Concepts of indirect calorimetry on metabolic disorders: a narrative review

Introdução: A calorimetria indireta continua sendo um padrão ouro na avaliação do gasto energético de repouso no campo clínico. Por meio de suas medições, é possível oferecer as necessidades energéticas de um paciente para maximizar os benefícios da terapia nutricional. No entanto, os conceitos e as bases metodológicas dos dados coletados podem ser dificultosos para serem interpretados pelos usuários na prática clínica. Objetivo: abordar os conceitos de gasto energético diário total e seus componentes, e, apresentar os aspectos metodológicos da calorimetria indireta que podem servir como guia no campo clínico. Método: Revisão bibliográfica narrativa, realizada pelas bases de dados eletrônicas Pubmed (US National Library of Medicine), SCOPUS e Scientific Electronic Library Online (SciELO). A pesquisa foi realizada no período entre 1905-2019, utilizando os seguintes identificadores em Descritores em Ciências da Saúde: Metabolismo Basal, Metabolismo Energético e Calorimetria Indireta. Foram selecionadas 55 pesquisas publicadas que apresentaram conteúdos relacionados aos objetivos deste estudo. Resultado: O gasto energético total diário (GETD) é composto por três componentes principais, tais como: atividade física (AF), efeito térmico dos alimentos (TEF) e taxa metabólica basal (TMB) e / ou gasto energético de repouso (GER). O GER é geralmente avaliado por calorimetria indireta, que também fornece informações sobre o coeficiente respiratório (CR) e oxidação de substratos, que pode variar de acordo com o metabolismo do paciente, como algum distúrbio metabólico, obesidade ou desnutrição. Portanto, o manejo adequado dos aspectos metodológicos da calorimetria indireta e sua posterior interpretação nos distúrbios metabólicos é fundamental para garantir a qualidade dos resultados. Conclusão: Os conceitos de gasto energético e as bases metodológicas da calorimetria indireta são relevantes para fornecer uma atenção individualizada aos pacientes com distúrbios metabólicos. As descrições desta revisão podem ser utilizadas como um guia prático, auxiliando a compreensão da aplicação correta da técnica de calorimetria indireta, em estudos relacionados ao gasto energético com ênfase nos distúrbios metabólicos.Introduction: Indirect calorimetry remains a gold standard in measuring resting energy expenditure in the clinical field. Through its measurements, it is possible to offers a patient’s energy needs to maximize nutritional therapy benefits. However, the concepts and methodological basis of collected data can be difficult to be interpreted by users in clinical practice. Objective: To address the concepts of total daily energy expenditure and its components and present the methodological aspects of indirect calorimetry that can guide the clinical field. Method: Narrative bibliographic review using the electronic Pubmed (US National Library of Medicine), SCOPUS, and Scientific Electronic Library Online (SCIELO) databases. The research was carried out in the period between 1905-2019, using the following identifiers in Health Sciences Descriptors: Basal Metabolism, Energy Metabolism and Indirect Calorimetry. We selected 55 researches published that presented contents related to the objectives of this study. Result: The total daily energy expenditure (TDEE) is comprised of three main components, such as physical activity (PA), thermic effect of food (TEF) and basal metabolic rate (BMR) and/or resting energy expenditure (REE). The REE is generally evaluated by indirect calorimetry, which also provides information on the respiratory coefficient (RQ) or oxidation of substrates. Its result varies depending on the existence of some metabolic disorders such as obesity or malnutrition. Therefore, the proper management of the methodological aspects of indirect calorimetry and its subsequent interpretation in metabolic disorders is essential to guarantee the results’ quality. Conclusion: Energy expenditure concepts and the methodological basis of indirect calorimetry are relevant to providing individualized attention to patients with metabolic disorders. This review can be used as a practical guide, helping to understand the correct application of the indirect calorimetry technique in studies related to energy expenditure with an emphasis on metabolic disorders

14-weeks combined exercise epigenetically modulated 118 genes of menopausal women with prediabetes

Background: Pre-diabetes precedes Diabetes Mellitus (DM) disease and is a critical period for hyperglycemia treatment, especially for menopausal women, considering all metabolic alterations due to hormonal changes. Recently, the literature has demonstrated the role of physical exercise in epigenetic reprogramming to modulate the gene expression patterns of metabolic conditions, such as hyperglycemia, and prevent DM development. In the present study, we hypothesized that physical exercise training could modify the epigenetic patterns of women with poor glycemic control. Methods: 48 post-menopause women aged 60.3 ± 4.5 years were divided according to their fasting blood glucose levels into two groups: Prediabetes Group, PG (n=24), and Normal Glucose Group, NGG (n=24). All participants performed 14 weeks of physical exercise three times a week. The Infinium Methylation EPIC BeadChip measured the participants’ Different Methylated Regions (DMRs). Results: Before the intervention, the PG group had 12 DMRs compared to NGG. After the intervention, five DMRs remained different. Interestingly, when comparing the PG group before and after training, 118 DMRs were found. The enrichment analysis revealed that the genes were related to different biological functions such as energy metabolism, cell differentiation, and tumor suppression. Conclusion: Physical exercise is a relevant alternative in treating hyperglycemia and preventing DM in post-menopause women with poor glycemic control

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt