Effect of the fatty acid composition of meals on postprandial energy expenditure: a systematic review

SUMMARY The energy imbalance produced by an increase in caloric intake and/or decrease in energy expenditure induces obesity. However, the fatty acid composition of a diet can affect the metabolism in different ways, having a role in the development of obesity. AIM To determine the effect of different fatty acids types and composition on Diet-Induced Thermogenesis (DIT) and postprandial energy expenditure in humans. METHODS A search in the PubMed and Web of Science databases, yielded a total of 269 potential articles as a first result; 254 were excluded according to the criteria. RESULTS Fifteen articles were used for this systematic review. The studies analyzed report different effects of the fatty acids of the treatment on the diet-induced thermogenesis. Evidence indicates that the consumption of polyunsaturated fatty acids causes a greater DIT than saturated fatty acids. Also, the consumption of medium-chain fatty acids compared to long-chain fatty acids has been shown to increase DIT. Likewise, the use of certain oils has shown positive effects on postprandial energy expenditure, as is the case of olive oil, compared to rapeseed oil. CONCLUSIONS The use of specific types of fatty acids in the everyday diet can increase postprandial energy expenditure in humans. Nevertheless, longer-term studies are required.

RESUMO O desequilíbrio energético produzido pelo aumento da ingestão calórica e/ou diminuição do gasto energético provoca obesidade. Sem embargo, a composição de ácidos graxos da dieta pode afetar diferencialmente o metabolismo, tendo um papel no desenvolvimento da obesidade. OBJETIVO Determinar os efeitos de diferentes tipos de ácidos graxos e sua composição na termogênese induzida por dieta e no gasto energético pós-prandial em humanos. MÉTODOS Uma busca nas bases de dados da PubMed e da Web of Science gerou um total de 269 artigos potenciais como primeiro resultado; 254 foram excluídos de acordo com os critérios. RESULTADOS Quinze artigos foram utilizados para esta revisão sistemática. Os estudos analisados informam os efeitos diferenciais dos ácidos graxos no tratamento da termogênese induzida pela dieta. As evidências indicam que o consumo dos ácidos graxos poli-insaturados ocasiona maior DIT que os ácidos graxos saturados. Além disso, demonstra-se que o consumo dos ácidos graxos da cadeia média, em comparação com os ácidos graxos da cadeia longa, aumenta o DIT. Do mesmo modo, o uso de certos azeites demonstra os efeitos positivos sobre o gasto de energia pós-prandial, como é o caso do azeite de oliva, em comparação com o azeite de colza. CONCLUSÃO O uso de tipos específicos de ácidos graxos na dieta habitual pode aumentar o gasto de energia pós-prandial nos seres humanos. Sem embargo, é necessária maior investigação no longo prazo.

Orange juice with a high-fat meal prolongs postprandial lipemia in apparently healthy overweight/obese women

ABSTRACT Objective We investigated the postprandial response of lipid markers to a high-fat meal (HFM) with two different beverages in apparently healthy normal-weight and overweight/obese women. Subjects and methods This crossover, randomized study enrolled 36 women, of whom 21 had normal weight (body mass index [BMI] 22 ± 1.8 kg/m2) and 15 had overweight/obesity (BMI 31 ± 3.7 kg/m2). In two different test days, the participants ingested a HFM (37% of energy as saturated fat) with 500 mL of water (HFM-W) or 500 mL of orange juice (HFM-OJ). Blood samples were collected at baseline (12-hour fasting), and at 2, 3, and 5 hours postprandial. The analysis included fasting and postprandial total cholesterol, HDL-c, LDL-c, triglycerides (TG), uric acid, and complement C3. Brazilian Clinical Trials Registry (ReBEC); Primary Identification Number: RBR-2h3wjn (www.ensaiosclinicos.gov.br). Results TG levels increased at 3 hours with HFM-OJ in normal-weight women (p = 0.01) and returned to normal levels at 5h. TG increased at 3 hours with HFM-W (p = 0.01) and HFM-OJ (p = 0.02), and remained high at 5 hours (p = 0.03) in overweight/obese women. Complement C3 remained unchanged, but showed different responses between meals (p = 0.01 for positive incremental area under the curve [piAUC] HFM-OJ vs. HFM-W, respectively). Conclusions In apparently healthy overweight/obese women compared with normal-weight ones, the concomitant intake of orange juice with a HFM prolonged postprandial lipemia but had no effect on postprandial complement C3 concentrations.

Blood pressure variability in the elderly. Association between postprandial and sleeping periods / Variabilidade da Pressão Arterial no Idoso. Associação entre os períodos pós prandial e sono

Abstract Introduction: The variability of arterial blood pressure (BP) is considered an important cardiovascular risk factor. Objective: To verify the possible associations between the postprandial and the sleeping blood pressure variability. Methods: This study evaluated systolic, diastolic, mean, pulse pressures and heart variability in 69 elderly patients in preprandial, postprandial and sleeping periods. One 24 hours ambulatory blood pressure monitoring was used for measurements and the results were showed in the time-rate index. Results: We observed a decrease in the systolic blood pressure values from preprandial to postprandial and to the sleeping periods (124.7 ± 14.6, 113.2 ± 15.3 and 108.5 ± 13.9mmHg, respectively; p = 0.003). Associations between BP variability of the postprandial and sleeping periods were obtained for systolic, diastolic and mean arterial pressure. Conclusion: The correlation between postprandial and sleeping BP variability has rarely been demonstrated in the literature. These correlations between BP changes after eating and during sleep might suggest that both events could coexist in other clinical situations.

Resumo Introdução: A variabilidade da Pressão Arterial Sistêmica (PAS) é considerada um importante fator de risco cardio vascular. Objetivo: Verificar as possíveis associações entre as variabilidades pressóricas nos períodos pós prandial e durante o sono. Métodos: A variabilidade das pressões sistólica, diastólica, média, de pulso e frequência cardíaca foram avaliadas em 69 pacientes idosos nos períodos pós prandial e durante o sono. A Monitorização Ambulatorial da Pressão Arterial de 24 horas foi usada para o cálculo da variabilidade pressórica e os resultados apresentados no índice frequência tempo. Resultados: Observamosuma redução nos níveis sistólicos pos prandiais em relação ao período pre prandial e durante o sono (124.7 ± 14.6, 113.2 ± 15.3 e 108.5 ± 13.9mmHg, respectivamente; p = 0.003). A associação das variabilidade das pressões sistólicas, diastólicas e média foram confirmadas (p < 0.005) entre osperíodos avaliados. Conclusão: A correlação entre as variabilidades da pressão arterial apos as refeições e o sono tem sido pouco demonstrada na literatura. Estas relações podem sugerir que ambos os eventos podem coexistir em outras situações clínicas.

Organ-specific distribution of chlorophyll-related compounds from dietary spinach in rabbits.

The distribution of chlorophyll-related compounds (CRCs) derived from dietary spinach was investigated in different organs the rabbits. The rabbits in the experimental group consumed 100 g of freeze-dried spinach powder after a 24 h fasting period and sacrificed 2, 4, 8, 12 and 24 h later and in the control group sacrificed after the 24 h fasting period. The main CRCs in the liver were found to be chlorophyll (Chl a) and b, chlorophyllide (Chlide) a and b, pheophytin (Phe) a and b and pheophorbide (Pho) a and b, which reached their peak values at 8 h post-feeding. The gallbladder contained mainly Chlide a and a', Pho a and a', Pho b and b', which peaked their values at 2 h post-feeding. Pho a and b were consistently observed in the blood and peaked at 12 h post-feeding. The earlier appearance of Chlide a', Pho a' and Pho b' in the gallbladder compared to the liver indicated that these CRCs were compartmentalized differently and might undergo the same type of vectorialized transport as characterized for the bile salts. Pho levels peaked later in the blood compared to the liver, suggesting that Pho might be released into the peripheral blood circulation from the liver. In conclusion, Chlide and Pho were the principal Chl metabolites in the rabbits. Our data may expand our understanding of the metabolism and biodistribution of CRCs in the human body. A number of biological functions, including anti-oxidation, anti-tumor and anti-aging have recently been attributed to CRCs, it will be interesting to explore, if the binding of Chlide and Pho to other nutrients or trace metal ions in the body mediate their biological functions.

Comparison of Postprandial Lipemia between Women who are on Oral Contraceptive Methods and Those who are not / Comparação da Lipemia Pós-Prandial de Mulheres que Utilizam e Não Utilizam Contraceptivo Oral

Background: Postprandial Lipemia (PPL) is a physiological process that reflects the ability of the body to metabolize lipids. Even though the influence of oral contraceptives (OC) on PPL is not known, it is a known fact that their use increases fasting lipid values. Objective: To compare the PPL between women who are on OC and those who are not. Methods: A prospective analytical study which assessed eutrophic women, aged between 18 and 28 years old, who were irregularly active and with fasting triglycerides ≤150 mg/dL. They were divided into two groups: oral contraceptive group (COG) and non-oral contraceptive group (NCOG). Volunteers were submitted to the PPL test, in which blood samples were collected in time 0 (12-hour fasting) and after the intake of lipids in times 180 and 240 minutes. In order to compare the triglyceride deltas, which reflect PPL, the two-tailed Mann-Whitney test was used for independent samples between fasting collections and 180 minutes (Δ1) and between fasting and 240 minutes (Δ2). Results: Forty women were assessed and equally divided between groups. In the fasting lipid profile, it was observed that HDL did not present significant differences and that triglycerides in COG were twice as high in comparison to NCOG. Medians of Δ1 and Δ2 presented significant differences in both comparisons (p ≤0.05). Conclusion: The results point out that women who are irregularly active and use OC present more PPL in relation to those who do not use OC, which suggests that in this population, its chronic use increases the risk of heart conditions. .

Fundamento: Lipemia pós-prandial (LPP) é um processo fisiológico que reflete a capacidade do organismo de metabolizar lipídeos. Embora não seja conhecida a influência dos contraceptivos orais (CO) na LPP, sabe-se que o seu uso eleva os valores lipídicos de jejum. Objetivo: Comparar LPP entre mulheres que utilizam e não utilizam CO. Métodos: Estudo analítico prospectivo, no qual foram avaliadas mulheres eutróficas, com idade entre 18 e 28 anos, irregularmente ativas e com triglicerídeos de jejum ≤150 mg/dL divididas em dois grupos: grupo contraceptivo (GCO) e grupo sem contraceptivo (GSCO). As voluntárias foram submetidas ao teste de LPP, no qual amostras sanguíneas foram coletadas no tempo 0 (jejum de 12 h) e após ingestão de lipídios nos tempos 180 e 240 minutos. Para comparação dos deltas dos triglicerídeos, que refletem a LPP, entre as coletas de jejum e 180 min (Δ1) e jejum e 240 min (Δ2), foi utilizado o teste de Mann-Whitney bidirecional para amostras independentes. Resultados: Foram avaliadas 40 mulheres divididas igualmente entre os grupos. No perfil lipídico de jejum, observou-se que a HDL não apresentou diferença significativa e que os triglicerídeos do GCO foram o dobro do GSCO. As medianas de Δ1 e Δ2 apresentaram diferença significativa nas duas comparações (p ≤0,05). Conclusão: Os resultados apontam que mulheres irregularmente ativas que utilizam CO apresentam LPP maior que aquelas que não utilizam CO, sugerindo que nessa população seu uso crônico aumenta o risco de doenças cardiovasculares. .

Influence of gastric emptying on the control of postprandial glycemia: physiology and therapeutic implications / Influência do esvaziamento gástrico sobre o controle da glicemia pós-prandial: fisiologia e implicações terapêuticas

The maintenance of glucose homeostasis is complex and involves, besides the secretion and action of insulin and glucagon, a hormonal and neural mechanism, regulating the rate of gastric emptying. This mechanism depends on extrinsic and intrinsic factors. Glucagon-like peptide-1 secretion regulates the speed of gastric emptying, contributing to the control of postprandial glycemia. The pharmacodynamic characteristics of various agents of this class can explain the effects more relevant in fasting or postprandial glucose, and can thus guide the individualized treatment, according to the clinical and pathophysiological features of each patient.

A manutenção da homeostase glicêmica é complexa e envolve, além da secreção e da ação da insulina e do glucagon, mecanismos hormonais e neurais, que regulam a taxa de esvaziamento gástrico. Esse mecanismo depende de fatores extrínsecos e intrínsecos. A secreção do peptídeo 1 semelhante ao glucagon regula a velocidade de esvaziamento gástrico, de modo a contribuir para o controle da glicemia pós-prandial. As características farmacodinâmicas dos diversos agentes dessa classe podem explicar os efeitos mais relevantes na glicemia de jejum ou pós-prandial e, portanto, podem orientar o tratamento individualizado, de acordo com as características clínicas e fisiopatológicas de cada paciente.

Avaliação do efeito da sobrecarga lipídica na reatividade microvascular em mulheres obesas / Evaluation of the effect of lipid overload in microvascular reactivity in obese women

As mudanças nos hábitos alimentares têm causado efeitos impressionantes na saúde pública, diretamente relacionados ao aumento da ingestão de refeições ricas em gorduras, principalmente gorduras saturadas. A principal consequência desse consumo é o estado prolongado e excessivo da lipemia pós-prandial (LPP), considerada um dos fatores relacionados às anormalidades metabólicas e aos danos vasculares. O objetivo do estudo foiavaliar o efeito da sobrecarga lipídica na reatividade microvascular em mulheres obesas. Das 41 participantes deste estudo, 21 apresentavam o diagnóstico de obesidade, com IMC de 32,4±1,6 kg/m2 (média ±SD) e idade 31,6±5 anos e 20 mulheres saudáveis, com IMC de 21,9±1,7 kg/m2 e idade 27,2±5,5 anos. Após a avaliação clínica e laboratorial, as participantes tiveram a microcirculação examinada por dois métodos: a dinâmica do leito periungueal, para avaliação da densidade capilar funcional (DCF), velocidade de deslocamento das hemácias no basal (VDH) e após uma isquemia de 1 min (VDHmax) e tempo de reperfusão (TVDHmax). A segunda técnica foi a do dorso do dedo para avaliação da DCF no repouso, durante a hiperemia reativa e após oclusão venosa. Foi feita a coleta de sangue para avaliação do colesterol total (CT), triglicerídeos (TG), HDL-c e ácidos graxos livres (AGL), glicose, insulina e viscosidade plasmática em 30 e 50 rotações por minuto (rpm). Também foram medidas a pressão arterial sistólica (PAS), diastólica (PAD) e frequência cardíaca (FC). Após essas análises no repouso, todas as participantes receberam uma refeição rica em lipídios, e após 30, 60, 120 e 180 minutos da ingestão da refeição, os exames de videocapilaroscopia e a coleta de sangue foram novamente realizados.As participantes com obesidade apresentaram, após a sobrecarga lipídica, valores significativamente menores do que no jejum para: DCF basal do dorso do dedo (p=0,02); DCF durante hiperemia reativa (p=0,02), DCF pós-oclusão venosa (p=0,02), HDL-c (p<0,0001)...

Changes in eating habits have caused striking effects on public health, directly related to increased intake of food rich in fat, mainly saturated fat. The main consequence of this consumption is the excessive and prolonged state of postprandial lipemia (PPL), considered one an important factor related to metabolic abnormalities and vascular damage. The aim of this study was to assess effects of fat overload on microvascular reactivity in obese women. Of the 41 study participants, 21 had the diagnosis of obesity, with BMI of 32.4 ± 1.6 kg/m2 (mean ± SD) and age of 31.6 ± 5 years and 20 healthy women with BMI of 21.9 ± 1.7 kg/m2and age 27.2 ± 5.5 years. After clinical and laboratorial assessment, participants had the microcirculation examined by two methods: dynamic, using the nailfold bed to assess functional capillary density (FCD), red blood cell velocity in in control conditions (RBCV) and peak (RBCVmax) and time (TRBCVmax) to reach it after 1 min arterial occlusion. The second technique was the finger dorsum to assess FCD at rest and during the reactive hyperemia response and after venous occlusion. Blood sampling was performed to determine total cholesterol (TC), triglycerides (TG), HDL- c and free fatty acids (FFA), glucose, insulin and plasma viscosity at 30 and 50 rotations per minute (rpm). Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) were also measured. After these measurements at rest, all participants received a meal rich in lipids, and after 30, 60, 120 and 180 min after ingestion, videocapillaroscopy exams and blood samples were taken again. Results - Obese participants, after fat overload, presented significantly lower values than at rest at finger dorsum of FCD (p = 0.02), FCD during reactive hyperemia (p = 0.02) and post- venous occlusion (p = 0.02), HDL-C (p <0.0001), LDL-C (p <0.0001) and FFA (p <0.0001) and high values for: RBCV at rest (p<0 ,0001), RBCVmax (p = 0.003), TRBCVmax (p = 0.004), glucose (p <0.0001)...

The influence of intense intermittent versus moderate continuous exercise on postprandial lipemia

INTRODUCTION: Postprandial lipemia is characterized by an increased concentration of circulating lipids after fat intake and is an independent risk factor for cardiovascular disease. Exercise is known to reduce postprandial lipemia and its negative clinical outcomes. OBJECTIVE: This study investigated the effect of intense intermittent versus moderate continuous exercise using the same energy expenditure in postprandial lipemia. MATERIALS AND METHODS: Twenty healthy men (aged 21.5 + 3.5 years) performed a random sequence of either rest or 500 Kcal tests separated by a minimum 48 h interval as follows: (a) no exercise (control), (b) intense intermittent exercise, or (c) moderate continuous exercise. Each test series was completed 30 min before ingestion of a high-fat meal (1 g fat/kg). Venous blood was collected before and at 1, 2, 3 and 4 hours after the high-fat meal. Postprandial lipemia was assessed using the area under the curve approach as well as a kinetic profile of mean lipid variables. Statistical significance was tested at the p<0.05 level. RESULTS: With both statistical approaches, intense intermittent and moderate continuous exercises were both effective in reducing postprandial triglycerides; however, only intense intermittent exercise reduced the levels of postprandial very low density lipoprotein. Intense intermittent and continuous exercise produced lower levels of insulinemia using the area under the curve analysis only. CONCLUSION: Intense intermittent or continuous exercise with an energy expenditure of 500 kcal completed 30 min before ingestion of high-fat meal reduced postprandial lipid levels to different levels in physically active men. Understanding these relevant differences will enable clinicians to provide the best exercise prescription for patients.

The cardio-protective diet.

Globalization has made calorie rich, cheap, convenient marketed foods the main menu for the common man. Indians are particularly susceptible to the adverse outcomes of this dietary change because of ethnic, epigenetic reasons and sarcopenic adiposity (less muscle more fat for the same body weight). Children have smaller body frame making them more susceptible to adverse effects of hyperglycaemia leading to stress on beta cells and their damage. This has resulted in escalation of lifestyle diseases by three-fold, that too at our younger age group at lower body mass indices. Preventive measures are necessary in early life to protect the beta cells, to achieve a metabolically healthy society. This will help in sustaining optimal beta cell function throughout a person’s life. Modification in dietary habits by educating the society, proper food labelling and legal regulation, restricting calorie, sugar, saturated fat, trans-fat and salt intake has proved its benefits in the developed world. Changes in the quality of food is as important as restricting calorie intake. This includes facilitation of increased consumption of dietary fiber, complex carbohydrates, nuts, fruits and vegetables. Restrictions are needed to reduce trans-fats, saturated fats and cooking habits such as deep frying which oxidizes cholesterol and lipids. Foods with long shelf-life shorten the life line because of their salt, sugar or trans-fat content. Individual meals need to be targeted in the general dietary guidelines, to minimize the post-prandial metabolic insult. In general, we need healthy start to early life particularly the first twenty years of life so that the habits cultured during childhood are sustained for the rest of productive years.

Como a monitorização contínua de glicose subcutânea pode colaborar na interpretação dos valores da HbA1c no diabetes melito tipo 1?: [revisão] / How the continuous glucose monitoring system can contribute to HbA1c interpretation in type 1 diabetes mellitus?: [review]

O objetivo desta revisão é avaliar como o sistema de monitorização contínua de glicose subcutânea (CGMS®) pode colaborar na interpretação dos valores da hemoglobina glicada (A1c) no diabetes melito tipo 1. Foi realizada uma revisão bibliográfica dos benefícios, dos métodos, da interpretação e da experiência com CGMS®. A utilização de sensores contínuos pode ser útil na avaliação de pacientes com diabetes melito com oscilações glicêmicas, hipoglicemias graves, especialmente as noturnas, e hiperglicemias pós-prandiais. A identificação de padrões glicêmicos alterados permite ajustes terapêuticos e melhora do controle metabólico. O CGMS® é um procedimento de fácil utilização, com efeitos adversos de pequena intensidade e boa tolerância pelos pacientes. Embora o fabricante preconize um período de utilização de até três dias, observa-se que o prolongamento do teste por mais dias permite a obtenção de dados que auxiliam em mudanças terapêuticas superiores às realizadas com os registros do tempo convencional.

The aim of the present study is a literature revision of the contribution of continuous glucose monitoring system (CGMS®) in the interpretation of HbA1c levels in type 1 diabetes (T1DM). We performed a revision of the efficacy, benefits, interpretation of methods and experience with this system. The CGMS® could be useful in T1DM patients that present great glycemic variability or severe hypoglycemia (mainly nocturnal) and postprandial hyperglycemia. The identification of altered patterns or the glycemic variability allows therapeutic adjustment and improvement of the metabolic control. CGMS® is a safe method with a rare occurrence of side effects and it is well-tolerated by patients. The extension of the procedure for more days, over the 72h period recommended by the standard test, allows us to get important data to changes and adjustments on the insulin management of the type 1 diabetes mellitus patients.

Determinación de los índices glicémicos y de insulina en fórmulas para alimentación enteral en adultos sanos / Glycemic and insulin indices of tube feeding formulas in healthy adults

Background: In acute illnesses, plasma glucose levels are often increased and generally parallel the severity of stress. Hyperglycemia caused by reduced insulin sensitivity and reduced insulin secretion is associated with increased susceptibility to infections. Maintaining blood glucose levels at or below 110 mg/dl reduces morbidity and mortality in critically ill patients. Aim: To measure the glucose and insulin responses of four commercially available enteral formulas compared with a standard meal reference product. Material and Methods: The glycemic index (GI) and the insulin index (II) were determined in a randomized, cross over protocol in 38 healthy volunteers between 18 and 46 years of age. Each subject underwent five tests: three with the standard meal (bread) and two with the study products. The enteral formulas were Clinutren HPR (whole protein of high protein value), Crucial® (casein peptide based formula), Peptamen®, (whey peptide based formula), Glytrol® (formula for diabetics with whole protein with fiber). Each study product was evaluated 10 times. Results: The diabetic formula and the high protein energy dense formulas induced a significantly lower GI (p <0.02) compared with the standard meal. The GI response did not appear to be due to enhanced insulin secretion. The other tested formulas had lower GI than the standard meal, but in addition they exhibited increased II The whey based peptide formulation produced the highest insulin response (p <0.03). Conclusions: Both GI and II are related to the concentration, form and type of protein contained in the enteral formula. The whey peptide formulation produced a low GI with the highest insulin index. Based on the low GI of these enteral products, all can be useful to provide nutritional support during metabolic stress, without adding an additional challenge to blood glucose management.

O papel da lipemia pós-prandial na gênese da aterosclerose: particularidades do diabetes mellitus / The role of post-prandial lipids in atherogenesis: particularities of diabetes mellitus

A aterosclerose é uma doença multifatorial e complexa, que determina eventos clínicos causadores de morbi-mortalidade significativa, representada pela ocorrência de infarto agudo do miocárdio, angina e morte súbita. Está associada a anormalidades lipídicas, ativação plaquetária, trombose, inflamação, disfunção endotelial, estresse oxidativo e alterações metabólicas da matriz, entre outros distúrbios. Todas essas anormalidades são mais comuns e acentuadas no paciente com diabetes, assim como no estado pós-prandial. Dentre os fatores de risco para doença arterial coronariana que ainda não são efetivamente empregados nas estratégias de prevenção da doença em grandes populações destaca-se a hiperlipemia pós-prandial, possível marcador precoce de anormalidades metabólicas e disfunção vascular não observadas em jejum. Recentes resultados mostram que as alterações que ocorrem após uma única sobrecarga lipídica se relacionam negativamente à função endotelial, sendo que as alterações na reatividade vascular estão fortemente associadas à progressão da aterosclerose e aos eventos cardiovasculares. Essas alterações podem revelar um estado de intolerância às gorduras que já são detectadas em indivíduos saudáveis, antes mesmo que anormalidades em jejum sejam percebidas. Esta revisão aborda a fisiopatologia envolvida na lipemia pós-prandial e sua relação com a aterogênese, com ênfase no diabetes mellitus.

Atherosclerosis is a complex and multifactorial disease, which determines clinical events that cause significant morbi-mortality, represented by acute myocardial infarction, angina and sudden death. It is associated with lipid disturbances, platelet activation, thrombosis, endothelial dysfunction, inflammation, oxidative stress, altered matrix metabolism, among other disturbances. All these abnormalities are usual and more pronounced in diabetic patients, as well as in the post-prandial state. Among the coronary artery disease risk factors that are not usually employed in clinical practice in the whole population, postprandial hyperlipemia plays a major role, being a possible early marker of metabolic abnormalities and vascular dysfunction not yet seen in the fasting state. Recent results showed that post-oral lipid overload changes are negatively associated with endothelial dysfunction, and vascular reactivity abnormalities are strongly related to atherosclerosis progression and cardiovascular events. These abnormalities could disclose a lipid intolerance state that can be detected in apparently healthy subjects even before fasting abnormalities are seen. This review will deal with the pathophysiology changes involved in post-prandial hyperlipemia and its relationship with atherogenesis, with particular emphasis to diabetes mellitus.

Postprandial leptin response to Thai meals with different macronutrient mixtures.

The objective of this study was to investigate the postprandial response of leptin, an appetite-regulating hormone, to different macronutrient mixtures in Thai meals. A within-subject repeat measurement was performed. Two groups of healthy Thais (10 men and 10 women in each group) received a single meal of equal calories composed either a high carbohydrate, low fat, low protein diet (HC-LFLP, carbohydrate:fat:protein = 70%:15%:15%) or a low carbohydrate, high fat, high protein diet (LC-HFHP, carbohydrate:fat:protein = 20%:50%:30%). Fasting and 30-minute interval postprandial blood levels of leptin, insulin and glucose were measured for a 2-hour period. In comparison to the LC-HFHP meal, the HC-LFLP meal produced a greater increase in glucose and insulin levels, but halted leptin from decreasing. Postprandial leptin levels were suppressed by a LC-HFHP meal but not by a HC-LFLP meal. The reduced leptin in conjunction with lower glucose and insulin levels may encourage overeating in habitual LC-HFHP diet consumers.

Comparison between pre-prandial and post-prandial heart rate variability (HRV).

After food ingestion, peptides are released in GIT, which cause local vasodilatation. Therefore, after meals, redistribution of blood occurs because of shifting of large amounts of blood into GIT. In normal individuals, this is well compensated and does not lead to post-prandial hypotension. The mechanism of post-prandial hypotension is well known. We hypothesized that there may be a decrease in parasympathetic activity (tone) after meals to compensate for the change in blood distribution. We carried out the study to find out the changes in the autonomic tone before and after meals (lunch) in normal individuals, using Heart Rate Variability (HRV). From the series of RR intervals marked, the time domain and frequency domain measures of HRV were obtained using Nevrokard software (version 6.4). Continuous ECG was recorded in 15 healthy adult subjects (mean age 29.06 +/- 6.2; 13 males and 2 females). The ECG was recorded in pre-prandial and post-prandial state for a period of five minutes each as follows: (1) just before the subjects had lunch, (2) 15 minutes after lunch, (3) 1 hour after lunch, and (4) 2 hours after lunch. Time domain and frequency domain measures of HRV were compared between pre-prandial state and rest of post-prandial states. The autonomic tone parameters did not show a significant change between the pre-prandial state and the immediate post-prandial state. [Range, i.e., the difference between the maximum and minimum RR intervals (406 +/- 161.14 vs. 416.66 +/- 125), standard-deviation of normal to normal RR interval (56.33 +/- 22.72 vs. 67.63 +/- 26.50), RMSSD (55.02 +/- 35.85 vs. 63.87 +/- 32.60), NN50 (42.13 +/- 29.43 vs. 51.86 +/- 29.83), PNN50 (12.67 +/- 10.29 vs. 15.27 +/- 9.71), HF (49.53 +/- 15.10 vs. 47.07 +/- 16.88), LF (41.41 +/- 13.18 vs. 46.49 +/- 15.99), LF/HF (0.98 +/- 0.53 vs. 1.26 +/- 0.90), total power (148.27 +/- 37.78 vs. 137.61 +/- 37.10)]. No significant change was seen in the above parameters between the pre-prandial state and the later phases of post-prandial state. Since there is no significant decrease in the time domain measures and the HF value between the pre-prandial and the post-prandial states, we conclude that the parasympathetic tone is not altered. The parameters denoting sympathetic tone, ie, LF and LF/HF, also do not show a significant change. This indicates that the cardiovascular autonomic tone is not affected by ingestion of meals in normal individuals. Thus we refute our hypothesis. In conclusion, the HRV parameters do not alter significantly after meals in normal individuals.

Lipemia pós-prandial: influência do envelhecimento / Postprandial lipemia: influence of aging

OBJETIVO: Investigar o comportamento da lipemia pós-prandial, avaliada por meio de medidas repetidas de triglicérides, em indivíduos saudáveis de 20 a 50 anos de idade, distribuídos em faixas etárias: GI - 20 a 30; GII - 31 a 40; GIII - 41 a 50 anos. MÉTODOS: Os triglicérides foram determinados em 3 condicões: após jejum de 12 h, 2 h e 6 h após refeicão padronizada contendo 40 g de gordura. RESULTADOS: A análise de medidas repetidas dos triglicérides demonstrou comportamento distinto dos grupos etários ao longo das 6 h. Os participantes mais jovens (GI) apresentavam reducão dos valores de triglicérides na 6ª hora; os da faixa etária (GIII) mais idosa, valores ascendentes na 6ª hora, e os da faixa etária intermediária (GII), manutencão dos triglicérides, comparando a 2ª com a 6ª hora de coleta. As diferencas de comportamento foram significantes (p=0,01). CONCLUSAO: Em amostra populacional adulta saudável, o envelhecimento exerce influência sobre o comportamento da lipemia pós-prandial.

Noninvasive Measurement of Gastric Accommodation by SPECT

No abstract available.

Insulin resistance, impaired postprandial lipid metabolism and abdominal obesity. adeadly Triad.

To review three 'emerging risk factors' for coronary heart disease, the physiological and pathophysiological mechanisms involved, and their inter-relationships. Classical risk factors for coronary heart disease cannot adequately explain the high incidence of this disease. Abdominal obesity and impaired postprandial lipid metabolism have long been recognised as associates of coronary heart disease but only relatively recently has their importance as risk markers been established. Insulin resistance is now often seen as a common theme underlying many factors predisposing to coronary heart disease [CHD]. Mechanisms: The mechanisms by which each of these markers relates to coronary heart disease may have common aspects. Specifically, they are all associated with a characteristic dyslipidaemia involving elevation of plasma triacylglycerol concentrations, reduction of high-density lipoprotein cholesterol [HDL-cholesterol] and the presence of small, dense low-density lipoprotein particles that may carry particular risk of atherogenesis. Insulin resistance is also associated with hypertension and impairment of endothelial function, and with a procoagulant state. Treatment: No specific or separate pharmacological treatment of any of these conditions separately has been shown to reduce the risk of CHD although each can be manipulated. Lifestyle modification, with increased physical activity and dietary change, may offer the best hope of primary prevention but to achieve this, interventions at government level rather than advice from individual physicians would probably be required. Conclusions: Abdominal obesity, impaired postprandial lipid metabolism and insulin resistance are all inter-related risk markers for CHD. They seem to reflect lifestyle in the developed and developing worlds and perhaps modification of lifestyle holds the greatest hope for their amelioration in the future