Associação entre resistência insulínica e secreção de GLP-2 em obesos: um estudo piloto

OBJECTIVE: The objective of this pilot study was to determine whether glugagon-like peptide 2 (GLP-2) secretion relates to insulin sensitivity (IS) in obese subjects. SUBJECTS AND METHODS: Twenty four obese subjects [body mass index (BMI) 40.0 ± 3.0 kg/m² (mean ± standard deviation)] were included, nine of which were male, age 43 ± 8 years. Twelve subjects had type 2 diabetes, all treated with oral anti-diabetic agents only. The subjects were submitted to standard meal tolerance test (MTT) for dosage of the curves: glucose, insulin, and GLP-2. Insulin sensitivity was measured by HOMA-IR, and OGIS was derived from the MTT. Spearman linear correlations and partial correlations were obtained. RESULTS: There was an inverse relationship between the GLP-2 secretion and IS: HOMA-IR correlated with GLP-2 AUC (R = 0.504; p = 0.012), and OGIS correlated with GLP-2 incremental AUC (R = -0.54; p = 0.054). The correlation persisted after controlling for BMI. CONCLUSION: We found an association of GLP-2 secretion and insulin resistance (IR). The understanding of the underlying mechanisms may provide future directions in the pharmacological manipulation of incretins, and in the treatment of obesity and related metabolic disorders.OBJETIVO: O objetivo deste estudo piloto foi determinar a relação entre a secreção de glugagon like peptide 2 (GLP-2) e a sensibilidade insulínica (SI) em indivíduos obesos. SUJEITOS E MÉTODOS: Vinte e quatro indivíduos obesos [IMC 40.0 ± 3.0 kg/m² (média ± desvio-padrão)] foram incluídos no estudo, sendo 9 homens, com idade de 43 ± 8 anos. Do total, 12 indivíduos tinham diabetes tipo 2, todos tratados somente com antidiabéticos orais. Os sujeitos foram submetidos ao teste de refeição padrão (MTT) para dosagens das curvas: glicose, insulina e GLP-2. A sensibilidade insulínica foi mensurada pelos HOMA-IR e OGIS, obtidos pelos valores do MTT. As correlações lineares e correlações parciais foram obtidas. RESULTADOS: Observou-se uma relação inversa entre a secreção de GLP-2 e SI: HOMA-IR correlacionou-se com GLP-2 AUC (R = 0,504; p = 0,012) e OGIS correlacionou-se com GLP-2 incremental AUC (R = -0,54; p = 0,054). A correlação persistiu controlando o IMC. CONCLUSÃO: Encontramos uma associação entre a secreção de GLP-2 e a resistência insulínica. A compreensão desses mecanismos poderá direcionar o futuro farmacológico da manipulação de incretinas no tratamento da obesidade e das desordens metabólicas.632635Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

BODY FAT COMPOSITION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A COMPARATIVE STUDY BETWEEN SKINFOLDS AND ULTRASONOGRAPHY

ABSTRACT Background: Inflammatory bowel diseases (IBD) are associated with important changes in nutritional status. Objective: The aim of the study was to compare body fat composition between two anthropometric methods: skinfolds and ultrasonography, in patients with IBD. Methods: Single-center cross-sectional study with IBD patients in remission or active disease. For the agreement analysis between the body fat assessment methods, the Bland Altman method was used. Results: A total of 101 patients with IBD were included, 75 with Crohn’s disease and 26 with ulcerative colitis. Approximately 56% of the patients with Crohn’s disease and 65.4% of those with ulcerative colitis had a body fat composition above normal levels, with no significant difference between the diseases (P=0.63). The Bland-Altman concordance analysis showed that the methods for assessing the percentage of fat by the adipometer and ultrasound were not in full agreement (P=0.001), despite both presented good correlation (CC 0.961; P=0.000). Conclusion: The analysis of body fat percentage in patients with IBD was different between the skinfolds and ultrasound. Both methods can be used to assess the of body fat percentage of patients with IBD. However, monitoring of body fat sequentially and longitudinally should always be performed using the same method throughout the disease course. Prospective longitudinal studies are warranted to precisely define the role of these two methods of measuring body composition in patients with IBD

INFLUENCE OF NEOADJUVANT THERAPY ON THE RATIO OF LYMPH NODES

ABSTRACT Background: To evaluate the relationship between the ratio of affected lymph nodes (LNR) and clinical and anatomopathological variables in patients with rectal adenocarcinoma submitted or not to neoadjuvant chemoradiotherapy. Methods: The LNR was determined by dividing the number of compromised LNR by the total number of LNR dissected in the surgical specimen. Patients were divided into two groups: with QRT and without QRT. In each group, the relationship between LNR and the following variables was evaluated: degree of cell differentiation, depth of invasion in the rectal wall, angiolymphatic /perineural invasion, degree of tumor regression and occurrence of metastases. The LNR was evaluated in patients with more than 1, LNR (LNR >12) or less (LNRT2; P12 with DFS and OS (17.984; 95%CI5.931-54.351; P<0.001 and 10.286; 95%CI 2.654-39.854; P=0.007, respectively). Conclusion: LNR was associated with histological aspects of poor prognosis, regardless of the use of QRT. In the occurrence of less than 12 evaluated LNR, the LNR was associated only with the DFS

Effect of yogurt containing polydextrose, Lactobacillus acidophilus NCFM and Bifidobacterium lactis HN019: a randomized, double-blind, controlled study in chronic constipation

BACKGROUND: Constipation is a frequent complaint and the combination of a prebiotic and probiotics could have a potentially synergic effect on the intestinal transit. The present study therefore aims to investigate the combination of polydextrose (Litesse®), L. acidophilus NCFM® and B. lactis HN019 in a yogurt on intestinal transit in subjects who suffer from constipation. METHODS: Patients with constipation were randomly divided into two groups, Control Group (CG) and Treatment Group (TG), and had to eat 180 ml of unflavored yogurt every morning for 14 days. Those in the CG received only yogurt, while the TG received yogurt containing polydextrose, L. acidophilus NCFM® (ATCC 700396) and B. lactis HN019 (AGAL NM97/09513). RESULTS: Favourable clinical response was assessed since Agachan score had a significant reduction at the end of the study in both groups and tended to be better in the TG. The subjects in the treatment group also had a shorter transit time at the end of the intervention compared to the control group (p = 0.01). CONCLUSION: The product containing yogurt with polydextrose, B. lactis HN019 and L. acidophilus NCFM® significantly shortened colonic transit time after two weeks in the TG compared to CG and may be an option for treatment of constipation

Nutrição e AIDS : aspectos epidemiologicos do estado nutricional de pacientes portadores do HIV/AIDS, acompanhados no Hospital das Clinicas da UNICAMP

Orientadores : Djalma de Carvalho Moreira Filho, Monica Jacques de MoraesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Este traballio relaciona o estado nutricional de indivíduos infectados pelo HIV/AIDS, em diferentes fases da doença. Foi desenvolvido um estudo analítico, longitudinal prospectivo de coortes dinâmicas de portadores de HIV/AIDS, acompanhados no Hospital das Clinicas da UNICAMP, entre os anos de 1998 a 2000. Foram avaliados 310 pacientes por até 4 vezes. As avaliações englobaram variáveis antropométricas, bioquímicas e imunológicas. Segundo a classificação da infecção pelo HIV, nas categorias predominantes neste estudo, A2 (assintomáticos) e A3 e C3 (doentes de AIDS), a maioria dos indivíduos apresentou-se com peso adequado ao longo do seguimento, independentemente da fase da doença. A introdução do tratamento com antiretrovirais modificou o perfil nutricional de pacientes infectados pelo HIV/AIDS. Atualmente, a desnutrição é menos prevalente (10% dos casos) nos indivíduos tratados com antiretrovirais, quando comparamos com o período pré-antiretroviral (60% dos casos). Ocorreram mudanças qualitativas na prevalência dos distúrbios nutricionais e atualmente encontramos 30% de sobrepeso e obesidade. Observou-~e, nesta coorte, melhora dos estados imunológico, clinico e nutricional, concomitante ao uso da terapia antiretroviral combinada de alta potência (HAART), com baixa probabilidade de morte por AIDS em 12 meses (0,49%). Porém, estes dados mostram que a desnutrição está associada a um risco 4 vezes maior de morrer de AIDS, quando comparada a outros estados nutricionais. A análise de regressão linear múltipla mostrou que o estado nutricional dos sujeitos infectados pelo HIV/AIDS deve ser mantido, segundo o!MC (índice de massa corpórea), por volta de 22 a 23 Kg/m2(peso adequado), pois os indivíduos que se encontravam nesta faixa apresentaram menos co-fatores clinicos, bioquímicos e imunológicos associados a imunodeficiência. O estado nutricional não interferiu nos níveis plasmáticos de vitaminas lipossolúveis, como também a imunodeficiência não foi um co-fator associado à diminuição sérica de vitaminas. A dislipidemia e as alterações na redistribuição de gordura corporal, devem ser diagnosticadas e tratadas rotineiramente na infecção pelo HIV/AIDS, por fazerem parte do atual espectro de manifestações da infecção, seja pelo prolongamento da sobrevida, seja por ação das drogas atualmente utilizadasAbstract: This study is a report on the nutritional status of individuals infected by mv /AIDS at various stages of the disease. It is an analytical, prospective longitudinal study of dynamic cohorts of individuals with HIV/AIDS, conducted ftom 1998 to 2000, at the Hospital das Clinicas,UNICAMP. This study consisted of310 patients who were each evaluated up to 4 times at four-month intervals. The assessments covered anthropometric, biochemical and immunologicalvariables. During folIow-up, most of the individuais in the here most ftequent categories of the classification of mv infection, which were A2(asymptomatic), A3, and C3(patients with AIDS), presented adequate weight, independent of the disease stage. The introduction of antiretroviral treatment modified the nutritional profile of mv /AIDS infected patients. Nowadays, malnutrition is less prevalent in patients treated with antiretroviral drugs (10%) in comparison with the antiretroviral perlod (60%). Qualitative changes have taken place and at present; there is a 30% prevalence of overweight and obesity. In this cohort study it was observed that concomitandy with the use of HAART, the immunological, clinical and nutritional condition improved and in 12 months the death probability due to AIDS was low (0.49%). However, these data demonstrate that malnutrition is related to a death risk 4 times greater in the case of AIDS than in other nutritional conditions. The multiple linear regression analysis demonstrated that jf the BMI of individuals infected with mv /AIDS was maintained at 22 to 23 Kglm2 (adequate weight) , the individuais presented less clinical, biochemical and immunological co-factors associated with immunodeficiency. The nutritional conditions did not affect the plasmatic levels of liposoluble vitamins and immunodeficiencywas also not found to be associated with the vitamin serum reduction. In order to prolong survival and to enhance the action of the drugs now being used in patients with mv/ AIDS, alterations like the redistribution of body fat (dislipidemia) should be routinely diagnosed and treated because they are part of the present spectrum of this infectious disease manifestationsDoutoradoDoutor em Saude Coletiv

Estudo epidemiologico da colesterolemia em escolares de uma escola publica de Campinas - SP, 1994, 1995

Orientadores: Djalma de Carvalho Moreira Filho, Erly Catarina de MouraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A investigação dos níveis de colesterol em crianças pode levar à identificação de indivíduos com risco de desenvolver doenças cardiovasculares quando adultos, uma vez que os níveis de colesterol total tendem a persistir ao longo da vida. O propósito deste estudo descritivo foi identificar os possíveis fatores de risco para a hipercolesterolemia em estudantes de uma escola pública de Campinas, SP, nos anos de 1994 e 1995. Para isto, examinaram-se 81 crianças no ano de 1994 e outras 78 em 1995. Foram pesquisadas as características sociais, de nascimento (peso e altura ao nascer, tempo de aleitamento materno e idade de introdução de alimentos no primeiro ano de vida) e os aspectos nutricionais destes escolares, utilizando-se como instrumento a entrevista concomitante com a mãe (ou responsável pela criança) e a criança. Foram, ainda, avaliadas as características bioquímicas dos escolares, através de exames laboratoriais, com dosagem de triglicérides, colesterol total e frações. Os resultados indicaram uma prevalência de hipercolesterolemia em 13,5% das crianças estudadas em 1994, atingindo 35% das estudadas em 1995. Na análise multivariada, as variáveis que permaneceram significantes em ãssociação com a hipercolesterolemia, nas meninas, foram: atividade fisica e idade de introdução de leite de vaca na alimentação, ou seja, as meninas que faziam atividade fisica regularmente e que começaram a tomar leite de vaca mais tarde tinham níveis menores de colesterol. Em relação ao sexo masculino, nenhuma variável mostrou-se associada à hipercolesterolemia. Este estudo sugere que escolares com níveis elevados de colesterol devem ser acompanhados nos programas de saúde, para que sejam realizadas modificações dietéticas e de estilo de vida, tanto da criança como de seus familiaresAbstract: An investigation about the levels of cholesterol in children could help identifY the risks involved in developing cardiovascular problems when they become adults, as the total leveI of cholesterol has a tendency to remain the same as they grow. This study identifies the possible risk factors involved in school children developing hypercholesterolemia. The study was carried out during the years 1994 and 1995 , in a public school in Campinas, São Paulo. 81 children were examined in 1994 and 78 children in 1995. A research was done on their social characteristies, details ofbirth (weight and height at birth , the length oftime the ehild was breast fed, when food was introdueed during their first year) and their nutritional aspects. This data was obtained in an interview with the mother or person responsible to gether with the child. The students bioehemieal eharacteristics were evaluated with help of laboratory examinations like the dosage oftriglyeerides, and that of total and fractional eholesterol. The results showed a prevalence ofhypercholesterolemia in 13.5% ofthe students in 1994 and 35% in 1995. In a multivariate analysis, the variables whieh showed a signifieant association with hypercholesterolemia in girls were: physieal activity and the age at which cow's milk was introduced. Those girls who regu1arly practised physical exereise and w~b started drinking cow's milk at a later date had lower 1evels of cholesterol. There was no variable found associated with hypercholesterolemia in the case of the male students. This study shows the need for special health programmes for students who have high levels of eholesterol, so that the life style of the ehild and family as well as the diet ean be modified.MestradoMestre em Saude Coletiv

HOSPITALIZATION, USE OF BIOLOGICS AND SURGERY RATES IN INFLAMMATORY BOWEL DISEASES: A SINGLE-CENTRE COMPARATIVE ANALYSIS BETWEEN PUBLIC AND PRIVATE HEALTHCARE SYSTEMS IN A TERTIARY UNIT FROM LATIN AMERICA

ABSTRACT Background: Inflammatory bowel diseases (IBD) have rising incidence and prevalence rates globally. In IBD, there are scarce studies comparing differences between patients according to socioeconomic status. Our aim was to comparatively evaluate hospitalizations, use of biologics and rates of surgery in patients with IBD between public and private healthcare systems. Methods: Single-center retrospective cohort study in patients with IBD from a tertiary referral unit from Latin America, between 2015 and 2021. CD and UC patients were classified into two subgroups: public and private systems. Demographic characteristics, hospitalizations, need for surgery and biologics were compared. Results: A total of 500 patients were included, 322 with CD and 178 with UC. CD-related hospitalizations were frequently observed in both healthcare systems (76.28% in private and 67.46% in public). More than half of the patients had been submitted to one or more CD-related abdominal surgery, with no significant difference between the subgroups. Although there was no difference in the rates of use of biological therapy in CD subgroups, infliximab was more used in the public setting (57.69% vs 43.97%). There was no difference in UC-related hospitalizations between the subgroups (public 30.69% and private 37.66%) as well as the rates of colectomy (public: 16.83%, private: 19.48%). Biologics were prescribed almost twice as often in private as compared to public (45.45 vs 22.77%). Conclusion: There were no differences in the rates of hospitalization and abdominal surgery between the systems. In patients with UC, there was greater use of biological therapy in the private healthcare setting

Perioperative Nutritional Optimization in Inflammatory Bowel Diseases: When and How?

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoperative complications, such as anastomotic dehiscences, reoperations, prolonged hospitalizations, and increased mortality. The diagnostic criteria for identifying individuals at nutritional risk, with clear indication for preoperative nutritional therapy, involves several factors. Oral nutrition should be the first choice of nutritional support. If the patient has difficulty in consuming food, the enteral route is the second option, through elementary (amino acids), semi-elementary (oligopeptides), or polymeric (whole proteins) formulas. When oral or enteral routes are not indicated (in the presence of intestinal obstruction or ischemia, fistula, or bleeding), total parenteral nutrition can meet the daily nutritional needs of the critically ill patient. Nutritional support can be performed exclusively or in an associated way, which will depend on the nutritional severity of the patient with IBD. Nutritional screening should be performed at all stages of the disease, always individually and with professionals with experience in IBD. The reduction of complications in the perioperative period is not only associated with adequate surgical technique, but also with adequate nutritional support and clinical preparation before surgery. Therefore, the dietitian with a focus in IBD has an important role in the multidisciplinary team, collaborating with all stages of treatment and with the optimization of the nutritional status of the surgical patient

Intestinal Microbiota and miRNA in IBD: A Narrative Review about Discoveries and Perspectives for the Future

Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC) and comprises a chronic gastrointestinal tract disorder characterized by hyperactive and dysregulated immune responses to environmental factors, including gut microbiota and dietary components. An imbalance of the intestinal microbiota may contribute to the development and/or worsening of the inflammatory process. MicroRNAs (miRNAs) have been associated with various physiological processes, such as cell development and proliferation, apoptosis, and cancer. In addition, they play an important role in inflammatory processes, acting in the regulation of pro- and anti-inflammatory pathways. Differences in the profiles of miRNAs may represent a useful tool in the diagnosis of UC and CD and as a prognostic marker in both diseases. The relationship between miRNAs and the intestinal microbiota is not completely elucidated, but recently this topic has gained prominence and has become the target of several studies that demonstrate the role of miRNAs in the modulation of the intestinal microbiota and induction of dysbiosis; the microbiota, in turn, can regulate the expression of miRNAs and, consequently, alter the intestinal homeostasis. Therefore, this review aims to describe the interaction between the intestinal microbiota and miRNAs in IBD, recent discoveries, and perspectives for the future

COMPARISON OF THE LEVELS OF C-REACTIVE PROTEIN, GLP-1 AND GLP-2 AMONG INDIVIDUALS WITH DIABETES, MORBID OBESITY AND HEALTHY CONTROLS: AN EXPLORATORY STUDY

ABSTRACT BACKGROUND: The glucagon-like peptides 1 and 2 (GLP-1/GLP-2) are gut hormones that may directly affect the glucose homeostasis and their activity seems to be significantly affected by chronic inflammation. OBJECTIVE: To evaluate the postprandial levels of glucagon-like peptides 1 and 2 (GLP-1/GLP-2), C-reactive protein (CRP), and the postprandial glucose and insulin levels among individuals with obesity, type 2 diabetes, and healthy controls. METHODS: An exploratory cross-sectional study, which involved individuals awaiting for bariatric/metabolic surgery and healthy controls. Postprandial levels of GLP-1, GLP-2, glucose, and insulin were obtained after a standard meal tolerance test. Inflammation was assessed by means of CRP. RESULTS: There were 30 individuals enrolled in the study, divided into three groups: non-diabetic with morbid obesity (NDO; n=11 individuals), diabetic with mild obesity (T2D; n=12 individuals), and healthy controls (C; n=7 individuals). The mean CRP levels were significantly higher in the NDO group (6.6±4.7 mg/dL) than in the T2D (3.3±2.2 mg/dL) and C groups (2.5±3.2 mg/dL) (P=0.038). The GLP-1 levels following standard meal tolerance test and the area under the curve of GLP-1 did not differ among the three groups. The GLP-2 levels were significantly lower in the NDO and T2D than in the C group following standard meal tolerance test at all the times evaluated. The area under the curve of the GLP-2 was significantly lower in the NDO and T2D groups than in the C group (P=0.05 and P=0.01, respectively). CONCLUSION: GLP-2 levels were impaired in the individuals with obesity and diabetes. This mechanism seems to be enrolled in preventing the worsening of the glucose homeostasis in these individuals