O impacto da suplementação proteica na manutenção de massa magra em pacientes submetidos a cirurgia bariátrica / The impact of protein supplementation on the maintenance of lean mass in patients undergoing bariatric surgery

Introdução: A obesidade é doença crônica que tem se tornado preocupação em saúde pública global. A cirurgia bariátrica é opção de tratamento eficaz para a obesidade mórbida, proporcionando a perda de peso e a melhora da qualidade de vida. No entanto, a perda de massa magra pós-operatória é preocupação importante. Objetivo: Estudo retrospectivo sobre o impacto da suplementação proteica com whey protein na perda de massa magra em pacientes submetidos ao bypass gástrico. Método: Pacientes de 18-60 anos sem complicações foram acompanhados por pelo menos 6 meses e divididos em 2 grupos: um que recebeu suplementação proteica com whey protein (Grupo A, n=19) e outro de controle que não recebeu suplementação (Grupo B, n=13). Os dados demográficos, antropométricos, clínicos e laboratoriais foram coletados e avaliação dos pacientes sobre qualidade de vida antes e depois da operação. Resultados: A média de idade foi de 38 anos. A perda média de massa magra foi de 34,67 kg. Não houve diferença estatisticamente significativa na perda de massa magra ou total entre os grupos (p=0,121 e p=0,072, respectivamente). A qualidade de vida média antes foi de 3,06 pontos e após a operação de 8,13 pontos. Houve diferença estatisticamente significativa na qualidade de vida entre os grupos (p=0,018). O grupo que recebeu suplementação apresentou média de adesão às orientações dietéticas de 8,06 pontos, enquanto aquele sem com média de 6,14 pontos (p=0,045). Conclusão: Os resultados indicaram que a suplementação proteica não teve efeito significativo na perda de massa magra. No entanto, ela melhorou a adesão dos pacientes às orientações dietéticas pós-cirúrgicas e não afetou a qualidade de vida.

Introduction: Obesity is a chronic disease that has become a global public health concern. Bariatric surgery is an effective treatment option for morbid obesity, providing weight loss and improved quality of life. However, postoperative lean mass loss is an important concern. Objective: Retrospective study on the impact of protein supplementation with whey protein on the loss of lean body mass in patients undergoing gastric bypass. Method: Patients aged 18-60 years without complications were followed up for at two years and divided into 2 groups: one received protein supplementation with whey protein (Group A, n=19) and another, control group, that did not receive supplementation (Group B , n=13). Demographic, anthropometric, clinical and laboratory data were collected and patients' assessment of quality of life before and after the operation. Results: The mean age was 38 years. The average loss of lean mass was 34.67 kg. There was no statistically significant difference in lean or total mass loss between groups (p=0.121 and p=0.072, respectively). The average quality of life before was 3.06 points and after the operation, 8.13 points. There was a statistically significant difference in quality of life between groups (p=0.018). The group that received supplementation had an average adherence to dietary guidelines of 8.06 points, while the one without an average of 6.14 points (p=0.045). Conclusion: The results indicated that protein supplementation had no significant effect on lean mass loss. However, improved patients' adherence to post-surgical dietary guidelines and did not affect quality of life.

Effect of Protein Supplementation plus Hyper-Caloric intake and Exercise on Hypertrophy, Hormones and Energy components among Underweight Males

The purpose of the study was to examine the efficacy of 8 weeks of protein supplementation plus hyper-caloricintake and resistance training on hypertrophy, hormones, and energy components of underweight males. Onehundred sixty-seven underweight males from Dhahran region aged 18 to 20 years with BMI of less than 18.5Kg/m2 were divided into protein supplementation with hyper-caloric intake and resistance training group 1 (G1, n =21), the resistance training group 2 (G-2, n=48), protein supplementation group 3 (G-3, n=32) and acontrol group 4 (G-4, n=38). The subjects were measured before and after the training Physical Characteristics(PC) [body mass (BM), optimal body mass (OBM), height (H), body mass index (BMI), percent body fat (%BF),fat-free mass (FFM)], hormones [Triiodothyronine (FT3), Thyroxine (FT4), Thyroid-stimulating hormone (TSH),cortisol and testosterone], energy components, food intake (FI), energy needs (EN) and 1Resistance Maximum(1RM) tests [leg press (LP), chest press (CP) and abdomen press (ABDO)]. The resistance training (RT) was for8 weeks, twice per week 30 minutes per session for G-1 and G-2. The data was analyzed using SPSS version 20.0software. Mean and the standard deviation was calculated for all subjects. One-way analysis of variance(ANOVA) was utilized to compare the mean differences between groups and the level was at P≤0.05. The resultsshowed that BM and FFM had main effects for time and interaction effects for a time by groups (P<0.05) but notfor groups (P>0.05). In 1RM strength tests for LP, CP, and ABDO there were main effects for the time, groups,and interaction effects for time for groups (P<0.05). FT3 and FT4 showed main effects for time only (P<0.05)but TSH, CORTI, and TESTO did show any changes. FI showed main effects for the time, groups, and interactioneffects for a time by groups (P<0.05). It was concluded that the intervention program helps in gaining bodyweightand increasing the fat-free mass. Besides, the resistance training aided to raise the strength, food intake with nochanges in the hormones

Avaliação do efeito da suplementação proteica na qualidade de vida dos pacientes na fase pré transplante hepático / Evaluation of the effect of protein supplementation on the quality of life of patients in the pre-liver transplant phase

Introdução: A doença hepática crônica cursa com alterações no estado nutricional que impactam negativamente na qualidade de vida (QV) dos pacientes. Assim, a utilização de suplementos alimentares poderia ser alternativa para melhorar a QV. Objetivo: Avaliar o efeito da suplementação de diferentes fontes proteicas na qualidade de vida, no estado nutricional e funcional de pacientes no período pré transplante hepático. Métodos: Tratase de ensaio clínico com pacientes candidatos ao transplante hepático (Tx). Os pacientes foram randomizados para receberem suplementação diária de proteína do soro do leite (PSL) ou caseína (20g de manhã e 20g a noite) durante 15 dias. O estado nutricional foi avaliado por meio da avaliação global subjetiva (AGS), dobra cutânea tricipital (DCT), circunferência do braço (CB) e a funcionalidade por meio da força de pressão palmar, medida pela dinamometria e teste de caminhada de seis minutos (TC6). Para avaliar a qualidade de vida foi aplicado o Chronic Liver Disease Questionnaire (CLDQ). Todas as avaliações foram realizadas antes e após a intervenção. A análise estatística incluiu teste t pareado (p < 0,05). Os dados foram analisados no Stata Statistical Software®, versão 12.0. Resultados: Foram avaliados 56 pacientes, sendo 72,4% do sexo masculino, com idade média 51,9 ±11,3 anos. Cirrose etanólica foi a causa mais frequente (25,9%) da doença hepática. Segundo AGS, 56,9% dos pacientes foram classificados como desnutridos dos quais, 33,4% desnutrição grave e 66,6% desnutrição moderada. Não houve alteração do estado nutricional dos pacientes após a suplementação independente da proteína utilizada (p>0,05). A qualidade de vida aumentou no grupo PSL (3,73 ± 0,98 para 4,70 ± 0,62) e no grupo Caseína (3,70 ± 1,08 para 4,70 ± 0,73) (p < 0,001), sem diferença significativa entre os grupos. A força do aperto de mão no grupo PSL antes da intervenção era 28,99 ± 2,04 e evoluiu para 29,78 ± 2,17 e no grupo Caseína era 29,96 ± 2,67 evoluiu para 31,20 ± 2,42 kg), no entanto, sem diferença significativa (p > 0,05). A média inicial do TC6 no grupo PSL foi de 446,0m±20,75 evoluindo para 454,61±19,63, já no grupo caseína foi de 433,5m4±21,35 e evolui para 449,62m ±16,61 (p>0,05). Conclusão: A doença hepática crônica reduz substancialmente a QV e o presente estudo sugere que a suplementação proteica, independente da fonte, melhora a QVRS em pacientes para o TxH.

Chronic liver disease is associated with changes in nutritional status that negatively impact patients' quality of life (QoL). Thus, the use of dietary supplements may be an alternative to improve the QoL. Objective: To evaluate the effect of supplementation of different protein sources on the quality of life, nutritional status and functional of patients in the pre-transplant period. Methods: This is a clinical trial with patients who are candidates for liver transplantation. Patients were randomized to receive daily supplementation of whey protein (WP) or casein (20 g in the morning and 20 g in the evening) for 15 days. The nutritional status was evaluated through subjective global assessment (SGA), triceps skinfold (TS), arm circumference (AC) and functionality through palmar pressure strength, measured by dynamometry and six-minute walk test (TC6). To evaluate the quality of life the chronic liver disease questionnaire (CLDQ) was applied. All evaluations were performed before and after the intervention. Statistical analysis included paired t test (p <0.05). Data were analyzed in Stata Statistical Software, version 12.0. Results: A total of 56 patients were evaluated, being 72.4% male, with a mean age of 51.90 ± 11.33 years. Ethanolic cirrhosis was the most frequent cause (25.9%) of liver disease. According to SGA, 56.9% of the patients were classified as malnourished, of which 33.4% were severe malnutrition and 66.6% were moderate malnutrition. There was no change in the nutritional status of the patients after supplementation (p> 0.05). Quality of life increased in the WP group (3.73 ± 0.98 to 4.70 ± 0.62) and in the Casein group (3.70 ± 1.08 to 4.70 ± 0.73) (p <0.001), with no significant difference between groups. Regarding dynamometry, the tightening force before intervention in the WP group was 28.99 ± 2.04 and evolved to 29.78 ± 2.17 and in the Casein group it was 29.96 ± 2.67 evolved to 31.20 ± 2.42 kg), however, there was no significant difference (p> 0.05). The initial mean of the 6MWT in the WP group was 446.0 ± 20.75, increasing to 454.61 ± 19.63, whereas the casein group was 433.5m4 ± 21.35 and increased to 449.62m ± 16, 61(p> 0.05). Conclusion: Chronic liver disease substantially reduces QOL and the present study suggests that protein supplementation, regardless of source, improves HRQoL in patients for TxH.

Alimentação de vacas F1 Holandês x Zebu com suplementos nitrogenados e monensina sódica: avaliação do consumo, parâmetros ruminais e produção de leite / Feeding F1 Holstein x Zebu cows with nitrogenated supplements and sodic monensin: feed intake, ruminal parameters and milk production

Avaliaram-se suplementos nitrogenados contendo ou não monensina sódica, adicionados à silagem, sobre o consumo de matéria seca (CMS), a digestibilidade da MS (DMS) e a produção de vacas F1 Holandês x Zebu. Vacas (n=15) com 21 dias em lactação, produzindo 19,2kg/dia, foram distribuídas em um delineamento quadrado latino 5X5, com três vacas por tratamento (T). Os T foram: 1- concentrado durante as ordenhas e silagem de milho após as ordenhas (C.SM); 2- C.SM + nitromineral (C.SMNM); 3- C.SM + nitroproteico (C.SMNP), 4- C.SMNM + monensina (C.SMNM+MO) e 5- C.SMNP + monensina (C.SMNP+MO). Os suplementos NP e NM adicionados à SM, (C.SMNP e C.SMNM) aumentaram o CMS (P<0,05). A adição de monensina não alterou o CMS nem a DMS (P>0,05). A suplementação proteica não aumentou o acetato (P>0,05), mas aumentou o propionato e o butirato (P<0,05). A adição de MO ao T C.SMNP reduziu o propionato e o butirato (P<0,05) em relação ao T C.SMNP. A concentração de nitrogênio amoniacal aumentou (P<0,05) no T C.SMNM em relação ao T C.SM e não diferiu dos demais. As produções de leite nos T C.SMNP e C.SMNPMO foram maiores do que no T C.SM (P<0,05). Vacas do T C.SM foram mais eficientes produzindo leite do que as do T C.SMNM (P<0,05).

The objectives of this study were to evaluate consumption, ruminal parameters and milk production of F1 Holstein x Zebu milking cows fed nitrogenated supplements with or without monensin added to the silage. Cows with 21 days on milk and producing initially 19.2kg of milk/day were distributed in a 5X5 Latin square design with three replicates per treatment. The treatments (T) were: 1- concentrate fed during the milking time and corn silage fed after milking (C.SM); 2- C.SM + nitromineral(NM) (C.SMNM); 3- C.SM + nitroproteico (NP) (C.SMNP); 4- C.SMNM + monensin (C.SMNM+MO) e 5- C.SMNP + monensin (C.SMNP+MO). The addition of NP e NM to the T C.SM increased the DMI when compared to C.SM (P<0.05). The addition of monensin did not change the DMI (P>0,05). The protein supplementation did not alter acetate (P>0,05), but increased propionate and butyrate concentrations. (P<0.05) The N-NH3 concentration increased (P<0.05) only in T C.SMNM (P<0.05). The addition of monensin to T C.SMNP decreased propionate and butyrate concentrations (P<0.05) related to T C.SMNP. The milk production was greater in the C.SMNP treatments than T C.SM (P<0.05). Cows in T C.SM produced milk more efficiently than cows fed C.SMNM (P<0.05), but did not differ from the others.

Mechanisms of heat acclimation with endurance training in humans: a role of active cutaneous vasodilator / 体力科学

Hypovolemia and hyperosmolality due to thermal dehydration suppress thermoregulatory responses of sweating and cutaneous vasodilation in humans, resulting in increasing a risk of heat illness. Recently, we found in young and older subjects that an ingestion of carbohydrate-protein supplement immediately after a bout of exercise during training accelerated an increase in plasma volume and an improvement of thermoregulatory responses. These results suggest that change in plasma volume alters cutaneous vasodilation and sweat rate through baroreflexes; however, no electrical signals in the efferent path of the reflex loop have not been identified. We have recently successfully recorded skin sympathetic nerve signal components synchronized and non-synchronized with cardiac cycles, separately, in passively heated young subjects, and found that although both components increased with cutaneous vasodilation and sweat rate in hyperthermia, an increase in synchronized component was suppressed by hypovolemia with suppressed cutaneous vasidilation, while an increase in non-synchronized component was not suppressed as sweat rate. On the other hand, we found that hyperosmolality suppressed the increases of both components with suppressed cutaneous vasodilation and sweat rate. These results suggest that a synchronized component controls cutaneous vasodilation while a non-synchronized component controls sweat rate, and also that beat-by-beat changes in atrial pressure due to a fluctuation of venous return to the heart varies cutaneous vasodilation through baroreflexes but not sweat rate.