Anesthesia for muscle biopsy to test susceptibility to malignant hyperthermia / Anestesia durante biópsia muscular para teste de suscetibilidade à hipertermia maligna

Abstract Introduction Malignant hyperthermia is an autosomal dominant pharmacogenetic disorder, characterized by hypermetabolic crisis triggered by halogenated anesthetics and/or succinylcholine. The standard method for diagnosing malignant hyperthermia susceptibility is the in vitro muscle contracture test in response to halothane-caffeine, which requires muscle biopsy under anesthesia. We describe a series of anesthetic procedures without triggering agents in malignant hyperthermia, comparing peripheral nerve block and subarachnoid anesthesia. Method We assessed the anesthetic record charts of 69 patients suspected of malignant hyperthermia susceptibility who underwent muscle biopsy for in vitro muscle contracture in the period of 7 years. Demographic data, indication for malignant hyperthermia investigation, in vitro muscle contracture test results, and surgery/anesthesia/recovery data were analyzed. Results Sample with 34 ± 13.7 years, 60.9% women, 65.2% of in vitro muscle contracture test positive. Techniques used: peripheral nerve blocks — lateral femoral and femoral cutaneous, latency 65 ± 41 min — (47.8%); subarachnoid anesthesia (49.3%), and total venous anesthesia (1.4%). There was 39.4% failure of peripheral nerve block and 11.8% of subarachnoid anesthesia. Adverse events (8.7%) occurred only with subarachnoid blockade (bradycardia, nausea, and transient neurological syndrome). All patients remained in the post-anesthesia care unit until discharge. Age and weight were significantly higher in patients with blockade failure (ROC cut-off point of 23.5 years and 59.5 kg) and blockade failure was more frequent in the presence of increased idiopathic creatine kinase. Conclusion Anesthesia with non-triggering agents has been shown to be safe in patients with malignant hyperthermia susceptibility. Variables such as age, weight, and history of increased idiopathic creatine kinase may be useful in selecting the anesthetic technique for this group of patients.

Resumo Introdução Hipertermia maligna é uma doença farmacogenética autossômica dominante, caracterizada por crise hipermetabólica desencadeada por anestésicos halogenados e/ou succinilcolina. O padrão para diagnóstico da suscetibilidade à hipertermia maligna é o teste de contratura muscular in vitro em resposta ao halotano-cafeína, para o qual é necessária biopsia muscular sob anestesia. Descrevemos uma série de anestesias sem agentes desencadeantes na hipertermia maligna e comparamos bloqueios de nervo periférico e anestesias subaracnóideas. Método Foram analisados os prontuários/fichas anestésicas de 69 pacientes suspeitos de susceptibilidade à hipertermia maligna, submetidos à biópsia muscular para teste de contratura muscular in vitro durante sete anos. Analisamos dados demográficos, indicação para investigação de hipertermia maligna, resultado do teste de contratura muscular in vitro e dados da cirurgia/anestesia/recuperação. Resultados Amostra com 34 ± 13,7 anos, 60,9% mulheres, 65,2% de teste de contratura muscular in vitro positivos. Técnicas empregadas: 47,8% bloqueios de nervo periférico (femoral e cutâneo femoral lateral, latência 65 ± 41 minutos), 49,3% anestesias subaracnóideas e 1,4% anestesia venosa total. Falha em 39,4% dos bloqueios de nervo periférico e 11,8% das anestesias subaracnóideas. Eventos adversos (8,7%) como bradicardia, náuseas e síndrome neurológica transitória só ocorreram com bloqueio subaracnóideo. Todos os pacientes permaneceram na sala de recuperação pós-anestésica até liberação. Idade e peso foram significativamente maiores nos pacientes com falha no bloqueio (ponto de corte da curva ROC de 23,5 anos e 59,5 Kg) e esta foi mais frequente na presença de aumento idiopático de creatinoquinase. Conclusão Anestesia com agentes não desencadeantes mostrou-se segura em pacientes suscetíveis à hipertermia maligna. Variáveis como idade, peso e antecedente de aumento idiopático de creatinoquinase podem ser úteis para selecionar a técnica anestésica nesse grupo.

Prevalencia del consumo de estimulantes por parte de estudiantes universitarios y factores asociados / Prevalence of stimulant use among university students and associated factors / Prevalência de uso de estimulantes por estudantes universitários e fatores associados

RESUMEN Objetivo Identificar la prevalencia de consumo de sustancias estimulantes en la población estudiantil de la Universidad Latina de Costa Rica, sede San Pedro, y algunos factores asociados a estos hábitos. Materiales y Métodos La investigación es un estudio transversal de tipo observacional y analítico en la Universidad Latina de Costa Rica Sede San Pedro. Donde se utilizó como instrumento de recolección de información encuestas dirigidas a estudiantes de las diferentes carreras universitarias. El análisis estadístico se realizó con el software SPSS 19. Resultados La edad promedio de los estudiantes universitarios es de 20,6 años y las sustancias estimulantes de mayor consumo por parte de estos son las bebidas gaseosas y el café. Existe una diferencia significativa entre el consumo productos que contienen nicotina entre hombre y mujeres. Más del 50% de la población universitaria encuestada pertenece a carreras del área de ciencias de la salud. Conclusiones El sexo, el estado civil, el estado laboral, el nivel académico, la facultad en la que se estudia y la provincia de residencia, no son factores que influyan de en el consumo de sustancias estimulantes dentro de la población universitaria de la Universidad Latina de Costa Rica, siendo la única excepción el consumo de nicotina y su relación con el sexo del sujeto.

ABSTRACT Objective To identify the prevalence of stimulant use among the student population at the Universidad Latina de Costa Rica, San Pedro Campus, and some factors associated with these habits. Materials and Methods This is an analytical observational cross-sectional study conducted at the Universidad Latina de Costa Rica, San Pedro Campus. Surveys aimed at students of the different university careers were used as an instrument to collect information. The statistical analysis was carried out with SPSS 19 software. Results The average age of university students was 20.6 years, and the most commonly used stimulants were soft drinks and coffee. There is a significant difference among men and women regarding the consumption of nicotine-containing products. More than 50% of the university population surveyed was enrolled in Health Sciences programs. Conclusions Sex, marital status, work status, academic level, the faculty in which the students are enrolled, and the province of residence are not factors that influence the use of stimulants by the university population of the Universidad Latina de Costa Rica. The only exception was nicotine consumption and its relationship to the sex of the individual.

RESUMO: Objetivo Identificar a prevalência do consumo de substâncias estimulantes na população estudantil da Universidade Latina da Costa Rica, campus de San Pedro, e alguns fatores associados a esses hábitos. Materiais e métodos A pesquisa é um estudo transversal observacional e analítico da Universidade Latina da Costa Rica, campus de San Pedro. Onde pesquisas destinadas a estudantes de diferentes carreiras universitárias foram usadas como um instrumento para coletar informações. A análise estatística foi realizada com o software SPSS 19. Resultados A idade média dos estudantes universitários é de 20,6 anos e as substâncias estimulantes mais consumidas por eles são refrigerantes e café. Existe uma diferença significativa entre o consumo de produtos que contêm nicotina entre homens e mulheres. Mais de 50% da população universitária pesquisada pertence a carreiras na área das ciências da saúde. Conclusões Sexo, estado civil, emprego, nível acadêmico, escola em que é estudado e província de residência não são fatores que influenciam o consumo de substâncias estimulantes na população universitária da Universidade Latina de Costa Rica, a única exceção é o consumo de nicotina e sua relação com o sexo do sujeito.(AU)

Profile of malignant hyperthermia susceptibility reports confirmed with muscular contracture test in Brazil / Perfil dos relatos de suscetibilidade à hipertermia maligna confirmados com teste de contratura muscular no Brasil

Abstract Background and objectives: Malignant hyperthermia is an autosomal dominant hypermetabolic pharmacogenetic syndrome, with a mortality rate of 10%-20%, which is triggered by the use of halogenated inhaled anesthetics or muscle relaxant succinylcholine. The gold standard for suspected susceptibility to malignant hyperthermia is the in vitro muscle contracture test in response to halothane and caffeine. The determination of susceptibility in suspected families allows the planning of safe anesthesia without triggering agents for patients with known susceptibility to malignant hyperthermia by positive in vitro muscle contracture test. Moreover, the patient whose suspicion of malignant hyperthermia was excluded by the in vitro negative muscle contracture test may undergo standard anesthesia. Susceptibility to malignant hyperthermia has a variable manifestation ranging from an asymptomatic subject presenting a crisis of malignant hyperthermia during anesthesia with triggering agents to a patient with atrophy and muscle weakness due to central core myopathy. The aim of this study is to analyze the profile of reports of susceptibility to malignant hyperthermia confirmed with in vitro muscle contracture test. Method: Analysis of the medical records of patients with personal/family suspicion of malignant hyperthermia investigated with in vitro muscle contracture test, after given written informed consent, between 1997 and 2010. Results: Of the 50 events that motivated the suspicion of malignant hyperthermia and family investigation (sample aged 27 ± 18 years, 52% men, 76% white), 64% were investigated for an anesthetic malignant hyperthermia crisis, with mortality rate of 25%. The most common signs of a malignant hyperthermia crisis were hyperthermia, tachycardia, and muscle stiffness. Susceptibility to malignant hyperthermia was confirmed in 79.4% of the 92 relatives investigated with the in vitro muscle contracture test. Conclusion: The crises of malignant hyperthermia resembled those described in other countries, but with frequency lower than that estimated in the country.

Resumo Justificativa e objetivo: Hipertermia maligna é uma síndrome farmacogenética hipermetabólica, autossômica dominante, com mortalidade entre 10%-20%, desencadeada por uso de anestésico inalatório halogenado ou relaxante muscular succinilcolina. O padrão-ouro para pesquisa de suscetibilidade à hipertermia maligna é o teste de contratura muscular in vitro em resposta ao halotano e à cafeína. A determinação da suscetibilidade nas famílias suspeitas permite planejar anestesias seguras sem agentes desencadeantes para os pacientes confirmados como suscetíveis à hipertermia maligna pelo teste de contratura muscular in vitro positivo. Além disso, o paciente no qual a suspeita de hipertermia maligna foi excluída pelo teste de contratura muscular in vitro negativo pode ser anestesiado de forma convencional. Suscetibilidade à hipertermia maligna tem manifestação variável, desde indivíduo assintomático que apresenta crise de hipertermia maligna durante anestesia com agentes desencadeantes, até paciente com atrofia e fraqueza muscular por miopatia central core disease. O objetivo deste trabalho é analisar o perfil dos relatos de suscetibilidade à hipertermia maligna confirmados com teste de contratura muscular in vitro. Método: Análise das fichas de notificação dos pacientes com suspeita pessoal/familiar de hipertermia maligna investigados com teste de contratura muscular in vitro, após assinatura do termo de consentimento, entre 1997-2010. Resultados: Dos 50 eventos que motivaram a suspeita de hipertermia maligna e a investigação familiar (amostra com 27 ± 18 anos, 52% homens, 76% brancos), 64% foram investigados por crise de hipertermia maligna anestésica, com mortalidade de 25%. Sinais mais comuns da crise de hipertermia maligna foram hipertermia, taquicardia e rigidez muscular. Suscetibilidade à hipertermia maligna foi confirmada em 79,4% dos 92 parentes investigados com teste de contratura muscular in vitro. Conclusão: Crises de hipertermia maligna assemelharam-se às descritas em outros países, porém com frequência inferior à estimada no país.

Does caffeine ingestion before a short-term sprint interval training promote body fat loss?

We investigated the effect of caffeine ingestion combined with a 2-wk sprint interval training (SIT) on training-induced reductions in body adiposity. Twenty physically-active men ingested either 5 mg/kg of cellulose as a placebo (PLA, n=10) or 5 mg/kg of caffeine (CAF, n=10) 60 min before each SIT session (13×30 s sprint/15 s of rest). Body mass and skinfold thickness were measured pre- and post-training. Energy expenditure was measured at rest, during exercise, and 45 min after exercise in the first SIT session. Body fat was similar between PLA and CAF groups at pre-training (P>0.05). However, there was a significant decrease in body fat after training in the CAF group (−5.9±4.2%, P<0.05) but not in PLA (1.5±8.0%, P>0.05). There was no difference in energy expenditure at rest and during exercise between PLA and CAF groups (P>0.05), but the post-exercise energy expenditure was 18.3±21.4% greater in the CAF than in the PLA group (P<0.05). In conclusion, caffeine ingestion before SIT sessions induced a body fat loss that may be associated with higher post-exercise energy expenditure.

Association between caffeine consumption in pregnancy and low birth weight and preterm birth in the birth cohort of Ribeirão Preto / Associação entre consumo de cafeína durante a gestação com baixo peso ao nascer e nascimento pré-termo na coorte de Ribeirão Preto

Abstract Objective To describe caffeine consumption during pregnancy and its association with low birth weight (LBW) and preterm birth in the birth cohort of Ribeirão Preto, state of São Paulo, Brazil, in 2010. Methods Cohort study, with descriptive and analytical approach. Data included 7,607 women and their newborns in Ribeirão Preto, state of São Paulo, Brazil. The women answered standardized questionnaires about reproductive health, prenatal care, life habits, sociodemographic conditions, and information about coffee intake. The independent variable was high caffeine consumption (≥300 mg/day) from coffee during pregnancy, and the dependent variables were LBW (birth weight < 2,500 g) and preterm birth (< 37 weeks of gestational age). Four adjusted polytomous logistic regression models, relative risk (RR) and 95% confidence interval (CI) were fitted: biological and sociodemographic conditions; obstetric history; current gestational conditions; and all variables included in the previous models. Results A total of 4,908 (64.5%) mothers consumed caffeine, 143 (2.9%) of whom reported high consumption. High caffeine intake was significantly associated with reduced education and with the occupation of the head of the family, nonwhite skin color, not having a partner, higher parity, previous abortion and preterm birth, urinary tract infection, threatened abortion, alcohol consumption and smoking. No association was found between high caffeine consumption and LBW or preterm birth in both Conclusion In this cohort, high caffeine intake was lower than in other studies and no association with LBW or preterm birth was found.

Resumo Objetivo Descrever a associação entre consumo de cafeína durante a gestação com baixo peso ao nascer (BPN) e nascimento pré-termo (PT) na coorte de Ribeirão Preto, estado de São Paulo, Brasil, em 2010. Métodos Estudo de coorte, com abordagem descritiva e analítica. Foram incluídas 7.607 mulheres e seus recém-nascidos em Ribeirão Preto, São Paulo, Brasil. As mulheres responderam a questionários padronizados sobre saúde reprodutiva, cuidados pré-natais, hábitos de vida, condições sociodemográficas e consumo de cafeína. A variável independente foi alto consumo de cafeína (≥300 mg/dia) durante a gestação e as dependentes foram BPN (peso < 2.500 g) e nascimento PT (< 37 semanas de gestação). Foram calculados riscos relativos (RRs) e intervalos de confiança (ICs) de 95% em quatro modelos de regressão logística: condições biológicas e sociodemográficas; história obstétrica; condições da gestação atual; e todas as variáveis incluídas nos modelos anteriores. Resultados Um total de 4.908 (64,5%) mães consumiram cafeína, e destas, 143 (2,9%) relataram alto consumo. Alto consumo de cafeína esteve associado com menor escolaridade materna, ocupação do chefe da família, cor de pele não branca, mulheres sem companheiro, maior paridade, aborto e nascimento PT anterior, infecção do trato urinário, ameaça de aborto, consumo de álcool e tabagismo. Não foi encontrada associação entre alto consumo de cafeína e BPN ou nascimento PT nas análises não ajustada (RR = 1,45; IC 95%: 0,91-2,32; e RR = 1,16; IC 95%: 0,77-1,75, respectivamente) e ajustada (RR = 1,42; IC 95%: 0,85-2,38; e RR = 1,03; IC 95%: 0,65-1,63, respectivamente). Conclusão Nessa coorte, o alto consumo de cafeína foimenor que emoutros estudos e não foi encontrada associação com BPN ou nascimento PT.

Effect of caffeine on vestibular evoked myogenic potential: a systematic review with meta-analysis / Efeito da cafeína no potencial evocado miogênico vestibular: uma revisão sistemática com metanálise

Abstract Introduction: Caffeine can be considered the most consumed drug by adults worldwide, and can be found in several foods, such as chocolate, coffee, tea, soda and others. Overall, caffeine in moderate doses, results in increased physical and intellectual productivity, increases the capacity of concentration and reduces the time of reaction to sensory stimuli. On the other hand, high doses can cause noticeable signs of mental confusion and error induction in intellectual tasks, anxiety, restlessness, muscle tremors, tachycardia, labyrinthine changes, and tinnitus. Objective: Considering that the vestibular evoked myogenic potential is a clinical test that evaluates the muscular response of high intensity auditory stimulation, the present systematic review aimed to analyze the effects of caffeine on vestibular evoked myogenic potential. Methods: This study consisted of the search of the following databases: MEDLINE, CENTRAL, ScienceDirect, Scopus, Web of Science, LILACS, SciELO and ClinicalTrials.gov. Additionally, the gray literature was also searched. The search strategy included terms related to intervention (caffeine or coffee consumption) and the primary outcome (vestibular evoked myogenic potential). Results: Based on the 253 potentially relevant articles identified through the database search, only two full-text publications were retrieved for further evaluation, which were maintained for qualitative analysis. Conclusion: Analyzing the articles found, caffeine has no effect on vestibular evoked myogenic potential in normal individuals.

Resumo Introdução: A cafeína pode ser considerada a droga mais consumida por adultos em nível mundial, podendo ser encontrada em inúmeros alimentos, como no chocolate, café, chá, refrigerante e outros. Em geral, a cafeína em doses moderadas, produz ótimos rendimentos físico e intelectual, aumenta a capacidade de concentração e diminui o tempo de reação aos estímulos sensoriais. Por outro lado, doses elevadas podem causar sinais perceptíveis de confusão mental e indução de erros em tarefas intelectuais, ansiedade, nervosismo, tremores musculares, taquicardia, alterações labirínticas e zumbido. Objetivo: Considerando que o potencial evocado miogênico vestibular é um teste clínico que avalia a resposta muscular decorrente de estimulação auditiva de alta intensidade, a presente revisão sistemática objetivou analisar o efeito da cafeína sobre o potencial evocado miogênico vestibular. Método: A formulação deste trabalho consistiu na busca dos estudos nas seguintes bases de dados: MEDLINE, CENTRAL, ScienceDirect, Scopus, Web of Science, LILACS, SciELO e Clinical-Trials.gov. Adicionalmente, a literatura cinzenta também foi pesquisada. A estratégia de busca incluiu termos relacionados à intervenção (consumo de cafeína ou café) e ao desfecho primário (potencial evocado miogênico vestibular). Resultados: A partir de 253 registros potencialmente relevantes identificados através da busca nas bases de dados, apenas duas publicações em texto completo foram recuperadas para avaliação mais aprofundada, sendo estas mantidas para a análise qualitativa. Conclusão: Diante dos artigos encontrados a cafeína não tem efeito sobre o potencial evocado miogênico vestibular em sujeitos normais.

Dural sinus thrombosis following epidural analgesia for delivery: a clinical case / Trombose de seios durais após analgesia peridural para parto: caso clínico

Abstract Background and objectives: Neurological complications of spinal anesthesia are rare conditions. Headache caused by low pressure of the cerebrospinal fluid is one of the most frequent, which occurs after post-dural puncture. A comprehensive history and physical exam must be carried out before making the diagnosis of Post-Dural Puncture Headache (PDPH) and additional tests are necessary to exclude the possibility of developing serious neurological complications such as Dural Sinus Thrombosis (DST). According to the Case Report a differential diagnosis between Dural Sinus Thrombosis with PDPH is discussed. Case report: A 22 year-old lady, ASA Physical Status Class I was admitted at 39 weeks of gestation for delivery. For labor pain relief she requested epidural for analgesia, but unfortunately accidental dural puncture occurred. She developed an occipital headache and neck pain in the second day postpartum which was relieved by both lying down and supporting treatment such as rehydration, analgesics and caffeine. On day third postpartum she was discharged without complaints. On day fifth postpartum the pain returned and became more intense and less responsive to oral analgesics. She was admitted to the hospital to do a complete neurological and image investigation that showed a lesion consistent with the diagnosis of cortical vein thrombosis and Dural Sinus Thrombosis (DST). She was treated with oral anticoagulants. After two days, a repeated magnetic resonance image (MRI) showed partial canalization of the central sinus thrombus. The patient was discharged from hospital five days after her admission without any of the initial symptoms. Conclusion: The report describes a patient who developed severe headache following continuous epidural analgesia for delivery. Initially it was diagnosed as PDPH, however with the aid of MRI the diagnosis of DST was later established and treated. DST is a rare condition and is often underdiagnosed. Because of its potentially lethal complications, it should always be considered in acute headache differential diagnosis.

Resumo Justificativa e objetivos: As complicações neurológicas da raquianestesia são condições raras. A cefaleia causada pela baixa pressão do fluido cerebrospinal é uma das mais frequentes e ocorre após a punção dural. Anamnese completa e exame físico geral devem ser feitos antes de fazer o diagnóstico de cefaleia pós-punção dural (CPPD) e testes adicionais são necessários para excluir a possibilidade de complicações neurológicas graves, como trombose de seios durais (TSD). De acordo com o relato do caso, discutiremos o diagnóstico diferencial entre TSD e CPPD. Relato de caso: Paciente de 22 anos, estado físico ASA I, foi admitida com 39 semanas de gestação para o parto. Para alívio da dor do trabalho de parto, a paciente solicitou analgesia peridural, mas infelizmente ocorreu uma punção dural acidental. A paciente desenvolveu cefaleia occipital e dor cervical no segundo dia pós-parto - ambas aliviadas com repouso e terapia de suporte, como reidratação, analgésicos e cafeína. No terceiro dia pós-parto, a paciente recebeu alta sem queixas. No quinto dia pós-parto, a dor retornou e ficou mais intensa e com pouca resposta aos analgésicos orais. Ela foi admitida no hospital para uma completa investigação neurológica e de imagem que mostrou uma lesão compatível com o diagnóstico de trombose venosa cortical e TSD. A paciente foi tratada com anticoagulantes orais. Após dois dias, a repetição de ressonância nuclear magnética (RM) mostrou canalização parcial de trombo do seio central. A paciente recebeu alta hospitalar cinco dias após a admissão, sem quaisquer dos sintomas iniciais. Conclusão: O caso descreve uma paciente que desenvolveu cefaleia grave após epidural contínua para o parto. Inicialmente ela foi diagnosticada como CPPD, contudo com o auxílio da RNM foi estabelecido o diagnóstico tardio de TSD. TSD é uma condição rara e frequentemente subdiagnosticada. Ela deve sempre ser considerada como diagnóstico diferencial de cefaleia aguda em decorrência de suas complicações potencialmente letais.

Consumo excesivo de cafeína y eventuales poblaciones de riesgo / Excessive caffeine consumption and eventual risk populations

La cafeína (1,3,7-trimetilxantina), es uno de los componentes alimentarios más consumidos y estudiados. Aunque un consumo moderado no implica riesgos para la salud, un ingesta excesiva puede conducir a efectos adversos, tales como ansiedad, irritabilidad, palpitaciones e insomnio. Con el propósito de caracterizar el riesgo para la salud en mujeres adultas de 18 a 70 años en Argentina, se abordaron los siguientes objetivos: determinar el contenido de cafeína en cinco bebidas disponibles en el mercado argentino y con estos datos y otros de fuentes bibliográficas estimar la ingesta media diaria de esta sustancia en dicha población para establecer si existen grupos en riesgo, estudiar la relación de dicha ingesta con el lugar de residencia y determinar el aporte de cada bebida y alimento a la ingesta diaria total. La determinación de cafeína se realizó por cromatografía líquida de alta resolución (HPLC). A través de un cuestionario distribuido en la web, se obtuvieron datos de consumo de cafeína de 1947 mujeres que cumplieron el criterio de inclusión. Se encontraron contenidos más altos de cafeína en café expreso (1300 mg/L) y mate cebado (950 mg/L). En el total de la muestra el consumo promedio de cafeína fue de 340 mg/día (5,5 mg/kg/día), excediendo, el 31% de las participantes la ingesta recomendada de 400 mg/día. De las mujeres en edad fértil, el 37% excedió la ingesta de 300 mg/día y el 52% la de 200 mg/día, recomendadas durante la gestación y la lactancia. En el percentil 90 estas mujeres consumieron 851 mg/día y 775 mg/día de cafeína, respectivamente. El mate cebado y el café resultaron los mayores contribuyentes a la ingesta diaria de cafeína en este grupo de mujeres y en la muestra total. Se encontraron diferencias regiona­les en el consumo del mate cebado, resultando Misiones y Corrientes las provincias de mayores ingestas. Si bien el 68% de las personas entrevistadas consumieron dosis moderadas de cafeína, más de un cuarto de las mujeres en edad reproductiva excedió las ingestas recomendadas para el embarazo y la lactancia.

Caffeine (1,3,7-trimethylxanthine) is one of the most consumed and studied food ingredients. Although moderate consumption does not imply health risks, excess intake may lead to adverse effects, such as anxiety, irritability, palpitations and insomnia. In order to characterize the health risk in adult women aged 18 to 70 in Argentina, the following objectives were ad­dressed: to determine the caffeine content in five beverages available in the Argentine market and with these data and others from bibliographic sources estimate the daily intake of caffeine in this population to establish if there are groups at risk; to study the relation of this intake with the place of residence and to determine the contribution of each beverage and food to the total daily intake. The determination of caffeine was performed by high performance liquid chromatography (HPLC). Through a questionnaire distributed on the web, caffeine consumption data were obtained from 1947 women who met the inclusion criteria. Higher caf­feine contents were found in espresso coffee (1300 mg/L) and mate "cebado" (950 mg/L). In the sample, mean caffeine intake was 340 mg/day (5.5 mg/kg/day), with 31% of the participants exceeding the recommended intake of 400 mg/day. Of the women of childbearing age, 37% exceeded the intake of 300 mg/day and 52% the intake of 200 mg/day recommended during gestation and lactation. In the 90th percentile, these women consumed 851 mg/day and 775 mg/day of caffeine, respectively. Mate "cebado" and coffee were the major contributors to daily caffeine intake in this group of women and in the total sample. Regional differences were found in the consumption of mate "cebado", being Misiones and Corrientes the provinces with the highest intakes. Although 68% of the people interviewed consumed moderate doses of caffeine, more than a quarter of the women of reproductive age exceeded the recommended intakes for pregnancy and lactation.

Intake of stimulant foods is associated with development of parasomnias in children / Ingestão de alimentos estimulantes está associada ao desenvolvimento de parassonias em crianças

ABSTRACT Objective To verify if nighttime feeding habits can influence parasomnia in children. Method Seven private and four public Elementary Schools took part in the study. A total of 595 Sleep Disturbance Scale for Children were distributed to the parents of children aged from 7 to 8 years. Data of dietary recall, starting time to school, physical activity, and nutritional status were studied. Results Of the 226 questionnaires completed, 92 (41%) reported parasomnia. Girls had 2.3 times more the chance to parasomnia than boys. Children who consumed stimulant foods had 2.6 times more chance to have parasomnia than those of children who consumed non-stimulant foods. There were no difference between parasomnia and no-parasomnia groups in food type (p = 0.78) or timing of last meal before bedtime (p = 0.50). Conclusion Our findings suggest that intake of stimulant foods is associated with development of parasomnia in children.

RESUMO Objetivo Verificar se hábitos de alimentação noturna influenciam parassonias em crianças. Método Sete escolas privadas e quatro públicas, de Ensino Fundamental, fizeram parte do estudo. Um total de 595 Escalas de Distúrbio do Sono para Crianças foram distribuídas para os pais de crianças entre 7 e 8 anos. Dados de recordatório alimentar, período escolar, atividade física e estado nutricional foram estudados. Resultados Dos 226 questionários preenchidos, 92 (41%) relataram presença de parassonias. Meninas tiveram 2,3 vezes mais chance de parassonias e crianças que consumiram alimentos estimulantes tiveram 2,6 vezes mais chance de parassonias em relação àquelas que consumiram alimentos não estimulantes. Não houve diferença entre os grupos em relação ao tipo de alimento (p = 0,78) ou horário da última refeição antes de ir para a cama (p = 0,50). Conclusão Nossos achados sugerem que a ingestão de alimentos estimulantes está associada com o desenvolvimento de parassonias em crianças.

Caffeine teratogenicity in rats: morphological characterization and hypothesized mechanisms

Caffeine consumption during pregnancy has been shown in the scientific literature to be associated with teratogenicity such as low birth weight, fetal malformations, and miscarriage. However, the morphological alterations of the offspring of dams exposed during pregnancy have not been consistently described, and the mechanisms why they occur remain elusive. Thus, we aimed to characterize the offspring malformations induced by moderate and high doses of caffeine during pregnancy. Dams were divided into three groups: control, moderate (0.3 g/L), and high dose (1.0 g/L) of caffeine, which was provided in the drinking water beginning on gestational day 1 and continuing throughout the entire gestation. At moderate doses, only one of the dams had stillborn pups, although no macroscopic malformations were observed. High doses of caffeine induced significantly more malformations (P<0.001) and early death (before P4). The malformations observed were related to fetal development and cardiovascular alterations, namely bruises, macrocephaly with short limbs, abnormal development (or absence) of head structures and limbs, labial malformations, hydrops fetalis, and poor placental formation. We discussed the proposed mechanisms by which caffeine might induce these phenotypes, which may involve down-regulation of adenosine A1 receptors, and increased mothers' catecholamines. Our findings further confirm the evidence of the teratogenic effects of high doses of caffeine administered during pregnancy. These findings support the recommendation to avoid caffeine exposure during pregnancy (AU)

Caffeine increases Nr1i3 expression and potentiates the effects of its ligand, TCPOBOP, in mice liver / A cafeína aumenta a expressão Nr1i3 e potencializa os efeitos do seu ligando, TCPOBOP, em fígado de camundongos

Caffeine is one of the world's most consumed substances. It is present in coffee, green tea and guarana, among others. The xenobiotic-sensing nuclear receptor subfamily 1, group I, member 3 (Nr1i3), also known as the Constitutive Androstane Receptor (Car) is a key regulator of drug metabolism and excretion. No consistent description of caffeine effects on this receptor has been described. Thus, to unravel the effects of caffeine on this receptor, we performed experiments in mice. First, C57Bl/6 mice that were treated daily with caffeine (50 mg/kg) for 15 days presented a slight but significant increase in Nr1i3 and Cyp2b10 gene expression. A second experiment was then performed to verify the effects of caffeine on TCPOBOP (1,4-bis-[2-(3,5-dichloropyridyloxy)]benzene, 3,3′,5,5′-tetrachloro-1,4-bis(pyridyloxy)benzene), the most potent agonist known for mice Nr1i3. Interestingly, caffeine potentiated TCPOBOP pleiotropic effects in mice liver, such as hepatomegaly, hepatotoxicity, hepatocyte proliferation and loss of cell-to-cell communication through gap junctions. In addition, caffeine plus TCPOBOP treatment increased liver gene expression of Nr1i3 and Cyp2b10 comparing with only caffeine or TCPOBOP treatments. Together, these results indicate that caffeine increases the expression of Nr1i3 in mice liver, although at this point it is not possible to determine if Nr1i3 directly or indirectly mediates this effect...

A cafeína é uma das substâncias mais consumidas mundialmente, estando presente no café, chá-verde e guaraná, entre outros. O receptor sensor de xenobióticos Receptor Nuclear subfamília 1, grupo I, membro 3 (Nr1i3, mais conhecido como Androstano Consititutivo - Car) é um regulador chave da biotransformação e excreção de substâncias e nenhuma descrição consistente dos efeitos da cafeína sobre este receptor foi feita. Então, para avaliar os efeitos da cafeína sobre este receptor, realizamos experimentos em camundongos. Primeiramente, camundongos C57/Bl/6 foram tratados diariamente com cafeína (50 mg/kg) por 15 dias e apresentaram um leve, mas significativo, aumento na expressão do Car e do seu gene alvo Cyp2b10. Assim, um segundo experimento foi realizado para verificar os efeitos da cafeína sobre o TCPOBOP (1,4-bis-[2-(3,5-dicloropiridiloxi)]benzeno,3,3′,5,5′-tetracloro-1,4-bis(piridiloxi)benzeno), o mais potente agonista do Nr1i3 de camundongos conhecido. Interessantemente, a cafeína potencializou os efeitos pleiotrópicos do TCPOBOP no fígado dos camundongos, como hepatomegalia, hepatotoxicidade, proliferação celular e perda da comunicação intercelular por junções do tipo gap. Os camundongos tratados com cafeína e TCPOBOP apresentaram maior expressão gênica de Nr1i3 e Cyp2b10, quando comparados aos camundongos tratados apenas com cafeína ou TCPOBOP. Juntos, nossos resultados indicam que a cafeína aumenta a expressão do receptor CAR em fígados de camundongos C57/Bl/6, porém nesta etapa ainda não é possível afirmar se estes efeitos são direta ou indiretamente mediados pelo Nr1i3...

Evaluación de la ingesta diaria de cafeína en niños y adolescentes de Argentina / Assessment of caffeine daily intake in children and adolescents from Argentina

. La cafeína (1,3,7 trimetilxantina) es un alcaloide de la familia de las xantinas. Está presente en una gran cantidad de bebidas como café, té, cacao, mate, guaraná, bebidas gaseosas y bebidas energizantes, y alimentos que son consumidos por adultos, adolescentes y niños. A fin de obtener información acerca de la ingesta de cafeína en población infantil y adolescente de Argentina, se plantearon los siguientes objetivos de trabajo: a) estimar la ingesta diaria de cafeína en niños y adolescentes que residen en conglomerados urbanos de Argentina; b) estudiar la asociación de dicha ingesta con distintas variables tales como el género, la edad, el nivel socioeconómico (NSE) y el lugar de residencia; c) estudiar la relación de la ingesta de cafeína con la duración del sueño y d) valorar la contribución de las distintas bebidas a la ingesta diaria de cafeína. Se obtuvieron los datos de consumo de bebidas de 425 participantes de hasta 20 años de edad, residentes de distintas ciudades del país y de diferente NSE. Los resultados mostraron que la ingesta diaria promedio de cafeína (11, 43, 76, 132 y 233 mg/día) aumentó con la franja etaria (menores de 2, de 3 a 5, de 6 a 12, de 13 a 17 y de 18 a 20 años, respectivamente), aunque al relacionarla con el peso corporal (mg/kg/día) el aumento no fue tan marcado. El 50 % de los niños de hasta 2 años evaluados, nunca había consumido bebidas con cafeína. Por el contrario, a partir de 3 años en adelante más del 90 % sí consumieron regularmente por lo menos una bebida con cafeína. Las ingestas promedio calculadas para los niños y adolescentes evaluados resultaron ser superiores a las reportadas por otros autores para otros países. No se encontraron diferencias en la ingesta según el género, el lugar de residencia o el NSE. No se encontró relación entre la ingesta de cafeína y la duración del sueño para ningún grupo etario, a excepción de la franja etaria de 18 a 20 años en la que se observó una disminución significativa en la duración promedio del sueño para el grupo de individuos con ingesta extrema. Las bebidas gaseosas cola se mostraron como principales contribuyentes a la ingesta promedio de cafeína, aunque el mate también se destacó en ese aspecto. Como conclusiones generales de este trabajo se destaca que se logró caracterizar la ingesta de cafeína en niños y adolescentes y establecer la composición de dicha ingesta en cuanto a sus contribuyentes mayoritarios y minoritarios. Por último, si bien se podría clasificar a las ingestas promedio obtenidas en este estudio como elevadas con respecto a las reportadas para otros países, se debe considerar que no se ha definido un valor de ingesta diaria recomendada para niños y adolescentes.

Caffeine (1,3,7 trimethylxanthine) is an naturally occurring alkaloid. It is present in many beverages such as coffee, tea, cocoa, mate, guarana, soft drinks and energy drinks, and foods, widely consumed by adults, adolescents and children. Since information about caffeine intake in children and adolescents in our country is scarce, the aims of the study were set as follows: a) estimate the caffeine daily intake of children and adolescents from Argentina, b) associate the intake to different variables such as gender, age, socioeconomic status (SES) and place of residence; c) study the relationship between caffeine intake and sleep duration, and d) assess the contribution of different beverages to the caffeine daily intake. Information on non alcoholic beverages consumption was obtained from 425 participants up to 20 years old. Participants were from different cities and of different SES all over the country. Results showed that the caffeine mean daily intake increased (11 , 43 , 76 , 132 and 233 mg/day ) with age range (up to 2 , 3 to 5, 6 to 12 , 13 to 17 and 18 20 years old, respectively), but when the intake was related to body weight (mg/ kg/day) the increase was not so marked. Fifty percent of children up to 2 years old had never consumed any caffeinated beverage. However, from ages 3 and up, more than 90% of children regularly consumed at least one caffeinated beverage. The mean daily intakes for the evaluated children and adolescents were higher to those reported by other authors for other countries. When data were analyzed by gender, place of residence or SES, no differences in caffeine intake were observed. No relationship between caffeine intake and sleep duration for any age group was found, except for the age group of 18-20 years, where a significant decrease in average sleep duration for the group of individuals with extreme intake was observed. Soft drinks showed to be main contributors to the mean caffeine daily intake, although mate also highlighted in that aspect. Characterization of the caffeine daily intake and identification of the major and minor contributors to that intake are remarked as achievements of this study. And finally, although caffeine mean daily intake obtained in this study could be considered as elevated when compared with those reported for other countries, it should be noted that a recommended daily intake value for children and adolescents has not already been set.

Effects of Coffee Intake and Intraperitoneal Caffeine on Bone Repair Process - A Histologic and Histometric Study

Studies have suggested that caffeine acts on bone promoting an increase of calcium excretion, inhibition of osteoblast proliferation and delay in tissue repair process, raising the risk of fractures, osteoporosis, periodontal disease and affecting the success of bone reconstructive procedures. The aim of this study was to analyze histomorphometrically the process of alveolar bone healing after tooth extraction in rats subjected to daily intake of boiled coffee or intraperitoneal administration of caffeine. Forty-five male rats were divided according to the treatment in Control group (C); Coffee group (CO) - treated with coffee since birth; and Caffeine (CAF) - intraperitoneal injection of aqueous solution of caffeine 1.5% (0.2 mL/100g body weight) for 30 days. When weighing between 250-300 g they were anesthetized, subjected to extraction of the maxillary right incisor, and euthanized 7, 21 and 42 days after surgery for histological assessments of bone volume and the quality of formed bone in the dental socket. The qualitative results demonstrated larger amounts of blood clot and immature bone in animals under treatment of pure caffeine compared to coffee and control. Histometric analysis revealed that coffee treatment led to a 40% drop in bone formation, and caffeine a 60% drop in comparison to control animals (ANOVA p≤0.01). It was concluded that both the daily ingestion of coffee and the intraperitoneal administration of caffeine in rats delayed the alveolar bone reparative process after tooth extraction, and this effect was more aggressive when pure caffeine was used.

Estudos têm sugerido que a cafeína age sobre o osso promovendo um aumento da excreção de cálcio, inibição da proliferação dos osteoblastos e retardo no processo de reparação tecidual, aumentando o risco de fraturas, osteoporose, doença periodontal, bem como afetando o sucesso de procedimentos de reconstrução óssea. O objetivo deste estudo foi analisar histomorfometricamente o processo de reparação óssea alveolar após extração dentária em ratos submetidos à ingestão diária de café fervido ou a administração intraperitoneal de cafeína. 45 ratos machos foram divididos de acordo com o tratamento, em controle (C); café (CO), tratados com café desde o nascimento; e cafeína (CAF), injeção intraperitoneal de solução aquosa de cafeína de 1,5 % (0,2 mL/100 g de peso corporal) durante 30 dias. Quando pesavam entre 250-300 g os animais foram anestesiados, submetidos à extração do incisivo superior direito, e sacrificados em 7, 21 e 42 dias após a cirurgia para análises histológicas quanto ao volume e à qualidade do osso formado no alvéolo dental. Os resultados qualitativos demonstraram grandes quantidades de coágulo sanguíneo e osso imaturo nos animais tratados com cafeína pura, em relação aos grupos café e controle. A avaliação histométrica mostrou que o tratamento com o café levou a uma queda na formação óssea de 40%, e com a cafeína de 60% em comparação ao grupo controle (ANOVA p≤0,01). Concluiu-se que tanto a ingestão diária de café quanto a administração intraperitoneal de cafeína em ratos retardou o processo de reparação do osso alveolar após extração dentária, e este efeito é mais agressivo quando do uso da cafeína pura.

Association of aaffeine intake and liver fibrosis in patients with chronic hepatiti cc / Associação do consumo da cafeína com o grau de fibrose hepática em pacientes com hepatite C crônica

Background Caffeine consumption has been associated to decreased levels of liver enzymes and lower risk of fibrosis in patients with hepatitis C virus. Objectives This study aimed to evaluate the association between caffeine consumption and inflammatory activity or degree of liver fibrosis in patients with hepatitis C virus infection. Methods A cross-sectional study of patients with chronic hepatitis C virus infection treated in an outpatient Gastroenterology Unit of Santa Casa Hospital (Porto Alegre - Brasil). Patients were interviewed regarding the consumption of caffeine and anthropometric assessment was performed. Liver biopsy was performed in a maximum period of 36 months before inclusion in the study Results There were 113 patients, 67 (59.3%) females, 48 (42.5%) were aged between 52 and 62 years, and 101 (89.4%) were white. The average caffeine consumption was 251.41 ± 232.32 mg/day, and 70 (62%) patients consumed up to 250 mg/day of caffeine. There was no association between caffeine consumption and inflammatory activity on liver biopsy. On the other hand, when evaluating the caffeine consumption liver fibrosis an inverse association was observed. Conclusions The greater consumption of caffeine was associated with lower liver fibrosis. There was no association between caffeine consumption and inflammatory activity. .

Contexto O consumo de cafeína tem sido relacionado à diminuição dos níveis de enzimas hepáticas e menor risco de fibrose em pacientes portadores do vírus da hepatite C. Objetivo O presente estudo tem por objetivo avaliar a associação do consumo da cafeína com a atividade inflamatória e o grau de fibrose hepática em pacientes com infecção pelo vírus da hepatite C. Métodos Estudo transversal, constituído por pacientes com infecção pelo vírus da hepatite C atendidos no ambulatório de Gastroenterologia do Complexo Hospitalar Santa Casa (Porto Alegre - Brasil). Os pacientes foram entrevistados e avaliados individualmente quanto ao consumo de cafeína e antropometria. A biópsia hepática foi realizada em um período de no máximo 36 meses antes da inclusão no estudo. Resultados Foram avaliados 113 pacientes, sendo 67 (59,3%) do sexo feminino, 48 (42,5%) apresentavam idade entre 52 e 62 anos, e 101 (89,4%) eram de cor branca. O consumo médio de cafeína foi de 251,41 ± 232,32 mg/dia, sendo que 70 (62%) pacientes consumiam até 250 mg/dia de cafeína. Não houve associação entre o consumo de cafeína e a atividade inflamatória na biópsia hepática. Por outro lado, quando avaliada a associação entre o consumo de cafeína e fibrose hepática observou-se relação inversa. Conclusões O maior consumo de cafeína apresentou associação com menor grau de fibrose hepática. Não houve associação entre o consumo de cafeína e a atividade inflamatória. .

Early Caffeine Use in Very Low Birth Weight Infants and Neonatal Outcomes: A Systematic Review and Meta-Analysis

The use of caffeine citrate for treatment of apnea in very low birth weight infants showed short-term and long-term benefits. A systematic review and meta-analysis of the literature was undertaken to document the effect providing caffeine early (0-2 days of life) compared to providing caffeine late (> or =3 days of life) in very low birth weight infants on several neonatal outcomes, including bronchopulmonary dysplasia (BPD). We searched MEDLINE, the EMBASE database, the Cochrane Library, and KoreaMed for this meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and Jadad's scale. Studies were included if they examined the effect of the early use of caffeine compared with the late use of caffeine. Two reviewers screened the candidate articles and extracted the data from the full-text of all of the included studies. We included a total of 59,136 participants (range 58,997-59,136; variable in one study) from a total of 5 studies. The risk of death (odds ratio [OR], 0.902; 95% confidence interval [CI], 0.828 to 0.983; P=0.019), bronchopulmonary dysplasia (BPD) (OR, 0.507; 95% CI, 0.396 to 0.648; P<0.001), and BPD or death (OR, 0.526; 95% CI, 0.384 to 0.719; P<0.001) were lower in the early caffeine group. Early caffeine use was not associated with a risk of necrotizing enterocolitis (NEC) and NEC requiring surgery. This meta-analysis suggests that early caffeine use has beneficial effects on neonatal outcomes, including mortality and BPD, without increasing the risk of NEC.

Prenatal and developmental toxicity study of meclizine and caffeine combination in female albino wistar rats.

Meclizine and caffeine combination is used for the treatment of morning sickness. Both compounds are teratogenic and caffeine is known to possess anti-fertility activity also. The present study was undertaken to evaluate the reproductive toxic effect of meclizine and caffeine combination. Three doses were taken for the study; low dose (LD; meclizine 3.7 mg/kg and caffeine 3 mg/kg) was selected from commercially available formulation, middle dose (MD; meclizine 37 mg/kg and caffeine 30 mg/kg) and high dose (HD; meclizine 370 mg/kg and caffeine 300 mg/kg). The mixture was administered 1-7 days and 8-14 days for fertility and embryotoxic studies respectively. Laparotomy was done on 10th day of gestation period. Number of implants and corpora lutea were counted, pre and post-implantation losses were determined. In embryo toxicity study fetuses were evaluated for external, skeletal and visceral examination. High dose was removed from both fertility and embryotoxicity studies due to its severe toxicity to the dam. Significant anti-fertility activity was observed at middle dose. Embryotoxicity study showed significant reduction in fetal body weight, body length and body mass index, dam body weight gain on gestation day 14. Absolute kidney weight in MD and absolute and relative spleen weight in both LD and MD were significantly reduced. There was no increase in external or internal congenital anomalies at both LD and MD. The, results suggest that prescription of meclizine and caffeine for morning sickness in early pregnancy should be reviewed carefully.

Avaliação da remoção de interferentes endócrinos, ativos farmacêuticos e cafeína em água para abastecimento público do estado de São Paulo / Assessment of endocrine disruptors, pharmaceuticals and caffeine removal in drinking water of the São Paulo State

Alguns compostos orgânicos como interferentes endócrinos e ativos farmacêuticos estão sendo encontrados em águas superficiais e vêm chamando a atenção de orgãos públicos e da comunidade científica. Dentre esses compostos, foram enfatizados nesse trabalho, o hormônio sintético 17α-etinilestradiol, o surfactante (4-nonilfenol), bisfenol A, o antibiótico ß-lactâmico amoxicilina e a cafeína como traçador de atividade antrópica. Estes compostos são continuamente introduzidos em corpos d'água pelo lançamento de esgoto in natura o que afeta a qualidade da água, a saúde dos ecossistemas e impacta o suprimento de água potável. Considerando a baixa taxa de remoção desses contaminantes pelo tratamento de água atualmente utilizado no Brasil e o estado de degradação dos mananciais de água para abastecimento público, esse trabalho apresenta o desenvolvimento de metodologia analítica para determinação dos compostos citados e a avaliação da eficiência de remoção quando o tratamento convencional de água é aplicado. A determinação foi baseada em métodos já estabelecidos e envolveram as etapas de limpeza e concentração de amostra usando extração em fase sólida (SPE) e análise por cromatografia a líquido de alta eficiência (HPLC) com detector de arranjo de diodos (DAD) e espectrometria de massas. As amostras do Reservatório do Guarapiranga foram utilizadas para ensaios em escala laboratorial que simulavam o tratamento convencional de água em planta real. Os resultados mostraram a adequação dos métodos utilizados para a separação e determinação desses compostos em amostras ambientais. Além disso, apontaram para a necessidade de se avaliar a utilização de metodologias não convencionais que otimizem a remoção pelo tratamento de água atualmente utilizado

Some organic compounds, such as endocrine disruptors and pharmaceuticals, are being found in the surface water, and are concerning both the public organs and the scientific community. Among these compounds, the synthetic hormone 17α-ethinylestradiol, the surfactant (4-nonylphenol), bisphenol-A, the ß-lactam antibiotic amoxicillin and the marker of human activity caffeine were highlighted in the present work. These compounds are continuously drained to the water bodies by sewers, affecting not only the water quality itself, but also the ecosystems, and impacting the drinking water availability. Currently in Brazil, the removal rate of these contaminants is low, whereas the water sources for public supply are highly degraded. In this context, the present work develops an analytical method to detect the aforementioned compounds, and to evaluate the efficiency of its removal by conventional water treatments. Detection was based on pre-established methods and steps involved clean up and samples concentration by solid phase extraction (SPE), high performance liquid chromatography with diode array detection (DAD), and mass spectrometry. Recovery tests were done using environmental samples from Guarapiranga Reservoir (São Paulo, SP). This samples were further used in laboratorial tests, simulating real scale water conventional treatments. Current results revealed the adequacy of the chosen methods in the separation and determination of the abovementioned compounds from natural samples. Also, they highlight the need for the evaluation of non-conventional methodologies that optimize removal by current water treatment

Coffee has hepatoprotective benefits in Brazilian patients with chronic hepatitis C even in lower daily consumption than in American and European populations

The potential role of coffee as a hepatoprotective substance for chronic liver diseases has been widely discussed. Our main aim was to evaluate the effect of coffee intake regarding clinical, biochemical tests and liver biopsy data in treatment naïve patients with chronic hepatitis C. One hundred and thirty-six patients with chronic hepatitis C, diagnosed through liver biopsy, or by means of clinical, ultrasound or endoscopic signs of cirrhosis, were assessed by determination of biochemical tests, metabolic and morphological alterations. Food frequency was scrutinized by using a structured questionnaire. Coffee intake represented more than 90% of the total daily caffeine, and the 75th percentile was 4-Brazilian coffee-cup/day (>255mL/day or >123mg caffeine/day). According to caffeine intake, patients were divided into two groups (< or >123mg caffeine/day). Patients with higher ingestion of caffeine had lower serum levels of aspartate aminotransferase (× upper limit of normal) (1.8±1.5 vs 2.3±1.5, p=0.04), lower frequencies of advanced (F3, F4) fibrosis (23.5% vs 54.5%, p<0.001) and of histological activity grade (A3, A4) observed in liver biopsies (13.8% vs 36.9%, p<0.001). By multivariate logistic regression, fibrosis was independently associated with caffeine intake (OR- 0.16; 95%CI - 0.03-0.80; p=0.026), γ-glutamil transferase serum levels and morphological activity. But only fibrosis was associated with histological activity. In conclusion caffeine consumption greater than 123mg/day was associated with reduced hepatic fibrosis. In addition, this study supports the assumption that coffee intake has hepatoprotective benefits for Brazilian patients with chronic hepatitis C, even in lower doses than that of American and European population intake.

Efeitos metabólicos de uma bebida esportiva cafeinada consumida durante uma partida de futebol / Efectos metabólicos de una bebida deportiva con cafeína consumida durante un partido de fútbol / Metabolic effects of a caffeinated sports drink consumed during a soccer match

The purpose of this study was to verify the effect of the intake of a caffeinated sport drink (CAFD) compared to a commercial carbohydrate drink (CHOD) on biochemical parameters and rate of perception exertion in youth soccer players. The experiment was setup in a double-blind crossover design where athletes consumed 5mL.Kg-1 body weight (BW) before the game and 3mL.Kg-1 BW every 15 minutes during the game. Intake of the CAFD resulted in increased blood glucose (BG) and blood lactate (BL) levels and average of maximum heart rate compared to consumption of the CHOD (p = 0.01). No difference was observed in the other variables. CAFD promoted greater plasmatic concentration of BG and BL compared with the CHOD. The CAFD did not increase the mobilization of free fatty acids, did not alter the plasma potassium concentration and was not able to reduce subjective perceived exertion.

O objetivo deste estudo foi verificar o efeito da ingestão de uma bebida esportiva cafeinada (CAFD) em comparação a uma bebida carboidratada comercial (CHOD) sobre parâmetros bioquímicos e a taxa de percepção de esforço em jogadores de futebol categoria juvenil. O desenho experimental foi duplo-cego cruzado, onde os atletas consumiram 5mL.Kg-1 de peso corporal (PC) antes do jogo e 3mL.Kg-1 PC a cada 15 minutos durante o jogo. A ingestão de CAFD resultou no aumento da glicemia (GS) e do lactato sanguíneo (LS) e do valor médio da frequência cardíaca máxima em relação ao consumo do CHOD (p = 0,01). Nenhuma diferença foi observada nas outras variáveis. CAFD promoveu maior concentração plasmática de GS e LS em comparação com o CHOD. A CAFD não aumentou a mobilização dos ácidos graxos livres, não alterou a concentração de potássio plasmático e não foi capaz de reduzir a percepção subjetiva do esforço.

El objetivo fue verificar el efecto del consumo de una bebida deportiva con cafeína (CAFD) frente a una bebida carbohidratada comercial (CHOD) sobre parámetros bioquímicos y el índice de percepción de esfuerzo percibido en jugadores de fútbol de la categoría juvenil. El diseño experimental utilizado fue de tipo doble-ciego cruzado, donde los deportistas ingieren 5mL.Kg-1 del peso corporal (PC) antes del partido y 3mL.Kg-1 PC a cada 15 minutos durante el partido. El consumo de CAFD produjo un aumento en la glucemia (GS) y del lactato sanguíneo (LS) y del valor medio de frecuencia cardiaca máxima frente al consumo de CHOD (p = 0,01). No hubo diferencias en las demás variables. CAFD produjo mayor concentración plasmática de GS y LS en comparación con la CHOD. La CAFD no aumento la movilización de ácidos grasos libres, no hubo alteración en la concentración de potasio plasmático y no fue capaz de reducir el índice de percepción de esfuerzo.