A family history of type 2 diabetes increases risk factors associated with overfeeding

Aims/hypothesis: The purpose of the study was to test prospectively whether healthy individuals with a family history of type 2 diabetes are more susceptible to adverse metabolic effects during experimental overfeeding. Methods: We studied the effects of 3 and 28 days of overfeeding by 5,200 kJ/day in 41 sedentary individuals with and without a family history of type 2 diabetes (FH+ and FH− respectively). Measures included body weight, fat distribution (computed tomography) and insulin sensitivity (hyperinsulinaemic–euglycaemic clamp). Results: Body weight was increased compared with baseline at 3 and 28 days in both groups (p<0.001), FH+ individuals having gained significantly more weight than FH− individuals at 28 days (3.4±1.6 vs 2.2±1.4 kg, p<0.05). Fasting serum insulin and C-peptide were increased at 3 and 28 days compared with baseline in both groups, with greater increases in FH+ than in FH− for insulin at +3 and +28 days (p<0.01) and C-peptide at +28 days (p<0.05). Fasting glucose also increased at both time points, but without a significant group effect (p=0.1). Peripheral insulin sensitivity decreased in the whole cohort at +28 days (54.8±17.7 to 50.3±15.6 μmol min−1 [kg fat-free mass]−1, p=0.03), and insulin sensitivity by HOMA-IR decreased at both time points (p<0.001) and to a greater extent in FH+ than in FH− (p=0.008). Liver fat, subcutaneous and visceral fat increased similarly in the two groups (p<0.001). Conclusions: Overfeeding induced weight and fat gain, insulin resistance and hepatic fat deposition in healthy individuals. However, individuals with a family history of type 2 diabetes gained more weight and greater insulin resistance by HOMA-IR. The results of this study suggest that healthy individuals with a family history of type 2 diabetes are predisposed to adverse effects of overfeeding.D. Samocha-Bonet, L.V. Campbell, A. Viardot, J. Freund, C.S. Tam, J.R. Greenfield and L.K. Heilbron

Variation in the Application of Methods Used for Predicting Energy Requirements in Acutely ill Adult Patients: A Survey of Practice

Objective: To determine current methods used by dietitians for estimating the energy requirement of a chronically and acutely ill adult patient and the variation in the application of methods

Suprimento de micronutrientes, adequação energética e progressão da dieta enteral em adultos hospitalizados Adequacy of energy and micronutrient supply and progression of enteral diet in hospitalized adult patients

OBJETIVO: Avaliar a adequação da dieta enteral, em termos de micronutrientes e energia e identificar fatores interferentes na progressão da dieta enteral prescrita a adultos hospitalizados em um hospital geral de alta complexidade. MÉTODOS: Entre junho de 2004 e maio de 2005, adultos internados em um hospital de alta complexidade do sul do Brasil foram avaliados quanto às suas características clínicas e da prescrição da nutrição enteral. As características da nutrição enteral foram avaliadas e comparadas às recomendações diárias de ingestão, obtendo-se o percentual de adequação de nutrientes prescritos na dieta enteral em relação aos valores de recomendação para cada paciente. Os fatores associados à prescrição de energia foram identificados por meio de Regressão Linear Múltipla. RESULTADOS: Foram acompanhados 230 pacientes em uso de nutrição enteral. As recomendações diárias foram alcançadas satisfatoriamente para vitaminas hidrossolúveis (exceto ácido fólico), lipossolúveis (exceto vitamina D) e minerais (exceto cálcio). Em média, as prescrições iniciais de nutrição enteral ofereceram 24,0kcal/kg/dia (desvio-padrão=10,8, e valores mínimo e máximo de 4,3 a 69,2), e progrediram até 28,4kcal/kg/dia (desvio-padrão=11,8, valores mínimo e máximo de 1,4 a 69,2). A recomendação de 25 a 35kcal/kg/dia foi prescrita para 32,6% dos pacientes. Para 15,7% dos pacientes foram prescritas acima de 40kcal/kg/dia. Somente o índice de massa corporal e o número de dias de hospitalização, ajustados para a quantidade de energia já inicialmente prescrita, associaram-se de forma independente à prescrição energética final. CONCLUSÃO: Pequena proporção das prescrições esteve adequada em relação à quantidade de energia, e a progressão da dieta enteral ocorreu independentemente das características clínicas dos pacientes.<br>OBJECTIVE: To asses the adequacy of enteral diet, in terms of micronutrients and energy and to identify factors that interfere in the progression of enteral diets prescribed to adults hospitalized in a high complexity general hospital. METHODS: From June 2004 to May 2005, adult patients hospitalized in a high complexity hospital, in Southern Brazil, were assessed in terms of enteral diet prescription and clinical characteristics. The characteristics of the enteral nutrition were assessed and compared with the recommended daily intakes, obtaining percentages of nutrient adequacy of the enteral diet. Factors associated with energy prescription were identified by multiple linear regression. RESULTS: Two hundred and thirty tube-fed patients were followed. The dietary reference intakes were satisfatory met for water-soluble vitamins (except for folic acid), fat-soluble vitamins (except for vitamin D) and minerals (except for calcium). The mean initial energy prescription was 24.0 kcal/kg/day (standard deviation=10.8, minimum and maximum values ranging from 4.3 to 69.2kcal/kg/day) and progressed to 28.4kcal/kg/day (standard deviation=11.8, minimum and maximum values ranging from 1.4 to 69.2kcal/kg/day).The recommendation of 25 to 35kcal/kg/day was prescribed to 32.6% of patients. Forty or more kcal/kg/day was presuibed to 15.7% of the patients. Only body mass index and the number of hospital stay days, adjusted to the energy prescribed at the beginning, were independently associated with the final energy prescription. CONCLUSION: A small proportion of the prescriptions were adequate in terms of Kcal/kg/day, and the progression of enteral diet occurs regardless of the clinical characteristics of the patients