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1.
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
3.
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
4.
Obesity (Silver Spring) ; 28(4): 822-829, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32144892

RESUMO

OBJECTIVE: The aim of this study was to test the protein leverage hypothesis in a cohort of youth with obesity. METHODS: A retrospective study was conducted in a cohort of youth with obesity attending a tertiary weight management service. Validated food questionnaires revealed total energy intake (TEI) and percentage of energy intake from carbohydrates (%EC), fats (%EF), and proteins (%EP). Individuals with a Goldberg cutoff ≥ 1.2 of the ratio of reported TEI to basal metabolic rate from fat-free mass were included. A subgroup had accelerometer data. Statistics included modeling of percentage of energy from macronutrients and TEI, compositional data analysis to predict TEI from macronutrient ratios, and mixture models for sensitivity testing. RESULTS: A total of 137 of 203 participants were included (mean [SD] age 11.3 [2.7] years, 68 females, BMI z score 2.47 [0.27]). Mean TEI was 10,330 (2,728) kJ, mean %EC was 50.6% (6.1%), mean %EF was 31.6% (4.9%), and mean %EP was 18.4% (3.1%). The relationship between %EP and TEI followed a power function (L coefficient -0.48; P < 0.001). TEI was inversely associated with increasing %EP. In the subgroup with < 60 min/d of moderate to vigorous physical activity (n = 48), lower BMI z scores were associated with higher %EP and moderate %EC. CONCLUSIONS: In youth with obesity, protein dilution by either carbohydrates or fats increases TEI. Assessment of dietary protein may be useful to assist in reducing TEI and BMI in youth with obesity.


Assuntos
Proteínas na Dieta/efeitos adversos , Ingestão de Energia/fisiologia , Obesidade/fisiopatologia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
5.
Clin Sci (Lond) ; 134(4): 389-401, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32064496

RESUMO

Obesity and increased body adiposity have been alarmingly increasing over the past decades and have been linked to a rise in food intake. Many dietary restrictive approaches aiming at reducing weight have resulted in contradictory results. Additionally, some policies to reduce sugar or fat intake were not able to decrease the surge of obesity. This suggests that food intake is controlled by a physiological mechanism and that any behavioural change only leads to a short-term success. Several hypotheses have been postulated, and many of them have been rejected due to some limitations and exceptions. The present review aims at presenting a new theory behind the regulation of energy intake, therefore providing an eye-opening field for energy balance and a potential strategy for obesity management.


Assuntos
Adiposidade , Proteínas na Dieta/efeitos adversos , Obesidade , Metabolismo Energético/efeitos dos fármacos , Humanos , Modelos Biológicos , Nutrientes/metabolismo
7.
Int J Artif Organs ; 43(1): 17-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31402728

RESUMO

INTRODUCTION: Achieving sodium balance is important for peritoneal dialysis patients, as sodium excess may lead to hypertension and extracellular water expansion. We wished to determine whether greater sodium removal had adverse consequences. METHODS: We calculated 24-h urinary and peritoneal sodium losses in peritoneal dialysis patients treated by automated cyclers, when attending for peritoneal membrane and bioimpedance assessments. RESULTS: We reviewed 439 peritoneal dialysis patients, 56.7% male, average age 54.6 years, median sodium loss 110 (68-155) mmol/day. Sodium loss was strongly associated with urine volume, r = 0.37, protein nitrogen appearance rate, r = 0.29, and body cell mass, r = 0.21, all p < 0.001. We found no association with blood pressure or anti-hypertensive medication prescription, or extracellular water. On multivariable logistic regression analysis, sodium loss was associated with greater urine output, odds ratio 1.001, 95% confidence interval 1.00-1.001, p < 0.001, and protein nitrogen appearance (odds ratio 1.023, confidence interval 1.006-1.04), p = 0.008. Adjusting for body weight, sodium loss was associated with urine output (odds ratio 1.001, confidence interval 1.001-1.002, p < 0.001), and negatively with body fat index (odds ratio 0.96, confidence interval 0.93-0.99, p = 0.008) and co-morbidity grade (odds ratio 0.58, confidence interval 0.36-0.39, p = 0.023). CONCLUSION: Heavier peritoneal dialysis patients with greater estimated dietary protein intake (protein nitrogen appearance), those with greater residual renal function and peritoneal clearances, along with lower co-morbidity, had greater daily sodium losses. Adjusting for body weight, then sodium losses were greater with higher daily urine output, and lower in patients with proportionately more body fat and co-morbidity. Sodium losses would appear to primarily determined by body size and not associated with hypertension or extracellular water expansion.


Assuntos
Líquido Extracelular/fisiologia , Diálise Peritoneal , Sódio/metabolismo , Distribuição da Gordura Corporal , Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/efeitos adversos , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Urina
8.
Nat Rev Endocrinol ; 16(1): 59-66, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31728051

RESUMO

Dietary protein is crucial for human health because it provides essential amino acids for protein synthesis. In addition, dietary protein is more satiating than carbohydrate and fat. Accordingly, many people consider the protein content when purchasing food and beverages and report 'trying to eat more protein'. The global market for protein ingredients is projected to reach approximately US$90 billion by 2021, largely driven by the growing demand for protein-fortified food products. This Perspective serves as a caution against the trend of protein-enriched diets and provides an evidence-based counterpoint that underscores the potential adverse public health consequences of high protein intake.


Assuntos
Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/efeitos adversos , Ingestão de Energia/fisiologia , Alimentos Fortificados , Proteínas na Dieta/metabolismo , Alimentos Fortificados/efeitos adversos , Humanos , Estado Pré-Diabético/induzido quimicamente , Estado Pré-Diabético/metabolismo , Fatores de Risco
9.
Int. j. odontostomatol. (Print) ; 14(3): 442-447, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1114919

RESUMO

Dietary supplements are being consumed with an increasingly high frequency among sports practitioners, whether at professional and/or amateur level. The supplements contain some nutritional properties in their composition, so they can dissolute the hydroxyapatite crystals of the enamel and favor the process of dental corrosion. The objective was to measure the corrosive power of protein-based supplementation (Whey Protein), under conditions that resemble the use of the supplement by the athletes, increasing the ecological validity of the study. The teeth of the test group (TG) were placed in contact with the Whey protein solution and then exposed to artificial saliva. And the teeth of the control group (CG) were exposed only to artificial saliva. The analysis occurred in natural healthy molar teeth, so that each tooth of the TG was immersed in 50 mL of supplement for 1.5 minutes and then placed in contact with the artificial saliva for 30 seconds. The same procedure was performed 5 times a day for 30, 60, 90, 120, 150 and 180 days. Each group, in its time (TG0 to TG180), underwent analysis of superficial roughness with the aid of optical profilometer (Talysurf CCI®, 3D model). The control group (CG) did not change its superficial roughness. Half of the teeth of the test group (TG) suffered loss of enamel surface. The values, in micrometers, of surface loss of the TG samples were 1.21; 2.1; 2.0; 1.04; 0.97; 0.8; 0.53; 1.14; 1.9; 2.0; 1.66; 1.80. The dietary supplement (Whey protein®) may be a potential cause of the dental corrosion process, considering the demineralization of hydroxyapatite that occurs along with the surface enamel loss.


Los suplementos dietéticos se consumen con una frecuencia cada vez más alta entre los practicantes de deportes, sea a nivel profesional y / o aficionado. Los suplementos contienen algunas propiedades nutricionales en su composición, por lo que pueden disolver los cristales de hidroxiapatita del esmalte y favorecer el proceso de corrosión dental. El objetivo fue medir el poder corrosivo de la suplementación a base de proteínas (proteína de suero), en condiciones que se asemejan al uso del suplemento por parte de los atletas, aumentando la validez ecológica del estudio. Los dientes del grupo de prueba (TG) se pusieron en contacto con la solución de proteína de suero y luego se expusieron a saliva artificial. Y los dientes del grupo de control (CG) estuvieron expuestos solo a saliva artificial. El análisis se realizó en dientes molares sanos naturales, cada diente del TG se sumergió en 50 ml de suplemento durante 1,5 minutos y luego se puso en contacto con la saliva artificial durante 30 segundos. El mismo procedimiento se realizó 5 veces al día durante 30, 60, 90, 120, 150 y 180 días. Cada grupo, en su momento (TG0 a TG180), se sometió a un análisis de rugosidad superficial con la ayuda de un perfilómetro óptico (Talysurf CCI®, modelo 3D). El grupo de control (CG) no cambió su rugosidad superficial. La mitad de los dientes del grupo de prueba (TG) sufrieron pérdida de la superficie del esmalte. Los valores, en micrómetros, de pérdida de superficie de las muestras de TG fueron 1.21; 2.1; 2,0; 1.04; 0,97; 0.8; 0,53; 1.14; 1.9; 2,0; 1,66; 1.80. El suplemento dietético (Whey protein®) puede ser una causa potencial del proceso de corrosión dental, considerando la desmineralización de la hidroxiapatita que ocurre junto con la pérdida de esmalte superficial.


Assuntos
Humanos , Esportes , Proteínas na Dieta/efeitos adversos , Desmineralização do Dente/induzido quimicamente , Suplementos Nutricionais/efeitos adversos , Saliva/química , Técnicas In Vitro , Projetos Piloto , Grupos Controle , Durapatita , Corrosão , Corrosão Dentária , Concentração de Íons de Hidrogênio
10.
Vopr Pitan ; 88(6): 61-67, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31860200

RESUMO

The study of mechanisms of the metabolic disorders in conditions of deficiency or excess of individual nutrients in the diet is a live issue. The influence of the simultaneous excess sucrose intake and protein deficiency in the diet on the functional state of the liver remains poorly understood. The aim of the research was to study the rate of generation of the superoxide radicals, the content of triglycerides and glycogen in the liver, as well as the activity of enzymatic markers of the liver state in rats fed diets with different protein and sucrose content. Material and methods. The studies were conducted over 28 days on 48 white non-linear rats, randomized into 4 groups: 1 - animals fed full-value semi-synthetic ration (14% protein); 2 - animals receiving low-protein ration (4.7% protein); 3 - animals receiving high-sucrose diet (40% sucrose), 4 - animals receiving low-protein high-sucrose diet. Serum sorbitol dehydrogenase activity was determined by the kinetic method in the reaction of NADH-dependent reduction of D-fructose to D-sorbitol. Serum alanine aminotransferase activity and aspartate aminotransferase was evaluated using a kit of reagents (Ukraine). Results and discussion. It was found that in rats fed low protein diet, no changes in the de Ritis coefficient were observed, while the activity of sorbitol dehydrogenase in blood serum increased 1.7 fold. However, no changes in the rate of superoxide radical formation, as well as glycogen and triglyceride level in the liver were observed. In animals fed highsugar diet, a rise in the de Ritis coefficient on the background of increased serum sorbitol dehydrogenase activity (more than 3.5 times) was revealed. At the same time, the rate of the superoxide radical formation in the liver mitochondria enhanced by 3 fold, with an increased accumulation of glycogen and triglycerides. The most pronounced changes in liver state were observed in animals fed low-protein/high-sugar diet: a marked increase in the de Ritis coefficient with a 5-fold increase in the activity of sorbitol dehydrogenase, and a 6-fold elevation in the intensity of the superoxide radical generation in liver mitochondria. The triglyceride content in the liver doubled, while the glycogen content remained at the level of control values. Conclusion. The data obtained represent disturbances of the functional liver state as a consequence of the relatively short-term excessive consumption of sucrose, especially in combination with a alimentary protein deficiency. It was found that the leading factor in the formation of destructive changes in the liver was excessive sucrose consumption, while the concomitant protein deficiency exacerbated the functional changes in hepatocytes.


Assuntos
Ração Animal , Carboidratos da Dieta/farmacologia , Proteínas na Dieta/farmacologia , Fígado/metabolismo , Mitocôndrias Hepáticas/metabolismo , Sacarose/farmacologia , Animais , Biomarcadores/metabolismo , Carboidratos da Dieta/efeitos adversos , Proteínas na Dieta/efeitos adversos , Feminino , Fígado/patologia , Masculino , Mitocôndrias Hepáticas/patologia , Ratos , Sacarose/efeitos adversos
11.
Pediatr. aten. prim ; 21(84): 411-414, oct.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191985

RESUMO

El síndrome de enterocolitis inducida por proteínas alimentarias (FPIES o food protein-induced enterocolytis syndrome) es una patología alérgica no mediada por IgE inducida por proteínas alimentarias. Cursa con vómitos de repetición asociados a diarrea, palidez, letargia o hipotensión 1-4 horas tras la ingesta del alimento desencadenante. Los desencadenantes más habituales son la leche de vaca y la soja; sin embargo, también se han descrito asociada a alimentos sólidos, como la patata


Food protein-induced enterocolitis syndrome (FPIES) is a non IgE mediated allergic disorder induced by food protein that presents in young infants. It is characterized by persistent vomiting associated to diarrhea, lethargy, pallor or hypotension presenting 1-4 hours after the ingestion of the triggering food. The most frequent triggers are cows's milk and soy, but solid foods have also been described as triggers, including potato


Assuntos
Humanos , Lactente , Hipersensibilidade Alimentar/diagnóstico , Enterocolite/diagnóstico , Proteínas na Dieta/efeitos adversos , Solanum tuberosum/efeitos adversos , Diagnóstico Diferencial , Enterocolite/etiologia , Diarreia Infantil/etiologia
12.
Nutrients ; 11(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31547446

RESUMO

Higher dietary protein intake is increasingly recommended for the elderly; however, high protein diets have also been linked to increased cardiovascular disease (CVD) risk. Trimethylamine-N-oxide (TMAO) is a bacterial metabolite derived from choline and carnitine abundant from animal protein-rich foods. TMAO may be a novel biomarker for heightened CVD risk. The purpose of this study was to assess the impact of a high protein diet on TMAO. Healthy men (74.2 ± 3.6 years, n = 29) were randomised to consume the recommended dietary allowance of protein (RDA: 0.8 g protein/kg bodyweight/day) or twice the RDA (2RDA) as part of a supplied diet for 10 weeks. Fasting blood samples were collected pre- and post-intervention for measurement of TMAO, blood lipids, glucose tolerance, insulin sensitivity, and inflammatory biomarkers. An oral glucose tolerance test was also performed. In comparison with RDA, the 2RDA diet increased circulatory TMAO (p = 0.002) but unexpectedly decreased renal excretion of TMAO (p = 0.003). LDL cholesterol was increased in 2RDA compared to RDA (p = 0.049), but no differences in other biomarkers of CVD risk and insulin sensitivity were evident between groups. In conclusion, circulatory TMAO is responsive to changes in dietary protein intake in older healthy males.


Assuntos
Dieta Rica em Proteínas/efeitos adversos , Proteínas na Dieta/efeitos adversos , Metilaminas/sangue , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/etiologia , LDL-Colesterol/sangue , Jejum/sangue , Microbioma Gastrointestinal , Humanos , Resistência à Insulina , Lipídeos/sangue , Masculino , Recomendações Nutricionais , Fatores de Risco
13.
J Urol ; 202(6): 1217-1223, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31430246

RESUMO

PURPOSE: High animal protein intake is a risk factor for nephrolithiasis. Whether plant based sources of protein are associated with kidney stone risk is not well studied. We examined the association of animal and plant protein intake with the risk of incident kidney stones in Shanghai, China. MATERIALS AND METHODS: Dietary intakes were obtained from a validated food frequency questionnaire at baseline. Self-reported stone events were ascertained at baseline and at followup visits. Multivariable Cox regression models were used to evaluate the associations of protein intake with the incident stone risk. RESULTS: During 319,211 and 696,950 person-years of followup 1,451 men and 1,202 women, respectively, reported incident stones. The average ± SD intake of animal and plant protein standardized to 2,000 kcal was 31.3 ± 13.7 and 48.4 ± 7.2 gm per day in women, and 30.8 ± 13.3 and 51.3 ± 7.6 gm per day, respectively, in men. On multivariable analysis participants in the highest quintiles of animal and nondairy animal protein intake showed an increased risk of incident stones compared to those in the lowest quintiles (HR 1.16, 95% CI 1.01-1.32, p=0.03 vs HR 1.14, 95% CI 1.01-1.30, p=0.04). Compared to the lowest quintile the highest intake quintiles of the animal-to-plant protein ratios and the nondairy animal-to-plant protein ratios were positively associated with stone risk (HR 1.17, 95% CI 1.03-1.33, p=0.02 and HR 1.20, 95% CI 1.06-1.36, p=0.005, respectively). No association was observed with plant protein intake (ptrend=0.14). CONCLUSIONS: In this population with a relatively low animal protein intake and a high plant protein intake, a greater animal protein intake was associated with a kidney stone risk. Increasing the proportion of plant protein relative to animal protein appeared protective against the risk.


Assuntos
Proteínas na Dieta/administração & dosagem , Comportamento Alimentar , Cálculos Renais/epidemiologia , Adulto , Idoso , China/epidemiologia , Proteínas na Dieta/efeitos adversos , Feminino , Humanos , Incidência , Cálculos Renais/etiologia , Cálculos Renais/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Autorrelato/estatística & dados numéricos
14.
JAMA ; 322(6): 514-523, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31408136

RESUMO

Importance: High gluten intake during childhood may confer risk of celiac disease. Objectives: To investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children. Design, Setting, and Participants: The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from the age of 2 years. Data on gluten intake were available in 6605 children (98%) by September 30, 2017. Exposures: Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years. Main Outcomes and Measures: The primary outcome was celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in 2 consecutive serum samples. The secondary outcome was celiac disease confirmed by intestinal biopsy or persistently high tissue transglutaminase autoantibody levels. Results: Of the 6605 children (49% females; median follow-up: 9.0 years [interquartile range, 8.0-10.0 years]), 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both outcomes peaked at the age of 2 to 3 years. Daily gluten intake was associated with higher risk of celiac disease autoimmunity for every 1-g/d increase in gluten consumption (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by the age of 3 years if the reference amount of gluten was consumed, 28.1%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34.2%; absolute risk difference, 6.1% [95% CI, 4.5%-7.7%]). Daily gluten intake was associated with higher risk of celiac disease for every 1-g/d increase in gluten consumption (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age of 3 years if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 27.9%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]). Conclusions and Relevance: Higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children.


Assuntos
Autoanticorpos/sangue , Doença Celíaca/etiologia , Proteínas na Dieta/efeitos adversos , Predisposição Genética para Doença , Glutens/efeitos adversos , Transglutaminases/imunologia , Autoimunidade , Doença Celíaca/epidemiologia , Doença Celíaca/genética , Doença Celíaca/imunologia , Pré-Escolar , Diabetes Mellitus Tipo 1/etiologia , Diabetes Mellitus Tipo 1/genética , Registros de Dieta , Feminino , Glutens/administração & dosagem , Humanos , Incidência , Lactente , Masculino , Estudos Prospectivos , Risco
15.
Nutrients ; 11(8)2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31349606

RESUMO

Aging and frailty are associated with a high risk of lean mass (LM) loss, which leads to physical disability and can be effectively alleviated by protein supplementation (PS) and muscle strengthening exercise (MSE). In this study, the associations between LM gain and PS + MSE efficacy (measured using physical outcomes) in elderly patients with a high risk of sarcopenia or frailty were identified. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) reporting the efficacy of PS + MSE in elderly patients with sarcopenia or frailty. The included RCTs were analyzed using meta-analysis and risk of bias assessment. We finally included 19 RCTs in this meta-analysis with a median (range/total) Physiotherapy Evidence Database score of 7/10 (5-9/10). The PS + MSE group exhibited significant improvements in the whole-body LM (standard mean difference (SMD) = 0.66; p < 0.00001), appendicular LM (SMD = 0.35; p < 0.00001), leg strength (SMD = 0.65; p < 0.00001), and walking capability (SMD = 0.33; p = 0.0006). Meta-regression analyses showed that changes in appendicular LM were significantly associated with the effect sizes of leg strength (ß = 0.08; p = 0.003) and walking capability (ß = 0.17; p = 0.04), respectively. Our findings suggest that LM gain after PS + MSE significantly contributes to the efficacy of the intervention in terms of muscle strength and physical mobility in elderly patients with a high risk of sarcopenia or frailty.


Assuntos
Composição Corporal , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Terapia por Exercício , Fragilidade/prevenção & controle , Músculo Esquelético/fisiopatologia , Sarcopenia/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/metabolismo , Suplementos Nutricionais/efeitos adversos , Terapia por Exercício/efeitos adversos , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/metabolismo , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/metabolismo , Sarcopenia/fisiopatologia , Resultado do Tratamento , Caminhada
16.
World J Gastroenterol ; 25(24): 2973-2976, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31293334

RESUMO

Until recently, with the exception of coeliac disease, gastroenterologists have not been particularly interested in the role of diet in the management of gastrointestinal disorders. However, patients have always felt that diet must play a part in their symptoms and, in the absence of any medical interest, have turned to alternative dietary practitioners for help, which can often have no evidence base. Fortunately, with the advent of the FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) and the realisation that diet can have a profound effect on the microbiome, medical opinion is now changing. Nevertheless, research on the various diets that are now available is often completely lacking. Lectins are carbohydrate binding proteins which are widely distributed in nature and are found in a whole variety of commonly consumed foods. It seems likely that the exclusion of lectins from the diet could become the next "food fashion" for alternative practitioners to promote, especially as there is some evidence to suggest that certain lectins may be harmful to health. It is, therefore, the purpose of this viewpoint to try and stimulate research on the dietary effects of lectins, which is currently minimal, so that we can pre-empt a situation where we are unable to give patients or the public evidence based advice on this topic.


Assuntos
Dietas da Moda , Dieta com Restrição de Proteínas/efeitos adversos , Proteínas na Dieta/efeitos adversos , Gastroenteropatias/dietoterapia , Lectinas/efeitos adversos , Terapias Complementares/métodos , Terapias Complementares/tendências , Dieta com Restrição de Carboidratos/efeitos adversos , Dieta com Restrição de Carboidratos/métodos , Dieta com Restrição de Proteínas/métodos , Proteínas na Dieta/administração & dosagem , Glutens/administração & dosagem , Glutens/efeitos adversos , Humanos , Lectinas/administração & dosagem , Monossacarídeos/administração & dosagem , Monossacarídeos/efeitos adversos , Oligossacarídeos/administração & dosagem , Oligossacarídeos/efeitos adversos
17.
Nutrients ; 11(7)2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31252583

RESUMO

Accumulating evidence suggests a potential role of dietary protein among nutritional factors interfering with the regulation of blood pressure. Dietary protein source (plant versus animal protein), and especially, protein composition in terms of amino acids has been postulated to interfere with mechanisms underlying the development of hypertension. Recently, mounting interest has been directed at amino acids in hypertension focusing on habitual dietary intake and their circulating levels regardless of single amino acid dietary supplementation. The aim of the present review was to summarize epidemiological evidence concerning the connection between amino acids and hypertension. Due to the large variability in methodologies used for assessing amino acid levels and heterogeneity in the results obtained, it was not possible to draw robust conclusions. Indeed, some classes of amino acids or individual amino acids showed non-causative association with blood pressure as well as the incidence of hypertension, but the evidence was far from being conclusive. Further research should be prompted for a thorough understanding of amino acid effects and synergistic actions of different amino acid classes on blood pressure regulation.


Assuntos
Aminoácidos/administração & dosagem , Pressão Sanguínea , Proteínas na Dieta/administração & dosagem , Hipertensão/epidemiologia , Estado Nutricional , Recomendações Nutricionais , Adulto , Idoso , Aminoácidos/efeitos adversos , Aminoácidos/sangue , Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/sangue , Feminino , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Medição de Risco , Fatores de Risco , Adulto Jovem
18.
Rev Alerg Mex ; 66(2): 257-262, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31200424

RESUMO

BACKGROUND: Food protein-induced enterocolitis syndrome or FPIES is a rare, not-IgE-mediated food allergy. The predominant feature is vomit from one to four hours after consuming the causal food. CLINICAL CASE: An 8-month-old boy, with no family history of allergy, with a personal pathological history of allergy to cow's milk protein. At 7 months of age, he had acute gastroenteritis with mixed shock and, at 8 months of age, he had acute gastroenteritis and moderate dehydration. In both episodes, he had eaten rice before the symptoms started. When infectious etiology and other causes of vomit and dehydration were ruled out, the diagnosis of FPIES, which is secondary to rice protein, was made and confirmed with a patch test. CONCLUSION: FPIES should be considered in the differential diagnosis of recurrent gastroenteritis, especially in severe cases without an identified infectious cause.


Assuntos
Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/imunologia , Enterocolite/etiologia , Hipersensibilidade Alimentar/complicações , Humanos , Lactente , Masculino , Síndrome
19.
Medicina (Kaunas) ; 55(6)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31141916

RESUMO

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in association with pallor, lethargy, and diarrhea, presenting within 1-4 h from the ingestion of a triggering food. In 2017, the international consensus guidelines for the diagnosis and management of FPIES were published. They cover all aspects of this syndrome, which in recent decades has attracted the attention of pediatric allergists. In particular, the consensus proposed innovative diagnostic criteria. However, the diagnosis of acute FPIES is still currently discussed because the interest in this disease is relatively recent and, above all, there are no validated panels of diagnostic criteria. We propose some ideas for reflection on the diagnostic and suspicion criteria of acute FPIES with exemplary stories of children certainly or probably suffering from acute FPIES. For example, we believe that new definitions should be produced for mild forms of FPIES, multiple forms, and those with IgE-mediated symptoms. Moreover, we propose two clinical criteria to suspect acute FPIES and to refer the child to the diagnostic oral food challenge.


Assuntos
Proteínas na Dieta/efeitos adversos , Enterocolite/etiologia , Animais , Bovinos , Criança , Pré-Escolar , Enterocolite/dietoterapia , Feminino , Hipersensibilidade Alimentar/complicações , Humanos , Lactente , Letargia/etiologia , Masculino , Leite/efeitos adversos
20.
Nephrol Ther ; 15(7): 491-497, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31056406

RESUMO

Metabolic acidosis is a frequent complication of chronic kidney disease. Although it is known to appear at advanced stages, many studies suggest a state of "global protonic retention" starting at early stages of the disease, responsible of tissue damage, particularly musculoskeletal, alteration of protidic metabolism and endocrine disorders, promoting malnutrition and chronic inflammation, and finally increasing mortality. The majority of international recommandations suggest of supplementation by alkali, most of the time by sodium bicarbonate, to struggle against this complication. An interesting alternative to correct acidosis would consist on the modulation of the endogenous production of acid by playing with the alimentary incomes. In fact, it has been demonstrated that some different types of food produce or consume protons during their metabolism. Low protein diet and rich fresh fruits and vegetables diet would manage to correct at least as well as the supplementation by sodium bicarbonate the metabolic acidosis, and to struggle against its complications, noteworthy by slowing the decline of glomerular filtration rate by limiting the toxic adaptative fibrotic mechanisms, demonstrated by the decrease of urinary tubulo-interstitial suffering markers. Of the condition of being well led, those diets do not seem to expose patients to an over-risk of malnutrition or hyperkaliemia. They therefore appear to be an attractive alternative, efficiency and safe, to fight against chronic kidney disease metabolic acidosis and its complications.


Assuntos
Acidose/dietoterapia , Insuficiência Renal Crônica/dietoterapia , Acidose/tratamento farmacológico , Acidose/etiologia , Acidose/prevenção & controle , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/prevenção & controle , Terapia Combinada , Dieta com Restrição de Proteínas , Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/farmacocinética , Frutas , Humanos , Hiperpotassemia/prevenção & controle , Hipoalbuminemia/etiologia , Hipoalbuminemia/prevenção & controle , Inflamação , Desnutrição/etiologia , Política Nutricional , Prótons , Insuficiência Renal Crônica/complicações , Sarcopenia/etiologia , Sarcopenia/prevenção & controle , Bicarbonato de Sódio/uso terapêutico , Verduras
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