El ayuno intermitente y sus efectos en la salud metabólica en humanos / Intermittent fasting and human metabolic health

Intermittent fasting (IF) has gained increasing scientific and general attention. Most studied forms of IF include alternate-day fasting, modified alternate-day fasting, and time-restricted eating (TRE). Several cardiometabolic effects of IF have been described in animal models and, to a lesser extent, in humans. This review analyzes the impact of IF on weight loss, glucose metabolism, blood pressure, and lipid profile in humans. A literature search was conducted in the Pubmed/Medline, Scopus, and Google Scholar databases. Controlled observational or interventional studies in humans, published between January 2000 and June 2021, were included. Studies comparing IF versus religious fasting were not included. Most studies indicate that the different types of IF have significant benefits on body composition, inducing weight loss and reducing fat mass. Changes in cardiometabolic parameters show more divergent results. In general, a decrease in fasting glucose and insulin levels is observed, together with an improved lipid profile associated with cardiovascular risk. High heterogeneity in study designs was observed, particularly in studies with TRE, small sample sizes, and short-term interventions. Current evidence shows that IF confers a range of cardiometabolic benefits in humans. Weight loss, improvement of glucose homeostasis and lipid profile, are observed in the three types of IF protocols evaluated.

La suplementación con zinc reduce la concentración de ácidos grasos libres en pacientes con diabetes tipo 2

RESUMEN Elevadas concentraciones de ácidos grasos libres (AGL) han sido asociadas con la patogénesis de resistencia a la insulina y diabetes tipo 2 (DT2), por lo que la regulación de la lipólisis resulta prioritaria en estos pacientes. El zinc mediante sus acciones insulinomiméticas e inducción de fosfodiesterasas podría regular la liberación de AGL desde el tejido adiposo. El objetivo de esta investigación fue evaluar en pacientes con DT2 el efecto de 24 meses de suplementación con zinc sobre las concentraciones séricas de AGL en ayuno. Para este propósito: se realizó la determinación de AGL en ayuno por colorimetría enzimática, zinc plasmático por espectrofotometría de absorción atómica, y parámetros bioquímicos y antropométricos de interés en 60 pacientes con DT2 que fueron asignados aleatoriamente para recibir suplementación con 30 mg/día de zinc (n= 30) o placebo (n= 30) por 24 meses. El grupo zinc presentó menor concentración sérica de AGL al mes 24 (p = 0,034). El cambio en el índice de masa corporal, el sexo y la suplementación con zinc contribuyeron significativamente como predictores de la concentración sérica de AGL al mes 24 (R= 0,493, R2= 0,243, p= 0,001). Conclusión: la suplementación con 30 mg/día de zinc en pacientes con DT2 tuvo un efecto significativo en reducir la concentración sérica de AGL en ayuno tras 24 meses de tratamiento. Estos resultados apoyan los beneficios del zinc como coadyuvante en el tratamiento de DT2.

ABSTRACT High concentrations of free fatty acids (FFA) have been associated with the pathogenesis of insulin resistance and type 2 diabetes (T2D), making lipolysis regulation a priority in these patients. Through its insulin-mimetic actions and phosphodiesterase induction, zinc could regulate FFA release from adipose tissue. The objective of this research was to evaluate the effect of 24 months of zinc supplementation on fasting serum FFA concentrations in patients with T2D. For this purpose: fasting FFA by enzymatic colorimetric, plasma zinc by atomic absorption spectrophotometry, and biochemical and anthropometric parameter of interest were determined in 60 T2D patients who were randomly assigned to 30 mg/day of zinc supplementation (n= 30) or placebo (n= 30) for 24 months. The zinc group had lower serum FFA concentration at month 24 (p= 0.034). Body mass index change, gender, and zinc supplementation contributed significantly as predictors of serum FFA concentration at month 24 (R= 0.493, R2= 0.243, p= 0.001). Conclusion: Supplementation with 30 mg/day of zinc in patients with T2D had a significant effect in reducing serum fasting FFA concentration after 24 months of treatment. These results support the benefits of zinc as coadjutant in T2D treatment.

Validación y generación de ecuaciones para estimar masa grasa corporal en adultos chilenos, formuladas a partir de bioimpedanciometría, en un amplio rango de edad e índice de masa corporal

Background: Equations for the evaluation of fat-free mass (FFM) and fat mass (FM) with Bioelectrical impedance analysis (BIA) were formulated in Caucasian populations. International recommendations suggest that population-specific equations should be formulated. Aim: To validate an equation previously formulated in Chileans adults and compare it to a new equation generated on an independent sample. Material and Methods: In 108 adult volunteers aged 38.1±14.1 years (44% males), with a body mass index (BMI) of 25.1± 4.1 kg/m2, body composition was measured by BIA (Bodystat) and dual X-ray absorptiometry (DXA: Lunar Prodigy). Body composition estimated using Schifferli equation and BIA were compared with DEXA, by the Bland-Altman method and simple linear regression. Results: FFM and FM measured by DXA were 45.2 ± 9.8 kg and 29.6 ± 11.7 % respectively. Resistance was 467.7 ± 76.3 ohm. Schifferli equation and BIA significantly overestimated FFM by 7.3 and 7.4 kg, respectively. The error was higher for high levels of FFM (slope β < 1, p < 0.01). Both equations underestimated FM measured by DXA (averages of 7.5 and 7.8%, respectively, p < 0.01), without a differential bias for Schifferli equation, but with a bias in low levels of FM measured with BIA (slope β < 1, p < 0.01). Estimation biases could be eliminated using the regression coefficients. Conclusions: Both equations behave similarly and have biases, although less with Schifferli. Statistically correcting for biases, the new adjusted equations provide clinically valid estimates of FFM and FM. Equations should not only be population-specific, but also device-specific.

Efecto del fraccionamiento de la dieta y cantidad de hidratos de carbono en el control metabólico en pacientes con diabetes mellitus tipo 2, sin terapia con insulina / Effect of meal frequency and carbohydrate intake on the metabolic control of patients with type 2 diabetes mellitus

Background: Increasing meal frequency is commonly used in the clinical practice as part of the nutritional treatment of patients with type 2 Diabetes Mellitus (DM2), although its effect on metabolic control parameters is controversial. Aim: To evaluate the association of energy intake, meal frequency, and amount of carbohydrates with fasting plasma glucose and glycosylated hemoglobin in a group of patients with DM2 without insulin therapy. Material and Methods: Dietary intake was evaluated in 60 subjects with DM2 through three-day food records. The meal frequency was estimated establishing the main meal times considering snacks. Results: Meal frequency was 4.7 ± 1.1 times per day. There was a positive association between glycosylated and fasting blood glucose levels (p <0.01). Meal frequency was associated with energy intake (p <0.01). When meal frequency, available carbohydrates and energy intake, body mass index and fasting plasma glucose were analyzed in a multiple linear regression model, fasting blood glucose was the variable that best predicted changes in glycosylated hemoglobin (45.5%). Meal frequency had no association with glycosylated hemoglobin. Conclusions: Meal frequency showed no association with metabolic control parameters in DM2 patients.

II Consenso de la Sociedad Chilena de Endocrinología y Diabetes sobre resistencia a la insulina

Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.

Formulación de una ecuación para predecir la masa grasa corporal a partir de bioimpedanciometría en adultos en un amplio rango de edad e índice de masa corporal / Formulation of an equation to predict fat mass using bioelectrical impedance in adults in a wide range of ages and body mass index

Background: Bioelectrical impedance (BIA) has a good correlation and agreement with reference techniques, such as dual energy X-ray absorptiometry (DEXA), to assess body composition. Aim: To develop and assess the concordance of an equation to predict body fat mass derived from anthropometric data, gender, age and resistance obtained from bioelectrical impedance in adults, using DEXA as the reference method. Patients and Methods: Cross-sectional study of 62 women and 59 men aged 18 to 64 years with a body mass index ranging from 18.5 to 34.8 kg/ m². The equation was constructed using a predictive statistical model, considering sex, age, weight, resistance index (height²(cm)/ resistance (ohms)), as independent variables, and fat mass as the dependent variable. Results: The R² of the regression model was 0.96, and the standard error of estimation was 2.58 kg (p < 0.001). When comparing with DEXA, no significant differences were observed for the estimation of FM, between the equation developed in this work and that proposed by the manufacturer of the BIA equipment. However, the latter equation, underestimated FM by -2.5 ± 9.5% (p > 0.05) and - 4.5 ± 8,9% (p < 0.05) in both genders and in women, respectively. Conclusions: The concordance between estimation of fat mass by the formula developed in this work and by DEXA was better than the estimation obtained using the formula proposed by the manufacturer of the BIA equipment.

Calidad de la alimentación de mujeres con obesidad severa y mórbida sometidas a bypass gastrico y gastrectomia vertical en manga

El objetivo de este estudio fue comparar la ingesta de energía y nutrientes y la calidad de la alimentación, en pacientes sometidos a bypass gástrico en Y de Roux y (BPGYR) y gastrectomía vertical en manga (GVM). En 36 mujeres con obesidad severa y mórbida se estudió la alimentación previa y a los 6 meses posteriores a la cirugía, mediante encuesta de registro de tres días, se analizó el grado de adecuación e índice de calidad nutricional (ICN). Se controló estrictamente el consumo de suplementos de vitaminas y minerales. El consumo de energía y nutrientes fue significativamente menor al sexto mes post cirugía comparado con el preoperatorio, sin diferencias significativas entre grupos, excepto calcio y vitamina C. El ICN fue similar entre grupos. La ingesta dietética de calcio, hierro, zinc, cobre, ácido fólico, vitamina C y E fue menor al 100% de adecuación al 6º mes. Sin embargo, al considerar en conjunto el aporte de la dieta como de los suplementos, la adecuación de prácticamente todos los nutrientes estudiados sobrepasa el 100% en ambos grupos, logrando una mayor adecuación el grupo sometido a BPGYR. Las excepciones las constituyen el calcio, el cual no alcanza a cubrir el 100% en ningún grupo y el ácido fólico en el grupo sometido a GVM. En conclusión, estos pacientes presentan reducciones importantes de la ingesta dietética de energía y micronutrientes, sin mayores diferencias dependientes del tipo de cirugía. Las características de los suplementos son críticos para lograr la cobertura de las necesidades.

The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass and sleeve surgery. In 36 women with severe and morbid obesity it was assessed their nutrient intakes and dietary quality before and 6 months after bariatric surgery through three-day food records. Vitamin and mineral intakes from supplements were strictly controlled. Energy and nutrient intakes were significantly decreased 6 months after surgery bypass compared to the pre-surgery period, with the exceptions of calcium and vitamin C. No differences were observed between groups. The Dietary quality index was also similar in both groups. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100% of adequacy from at the 6th month after the surgery. Nevertheless, by considering both diet and supplements supply, nutrient adequacy of all but calcium and folic acid was above 100% in both groups. Gastric bypass patients presented greater values. In conclusion, these patients present an important reduction of their energy and nutrient intakes, with no major impact of the type of surgery. Supplement characteristics are crucial to cover nutritional needs.

Diagnóstico, evaluación y tratamiento no farmacológico del paciente con sobrepeso u obesidad / Statement about diagnosis assessment ano non pharmacological treatment of obesity

The risk of complications of obesity is proportional to body mass index and is higher in severe or morbid obesities and when abdominal or visceral fat is predominant. In Chile the prevalence of obesity is increasing. According to the World Health Organization, obese subjects must reduce at least a 5 percent of their weight to reduce the risk of complications. Although this amount of reduction is seldom achieved with non pharmacological treatments, better results are obtained with multidisciplinary/ approaches that include a medical, psychosocial and laboratory assessment, to determine obesity level and different factors involved and the associated complications. In a second stage, goals of treatment are set and a personalized treatment is designed including dietary changes and physical activity. The aim is to obtain perdurable lifestyles modifications.

Tratamiento farmacológico o quirúrgico del paciente con sobrepeso u obesidad / Statement about the medical and surgical treatment of overweight and obesity

This is an updated review of the available treatments for obesity, which can be used when lifestyles modifications fail. Using the available information and the experience of the members of this advisory group, a recommendation is given about the most useful treatments, according to the severity of obesity and its complications. With regards to pharmacological treatments, only sibutramine and orlistat are approved on a worldwide basis for the treatment of obesity. These medications achieve a 10 percent higher weight reduction than lifestyles modification. A third medication, rimonobant, is also more effective than lifestyles modifications, but it was withdrawn due to psychological safety issues. The indications for surgical treatment and a brief description of the available techniques, success rates and complications are outlined. Finally, the need to have followed up protocols for patients and the formation of multidisciplinary treatment teams is underscored.

Evolución y calidad de la alimentación de mujeres con obesidad severa y mórbida sometidas a bypass gástrico / Evolution and quality of the diet of women with severe and morbid obesity undergoing gastric bypass

El objetivo de este estudio fue evaluar los cambios en la ingesta energía y nutrientes y el grado de suficiencia de la alimentación en pacientes sometidos a bypass gástrico. En 44 mujeres con obesidad severa y mórbida se estudió la alimentación previa y a los 6, 12 y 18 meses después de realizada la intervención quirúrgica mediante encuesta de registro de tres días. El consumo de suplementos de vitaminas y minerales se controló estrictamente mediante el registro individualizado de su consumo. Con la excepción de la ingesta de calcio y vitamina A, el consumo de energía y nutrientes fue significativamente menor a los 6, 12 y 18 meses post cirugía comparado con el período preoperatorio. La ingesta dietética de calcio, hierro, zinc, cobre, ácido fólico, vitamina C y vitamina E estuvo por debajo del 100 por ciento de adecuación a partir del 6º mes post operatorio, situación que se revierte al considerar el consumo de estos nutrientes a partir de los suplementos. Aun cuando se observó una tendencia a una curva en “U” en la ingesta de micronutrientes durante el período experimental, en la mayoría de ellos las diferencias entre los valores obtenidos a los meses 12 y 18 no fue significativa. En conclusión, estos pacientes presentan reducciones importantes de la ingesta dietética de energía y micronutrientes. El consumo rutinario de suplementos podría revertir esta situación, sin embargo, las alteraciones anatómicas inherentes a esta intervención podrían producir que cifras de adecuación ligeramente superiores al 100 por ciento sean, en la práctica, insuficientes para asegurar que no se desarrollen cuadros de deficiencia.

The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass. In fortyfour women with severe and morbid obesity it was assessed their nutrient intakes before and 6, 12, and 18 months after gastric bypass by using three-day food records. Vitamin and mineral intakes from supplements were strictly controlled though personalized records. With the exceptions of calcium and vitamin A, energy and nutrient intakes were significantly decreased at 6, 12, and 18 month after bypass compared to the pre-surgery period. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100 percent of adequacy from the 6th month after the surgery and thereafter. This situation is reverted when nutrient intakes supplied by supplements are taken into account. Although a “U” shape trend was observed in the nutrient intakes results during the experimental period, in most cases the differences between the observed values at month 12 and 18 were not significant. In conclusion, these patients had important reductions of their energy and nutrient intakes as result of gastric bypass. Routine supplements may correct this situation, nevertheless, the anatomical alterations inherent to this type of surgery may cause that total nutrient intakes reaching adequacy values slightly above 100 percent, may not necessarily be able to avoid the development of nutritional deficiencies.

Prevalencia de sobrepeso y obesidad en estudiantes adolescentes ecuatorianos del área urbana

Se trata del primer estudio nacional para establecer la prevalencia de sobrepeso y obesidad en estudiantes adolescentes en Ecuador. La muestra estudiada fue de 2.829 estudiantes, 1.461 mujeres y 1.368 varones, entre 12 y <19 años. De estos, 1.435 estudiantes estuvieron matriculados en 60 colegios públicos y privados de las seis principales ciudades de la Costa y 1.394 estuvieron matriculados en 60 colegios de las seis principales ciudades de la Sierra. A los participantes se les midió el peso y la talla y se calculó el Índice de Masa Corporal (IMC). Se diagnosticó con sobrepeso a los adolescentes cuyo IMC estuvo entre los percentiles 85 y <95 y con obesidad a los adolescentes cuyo IMC fue = 95. Los resultados indican que el exceso de peso afecta al 21,2% de los adolescentes: sobrepeso, 13,7% y obesidad 7,5%. El exceso de peso fue significativamente mayor en la Costa, 24.7% que en la Sierra, 17.7% (P 0.001). Igualmente, el exceso de peso fue significativamente mayor en los adolescentes de colegios privados, 25.3% que de colegios públicos 18.9%, (P = 0.001) y fue mas común en las mujeres que en los hombres (21.5% versus 20.8%, respectivamente). El estudio demostró también que el 16.8% de los adolescentes tuvieron bajo peso. En su conjunto, estos datos indican que cerca del 40% de la población estudiada está mal-nutrida siendo la sobre-nutrición, el problema más grave. Se hacen necesarias medidas de intervención inmediatas para prevenir y tratar estos graves problemas de Salud Pública.

Prevalence of overweight and obesity in Ecuadorian adolescent students in the urban area. This is the first study to establish the prevalence of overweight and obesity among Ecuadorian adolescent students. The population studied was made up of 2.829 students, 1.461 females and 1.368 males between 12 and <19 years of age. One thousand four hundred and thirty five students were registered in 60 schools, public and private, in the six main cities of the Coastal Region; the remaining 1.394 students were registered in 60 schools, public and private, in the six main cities in the Andean Region. Height and weight were measured in all participants and the body mass index (BMI) of each individual was calculated. Overweight was diagnosed in those adolescents whose BMI was between percentiles 85 and <95, and obesity was diagnosed in the subjects whose BMI was >95. Results indicate that 21.2% of adolescents had excess weight: 13.7% were overweight and 7.5% had obesity. Excess weight was higher in the Coast (24.7%) than in the Andean Region (17.7%; P<0.0001). In the same way, excess weight was higher among students attending private schools (25,3%) than in those attending public schools (18.9%; P<0.0001). Data also indicate that excess weight was more common in women than in men, 21.5% versus 20.8%, respectively (P<0.02). The study also indicated that 16.8% of adolescents were underweight. Taken together, these data indicate that 38% of the studied population was malnourished. It is necessary to take measures to prevent and treat these important public health problems in Ecuador.

Gasto energético y composición corporal en mujeres con obesidad severa y mórbida sometidas a bypass gástrico / Energy expenditure and body composition in severe and morbid obese women after gastric bypass

The effects of gastric bypass (GBP) on resting energy expenditure (REE) are not well known. Aim: To evaluate the changes in REE and its relationship with body composition in severe and morbid obese women before and six and twelve months after GBP. Patients and methods: Twenty three women aged 37±10 years, with a body mass index of 44±4 kg/m², were evaluated before, six and twelve months after GBP. REE was measured in a Deltatrac indirect calorimeter and expressed as kcal/day Fat mass (EM), and fat free mass (EEM) were determined by double beam Xray densitometry (DEXA). Results: Body weight reduction six and twelve months after GBP was 29.0±4.3 and 35.8±6.9 percent, respectively. The best predictor of weight reduction was initial weight (p <0.01). At six and twelve months, REE decreased by 291.7±260.0 and 353.8±378.4 kcal/day, respectively. In the same periods REE/kg body weight increased by 3.3 and 4.8 kcal/kg respectively, compared to baseline. REE/kg EEM was unchanged. Conclusions: GBP was associated with significant changes in body composition after six and twelve months. However, despite weight reduction, resting energy expenditure per fat free mass unit did not change significantly.

Evaluación de un programa piloto de intervención en adultos con sobrepeso u obesidad, en riesgo de diabetes / Evaluation of a pilot intervention program for overweight and obese adults at risk of type 2 diabetes

Background: The Ministry of Health of Chile and selected obesity specialized centers implemented an interdisciplinary pilot program for overweight adults at risk of diabetes to decrease the risk of type 2 diabetes (T2D) and cardiovascular risk factors (CVRF). Aim To assess the results of this program. Patients and methods: Beneficiaries of the public primary health system aged 18-45 years, with a body mass index (BMI) 25-38 kg/m² and fasting blood glucose 100-125 mg/dL or with any direct family member with T2D, were recruited. During the four months of the study, they were scheduled for three physician visits, four dietitian consultations, 14 physical activity sessions and four group workshops (two with a psychologist or therapist). In fasting blood samples, at the beginning and at the fourth month, glucose, insulin and lipids were determined. The Homeostasis model assessment (HOMA) index was calculated. Results: Two hundred-seventy-six patients were recruited and 160 (141 women), completed the four months of follow up. In this subgroup, at the start and end of the intervention, a BMI equal to or greater than 30 kg/m² was observed in 69 percent and 52 percent of subjects respectively, a systolic blood pressure equal to or greater than 140 mm Hg was observed in 24 percent and 6 percent respectively, a diastolic blood pressure equal to or greater than 90 mm Hg was observed in 28 percent and 9 percent respectively, a blood glucose equal to or greater than 100 mg/dL was observed in 61 percent and 19 percent respectively, a plasma insulin equal to or greater than 12,5 fi Ul/rnl was observed in 49 percent and 34 percent respectively and a HOMA equal to or greater than 2.5 was observed in 63 percent and 42 percent respectively (all these comparisons are significant with a p <0.05). Conclusions: In those patients that completed the follow up period, this intervention induced a significant decrease of some CVRF, such as BMI, fasting glucose levels...

Exactitud del índice de masa corporal de la predicción de la adiposidad media por impedanciometría bioeléctrica / Predictive accuracy of body mass index in estimating body fatness measured by bioelectrical impedance

El objetivo del estudio fue determinar la exactitud del IMC para diagnosticar obesidad y su capacidad de predecir la masa grasa corporal en una población de adultos chilenos. En 433 mujeres (18-73 años; IMC: 19,7-69,7 Kg/m²) y 264 hombres (18-83 años; IMC: 19,1-54,8 kg/m²), se midió la resistencia por bioimpedanciometría y se calculó el porcentaje de masa grasa (por ciento MG), aplicando las ecuaciones del Segal según adiposidad. Se definió obesidad con un IMC³ 30Kg/m², y exceso de adiposidad con un por ciento MG³ 25 por ciento en hombres y ³30 por ciento en mujeres. Un 60,4 por ciento de las mujeres y 23,6 por ciento de los hombres con IMC<30 Kg/m² presentaron un porcentaje MG ³30 y ³25 por ciento, respectivamente. Según análisis de sensibilidad vs. especificidad, un IMC de 26 Kg/m² en mujeres y de 30Kg/m² hombres se aproxima mejor a los puntos de corte de adiposidad. Las ecuaciones para predecir adiposidad son porcentaje MG mujeres= 0.96*IMC+0.154*edad+1,44 (r²= 0,75; error estándar 3,8 por ciento); por ciento MG hombres= 0.99*IMC+0.141*edad-9.914 (r²=0.66; error estándar 4,4 por ciento). La diferencia entre la medición y estimación del por ciento MG mostró una gran dispersión de valores, con un intervalo de ± 2ds de 7,5 por ciento MG en mujeres y 8,8 por ciento MG en hombres. El IMC de 30 Kg/m²muestra un abaja densidad para identificar individuos con exceso de masa grasa, especialmente en mujeres. En este estudio el IMC muestra na baja confiabilidad para estimar adiposidad a nivel individual, particularmente en hombres y cuando el IMC es menor de 30 kg/m²

Nutritional supplementation according to energy and protein requirements in malnourished HIV-infected patients

To evaluate the effects of nutritional supplements on nitrogen and energy balances, body composition and immune parameters, HIV-infected malnourished adult outpatients were prospectively studied. Forty-six patients (4 females and 42 males; 37 +/- 12 y) were supplemented with a polymeric diet (PD) or regular foods (RF) on two consecutive 45-day periods on a crossover design. Weight, skinfold thicknesses, plasma albumin (PA), CD4 and CD8 lymphocyte counts (LC), resting energy expenditure (REE) and urinary nitrogen excretion were measured at baseline, 45 and 90-day. Food intake was weekly recorded by food surveys. Thirty-five patients completed the protocol (18 in Group 1:PD-->RF; 17 in Group 2:RF-->PD). In both groups, weight, fat free mass (FFM), energy balance (EB) and nitrogen balance (NB) increased significantly after PD, whereas LC and PA remained unchanged in both groups. The best results in terms of weight gain were obtained in the PD group and PD plus zidovudine subgroup (n = 8) during the first 45 days (weight gain/FFM gain: 4.8/2.6 kg and 6.8/3.1 kg, respectively). Nutritional supplement with PD, according to the EB and NB goals, was well tolerated and permitted to achieve a significant weight and FFM gain over a 90-day follow-up.

Factores asociados con el incumplimiento del tratamiento antipalúdico en pacientes ecuatorianos / The factors associated with noncompliance with antimalarial treatment in Ecuadorian patients

A total of 249 persons living in the northwest part of Ecuador with a clinical diagnosis of malaria confirmed by thick blood films were treated with chloroquine and primaquine according to the therapeutical system in force in the National Service for Eradication of Malaria. New clinical assessment and thick blood film were applied after 4 days in P. falciparum (n = 120) cases and after 8 days in P. vivax (n = 129) cases; patients were questioned about the compliance or non-compliance with the treatment, and the reasons for their acting in either way were studied. EPI-INFO 6.04 and SPSS PC 7.0 packages served to process the information: "kind adjustment test" (bondad de ajuste) abd factorial analysis of correspondences were used. The patient who daily took his/her pills for the number of days indicated, at the established intervals and at the right time was defined as a patient complying with the drug therapy. For every 3 patients complying with treatment, there were 2 who did not; non-compliance was not significantly related to age, sex, educational level, ethnic group, urban or rural setting or level of income, but learning about seriousness of the infection did help to compliance with the therapy. The reasons for non-compliance were mainly associated with drugs (side effects/reluctancy to take drugs), with the fact of forgetting to take them and of "getting cured quickly". The profile of the patient who did not comply with treatment corresponded to male, teenager, mixed race, poor and rural setting.