Associações do estado nutricional, homocisteinemia e suplementação de folato com a disfunção cognitiva de mulheres idosas / Associations of nutritional status, homocysteine and folate supplementation with cognitive impairment in elderly women / Asociaciones del estado nutricional, suplementación con ácido fólico y homocisteína con deterioro cognitivo en las mujeres mayores

Introdução: A hiperhomocisteinemia é o principal fator isolado da aterosclerose, além de constituir-se em potente fator pró-oxidante. Ambas as situações somam-se na etiologia da deficiência cognitiva do idoso. Objetivo: Investigar as implicações mentais da homocisteinemia e da sua suplementação oral de folato em idosas e verificar possíveis alterações nas concentrações de homocisteína e sua influência sobre os escores cognitivos e concentrações plasmáticas de glicose e lipídios destes indivíduos. Método: Foram estudadas 32 mulheres (70,2 + 4,8 anos) do grupo de intervenção (G1) e 24 (67 + 5,2 anos) do grupo controle (G2) todas submetidas, no momento inicial, a avaliação clínica, laboratorial, antropométrica, consumo alimentar e cognitiva (Mini Mental state Examination - MMSE). As avaliações foram repetidas, no grupo G1, após 60 dias ao término da suplementação de ácido fólico. Resultados: O grupo G1 era mais velho, com valores maiores de glicemia e menores de MMSE (p<0,05). Não houve correlação do MMSE com Hcy (r= 0,03) folato (r=0,152) e vitamina B12 (r=0,036). A suplementação de folato (G1) aumentou a folacemia, reduziu a homocisteinemia e a glicemia, com redução de 50% de hiperglicêmicos, assim como dos hiperhomocisteinêmicos, de 45,8% para 18,8%. As respostas à suplementação ocorreram no subgrupo com Hcy >13 mol/L, com elevação da folacemia, sem alteração do MMSE e da B12, e, no subgrupo MMSE <= 23, com elevação da folacemia e redução da homocisteinemia, sem alteração da B12. Conclusão: embora sem correlacionar-se com Hcy, folato ou vitamina B12, o MMSE deficitário responde positivamente ao tratamento nutricional redutor da hiperhomocisteinemia, com elevação da folacemia independentemente da vitamina B12.

Introduction: Hyperhomocysteinemia is a major factor isolated from atherosclerosis, besides being potent factor in pro-oxidant. Both situations are added to the etiology of cognitive impairment in the elderly. Objective: To investigate the implications of mental homocysteinemia and its oral folate supplementation in elderly women and to assess possible changes in the concentrations of homocysteine and its influence on cognitive scores and plasma concentrations of glucose and lipids of these individuals. Methods: We studied 32 women (70.2 + 4.8 years) in the intervention group (G1) and 24 (67 + 5.2 years) in the control group (G2) all submitted at the time initial clinical evaluation, laboratory, anthropometric, dietary intake and cognitive (Mini Mental State Examination - MMSE). The assessments were repeated, G1, 60 days after the end of the supplementation of folic acid. Results: The G1 group was older, with higher values of blood glucose levels and lower MMSE (p <0.05). There was no correlation of MMSE with Hcy (r = 0.03), folate (r = 0.152) and vitamin B12 (r = 0.036). Folate supplementation (G1) increased folacemia, homocysteinemia and decreased blood glucose, with 50% of hyperglycemic, and of hiperhmocisteinêmicos, 45.8% to 18.8%. Responses to supplementation occurred in the subgroup with Hcy> 13 mol/L, with elevated folacemia without changing the MMSE and B12, and in the subgroup MMSE <= 23, with elevated homocysteine and decreased folacemia, without changing the B12 . Conclusion: Although not correlate with Hcy, folate or vitamin B12, the MMSE deficit responds positively to the nutritional treatment of hyperhomocysteinemia reducer, with elevated folacemia regardless of vitamin B12.

Introducción: La hiperhomocisteinemia es un factor importante aislado de la aterosclerosis, además de ser factor potente en la pro-oxidante. Ambas situaciones se añaden a la etiología del deterioro cognitivo en los ancianos. Objetivo: investigar las consecuencias de homocisteinemia mental y su complementación con folato oral en mujeres de edad avanzada y para evaluar posibles cambios en las concentraciones de homocisteína y su influencia en los resultados cognitivos y las concentraciones plasmáticas de glucosa y los lípidos de estos individuos. Métodos: Se estudiaron 32 mujeres (70,2 + 4,8 años) en el grupo de intervención (G1) y 24 (67 + 5,2 años) en el grupo control (G2) presentados en su totalidad en el momento de la evaluación clínica inicial, laboratorio, antropométricas, la ingesta alimentaria y cognitiva (Mini Mental State Examination - MMSE). Las evaluaciones se repitieron, G1, 60 días después del final de la suplementación de ácido fólico. Resultados: El grupo G1 fue mayor, con valores más altos de los niveles de glucosa en la sangre y disminuyen MMSE (p <0,05). No se encontró correlación con los niveles de homocisteína de MMSE (r = 0,03), ácido fólico (r = 0,152) y vitamina B12 (r = 0,036). Suplementos de ácido fólico (G1) folacemia aumentado, homocisteinemia y la disminución de glucosa en la sangre, con un 50% de la hiperglucemia y de hiperhomocisteinêmicos, el 45,8% a 18,8%. Las respuestas a la suplementación se produjo en el subgrupo con Hcy> 13 mol / L, con folacemia elevados sin cambiar el MMSE y B12, y el subgrupo MMSE <= 23, con la homocisteína elevada y la disminución de folacemia, sin cambiar el B12 . Conclusión: Si bien no se correlacionan con los niveles de homocisteína, ácido fólico o de vitamina B12, el déficit MMSE responde positivamente a la reducción de tratamiento nutricional de hiperhomocisteinemia con folacemia elevados independientemente de la vitamina B12.

Efeito da suplementação de cisteína ou glutamina sobre o metabolisno dos aminoácidos sulfurados e glutationa de pacientes infectados pelo HIV nas condições de jejum e pós-sobrecarga de metionina / Effect of the cysteine or glutamine supplementation on the metabolism of sulphurated amino acids and glutathione state of HIV patients on fasting and after-methionine load

INTRODUÇÃO: Metionina (Met), cisteína (Cys), homocisteína (Hcy) e taurina (Tau) são os qautro aminoácidos sulfurados (AAS), mas apenas a Met e Cys são incorporadas em proteínas. Os três principais produtos dos AAS, glutationa, (GSH), Hcy e Tau influenciam, principalmente, as respostas inflamatória e imune. A Tau e GSH melhoram a inflamação, enquanto que a Hcy apresenta efeito oposto. Os pacientes HIV+ apresentam baixos níveis de GSH e outros nutrientes antioxidantes, mostrando relação direta entre Cys (e GSH) com células CD4 +. Não se conhece o mecanismo pelo qual as mudanças na ingestão dos AAS influenciam este fenômeno e as relações entre Hcy, doenças inflamatórias e alterações in vitro no comportamento das células imunes criou nota cautelar sobre a suplementação de dietas com AAS. OBJETIVOS: investigar as vias dos AAS em pacientes HIV+ nas condições de jejum e pós-sobrecarga de Met frente à dieta habitual (DH) isolada ou acompanhada da suplementação de Cys (NAC) ou glutamina (GIn). MÉTODOS: 12 pacientes HIV+ (6 M e 6 F, de 25 a 36 anos), sob tratamento anti-retroviral pelo esquema tríplice, sem infecções secundárias e 20 controles saudáveis (10 M e 10 F, 23-28 anos) foram randomicamente distribuídos para suplementação com NAC (N-acetilcisteína, 1g/d ou GIn (20 g/d) em estudo cruzado com 7 dias de dieta separados por uma semana de washout (Wo com DH). Amostras de sangue após jejum noturno de 10 a 12 horas foram coletadas antes (MO) e após (M1) cada regime dietético. A seguir, os indivíduos ingeriram metionina (100 mg/kg) com coletas de sangue após 2 e 4 horas para a determinação da área abaixo da curva (AAC)...

Methionine (Met), cysteine (Cys), homocysteine (Hcy), and, taurine (Tau) are the 4 sulfur-containing amino acids (SAA), but only Met and Cys are incorporated into proteins. The 3 major products of SAA, glutathione (GSH), Hcy and Tau influence, mainly, inflammatory and of immune responses. Tau and GSH ameliorate inflammation whereas Hcy has the opposite effect. HIV+ patients present low levelis of GSH and other antioxidants nutrients, showing a direct relationship between Cys (and GSH) with CD4+/ cells. How changes in SAA intake influence this phenomenon is unknown and the relationships among Hcy, inflammatory diseases, and in vitro alterations in immune cell behavior create a cautionary note about supplementation of diets with SAA. OBJECTIVE: To investigate SAA pathways in HIV+ patients on fast and Met-overload (Met-DL) states after taken diet habitual without (HD) or with supplements of Cys (NAC) or glutamine (Gln). METHOOS: 12 HIV+ (6M and 6F, 25-36 yrs old) patients under HAART without secondary infections and 20 healthy (10M and 10F, 23-28 yrs old) controls were randomly assigned to either NAC (N-acetylcysteine, 1g/d) or Gln (20g/d) diets, in a 7-day diet crossover design, separated by a 7-day washout (with HD) period. Blood samples were drawn after overnight fast before (MO) and after each dietary treatments (M1) for the resting measurements. Immediately after blood sampling ali subjects started the Met-DL by ingesting at once 100 mg Met/kg BW and having the blood draw after 2 and 4 hours for the area under the curve (AUC) determination. At MO both groups were assessed for anthropometry (BMI, kg/m2), glomerular (plasma urea and creatinina) and hepatocellular (plasma γGT activity) funetions, nutritional (albumin, calcium, folic acid and vitamin B12) and antioxidant (uric acid, GSH, GSSG, Hey) states, glucose, lipids (triglycerides and cholesterol fractions) and SAA, serine (Ser), glyeine (Gly), glutamate (Glu) and Gln. The HIV+ group was characterized also by viral load, CD4+ and CD8+ counts. The statistical comparisons between groups and among diets showed group homogeneity for 8MI, albumin, calcium, vitamin B12, Hey, HDL-cholesterol, urea and creatinine. The patients presented higher values of glucose, triglycerides, γ-GT, LDL-cholesterol, and GSSG along with lower concentrations of uric acid, GSH and all but Hcy amino acids. The Met-OL equalized (Δ values) the groups for Met, Hcy, Tau and Gln. NAC and Gln diets led the HIV+ group to a higher concentrations of GSH (NAC > Gln) by acting differently on its precursors: Gly (Gln > NAC) and Cys (NAC > Gln), resulting similar consumption of Ser and production of Tau. Both diets reduced GSSG/GSH (NAC > Gln) and only NAC increased (6 x) Hey. The later was worsened by Met-OL. Thus HIV+ results in multiple deficiencies of vitamins and amino acids leading to lower levels of GSH and higher GSSG/GSH ration. The main problems of lower formation of Cys and low ineorporation of Cys and Gly into GSH were greatly solved by giving Met, NAC and Gln to the patients, hence remaining the drawback of increasing Hcy with Met or NAC supplements.

Bases metabólicas da suplementação de cisteína / Metabolic Basis of supplemental cysteine / Metabólicas Bases de cisteína suplementaria

A cisteína (Cys) é um aminoácido sulfurado produzido, endogenamente, a partir da transulfuração da homocisteína. É limitante da síntese da glutationa, principal antioxidante (peroxidase) solúvel no citosol e maior fonte sulfurada endógena. Adicionalmente, a Cys origina a taurina (Tau) com papel neurotransmissor, inativador de ácidos biliares, osmolito intracelular e agente antioxidante intrafagocitário. Apenas o fígado, pãncreas e rins formam Cys a partir da metionina (Met). Nos demais tecidos, a principal fonte de Cys é a sua concentração plasmática ou as de GSH e GSSG (desde que a célula contenha y-glutamil transpeptidase e dipeptidase). A Cys (SH) é instável e se oxida facilmente a cistina (S-S), forma predominante no plasma. As células desprovidas de redutase, como os linfócitos, não convertem a Cis (S-S) a Cys (SH) e tornam-se dependentes da Cys gerada por outras células sanguíneas ou da Cys plasmática. A Cys ativa a proliferação celular e as funções de quimiotaxia, fagocitose e citoxicidade natural (de células malignas). A deficiência de Cys está associada não apenas aos menores níveis de GSH e menor defesa antioxidante, mas também à diminuição de glutamina e consequente deficiência imunitária. Não há recomendações específicas para a Cys.A RDA para Met+Cys é de 17 mg/g...

The cysteine (Cys) is a sulfur-containing amino acid produced endogenously from the transsulfuration of homocysteine. It is limiting the synthesis of glutathione, the main antioxidant (peroxidase) soluble in the cytosol and increased endogenous sulfur source. Additionally, Cys originates taurine (Tau) with paper neurotransmitter inactivation of bile acids, intracellular osmolyte and antioxidant agent intrafagocitário. Only liver, pancreas and kidneys form Cys from methionine (Met). In other tissues, the main source of Cys is its plasma concentration or GSH and GSSG (as long as the cell containing y-glutamyl transpeptidase and dipeptidase). The Cys (SH) is unstable and easily oxidized to cystine (SS), the predominant form in plasma. Cells devoid of reductase, such as lymphocytes, do not convert to Cys (SS) to Cys (SH) and become dependent on Cys generated by other blood cells or plasma Cys. The Cys active cell proliferation and functions of chemotaxis, phagocytosis, and natural cytotoxicity (malignant cells). Cys deficiency is associated not only with lower levels of GSH and lower antioxidant defense, but also to the decrease of glutamine and subsequent immune deficiency. There are no specific recommendations for Cys.A for Met + Cys RDA is 17 mg / g...

Detecção de fatores de risco alterados em pacientes coronariopatas hospitalizados / Detection of altered risk factors in hospitalized patients with coronary artery disease

OBJECTIVE: To assess biochemical, anthropometric, and dietary variables considered risk factors for coronary artery disease. METHODS: Using anthropometrics, dietary allowance, and blood biochemistry, we assessed 84 patients [54 males (mean age of 55± 8 years) and 30 females (mean age of 57±7 years)], who had severe ( > or = 70 percent coronary artery obstruction) and nonsevere forms of coronary artery disease determined by cardiac catheterization. The severe form of the disease prevailed in 70 percent of the males and 64 percent of the females, and a high frequency of familial antecedents (92 percent ' 88 percent) and history of acute myocardial infarction (80 percent ' 70 percent) were observed. Smoking predominated among males (65 percent) and diabetes mellitus among females (43 percent). RESULTS: Males and females had body mass index and body fat above the normal values. Females with nonsevere lesions had HDL > 35 mg/dL, and this constituted a discriminating intergroup indicator. Regardless of the severity of the disease, hyperglycemia and hypertriglyceridemia were found among females, and cholesterolemia > 200 mg/dL in both sexes, but only males had LDL fraction > 160 mg/dL and homocysteine > 11.7 mmol/L. The male dietary allowance was inadequate in nutrients for homocysteine metabolism and in nutrients with an antioxidant action, such as the vitamins B6, C, and folate. Individuals of both sexes had a higher lipid and cholesterol intake and an inadequate consumption of fiber. The diet was classified as high-protein, high-fat, and low-carbohydrate. CONCLUSION: The alterations found had no association with the severity of lesions, indicating the need for more effective nutritional intervention

Desnutrição protético-energético no paciente gastrectomizado / Protein-energy malnutrition in the gastrectomized patient

Gastrectomy leads to nutritional consequences that although expected, are not usually measured due to methodological limitations. AIM: To assess the protein-energy deficiency degrees estimated by isolated or combined indicators. PATIENTS AND METHODS: There were studied 71 patients, who had undergone partial (n = 53) or total (n = 18) gastrectomy in the last 6-24 months (M1) or 24-60 months (M2). The dietary intake, body composition and biochemical data were estimated and compared between groups and moments. RESULTS: The surgeries were undertaken after complications of peptic ulcer (68%) or due to gastric cancers (32%). Weight loss was referred by 70% of patients and higher (16 +/- 5 x 10 +/- 6 kg) in total gastrectomy group. The patients showed anthropometric deficits along with normal albumin and low energy intake, suggesting chronic-energy deficiency. Hematocrit, hemoglobin and iron showed the most prominent reductions. Anemia was installed earlier and worsened in the total gastrectomy group. Thus, when combining hemoglobin + albumin, + total lymphocyte count + arm circumference and subscapular skinfold, the protein-energy deficiency prevalence was higher and more severe than when hemoglobin was omitted. The protein-energy deficiency occurred earlier and it was more severe in total gastrectomy patients, while in partial gastrectomy the protein-energy deficiency increased in the late post-operative period. CONCLUSION: The protein-energy deficiency resulted from gastrectomy is more marasmus-like coarsing with anemia, both installed earlier and severer in total gastrectomy than partial gastrectomy but ending up similarly at the late postoperatory