A spurious elevation of serum creatinine level in a patient with Crohn's disease without histologic kidney damage: a case report and review of the literature / Elevação espúria do nível de creatinina sérica em ­paciente com doença de Crohn sem lesão renal histológica: relato de caso e revisão da literatura

ABSTRACT Patients with inflammatory bowel disease (IBD) are prone to develop kidney injury. Renal involvement in IBD patients is usually diagnosed by the measurement of serum creatinine and the estimation of the glomerular filtration rate. We describe a patient with IBD who presented with large fluctuations in his serum creatinine level (~3.0-fold) without significant histologic abnormalities and with a normal cystatin C level. This appears to be related to a high-protein diet and intermittent fasting. Even though the impact of a high-protein diet on mild elevations of the serum creatinine level has been described, large fluctuations in serum creatinine from diet alone, as seen in this case, have never been reported, raising the question about the potential contribution of inflamed bowel on gut absorption or metabolism of creatinine. This case highlights the importance of a detailed history, including the dietary habits, when encountering a patient with increased serum creatinine level, and careful interpretation of serum creatinine in a patient with a creatinine high-protein diet or underlying IBD.

RESUMO Pacientes com doença inflamatória intestinal (DII) são propensos a desenvolver lesão renal. O envolvimento renal em pacientes com DII é geralmente diagnosticado pela medição da creatinina sérica e pela estimativa da taxa de filtração glomerular. Descrevemos um paciente com DII que apresentou grandes flutuações em seu nível de creatinina sérica (~3,0 vezes) sem anormalidades histológicas significativas e com nível normal de cistatina C. Isso parece estar relacionado a uma dieta rica em proteínas e jejum intermitente. Ainda que o impacto de uma dieta rica em proteínas em elevações leves do nível de creatinina sérica tenha sido descrito, nunca foram relatadas grandes flutuações na creatinina sérica apenas devido à dieta, como observado neste caso, o que levanta a questão sobre a possível contribuição do intestino inflamado na absorção intestinal ou no metabolismo da creatinina. Esse caso destaca a importância de um histórico detalhado, incluindo os hábitos alimentares, ao se deparar com um paciente com nível de creatinina sérica aumentado, e a interpretação cuidadosa da creatinina sérica em um paciente com dieta rica em proteínas ou DII subjacente.

High-intensity functional training with an adequate and carbohydrate restricted hypocaloric diet promotes weight loss and cardiometabolic improvements

INTRODUCTION: Excess body weight and its comorbidities represent a major public health issue. Interventions based on diet and exercise have not only been shown to promote weight loss, but also improve overall health, including cardiovascular health. OBJECTIVE: This study aimed to evaluate the effects of a 12-week hypocaloric low-carbohydrate (CHO) diet coupled with high-intensity functional training (HIFT) on the cardiometabolic risk of overweight adults. METHODS: This is a randomized controlled trial. A total of 31 overweight adults participated in this study, divided into two groups based on the dietary intervention: reduced-CHO (R-CHO, ≤130 g/day; n=15) and adequate-CHO (A-CHO, >130 g/day; n=16). The cardiometabolic risk was assessed using lipidaemic, insulinemia, and glycaemic parameters. A two-way ANOVA with Bonferroni post hoc test was utilized to evaluate the effects of the intervention. A p-value < 0.05 was considered statistically significant. RESULTS: Participants from both groups displayed decreased low-density lipoprotein, very-low-density lipoprotein, total cholesterol, and triacylglycerol concentrations, as well as the number of risk factors for the metabolic disease after 12 weeks. The high-density lipoprotein (HDL) cholesterol concentration of both groups increased after 12 weeks, however, the result of the intragroup analysis revealed that a significant increase was only observed in the participants from the A-CHO group. CONCLUSION: Reduced or adequate CHO intake was both found to be effective in reducing cardiometabolic risk. However, improvements in HDL and final cardiometabolic classification risk indicated that CHO adequacy in the diet might be a better strategy associated with caloric restriction and HIFT.

Nutritional support therapy for patient with acute prerenal failure complicated with urinary tract infection / 药学实践杂志

Objective To explore the formulation and adjustment of nutritional therapy by nutrition support pharmacists in patient with acute prerenal failure complicated with urinary tract infection, and to provide a reference for nutritional therapy in such patient. Methods With nutrition support pharmacists participated in nutrition treatment management and case analysis of a patient with acute prerenal failure complicated with urinary tract infection, we explored the nutritional support treatment plan for this type of patient. Results Nutrition support pharmacists provided pharmaceutical care throughout the course for patient with acute prerenal failure and designed an individualized low-calorie and high-protein nutritional support treatment according to the change of patient's condition, to increase the patient's serum albumin level and maintain at 35 g/L, at the same time the infection was effectively controlled and the creatinine value decreased to normal. Conclusion Small-volume, low-calorie, high-protein nutritional support solution ≤1 000 ml, calorie intake is about 1, 000 kcal, and protein is maintained at 1.2 g/(kg·d) throughout the course of acute prerenal renal failure with urinary tract infected patients can obtain better clinical outcomes and prognosis, and can better maintain clinical operability, and fully improve the safety, effectiveness and economics of nutritional support treatment.

Effect of resistance training exercise combined with high protein diet on body weight and muscle mass in underweight adolescent males

@#Introduction: Many underweight males take commercial protein supplements to increase their body weight and build muscle. Nonetheless, commercial protein supplements may cause adverse effects. This study aimed to determine the effects of resistance training exercise combined with a high protein diet on body weight and muscle mass in underweight adolescent males. Methods: A repeated measures design study was conducted on nine males aged 12-15 years with low body weight. Energy and protein requirements were calculated, and energy and protein consumptions were measured for each meal during the high protein diet without exercise (HP) period and the high protein diet with resistance exercise (HPE) period. Subjects engaged in three resistance training sessions each week during HP-E period, for eight weeks. Dietary intake, body composition, blood biochemistry, physical fitness, and self-esteem were assessed. Results: In HP-E period, resistance training exercise combined with a high protein intake (2.14 g/kg/d) increased body weight and lean tissue mass (LTM) by 0.5 kg and 0.5 kg, respectively. Resistance training during HP-E period increased arm, leg, and trunk muscle strength by 20.2%, 7.2%, and 14.5%, respectively, more than high protein diet alone during HP period. High protein intake in HP-E period did not affect blood urea nitrogen (BUN) and creatinine levels (11.0 mg/dL and 0.70 mg/dL, respectively). Conclusion: Eight weeks of resistance training combined with a high protein diet increased body weight and LTM without adverse effects. In particular, resistance exercise predominantly increased muscle strength. Kidney function was not affected by high protein consumption throughout this study.

Efeitos da restrição de carboidratos no manejo do diabetes mellitus: revisão de literatura científica / Effects of carbohydrate-restricted diets in the management of diabetes mellitus: review of scientific literature

O objetivo do presente estudo foi avaliar, por meio de uma revisão da literatura, evidências da utilização de dietas com restrição de carboidratos no manejo do diabetes mellitus (DM). As buscas eletrônicas e manuais foram até abril de 2019, e incluíram trabalhos publicados a partir de 2008. Foram excluídos estudos de pesquisas in vitro e em animais, revisões de literatura, livros, monografias, dissertações, teses, estudos de caso e relatos de caso. Os artigos remanescentes foram submetidos à análise de sua qualidade metodológica pela Escala JADAD cinco pontos. Um total de 19 estudos randomizados e com qualidade média de três pontos foram selecionados e analisados quanto aos tipos de dieta utilizadas, adesão, tipo de DM, tempo de intervenção, consumo reportado de carboidratos e resultados observados para os grupos controle e intervenção. Dentre os parâmetros escolhidos para mensurar os possíveis efeitos das dietas, destacaram-se alteração de peso e IMC, Hb1Ac, variabilidade ou controle glicêmico, perfil lipídico e alteração nas doses de insulina ou medicação utilizadas. Em quatro estudos não foram observadas vantagens significativas de uma dieta restrita em carboidratos, e 15 trabalhos relataram melhoras em um ou mais parâmetros. Tais resultados podem representar uma grande vantagem na adoção desta estratégia alimentar no manejo do DM e na prevenção de complicações da doença. Contudo, existem limitações nos estudos, que precisam ter suas hipóteses verificadas no longo prazo, e pesquisas adicionais devem ser realizadas para configurar uma estratégia oficial no controle do DM. (AU)

This study aimed to evaluate, through a literature review, evidence of the use of diets with carbohydrate restriction in the management of diabetes mellitus (DM). Electronic and manual searches were conducted until April 2019, including works published from 2008 onwards. Studies on in vitro and animal research, literature reviews, books, monographs, dissertations, theses, case studies and case reports were excluded. The remaining articles were submitted to analysis of their methodological quality by the five-point JADAD Scale. Nineteen randomized studies with an average quality of three points were selected and analyzed regarding the types of diet used, adherence, type of DM, time of intervention, reported consumption of carbohydrates and results observed for the control and intervention group. Among the parameters chosen to measure the possible effects of diets, weight and BMI changes, Hb1Ac, variability or glycemic control, lipid profile and changes in insulin doses or medication used stood out. In four studies, no significant advantages were observed from a carbohydraterestricted diet, and 15 studies reported improvements in one or more parameters. Such results can represent a great advantage in adopting this dietary strategy in the management of DM and in preventing complications of the disease. However, there are limitations in the studies, which need to have their hypotheses verified in the long term, and additional research must be carried out to configure an official strategy in the control of DM. (AU)

Feed restriction since lactation has reduced anxiety in adult Wistar rats / A restrição alimentar desde a lactação reduziu a ansiedade em ratos Wistar adultos

ABSTRACT Objective To evaluate the effects of macronutrients (protein, carbohydrate and/or lipid) in the diet of young adult (72 days) and adult (182 days) Wistar rats treated ad libitum and with 30% restriction from birth on anxiety in the elevated plus-maze. Methods We used 238 rats treated from birth, composing the groups: Control, Protein, Carbohydrate, Lipid, Carbohydrate and Lipid, Control Restriction, Protein Restriction, Carbohydrate Restriction, Lipid Restriction and Carbohydrate and Lipid Restriction. The animals were weighed at the beginning and at the end of the experiment and tested in the elevated plus-maze. Data were submitted to analysis of variance, followed by the Newman-Keuls Test (p<0.05). Results Among the animals treated ad libitum, the Control, Carbohydrate plus Lipid and Lipid gained more weight than the Carbohydrate and Protein; ad libitum animals gained more weight than those on restriction; among the restrictions, Carbohydrate Restriction rats were the ones that gained less weight. Diet-restricted animals exhibited reduced first-entry latency, greater percentage of entries and time spent, frequency of open arm extremity visits, head dipping (protected and unprotected), and length of stay in the central area of the elevated plus-maze. The animals with 182 days presented greater latency for first entry, reduced frequency of false entries and visits to the ends of the open arms and protected head dipping. Conclusion Food restricted animals, regardless of the macronutrient present in the diet, were less anxious and/or increased their impulsivity and those at 182 days were more anxious and/or with reduced impulsivity.

RESUMO Objetivo Este estudo buscou avaliar os efeitos dos macronutrientes (proteína, carboidrato e/ou lipídeos) na alimentação de ratos Wistar adultos jovens (72 dias) e adultos (182 dias) tratados ad libitum e com restrição a 30% desde o nascimento quanto à ansiedade através do labirinto em cruz elevado. Métodos Foram utilizados 238 ratos tratados desde o nascimento, compondo os grupos Controle, Proteína, Carboidrato, Lipídeos, Carboidrato e Lipídeos, Restrição Controle, Restrição Proteína, Restrição Carboidrato, Restrição Lipídeos e Restrição Carboidrato e Lipídeos. Os animais foram pesados no início e no final do experimento e testados no labirinto em cruz elevado. Os dados foram submetidos à análise de variância, seguida do teste de Newman-Keuls (p<0,05). Resultados Entre os animais tratados ad libitum, os dos grupos Controle, Carboidrato e Lipídeos, e Lipídeos ganharam mais peso do que os Carboidrato e Proteína; os ad libitum ganharam mais peso do que os de restrição; os Restrição Carboidrato foram os que ganharam menos peso. Animais alimentados com restrição de dieta apresentaram menor latência de primeira entrada, maior porcentagem de entradas e de tempo gasto, frequência de visitas às extremidades dos braços abertos, de mergulho (protegido e desprotegido) e tempo de permanência na área central do labirinto em cruz elevado. Os animais com 182 dias demonstraram maior latência para primeira entrada, menor frequência de falsas entradas e visitas às extremidades dos braços abertos e mergulho protegido. Conclusão Os animais em restrição alimentar, independentemente do macronutriente presente na dieta, foram menos ansiosos e/ou mais impulsivos, e os com 182 dias foram mais ansiosos e/ou menos impulsivos.

Nuts and Cardiovascular Diseases: Focus on Brazil Nuts

Cardiovascular diseases (CVD) are the main cause of death globally and most CVD can be prevented by addressing their risk factors, such as an unhealthy diet. Many authors have studied the benefits of nut consumption on CVD. Nuts contain high amounts of vegetable protein, unsaturated fatty acids, dietary fibers, vitamins, minerals and many other bioactive compounds, like phytosterols and phenolic compounds, which are able to reduce cholesterol levels and promote antioxidant and anti-inflammatory effects, thereby reducing cardiovascular risks. This review aims to describe studies involving the consumption of nuts, including Brazil nuts and CVD risk factors with positive results in the improvement of lipid profile, glucose metabolism, vascular function, and inflammatory and oxidative stress biomarkers

Comparação entre ingestão ideal de calorias mais alto teor de proteínas e ingestão calórico-proteica recomendada em pacientes críticos: um ensaio clínico fase II, prospectivo, randomizado e controlado / Optimized calorie and high protein intake versus recommended caloric-protein intake in critically ill patients: a prospective, randomized, controlled phase II clinical trial

RESUMO Objetivo: Avaliar as diferenças entre os desfechos da terapia nutricional com ingestão ideal de calorias mais alto teor proteico e do padrão de cuidados nutricionais em pacientes críticos adultos. Métodos: Randomizamos pacientes com previsão de permanecer na unidade de terapia intensiva por pelo menos 3 dias. No grupo com ingestão ideal de calorias mais alto teor proteico, a necessidade de ingestão calórica foi determinada por calorimetria indireta e a ingestão proteica foi estabelecida em níveis de 2,0 a 2,2g/kg/dia. O grupo controle recebeu calorias em nível de 25kcal/kg/dia e 1,4 a 1,5g/kg/dia de proteínas. O desfecho primário foi o escore do sumário do componente físico obtido aos 3 e 6 meses após a randomização. Os desfechos secundários incluíram força de preensão manual quando da alta da unidade de terapia intensiva, duração da ventilação mecânica e mortalidade hospitalar. Resultados: A análise incluiu 120 pacientes. Não houve diferença significante entre os dois grupos em termos de calorias recebidas. Contudo, a quantidade de proteínas recebidas pelo grupo com nível ideal de calorias mais alto teor de proteínas foi significantemente mais alta do que a recebida pelo grupo controle. O escore do sumário componente físico aos 3 e 6 meses após a randomização não diferiu entre ambos os grupos, assim como não diferiram os desfechos secundários. Entretanto, após ajuste para covariáveis, um delta proteico negativo (proteínas recebidas menos a necessidade proteica predeterminada) se associou com escore do sumário do componente físico mais baixo nas avaliações realizadas 3 e 6 meses após a randomização. Conclusão: Neste estudo, a estratégia com ingestão calórica ideal mais elevado teor proteico não pareceu melhorar a qualidade de vida física em comparação aos cuidados nutricionais padrão. Contudo, após ajuste para covariáveis, um delta proteico negativo se associou com escores do sumário do componente físico mais baixos nas avaliações realizadas aos 3 e aos 6 meses após a randomização. Esta associação ocorreu independentemente do método de cálculo do alvo proteico.

ABSTRACT Objective: To evaluate differences in outcomes for an optimized calorie and high protein nutrition therapy versus standard nutrition care in critically ill adult patients. Methods: We randomized patients expected to stay in the intensive care unit for at least 3 days. In the optimized calorie and high protein nutrition group, caloric intake was determined by indirect calorimetry, and protein intake was established at 2.0 to 2.2g/kg/day. The control group received 25kcal/kg/day of calories and 1.4 to 1.5g/kg/day protein. The primary outcome was the physical component summary score obtained at 3 and 6 months. Secondary outcomes included handgrip strength at intensive care unit discharge, duration of mechanical ventilation and hospital mortality. Results: In total, 120 patients were included in the analysis. There was no significant difference between the two groups in calories received. However, the amount of protein received by the optimized calorie and high protein nutrition group was significantly higher compared with the control group. The physical component summary score at 3 and 6 months did not differ between the two groups nor did secondary outcomes. However, after adjusting for covariates, a negative delta protein (protein received minus predetermined protein requirement) was associated with a lower physical component summary score at 3 and 6 months postrandomization. Conclusion: In this study optimized calorie and high protein strategy did not appear to improve physical quality of life compared with standard nutrition care. However, after adjusting for covariates, a negative delta protein was associated with a lower physical component summary score at 3 and 6 months postrandomization. This association exists independently of the method of calculation of protein target.

Effects of Low-Calorie Diet Including High Protein-Low Carbohydrate Protein Bar on Weight Loss and Serum Lipid Indicators in Overweight Women according to Dietary Compliance / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to investigate the effect of a 6-week low-calorie diet (LCD) program including high protein-low carbohydrate protein bar on weight loss, blood pressure, and blood lipid profile in 40 overweight women according to dietary compliance.METHODS: Subjects were 62 healthy overweight women (BMI ≥ 23.0 or body fat percentage ≥ 28%), aged 20~59 yrs who were provided a high protein-low carbohydrate protein bar (each 35 g, 154 kcal, protein energy %: 28.6%, carbohydrate energy %: 38.7%) as part of dinner for 6 weeks. Forty subjects who completed the whole diet program were categorized into high compliance (HC) group (days of eating protein bar ≥ 5 weeks) or low compliance (LC) group (days < 5 weeks).RESULTS: Energy intake significantly decreased from 1,867.5 kcal at baseline to 1,137.4 kcal at 6 weeks for the HC group and from 1,971.7 kcal to 1,362.2 kcal for the LC group, respectively. On the other hand, a significant increase in protein energy percentage was observed in each group (HC group: 3.5%, LC group: 2.2%). Both groups showed significant decreases in weight (HC group: 1.8 kg, LC group: 1.1 kg), BMI, fat mass, systolic blood pressure, total cholesterol, and LDL-cholesterol. Reduction of body fat percentage and diastolic blood pressure were only observed in the HC group.CONCLUSIONS: The inclusion of a high protein-low carbohydrate protein bar as part of a low-calorie diet for a short period can be effective to achieve weight loss and concomitantly improve blood cholesterol level without serious physiological side effects. More evident results can be achieved by eating a diet with low calorie diet including high protein-low carbohydrate protein bar for more than 5 weeks.

Efeitos da Dieta Paleolítica nos Parâmetros Comportamentais, Bioquímicos e Teciduais em Camundongos Sadios / The Effects the Paleolithic Diet in Biochemical, Behavioral and Tissue Parameters in HealthyMice

A obesidade está associada aos riscos para a saúde, devido a sua relação com o aumento da pressão arterial, dos níveis de colesterol e triglicerídeos sanguíneos e também a resistência à insulina. A causa principal da obesidade está intrinsecamente relacionada aos hábitos alimentares e interações do material genético do indivíduo e, também, está ligada aos fatores sociais, ambientais e comportamentais. Atualmente, são utilizadas muitas dietas com diferentes parâmetros, dentre estas a Dieta Paleolítica. A Dieta Paleolítica tem o propósito de usar como classes principais de alimentos: proteínas, vegetais, frutas e gorduras não-industrializadas, excluindo não-inteiramente o consumo de hidratos de carbono, sendo este o grande diferencial da Dieta Paleolítica, quando comparada às dietas modernas para perda de peso. O objetivo do presente trabalho foi avaliar os efeitos da dieta paleolítica nos níveis comportamentais em camundongos C57BL/6 sadios. O estudo foi realizado na unidade Uniderp Agrárias, na cidade de Campo Grande ­ MS. Foram utilizados camundongos C57BL/6, organizados aleatoriamente em oito grupos e foi realizado o monitoramento dos parâmetros comportamentais, de peso e ingesta de ração, pelos períodos de 15 ou 30 dias de tratamento. Os resultados demonstraram que os grupos que receberam a Dieta Paleolítica por 15 ou 30 dias não apresentaram diferença significativa nos parâmetros comportamentais e ingesta de água e ração. Por tanto, é possível concluir que a Dieta Paleolítica não altera o comportamento, o consumo de ração e peso corporal. (AU).

The obesity is associated to health risks, due to its relation in increasing the blood pressure, cholesterol and triglycerides levels and also to its increase in insulin resistance. The main cause of obesity is intrinsically related to eating habits and interactions of genetics and, also, bounded to social, environmental e behavioral factors. Nowadays, many diets with different parameters have been used, among them is the Paleolithic Diet. The Paleolithic Diet has as purpose to use as main food groups: proteins, vegetables, fruits and non-industrialized fat, excluding not entirely the intake of carbohydrates, this being the great differential in comparison to modern weight loss diets. The objective of the present paper is to evaluate the effects of the Paleolithic Diet in behavioral levels in C57BL/6 healthy mice. The experiment was carried out in UNIDERP Agrárias, in Campo Grande ­ MS. C57BL/6 mice were divided randomly in 8 groups, and the monitoring of behavior, weight and food intake were done during 15 or 30 days of diet. The results demonstrated that the groups that took the Paleolithic Diet for 15 or 30 days did not present any important difference in behavioral, food and water intake parameters. Therefore, it is possible to conclude that the Paleolithic Diet does not alter the, behavioral, food intake and weight parameters. (AU)

Efecto sobre la saciedad de un desayuno hiperproteico versus uno normoproteico y consumo prospectivo de alimentos durante el día en mujeres adultas / Effect on the satiety of a hyperproteic breakfast versus a normoproteic one and prospective consumption of food during the day in adult women

Introducción: resultan altamente complejos los mecanismos para controlar hambre y saciedad. Seleccionar preparaciones/alimentos más saciógenos podría ser una estrategia útil para controlar peso corporal. Objetivo: evaluar el efecto sobre la saciedad de un desayuno hiperproteico (HP) versus normoproteico (NP) y el consumo prospectivo de alimentos Ad libitum durante el resto del día en mujeres adultas. Metodología: ensayo clínico cruzado en mujeres voluntarias sanas (30 a 70 años), residentes en Gran Buenos Aires sur (Julio-Agosto 2014). Se aleatorizaron 60 participantes para consumir desayuno HP y NP durante tres días consecutivos cada uno, actuando las mismas mujeres como casos y autocontroles. Ambos desayunos fueron similares en densidad energética (1,22 y 1,23 kcal/g, respectivamente) y grasas, variando la relación proteínas/ carbohidratos (Pr/C): HP (41 g proteínas; P/C: 3,72) y NP (7 g proteínas; Pr/C: 0,13). Diariamente se registró saciedad percibida a cada hora del momento de ingerido (4 mediciones), mediante escala tipo Likert unidimensional (1= sin ganas de comer a 5= con muchas ganas de comer). Se calculó consumo de energía y macronutrientes aportados por alimentos consumidos Ad libitum durante el resto del día, mediante programa SARA-versión 1.2.12; grado de aceptación mediante escala hedónica verbal de cinco puntos (1=nada a 5= muchísimo) y elección del tipo de desayuno para su consumo habitual. Análisis de datos por SPSS 19.0, presentándose estadísticas descriptivas para comparación de muestras relacionadas no paramétricas y prueba de Wilcoxon, considerando nivel significativo p < 0,05. Resultados: edad media: 41 (DS=11,1) años. IMC: 25,8 (DS=7,4) kg/m². Fue mayor la aceptabilidad media del desayuno HP: 3,23 (DS=1,07) vs el NP: 2,72 (DS=1,05) (p=0,000). Sin embargo, la mayoría (58,3%) eligió para consumo habitual el desayuno NP vs el HP (33.3%) (p=0,01). La saciedad fue significativamente mayor con desayuno HP en la primera (p: 0,014), tercera (p: 0,048) y cuarta medición (p: 0,000). No se observaron diferencias en el consumo de alimentos Ad libitum después de ambos desayunos. Conclusiones: el desayuno HP contribuyó a controlar el apetito mejorando la saciedad a corto plazo respecto al desayuno NP. Sin embargo, a lo largo del día, no pudo observarse su efectividad dado que, independientemente del tipo de desayuno, el consumo de alimentos prospectivos Ad libitum fue similar.

Introduction: the mechanisms to control hunger and satiety are highly complex. Selecting preparations / foods more satiety could be a useful strategy to control body weight. Objective: to evaluate the effect of satiety of an hyperproteic breakfast (HP) versus a normoproteic (NP) one and prospective consumption of food Ad libitum during the rest of the day in adult women. Methodology: cross-sectional clinical test in healthy volunteer women (30 to 70 years old), residents of South Gran Buenos Aires (July-August 2014). Sixty participants were randomized to consume HP and NP breakfast for three consecutive days each, the same women acting as cases and self-controls. Both breakfasts were similar in energy density (1.22 / 1.23 kcal/g respectively) and fat, varying the protein/carbohydrate ratio (P/C): HP (41 g protein, P/C: 3.72) and NP (7 g proteins, P / C: 0.13). Daily perceived satiety was registered at each hour of the moment of ingestion (4 measurements), using one dimensional Likert scale (1= no desire to eat to 5= eager to eat). Energy consumption and macronutrients contributed by foods consumed Ad libitum during the rest of the day were calculated through SARA Program-version 1.2.12; degree of acceptance through five-point verbal hedonic scale (1= nothing to 5= very much) and choice of type of breakfast for their usual consumption. Data analysis by SPSS 19.0, presenting descriptive statistics for comparison of nonparametric related samples and Wilcoxon test, considering significant level p<0.05. Results: average age: 41 (SD=11.1) years old. BMI: 25.8 (SD=7.4) kg/m². The average acceptability of the HP breakfast was higher: 3.23 (SD=1.07) vs NP: 2.72 (SD=1.05) (p=0.000). However, the majority (58.3%) chose breakfast NP vs HP for usual consumption (33.3%) (p=.01). Satiety was significantly higher with HP breakfast in the first (p: 0.014), third (p: 0.048) and fourth measurement (p=0.000). No differences were observed in the consumption of Ad libitum foods after both breakfasts. Conclusions: the HP breakfast helped to control appetite by improving satiety in the short term compared to breakfast NP. However, throughout the day, its effectiveness could not be observed since, independently of the type of breakfast, the consumption of prospective foods Ad libitum was similar.

Dieta hiperproteica e função renal: discutindo seus efeitos em adultos normais / High-protein diet and kidney disease: a discussion on effects in regular adults

OBJETIVOS: O objetivo deste estudo é revisar e atualizar a literatura sobre os efeitos de uma dieta hiperprotéica em comparação com uma dieta hipoprotéica na função renal de indivíduos adultos previamente hígidos. MÉTODOS: Foram utilizadas as bases digitais Pubmed/Medline e Lilacs durante o mês de maio de 2018. Os termos utilizados foram "Diet, High-protein AND Kidney Disease", ambos Mesh Terms, sendo pesquisados artigos em língua portuguesa e em língua inglesa. Os critérios de inclusão utilizados selecionaram adultos saudáveis em uso de dieta hiperproteica, com função renal preservada ou minimamente alterada. Estudos que não preenchessem esses critérios, bem como artigos que abordaram grupos de neonatos, crianças e adolescentes, não foram selecionados. RESULTADOS: Foram selecionados 11 estudos. Analisamos os efeitos da ingestão aumentada de proteínas na Taxa de Filtração Glomerular (TGF), da pressão arterial e do metabolismo do cálcio e da ureia. O conteúdo das revisões dos estudos conflagra um aumento dos níveis de vasopressina, combinado à elevação da Taxa de Filtração Glomerular, da excreção de cálcio na urina e dos níveis séricos de ureia. Não foram encontradas evidências significativas quanto a risco de lesões renais. CONCLUSÕES: De acordo essa revisão, não foram encontradas evidências de que uma dieta com alto teor protéico possa acarretar prejuízo na função renal a curto ou médio prazo, em indivíduos normais.

AIMS: This study aims to review and atualize the literature about the effects on renal function comparing a high-protein diet and a low-protein diet in healthy adults. METHODS: Pubmed/Medline and Lilacs were the digital databases in which the search was performed during May 2018. The Mesh terms used here were "Diet, High-protein AND Kidney Disease" and the articles chosen were either in portuguese or english language. There were only included studies related to hiperproteic diets in healthy human adults with null or negative outcomes towards renal functionality. Studies that did not meet this criteria, such as articles that approached newborn, children or teenagers, were not picked up. RESULTS: We picked 11 studies. We analyzed the effects of high-protein diets in the Glomerular Filtration Rate (GFR), blood pressure and in urea and calcium metabolism. The review content of the studies could display an increase of vasopressin levels, as well as Glomerular Filtration Rate, excretion of calcium and serum level of urea. There were not identified significant evidence about risk of renal lesions. CONCLUSIONS: According to this review, any evidence that a high-protein diet is capable of causing renal impairment at short and medium term in healthy individuals could not be found.

Avaliação nutricional e o uso da levodopa com refeições proteicas em pacientes com doença de Parkinson do município de Macaé, Rio de Janeiro / Nutritional assessment and the use of levodopa with protein meals among patients with Parkinson's disease in the city of Macaé, Rio de Janeiro, Brazil

Resumo A doença de Parkinson (DP) é caracterizada pela redução da dopamina no sistema nervoso central. Apresenta progressão gradativa e é conhecida, principalmente, por tremores e dificuldade em realizar movimentos. Estudos demonstram que há significativa alteração do estado nutricional nos pacientes com DP. O principal medicamento utilizado no tratamento dos pacientes é a levodopa e a sua administração, sem respeitar o intervalo de no mínimo 30 minutos antes ou uma hora após as refeições, pode diminuir o efeito farmacológico da substância devido à interação droga-nutriente. Este estudo objetivou identificar, no município de Macaé-RJ, pacientes com DP em risco nutricional e o consumo proteico associado ao uso da levodopa. Trata-se de um estudo transversal, quantitativo e descritivo.Os instrumentos utilizados foram a Mini Avaliação Nutricional (MAN) e o registro alimentar estimado de três dias. A análise foi descritiva. Para compor a amostra, foi realizado um levantamento do número de pacientes com diagnóstico de DP de dois programas da Secretaria de Saúde e da Associação Parkinson de Macaé. Foram avaliados 40 indivíduos, desses, 57,5% eram do sexo masculino. Apresentaram risco de desnutrição ou desnutrição pela MAN 62,5% dos pacientes, caracterizando déficit nutricional. A ingestão proteica da população foi de 1,4g/Kg/dia. A maior ingestão de proteínas foi no período do dia, considerando as refeições compreendidas entre o café da manhã e o lanche da tarde. O consumo pela população nesse período foi de 74,7% da proteína total. Dos idosos, 75,0% ingeriam seus medicamentos compostos de levodopa simultaneamente às refeições ou não, seguindo o intervalo recomendado pela ANVISA. O estudo verificou que a maioria dos indivíduos apresentou risco nutricional, a maior parte realizava uma ingestão diária total hiperproteica, sendo o conteúdo proteico mal distribuído nas refeições ao longo do dia, além do não cumprimento ao intervalo recomendado da levodopa.

Abstract Parkinson's disease (PD) is characterized by a reduction in dopamine in the central nervous system. It has a gradual progression, and is mainly known for causing tremors and difficulty in performing movements. Studies have shown that there is a significant change in the nutritional status of patients with PD. The main medication used in the treatment of patients is levodopa, and its use, without respecting the minimum intervals of 30 minutes before or one hour after meals, may diminish the pharmacological effect of the drug because of drug-nutrient interactions. The present study aimed to identify PD patients at nutritional and protein consumption risk associated with the use of levodopa in the city of Macaé. A cross-sectional quantitative and descriptive study was performed. The instruments used were the Mini Nutritional Assessment (MNA) and an estimated 3-day dietary record. The analysis was descriptive. To form the sample population a survey was performed of patients diagnosed with PD in two Department of Health programs and from the Parkinson's Association of Macaé. A total of 40 individuals were evaluated, of whom 57.5% were male. Of these, 62.5% presented a risk of malnutrition or MNA defined malnutrition, with nutritional deficit. The protein intake of the study population was 1.4 g/kg/day. The highest protein intake was during the day, including the meals between breakfast and the afternoon snack. A total of 74.7% of total protein was consumed by the population during this period. Overall, 75.0% of the elderly persons consumed their medications containing levodopa simultaneously with meals or did not follow the interval recommended by ANVISA. The study found that the total daily intake of most individuals was hyper-proteic, with proteic content being poorly distributed among meals throughout the day, and that they did not follow the recommended levodopa interval.

Bebida achocolatada alta en proteínas con base en cajannus cajan fermentado y avena / High protein content chocolate beverage based on fermented cajanus cajan and oats

Se formuló una bebida achocolatada a base de concentrado de Cajanus cajan extraído de granos fermentados y hojuelas de avena. La formulación de la bebida se realizó siguiendo un diseño factorial 23. Se evaluó la aceptabilidad por parte de consumidores, la intensidad de atributos por un panel semientrenado y se describieron las fórmulas más aceptadas utilizando la metodología de perfil de libre elección. Finalmente, se determinó la composición proximal de la bebida seleccionada. Los resultados obtenidos indican que existe correlación negativa entre el contenido de avena y la aceptabilidad. En el panel semientrenado, las fórmulas más aceptadas por los consumidores se caracterizaron por ser calificadas con la mayor intensidad en los atributos de color, olor y sabor a chocolate y la menor intensidad en el atributo de viscosidad. El perfil de libre elección de las fórmulas más aceptadas, permitió la identificación de descriptores que pudieran atribuirse a compuestos formados durante el proceso de fermentación de la leguminosa. Según la composición proximal de la fórmula seleccionada, 200mL de la bebida constituyen un alimento con alto contenido de proteína y bajo en grasa(AU)

A chocolate flavored beverage was developed based on Cajanus cajan concentrate, extracted from fermented grains, and oats. The beverage formulation was performed following a 23 factorial design. Consumer acceptability and intensity of attributes were evaluated by a semi-trained panel, and the accepted fórmulas were described using the methodology of free choice profile. Finally, the proximal composition was determined on the selected beverage. The results indicate that there is a negative correlation between the content of oats and acceptability. For the semi-trained panel, fórmulas with higher consumer acceptance were scored with the highest intensities of color, smell and flavor of chocolate and lower intensity in the attribute of viscosity. The free choice profile of the most accepted formulas, allowed the identification of descriptors that could be attributed to compounds formed during the fermentation process of the legume. According to the proximal composition of the selected formula, a portion of 200mL constitutes a high protein and low fat beverage(AU)

Effects of protein-enriched meal on triglyceride, uric acid and renal function among overweight and obese adults / 中华健康管理学杂志

Objective To investigate the effects of protein-enriched meal on uric acid and renal function among overweight and obese Chinese adults during weight loss. Methods People, 18-55 yearsold, with body mass index 25-35 kg/m2 and triglycerides 1.7-5.4 mmol/L were enrolled. Major exclusion criteria were: type 2 diabetes, weight reducing surgery or use of weight loss drugs, chronic kidney disease, and hepatic dysfunction. A high-protein (HP) diet (protein energy ratio was 30%) or a standard-protein (SP) diet (protein energy ratio was 15%) was provided to eligible subjects for 12 weeks (84 days). Energy intake was calculated by Katch-McArdle formula:basal metabolic rate=370+21.6 × lean body mass (kg) and coefficient of variation. All the subjects were followed up at day 0,week 4,week 8,and week12. The changes of triglyceride (TG), total cholesterin (TC), low density lipoprotein (LDL), uric acid (UA), blood urine nitrogen (BUN) and creatinine (Cre) were determined at day 0, week 4, and week 12. Results Ninety-four subjects with HP (n=49) or SP (n=45) were enrolled, and seven subjects were withdrawn for refusing the following visit. The average age was (42.68±8.98) years in HP group, and (41.09±9.67) years in SP group (P>0.05). At week 12, the BMI drop was significant in both groups from baseline, but with no significant difference between the two groups. The decreases of TG (mmol/L) at 4 weeks and 12 weeks were significant compared with the baseline (0 d, 4weeks, 12 weeks:HP:2.18±1.18, 1.77±0.82, 1.86±0.83;SP:2.60±2.67, 2.03±1.28, 1.92±0.79) (P<0.05),but with no significant difference between the two groups. Compared with the baseline, the decrease of UA (mmol/L) at 4 weeks in HP group was significant (0 d, 4 weeks, 12 weeks:HP:326.12± 88.31, 294.76 ± 106.57,307.15 ± 94.70;SP:325.62 ± 87.16,321.51 ± 101.19,315.71 ± 86.77) (P<0.05). The BUN and CRE in both groups increased slightly compared to baseline level, but remained in the normal range. Conclusion Comparison of HP and SP groups showed that renal function did not change significantly, the levels of UA in HP group decreased significantly than that in SP group.

Effect of postnatal high protein feeding on cognitive abilities in premature rats / 中华实用儿科临床杂志

Objective To study the influence of postnatal high protein feeding on learning and memory abilities of preterm rats.Methods After weaning,the SD offspring were divided into 6 groups randomly according random digits table:preterm standard protein group (group A),term standard protein group (group B),preterm low protein group (group C),term low protein group (group D),preterm high protein group (group E),and term high protein group (group F),with 34 rats in each group.Starting from 22 days of age,the standard protein group,low-protein group and the high-protein group were respectively fed with a standard protein diet (containing 18％ protein),low-protein diet (containing 8％ protein) and a high-protein diet (containing 30％ protein) until the end of experiment.Within each group,the rats were respectively tested in 6 weeks and 8 weeks.Morris water maze task was performed to assess the learning and memory abilities of the premature rats.Results 1.Directional navigation experiments:(1) At the age of 6 weeks,the escape latencies to find the platform were shortened with increased training times for full-term rats.The escape latencies of the premature rats did not change significantly on the third and fourth day of the experiment.(2) At the age of 8 weeks,the escape latencies to find the platform were shortened with increased training time for all of the rats.2.Probe trial test:(1)At the age of 6 weeks,premature rats spent significantly less time in target quadrant than full-time rats.And the percent age of traveled distance in target quadrant of premature rats was significantly less than full term rats (P ＜ 0.05).(2) At the age of 8 weeks,group E [(68.48 ± 20.65) s] spent significantly greater time in target quadrant than group A and group C [group A(52.41 ± 11.24) s,group C (49.54 ± 11.04) s].And the percent age of traveled distance in target quadrant of group E [(36.56 ± 10.44) ％] were significantly higher than group A and group C [group A (29.83 ± 8.33) ％,group C (26.97 ± 5.41) ％] (P ＜ 0.05).(3) At the age of 8 weeks,group E spent time in target quadrant and the percent of traveled distance in target quadrant [(68.48 ± 20.65) s,(36.56 ±10.44)％] were higher than group F [(61.29 ± 16.27) s,(35.71 ±6.61)％],but there was no significant difference (P ＞ 0.05).Conclusions In the early growth and development process of the brain,premature birth may seriously affect early brain functions in rats,and the learning and cognitive abilities of the premature rats are worse than full-term rats.In the subsequent process of growth and development,after a long time of high protein nutritional intake,the learning and cognitive abilities of the premature rats can be restored and they can catch up with full-term rats.

Change of dietary intake before and after hematopoietic stem cell transplantation in pediatric patients / 中华临床营养杂志

Objective To explore the change of dietary intake and nutritional status before and after hematopoietic stem cell transplantation (HSCT) in pediatric patients to assess the importance of nutritional interventions.Methods In this observational cohort study,65 children undergoing HSCT between January 2012 and November 2012 in the Department of Hematology and Oncology,Shanghai Children's Medical Center were enrolled.The data collected before preconditioning were considered as the baseline data.We also collected data twice a week between preconditioning and 30 days after HSCT,and once a week from 30 days to 100 days after HSCT.Dietary analysis and urea nitrogen analysis were conducted in parallel.Results The baseline level of energy intake was (5 844.9 ±2 490.4) kJ/d,protein intake was (56.4 ±28.6) g/d,fat intake was (49.7 ±38.9) g/d,and carbohydrate intake was (190.9 ± 91.1) g/d.With the hematopoietic reconstruction,the oral nutrients intake significantly decreased compared with the baseline levels (all P =0.000).During the recovery period after HSCT,the energy intake showed no significant difference when compared with the baseline level in the 6th postoperative week,protein in the 13th week,carbohydrate in the 4th week,and fat in the 6th week.The urine nitrogen was (3.9 ± 2.4) g/d before HSCT,which increased to (16.7 ± 11.0) g/d after preconditioning (P=0.000).In the 1st postoperative week,the weight (P =0.000),triceps skin fold thickness (P =0.003),mid-upper arm circumference (P =0.000),serum albumin (P =0.000) and prealbumin (P =0.000) of the patients all significantly decreased compared with the baseline levels.In the 9th postoperative week,the fat-free body weight percentage (P =0.010),muscle percentage (P =0.001) and protein percentage (P =0.000) were significantly lower than the baseline levels,while the body fat percentage was higher than the baseline level (P =0.002).Conclusions Children undergoing HSCT exhibit a marked reduction in nutrient intakes at the early stage of HSCT,which may gradually return normal during the recovery period.This process may be slow,especially for the protein,and therefore may affect the serum protein level in these pediatric patients.Thus,more careful nutrition guidance is necessary during HSCT for pediatric patients,emphasizing oral nutrients intakes,and high protein dietary or formula may be helpful.

Protein intake and the use of levodopa in patients with Parkinson's disease / Ingesta de proteínas y el uso de la levodopa en pacientes con enfermedad de Parkinson

Levodopa is the principal pharmacological treatment for Parkinson's disease (PD); however the protein content in diet may compromise its effectiveness. The aim of this study was to investigate the relationship of protein intake and the use of levodopa in ambulatory patients with PD. Thirty four PD patients were assessed for protein intake, evaluating the relation energy-protein intake by means of a register. An intake of 1762 kcal/day, 70.9 g of protein/day equivalent to 16.6% of the total energy intake as protein at a level of 1.1 g/kg bw/day. Of all patients, 47.1% took their medications with meals. We conclude that the studied patients consume more protein in their diet than those recommended for PD, with half the sample taking the medications with meals, which may affect the treatment.

La levodopa es el principal tratamiento farmacológico para la enfermedad de Parkinson, sin embargo, la proteína de la dieta puede comprometer su eficacia. El objetivo de este estudio fue investigar la ingesta de proteínas y el uso de la levodopa en pacientes con enfermedad de Parkinson tratados en régimen ambulatorio, 34 pacientes fueron evaluados. Evaluación de la ingesta de alimentos por los registros, tomas de 1762 kcal/día, 70.9 g/día, el 16,6% del total de energía y 1.1 g/kg/dia de energía y proteína, respectivamente, y que la ingesta de proteínas durante el día era 70,4% del total de proteínas diario. Todos los pacientes estaban tomando levodopa y 47,1% consumían sus medicamentos con las comidas. Se concluyó que, según las recomendaciones para la enfermedad de Parkinson, los pacientes estudiados consumían una dieta rica en proteínas y con una mayor concentración de este nutriente durante el día. Aproximadamente la mitad de la muestra ingiere los medicamentos con la comida, costumbre que puede afectar el tratamiento farmacológico de la enfermedad.

Effects of normal caloric high-protein diet on metabolic parameters and gastrointestinal hormones in patients with obesity or type 2 diabetes mellitus / 中华临床营养杂志

Objective To investigate the effects of normal caloric high-protein diet on metabolic parameters and gastrointestinal hormones in patients with obesity or type 2 diabetes mellitus (T2DM).Methods Totally 30 obese subjects (OB group) and 40 obese patients with type 2 diabetes mellitus (T2DM group) received normal caloric high-protein diet for 24 weeks.Then body weight,fat mass,and metabolic parameters were assessed.The serum ghrelin and glucagon-like peptide-1 (GLP-1) levels were also measured at 0 and 2 h after an oral 100 g of steamed bread meal test.Results After 24 weeks,body weight [(78.23 ± 7.51) kg vs (80.83±8.13) kg,P=0.016; (80.45±7.48) kg vs (83.26±9.35) kg,P=0.011],body mass index [(31.03 ±2.72) kg/m2 vs (32.01 ±2.95) kg/m2,P=0.033; (32.63 ±2.81) kg/m2 vs (33.86±3.03) kg/m2,P =0.043],waist circumference [(93.65 ± 6.23) cm vs (97.30 ± 7.81) cm,P =0.041 ;(97.02±7.43) cm vs (101.87 ±9.87) cm,P =0.034],fat mass [(30.42 ±6.18) kg vs (32.47 ±5.91) kg,P=0.022; (34.23 ±7.03) kg vs (36.64 ±6.83) kg,P =0.032],fasting serum insulin [(10.81±3.69) mmol/Lvs (13.58±4.86) mmol/L,P=0.012; (9.58±3.51) mmol/Lvs (10.82±4.28) mmol/L,P =0.015],HOMA-insulin resistance index [(2.42 ± 0.83) vs (3.16 ± 1.21),P =0.019; (3.15±0.74) vs (4.13±0.67),P=0.024] and triglycerides [(1.24±0.32) mmol/Lvs (1.49±0.52) mmol/L,P=0.046; (1.86±1.05) mmol/L vs (2.46±1.85) mmol/L,P=0.034] were significantly decreased in OB and T2DM groups,respectively,compared with 0 week.Fasting blood glucose (FBG)and glycosylated hemoglobin were also significantly declined in T2DM group [FBG:(6.73 ± 1.25) mmol/Lv s (8.63 ±2.81)) mmol/L,P=0.010; HbA1c (6.44 ±0.47) vs (7.38 ±0.33),P=0.031].The serum ghrelin and GLP-1 both increased at 0h and 2 h after meal test in OB and T2DM groups [fasting serum ghrelin:(4.98 ±0.89) μg/L vs (3.95 ±0.98) μg/L,P=0.021; (4.23 ± 1.67) μg/L vs (3.15 ± 1.01) μgL,P=0.025; 2 h postprandial serum ghrelin:(2.98 ±0.96) μg/L vs (2.56 ±0.83) μg/L,P =0.046; (2.83 ± 1.03) μg/L vs (1.95 ±0.92) μg/L,P =0.033; fasting serum GLP-1:(6.06 ±0.63) μg/L vs (5.13±0.59) μg/L,P=0.041; (5.23±0.71) μg/Lv s (4.49±0.53) μg/L,P=0.039; 2 h postprandialserum GLP-1:(10.01±1.01) μg/L vs (7.68±0.94) μg/L,P=0.007; (8.87±0.94) μg/Lvs (6.59 ± 0.87) μg/L,P =0.013].Conclusions Normal caloric high-protein diet can reduce body weight and serum glucose.Those effects may be due to the increase in secretion of GLP-1.

The Combination of a High-protein Formula Diet and Polyglucosamine Decreases Body Weight and Parameters of Glucose and Lipid Metabolism in Overweight and Obese Men and Women.

Aims: To examine the efficacy of a weight loss strategy using a high-protein formula diet in combination with a lipid adsorbing fibre, polyglucosamine, over 12 weeks. Study Design: Randomised, double-blind, placebo-controlled, parallel group study. Place and Duration of Study: Institute of Food Science, Unit of Nutrition Physiology and Human Nutrition, Leibniz University of Hannover, Germany, between February 2010 and July 2010. Methodology: 120 overweight and obese subjects participated in this study and ingested a protein-rich formula diet as a meal replacement once daily. Half of the participants (n = 60) additionally took two lipid-adsorbent tablets (F+LA), polyglucosamine, once daily, while the other half (n = 60) received two placebo tablets (F+P). Measurements were taken at weeks 0, 6 and 12 to determine the response to intervention. Results: Both groups achieved a highly significant (P < 0.001) weight loss (F+LA: -5.5 ± 3.8 kg vs. F+P: -4.7 ± 3.9 kg, Full Analysis Set (FAS) population). There was a significant decrease in HbA1c (P < 0.01), total cholesterol (P < 0.001), LDL cholesterol (P = 0.002), and triacylglycerol (P = 0.001) in the F+LA group, while the F+P group experienced no changes. Conclusion: The investigation demonstrated that a formula diet alone or combined with polyglucosamine were both effective in weight reduction. The additional administration of polyglucosamine was more effective on the reduction of glucose and lipid parameters than the formula diet alone.