Análisis clínicos en pediatría: la necesidad de minimizar las horas de ayuno / Clinical analysis in pediatrics: the need to minimize fasting hours

Los informes de laboratorio tienen impacto en las decisiones médicas. El ayuno es un factor preanalítico "controlable" que influye en los distintos parámetros bioquímicos. El objetivo del presente trabajo es poner en discusión la realización en pediatría de análisis clínicos con la indicación de un ayuno fisiológico , analizando resultados obtenidos por diferentes autores y evaluando las diferencias clínicas encontradas según los criterios de calidad establecidos por el laboratorio de Química Clínica. La mayoría de los individuos durante el día se encuentran en estado postprandial. Los resultados del perfil lipídico en ayunas no representan las concentraciones reales promedios de los lípidos plasmáticos de un paciente. El ayuno no sería crítico en la etapa de pesquisa , pero puede ser relevante para establecer un diagnóstico certero o inicio de tratamiento. En el caso de la glucemia si se indica en el control rutinario del paciente, y no hay sospecha de alteraciones en el metabolismo de los hidratos de carbono la glucemia sin ayuno puede ser solicitada comparando la misma con valores de corte adecuado. Las diferentes guías nacionales e internacionales recomiendan que la elección de la métrica para la evaluación, control y seguimiento de pacientes con diagnóstico de diabetes se realicen según el objetivo terapéutico. En los trabajos analizados, observamos que varios parámetros bioquímicos presentaron diferencias estadísticas, aunque las diferencias clínicas no fueron relevantes y permanecieron dentro de los intervalos de referencia. El factor limitante para evaluar parámetros bioquímicos sin ayuno es la falta de valores de referencia adecuados. Hay evidencia suficiente para que tanto el perfil lipídico, la glucemia como el resto de los parámetros bioquímicos del laboratorio de química clínica, sean solicitados con la indicación de un ayuno fisiológico de 2, 4 o 6 horas, dependiendo siempre del motivo de consulta y/o la edad del paciente. Es esencial extender la evaluación a otros analitos en población pediátrica, así como evaluar nuevos puntos de corte para parámetros bioquímicos sin ayuno (AU)

Laboratory reports have an impact on medical decision-making. Fasting is a "controllable" preanalytical factor that influences the different biochemical parameters. The aim of this study is to discuss the performance of clinical analyses in pediatrics with the indication of physiological fasting, analyzing results obtained in different disciplines, and evaluating the clinical differences found according to the quality criteria established by the clinical chemistry laboratory. During the day, most patients are in a postprandial state. Fasting lipid profile results do not represent the actual average plasma lipid concentrations of a patient. Fasting would not be critical in the screening stage, but it may be relevant to establish an accurate diagnosis or initiate treatment. Regarding glycemia, if it is indicated in the routine control of the patient and there is no suspicion of alterations in carbohydrate metabolism, non-fasting glycemia can be requested, comparing it with adequate cut-off values. Different national and international guidelines recommend that the choice of metrics for the evaluation, control, and follow-up of patients with diabetes should be made according to the therapeutic objective. In the studies analyzed, we found that several biochemical parameters presented statistical differences, although the clinical differences were not relevant and remained within the reference range. The limiting factor in the evaluation of biochemical parameters without fasting is the lack of adequate reference values. There is sufficient evidence that the lipid profile, glycemia, and the remaining biochemical parameters of the clinical chemistry laboratory should be requested with the indication of a physiological fast of 2, 4, or 6 hours, always depending on the reason for consultation and/or the patient's age. It is essential to extend the evaluation to other analytes in the pediatric population, as well as to evaluate new cut-off points for biochemical parameters without fasting (AU)

Administración crónica de cafeína evita la alteración de la glucosa postprandial en ratas / Chronic caffeine administration prevents postprandial glucose disturbance in rats

La administración crónica de cafeína evita la alteración de la glucosa postprandial en ratas. El aumento en el consumo de la cafeína alrededor del mundo no es discutible, es así como su investigación se ha vuelto extensa en sus diferentes campos. Objetivo. Analizar los efectos de la administración crónica de cafeína en ratas alimentadas con dieta de cafetería, a través de evaluar índices de consumo, antropométricos y bioquímicos. Materiales y métodos. La dieta de cafetería es un modelo dietético equivalente a las características de la dieta occidental típica que origina síndrome metabólico en humanos. En esta investigación se realizó la administración crónica vía intraperitoneal de cafeína por ocho semanas a ratas adultas macho Wistar alimentadas con dieta de cafetería. Dada la poca evidencia acerca de los efectos biológicos y comportamentales de la administración crónica de dicha sustancia frente a un modelo de dieta de cafetería se evaluaron parámetros de consumo, antropométricos y bioquímicos. Resultados. La dieta de cafetería ocasionó anomalías asociadas al síndrome metabólico; no obstante, la administración de cafeína en las ratas alimentadas con esa dieta resultó ser un factor protector en la glucosa postprandial, más no en la alteración de la tolerancia a la glucosa o perfil lipídico. Conclusiones. La cafeína permitió proteger los niveles de glucosa postprandial al término del experimento y un descenso en el peso corporal y consumo de alimento solo en la primera semana. Sin embargo, no se observaron mejoras significativas en el perfil de lípidos, adiposidad, tolerancia a la glucosa y glucosa plasmática(AU)

Chronic caffeine administration prevents postprandial glucose disturbance in rats. The increase in caffeine consumption is not debatable, this is how his research has become extensive in his different fields. Objective. To analyze the effects of chronic administration of caffeine in rats fed a cafeteria diet, by evaluating consumption, anthropometric and biochemical indices. Previous studies refer to administering caffeine in diets high in carbohydrates and / or in fat that induce obesity or symptoms of metabolic syndrome. Material and methods. The cafeteria diet is a dietary model equivalent to the characteristics of the typical western diet that causes metabolic syndrome in humans. In this research, chronic intraperitoneal administration of caffeine was performed for 8 weeks to adult male Wistar rats fed a cafeteria diet. Given the little evidence about the biological and behavioral effects of the chronic administration of this substance against a cafeteria diet model, consumption, anthropometric and biochemical parameters were evaluated. Results. After eight weeks it was found that the cafeteria diet given to the controls caused abnormalities associated with the metabolic syndrome; regarding the administration of caffeine in the rats fed this diet, the treatment turned out to be a protective factor in postprandial glucose, but not in the alteration of glucose tolerance or lipid profile. Conclusions. Caffeine allowed to protect postprandial glucose levels at the end of the experiment and a decrease in body weight and food consumption only in the first week. However, no significant improvements were seen in lipid profile, adiposity, glucose tolerance, and plasma glucose(AU)

Efecto sobre la saciedad y glucemia postprandial de un yogur hiperproteico vs otro normoproteico en mujeres adultas / Effect on post-prandial saciety and glucemia of a hyperproteic vs another normoproteic yogurt in adult women

Introducción: las proteínas presentes en los alimentos juegan un rol saciógeno y pueden actuar sobre la respuesta insulínica y la glucemia plasmática postprandial. Objetivos: evaluar saciedad y glucemia postprandial luego del consumo de yogur hiperproteico vs normoproteico en mujeres adultas aparentemente sanas, residentes de la Ciudad Autóno-ma Buenos Aires y el Gran Buenos Aires. Materiales y métodos: ensayo clínico cruzado simple ciego, sobre una muestra de 79 mujeres adultas (25-65 años), no diabéticas ni intolerantes a la glucosa. Se comparó saciedad, impacto glucémico y agradabilidad de dos yogures ofrecidos como merienda, con diferente aporte proteico, controlados en grasas y carbohidratos, con relación proteínas/carbohidratos: 0,56 en yogur hiperproteico y 0,33 en normoproteico. Se va-loró estado nutricional mediante índice de masa corporal (bajo peso <18,5 kg/m2, normopeso: 18,5 a 24,9 kg/m2, sobrepeso u obesidad: ≥25 kg/m2) y riesgo cardiometabólico mediante índice cintura/talla (≥0,50). Estadística mediante software SPSS 22.0, aplicando prueba de Wilcoxon y chi cuadrado o prueba exacta de Fisher, con nivel de significación estadística <0,05. Resultados: edad promedio: 34,4±11 años. El 65,8% con ade-cuado estado nutricional según IMC y 26,6% con riesgo cardio-metabólico aumentado, ambas variables asociadas en forma di-recta con la edad (p=0,0000 y p=0,001 respectivamente).El yogur hiperproteico fue más aceptado (p=0,03) con mejor res-puesta sobre saciedad post ingesta que el yogur normoproteico, a la hora y a las dos horas de ingerido (p=0,001 y p=0,000 res-pectivamente). A su vez, impactó significativamente más sobre la respuesta glucémica postprandial sólo a los 30 minutos de consu-mido (p=0,02), pero no a los 60 minutos (p=0,59). Conclusiones: el yogur hiperproteico alcanzó mayor agra-dabilidad y otorgó, a igual porción estándar, mayor saciedad postprandial que un yogur similar normoproteico, sin afectar la glucemia postprandial.

Efecto de un desayuno alto en ácidos grasos saturados vs insaturados, sobre las cifras postprandiales de glucosa y lípidos en pacientes diabéticos tipo 2 / Effect of a breakfast high in saturated vs unsaturated fatty acids on postprandial glucose and lipid values in type 2 diabetic patients

Introducción: la diabetes tipo 2 es una enfermedad cuya prevalencia se incrementa rápidamente en los países de ingresos medianos y bajos. Siendo los carbohidratos el principal determinante de la glucemia posprandial, se ha evidenciado que existe también influencia de los ácidos grasos sobre las cifras postprandiales de glucosa y lípidos. El objetivo del presente estudio es determinar si los niveles postprandiales de glucosa y lípidos difieren entre un desayuno con ácidos grasos saturados vs ácidos grasos insaturados en pacientes con diabetes mellitus tipo 2 (DMT2). Métodos: Es un estudio de tipo cuasi experimental con diseño cruzado, en el cual se realizó eva-luación antropométrica (peso, talla, IMC, circunferencia de cintura, porcentaje de grasa y músculo) y evaluación bioquímica preprandial y postprandial (glucosa, colesterol total, colesterol HLD, colesterol LDL, triglicéridos) en 30 pacientes adultos con diabetes tipo 2, a los cuales se les administró dos tipos de desayunos isocalóricos, el uno con aporte de ácidos grasos saturados 99,3 Kcal y el otro de ácidos grasos insaturados 113,4 Kcal. Resultados: la ingesta de ácidos grasos saturados produce una mayor elevación de las cifras postpran-diales de glucosa (p=0,01) y no de los lípidos postprandiales. Los ácidos grasos insaturados, permitieron llegar al objetivo de glucosa postprandial recomendada (<140mg/dL), en un mayor porcentaje de pacientes (p=0,02). Conclusiones: el consumo de un desayuno alto en ácidos grasos insaturados permitió un mejor control de las cifras postprandiales de glucosa en comparación con el consumo de un desayuno alto en ácidos grasos saturados. No existió diferencia en las cifras de lípidos posprandiales en los dos tipos de desayuno

Background and objective: type 2 diabetes mellitus is a disease that has been increasing rapidly in low- and middle-income countries, affecting a large population group. Being the carbohydrates, the main determinant of the postprandial glucose elevation, it has been evidenced that there is also an influence of the fatty acids on the postprandial values of glucose and lipids. The aim of the present study is to compare the postprandial levels of glucose and lipids between a breakfast high in saturated fatty acids vs unsaturated fatty acids in patients with T2DM. Materials and methods: it is an cuasi experimental crossover study. We did an anthropometric evaluation (weight, height, BMI, waist circumference, percentage of fat and muscle) and preprandial and postprandial biochemical evaluation (glucose, total cholesterol, HLD cholesterol, LDL cholesterol, Triglycerides) in 30 adults patients with type 2 diabetes, to determine the influence of fatty acids in two different breakfasts with the same caloric load, but each with a different contribution of saturated 99.3 Kcal or unsaturated fatty acids 113.4 Kcal. Results: the intake of a breakfast high in saturated fatty acids produced a higher increase in postprandial glucose values (p = 0.01) and not in postprandial lipids. Unsaturated fatty acids permit attain the goal of postprandial glucose (<140mg /dL) (p = 0.02) in most patients. Conclusions: The intake of high unsaturated fatty acids breakfast allowed a better postprandial glucose control, in comparison to the consumption of a breakfast high in saturated fatty acids. We did not find any difference in postprandial lipids with both types of breakfast.

Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial

ABSTRACT Objective To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. Subjects and methods The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. Results Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. Conclusions Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.

Effect of the fatty acid composition of meals on postprandial energy expenditure: a systematic review

SUMMARY The energy imbalance produced by an increase in caloric intake and/or decrease in energy expenditure induces obesity. However, the fatty acid composition of a diet can affect the metabolism in different ways, having a role in the development of obesity. AIM To determine the effect of different fatty acids types and composition on Diet-Induced Thermogenesis (DIT) and postprandial energy expenditure in humans. METHODS A search in the PubMed and Web of Science databases, yielded a total of 269 potential articles as a first result; 254 were excluded according to the criteria. RESULTS Fifteen articles were used for this systematic review. The studies analyzed report different effects of the fatty acids of the treatment on the diet-induced thermogenesis. Evidence indicates that the consumption of polyunsaturated fatty acids causes a greater DIT than saturated fatty acids. Also, the consumption of medium-chain fatty acids compared to long-chain fatty acids has been shown to increase DIT. Likewise, the use of certain oils has shown positive effects on postprandial energy expenditure, as is the case of olive oil, compared to rapeseed oil. CONCLUSIONS The use of specific types of fatty acids in the everyday diet can increase postprandial energy expenditure in humans. Nevertheless, longer-term studies are required.

RESUMO O desequilíbrio energético produzido pelo aumento da ingestão calórica e/ou diminuição do gasto energético provoca obesidade. Sem embargo, a composição de ácidos graxos da dieta pode afetar diferencialmente o metabolismo, tendo um papel no desenvolvimento da obesidade. OBJETIVO Determinar os efeitos de diferentes tipos de ácidos graxos e sua composição na termogênese induzida por dieta e no gasto energético pós-prandial em humanos. MÉTODOS Uma busca nas bases de dados da PubMed e da Web of Science gerou um total de 269 artigos potenciais como primeiro resultado; 254 foram excluídos de acordo com os critérios. RESULTADOS Quinze artigos foram utilizados para esta revisão sistemática. Os estudos analisados informam os efeitos diferenciais dos ácidos graxos no tratamento da termogênese induzida pela dieta. As evidências indicam que o consumo dos ácidos graxos poli-insaturados ocasiona maior DIT que os ácidos graxos saturados. Além disso, demonstra-se que o consumo dos ácidos graxos da cadeia média, em comparação com os ácidos graxos da cadeia longa, aumenta o DIT. Do mesmo modo, o uso de certos azeites demonstra os efeitos positivos sobre o gasto de energia pós-prandial, como é o caso do azeite de oliva, em comparação com o azeite de colza. CONCLUSÃO O uso de tipos específicos de ácidos graxos na dieta habitual pode aumentar o gasto de energia pós-prandial nos seres humanos. Sem embargo, é necessária maior investigação no longo prazo.

Isolated branched-chain amino acid intake and muscle protein synthesis in humans: a biochemical review / Consumo isolado de aminoácidos de cadeia ramificada e síntese de proteína muscular em humanos: uma revisão bioquímica

ABSTRACT Alongside a proper diet, ergogenic aids with potential direct and/or indirect physical performance enhancing effects are sought after for improved adaptation to physical training. Nutritional ergogenics include diet composition changes and/or dietary supplementation. Branched-chain amino acids valine, leucine and isoleucine are widely popular among products with ergogenic claims. Their major marketing appeal derives from allegations that branched-chain amino acids intake combined with resistance physical exercise stimulates muscle protein synthesis. Evidence supporting the efficacy of branched-chain amino acids alone for muscle hypertrophy in humans is somewhat equivocal. This brief review describes physiological and biochemical mechanisms underpinning the effects of complete protein source and branched-chain amino acid intake on skeletal muscle growth in the postabsorptive and post-exercise state. Evidence in favor of or against potential anabolic effects of isolated branched-chain amino acid intake on muscle protein synthesis in humans is also examined.

RESUMO No treinamento físico, buscam-se, além de uma dieta adequada, recursos ergogênicos que possam maximizar direta e/ou indiretamente o desempenho físico. Entre as categorias de recursos ergogênicos, o nutricional compreende a modulação da composição dietética e/ou uso de suplementação. A comercialização dos suplementos de aminoácidos de cadeia ramificada valina, leucina e isoleucina possui muita popularidade entre aqueles com alegação ergogênica. O principal marketing está na afirmação de que o consumo isolado de aminoácidos de cadeia ramificada associado ao exercício físico resistido estimula a síntese de proteína muscular. As evidências da eficácia da ingestão isolada de aminoácidos de cadeia ramificada para a hipertrofia muscular em humanos parecem equivocadas. Nesta breve revisão, apresentamos a compreensão fisiológica e bioquímica de como a ingestão de uma fonte completa de proteína e de aminoácidos de cadeia ramificada afeta o crescimento do músculo esquelético no estado pós-absortivo e pós-exercício. Mostramos também as evidências que suportam ou não a afirmação dos potenciais efeitos anabólicos na síntese de proteína muscular dos aminoácidos de cadeia ramificada quando consumidos isoladamente em humanos.

Metabolic and endocrinal effects of epidural glucocorticoid injections

INTRODUCTION@#Epidural steroid injections are an integral part of nonsurgical management of radicular pain from lumbar spine disorders. We studied the effect of dexamethasone 8 mg epidural injections on the hypothalamic-pituitary-adrenal axis and serum glucose control of Asian patients.@*METHODS@#18 patients were recruited: six diabetics and 12 non-diabetics. Each patient received a total of dexamethasone 8 mg mixed with a local anaesthetic solution of lignocaine or bupivacaine, delivered into the epidural space. Levels of plasma cortisol, adrenocorticotropic hormone (ACTH), serum glucose after an overnight fast and two-hour postprandial glucose, as well as weight, body mass index, blood pressure and heart rate were measured within one week prior to the procedure (baseline) and at one, seven and 21 days after the procedure.@*RESULTS@#Median fasting blood glucose levels were significantly higher on post-procedure Day 1 than at baseline. However, there was no significant change in median two-hour postprandial blood glucose from baseline levels. At seven and 21 days, there was no significant difference in fasting or two-hour postprandial glucose levels. Both ACTH and serum cortisol were significantly reduced on Day 1 compared to baseline in all patients. There was no significant difference in ACTH and serum cortisol levels from baseline at Days 7 and 21.@*CONCLUSION@#Our study shows that epidural steroid injections with dexamethasone have a real, albeit limited, side effect on glucose and cortisol homeostasis in an Asian population presenting with lower back pain or sciatica.

Rol del enterocito en la dislipidemia de la diabetes mellitus tipo 2 / Role of the enterocyte in type 2 diabetes mellitus associated dyslipidemia

En la diabetes mellitus tipo 2 el aumento en la producción de quilomicrón en el estado post-prandial se asocia a mayor riesgo cardiovascular. La evidencia actual posiciona al enterocito como actor principal en la dislipemia de la diabetes mellitus tipo 2 debido a que aumenta la producción de apolipoproteína B-48 en respuesta a una elevación de ácidos grasos libres y glucosa. El metabolismo del quilomicrón se encuentra regulado por múltiples factores independientes además de la ingesta de grasa alimentaria. Entre estos factores se destacan las hormonas intestinales, como el péptido similar al glucagón tipo 1 que disminuye la producción de apolipoproteína B-48 y el péptido similar al glucagón tipo 2 que la aumenta. Por otro lado, la insulina inhibe de forma aguda la producción de quilomicrón en el sujeto sano mientras que en la diabetes mellitus tipo 2, este efecto está ausente. La comprensión de los factores reguladores emergentes de la secreción de quilomicrón permite vislumbrar nuevos mecanismos de control en su metabolismo y aportar estrategias terapéuticas focalizadas en la hiperlipidemia posprandial en la diabetes mellitus tipo 2 con la reducción del riesgo cardiovascular.

In type 2 diabetes mellitus there is an overproduction of chylomicron in the postprandial state that is associated with increased cardiovascular risk. Current evidence points out a leading role of enterocyte in dyslipidemia of type 2 diabetes mellitus, since it increases the production of apolipoprotein B-48 in response to a raise in plasma free fatty acids and glucose. The chylomicron metabolism is regulated by many factors apart from ingested fat, including hormonal and metabolic elements. More recently, studies about the role of gut hormones, have demonstrated that glucagon-like peptide-1 decreases the production of apolipoprotein B-48 and glucagon-like peptide-2 enhances it. Insulin acutely inhibits intestinal chylomicron production in healthy humans, whereas this acute inhibitory effect on apolipoprotein B-48 production is blunted in type 2 diabetes mellitus. Understanding these emerging regulators of intestinal chylomicron secretion may offer new mechanisms of control for its metabolism and provide novel therapeutic strategies focalized in type 2 diabetes mellitus postprandial hyperlipidemia with the reduction of cardiovascular disease risk.

Comparação dos níveis de proteína C reativa, GLP-1 e GLP-2 entre indivíduos diabéticos, obesos mórbidos e controles saudáveis: um estudo exploratório / Comparison of the levels of c-reactive protein, glp-1 and glp-2 among individuals with diabetes, morbid obesity and healthy controls: an exploratory study

ABSTRACT BACKGROUND: The glucagon-like peptides 1 and 2 (GLP-1/GLP-2) are gut hormones that may directly affect the glucose homeostasis and their activity seems to be significantly affected by chronic inflammation. OBJECTIVE: To evaluate the postprandial levels of glucagon-like peptides 1 and 2 (GLP-1/GLP-2), C-reactive protein (CRP), and the postprandial glucose and insulin levels among individuals with obesity, type 2 diabetes, and healthy controls. METHODS: An exploratory cross-sectional study, which involved individuals awaiting for bariatric/metabolic surgery and healthy controls. Postprandial levels of GLP-1, GLP-2, glucose, and insulin were obtained after a standard meal tolerance test. Inflammation was assessed by means of CRP. RESULTS: There were 30 individuals enrolled in the study, divided into three groups: non-diabetic with morbid obesity (NDO; n=11 individuals), diabetic with mild obesity (T2D; n=12 individuals), and healthy controls (C; n=7 individuals). The mean CRP levels were significantly higher in the NDO group (6.6±4.7 mg/dL) than in the T2D (3.3±2.2 mg/dL) and C groups (2.5±3.2 mg/dL) (P=0.038). The GLP-1 levels following standard meal tolerance test and the area under the curve of GLP-1 did not differ among the three groups. The GLP-2 levels were significantly lower in the NDO and T2D than in the C group following standard meal tolerance test at all the times evaluated. The area under the curve of the GLP-2 was significantly lower in the NDO and T2D groups than in the C group (P=0.05 and P=0.01, respectively). CONCLUSION: GLP-2 levels were impaired in the individuals with obesity and diabetes. This mechanism seems to be enrolled in preventing the worsening of the glucose homeostasis in these individuals.

RESUMO CONTEXTO: Os peptídeos semelhantes ao glucagon 1 e 2 (GLP-1/GLP-2) são hormônios gastrointestinais que podem afetar diretamente a homeostase glicêmica; a atividade de ambos parece ser significativamente afetada pela inflamação crônica. OBJETIVO: Avaliar os níveis pós-prandiais dos peptídeos semelhantes ao glucagon 1 e 2 (GLP-1/GLP-2), proteína C reativa (PCR) e as curvas pós-prandiais de glucose e insulina entre indivíduos com obesidade, diabetes tipo 2 e controles saudáveis. MÉTODOS: Estudo piloto transversal, que envolveu indivíduos aguardando a realização de cirurgia bariátrica/metabólica e controles saudáveis. Os níveis de GLP-1, GLP-2, glucose e insulina foram obtidos após um teste de refeição padrão. A inflamação foi avaliada através dos níveis de PCR. RESULTADOS: Houve 30 indivíduos avaliados no estudo, divididos em três grupos: obesos mórbidos sem diabetes (NDO; n=11 pacientes), diabéticos com obesidade leve (T2D; n=12 pacientes) e controles (C; n=7 pacientes). Os níveis médios de PCR foram significativamente maiores no grupo NDO (6,6±4,7 mg/dL) do que nos grupos T2D (3,3±2,2 mg/dL) e C (2,5±3,2 mg/ dL) (P=0,038). Os níveis de GLP-1 após o teste de refeição padrão e a área sob a curva do GLP-1 não diferiram significativamente entre os grupos. Os níveis de GLP-2 foram significativamente mais baixos nos grupos NDO e T2D do que no grupo C em todos os tempos avaliados. A área sob a curva do GLP-2 foi significativamente menor nos grupos NDO e T2D do que no grupo C (P=0,05 and P=0,01, respectivamente). CONCLUSÃO: Os níveis de GLP-2 encontram-se alterados em indivíduos com obesidade e diabetes. Este mecanismo parece estar envolvido na prevenção da piora da homeostase glicêmica nestes indivíduos.

Gastric emptying scintigraphy in postprandial distress syndrome

Objective: To find out the pattern of gastric emptying scintigraphy [GES] in patients with post prandial distress syndrome [PDS]

Methods: This study was carried out from January 2015 to July 2016 at Combined Military Hospital [CMH] Kharian and Nuclear Medical Centre [NMC] of Armed Forces Institute of Pathology [AFIP] Rawalpindi. Patient's inclusion criteria were dyspepsia of post prandial distress type for more than six months duration. Patients with dyspepsia due to epigastric pain syndrome and other organic disorder were excluded. Upper gastrointestinal endoscopy was performed in all patients to rules out organic causes. Four-hour Gastric emptying scintigraphy was carried out at NMC, AFIP. Results were compiled and statistical assessment was done by utilizing SPSS IBM 22 version

Results: Thirty-eight patients were included in the study with age range from 15-72 years with mean age of 37.05 +/- 13.5 years. Males were 28[73.7%] and 10[26.7%] were female. Mean gastric retention with SD at one, two, three and four hours were 63 +/- 19.04, 37 +/- 20.62, 19 +/- 16.66 and 10 +/- 12.73 percent respectively. Early gastric emptying was in 3[7.89%] and delayed gastric emptying at two and four hours was seen in 4[10.52%] and 12[32%] respectively. Seventeen [44%] of the patients had normal gastric emptying despite the classical symptoms of PDS

Conclusion: Gastric dysmotility in GES seen in half of the patients points some additional mechanism as well like gastric accommodation or visceral hypersensitivity in the patients with PDS

Increased Postprandial Colonic Motility and Autonomic Nervous System Activity in Patients With Irritable Bowel Syndrome: A Prospective Study

BACKGROUND/AIMS: The prevalence and severity of irritable bowel syndrome (IBS) declines with age, but the cause of this is unknown. This study tested 2 hypotheses: (1) autonomic nervous system responses to eating and bowel distention, measured by heart rate variability (HRV), differs by age in IBS patients and (2) HRV is correlated with colonic motility and IBS symptoms. METHODS: One hundred and fifty-six Rome III positive IBS patients and 31 healthy controls underwent colonic manometry with bag distention in the descending colon, followed by ingestion of an 810-kcal meal. HRV, evaluated by low frequency (%LF; 0.04–0.15 Hz) component, high frequency (%HF; 0.15–0.40 Hz) component, and the LF/HF ratio, was measured during colonic distention and after the meal. Motility index and subjective symptom scores were simultaneously quantified. RESULTS: Both colonic distention and eating decreased %HF and increased the LF/HF ratio, and both indices of autonomic nervous system correlated with age. In IBS patients, %HF negatively correlated with the postprandial motility index after adjusting for age. The %HF and LF/HF ratios also correlated with psychological symptoms but not bowel symptoms in IBS patients. CONCLUSION: Decreased vagal activity is associated with increase in age and greater postprandial colonic motility in patients with IBS, which may contribute to postprandial symptoms.

Efeito de uma refeição hiperlipídica no período pós-prandial sobre a expressão de microRNA em mulheres saudáveis / Effect of a high-fat meal in the postprandial period on microRNA expression in health women

Introdução - Evidências mostram que a ingestão de uma refeição hipercalórica, rica em lipídios e açúcares, provoca elevação da concentração plasmática de glicose e de triacilgliceróis (TG), bem como de lipopolissacarídeos (LPS) no período pós-prandial. Sugere-se que essa condição esteja envolvida na gênese da inflamação subclínica, caracterizada pelo aumento da concentração de biomarcadores pró-inflamatórios na circulação sanguínea, como o fator de necrose tumoral (TNF)-α, interleucina (IL)-1β, IL- 6 e as moléculas de adesão intracelular solúvel (sICAM)-1 e vascular solúvel (sVCAM)- 1, o que contribui para o aumento do risco para doenças cardiovasculares. Estudos recentes sugerem que os microRNA (miRNA) atuam como biomarcadores inflamatórios e a análise da sua expressão no período pós-prandial pode contribuir para a redução do risco de doenças cardiovasculares. Objetivo - Investigar o efeito de uma refeição hiperlipídica, rica em ácidos graxos saturados, sobre a expressão de microRNA e a concentração de LPS no plasma no período pós-prandial em mulheres saudáveis. Métodos - Realizou-se um estudo de intervenção no qual foi oferecido uma refeição matinal com alto teor de lipídios, principalmente, de ácidos graxos saturados, mais 500 mL de água, realizando-se coletas de sangue no período basal e 1, 3 e 5 horas após a ingestão da refeição hiperlipídica. A população do estudo foi composta por mulheres saudáveis (n = 11), com idade entre 20 e 40 anos, e IMC de 18,5 a 25 kg/m². Foram avaliadas as concentrações plasmáticas de glicose, insulina, perfil lipídico e de ácidos graxos, citocinas, moléculas de adesão, MCP-1 e LPS. Analisou-se pelo ensaio de PCR em tempo real, um perfil de expressão de 752 miRNA plasmáticos humanos. Essas análises foram realizadas em todos os tempos da coleta de sangue. Resultados - Houve aumento significativo das concentrações plasmáticas de LPS e TG nos tempos 1, 3 e 5 horas em relação ao período basal. As concentrações plasmáticas de insulina elevaram-se de forma significativa após 1 e 3 horas em comparação ao período basal, e reduziu após 5 h se comparado ao tempo 1 h. Os ácidos graxos saturados plasmáticos mirístico e palmítico aumentaram após o consumo da refeição. Houve aumento das concentrações plasmáticas de TNF-α após 5h se comparado ao basal e ao tempo 1 h. E houve aumento da concentração de sVCAM-1 após 5 h vs o basal. Em relação aos miRNA, 45 miRNA tiveram suas concentrações alteradas se comparadas entre todos os tempos, destes 33 miRNA vs o basal. Conclusões - O aumento de TG e insulina após a refeição hiperlipídica pode contribuir para explicar a participação da dieta no desenvolvimento de um quadro inflamatório, promovido, também, por um quadro de endotoxemia pós-prandial. Junto a isso, os miRNA podem exercer papel importante na regulação deste quadro. Uma refeição hiperlipídica, com elevado teor de ácidos graxos saturados, ocasiona um quadro de endotoxemia metabólica e altera a expressão de microRNA plasmáticos envolvidos na regulação do processo inflamatório no período pós-prandial

Introduction Evidence shows that a high caloric meal, rich in lipids and carbohydrates, increase glucose and triacyclglycerols (TG) concentrations, furthermore in lipopolysaccharides (LPS) in the postprandial period. This condition is involved with subclinic inflammation genesis, characterized by increased concentration of inflammatory biomarkers in blood circulation, like tumor necrose fator (TNF)-α, interleukin (IL)-1β, IL-6 and soluble intracellular adhesion molecule (sICAM)-1 and soluble vascular (sVCAM)-1, what contributes to rise cardiovascular disease risk. Recent studies indicate that microRNAs (miRNA) act as inflammatory biomarkers and analysis of their expression in the postprandial state could contribute to reduction of cardiovascular disease risk. Objective This study investigates the high-fat high-saturated meal effect above miRNA expression and LPS concentration at the postprandial period in healthy women. Methods An interventional study was carried out in which a breakfast with a high lipid content, mainly of saturated fatty acids, plus 500 mL of water was offered. Blood samples were collected at baseline and 1, 3 and 5 hours after ingestion of the high-fat meal. The study population consisted of healthy women (n = 11), aged between 20 and 40 years, and BMI of 18.5 to 25 kg / m². Plasma concentrations of glucose, insulin, lipid profile and fatty acids, cytokines, adhesion molecules, MCP-1 and LPS were evaluated. An expression profile of 752 human plasma miRNA was analyzed by the real-time PCR assay. These analyzes were performed at all times of blood collection. Results - There was a significant increase in the plasma concentrations of LPS and TG at times 1, 3, 5 hours in relation to the baseline. Plasma insulin concentrations increased significantly after 1 and 3 hours compared to baseline, and decreased after 5 h compared to 1 h. Myristic and palmitic saturated fatty acids increased after consumption of the meal. There was an increase in plasma concentrations of TNF-α after 5 hours compared to the baseline and at 1 h. And there was an increase in sVCAM-1 concentration after 5 hours vs baseline. Regarding the miRNA, 45 miRNA had their concentrations altered when compared among all the times, of these 33 miRNA vs the baseline. Conclusions - The increase of TG and insulin after the high-fat meal may contribute to explain diet participation in the development of an inflammatory condition, also promoted by postprandial endotoxemia. In addition, microRNAs may play a key role in the regulation of this condition. High-fat high-saturated meal generates a metabolic endotoxemia state and changes plasma microRNAs expression which are involved in regulation to inflammatory process in the postprandial period

Orange juice with a high-fat meal prolongs postprandial lipemia in apparently healthy overweight/obese women

ABSTRACT Objective We investigated the postprandial response of lipid markers to a high-fat meal (HFM) with two different beverages in apparently healthy normal-weight and overweight/obese women. Subjects and methods This crossover, randomized study enrolled 36 women, of whom 21 had normal weight (body mass index [BMI] 22 ± 1.8 kg/m2) and 15 had overweight/obesity (BMI 31 ± 3.7 kg/m2). In two different test days, the participants ingested a HFM (37% of energy as saturated fat) with 500 mL of water (HFM-W) or 500 mL of orange juice (HFM-OJ). Blood samples were collected at baseline (12-hour fasting), and at 2, 3, and 5 hours postprandial. The analysis included fasting and postprandial total cholesterol, HDL-c, LDL-c, triglycerides (TG), uric acid, and complement C3. Brazilian Clinical Trials Registry (ReBEC); Primary Identification Number: RBR-2h3wjn (www.ensaiosclinicos.gov.br). Results TG levels increased at 3 hours with HFM-OJ in normal-weight women (p = 0.01) and returned to normal levels at 5h. TG increased at 3 hours with HFM-W (p = 0.01) and HFM-OJ (p = 0.02), and remained high at 5 hours (p = 0.03) in overweight/obese women. Complement C3 remained unchanged, but showed different responses between meals (p = 0.01 for positive incremental area under the curve [piAUC] HFM-OJ vs. HFM-W, respectively). Conclusions In apparently healthy overweight/obese women compared with normal-weight ones, the concomitant intake of orange juice with a HFM prolonged postprandial lipemia but had no effect on postprandial complement C3 concentrations.

Blood pressure variability in the elderly. Association between postprandial and sleeping periods / Variabilidade da Pressão Arterial no Idoso. Associação entre os períodos pós prandial e sono

Abstract Introduction: The variability of arterial blood pressure (BP) is considered an important cardiovascular risk factor. Objective: To verify the possible associations between the postprandial and the sleeping blood pressure variability. Methods: This study evaluated systolic, diastolic, mean, pulse pressures and heart variability in 69 elderly patients in preprandial, postprandial and sleeping periods. One 24 hours ambulatory blood pressure monitoring was used for measurements and the results were showed in the time-rate index. Results: We observed a decrease in the systolic blood pressure values from preprandial to postprandial and to the sleeping periods (124.7 ± 14.6, 113.2 ± 15.3 and 108.5 ± 13.9mmHg, respectively; p = 0.003). Associations between BP variability of the postprandial and sleeping periods were obtained for systolic, diastolic and mean arterial pressure. Conclusion: The correlation between postprandial and sleeping BP variability has rarely been demonstrated in the literature. These correlations between BP changes after eating and during sleep might suggest that both events could coexist in other clinical situations.

Resumo Introdução: A variabilidade da Pressão Arterial Sistêmica (PAS) é considerada um importante fator de risco cardio vascular. Objetivo: Verificar as possíveis associações entre as variabilidades pressóricas nos períodos pós prandial e durante o sono. Métodos: A variabilidade das pressões sistólica, diastólica, média, de pulso e frequência cardíaca foram avaliadas em 69 pacientes idosos nos períodos pós prandial e durante o sono. A Monitorização Ambulatorial da Pressão Arterial de 24 horas foi usada para o cálculo da variabilidade pressórica e os resultados apresentados no índice frequência tempo. Resultados: Observamosuma redução nos níveis sistólicos pos prandiais em relação ao período pre prandial e durante o sono (124.7 ± 14.6, 113.2 ± 15.3 e 108.5 ± 13.9mmHg, respectivamente; p = 0.003). A associação das variabilidade das pressões sistólicas, diastólicas e média foram confirmadas (p < 0.005) entre osperíodos avaliados. Conclusão: A correlação entre as variabilidades da pressão arterial apos as refeições e o sono tem sido pouco demonstrada na literatura. Estas relações podem sugerir que ambos os eventos podem coexistir em outras situações clínicas.

The role of dietary fatty acid intake in inflammatory gene expression: a critical review / O papel da ingestão dos ácidos graxos da dieta na expressão de genes inflamatórios: uma revisão crítica

ABSTRACT CONTEXT AND OBJECTIVE: Diet is an important modifiable factor involved in obesity-induced inflammation. We reviewed clinical trials that assessed the effect of consumption of different fatty acids on the expression of inflammation-related genes, such as cytokines, adipokines, chemokines and transcription factors. DESIGN AND SETTING: Narrative review study conducted at a research center. METHODS: This was a review on the effect of fat intake on inflammatory gene expression in humans. RESULTS: Consumption of saturated fatty acids (SFAs) was related to postprandial upregulation of genes associated with pro-inflammatory pathways in peripheral blood mononuclear cells (PBMCs), in comparison with monounsaturated fatty acid (MUFA) or polyunsaturated fatty acid (PUFA) intake. In addition, acute intake of a high-SFA meal also induced a postprandial pro-inflammatory response for several inflammatory genes in subcutaneous adipose tissue. Both high-MUFA and high-PUFA diets showed anti-inflammatory profiles, or at least a less pronounced pro-inflammatory response than did SFA consumption. However, the results concerning the best substitute for SFAs were divergent because of the large variability in doses of MUFA (20% to 72% of energy intake) and n3 PUFA (0.4 g to 23.7% of energy intake) used in interventions. CONCLUSIONS: The lipid profile of the diet can modulate the genes relating to postprandial and long-term inflammation in PBMCs and adipose tissue. Identifying the optimal fat profile for inflammatory control may be a promising approach for treating chronic diseases such as obesity.

RESUMO CONTEXTO E OBJETIVO: A dieta é um importante fator modificável envolvido na inflamação induzida pela obesidade. Nós revisamos ensaios clínicos que avaliaram o efeito do consumo de diferentes ácidos graxos sobre a expressão de genes relacionados com a inflamação, tais como citocinas, adipocitocinas, quimiocinas e fatores de transcrição. TIPO DE ESTUDO E LOCAL: Estudo de revisão narrativa realizado em um centro de pesquisa. MÉTODOS: Revisão do efeito da ingestão de gordura sobre a expressão de genes envolvidos com inflamação em seres humanos. RESULTADOS: O consumo do ácido graxo saturado (AGS) foi relacionado com a regulação favorável pós-prandial de genes associados com vias pró-inflamatórias nas células mononucleares de sangue periférico (CMSP), em comparação com a ingestão do ácido graxo monoinsaturado (AGMI) ou do ácido graxo poli-insaturado (AGPI). Além disso, o consumo agudo de uma dieta com alto conteúdo de AGS também induziu uma resposta pró-inflamatória pós-prandial para vários genes da inflamação no tecido adiposo subcutâneo. Ambas as dietas com alto conteúdo de AGMI e AGPI apresentaram perfil anti-inflamatório ou, pelo menos, menor resposta pró-inflamatória em relação ao consumo de AGS. Contudo, os resultados são controversos acerca do melhor substituto para o AGS, devido à grande variabilidade na dose de AGMI (20% a 72% da ingestão energética) e AGPI n3 (0,4 g para 23,7% da ingestão energética) utilizados nos estudos de intervenção. CONCLUSÕES: O perfil lipídico da dieta pode modular os genes relacionados com inflamação pós-prandial e a longo prazo em CMSP e no tecido adiposo. Identificar o perfil lipídico ideal no controle inflamatório pode ser uma abordagem promissora para o tratamento de doenças crônicas como a obesidade.

Effect of diacerein as an add-on to metformin in patients with type 2 diabetes mellitus and inadequate glycemic control

ABSTRACT Objective To evaluate the effect of diacerein as an add-on to metformin in patients with type 2 diabetes mellitus (T2DM) and inadequate glycemic control. Materials and methods A randomized, double-blind, placebo-controlled clinical trial was carried out on 12 patients with T2DM and inadequate glycemic control [glycated hemoglobin A1c (A1C) ≥ 7%] with metformin as monotherapy (≥ 1500 mg per day) for at least the previous 90 days. Fasting and postprandial glucose were measured before and after the pharmacological intervention. A1C, lipid profile, creatinine and uric acid were also evaluated. After randomization, all patients continued with their dose of metformin. Six subjects received placebo and the other six volunteers took diacerein. Data were tested using the Wilcoxon signed-rank, Mann-Whitney U and chi-square tests. The Institutional Ethics Committee approved the study protocol. Results After 90 days of diacerein as an add-on to metformin, there was a significant decrease in fasting glucose (196 ± 79 vs. 149 ± 70 mg/dL, p < 0.05), postprandial glucose (262 ± 99 vs. 187 ± 70 mg/dlL, p < 0.05) and A1C (8.4 ± 2.0 vs. 6.7 ± 1.7 %, p < 0.05). Conclusions Diacerein as an add-on to metformin in patients with T2DM improved their glycemic control.