.0 g/kg/d but < 4.0 g/kg/d) from formula accelerates weight gain. However, limited information is available regarding the impact of higher formula protein intake on long-term outcomes such as neurodevelopment. Research is needed to investigate the safety and effectiveness of protein intake ≥ 4.0 g/kg/d.


Assuntos
Desenvolvimento Infantil/fisiologia , Proteínas na Dieta/administração & dosagem , Fórmulas Infantis/química , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Proteínas na Dieta/efeitos adversos , Cabeça/crescimento & desenvolvimento , Humanos , Recém-Nascido , Criança Pós-Termo , Nitrogênio/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
18.
An. pediatr. (2003. Ed. impr.) ; 92(6): 345-350, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199668

RESUMO

INTRODUCCIÓN: La enterocolitis inducida por proteínas de la dieta, o también conocida como food protein-induced enterocolitis syndrome (FPIES), es un síndrome gastrointestinal de hipersensibilidad alimentaria no mediada por IgE. Los desencadenantes más comunes son la leche de vaca y de soja. El pescado es una de las causas reportadas con más frecuencia en España. El objetivo de esta investigación es describir las características clínicas de los pacientes diagnosticados de FPIES en nuestra consulta de alergología pediátrica. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo, realizado mediante revisión de historias clínicas de los pacientes diagnosticados con FPIES en la Unidad de Alergología Pediátrica del Hospital Infantil Miguel Servet desde 2007 a 2017. RESULTADOS: Desde enero de 2007 hasta diciembre de 2017 fueron diagnosticados 135 pacientes: 45% hombres y 55% mujeres. La edad media al diagnóstico fue de 11 ± 1,5 meses y la edad media de superación 2 años y 6 meses ± 2,5 años (n = 83). Un 31,9% presentó antecedentes personales de atopia. Los principales alimentos desencadenantes fueron: pescado blanco (41,4%), leche de vaca (25,1%) y huevo (15,5%). Un 4,4% presentó conversión a alergia IgE mediada. El 81,5% de los casos presentó vómitos, con una media de 1,75 ± 1,1 horas de latencia; diarreas en un 41,5%, con una media de 7,86 ± 15,16 horas de latencia; decaimiento en el 30,4% con una media de 3,81 ± 11,57 horas de latencia. DISCUSIÓN: En nuestra serie el desencadenante más frecuente fue el pescado. Se manifestó principalmente por vómitos tardíos, y alcanzó una tolerancia en su mayoría hacia los 2 años 6 meses


INTRODUCTION: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a gastrointestinal syndrome due to a non-IgE mediated food hypersensitivity. The most common triggers are cow's milk and soy. Fish is one of the most frequently reported causes in Spain. The objective of this study is to describe the clinical characteristics of patients diagnosed with (FPIES) in a Paediatric Allergy Clinic. MATERIAL AND METHODS: A retrospective descriptive study was carried out by reviewing medical records of patients diagnosed with FPIES in the Paediatric Allergy Unit of the Miguel Servet Children's Hospital from the years 2007 to 2017. RESULTS: A total of 135 patients were diagnosed during the study period, of whom 45% were male and 55% were female. The mean age at diagnosis was 11 ± 1.5 months and the mean age of improvement was 2 years and 6 months ± 2.5 years (n = 83). A personal history of atopy was observed in 31.9%. The main trigger foods were: white fish (41.4%), cow's milk (25.1%), and egg (15.5%). A conversion to IgE-mediated allergy was seen in 4.4% of patients. There was vomiting in 81.5% of the cases, with a mean of 1.75 ± 1.1 hours of latency, as well as diarrhoea in 41.5%, with a mean of 7.86 ± 15.16 hours of latency, and decline in 30.4% with a mean latency of 3.81 ± 11.57 hours. DISCUSSION: In our series, the most frequent trigger of the FPIES was fish. It was manifested mainly by late vomiting and a tolerance was reached mostly at 2 years 6 months


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Proteínas na Dieta/efeitos adversos , Enterocolite/etiologia , Hipersensibilidade Alimentar/diagnóstico , Instituições de Assistência Ambulatorial , Proteínas na Dieta/imunologia , Enterocolite/diagnóstico , Enterocolite/imunologia , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/imunologia , Pediatria , Estudos Retrospectivos
19.
Cochrane Database Syst Rev ; 5: CD012616, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32390133

RESUMO

BACKGROUND: Malnutrition is common in patients with chronic kidney disease (CKD) on dialysis. Oral protein-based nutritional supplements are often provided to patients whose oral intake is otherwise insufficient to meet their energy and protein needs. Evidence for the effectiveness of oral protein-based nutritional supplements in this population is limited. OBJECTIVES: The aims of this review were to determine the benefits and harms of using oral protein-based nutritional supplements to improve the nutritional state of patients with CKD requiring dialysis. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 12 December 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) of patients with CKD requiring dialysis that compared oral protein-based nutritional supplements to no oral protein-based nutritional supplements or placebo. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for eligibility, risk of bias, and extracted data from individual studies. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference and 95% CI for continuous outcomes. MAIN RESULTS: Twenty-two studies (1278 participants) were included in this review. All participants were adults on maintenance dialysis of whom 79% were on haemodialysis (HD) and 21% peritoneal dialysis. The follow-up period ranged from one to 12 months. The majority of studies were at unclear risk of selection, performance, and reporting bias. The detection bias was high for self-reported outcomes. Oral protein-based nutritional supplements probably lead to a higher mean change in serum albumin compared to the control group (16 studies, 790 participants: MD 0.19 g/dL, 95% CI 0.05 to 0.33; moderate certainty evidence), although there was considerable heterogeneity in the combined analysis (I2 = 84%). The increase was more evident in HD participants (10 studies, 526 participants: MD 0.28 g/dL, 95% CI 0.11 to 0.46; P = 0.001 for overall effect) and malnourished participants (8 studies, 405 participants: MD 0.31 g/dL, 95% CI 0.10 to 0.52, P = 0.003 for overall effect). Oral protein-based nutritional supplements also probably leads to a higher mean serum albumin at the end of the intervention (14 studies, 715 participants: MD 0.14 g/dL, 95% CI 0 to 0.27; moderate certainty evidence), however heterogeneity was again high (I2 = 80%). Again the increase was more evident in HD participants (9 studies, 498 participants: MD 0.21 g/dL, 95% CI 0.03 to 0.38; P = 0.02 for overall effect) and malnourished participants (7 studies, 377 participants: MD 0.25 g/dL, 95% CI 0.02 to 0.47; P = 0.03 for overall effect). Compared to placebo or no supplement, low certainty evidence showed oral protein-based nutritional supplements may result in a higher serum prealbumin (4 studies, 225 participants: MD 2.81 mg/dL, 95% CI 2.19 to 3.43), and mid-arm muscle circumference (4 studies, 216 participants: MD 1.33 cm, 95% CI 0.24 to 2.43) at the end of the intervention. Compared to placebo or no supplement, oral protein-based nutritional supplements may make little or no difference to weight (8 studies, 365 participants: MD 2.83 kg, 95% CI -0.43 to 6.09; low certainty evidence), body mass index (9 studies, 368 participants: MD -0.04 kg/m2, 95% CI -0.74 to 0.66; moderate certainty evidence) and lean mass (5 studies, 189 participants: MD 1.27 kg, 95% CI -1.61 to 4.51; low certainty evidence). Due to very low quality of evidence, it is uncertain whether oral protein-based nutritional supplements affect triceps skinfold thickness, mid-arm circumference, C-reactive protein, Interleukin 6, serum potassium, or serum phosphate. There may be little or no difference in the risk of developing gastrointestinal intolerance between participants who received oral protein-based nutritional supplements compared with placebo or no supplement (6 studies, 426 participants: RR 2.81, 95% CI 0.58 to 13.65, low certainty evidence). It was not possible to draw conclusions about cost or quality of life, and deaths were not reported as a study outcome in any of the included studies. AUTHORS' CONCLUSIONS: Overall, it is likely that oral protein-based nutritional supplements increase both mean change in serum albumin and serum albumin at end of intervention and may improve serum prealbumin and mid-arm muscle circumference. The improvement in serum albumin was more evident in haemodialysis and malnourished participants. However, it remains uncertain whether these results translate to improvement in nutritional status and clinically relevant outcomes such as death. Large well-designed RCTs in this population are required.


Assuntos
Proteínas na Dieta/administração & dosagem , Desnutrição/terapia , Diálise Renal , Insuficiência Renal Crônica/terapia , Albumina Sérica/metabolismo , Administração Oral , Braço/anatomia & histologia , Viés , Biomarcadores/sangue , Proteínas na Dieta/efeitos adversos , Humanos , Desnutrição/sangue , Desnutrição/etiologia , Diálise Peritoneal/estatística & dados numéricos , Placebos/administração & dosagem , Pré-Albumina/metabolismo , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Pregas Cutâneas
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