Effect of hypocaloric meals with different macronutrient compositions on energy metabolism and lung function in obese women.

OBJECTIVE: We investigated the effect of hypocaloric mixed diets with different proportions of carbohydrate, protein, and fat on resting metabolic rate and the thermic effect of food in obese women. METHODS: Three mixed hypocaloric diets were consumed in random order during separate periods lasting 7 d each. Between each dietary period there was a washout period of 10 d. Diet 1 had a higher proportion of energy from carbohydrate (72%), diet 2 had a higher proportion of energy from protein (43%), and diet 3 had a higher proportion of energy from fat (68%). Indirect calorimetry and lung function tests were done after the completion of each 7-d diet. Seven obese women, ages 22 to 45 y and with body mass indexes of 32 to 59 kg/m(2), participated in the study. Oxygen consumption, carbon dioxide production, resting metabolic rate, and the thermic effect of food by indirect calorimetry were measured. Lung function tests included spirometry in the seated and upright positions, arterial blood gas analysis, and maximal inspiratory and expiratory pressures. RESULTS: There were no statistically significant differences in the resting metabolic rate and the thermic effect of food resulting from the three diets. The mean resting metabolic rates (kJ/d) were 7453 +/- 1446 for diet 1, 7461 +/- 1965 for diet 2, and 7076 +/- 2048 for diet 3. The mean thermic effects of food (kcal/min) were -0.02 +/- 0.07 for diet 1, -0.01 +/- 0.25 for diet 2, and 0.05 +/- 0.13 for diet 3. Lung function tests were normal before and after the hypocaloic diets: partial pressure of oxygen (mmHg) values were 81 +/- 13, 77 +/- 8, and 78 +/- 11 for diets 1 to 3, respectively; and partial pressure of carbon dioxide (mmHg) were 37 +/- 4, 37 +/- 3, and 37 +/- 4 for diets 1 to 3, respectively. CONCLUSIONS: Obese women with normal lung function tests and consuming mixed hypocaloric diets showed no alteration in resting metabolic rate and a reduced or absent thermic effect of food independently of the macronutrient composition.

Serum levels assessment of vitamin A, E, C, B2 and carotenoids in malnourished and non-malnourished hospitalized elderly patients.

AIMS & METHODS: Serum levels of vitamins A, E, C, B2 and carotenoids were determined in protein-energy malnourished (PEM, with body mass index, BMI<18.5 kg/m2) and non-PEM (BMI+/-18.5 kg/m2) hospitalized elderly (age > or = 65 years) patients, in the University Hospital of Faculty of Medicine of Ribeirão Preto, São Paulo University. RESULTS: PEM (n=21) and non-PEM (n=106) patients were paired for age (73.6+/-7.3 vs. 71.6+/-5.6 years) and male percentage (65.1 vs. 52.4%). As expected, PEM elderly showed lower (P<0.05) body weight (median 43.1; range: 29.9-51.4 vs. 58.1; range: 45.7-143.5 kg), triceps skinfold (5.2+/-3.1 vs. 10.1+/-4.9 mm), and mid-arm muscle circumference (20.3+/-2.5 vs. 23.1+/-3.4 cm). Serum albumin (4.0+/-0.9 vs. 4.1+/-0.7 g/dl) and total lymphocytes count (1918.3+/-919 vs. 1842.7+/-862 mm(3)) were similar, respectively, among PEM and non-PEM patients. The percentage of biochemical riboflavin deficiency (58.8 vs. 56.2), low serum levels of vitamin A (28.6 vs. 29.6) and vitamin E (18.7 vs. 25) were similar, respectively, between PEM and non-PEM groups. The prevalence of low serum levels of water soluble vitamins was higher (P<0.01) in malnourished elderly than in the non-PEM group (ascorbic acid, 80.9 vs. 56.7%, and carotenoids, 14.3 vs. 3%, respectively). CONCLUSIONS: These results suggest that hospitalized malnourished elderly show high percentage of low water soluble vitamin serum levels, a phenomenon possibly linked to decreased food intake, especially fruits and vegetables.

Effect of local diets with added sucrose on glycemic profiles of healthy and diabetic Brazilian subjects.

OBJECTIVE: We set out to determine the daily glycemic profile of healthy and non-insulin-dependent diabetes mellitus (NIDDM) persons and to test the hypothesis that small amounts of sucrose added to NIDDM meals would not change their responses. METHODS: Thirteen NIDDM and six healthy volunteers participated in the study. They initially consumed a diet similar to their home diet and later a diabetic hospital dietary regimen, with and without 30 g/day sugar replacing equivalent food energy. The hospital diet included their usual foods: bread, milk, rice, beans, meat, vegetables and fruits at breakfast, lunch and dinner. To follow their glycemic profile we drew several blood samples during a 22-hour period. RESULTS: The day-long plasma glucose profile of the NIDDM and healthy subjects showed similar patterns, increasing after the meals and returning later to baseline levels. The extra amount of sucrose consumed did not change the daily glycemic profile or the calculated glycemic area under the 22-hour glycemic curves. These results call attention to the importance of the 22-hour glycemic profile compared to other shorter glycemic indexes. CONCLUSION: The 22-hour profile has obvious advantage for planning day-long diabetic diets, taking in consideration local daily foods and usual eating habits. Maintenance of a small and traditional amount of food, e.g., sucrose, without harmful effects to the subjects, is another advantage of this proposition. It improves patient compliance as well as social daily life.

Síndrome do intestino curto: aspectos fisiopatológicos, clínicos e suporte nutricional de longa duraçäo / Short bowel syndrome: physiopathological and clinical aspects, and long-term nutritional support

Os pacientes com Síndrome do Intestino Curto (SIC) necessitam de suporte nutricional parenteral, sem o que a taxa de mortalidade é superior a 80 por cento. A unidade Metabólica do Hospital de Clínicas da Faculdade de Medicina de Ribeirao Preto mantém programa de suporte nutricional parenteral em regime ambulatorial para o paciente com SIC, estabelecido de acordo com a necessidade individual de cada paciente, o que é determinado pela avaliaçao periódica do estado nutricional por meio de critérios clínicos, dietéticos, antropométricos e bioquímicos. Este artigo discute os aspectos fisiopatológicos e clínicos da SIC, bem como a conduta do suporte nutricional de longa duraçao empregada nos pacientes tratados na Unidade Metabólica do Hospital de Clínicas da Faculdade de Medicina de Ribeirao Preto.

[Serum levels of vitamin A, E, C and B2, carotenoid and zinc in hospitalized elderly patients]. / Avaliação dos níveis séricos das vitaminas A, E, C e B2, de carotenóides e zinco, em idosos hospitalizados.

Serum levels of carotenoids, zinc and vitamins A, E, C and B2 were measured in al (n = 202) the elderly patients hospitalized in different wards of the hospital studied from February 1986 to October 1988. The study was conducted on 130 men and 72 women with a mean age of 67.8 years (range: 60 to 88 years). The percentage of nutritional deficiency was 59.5% for zinc, 56.5% for vitamin C, 34.5% for vitamin B2, 25.9% for vitamin E, 13.2% for vitamin A, and 6.8% for carotenoids. Elderly patients with leucoses, megaesophagus, chronic obstructive pulmonary disease, and congestive heart failure represent a group with a high prevalence of deficiency both of zinc and of the vitamins under study. These results show the importance of detecting deficiencies of these micronutrients and provide a basis for a more rational approach to the treatment of elderly patients.