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.

Daño en la pared arterial de las ratas Wistar sometidas a dieta hiperglucídica / Arterial wall damage in Wistar rats subjected to a hyperglycemic diet

RESUMEN Introducción: Los modelos experimentales en animales proporcionan una valiosa información para comprender los procesos fisiopatológicos de las lesiones de los vasos sanguíneos y sus consecuencias. Objetivo: Analizar los cambios histológicos y morfométricos que se observaron en la aorta abdominal de las ratas Wistar sometidas a una dieta hiperglucídica. Métodos: Se formaron aleatoriamente dos grupos experimentales de 10 animales cada uno. El grupo control alimentado con dieta estándar para la especie, y el grupo experimental alimentado con dieta estándar más sacarosa al 35 %, como agua de bebida desde el destete hasta las 20 semanas de vida. El estudio se realizó en muestras de aorta fijadas y procesadas por la técnica clásica de inclusión en parafina y coloreadas con las técnicas de hematoxilina - eosina y Verhoeff. Se realizó la descripción de las capas de la pared arterial y la determinación de variables morfométricas en cada lámina histológica. Resultados: Las ratas Wistar pertenecientes al grupo experimental desarrollaron modificaciones incipientes en la pared arterial de la aorta abdominal, las cuales corresponden con la presencia de tumefacción en la célula endotelial y vacuolización en la célula muscular lisa vascular, así como marcada desorganización de las fibras elásticas y musculares de la capa media. Las variables morfométricas que mostraron diferencias significativas entre los grupos fueron el grosor de la túnica media y el cociente media/ lumen. Conclusiones: La pared media resultó ser la capa más afectada demostrándose el efecto nocivo de la dieta hiperglucídica en la pared arterial.

ABSTRACT Introduction: experimental animal models provide valuable information to understand the physiological and pathological processes of blood vessel injuries and their consequences. Objective: to analyze the histological and morphometric changes observed in the abdominal aorta of Wistar rats subjected to a hyperglycemic diet. Methods: two experimental groups of 10 animals each were randomly formed. The control group was fed with a standard diet for this species, and the experimental group was fed with a standard diet plus 35% sucrose, as drinking water from weaning to 20 weeks of life. The study was performed on aortic samples fixed and processed by the classic paraffin embedding technique and stained with the hematoxylin-eosin and Verhoeff techniques. The description of the layers of the arterial wall and the determination of morphometric variables in each histological slide were made. Results: the Wistar rats belonging to the experimental group developed incipient changes in the arterial wall of the abdominal aorta, which correspond to the presence of endothelial cell swelling and vacuolation in the vascular smooth muscle cell, as well as marked disorganization of the muscle and elastic fibers of the middle layer. The morphometric variables that showed significant differences between the groups were the thickness of the tunica media and the media/lumen ratio. Conclusions: the middle wall turned out to be the most affected layer, demonstrating the harmful effect of the hyperglycemic diet on the arterial wall.

Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: a randomized clinical trial / 医学前沿

Lifestyle interventions, including dietary adjustments and exercise, are important for obesity management. This study enrolled adults with overweight or obesity to explore whether either low-carbohydrate diet (LCD) or exercise is more effective in metabolism improvement. Forty-five eligible subjects were randomly divided into an LCD group (n = 22) and an exercise group (EX, n = 23). The subjects either adopted LCD (carbohydrate intake < 50 g/day) or performed moderate-to-vigorous exercise (⩾ 30 min/day) for 3 weeks. After the interventions, LCD led to a larger weight loss than EX ( - 3.56 ± 0.37 kg vs. - 1.24 ± 0.39 kg, P < 0.001), as well as a larger reduction in fat mass ( - 2.10 ± 0.18 kg vs. - 1.25 ± 0.24 kg, P = 0.007) and waist circumference ( - 5.25 ± 0.52 cm vs. - 3.45 ± 0.38 cm, P = 0.008). Both interventions reduced visceral and subcutaneous fat and improved liver steatosis and insulin resistance. Triglycerides decreased in both two groups, whereas low-density lipoprotein cholesterol increased in the LCD group but decreased in the EX group. Various glycemic parameters, including serum glycated albumin, mean sensor glucose, coefficient of variability (CV), and largest amplitude of glycemic excursions, substantially declined in the LCD group. Only CV slightly decreased after exercise. This pilot study suggested that the effects of LCD and exercise are similar in alleviating liver steatosis and insulin resistance. Compared with exercise, LCD might be more efficient for weight loss and glucose homeostasis in people with obesity.

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)

Low FODMAPs diet for functional abdominal pain disorders in children: critical review of current knowledge / Dieta com baixo teor de FODMAPs para distúrbios de dor abdominal funcional em crianças: revisão crítica do conhecimento atual

ABSTRACT Objective: This narrative review aimed to provide practitioners a synthesis of the current knowledge on the role of a low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in reducing symptoms associated with functional abdominal pain disorders in children. This review is focused on the pathophysiology, efficacy and criticism of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in children. Sources: Cochrane Database, Pubmed and Embase were searched using specific terms for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet interventions and functional abdominal pain disorders. Summary of the findings: In children, only one Randomized Control Trial and one open-label study reported positive results of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet; one Randomized Control Trial showed exacerbation of symptoms with fructans in children with Irritable Bowel Syndrome; no effect was found for the lactose-free diet whilst fructose-restricted diets were effective in 5/6 studies. Conclusions: In children there are few trials evaluating low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols in functional abdominal pain disorders, with encouraging data on the therapeutic efficacy particularly of fructose-restricted diet. Additional efforts are still needed to fill this research gap and clarify the most efficient way for tailoring dietary restrictions based on the patient's tolerance and/or identification of potential biomarkers of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols efficacy, to maintain nutritional adequacy and to simplify the adherence to diet by labeling Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols content in commercial products.

RESUMO Objetivo: Nos últimos anos, foram feitos esforços consideráveis para esclarecer o papel da dieta com baixo teor de oligossacarídeos fermentáveis, dissacarídeos, monossacarídeos e polióis (FODMAPs) para o tratamento de distúrbios gastrintestinais funcionais (DGIFs). Esta revisão narrativa teve como objetivo fornecer aos profissionais uma síntese do conhecimento atual sobre o papel de uma dieta com baixo teor de FODMAPs (BFM) na redução dos sintomas associados a distúrbios funcionais de dor abdominal (DFDA) em crianças. Esta revisão está focada na fisiopatologia, eficácia e crítica da dieta BFM em crianças. Fontes: O banco de dados Cochrane, Pubmed e Embase foram pesquisados com o uso dos termos específicos para intervenções na dieta FODMAP e DFDA. Resumo dos achados: Em crianças, apenas um estudo controlado randomizado e um estudo aberto relataram resultados positivos da dieta BFM; um estudo controlado randomizado mostrou exacerbação dos sintomas com frutanos em crianças com síndrome do intestino irritável; nenhum efeito foi encontrado para a dieta livre de lactose, enquanto dietas com restrição de frutose foram eficazes em 5/6 estudos. Conclusões: Existem poucos estudos que avaliam BFM em DFDA em crianças, com dados encorajadores sobre a eficácia terapêutica, particularmente de dietas com restrição de frutose. Esforços adicionais ainda são necessários para preencher essa lacuna de pesquisa e esclarecer a maneira mais eficiente de adaptar as restrições dietéticas com base na tolerância do paciente e/ou identificação de biomarcadores potenciais de eficácia da BFM, para manter a adequação nutricional e simplificar a adesão à dieta, ao incluir informações sobre conteúdo de FODMAPs em rótulos de produtos comerciais.

Restrição de carboidratos no manejo do diabetes mellitus tipo 2: revisão crítica de ensaios clínicos randomizados / Carbohydrate restriction in the management of diabetes mellitus type 2: critical review of randomized clinical tests

O diabetes mellitus tipo 2 (DM2) é considerado um dos principais distúrbios metabólicos relacionados ao desenvolvimento de doenças cardiovasculares e outras comorbidades, com elevada incidência e prevalência no Brasil e no mundo. Apesar dos avanços em seu tratamento, a projeção mundial é de aumento no número de diagnósticos. No Brasil, o total de pessoas com a doença cresceu mais de 60% em 10 anos. Como o manejo dietético é um dos pilares no tratamento do DM2, este trabalho objetivou analisar os estudos que compararam as dietas restritas em carboidratos com outras abordagens dietéticas a fim de elucidar se esta seria a opção mais adequada para os pacientes com DM2. Assim, fez-se uma revisão de ensaios clínicos randomizados por meio das plataformas de pesquisa PubMed e Cochrane Library em outubro de 2018, selecionando os estudos segundo a estratégia PICO de pesquisa. Dos 398 artigos encontrados, 19 atenderam os critérios de elegibilidade. Após a análise, demonstrou-se que as dietas restritas em carboidratos favorecem o controle glicêmico, melhora do perfil lipídico e redução dos medicamentos para DM2 em relação às outras opções dietéticas, no entanto, os trabalhos apresentam vieses metodológicos e são, em geral, de curto prazo. Sendo assim, é precipitado afirmar que essas dietas são mais efetivas para o tratamento do DM

Type 2 diabetes mellitus (T2DM) is considered one of the primary metabolic disorders related to the development of cardiovascular diseases and other comorbidities, with high incidence and prevalence in Brazil and in the world. Despite advances in its treatment, an increase in the number of diagnoses is estimated worldwide. In Brazil, the total number of people with the disease has grown more than 60% in 10 years. As dietary management is one of the mainstays in the treatment of T2DM, this study aimed to analyze the studies that compared carbohydrate-restricted diets with other dietary approaches to elucidate if this would be the most appropriate option for patients with T2DM. Thus, randomized clinical trials were reviewed through the PubMed and Cochrane Library research platforms in October 2018, selecting the studies according to the PICO research strategy. Of the 398 articles found, 19 met the eligibility criteria and had their data collected. After the analysis, it was demonstrated that carbohydrate-restricted diets support glycemic control, loss of body mass, improvement of lipid profile and reduction of medications for T2DM compared to other dietary options. However, a significant part of the studies has methodological biases and is generally short-term. Therefore, the level of evidence supporting dietary restriction of carbohydrates in the management of T2DM is considered moderate. Thus, according to the principle of the null hypothesis, it is unwise to affirm that these diets are superior in the treatment of DM2

Heterotaxy syndrome with agenesis of dorsal pancreas and diabetes mellitus: case report and review of the literature

SUMMARY Heterotaxy syndrome (HS) is a rare congenital condition with multifactorial heritance, characterized by an abnormal arrangement of thoraco-abdominal organs and vessels. Patients present with multiple cardiac, gastrointestinal, hepatosplenic, pancreatic, renal, neurological and skeletal disorders without any pathognomonic alteration. Despite the described increased risk of diabetes mellitus (DM) in patients with altered pancreatic anatomy, just one case was reported in Korea regarding the association of HS and DM in a 13-year-old girl. Our report refers to a 40-year-old female Brazilian patient with a history of DM and HS with polysplenia and agenesis of dorsal pancreas without cardiac abnormalities. She presented a worsening glycemic control associated with weight gain and signs of insulin resistance. After a proper clinical management of insulin and oral medications, our patient developed an improvement in glycemic control. Although it is a rare disease, HS with polysplenia and pancreatic disorders can be associated with an increased risk of DM. This case highlights the importance of investigating DM in patients with HS, especially those with pancreatic anatomical disorders, for proper clinical management of this rare condition.

Comparação entre dietas com restrição de carboidratos e de gorduras no combate à obesidade: uma revisão sistemática / Comparison of diets with carbohydrate and fat restriction to fight obesity: a systematic review

OBJETIVO: Comparar dietas com restrição de carboidratos e com restrição de gorduras, para analisar a eficácia de ambas em relação a perda de peso, LDL-c, HDL-c, triglicerídeos, glicemia em jejum e pressão arterial. MÉTODOS: Foram analisados, em três diferentes bancos de dados, estudos de intervenção randomizados publicados entre 2002 e 2016. Após avaliação de qualidade, oito artigos foram selecionados para o presente estudo. RESULTADOS: Dietas com restrição de carboidratos demonstraram maior eficácia em relação à perda ponderal, à elevação dos níveis de HDL-c e à diminuição dos níveis de triglicerídeos, glicemia de jejum e pressóricos. A única variável em que houve maior benefício aparente com a restrição de gorduras foi a diminuição dos níveis de LDL-c. CONCLUSÃO: Uma dieta com restrição de carboidratos pode ser uma alternativa mais eficaz do que com restrição de gorduras no combate à obesidade e à síndrome metabólica. No entanto, a realização de estudos mais aprofundados é essencial para avaliar alterações em outros marcadores metabólicos importantes. (AU)

OBJECTIVES: To compare low-carbohydrate and low-fat diets to analyze their efficacy in relation to weight loss, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting glycaemia and blood pressure. METHODS: For this, three randomized intervention studies published between 2002 and 2016 were analyzed in three different databases. After being evaluated for quality, eight articles were selected for the present study. RESULTS: Low-carbohydrate diets demonstrated greater efficacy concerning weight loss, elevated HDL-C levels and a decrease in triglyceride levels, fasting glycaemia and blood pressure levels. The only variable in which there was a greater apparent benefit with low-fat diet was the decrease in LDL-C levels. CONCLUSION: A low-carbohydrate diet may be a more effective alternative than a low-fat diet in the fight against obesity and metabolic syndrome. However, more in-depth studies are essential to evaluate changes in other important metabolic markers. (AU)

Dieta baja en oligosacáridos, disacáridos, monosacáridos y polioles fermentables y calidad de vida en pacientes con síndrome de intestino irritable en Colombia / Diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols, and quality of life in patients with irritable bowel syndrome in Colombia

Resumen Introducción. Cada vez hay más información sobre la efectividad de una dieta baja en oligosacáridos, disacáridos, monosacáridos y polioles fermentables (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, FODMAP) en pacientes con síndrome de intestino irritable. Sin embargo, no hay estudios que estimen la eficacia de esta estrategia en nuestro medio. Objetivo. Determinar el efecto de una dieta baja en FODMAP en la calidad de vida y en la intensidad de los síntomas en pacientes con síndrome de intestino irritable en Colombia. Materiales y métodos. Se recopiló información clínica y demográfica de todos los pacientes en el momento de su inclusión; después, un encuestador entrenado utilizó la encuesta Irritable Bowel Syndrome Quality of Life (IBS-QoL) para estimar la calidad de vida de los pacientes. La intensidad de los síntomas se evaluó mediante una escala visual, antes y después del inicio de la dieta baja en FODMAP. Resultados. La muestra final incluyó a 50 personas. Se observó una reducción significativa de todos los síntomas (reducción promedio de todas las escalas: 19,8 mm; IC95%: 16,2-23,4 mm; p<0,001), y un incremento en todas las escalas de la IBS-QoL, incluida la de resumen global de la encuesta (14,7 puntos; IC95%: 9,4-20,1; p<0,001). El sexo, la edad, el índice de masa corporal, el estado socioeconómico y el régimen de salud, no se asociaron con la mejoría de la calidad de vida relacionada con la salud. Conclusión. La dieta supervisada y baja en FODMAP disminuyó los síntomas y mejoró la calidad de vida en pacientes con síndrome de intestino irritable. Es necesario hacer estudios controlados sobre otros factores ligados a la evolución del síndrome para confirmar estos resultados.

Abstract Introduction: A growing body of evidence has pointed out the effectiveness of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) in patients with irritable bowel syndrome. However, there are no local studies to estimate the effects of this strategy on the symptoms and the health-related quality of life in these patients in Colombia or Latin America. Objective: To determine the effect of a diet low in FODMAP on the quality of life and the severity of symptoms in patients with irritable bowel syndrome in Colombia. Materials and methods: We collected clinical and demographic information of all patients at the time of inclusion. Immediately afterwards, a trained interviewer applied the IBS-QoL survey to estimate the quality of life of patients. Then, we evaluated the intensity of the symptoms using an analogue visual scale, before and after the diet low in FODMAP. Results: We included 50 subjects in the final analysis. We observed an increase in all the IBS-QoL scales (average increase in overall summary: 14.7 points, 95% CI: 9.4 to 20.1; p<0.001) and a significant reduction in all symptoms (-19.8 mm; 95% CI: 23.4 mm 16.2 mm; p<0.001). Sex, age, body mass index, socioeconomic status and the health care provider were not associated with the improvement in the health-related quality of life. Conclusion: A low diet in FODMAP reduced symptoms and improved quality of life in Colombian patients with irritable bowel syndrome. Controlled studies taking into account other factors linked to the severity of irritable bowel syndrome are required.

Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis

Abstract Objective: This study aimed to evaluate the effectiveness and safety of carbohydrate counting (CHOC) in the treatment of adult patients with type 1 diabetes mellitus (DM1). Materials and methods: We performed a systematic review of randomized studies that compared CHOC with general dietary advice in adult patients with DM1. The primary outcomes were changes in glycated hemoglobin (HbA1c), quality of life, and episodes of severe hypoglycemia. We searched the following electronic databases: Embase, PubMed, Lilacs, and the Cochrane Central Register of Controlled Trials. The quality of evidence was analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: A total of 3,190 articles were identified, and two reviewers independently screened the titles and abstracts. From the 15 potentially eligible studies, five were included, and 10 were excluded because of the lack of randomization or different control/intervention groups. Meta-analysis showed that the final HbA1c was significantly lower in the CHOC group than in the control group (mean difference, random, 95% CI: −0.49 (-0.85, −0.13), p = 0.006). The meta-analysis of severe hypoglycemia and quality of life did not show any significant differences between the groups. According to the GRADE, the quality of evidence for severe hypoglycemia, quality of life, and change in HbA1c was low, very low, and moderate, respectively. Conclusion: The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.

Effectiveness and safety of low-carbohydrate diets

With the recent assertions made by certain Korean media that low-carbohydrate, high-fat diets are panaceas for weight reduction and health improvement, such diets have been in the public spotlight. Medical and nutrition professionals have claimed that the inordinate popularity of low-carbohydrate, high-fat diets may pose a significant threat to public health. The aim of this review was to explore the latest evidence on the effectiveness and safety of low-carbohydrate diets. Recent clinical trials have shown that low-carbohydrate diets result in favorable changes in body weight and biochemical cardiovascular risk factors. However, the safety of low-carbohydrate diets remains inconclusive in the long term. Although the latest guidelines for the management of obesity recommend obese adults to use low-carbohydrate diets as an alternative dietary approach to achieve weight loss depending on each patient's dietary habits and medical status, such diets cannot currently be recommended as a strategy for health promotion among the general population due to long-term safety concerns. The results of cohort studies in Japan that have shown moderate diets lower in carbohydrates to be associated with decreased risks of cardiovascular mortality, total mortality, and type 2 diabetes in Japanese women, suggest that a low-glycemic load diet might be an optimal dietary approach for Korean obese adults with insulin resistance.

Effectiveness and safety of low-carbohydrate diets

With the recent assertions made by certain Korean media that low-carbohydrate, high-fat diets are panaceas for weight reduction and health improvement, such diets have been in the public spotlight. Medical and nutrition professionals have claimed that the inordinate popularity of low-carbohydrate, high-fat diets may pose a significant threat to public health. The aim of this review was to explore the latest evidence on the effectiveness and safety of low-carbohydrate diets. Recent clinical trials have shown that low-carbohydrate diets result in favorable changes in body weight and biochemical cardiovascular risk factors. However, the safety of low-carbohydrate diets remains inconclusive in the long term. Although the latest guidelines for the management of obesity recommend obese adults to use low-carbohydrate diets as an alternative dietary approach to achieve weight loss depending on each patient's dietary habits and medical status, such diets cannot currently be recommended as a strategy for health promotion among the general population due to long-term safety concerns. The results of cohort studies in Japan that have shown moderate diets lower in carbohydrates to be associated with decreased risks of cardiovascular mortality, total mortality, and type 2 diabetes in Japanese women, suggest that a low-glycemic load diet might be an optimal dietary approach for Korean obese adults with insulin resistance.

Ketogenic diet for epilepsy treatment / Dieta cetogênica para o tratamento da epilepsia

ABSTRACT The ketogenic diet (KD), a high-fat, low-carbohydrate, and adequate-protein diet is an established, effective nonpharmacologic treatment option for intractable childhood epilepsy. The KD was developed in 1921 and even though it has been increasingly used worldwide in the past decade, many neurologists are not familiar with this therapeutic approach. In the past few years, alternative and more flexible KD variants have been developed to make the treatment easier and more palatable while reducing side effects and making it available to larger group of refractory epilepsy patients. This review summarizes the history of the KD and the principles and efficacy of the classic ketogenic diet, medium-chain triglyceride(s) (MCT) ketogenic diet, modified Atkins diet, and low glycemic index treatment.

RESUMO A dieta cetogênica, rica em gorduras, adequada em proteínas e pobre em carboidratos é uma opção de tratamento efetiva e bem estabelecida para epilepsia de difícil controle na infância. Foi desenvolvida em 1921 e nos últimos 20 anos tem sido utilizada em diferentes países e culturas, porém ainda é desconhecida entre muitos neurologistas e outras especialidades. Recentemente, no esforço de tornar a dieta mais palatável, de fácil administração e com menos efeitos adversos, dietas cetogênicas alternativas foram criadas, possibilitando a sua administração a um maior número de pacientes. Nesta revisão abordaremos a história, príncipios e eficácia da dieta cetogênica, da dieta com triglicérides de cadeia média, da dieta modificada de Atkins e da dieta com baixos índices glicêmicos.

Glucose metabolism disorders and vestibular manifestations: evaluation through computerized dynamic posturography / Distúrbios do metabolismo da glicose e manifestações vestibulares: avaliação pela posturografia dinâmica computadorizada

ABSTRACT INTRODUCTION: Global sugar consumption has increased in the past 50 years; its abusive intake is responsible for peripheral insulin resistance, which causes the metabolic syndrome - obesity, diabetes mellitus, hypertension, and coronary heart disease. OBJECTIVE: To evaluate the effect of a fractionated diet without glucose as treatment for labyrinthine disorders associated with glucose-insulin index. METHODS: The study design was a prospective randomized controlled trial. Fifty-one patients were divided into two groups: the diet group (DG), which comprised subjects treated with a fractionated diet with glucose restriction, and the control group (CG), in which individuals were not counseled regarding diet. Patients underwent computerized dynamic posturography (CDP) and visual analog scale (VAS) on the first and 30th days of the study. RESULTS: There was improvement in the assessed posturographic conditions and VAS self-assessment in the DG group after 30 days when compared to the control group. CONCLUSION: The fractionated diet with glucose restriction was effective for the treatment of vestibular dysfunction associated with glucose metabolism disorders.

Resumo Introdução: O consumo mundial de açúcar triplicou nos últimos 50 anos e a sua ingesta abusiva é responsável pela resistência periférica à insulina que origina a síndrome metabólica-obesidade, diabetes mellitus, hipertensão arterial e doenças coronarianas. Objetivo: Avaliar de forma objetiva o efeito da dieta fracionada e sem glicose como forma de tratamento dos distúrbios labirínticos associados às alterações da curva glicoinsulinêmica. Método: Trata-se de um ensaio clínico controlado randomizado prospectivo. Estudo realizado com 51 pacientes divididos em dois grupos: Grupo Dieta composto por indivíduos tratados com dieta fracionada com restrição de glicose e Grupo Controle no qual os indivíduos não foram orientados em relação à dieta. Os pacientes realizaram Posturografia Dinâmica Computadorizada e Escala Análogo Visual no primeiro e trigésimo dias do estudo. Resultados: Foi observada melhora nas condições posturográficas avaliadas e melhora clínica do grupo dieta na análise da escala análogo visual quando comparados grupo dieta e grupo controle. Conclusão: A dieta fracionada e restritiva de glicose mostrou-se eficaz no tratamento das disfunções vestibulares associadas aos distúrbios do metabolismo da glicose.

Ketogenic Diet for Children with Epilepsy: A Practical Meal Plan in a Hospital

A ketogenic diet (KD) is a dietary approach to treat intractable epilepsy. The KD begins with hospitalization and the child and their parents can adapt to the KD for 1-2 weeks. Recently, various type of dietary intervention such as the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) have been performed. Since 2010, we carried out the KD, MAD, and LGIT for total of 802 patients; 489 patients (61%) for the KD, 147 patients (18.3%) with the MAD, and 166 patients (20.7%) for the LGIT. In this report, application of these dietary practices in Severance Hospital is shared.

Dieta baja en FODMAP en el síndrome de intestino irritable / Low FODMAP diet in irritable bowel disease

La dieta baja en FODMAP ha mostrado ser una herramienta eficaz en el manejo de los síntomas del Síndrome de Intestino Irritable (SII). Los estudios recientes aleatorizados, controlados y prospectivos apoyan el uso de esta dieta como parte del tratamiento de esta patología. Los mecanismos mediante los que la dieta baja en FODMAP alivia los síntomas son variados y se relacionan con la fisiopatología del SII. Esta dieta puede generar cambios en la flora intestinal, efecto que aún no ha sido ampliamente estudiado.

The low FODMAP diet has been shown to be an efficacious therapy for reduction of functional gastrointestinal symptoms seen in Irritable Bowel Disease (IBS). Recent publications provide randomized controlled trial and prospective evidence in support of the diet for symptom management. The mecanisms of the low FODMAP diet to relief sympotms are assorted and in realtionship with the physiopathology of IBS. This diet can turno n changes in microbiota. This effect has not be completely understood. Further research to determine the potential health implications and microbiotal effect is required.

Chronic intermittent hypoxia increases encoding pigment epithelium-derived factor gene expression, although not that of the protein itself, in the temporal cortex of rats, / Hipóxia intermitente crônica aumenta a expressão gênica, mas não proteica, de pigment epithelium-derived factor no córtex temporal de ratos

Objective: Obstructive sleep apnea syndrome is mainly characterized by intermittent hypoxia (IH) during sleep, being associated with several complications. Exposure to IH is the most widely used animal model of sleep apnea, short-term IH exposure resulting in cognitive and neuronal impairment. Pigment epithelium-derived factor (PEDF) is a hypoxia-sensitive factor acting as a neurotrophic, neuroprotective, and antiangiogenic agent. Our study analyzed performance on learning and cognitive tasks, as well as PEDF gene expression and PEDF protein expression in specific brain structures, in rats exposed to long-term IH. Methods: Male Wistar rats were exposed to IH (oxygen concentrations of 21-5%) for 6 weeks-the chronic IH (CIH) group-or normoxia for 6 weeks-the control group. After CIH exposure, a group of rats were allowed to recover under normoxic conditions for 2 weeks (the CIH+N group). All rats underwent the Morris water maze test for learning and memory, PEDF gene expression and PEDF protein expression in the hippocampus, frontal cortex, and temporal cortex being subsequently assessed. Results: The CIH and CIH+N groups showed increased PEDF gene expression in the temporal cortex, PEDF protein expression remaining unaltered. PEDF gene expression and PEDF protein expression remained unaltered in the frontal cortex and hippocampus. Long-term exposure to IH did not affect cognitive function. Conclusions: Long-term exposure to IH selectively increases PEDF gene expression at the transcriptional level, although only in the temporal cortex. This increase is probably a protective mechanism against IH-induced injury. .

Objetivo: A síndrome da apneia obstrutiva do sono caracteriza-se principalmente por episódios de hipóxia intermitente (HI) durante o sono e associa-se a diversas complicações. A exposição à HI é o mais usado modelo animal de apneia do sono, e protocolos de curta duração causam diversos prejuízos cognitivos e neuronais. Pigment epithelium-derived factor (PEDF, fator derivado do epitélio pigmentado) é um fator neurotrófico, neuroprotetor e antiangiogênico sensível à hipóxia celular. Nosso estudo analisou o desempenho em tarefas cognitivas e de aprendizagem, bem como a expressão do gene PEDF e da proteína PEDF em estruturas cerebrais específicas em ratos expostos a HI de longa duração. Métodos: Ratos Wistar foram expostos a HI (21-5% de oxigênio) durante 6 semanas - o grupo HI crônica (HIC) - ou a normóxia durante 6 semanas - o grupo controle. Após a exposição à HIC, um grupo de ratos foi exposto a normóxia durante 2 semanas (o grupo HIC+N). Todos os animais foram submetidos ao labirinto aquático de Morris para avaliação de memória e aprendizado; avaliou-se também a expressão do gene PEDF e da proteína PEDF no hipocampo e nos córtices frontal e temporal. Resultados: Os grupos HIC e HIC+N apresentaram um aumento de expressão do gene PEDF no córtex temporal, porém sem aumento dos níveis proteicos. A expressão do gene PEDF e da proteína PEDF manteve-se inalterada nas demais estruturas. A exposição de longa duração à HI não afetou a função cognitiva. Conclusões: A exposição de longa duração à HI aumenta seletivamente a expressão do gene PEDF ao nível transcricional, embora apenas no córtex temporal. Esse aumento é provavelmente um mecanismo de proteção contra a HI. .