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.

Regulación circadiana, patrón horario de alimentación y sueño: Enfoque en el problema de obesidad / Circadian rhythms, eating patterns, and sleep: A focus on obesity

RESUMEN El reloj biológico determina la mantención de los ritmos circadianos en mamíferos, un tipo particular de ritmos biológicos de duración cercana a 24 horas. Existe una estrecha relación entre el funcionamiento del sistema circadiano, la alimentación y la regulación metabólica, lo que actualmente constituye un área de intensa investigación. En particular, la alteración de la ritmicidad circadiana a partir de modificaciones genéticas, conductuales o dietarias, lleva a trastornos comportamentales, ganancia de peso excesiva y alteraciones metabólicas. Algunos factores que contribuyen a la alteración o desajuste circadiano incluyen el jet-lag, el trabajo por turnos horarios, la desorganización temporal y restricción de sueño, y desorden del patrón horario de alimentación. Este trabajo resume la evidencia acerca de la influencia de los ritmos circadianos en procesos relacionados con la alimentación y las consecuencias metabólicas de su alteración. Se hace énfasis en las consecuencias de la alteración de los ritmos de alimentación-ayuno y de sueño-vigilia, y su relación con la ganancia de peso excesiva, la obesidad y trastornos metabólicos asociados, condiciones altamente prevalentes en sociedades occidentalizadas.

ABSTRACT In mammals, the biological clock is driven by circadian rhythms, a particular type of biological rhythm that last about 24 hours. There is a close relationship between the functioning of the circadian system, eating and metabolic regulation, which is currently an area of intense research. Alteration of circadian rhythmicity from genetic, behavioral or dietary modifications, leads to behavioral and metabolic disorders, and excessive weight gain. Factors that contribute to circadian disruption include, among others, jet lag, shift work, mistimed and restricted sleep, and irregular eating patterns. This review summarizes the evidence regarding the influence of circadian rhythms on eating processes and the metabolic consequences of circadian disruption. Special focus is on the consequences of disruption of regular eating-fasting and sleep-wake rhythms, and relationships with excessive weight gain, obesity and obesity-related metabolic disorders that are highly prevalent in westernized societies.

Incidencia del gasto catastrófico en salud de los hogares costarricenses 2004 y 2013

bjetivo: identificar el porcentaje de hogares cuyos desembolsos por concepto del gasto de bolsillo pueden llegar a constituirse en una catástrofe financiera (30 o 40%del ingreso familiar).Métodos:se utiliza el módulo de Equidad y Protección Financiera del software ADePT, del Grupo de Investigación y Desarrollo del Banco Mundial, así como una serie de rutinas programables que replican la metodología de análisis del gasto catastrófico del estudio desarrollado por Knaul, Wong, y Arreola-Ornelas (2012).Resultados: la incidencia de gasto catastrófico se incrementó levemente al pasar de un 0.6 % de los hogares en el año 2004 a un 0.8 % en el 2013.Conclusiones:la incidencia del gasto catastrófico en salud de los hogares costarricenses no representa un problema para el sistema de salud costarricense, pero es un aspecto que debe focalizarse a sus características estructurales.

bjetive: Identify the percentage of households whose out-of-pocket expenditures turn out to be a financial catastrophe (thirty to forty percent of household income).Methods: The World Bank's Research and Development Group Equity and Financial Protection module ADePT software is used along with a series of programmable routines that replicate the catastrophic expenditure analysis methodology of the study developed by Knaul, Wong, and Arreola-Ornelas (2012).Results: The incidence of catastrophic expenditure increased slightly from 0.6 percent of households in 2004 to 0.8 percent in 2013.Conclusions: The incidence of catastrophic health expenditure in Costa Rican households is not a problem for the Costa Rican health system, but the concern should be issue targeted.

Evaluación de la aceptabilidad de dos aceites vegetales con diferentes niveles de ácido alfa-linolénico en embarazadas de la Región Metropolitana de Chile / Acceptability assessment of two vegetable oils with different level of alpha-linolenic acid in pregnant women from the Metropolitan Region of Chile

Polyunsaturated Omega-3 fatty acids (ω-3 PUFA), particularly docosahexaenoic acid (C22:6 ω-3, DHA), are critical nutrients during pregnancy with a key role for visual and brain development. Fish, especially oily fish, is an excellent dietary source of DHA. However, its dietary consumption is low. Bioconversion from alpha-linolenic acid (C18: 3 ω-3, ALA) to DHA is a limited metabolic pathway in humans, however, it increases during fertility and pregnancy. The chia seed oil (Salvia hispanica) is a good vegetal source of ω-3 PUFA, containing a large proportion (60-65% of total fatty acids) as ALA. The aim of this study was to compare the acceptability of two different commercial oils: chia oil (63% ALA) and canola oil (10% ALA) in a group of Chilean pregnant women. A sample of 41 women was included. Each participant performed: a) an assessment of the acceptability of two commercial oils (hedonic scale), b) a dietary intake questionnaire and, c) a test of knowledge related to ω-3 PUFAs. Main results indicated that 57% of the participants properly recognized food sources of ω-3 PUFA, and 12.2% met their dietary requirements. The characteristics that had the highest scores were the appearance of chia oil and the taste of canola oil. However, there were no significant differences between the overall acceptability of both evaluated oils. It is concluded that chia oil could be a new and useful alternative to increase dietary ALA intake in pregnant women.

Los ácidos grasos (AG) poliinsaturados omega 3 (AGPI ω-3), y especialmente el ácido docosahexaenoico (C22:6 ω-3, DHA) participan en el desarrollo cerebral y visual del feto y del lactante, constituyendo nutrientes críticos durante el embarazo. Los pescados grasos, representan una excelente fuente de consumo de DHA, sin embargo, su consumo a nivel poblacional es bajo. El ácido alfa-linolénico (C18:3 ω-3, ALA) es el precursor del DHA, vía metabólica limitada en el ser humano, pero que aumenta en mujeres en edad fértil y embarazadas. El aceite de semilla de chía (Salvia hispánica) contiene en una gran cantidad de AGPI ω-3 (60-65% del total de AG) y su aceite podría representar una nueva fuente de este tipo de AG. El objetivo de este estudio fue comparar la aceptabilidad de un aceite de canola (10% ALA) y chía (63% ALA) en embarazadas chilenas. Se estudió una muestra de 41 embarazadas quienes respondieron una encuesta de aceptabilidad (escala hedónica), una encuesta de tendencia de consumo modificada y una prueba de conocimiento respecto a los AGPI ω-3. Los resultados indicaron que el 57% de las embarazadas reconoció correctamente los alimentos fuentes de AGPI ω-3 y 12.2% de ellas cumplió con sus requerimientos dietarios. Las características que presentaron los mayores puntajes fueron la apariencia del aceite de chía, y el sabor del aceite de canola. Sin embargo, no existió diferencia significativa entre la aceptabilidad de ambos aceites evaluados. Se concluye que el aceite de chía podría ser utilizado como una alternativa dietaria de buena fuente de ALA en embarazadas.

La reducción del sueño como factor de riesgo para obesidad / Sleep deprivation as a risk factor for obesity

Nocturnal sleep patterns may be a contributing factor for the epidemic of obesity. Epidemiologic ana experimental studies have reported that sleep restriction is an independent risk factor for weight gain and obesity. Moreover, sleep restriction is significantly associated with incidence and prevalence of obesity and several non-transmissible chronic diseases. Experimental sleep restriction is related to altered plasma leptin and ghrelin concentrations. Both hormones are directly related to appetite and satiety mechanisms. Also, a higher activity of the orexin/hypocretin system has been reported, as well as changes in glucose metabolism and autonomic nervous system. Some studies indicate that these endocrine changes could be associated with a higher diurnal food intake and preference for energy- dense foods. All these changes could result in a positive energy balance, leading to weight gain and a higher obesity risk in the long-term. The present article summarizes the epidemiologic and experimental evidence related to sleep deprivation and higher obesity risk. The possible mechanisms are highlighted.