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)

Avaliação do consumo alimentar de pacientes com síndrome do intestino irritável em acompanhamento ambulatorial / Evaluation of carbohydrate and fiber consumption in patients with irritable bowel syndrome in outpatient treatment

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional condition, which main symptoms of pain, discomfort and abdominal distension, constipation, diarrhea, altered fecal consistency and sensation of incomplete evacuation can be influenced by the presence of dietary fiber and fermentable carbohydrates (FODMAPs). This study aimed to assess the relationship between the quantity of fermentable carbohydrates (FODMAP) and fiber consumed by individuals diagnosed with IBS, and their classification according to the Rome III criteria. METHODS: A transversal study was carried out in the Intestinal Outpatient Clinic of the Gastroenterology Discipline of UNIFESP. The nutrients of interest for the study were: fiber, general carbohydrates and FODMAPs, with intake quantity measured in grams, analyzed through portions consumed. A nutrition log was used, along with a semi-quantitative questionnaire of consumption frequency. RESULTS: The sample included 63 adult patients; 21 with constipated IBS, 21 with diarrhea IBS, and 21 with mixed IBS. Carbohydrate intake was suboptimal in 55.6% of patients in all groups; excessive consumption was identified in 38.1% of the diarrhea group, 14.3% of the mixed group and 38.1% of the constipated group. Low consumption of carbohydrates was found in 28.6% of diarrhea patients and 47.6% of the mixed group. A mean intake of 23 g of fiber per day was identified, lower than recommended. CONCLUSION: The study identified a number of inadequacies in the consumption of different nutrients, excessive carbohydrate intake, especially FODMAPs, identified by the respondents as responsible for a worsening of their conditions. By contrast, other food groups such as meat, eggs and dairy were consumed by the sample population in insufficient quantities.

RESUMO CONTEXTO: A síndrome do intestino irritável é um distúrbio funcional crônico, no qual a dieta, principalmente o teor de fibra dietética e presença de carboidratos fermentativos (FODMAPs) podem influenciar nos principais sintomas: dores, desconforto e/ou distensão abdominal, constipação, diarreia, alteração na consistência das fezes, sensação de evacuação incompleta. OBJETIVO: Este estudo teve como objetivo avaliar as quantidades de carboidratos fermentativos (FODMAP) e fibras consumidas por indivíduos com o diagnóstico de síndrome do intestino irritável e relacionar com seu modelo da classificação, segundo os critérios Roma III. MÉTODOS: Estudo transversal, realizado no Ambulatório de Doenças Intestinais da Disciplina de Gastroenterologia/UNIFESP. Os nutrientes de interesse para o estudo foram: fibras, carboidratos em geral e FODMAPs, calculando-se suas quantidades em gramas, analisadas através das porções consumidas. Os instrumentos de pesquisa utilizados: ficha de acompanhamento nutricional e questionário de frequência alimentar semi-quantitativo. RESULTADOS: A amostra incluiu 63 pacientes adultos, com síndrome do intestino irritável constipado (21), diarreico (21) e misto (21). O consumo de carboidratos mostrou-se inadequado em 55,6% dos indivíduos em todos os grupos; os que tinham alto consumo (38,1%) pertenciam ao grupo diarreia, 14,3% ao misto e 38,1 % ao constipado. Baixo consumo deste nutriente foi 28,6% nos casos de diarreia e 47,6% do misto. Observamos uma ingestão média de fibras equivalente à 23 g/dia, nos três grupos, inferior ao recomendado. CONCLUSÃO: O estudo permitiu reconhecer várias inadequações no consumo dos diferentes grupos de alimentos, particularmente excesso de carboidratos, incluindo os classificados como FODMAPs, identificados pelos doentes como responsáveis pela piora das suas queixas. Em contrapartida, nutrientes fundamentais, como carnes, ovos, leite e derivados estiveram referidos em níveis abaixo do recomendado.

Very low protein diet plus ketoacid analogs of essential amino acids supplement to retard chronic kidney disease progression

BACKGROUND: A very low protein diet (VLPD) with ketoacid analogs of essential amino acids (KA/EAA) administration can remarkably influence protein synthesis and metabolic disturbances of patients with advanced chronic kidney disease (CKD), and may also slow the decline in renal function. METHODS: A retrospective cohort study was carried out to monitor renal progression and metabolic and nutritional status among 140 patients with CKD stage III or IV. One group (n = 70) was on a low protein diet (LPD) with 0.6 g of protein intake, and another group (n = 70) was on a VLPD with 0.3 g of protein and KA/EAA supplementation of 100 mg/kg/day for 12 months. RESULTS: At 12-month follow-up, estimated glomerular filtration rate (GFR) significantly decreased from 41.6 ± 10.2 to 36.4 ± 8.8 mL/min/1.73 m2 (P 10% annually (adjusted hazard ratio, 0.42; 95% confidence interval, 0.23–0.79; P = 0.006) and significant correlations were found between using VLPD plus KA/EEA and increased GFR. CONCLUSION: VLPD supplementation with KA/EAA is associated with delayed renal progression while preserving the nutritional status in the patients with CKD. Co-administration of VLPD and KA/EAA may prove an effective alternative to conservative management of CKD.

Long-term symptom development of functional bowel disease and the effects of lactose-restricted diet on the symptoms / 中华消化杂志

Objective To explore the long-term symptom development in functional bowel disorders (FBD) and the effects of lactose-restricted diet on the symptoms.Methods From January 2008 to December 2010,805 patients with FBD were included.Among them 245 patients who completed lactose hydrogen breath test and the lactose intake exceeded median value (48.75 g/month) were followed up with telephone interview.The changes of gastrointestinal symptoms,lactose intake and anxiety/ depression status of the patients were observed.Chi-square test,t test and inspection rank test were performed for statistically analysis.Binary Logistic regression analysis was used for influence factors analysis.Results Among 805 patients with FBD,there were 432 (53.7％) mild patients and 373 (46.3％) severe patients.The proportions of female patients,patients with gastrointestinal disease history (gastroenteritis,ulcers,chronic diarrhea etc.),anxiety,depression and irritable bowel syndrome (IBS) of severe patients were all higher than those of mild patients (50.4％,188/373 vs 40.3％,174/432;53.6％,200/373 vs 43.5％,188/432;29.5％,110/373 vs 16.9％,73/432;32.2％,120/373 vs 21.5％,93/432;77.2％,288/373 vs 45.1％,195/432),and the differences were statistically significant (x2 =8.60,0.90,18.10,22.10 and 8.20,all P＜0.05).Among 245 FBD patients included in telephone follow-up,144 cases (58.8％) were successfully followed up (follow-up group) and the follow-up duration was five to seven years.Since the first visit,some diseases have been detected including five cases of colonic polyps,three cases of ulcerative colitis (UC),three cases of gallbladder common bile duct stones,two cases of H.pylori-related peptic ulcer,one case of digestive tract hemorrhage and one case of chronic pancreatitis.The frequency scores of abdominal pain,abdominal distension,hard stools and loose stools were all lower than initial status (0 (0 to 1) vs 5 (3 to 6),0 (0 to 1) vs 3 (0 to 5),0 (0 to 0) vs 0 (0 to 1),0 (0 to 2) vs 2 (1 to 3));the general sensation improved compared with that of initial status (2(1 to 2) vs 3(3 to 4)),and the differences were statistically significant (Z=11.23,7.82,2.19,8.42 and 11.49,all P＜0.05).During follow-up,anxiety/depression symptoms of patients in follow-up group were improved (4 (3 to 4) vs 3 (3 to 4),1 (1 to 1) vs 2 (1 to 2));and the differences were statistically significant (Z=-5.81 and 5.06,both P＜0.01).The median value of lactose intake was decreased compared with before in follow-up group (27.0 g/month (3.0 g/month to 99.8 g/month) vs 135.1 g/month (91.6 g/month to 238.6 g/month));and the difference was statistically significant (Z=-0.14,P＜ 0.01).Lactose-restricted diet could improve the gastrointestinal symptoms including abdominal pain,bloating,loose stool and overall feelings of patients,and the differences were statistically significant (x2 =6.09,5.46,10.04 and 6.40,all P＜0.05).Conclusions Over time,there is still possibility that FBD developed into organic diseases.So the patients still needed close follow-up.Lactose-restricted diet could improve the symptoms of FBD.

An Adequate Intake of Carbohydrates for Gestational Diabetes Mellitus / 임상당뇨병

Gestational diabetes mellitus (GDM) is commonly defined a frequent metabolic condition associated with pregnancy that leads to substantial maternal and perinatal complications. Medical nutrition therapy (MNT) is the cornerstone treatment on patients with GDM, and accordingly, it has a significant impact in women and newborns. The main purpose of MNT in GDM is carbohydrates because they are the major nutrient affecting postprandial euglycemia. Recent epidemiological studies suggest that low-carbohydrate intake is related to beneficial effects on maternal and newborn outcomes. Current evidence consistently supports the advantages of using the glycemic index for additional benefit. Therefore in this context, we will discuss from summarize studies involving carbohydrate in GDM. In addition, this article describes the efficacy of low glycemic index diet for the management of GDM.

The influencing factors of patient compliance to low-sodium diet in chronic heart failure patients:a review / 中国实用护理杂志

The mainstay of nonpharmacological therapy of chronic heart failure patients is low sodium diet. This paper introduced the modified and unmodified influencing factors of patient compliance to low-sodium diet in chronic heart failure patients in order to provide new clues for the development of patient compliance.

Desenvolvimento de receitas especiais para fenilcetonúricos / Development of special recipes for phenylketonuria

Objective: To systematize a route for the development of recipes with reduced phenylalanine and nutritional and sensory quality. Methods: A systematization of steps for the development of recipes was carried out based on the concepts of dietetics and cooking techniques, besides the pertinent literature. The development of recipes, performed in the laboratory, followed the steps of (1) definition of the objective ofeach culinary preparation; (2) choice of existing recipes that serve as starting points; (3) research of the ingredients allowed in the treatment of phenylketonuria, targeted at technological properties for replacement of eggs, milk and wheat flour; and (4) development and adaption of recipes with standardization of household measures. A nutritional analysis of the preparations was realized based on food composition tables; sensory acceptance tests were also conducted. Results: The preparationswere appropriate for phenylketonuria patients? consumption, because the average phenylalanine value found in each portion was 22.08mg and the scores obtained in the sensory tests were positive. The recipes were developed with ingredients such as fruits and vegetables and were low in fat, which contributed to the nutritional quality of the preparations. Conclusions: The systematization proposed favors the developmentof recipes for phenylketonuria patients with sensory and nutritional quality

Objetivo: Sistematizar um percurso para o desenvolvimento de receitas com redução de fenilalanina e com qualidade nutricional e sensorial. Métodos: Foi realizada sistematização das etapas para o desenvolvimento das receitas, com base nos conceitos da técnica dietética e da gastronomia, além da literatura pertinente. O desenvolvimento das receitas, realizado em laboratório, seguiu as etapas de (1) definição do objetivo decada preparação culinária; (2) escolha de receitas existentes que serviriam de ponto de partida; (3) pesquisa de ingredientes permitidos no tratamento da fenilcetonúria e com propriedades tecnológicas voltadas para a substituição de ovos, leite e farinha de trigo, e (4) desenvolvimento e adequação das receitas com padronização das medidas caseiras. A análise nutricional das preparações foi realizada a partir de tabelas de composição dos alimentos e, além disso, foram realizados testes sensoriais de aceitação. Resultados: As preparações apresentaram-se adequadas para consumo de pacientes fenilcetonúricos, uma vez que o valor médio de fenilalanina encontrado nas porções foi de 22,08mg e os escores alcançados nos testes sensoriais foram positivos. As receitas foram desenvolvidas com ingredientes, como frutas e vegetais, e com baixos teores de gordura, que contribuíram para a qualidade nutricional das preparações. Conclusões: A sistematização proposta favoreceu o desenvolvimento de receitas para fenilcetonúricos com qualidade sensorial e nutricional.

Effects of habitual exercise and diet restriction on the hepatic fat accumulation in Zucker fatty rats / 体力科学

We investigated the effects of habitual exercise and diet restriction on the hepatic fat accumulation in Zucker fatty rats. Male 6-week-old Zucker fatty rats were divided into obese (Ob), diet restriction (DR), and diet restriction + exercise (DR + Ex) groups. Male Zucker lean rats (L) were used as a control group. The rats in the L and Ob groups were maintained on ad libitum diets. The rats in the DR and DR + Ex groups were fed a 30% restricted diet. The rats in the DR + Ex group exercised voluntarily on a wheel ergometer. After 6 weeks of intervention, the serum free fatty acid and leptin levels in the Ob group were significantly higher than those in the L group. In the Ob group, the hepatic triglyceride content was higher than that in the L group and hepatocyte fat infiltration was observed on haematoxylin and eosin staining. These changes were suppressed by DR + Ex, but not by the DR intervention. These results suggest that habitual exercise inhibits fat accumulation in the liver of Zucker fatty rats.

Dietary Sodium Intake and Health-Related Quality of Life in Patients with Stable Heart Failure

BACKGROUND: Dietary sodium restriction is an essential component of self-care behavior for improved health-related quality of life (HRQoL) in patients with heart failure (HF). However, there is little direct evidence about the impact of dietary sodium restriction on HRQoL. The purpose of this study was to determine the impact of dietary sodium intake on HRQoL in HF patients with no cardiac events over 1-year of follow-up. METHODS: A total of 106 patients with HF completed a 3-day food diary to estimate daily sodium intake. Patients were divided into 4 groups (4 g). The Minnesota Living with Heart Failure Questionnaire was used to assess HRQoL at baseline and one year later. Hierarchical linear and logistic regressions were used to determine the relationship between dietary sodium intake and HRQoL. RESULTS: Thirty-seven (35%) patients had a daily sodium intake >3 g. Greater than 4 g of daily sodium intake was independently associated with a worse HRQoL at baseline and one year later (F=3.15, P=0.028; F=4.33, P=0.006) and an almost 5.2 times higher risk of a worsening HRQoL at one year follow-up (P=0.040) after controlling for age, gender, etiology, body mass index, New York Heart Association class, ejection fraction, total comorbidity score, and use of beta blockers. CONCLUSIONS: This finding provides additional evidence that greater than 4 g of daily sodium intake is associated with worsening HRQoL in stable HF patients who are free from cardiac events.

Dietary Sodium Intake and Health-Related Quality of Life in Patients with Stable Heart Failure

BACKGROUND: Dietary sodium restriction is an essential component of self-care behavior for improved health-related quality of life (HRQoL) in patients with heart failure (HF). However, there is little direct evidence about the impact of dietary sodium restriction on HRQoL. The purpose of this study was to determine the impact of dietary sodium intake on HRQoL in HF patients with no cardiac events over 1-year of follow-up. METHODS: A total of 106 patients with HF completed a 3-day food diary to estimate daily sodium intake. Patients were divided into 4 groups (4 g). The Minnesota Living with Heart Failure Questionnaire was used to assess HRQoL at baseline and one year later. Hierarchical linear and logistic regressions were used to determine the relationship between dietary sodium intake and HRQoL. RESULTS: Thirty-seven (35%) patients had a daily sodium intake >3 g. Greater than 4 g of daily sodium intake was independently associated with a worse HRQoL at baseline and one year later (F=3.15, P=0.028; F=4.33, P=0.006) and an almost 5.2 times higher risk of a worsening HRQoL at one year follow-up (P=0.040) after controlling for age, gender, etiology, body mass index, New York Heart Association class, ejection fraction, total comorbidity score, and use of beta blockers. CONCLUSIONS: This finding provides additional evidence that greater than 4 g of daily sodium intake is associated with worsening HRQoL in stable HF patients who are free from cardiac events.

Dietary Sodium Intake and Health-Related Quality of Life in Patients with Stable Heart Failure

BACKGROUND: Dietary sodium restriction is an essential component of self-care behavior for improved health-related quality of life (HRQoL) in patients with heart failure (HF). However, there is little direct evidence about the impact of dietary sodium restriction on HRQoL. The purpose of this study was to determine the impact of dietary sodium intake on HRQoL in HF patients with no cardiac events over 1-year of follow-up. METHODS: A total of 106 patients with HF completed a 3-day food diary to estimate daily sodium intake. Patients were divided into 4 groups (4 g). The Minnesota Living with Heart Failure Questionnaire was used to assess HRQoL at baseline and one year later. Hierarchical linear and logistic regressions were used to determine the relationship between dietary sodium intake and HRQoL. RESULTS: Thirty-seven (35%) patients had a daily sodium intake >3 g. Greater than 4 g of daily sodium intake was independently associated with a worse HRQoL at baseline and one year later (F=3.15, P=0.028; F=4.33, P=0.006) and an almost 5.2 times higher risk of a worsening HRQoL at one year follow-up (P=0.040) after controlling for age, gender, etiology, body mass index, New York Heart Association class, ejection fraction, total comorbidity score, and use of beta blockers. CONCLUSIONS: This finding provides additional evidence that greater than 4 g of daily sodium intake is associated with worsening HRQoL in stable HF patients who are free from cardiac events.

Estimativas do consumo de sódio no Brasil, revisão dos benefícios relacionados à limitação do consumo deste nutriente na Síndrome Metabólica e avaliação de impacto de intervenção no local de trabalho / Estimates of sodium consumption in Brazil, review of benefits related to limiting the consumption of this nutrient in the Metabolic Syndrome and assessment of impact of intervention at the workplace

O consumo excessivo de sódio tem se associado com vários efeitos prejudiciais à saúde, como aumento da pressão arterial (PA) e doença cardiovascular. Objetivos: Os objetivos da tese foram avaliar a disponibilidade de sódio no Brasil, analisar os efeitos de dietas com teores reduzidos de sódio em indivíduos com Síndrome Metabólica (SM) ou resistência à insulina (RI) e avaliar o impacto de uma intervenção que promoveu a redução da adição de sal aos alimentos. Sujeitos e métodos: A tese está composta de três artigos. O primeiro deles avaliou as aquisições de alimentos e bebidas realizadas pelos domicílios na Pesquisa de Orçamento Familiar de 2002/2003 do Instituto Brasileiro de Geografia e Estatística. O segundo artigo revisou a literatura de forma sistemática acerca dos ensaios clínicos realizados em adultos entre anos de 2004 e 2008. E o último artigo avaliou o impacto de uma intervenção, baseada no modelo ecológico de promoção de saúde, na redução da adição de sal nos alimentos consumidos por trabalhadores de empresas da cidade de São Paulo. Resultados: A quantidade diária de sódio disponível para consumo nos domicílios brasileiros foi de 4,7 g per capita e para uma ingestão diária de 2.000 kcal. A maior parte do sódio disponível para consumo proveio do sal de cozinha e de condimentos à base desse sal (76,2 por cento). A fração proveniente de alimentos processados com adição de sal representou 9,7por cento do total de sódio no quinto inferior da distribuição da renda per capita e 25,0 por cento no quinto superior. A restrição no consumo de sódio associou-se ao aumento da RI em dois artigos e à diminuição em três outros. Em sete dos nove artigos, uma dieta com teor reduzido de sódio determinou redução da PA e em dois artigos ocorreram efeitos adversos em marcadores da SM...

The excess of sodium consumption has been associated with several adverse health effects, such as increased of blood pressure (BP) and cardiovascular disease. Objectives: Evaluate the availability of sodium in Brazil, analyze the effects of diets with reduced sodium content in subjects with Metabolic Syndrome (MS) or insulin resistance (IR) and evaluate the impact of an intervention which promoted the reduction of adding salt to foods. Subjects and Methods: The thesis is composed of three articles. The first one assessed the food and beverage purchases made by households in the Household Budget Survey of 2002/2003, by the Brazilian Institute of Geography and Statistics. The second article reviewed the literature in a systematic way about clinical trials performed in adults between the years 2004 and 2008. And the last paper assessed the impact of an intervention, based on the ecological model of health promotion, in reducing the added salt to foods consumed by employees of Sao Paulo based companies. Results: The daily amount of sodium available in Brazilian households was 4.7 g daily per person for 2,000 kcal intake. Most of the sodium available for consumption comes from the salt and salt based seasonings (76.2 per cent). The fraction derived from processed foods with added salt represented 9.7 per cent of total sodium intake at the bottom of per person income distribution and 25.0 per cent at the top fifth. The restriction in sodium intake was associated with increased IR in two articles and the decrease in three others. In seven of the nine articles, the salt intake restriction had caused decreased in BP and in two articles have occurred adverse effects on markers of MS...

Consumo de sódio e síndrome metabólica: uma revisão sistemática / Sodium intake and metabolic syndrome: a systematic review

Estudos recentes mostram que restrições na ingestão de sódio podem aumentar a resistência à insulina (RI) e induzir alterações nas lipoproteínas séricas e em marcadores de inflamação semelhantes às encontradas na síndrome metabólica (SM). Realizou-se uma revisão sistemática da literatura sobre os efeitos da restrição do consumo de sódio sobre a SM ou a RI. Nove artigos foram incluídos na revisão. A restrição no consumo de sódio associou-se ao aumento da RI em dois artigos e a diminuição em três outros. Em sete dos nove artigos, a restrição na ingestão de sal determinou redução da pressão arterial e em dois artigos ocorreram efeitos adversos em marcadores da SM. A maioria dos estudos mostrou efeitos benéficos da restrição moderada de sódio da dieta associados ou não a outras modificações nutricionais ou ao aumento da atividade física. Novos estudos são necessários para avaliar os efeitos de reduções moderadas no consumo de sódio sobre a SM e a RI.

Recent studies have shown that sodium intake restrictions may increase insulin resistance (IR) and induce changes on serum lipoproteins and on inflammation markers that are similar to those found in metabolic syndrome (MS). We performed a systematic review of literature regarding the effects of restricting sodium intake on MS or on IR. Nine articles were included in the review. Restriction of sodium consumption was associated with increase insulin resistance in two articles and with decrease in three others. In seven of nine articles, salt intake restriction determined blood pressure reduction, and in two articles adverse effects on markers of MS were found. Most studies showed beneficial effects of moderate sodium intake restriction, associated or not to others nutritional modifications or increased physical activity. Further studies are needed to evaluate the effects of moderate sodium consumption reductions on MS and IR.

Abundance and temporal distribution of Gonioterma exquisita Duckworth (Lepidoptera, Elachistidae, Stenomatinae) on Byrsonima pachyphylla Griseb. (Malpighiaceae) in the Brazilian Cerrado

The seasonal characteristics of the Cerrado region strongly influence food resource predictability and vegetal tissue nutritional content. The aims of this work were to record the abundance and temporal distribution of Gonioterma exquisita Duckworth, 1964 (Lepidoptera, Elachistidae) and its relation with phenological, physical, and chemical traits of the host plant Byrsonima pachyphylla Griseb. (Malpighiaceae). Four nutritional quality parameters were determined for new and mature leaves: gross protein and nitrogen content, dry matter, and in vitro digestibility. We inspected 200 plants per month, searching for G. exquisita caterpillars. About 35.8 percent of the 2,400 plants inspected presented caterpillars, with an abundance peak in the wet season. Caterpillar abundance was positively correlated with mature leaf availability, their food resource. Although mature leaves presented lower gross protein and nitrogen contents than new leaves, this difference was small during the abundance peak of G. exquisita.

As características sazonais da região do Cerrado influenciam fortemente a previsibilidade dos recursos alimentares no tempo e no espaço como também a qualidade nutricional dos tecidos vegetais. Os objetivos deste trabalho foram registrar a abundância e a distribuição temporal de Gonioterma exquisita Duckworth, 1964 (Lepidoptera, Elachistidae) e sua relação com aspectos fenológicos, físicos e químicos de sua planta hospedeira, Byrsonima pachyphylla Griseb. (Malpighiaceae). Quatro parâmetros nutricionais foram determinados para folhas novas e maduras: proteína bruta, conteúdo de Nitrogênio, matéria seca e digestibilidade in vitro. Inspecionamos, mensalmente, 200 plantas a procura de lagartas de G. exquisita. Das 2.400 plantas inspecionadas, 35.8 por cento apresentaram lagartas e seu pico de abundância ocorreu na estação chuvosa. A abundância de lagartas mostrou correlação positiva com a disponibilidade de folhas maduras, seu recurso alimentar. Embora as folhas maduras tenham apresentado taxas menores de proteína bruta e de Nitrogênio que as folhas novas, esta diferença foi muito pequena durante o pico de abundancia de G. exquisita.

On the immature stages and natural history of Gonioterma exquisita Duckworth (Lepidoptera, Elachistidae, Stenomatinae)

In the present work the natural history and immature stages of Gonioterma exquisita Duckworth, 1964 of the Brazilian cerrado region are described. The caterpillars are external folivorous feeders and present a diet restricted to pubescent-leaved host plants of the genus Byrsonima Rich. (Malpighiaceae). They are solitary caterpillars and they build a hard individual shelter that looks like a planorbid shell, made from silk and frass, covered with trichomes and silk, where they develop until the last larval instar on the host plant, and remain inside it until the adult emergence on herbaceous stratum. The larval development presented eight instars. Egg, larval head capsules, instar duration, pupa, shelter, and behavior are also described. Diapause is mentioned for the first time in this species.

Este trabalho apresenta a história natural e descreve os imaturos de Gonioterma exquisita Duckworth, 1964 em uma região do cerrado brasileiro. As larvas são folívoras externas e apresentam dieta restrita a plantas de folhas pubescentes do gênero Byrsonima Rich. (Malpighiaceae). São larvas solitárias que constróem um abrigo bastante rígido com formato de uma concha de moluscos planorbídeos. Neste abrigo, feito de seda e fezes e coberto de seda e tricomas, as larvas desenvolvem-se até o instar final na planta hospedeira e permanecem dentro dele até a emergência do adulto, já no estrato herbáceo. O desenvolvimento larval caracteriza-se por apresentar oito ínstares. Ovo, larvas, cápsulas cefálicas, duração dos ínstares e do período de pupa, abrigos e comportamento são também descritos. Pela primeira vez é mencionada a diapausa nesta espécie.

The effect of four weeks restricted diet on serum soluble leptin receptor levels and adipocyte leptin receptor density in normoweight rattus norvegicus strain Wistar.

One of the five possible mechanisms of leptin resistance in human obesity is the defect in the leptin receptor (Ob-R). Evidence has accumulated that leptin-binding activity in human serum is related to a soluble form of the leptin receptor, and restriction of energy intake resulted a decrease in circulating leptin levels. Aim of this study is to examine the difference of serum soluble leptin receptor level and leptin receptor density in rat adipose tissue of adventitial aorta after four weeks treated with different restricted diets. Soluble leptin receptor level was measured by ELISA and leptin receptor density by using immuno-histochemistry. The soluble leptin receptor in group treated with 40% of normal daily calori diet was found significantly lower than control (p = 0.02). There were no any significant differences among group treated with 40 % of normal daily calori diet, “1 day fast-1day eat”, and ”1day fast-2 days eat” groups, and among 1 day fast-1 day eat”, ”day fast - 2 days eat” and control groups as well. On the other hand, leptin receptor density in adipose tissues was higher in restricted diet group than control. Diet of 40 % normal daily calorie for 4 weeks decreased soluble leptin receptor level, but increased adipocyte leptin receptor density of the adipose tissue of rat adventitial aorta. These changes may be resulted from an up regulation mechanism in relation with homeostatic maintenance.

Two Cases of Rickets that Developed as a Result of by Diet Restriction due to Atopic Dermatitis / 대한소아소화기영양학회지

Nutritional rickets, which is caused by deficiency of calcium or vitamin D, is a rare disease in developed countries. However some cases have been reported recently, that developed as a result of a restricted and nutritionally imbalanced diet due to atopic dermatitis and related food allergy. We treated two infant cases of nutritional rickets. The infants had suffered from atopic dermatitis, and were fed "Sun-sik" (a powdery mixture of several grains and fruits) without receiving cow's milk or any milk products in their diet. After an adequate supply of calcium and nutritional management, they were markedly improved.

A Case of Chronic Eczema Improved by a Nickel Restricted Diet in a Nickel Sensitive Patient / 대한피부과학회지

Most nickel-sensitive patients often experience aggravation of skin lesions after direct contact with nickel which is released from a variable of objects. In some patients, it is difficult to ascertain the source of exposure and alleviate symptoms, even though they avoid contact with nickel-containing objects. This suggests the possibility of an endogenous cause of nickel-induced dermatitis. Here in, we report the successful therapeutic use of a nickel-restricted diet for a nickel-sensitive patient with chronic eczema. A 39-year-old female patient was diagnosed as having endogenous nickel-induced dermatitis on the basis of personal history, physical examination and a nickel oral challenge test. Her skin lesions cleared up after follwing a nickel-restricted diet for 8 weeks.

Decreased osteopontin expression in the rat kidney on a sodium deficient diet

Osteopontin (OPN) is a secreted phosphoprotein that is constitutively expressed in the normal kidney and is induced by various experimental and pathologic conditions. Several possible functions of OPN have been suggested, however the mechanism and significance of OPN expression are still uncertain. Since high salt concentration or salt crystal have been known to enhance OPN expression in intact kidney or cultured renal cells, in the present study we examined whether or not a low salt condition had an effect on OPN expression in the kidney. Adult male Sprague-Dawley rats were fed either a normal sodium or a sodium deficient diet for 1 week. Kidneys were processed for in situ hybridization using a digoxigenin-labeled riboprobe and for immunohistochemistry using antibodies to OPN, renin, and Na-K-ATPase. In rats fed a normal sodium diet, OPN mRNA and protein were expressed only in the descending thin limbs of Henle's loop (DTL) and in the papillary and pelvic surface epithelium (PSE). In rats fed a sodium deficient diet, there was a marked decrease in OPN immunoreactivity in the DTL, but no changes in PSE. In contrast, no changes were observed in OPN mRNA expression in the DTL by in situ hybridization, indicating that decreased OPN protein expression was a result of translational regulation. As expected, rats fed a sodium deficient diet were associated with increased immunoreactivity for Na-K-ATPase and renin compatible with activation of the renin-angiotensin system. These results suggest that dietary sodium may be involved in the regulation of OPN expression in the DTL of the rat kidney.