Evolución de la cirugía bariátrica en Chile y el mundo / Bariatric Surgery's History in Chile and the World

Resumen La obesidad es reconocida como "la gran epidemia" del siglo XXI. Los primeros tratamientos fueron enfocados en el manejo médico, sin lograr los resultados esperados, por lo cual surge la cirugía bariátrica (CB) como la mejor alternativa. Inicialmente la obesidad se concibe como una figura de poder en el imperio egipcio, luego como enfermedad por Galeno e Hipócrates, reapareciendo más tarde como símbolo de fecundidad en Europa. Las primeras técnicas fueron el bypass yeyuno-colónico por Payne y De Wind modificado luego por Scopinaro, consolidándose más tarde como el bypass actual por Mason, Wittgrove e Higa. Por su parte, la gastrectomía en manga fue concebida por Gagner como puente de la derivación biliopancreática, pero dado sus excelentes resultados se consolida como técnica por sí sola. A su vez, la CB evidencia efectos metabólicos inesperados, posicionándose en la actualidad como el mejor tratamiento tanto para la obesidad como para el síndrome metabólico. En Chile la CB se inicia en 1986 con González del Hospital Van Buren con la experiencia en bypass yeyuno-ileal, continuando con Awad y Loehnert del Hospital San Juan de Dios. Luego se consolida con el desarrollo de la CB moderna tanto en la Universidad Católica como en la Universidad de Chile, llegando en la actualidad a ser un procedimiento ampliamente difundido en todo el país. El objetivo principal de la siguiente revisión es analizar el concepto de obesidad en la historia y la evolución de la CB en Chile y el mundo, rememorando sus inicios y destacando su constante desarrollo.

Obesity is recognized as "the great epidemic" of the 21st century. The first treatments were focused on medical management, failing to achieve the expected results, which is why bariatric surgery (BC) emerges as the best alternative. Obesity was initially conceived as a power figure in the Egyptian empire, later as a disease by Galen and Hippocrates, later reappearing as a symbol of fertility in Europe. The first techniques were the jejuno-colonic bypass by Payne and De Wind, later modified by Scopinaro, to finally consolidate as the current bypass by Mason, Wittgrove and Higa. For its part, sleeve gastrectomy was conceived by Gagner as a bridge for biliopancreatic diversion, but given its excellent results, it is consolidated as a technique by itself. In turn, BC shows unexpected metabolic effects, currently positioning itself as the best treatment for both obesity and metabolic syndrome. In Chile, BC started in 1986 with González at the Van Buren Hospital with his experience in jejuno-ileal bypass, continuing with Awad and Loehnert at the San Juan de Dios Hospital. Later, it was consolidated with the development of modern BC both at the Catholic University and at the University of Chile, currently becoming a widely disseminated procedure throughout the country. The main objective of the following review is to analyze the concept of obesity in history and the evolution of BC in Chile and the world, recalling its beginnings and highlighting its continuous development.

Experiencia en el uso de fibrina rica en plaquetas en pacientes con pie diabético / Experience in the use of platelet-rich fibrin in patients with diabetic foot

Resumen Objetivos: Describir las características clínicas y de laboratorio de los pacientes diabéticos tipo 2 (DM2) en tratamiento con fibrina rica en plaquetas (FRP) en el Hospital Clínico Herminda Martín entre los años 2014 y 2016. Materiales y Método: Se revisaron las fichas clínicas de todos los pacientes tratados con FRP en el policlínico de biomateriales en busca de los valores de HbA1c y glicemia, además de otras variables clínicas y de laboratorio que pudieren estar relacionadas con la evolución de las heridas de pie diabético. Se estableció tres grupos de comparación según el tiempo de cicatrización en cicatrización rápida (tiempo percentil 75). Resultados: De un universo de 147 pacientes con DM2 se reportan resultados de 85 (58%). El promedio de edad fue de 61 años, con una glicemia promedio de 243 g/dL y HbA1c de 9,4%. Presentaron un contaje plaquetario dentro de los parámetros normales (promedio 279 plaquetas/mm3). Se encontraron diferencias estadísticas en la escala de valoración de heridas, específicamente en la valoración del puntaje total, así como los parámetros como extensión, profundidad, y dolor entre los grupos de cicatrización rápida y lenta. No se evidenciaron diferencias en el nivel de HbA1c o glicemia en los grupos de cicatrización rápida o lenta, como tampoco en otras variables como edad, creatinina, recuento de plaquetas. Conclusión: No se encontró una asociación entre la velocidad de cicatrización y el nivel de HbA1c en individuos tratados con FRP.

Aims: To describe the clinical and laboratory characteristics of type 2 diabetic patients (DM2) treated with Platelet Rich Fibrin (FRP) at Hospital Clínico Herminda Martín between 2014 and 2016. Materials and Method: Analytical study that includes information from a secondary database. The clinical records of all patients treated with FRP at the Biomaterials Polyclinic were reviewed to search the HbA1c and glycemia values, as well as other clinical and laboratory variables that could be related to the evolution of diabetic foot wounds. Three comparison groups were established according to the healing time in rapid (time 75th percentile). Results: From a universe of 147 patients with DM2, results of 85 (58%) are reported. The average age in the included patients was 61 years. They had an average glycaemia of 243 g/dL, and HbA1c of 9.4%. They presented a platelet count within normal range (average 279 platelets/mm3). Statistical differences between the fast and slow healing groups were found in the wound assessment scale, specifically in the assessment of the total score, extension, depth, and pain. There were no differences in the HbA1c or glycemia level in the fast or slow healing groups, nor in other variables such as age, creatinine, and platelet count. Conclusion: No association was found between healing speed and HbA1c level in individuals treated with FRP.

Influence of Alzheimer's disease on the relationship between nutritional status and risk of fall

Although malnutrition and risk of falls in the elderly have increased in recent years, uncertainties exist as to whether these conditions are associated after controlling for sociodemographic variables, body composition, metabolic condition, and Alzheimer's disease (AD). This study aimed to analyze the association between nutritional status and risk of fall in the elderly population. Participants were matched by gender and age, after they had been grouped on the basis of diagnosis of AD. The risk of falls, nutritional status, and mental status were assessed using the Downton Fall Risk Score (FRS), Mini Nutritional Assessment (MNA), and Mini Mental State Evaluation (MMSE), respectively. Logistic regression modelsadjusted for the main confounders were used in the analyses. Among the 68 elderly individuals studied, participants who were malnourished or at risk of malnutrition were more likely to fall (odds ratio = 8.29; 95% confidence interval = 1.49-46.04) than those with normal nutritional status, regardless of gender, age, education, body composition, and metabolic condition. This association did not remain significant after adjustment for AD, a potential confounder in this association. Malnutrition or its risk was independently associated with high risk of fall; thus, malnutrition should be considered in the prevention of falls among the elderly population.

Interrelationships between obesity, blood pressure and metabolic profile in climacteric women / Inter-relações entre obesidade, pressão arterial e perfil metabólico em mulheres climatéricas

ABSTRACT Objective This study aimed to evaluate the interrelationships between obesity, blood pressure and metabolic profile in climacteric women. Methods This is a cross-sectional study with a random sample of 874 women, aged 40 to 65 years, assisted in Family Health Strategies units in Montes Claros, Minas Gerais, Brazil. A structural equation model was used to assess the interrelationships between obesity, blood pressure and metabolic profile, adjusted for age. The variables blood pressure, obesity and metabolic profile were treated as constructs, which measurement models were developed using confirmatory factor analysis. Results It was observed that age has a positive and significant effect on blood pressure (β=0.20; p<0.001) and obesity (β=0.10; p=0.004). There was a direct and positive effect of obesity on blood pressure (β=0.26; p<0.001) and on the metabolic profile (β=0.10; p=0.037), adjusted for physical activity. Conclusions The simultaneous analysis of the relationships between age, obesity, blood pressure and metabolic profile in menopausal women suggests that, ageing has an effect on the increase of obesity and blood pressure, just as obesity increases blood pressure and changes the metabolic profile.

RESUMO Objetivo Avaliar as inter-relações entre obesidade, pressão arterial e perfil metabólico em mulheres climatéricas. Métodos Trata-se de estudo transversal com amostra aleatória composta por 874 mulheres com idade entre 40 a 65 anos assistidas em unidades de Estratégias de Saúde da Família em Montes Claros, Minas Gerais, Brasil. Foi utilizado modelo de equação estrutural para avaliar as inter-relações entre obesidade, pressão arterial e perfil metabólico, ajustado pela idade. As variáveis pressão arterial, obesidade e perfil metabólico foram tratadas como construtos, cujos modelos de mensuração foram construídos utilizando-se a análise fatorial confirmatória. Resultados Observou-se que a idade exerce efeito positivo e significativo sobre a pressão arterial (β=0,20; p<0,001) e a obesidade (β=0,10; p=0,004). Houve efeito direto e positivo da obesidade na pressão arterial (β=0,26; p<0,001) e no perfil metabólico (β=0,10; p=0,037), ajustado por atividade física. Conclusão A análise simultânea das relações entre idade, obesidade, pressão arterial e perfil metabólico em mulheres no climatério sugere que o aumento da idade tem efeito sobre o aumento da obesidade e da pressão arterial, assim como a obesidade tem efeito positivo sobre o aumento da pressão arterial e sobre a alteração no perfil metabólico.

Alimentación neonatal asociada a sobrepeso y obesidad en niños y adolescentes de Cuenca, Ecuador / Neonatal feeding associated with overweight and obesity in children and adolescents of Cuenca, Ecuador

Introducción: La alimentación inadecuada en la etapa neonatal se asocia con la aparición de enfermedades metabólicas en períodos ontogenéticos posteriores. Objetivo: Asociar la lactancia materna y el destete con el sobrepeso y obesidad en niños y adolescentes de la Unidad Educativa César Dávila Andrade, Cuenca, Ecuador, en el período de octubre de 2016 a marzo de 2017. Materiales y Métodos: Se realizó un estudio observacional de tipo descriptivo durante el período noviembre 2016 a enero 2017 en el Cantón Cuenca, provincia Azuay, Ecuador. El muestreo probabilístico por conglomerados de iguales proporciones seleccionó 137 niños y adolescentes entre 5 y 18 años de edad. Se aplicó un cuestionario que recogió datos sociodemográficos, de lactancia materna y destete. Se realizaron mediciones de peso y talla, y el cálculo del índice de Masa Corporal. Se procesaron los datos mediante estadística descriptiva (media y desviación estándar), inferencial (Prueba T y X2) y correlaciones bivariada (X2, odds ratio) y multivariada (regresión logística binaria) mediante SPSS 23.0. Resultados: La lactancia materna por menos de 6 meses, la introducción de alimentos de manera temprana y la actividad física leve incrementan el riesgo de sobrepeso y obesidad en más de 3 veces cada una en niños y adolescentes. Conclusiones: La lactancia materna y el destete están asociadas al sobrepeso y obesidad desde etapas tempranas del desarrollo humano. El valor explicativo que tienen en niños y adolescentes es relevante, y sugiere su empleo en programas educativos y preventivos en salud(AU)

Introduction: Inadequate feeding in the neonatal stage is associated with the appearance of metabolic diseases in further ontogenetic periods. Objective: To associate breastfeeding and weaning with overweight and obesity in children and adolescents in the Educational Unit César Dávila Andrade in the Cuenca region, Ecuador, from October 2016 to March 2017. Material and Methods: A descriptive, associative, and empirical study was conducted during the period of November 2016 - January 2017 in Cuenca, province of Azuay, Ecuador. The probability sampling by conglomerates of equal proportions selected 137 children and adolescents from 5 to 18 years of age. A questionnaire that collected sociodemographic data about breastfeeding and weaning was applied. Measurements of weight and height were made, as well as the calculation of the Body Mass Index. The data were processed by descriptive statistics (mean, standard deviation); inferential statistics (T Test, X2); bivariate correlations (X2, odds ratio), and binary logistic regression, using SPSS 23.0. Results: Breastfeeding for less than six months, the introduction of food at an early stage of the life, and mild physical activity are factors that increase the risk of overweight and obesity more than 3 times in children and adolescents. Conclusions: Breastfeeding and weaning are associated with overweight and obesity from early stages of human development. The explanatory value that children and adolescents have is relevant, suggesting its implementation in educational and preventive health programs(AU)

Efeitos da urbanização nos ritmos biológicos e repercussões metabólicas na saúde de trabalhadores de uma comunidade amazônica / Effects of urbanization on biological rhythms and metabolic repercussions on the health of workers in an Amazonian community

Objetivo - Avaliar o sono, ritmos biológicos e metabolismo de trabalhadores de uma comunidade amazônica do Acre, segundo diferentes graus de urbanização das residências. Métodos - Foram executados três sub-estudos distintos. No primeiro estudo foram feitas análises de dados referentes às características sociodemográficas, medidas antropométricas, hábitos de vida, características do sono e morbidades referidas de trabalhadores da reserva extrativista de Xapuri, Acre. Para o segundo estudo foi executada uma análise de dados alimentares de recordatório de 24 horas para obtenção de padrões alimentares e suas associações possíveis para variáveis de sono e sonolência em trabalhadores. Para o último estudo foram realizadas coleta e análise de dados alimentares, antropométricos, variáveis metabólicas, relacionados ao sono e aos hábitos de vida de trabalhadores residentes nas regiões rurais e urbanas de Xapuri. Resultados - Foram produzidos três manuscritos que representaram os três sub-estudos distintos que compõe este trabalho múltiplo. O primeiro estudo avaliou os efeitos do tipo de trabalho (elevado ou baixo esforço físico) e o estilo de vida sobre o sono dos trabalhadores da reserva amazônica. O segundo estudo propôs uma nova abordagem na avaliação do consumo alimentar e suas relações com o sono e sonolência de trabalhadores, envolvendo a investigação dos padrões alimentares. O terceiro estudo apresentou os principais achados comparando trabalhadores rurais e urbanos da reserva amazônica no que tange estilo de vida, sono, exposição à luz, aspectos metabólicos, estado nutricional e consumo alimentar. Conclusão - No que tange aos aspectos metabólicos, destaca-se alta prevalência de sobrepeso e obesidade entre trabalhadores urbanos, bem como marcadores alterados para doenças metabólicas. No que se refere ao sono, trabalhadores rurais apresentam um alta prevalência de distúrbios de sono; entretanto, entre os residentes urbanos destacam-se uma redução da duração de sono, horário de sono tardio e menor exposição à luz. O estudo de padrões alimentares demonstrou-se possível e eficaz eficaz na avaliação de desfechos relacionados à alimentação e ritmos biológicos, em especial o sono

Aim - To evaluate the sleep, biological rhythms and metabolism of workers of an Amazonian community of Acre, according to different degrees of urbanization of the residences. Methods - Three different sub-studies were performed. In the first study, data were analyzed regarding socio-demographic characteristics, anthropometric measurements, lifestyle, sleep characteristics and referred morbidity of workers from the Xapuri Extractive Reserve, Acre. For the second study, a 24 hour recall data analysis was performed to obtain dietary patterns and their possible associations for sleep and sleepiness variables in workers. For the last study were collected and analyzed food data, anthropometric, metabolic variables, related to sleep and living habits of workers residing in the rural and urban regions of Xapuri. Results - Three manuscripts were produced that represented the three distinct sub-studies that compose this multiple work. The first study evaluated the effects of the type of work (high or low physical effort) and the sleep lifestyle of the workers of the Amazon reserve. The second study proposed a new approach in the evaluation of food consumption and its relationships with sleep and drowsiness of workers, involving the investigation of dietary patterns. The third study presented the main findings comparing rural and urban workers in the Amazon Reserve in relation to lifestyle, sleep, light exposure, metabolic aspects, nutritional status and food consumption. Conclusion - Regarding the metabolic aspects, there is a high prevalence of overweight and obesity among urban workers, as well as altered markers for metabolic diseases. As far as sleep is concerned, rural workers have a high prevalence of sleep disorders; however, among urban residents, there is a reduction in sleep duration, late sleep time and less light exposure. The study of dietary patterns has proved to be possible and effective in evaluating outcomes related to diet and biological rhythms, especially sleep

Perfil metabólico de vacas Jersey clinicamente saudáveis / Metabolic profile of clinically healthy Jersey cows

O conhecimento do metabolismo dos animais é de suma importância para se obter sucesso em qualquer atividade que envolva rebanhos. Objetivou-se determinar o perfil bioquímico sérico de vacas Jersey clinicamente saudáveis no pré e pós-parto, mantidas em sistema de criação semi-intensivo na região de Uberlândia, Minas Gerais, Brasil. Realizou-se o exame clínico e coleta de sangue de 40 vacas da raça Jersey multíparas e lactantes em 15 momentos, entre -150 dias pré-parto até 60 dias pós-parto (DPP). No laboratório, foram analisadas as concentrações séricas de proteínas totais, albumina, globulinas, ureia, creatinina, ácidos graxos não esterificados (NEFA), ß-hidroxibutirato (BHBA), triglicerídeos, colesterol, lipoproteínas de alta densidade (HDL), lipoproteínas de muita baixa densidade (VLDL), lipoproteínas de baixa densi­dade (LDL), aspartato aminotransferase (AST), gama-glutamil transferase (GGT), creatina quinase (CK), cálcio, fósforo e magnésio. Dos 40 animais, apenas 21 vacas atenderam aos critérios de inclusão e seus dados foram utilizados. Procedeu-se o teste de Tukey para os dados paramétricos e para os dados não paramétricos realizou-se o teste de Kruskal Wallis na comparação entre os momentos avaliados. Não houve interferência do balanço energético negativo e da hipocalcemia subclínica na ocorrência de doenças uterinas e no desempenho reprodutivo. Concluiu-se que vacas da raça Jersey apresentam perfil bioquímico caracterizado por hiperglobulinemia durante o periparto, além de níveis elevados de triglicérides, entretanto, sem comprometimento da função hepática e desempenho reprodutivo.(AU)

The understanding of animal metabolism is important for the success of livestock activity. The aim of this study was to determine the serum biochemical profile of clinically healthy Jersey cows in pre and postpartum, housed in semi-intensive production system in Uberlândia, Minas Gerais, Brazil. Clinical examination and blood collection from 40 multiparous lactating dairy cows, between -150 days prepartum up to 60 days postpartum (DPP) were performed. At the laboratory, serum parameters of total proteins, albumin, globulins, urea, creatinine, non-esterified fatty acids (NEFA), ß-hydroxybutyrate (BHBA), triglycerides, cholesterol, high density lipoprotein (HDL), very low density lipoproteins (VLDL), low density lipoproteins (LDL), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), creatine kinase (CK), calcium, phosphorus and magnesium were analyzed. To the total of cows (n=40) enrolled, only 21 cows were complied with the inclusion criterias. It was proceeded the Tukey test for parametric data, and to the nonparametric data it was held the Kruskal Wallis test for the comparison between days evaluated. There was no interference of negative energy balance and subclinical hypocalcemia in the occurrence of uterine diseases and reproductive performance. In conclusion, Jersey cows have biochemical profile characterized by hyperglobulinemia during peripartum, and high levels of triglycerides, but without impaired liver function and reproductive performance.(AU)

Metabolomics and Exercise: possibilities and perspectives

Abstract Aim This review aimed to provide an overview of the publications using metabolomics in research with physical exercises and to demonstrate how researchers have been applying this approach. Methods A systematic search in the databases Web of Science, SCOPUS and PubMed was performed, with the key words: "metabolomics" OR "metabonomics" and with "metabolomics" OR "metabonomics" AND "exercise" in the title or abstract of the articles. The search period was from 2000 to 2016. Forty-four original articles were selected. The studies found were separated into four categories: metabolic responses to physical exercise, supplementation and physical exercise, sports performance, and physical exercise related to diseases. Results It was possible to observe the exponential growth of the use of this approach in Sports and Health Sciences, and the four sub-fields towards which these researches involving exercise are directed, enabling a more comprehensive characterization of different metabolic profiles, as well as their study for identifying new biomarkers related to physical exercise. Conclusions The possibilities of using metabolomics approach are increasing in the fields of Health Sciences, Sports, and Physical Activity. The experimental design of the study is essential to take advantage of this tool and be able to answer questions in the metabolism comprehension.(AU)

Metabolic profile and spontaneous physical activity modulation under short-term food restriction in young rats

Abstract AIMS The aim of this study was to investigate the effects of short-term food restriction (6-weeks) on metabolic profile and spontaneous physical activity (SPA) of young male Wistar rats. METHODS Thirty rats had their baseline SPA measured at 21 days-old and were separated into two groups at 28 days-old: Control (CG) and 50% of food restriction (FR). The food restriction protocol lasted six weeks, being the SPA measured weekly by a gravimetric apparatus. At the end of the experiment, biochemical analyses were performed in serum and tissue samples with statistical significance set at 5%. RESULTS FR showed less SPA than CG, as occurred for body mass, water intake, adipose tissue and liver, heart and soleus glycogen, serum glucose, total protein, triglycerides and total cholesterol (P<0.05). CONCLUSION Data set demonstrates that low substrate stores signaled to decrease spontaneous physical activity to save energy.(AU)

Starvation and refeeding in rats: effect on some parameters of energy metabolism and electrolytes and changes of hepatic tissue

Regarding the importance of starvation and refeeding and the occurrence of refeeding syndrome in various conditions, the present study was conducted to investigate the effects of refeeding on some parameters of energy metabolism and electrolytes and changes of hepatic tissue in male Wistar rats. Fifty-seven rats were divided into six groups, having 6 to 11 rats. Food was provided ad-libitum until three months and then the first group was considered without starvation (day 0). Other rats were fasted for two weeks. Group 2 was applied to a group immediately after starvation (day 14). Groups 3 to 6 were refed in days 16 till 22, respectively. At the end of each period, blood and tissue samples were taken and histopathological and serum analysis, including serum electrolytes (calcium, phosphorus, sodium, potassium), the energy parameters (glucose, insulin, cortisol) and the liver enzymes (ALT, AST, ALP) were determined. Insulin decreased by starvation and then showed an increasing trend compared to starvation period, which the highest amount of this parameter was observed eight days post-refeeding. Serum glucose level showed the opposite pattern of insulin. Histopathological examination of the tissue sections revealed clear vacuoles after starvation and refeeding, in which the severity of lesions gradually decreased during refeeding. The cortisol level decreased by starvation and then increased during refeeding. Also, potassium and phosphorus concentrations declined by refeeding and the serum sodium and potassium levels were changed in the relatively opposite manner. The calcium level decreased by starvation and then increased during refeeding. These results could help recognize and remedy the refeeding syndrome.(AU)

Physical activity, BMI and metabolic risk in Portuguese adolescents / Atividade física, IMC e risco metabólico em adolescentes portugueses

Abstract It has been reported, in the last decades, a significant decrease in physical activity (PA) levels, with a consequent increase in obesity and metabolic risk factors among youth. The aims of this study were to describe PA levels, the prevalence of overweight/ obesity and metabolic risk factors, and to examine the association between PA and body mass index (BMI) with metabolic risk among Portuguese youth. The sample comprises 212 Portuguese adolescents (12-16 years old). Height and weight were measured. PA was estimated with the Bouchard questionnaire (3 days recall), as well as with the use of a pedometer (used for 5 consecutive days). Metabolic risk factors comprised fasting glucose, triglycerides, HDL-cholesterol, systolic blood pressure and waist circumference. Subjects were classified as normal weight, overweight or obese according to BMI; the maturational status was indirectly estimated with the maturity offset procedure. A continuous metabolic risk score was computed (zMR) and PA values were divided into tertiles. Quisquare test, t-test and ANOVA were used in statistical analyses. SPSS 18.0 and WinPepi softwares were used and p<0.05. A moderate to high prevalence of overweight/obesity and HDL-cholesterol was found, as well as a high prevalence of high blood pressure and low to moderate PA levels among Portuguese youth. The relationship between BMI and zMR showed that obese adolescents have higher zMR when compared to normal weight or overweight adolescents. This finding suggests that increased levels of PA and reduction in the prevalence of overweight/obesity may have a positive role against the development of metabolic risk factors.

Resumo Tem-se verificado, nas últimas décadas, uma redução substancial nos níveis de atividade física (AF), com o consequente aumento da prevalência de sobrepeso/obesidade e fatores de risco metabólico entre jovens. O presente estudo teve por objetivos identificar os níveis de AF e as prevalências de sobrepeso/obesidade e risco metabólico, e associar o índice ponderal com os níveis de AF e risco metabólico em jovens portugueses. A amostra foi composta por 212 jovens portugueses (12-16 anos). Estatura e peso foram mensurados. AF foi estimada a partir do recordatório de 3 dias de Bouchard e pelo uso do pedômetro (durante 5 dias). Os indicadores de risco metabólico considerados foram: glicose, triglicerídeos, HDL-colesterol, tensão arterial sistólica e perímetro da cintura. Os sujeitos foram classificados consoante índice ponderal a partir do índice de massa corporal, enquanto que o estatuto maturacional foi estimado a partir do offset maturacional. Score contínuo de risco metabólico (zRM) foi calculado, e a AF foi dividida em tercis. Os testes estatísticos utilizados foram o Qui-quadrado, teste t independente e ANOVA, as análises foram conduzidas no SPSS 18.0 e WinPepi (p<0,05). Observou-se uma prevalência moderada a elevada de sobrepeso/obesidade e HDL-colesterol, uma elevada prevalência de risco para tensão arterial, e níveis de AF baixos a moderados entre jovens portugueses. A relação entre índice ponderal e zRM mostrou que adolescentes obesos apresentam maior zRM comparativamente aos adolescentes normoponderais ou com sobrepeso. Incrementos nos níveis de AF e redução da prevalência de sobrepeso/obesidade podem ter um papel relevante na redução de fatores de risco metabólico.

Biogenêse mitocondrial e exercício físico: hipótese do acoplamento elétrico-transcripcional / Mitochondrial biogenesis and physical exercise: electric-transcriptional coupling hypothesis

Resumo Uma das principais modificações ocorridas no organismo em decorrência do treinamento físico-esportivo envolvendo exercícios físicos de longa duração é o aumento na quantidade e qualidade funcional de mitocôndrias do tecido muscular esquelético. Não existe até o momento um mecanismo causal explicativo para esse fenômeno. A proposta a ser discutida neste ensaio é denominada por "hipótese do acoplamento elétrico-transcripcional". Segundo a mesma, modificações na atividade elétrica celular, principalmente de despolarização membranar, constituem-se em método de controle e regulação dos processos de biossíntese no organismo multicelular. Por exemplo, estudos que provocaram hiperpolarização artificial em células somáticas induziram diferenciação celular e supressão da proliferação, sendo que o contrário ocorreu com a despolarização. Ou seja, a despolarização celular durante o exercício físico devido a contração muscular intensa e constante pode ativar processos responsáveis por biossínteses e, possivelmente, duplicação de mitocôndria.

Abstract One of the main changes happened in skeletal muscle tissue as a result of physical and sport training with prolonged exercise is the increase in the quantity and functional quality of mitochondria. There is not yet an explanatory causal mechanism for this phenomenon. The suggestion to be discussed in this assay is called "electric-transcriptional coupling hypothesis". In this hypothesis, changes in electrical activity, mainly membrane depolarization, are considered methods used for the control of biosynthesis in multicellular organisms. For example, studies that resulted in somatic cell hyperpolarization induced suppression of differentiation and proliferation, and the opposite happened with depolarization. That is, cell depolarization that occur during the exercise as a consequence of intense and prolonged muscle contraction could activate processes responsible for biosynthesis and, possibly, mitochondrial replication.

Perfil mineral de vacas mestiças Girolanda no período de transição em sistema semi-intensivo em duas estações do ano / Serum mineral profile of Girolanda cows during transition period in semi-intensive system in two seasons

Neste estudo foi avaliado o perfil metabólico de vacas leiteiras no período de transição durante o verão e o inverno. Foram utilizados 31 animais pluríparos mestiços girolando em cada estação, totalizando 62 vacas. No verão permaneciam em pasto com suplementação de silagem de milho e concentrado. No inverno, a exigência nutricional era suprida apenas com silagem de milho e concentrado. Foram feitas um total de 11 coletas de sangue de cada animal segundo o seguinte protocolo: quatro coletas pré-parto espaçadas semanalmente, no dia do parto e com 2, 5, 10, 15, 21 e 30 dias pós-parto. Foram avaliadas as concentrações de cálcio, fósforo e magnésio. Todos os analitos variaram em função do estatus fisiológico. As concentrações médias de cálcio e magnésio foram maiores no verão do que no inverno. Em ambas as estações, as menores concentrações médias de cálcio ocorreram próximas ao parto, sendo que 75% dos animais no inverno e 35,48% dos animais no verão estavam hipocalcêmicos. Apenas no décimo dia as concentrações de cálcio voltaram aos níveis do pré-parto, demonstrando que esse tempo é necessário para a adaptação da nova condição de lactante. As concentrações de magnésio foram menores no pós-parto do que no pré-parto nas duas estações, demonstrando a necessidade desse mineral para a produção de leite. As concentrações médias de magnésio permaneceram sempre dentro dos valores de referência, porém 19% dos animais aos dois dias pós-parto no inverno e 7% dos animais aos 10 dias pós-parto no verão tinham concentrações inferiores a esses limites. As concentrações de fósforo sofreram grande variação ao longo do peri-parto, porém sempre em níveis elevados, sendo que 49,8% dos animais no inverno e 37,3% no verão tinham níveis de fósforo acima dos valores de referência.

The metabolic profile of dairy cows in the transition period during summer and winter was evaluated. Were used 31 crossbred Holstein/Gir cows at each season, totaling 62 cows. During summer they remained in pasture with supplementation of corn silage and concentrate and in the winter, corn silage and concentrate was offered to furnish the nutritional requirements. A total of 11 blood samples from each animal were taken according to the following protocol: four collections weekly antepartum, at birth and at 2, 5, 10, 15, 21 and 30 days postpartum. Concentrations of calcium, phosphorus and magnesium were evaluated. All analytes varied according to the physiological status. The average concentrations of calcium and magnesium were higher in summer than in winter. In both seasons, the lowest mean calcium concentrations occurred near calving, and 75% of the animals in winter and 35.48% of the animals in the summer were hypocalcemic. Only on the tenth day postpartum, the calcium concentrations returned to levels of prepartum, demonstrating that this time is necessary for the adaptation of the new condition of lactating. Magnesium concentrations were lower postpartum than prepartum in both seasons, demonstrating the need for this mineral for the production of milk. The average concentrations of magnesium remained always within the reference values for the species, but 19% of the animals at two days postpartum in winter and 7% of the animals at 10 days postpartum in summer had concentrations below these limits. Phosphorus concentrations suffered large variation along the peri-partum, but always at high levels, with 49.8% of the animals in winter and 37.3% in summer had phosphorus levels above the reference range of the species.

Correlación de parámetros metabólicos, hemodinámicos y gasométricos en pacientes graves inestables / Correlation of metabolic, hemodynamic and gasometrical parameters in unstable patients in serious conditions

FUNDAMENTO: el análisis integral del paciente critico inestable hemodinámicamente al pie de la cama siempre constituye un reto para el médico intensivista, por lo que interpretar correcta y oportunamente variables fisiopatológicas relacionadas con estos eventos resulta de suma importancia. OBJETIVO: identificar algunas de estas variables metabólicas, gasométricas y hemodinámicas que permitan un mejor análisis integrado del paciente inestable. Método: se realizó un estudio analítico descriptivo en la unidad de cuidados intensivos del Hospital Universitario Manuel Ascunce Domenech, de enero del 2000 a enero del 2014. El universo quedó conformado por 533 pacientes en estado de choque, de ellos 332 en estado de choque no cardiogénico y 210 con choque cardiogénico. Se sugirió como criterio de inclusión a todos los pacientes monitorizados de forma invasiva y en estado de choque en sus primeras 72 horas de evolución. Se estimó el modelo utilizando la técnica de análisis multivariado y de regresión logística binaria y coeficiente para cada una de las variables independientes introducidas. RESULTADOS: Predominó la asociación de presión arterial media con un nivel de significación de 0, 000 y de importancia de 0, 99; exceso de base 0, 000 y de importancia de 0, 82; de saturación venosa central de oxígeno significación de 0, 000, importancia 0, 89 y saturación venosa mixta de oxígeno con un nivel de significación estadística de 0,005 y de importancia de 1, 061. CONCLUSIONES: la interpretación correcta de estas variables resulta de vital importancia para el análisis del paciente en estado de choque, pues permite un análisis más integral y oportuno de estos pacientes y establecer protocolos de tratamientos más razonables sin pérdida de tiempo.

BACKGROUND: the present study demonstrates the economic results achieved with the sequential application of antimicrobials in children treated because of complicated acute appendicitis in the pediatric surgery department of Camagüey. METHOD: a transversal quasi-experimental study was conducted in all the cases of children treated because of complicated acute appendicitis between January, 2010 and December, 2013 in the pediatric surgery department of the Eduardo Agramonte Piña Pediatric Teaching Hospital of Camagüey. The economic results were compared to those obtained from the patients treated because of the same disease between January, 2006 and December, 2009. RESULTS: four hundred and one patients were included in the study. Between the years 2006-2009 the hospital stay was of 7, 03 days/ patient; on the other hand, between the years 2010-2013 it was of 4, 02 days/patient. On average, the cost per patient was $ 578, 8 for the cases and $ 953, 6 for the controls. The consumption of antimicrobials, between 2006 and 2009, was of 3 755 ampoules of ceftriaxone, 2 253 ampoules of amikacin and 4 506 bottles of metronidazole; between 2010 and 2013 only 1 965 ampules of ceftriaxone, 1 179 ampoules of amikacine and 2 358 bottles of metronidazole were used. CONCLUSIONS: the study demonstrated a notable reduction in hospital stay and costs and in the use of expensive antimicrobials.

Perfil metabólico de vacas mestiças leiteiras com baixo escore de condição corporal no periparto / Metabolic profile in crossbred dairy cows with low body condition score in the peripartum period

Objetivou-se avaliar o perfil metabólico energético, proteico e enzimático de vacas mestiças leiteiras com baixo escore de condição corporal (ECC) no periparto. Foram colhidas amostras sanguíneas uma semana antes do parto, no dia do parto, e aos sete, 14, 21, 28 e 43 dias pós-parto (DPP) de 36 animais, com média de ECC de 2,6±0,5, com eutocia e pós-parto fisiológico e sem tratamentos nesta fase. Analisaram-se as concentrações séricas de proteínas totais, albumina e globulinas para o perfil protéico; AST, ALT, GGT e fosfatase alcalina para o perfil enzimático; ácidos graxos não-esterificados (NEFA), β-hidroxibutirato (BHBA), triglicerídeos, colesterol e lipoproteínas (VLDL, HDL e LDL) para o perfil energético. As vacas apresentaram no pré-parto hipoproteinemia, hipoalbuminemia, hipocolesterolemia e aumento das enzimas GGT e AST. No dia do parto houve lipólise e hipoglobulinemia. Concluiu-se que vacas mestiças leiteiras com baixo ECC apresentam balanço energético negativo, hipoproteinemia com hipoalbuminemia e lesão hepática no periparto, com restabelecimento aos 30 DPP, mas não recuperam sua condição corporal até o final do puerpério.

The aim of this study was to evaluate the metabolic profile of protein, energy and enzyme in crossbred dairy cows with low body condition score (BCS) in the peripartum period. Blood samples were collected from 36 animals with 2.6±0.5 BCS, eutocia, physiological postpartum and without any treatment, on following days: one week before calving, calving and 7, 14, 21, 28 and 43 days in milk (DIM). It was evaluated serum total protein, albumin and globulins for protein profile; AST, ALT, GGT and alkaline phosphatase for mineral profile; nonesterified fatty acids (NEFA), β-hydroxybutyrate (BHBA), triglycerides, cholesterol and lipoproteins (VLDL, HDL and LDL) for energy profile. Crossbred dairy cows had hypoproteinemia, hypoalbuminemia, hypocholesterolemia and increased that both enzymes AST and GGT at the precalving. There were lipolysis and hypoglobulinemia at parturition. It was concluded that crossbred dairy cows with low BCS have negative energy balance, hypoproteinemia with hypoalbuminemia and hepatic injury in the peripartum. This condition is restored at 30 DIM, but there is no recovery of the body condition by the end of puerperium.

Determinantes sociales en salud: su relación con el síndrome metabólico / Social Determinants of Health: its relationship with the metabolic syndrome

El propósito de esta investigación es hacer una revisión del síndrome metabólico, su impacto en la salud de la población adulta y la intervención de los servicios de salud por medio de programas, así como su abordaje en los ámbitos biológico, político, económico y social, llamados determinantes sociales. El perfil epidemiológico, demográfico y económico conlleva la salud o enfermedad de la población. En el mundo 1,600 millones de personas tienen sobrepeso; de ellas, 400 millones son obesas. Los índices de morbimortalidad prematura se han incrementado. Las complicaciones por enfermedad cerebrovascular y la diabetes afectan la calidad de vida de la población y los presupuestos sanitarios. En México hay más de 17 millones de hipertensos, 14 millones de dislipidémicos, seis millones de diabéticos y más de 35 millones de adultos –siete de cada diez– con sobrepeso u obesidad. Presentamos un recorrido histórico del proceso-establecimiento del síndrome metabólico. En la actualidad las organizaciones American Heart Association/National Heart, Lung and Blood Institute y el Panel de Tratamiento del Colesterol han establecido los criterios para definir esa patología. Se describen y analizan los determinantes sociales como un entramado de factores estructurales e intermediarios políticos, ambientales y sociales que acotan el estado de salud de los individuos y las comunidades. Es necesario conjuntar las estrategias de los sistemas de salud, políticas públicas y el colectivo de la población para mejorar la salud.

The purpose of this research is to review metabolic syndrome, its impact on the health of adult population, the intervention of health services through programs, as well as its approach in the biological, economic, political and social health areas, the so-called social determinants. The epidemiological, demographic and economic profile of a population leads to its health or illness. 1.6 million people worldwide are overweight, of which 400 million are obese. The rate of morbidity and premature mortality has increased. Complications from cerebrovascular disease and diabetes affect the quality of life of the population and the health budgets. In Mexico, more than 17 million people are hypertensive, 14 million dyslipidemic, 6 million diabetic, and more than 35 million adults –seven out of every ten– are overweight or obese. We present a historical view of metabolic syndrome. Today organizations such as the American Heart Association/National Heart, Lung and Blood Institute and the Cholesterol Treatment Panel have established criteria for defining such pathology. We analyze and describe the social determinants as a set of structural factors and political, environmental and social intermediaries that strongly influence the health status of individuals and communities. It is necessary to aggregate the strategies of the health systems, public policies and the general population to attain an overall health improvement.

Medicamentos que favorecen la pérdida de peso y el control metabólico en las personas obesas con diabetes mellitus tipo 2 / Drugs for loss of weight and metabolic control in obese persons with type 2 diabetes mellitus

Introducción: la obesidad es una enfermedad compleja y multifactorial, frecuente, creciente, que afecta a casi todos los países, independientemente de su desarrollo económico, a ambos sexos, a todas las edades y grupos sociales. Genera importantes costos al sistema de salud, en particular cuando se vincula con la diabetes mellitus tipo 2. En tal sentido se hace necesario optimizar el tratamiento en estos pacientes. Objetivos: describir los medicamentos que deben ser usados en personas con diabetes mellitus tipo 2 que presentan sobrepeso u obesidad, con el objetivo de obtener un buen control metabólico y favorecer la pérdida de peso, o al menos, evitar su aumento. Desarrollo: la relación entre la diabetes mellitus tipo 2 y el exceso de peso está bien establecida. El tratamiento con hipoglucemiantes como sulfonilureas, meglitinidas, tiazolidinedionas, e incluso insulina, pueden ocasionar un aumento de peso como efecto secundario potencial; por tanto, es necesario el empleo en estas personas de fármacos que atenúen la ganancia de peso. Conclusiones: el uso de metformina y el análogo de insulina detemir en pacientes con diabetes mellitus tipo 2 y sobrepeso corporal, se asocia a un efecto neutral o a una modesta pérdida de peso corporal. Los inhibidores de la dipeptidil peptidasa-4, sitagliptina y vildagliptina tienen un efecto neutro sobre el peso, mientras que los agonistas del receptor de glucagon-like peptide 1, exenatide y liraglutide, así como el análogo de amilina, pramlintide, promueven la pérdida de peso(AU)

Introduction: obesity is a growing complex and multifactoral disease that frequently affects people from sexes, age groups and social segments in almost all the countries regardless of their economic development. It brings about substantial costs for the health care system, particularly when it is linked to type 2 diabetes mellitus. In this regard, it is necessary to optimize the medical treatment for these patients. Objectives: to describe the drugs that should be used in persons with type 2 diabetes mellitus, who present with overweight or obesity, in order to keep good metabolic control and encourage loss of weight or at least to avoid weight gain. Development: the association of type 2 diabetes mellitus and excessive weight is well-established. The treatment with hypoglycemic such as sulphonylureas, meglitinides, thiazolidonediones and even insulin, may cause weight gain as a potential secondary effect and therefore, it is necessary to use drugs diminishing the weight gain in these persons. Conclusions: the use of metformine and insulin analogue called detemir in patients with type 2 diabetes mellitus and body overweight is associated to neutral effect or to modest loss of body weight. The dipeptidyl peptidase-4, sitagliptin and vildagliptin inhibitors have neutral effect on weight whereas the glucagon-like peptide 1 receptor agonists called exenatide and liraglutide as well as amiline analogue called pramlintide encourage loss of weight(AU)

Metabolismo energético, proteico e mineral de ovelhas Santa Inês hígidas e com mastite subclínica / Energy, protein and mineral metabolism in Santa Inês ewes, both healthy and with subclinical mastitis

Este estudo teve por objetivo avaliar o metabolismo energético, proteico e mineral de ovelhas Santa Inês hígidas e com mastite subclínica acompanhadas durante o final da gestação e na lactação. Foram acompanhadas ovelhas submetidas ao mesmo sistema de criação semi-intensivo. Os animais foram avaliados conforme os momentos a seguir: 10 dias que precedeu o parto (dap) e 15 dias pós parto (dpp), 30 dpp, 60 dpp e 90 dpp. Os metabólitos sanguíneos foram avaliados a partir do momento que antecedeu ao parto e os metabólitos no soro lácteo nos momentos subsequentes. Após exame clínico e bacteriológico foi realizada a triagem das ovelhas acompanhadas neste estudo, sendo 12 hígidas e 18 com mastite subclínica. Durante a lactação, mantendo os mesmos critérios de triagem, foram selecionadas 11 glândulas mamárias sadias e 20 infectadas, das quais foi colhido o leite para obtenção do soro lácteo. Foram mensurados no soro sanguíneo os metabólitos do perfil energético (ácidos graxos não esterificados (AGNEs), β-hidroxibutirato (BHB), frutosamina, colesterol e triglicérides), do perfil proteico (proteína total, albumina, uréia e creatinina) e do perfil mineral (ferro, cobre, zinco, magnésio, cálcio total, cálcio ionizado, sódio e potássio). No soro lácteo foram mensurados os íons cálcio, sódio e potássio, bem como os AGNEs e o BHB. A bioquímica sanguínea revelou haver influência (P<0,05) do período do periparto e da lactação sobre as concentrações sanguíneas dos AGNEs, BHB, colesterol, albumina, uréia, cálcio ionizado e no soro lácteo sobre o íon potássio. As ovelhas portadoras de mastite subclínica apresentaram valores sanguíneos superiores (P<0,05) de colesterol, albumina e cobre e no soro lácteo teores superiores do íon sódio e dos AGNEs e inferiores do íon potássio. O bom escore corporal das ovelhas observado durante o estudo aliado aos achados bioquímicos permitiu concluir ter ocorrido maior requerimento energético no primeiro mês da lactação, porém não o suficiente para desencadear qualquer transtorno metabólico e o aparecimento de um quadro de cetonemia, sendo estas discretas alterações mais expressivas nas ovelhas com mastite subclínica.

The study aimed to evaluate the energy, protein and mineral metabolism in Santa Inês ewes, healthy and with subclinical mastitis, followed up during late gestation and lactation periods. Ewes subjected to the same semi-intensive nursing system were followed up. The animals were evaluated according to the following stages: 10 days before parturition (dbp) and 15 days postpartum (dpp), 30 dpp, 60 dpp, and 90 dpp. Blood metabolites were evaluated starting from the stage previous to parturition and whey metabolites were evaluated in the subsequent stages. A screening of the ewes followed up in this study (12 healthy and 18 with subclinical mastitis) was performed after a clinical and bacteriological examination. During lactation, maintaining the same screening criteria, 11 healthy and 20 infected mammary glands were selected; the milk for whey extraction was collected from these glands. Energy profile metabolites (non-esterified fatty acids [NEFAs], β-hydroxybutyrate [BHB], fructosamine, cholesterol and triglycerides), protein profile (total protein, albumin, urea and creatinine) and mineral profile (iron, copper, zinc, magnesium, total calcium, ionized calcium, sodium, and potassium) were measured in the blood serum. Calcium, sodium and potassium ions, as well as NEFAs and BHB were measured in the whey. Blood biochemistry revealed an influence (P<0.05) of the peripartum and lactation periods on the blood concentrations of NEFAs, BHB, cholesterol, albumin, urea, ionized calcium. An analysis of the whey also revealed an influence on the potassium ion. Ewes with subclinical mastitis showed higher (P<0.05) blood levels of cholesterol, albumin and copper; higher sodium ion concentrations and NEFAs, and lower potassium ion in whey. Good physical score of ewes observed during this study, combined with the biochemical findings, allowed us to conclude that there was a larger energy requirement in the first month of lactation; however, this requirement was not enough to trigger any metabolic disorder or the emergence of ketonemia, and these discrete changes were more apparent in ewes with subclinical mastitis.

Efeito da ordem de parto e da perda de peso durante a lactação no desempenho reprodutivo subsequente de matrizes suínas / The effect of parity order and lactation weight loss on subsequent reproductive performance of sows

Investigou-se o efeito da ordem de parto (OP) e da perda de peso durante a lactação no desempenho reprodutivo de 666 matrizes suínas. Foram formadas três classes de OP (OP1, OP2 e OP3-5) e duas classes de percentual de perda de peso (≤1% e >1%) durante a lactação. Foram avaliados: taxa de parto, intervalo desmame-estro (IDE) e tamanho da leitegada subsequente. Houve interação de OP versus perda de peso na taxa de parto das fêmeas (P<0,05). As fêmeas OP1 e OP2 tiveram maior chance (P<0,05) de não parir na classe >1% de perda de peso. A maior perda de peso não foi um fator de risco para não parir na condição OP3-5 (P>0,05). Não houve interação de OP versus perda de peso (P>0,05) para IDE e total de leitões nascidos. Fêmeas OP1 apresentaram IDE mais longo e menor tamanho da leitegada no parto subsequente (P<0,05) do que fêmeas OP2 e OP3-5. As perdas corporais na lactação não influenciaram o IDE (P>0,05), mas reduziram o tamanho da leitegada subsequente (P<0,05). Conclui-se que maior perda de peso na lactação resulta em aumento de falhas reprodutivas nas fêmeas mais jovens e reduz o tamanho da leitegada subsequente em todas as OP.

The effect of parity (PO) and weight loss during lactation on the subsequent reproductive performance of 666 sows was investigated. Sows were allocated into three PO classes (PO1, PO2 and PO3-5) and into two classes of weight loss percentage (≤1% and >1%) during lactation. Farrowing rate, weaning to estrus interval (WEI) and total born at next farrow were evaluated. There was an interaction effect between PO and weight loss on the farrowing rate (P<0.05). PO1 and PO2 females had more chance (P<0.05) of failure to farrow when weight loss was higher than 1%. However, the higher weight loss was not a risk factor to low farrowing rate in PO3-5 females (P>0.05). There was no interaction between PO and weight loss (P>0.05) on WEI and subsequent total born. PO1 females showed longer WEI and lower litter size on subsequent farrowing compared to PO2 and PO3-5 females. Weight loss did not affect WEI (P>0.05), but it decreased subsequent litter size (P<0.05). High weight loss during lactation results an increase in reproductive failures in young females and decreases subsequent litter size in all parity orders.

Efeito do regime alimentar sobre o perfil metabólico de ovinos Santa Inês em confinamento / Effect of diet on the metabolic profile of Santa Inês sheep feedlot

Avaliou-se o perfil metabólico de 40 ovinos Santa Inês, inteiros, com peso vivo médio inicial de 17±1,7kg,, submetidos à restrição alimentar seguida de realimentação em confinamento, distribuídos em quatro tratamentos: 0, 20, 40 e 60% de restrição alimentar. Dois ensaios foram desenvolvidos, um referente à restrição e outro à realimentação. Para tanto, foi utilizado delineamento experimental inteiramente ao acaso, com quatro tratamentos e 10 repetições, e distribuído em fatorial cruzado 4x3. Observou-se na fase de restrição que os níveis de fósforo foram mais altos nos animais sob restrição alimentar; o mesmo ocorrendo na fase final para as concentrações de proteínas totais (PT), albumina (Alb) e colesterol total. A gama-glutamiltransferase (GGT) decresceu de forma linear com o aumento da restrição. No segundo ensaio, verificou-se que as concentrações de PT, Alb, globulina, colesterol total, lipoproteína de alta densidade, GGT e magnésio (Mg) apresentaram diferença (P<0,05) entre os períodos de coleta. Já na restrição prévia, observou-se comportamento linear decrescente para GGT e interação tratamento versus período de coleta para a concentração de cálcio. Os níveis de restrição alimentar afetaram o metabolismo proteico e não interferiram no metabolismo energético, e a realimentação resultou em alteração no metabolismo proteico, energético e mineral.

The objective of this study was to evaluate the metabolic profile of 40 Santa Inês sheep, whole, with average weight of 17±1,7kg, submitted to food restriction followed by refeeding in confinement, distributed in four treatments: 0, 20, 40 and 60% restriction food. Two tests were developed, one for restriction and one for refeeding. In this experiment a completely randomized design was used, with four treatments and 10 repetitions, distributed in a factorial 4x3 crossover. In the constraint phase it was observed that phosphorus levels were higher in animals under food restriction, this also occurred in the final stage for of total protein (TP), albumin (Alb) and total cholesterol concentrations. The gamma-glutamyl transferase (GGT) decreased linearly with increasing restriction. On the second trial it was found that concentrations of PT, Alb, globulin, total cholesterol, high density lipoprotein, GGT and Mg were similar (P<0,05) between collection periods. In the previous restriction, a decreasing linear behavior and interaction treatment for GGT versus collection period for the concentration of calcium was observed. The levels of food restriction affect protein metabolism and did not interfere with energy metabolism, and feedback resulted in changes in protein, energy and mineral metabolism.