Efectos de la ingesta de los edulcorantes estevia y D-tagatosa sobre el metabolismo de la glucosa, ácido úrico y apetito-saciedad / Effects of stevia and D-tagatose sweeteners intake om glucose, uric acid metabolism and appetite-satiety

INTRODUCCIÓN: Si bien, los edulcorantes no nutritivos (ENN) estevia y D-tagatosa han sido reportados como seguros, han demostrado tener algunos efectos metabólicos tras su ingesta. OBJETIVO: Describir los efectos de la ingesta de estevia y D-tagatosa sobre el metabolismo de la glucosa y ácido úrico, y del apetito-saciedad, a partir de la evidencia disponible. MÉTODOS: Revisión descriptiva. Se realizó búsqueda en PubMed utilizando los siguientes términos y palabras clave: "stevia rebaudiana", "tagatose", "D-tagatose", "blood glucose", "insulin", "metabolic processes", "uric acid", "hyperuricemia", "appetite" o "satiety". El análisis de los estudios seleccionados fue discrecional. RESULTADOS: Existen estudios que demuestran efectos beneficiosos tras el consumo de estevia o D-tagatosa sobre el control glicémico, apetito y saciedad tanto en sujetos sanos como con alteraciones en el metabolismo de la glucosa. Por otra parte, un número importante de estudios que evalúan la ingesta de estevia reportan efectos nulos sobre dichos parámetros. En relación al ácido úrico, solo un estudio en sujetos con enfermedad renal crónica reporta aumento en la concentración de ácido úrico plasmático tras la ingesta de 500 mg/día de estevia. Pocos estudios han evaluado el efecto de la ingesta de D-tagatosa sobre uricemia, en sujetos sanos y diabéticos, reportando un aumento transitorio y significativo en los niveles de ácido úrico sérico, sin embargo, no se ha logrado demostrar un efecto hiperuricémico asociado. Es importante destacar que la metodología de los estudios revisados es heterogénea, especialmente en relación al tamaño muestral, tiempo, dosis y vía de adminitración del edulcorante. CONCLUSIÓN: La ingesta de estevia y D-tagatosa ha demostrado efectos beneficiosos sobre el metabolismo de la glucosa, el apetito y la saciedad. El efecto del consumo de D-tagatosa sobre ácido úrico sérico requiere mayor evidencia para demostrar su significancia clínica.

INTRODUCTION: No-nutritive sweeteners stevia and D-tagatose have been reported as safe according to their acceptable daily intake, however, they have been shown to have metabolic effects after their ingestion. OBJECTIVE: To describe the effects of stevia and D-tagatose intake on parameters associated to glucose, uric acid metabolism and on appetite-satiety, considering the available evidence. METHODS: Descriptive review. PubMed search was carried out to identify the totality of the published articles. The following terms and key words were used: "stevia rebaudiana", "tagatose", "D-tagatose", "blood glucose", "insulin", "metabolic processes", "uric acid", "hyperuricemia", "appetite" o "satiety". The analysis of the selected studies was discretionary. RESULTS: studies have shown beneficial effects of stevia and D-tagatose consumption on glycemic control, appetite and satiety in healthy subjects as well as subjects with impairment glucose metabolism. On the other hand, a significant number of studies evaluating estevia intake report null effects on these parameters. In relation to uric acid, only one study in subjects with chronic kidney disease reported an increase in plasmatic uric acid concentration after the intake of 500 mg/day of stevia. Several studies have evaluated the effect of D-tagatose intake on plasmatic uric acid, in healthy and diabetic subjects, reporting a transient and significant increase in serum uric acid levels, however, has not been able to demonstrate an associated hyperuricemic effect. It is important to highlight that the methodology of the studies reviewed is heterogeneous, especially in relation to sample size, dose administered, time and route of exposure to the sweetener. CONCLUSION: Stevia and D-tagatose intake has shown beneficial effects on glucose metabolism, appetite and satiety. The effects of the consumption of both sweeteners on uric acid require further study to demonstrate their clinic significance.

Ingesta de hidratos de carbono y ácidos grasos de la dieta en sujetos con esquizofrenia y trastorno bipolar, y su asociación con parámetros antropométricos / Association of carbohydrate and fatty acid intake with anthropometric parameters in subjects with schizophrenia and bipolar disorders

Background: People with psychiatric disorders have higher rates of obesity, diabetes mellitus and dyslipidemia. These comorbidities are associated with the underlying psychopathology and drug therapy. Aim: To determine the quality and quantity of carbohydrates and fatty acids in the diet and their association with anthropometric parameters in subjects with schizophrenia and bipolar disorders. Patients and Methods: We studied 30 patients with schizophrenia and bipolar disorders in treatment with atypical antipsychotics or mood stabilizers. Three 24-hour recall dietary surveys were carried out. Glycemic index, intake of carbohydrates and fatty acids (g/day) were calculated, and the ratio of saturated, monounsaturated and polyunsaturated fatty acids was determined. Body mass index, waist circumference (WC) and body fat percentage were evaluated. Results: The average intakes of carbohydrates and fatty acids were 295 ± 111 and 73 ± 38 g/day respectively. The mean glycemic index was 59% ± 5.4, while the ratio of saturated, monounsaturated and polyunsaturated fatty acids was 2: 1.4: 0.6. No association between dietary and anthropometric variables was found. Patients using second-generation antipsychotics had a significantly higher waist circumference than those using mood stabilizing drugs. Conclusions: We found no association between the amount and quality of carbohydrate or fatty acid dietary intake and anthropometric parameters.

Relación del consumo de alimentos de alto índice glicémico en la dieta y los niveles de HbA1c en individuos Diabéticos Tipo 2 en tratamiento con dieta y/o Metformina

En la actualidad aún no existe consenso acerca de recomendaciones claras sobre el uso de IG (índice glicémico) de los alimentos para el control dietético de la DM2 (diabetes mellitus 2). Distintas entidades proponen el uso de conteo de CHO (hidratos de carbono), pues no se cuenta con evidencia suficiente para la planificación dietética en base al IG. El objetivo de este estudio fue relacionar el consumo de alimentos de alto IG con el control glicémico de pacientes DM 2 del programa de salud cardiovascular de tres CESFAM (centro de salud familiar) de la comuna de Santiago, Chile. Se seleccionaron 40 sujetos a quienes se les realizó evaluación antropométrica y una encuesta de frecuencia de consumo alimentaria de 30 dias modificada. Se obtuvieron IG, CG (carga glicémica), número de porciones de alto IG consumidas/dia y cantidad de CHO totales consumidos/día. Éstos se correlacionaron con valores de HbA1c (hemoglobina glicosilada) de los últimos 3 meses obtenidos de la ficha clínica. La edad promedio total fue 58.6 ± 9.5 años. El porcentaje de obesidad fue 62,5% y el promedio IMC de 32.5. El valor promedio de HbA1c fue 7.08 ± 1.6, para HbA1c <7% fue 57.5%. La cantidad total de CHO ingerida/dia fue de 403.8 g. El promedio de IG y CG fue de 78.5 y 317.5 g respectivamente. El número total de porciones de alimentos con IG alto consumido al día fue 21.8. Se obtuvo correlación estadísticamente significativa entre HbA1c y número de porciones de alto IG (r= 0.56 p=0.002). Para el resto de las variables no se encontró correlación con significancia estadística (p>0.05). Por cada porción extra de alimentos con alto IG se observó un aumento de la HbA1c en un 0,9%. En nuestra población estudiada la cantidad de alimentos con alto IG consumidos/dia se correlacionó signicativamante con los valores de HbA1c.

Relationship of consumption of high glycemic index food in the diet and levels of HbA1c in type 2 diabetic patients treated with diet and / or Metformin. At present there is still no clear consensus on recommendations on the use of GI of foods for the dietary management of T2DM. Rather different entities propose the use of carbohydrate counting, because there is not even enough evidence for dietary planning based on this index. The aim of this study was to relate consumption of high GI food with glycemic control of type 2 diabetes patients from the cardiovascular health program of 3 CESFAM (Family Health Centers) in Santiago, Chile. Forty individuals were selected, anthropometric measurements were conducted as well as a modified poll of frequency of food consumption of 30 days. Data from GI, GL, number of servings with high GI consumed per day and total amount of CARB consumed per day. Correlations were determined with values of HbA1c of the last 3 month obtained from the medical record. The average age was 58.6 ± 9.5 years. The percentage of obesity was 62,5% and the average BMI was 32,5. The average HbA1c value was 7.08 ± 1.6, for HbA1c <7% it was 57,5%. The total amount of CARB ingested/day was 403,8 g. The average of GI and GL was 78.5 and 317.5 respectively. The total number of servings of food with high GI ingested per day was 21,8. There was a statistically significant correlation between HbA1c and number of servings with high GI (r= 0.56 p=0.002). For the remaining variables there was no statistically significant correlation (p>0.05). For each extra serving of high GI food there was an increase of 0.9% of HbA1c. In our research population the amount of food with high GI ingested per day was significantly correlated with values of HbA1c.