Efeito da dieta cetogênica clássica no tratamento de crises epilépticas refratárias

Objective The ketogenic diet is used as a therapeutic alternative for the treatment of epilepsy in patients with refractory epilepsy. It simulates biochemical changes typical of fasting. The present study verified the nutritional impact of the ketogenic diet on children with refractory epilepsy. Methods Nutritional status data (dietary, biochemical and anthropometric measurements), seizure frequency, and adverse events were collected from the medical records and during outpatient clinic visits of children over a period of 36 months. Results Of the 29 children who initiated the ketogenic diet, 75.8% presented fewer seizures after one month of treatment. After six months, 48.3% of the patients had at least a 90.0% decrease in seizure frequency, and 50.0% of these patients presented total seizure remission. At 12 months, eight patients continued to show positive results, and seven of these children remained on the ketogenic diet for 24 months. There was an improvement of the nutritional status at 24 months, especially in terms of weight, which culminated with the recovery of proper weight-for-height. There were no significant changes in biochemical indices (total cholesterol and components, triglycerides, albumin, total protein, creatinine, glycemia, serum aspartate transaminase and serum alanine transaminase). Serum cholesterol levels increased significantly in the first month, fell in the following six months, and remained within the normal limits thereafter. Conclusion In conclusion, patients on the classic ketogenic diet for at least 24 months gained weight. Moreover, approximately one third of the patients achieved significant reduction in seizure frequency, and some patients achieved total remission.OBJETIVO: A dieta cetogênica é empregada como uma terapia alternativa para o tratamento da epilepsia em pacientes com epilepsia refratária e simula as alterações bioquímicas de jejum. Neste trabalho, verificouse o impacto nutricional da dieta cetogênica em crianças com epilepsia refratária.\ud MÉTODOS: Os dados sobre o estado nutricional (bioquímica, alimentar e medidas antropométricas), a frequência de crises e os eventos adversos de crianças acompanhadas durante 36 meses foram coletados de prontuários médicos e visitas ambulatoriais.\ud \ud RESULTADOS: Vinte e nove crianças iniciaram o tratamento; após um mês, 75,8% apresentaram redução das crises. Em seis meses, 48,3% dos pacientes tiveram pelo menos 90,0% de redução na frequência de crises, e, desses, 50,0% obtiveram o controle completo das crises. Aos doze meses, oito pacientes continuaram a apresentar Resultados positivos, e, desses, sete permaneceram em dieta cetogênica durante 24 meses. Observouse melhora do estado nutricional aos 24 meses de tratamento, especialmente em termos de peso, o que indica a recuperação da condição peso para altura. Não houve mudanças significativas nos índices bioquímicos analisados (colesterol total e de componentes, triglicerídeos, albumina, proteína total, creatinina, glicemia, transaminase glutâmico oxalacética sérica e transaminase glutâmico pirúvico sérica). Os níveis de colesterol aumentaram significativamente no primeiro mês, mas diminuíram nos seis meses seguintes e, posteriormente, se mantiveram dentro dos valores de referência.\ud \ud CONCLUSÃO: Os pacientes em uso da dieta cetogênica clássica por pelo menos 24 meses apresentaram melhora de peso e cerca de um terço dos pacientes conseguiu uma redução significativa da frequência de crises, com alguns pacientes completamente livres delas

Plasma free amino acids profiling of patients undergoing bariatric surgery

Devido às modificações na anatomia e fisiologia do trato gastrointestinal decorrente do procedimento cirúrgico, o pós-operatório da cirurgia bariátrica é acompanhado de significativa perda de peso e melhoras das comorbidades associadas à obesidade, entretanto, também é observado presença de deficiências vitamínico-minerais e de intolerâncias alimentares, principalmente a alimentos fontes de proteína. Por outro lado, os exames bioquímicos de proteína total e albumina não mostram alterações, e é baixa a presença de hipoalbuminemia relatada pela literatura. Assim, o presente trabalho teve como objetivo avaliar o perfil proteico de pacientes submetidos à cirurgia bariátrica pela dosagem dos aminoácidos livres no plasma. Foi realizada avaliação nutricional incluindo antropometria (peso, estatura, circunferência abdominal, cálculo do índice de massa corporal) e composição corporal (bioimpedância elétrica), avaliação da ingestão alimentar (recordatório de 24 horas), dosagens das concentrações séricas de proteína total e albumina e das concentrações plasmáticas de aminoácidos (pelo método de cromatografia líquida de alta eficiência) em 30 mulheres obesas antes e após 3, 6 e 12 meses da cirurgia bariátrica pela técnica de derivação gástrica em Y de Roux. Observou-se redução do peso durante todo o estudo, a maior perda ocorreu no primeiro trimestre no qual também se observou perda de massa magra. Houve redução da ingestão proteica no período pós-operatório, a qual se manteve abaixo dos valores recomendados (<0,8 g/kg/dia). Houve redução das concentrações de proteína total e albumina após 12 meses, entretanto os valores continuaram dentro da normalidade. O perfil aminoacídico mostrou aumento nas concentrações da maioria dos aminoácidos após 3 meses da cirurgia. Após 6 meses da cirurgia, houve redução das concentrações que se manteve até os 12 meses. No final do estudo foi observado que a maior parte dos pacientes apresentou deficiência para a maioria dos aminoácidos, principalmente para os essenciais. A dieta hipocalórica e hipoproteica do pós-operatório, acompanhada da rápida perda de peso inicial, pode promover o catabolismo da musculatura esquelética, aumentando os níveis de aminoácidos circulantes, objetivando suprir a síntese proteica hepática e a gliconeogênese. Assim, observa-se que dosagens de proteína total e albumina são questionáveis na avaliação do perfil proteico de pacientes pós cirurgia bariátrica, visto que, apesar dos valores de normalidade, há uma modificação do perfil de aminoácidos livres no plasma, caracterizado por deficiência para a maioria destes após 12 meses de cirurgiaDue to changes in the anatomy and physiology of the gastrointestinal tract resulting from the surgical procedure, the postoperative period of bariatric surgery is accompanied by a significant weight loss and by improvement of the comorbidities associated with obesity. However, vitamin-mineral deficiencies and food intolerance are also observed, especially regarding foods that are protein sources. On the other hand, biochemical tests for total protein and albumin do not show any changes, and the presence of hypoalbuminemia reported in the literature is low. Thus, the objective of the present study was to assess the patients protein profile submitted to bariatric surgery by measuring free amino acids in plasma. 30 obese women before and 3, 6 and 12 months after bariatric surgery by Roux-en-Y gastric bypass were submitted to nutritional evaluation including anthropometry (weight, height, abdominal circumference, and body mass index calculation) and body composition (bioelectrical impedance), food intake evaluation (24-hour food recall), total protein and albumin serum concentrations and plasma amino acid concentrations by HPLC. Weight reduction was observed throughout the study, with the greatest loss occurring during the first trimester, when a loss of lean mass was also observed. There was a protein reduction intake during the postoperative period, which remained below recommended values (<0.8 g/kg/day). After 12 months, total protein and albumin concentrations were reduced, although their values were still within normal limits. The amino acid profile showed an increase in the concentrations of most amino acids by 3 months after surgery, whereas by 6 months there was a reduction of their concentrations which persisted up to 12 months. At the end of the study, most patients presented deficiencies of most amino acids, especially the essential ones. The low-calorie and low-protein postoperative diet, accompanied by the rapid early weight loss, may promote catabolism of skeletal muscles, increasing the levels of circulating amino acids in order to provide hepatic protein synthesis and neoglucogenesis. Thus, it can be seen that total protein and albumin measurements are questionable for the evaluation of the protein profile of patients after bariatric surgery because, despite normal values, there is a modification of the free amino acid profile in plasma, characterized by deficiency of most of them 12 months after surger

Plasma free amino acids profiling of patients undergoing bariatric surgery

Devido às modificações na anatomia e fisiologia do trato gastrointestinal decorrente do procedimento cirúrgico, o pós-operatório da cirurgia bariátrica é acompanhado de significativa perda de peso e melhoras das comorbidades associadas à obesidade, entretanto, também é observado presença de deficiências vitamínico-minerais e de intolerâncias alimentares, principalmente a alimentos fontes de proteína. Por outro lado, os exames bioquímicos de proteína total e albumina não mostram alterações, e é baixa a presença de hipoalbuminemia relatada pela literatura. Assim, o presente trabalho teve como objetivo avaliar o perfil proteico de pacientes submetidos à cirurgia bariátrica pela dosagem dos aminoácidos livres no plasma. Foi realizada avaliação nutricional incluindo antropometria (peso, estatura, circunferência abdominal, cálculo do índice de massa corporal) e composição corporal (bioimpedância elétrica), avaliação da ingestão alimentar (recordatório de 24 horas), dosagens das concentrações séricas de proteína total e albumina e das concentrações plasmáticas de aminoácidos (pelo método de cromatografia líquida de alta eficiência) em 30 mulheres obesas antes e após 3, 6 e 12 meses da cirurgia bariátrica pela técnica de derivação gástrica em Y de Roux. Observou-se redução do peso durante todo o estudo, a maior perda ocorreu no primeiro trimestre no qual também se observou perda de massa magra. Houve redução da ingestão proteica no período pós-operatório, a qual se manteve abaixo dos valores recomendados (<0,8 g/kg/dia). Houve redução das concentrações de proteína total e albumina após 12 meses, entretanto os valores continuaram dentro da normalidade. O perfil aminoacídico mostrou aumento nas concentrações da maioria dos aminoácidos após 3 meses da cirurgia. Após 6 meses da cirurgia, houve redução das concentrações que se manteve até os 12 meses. No final do estudo foi observado que a maior parte dos pacientes apresentou deficiência para a maioria dos aminoácidos, principalmente para os essenciais. A dieta hipocalórica e hipoproteica do pós-operatório, acompanhada da rápida perda de peso inicial, pode promover o catabolismo da musculatura esquelética, aumentando os níveis de aminoácidos circulantes, objetivando suprir a síntese proteica hepática e a gliconeogênese. Assim, observa-se que dosagens de proteína total e albumina são questionáveis na avaliação do perfil proteico de pacientes pós cirurgia bariátrica, visto que, apesar dos valores de normalidade, há uma modificação do perfil de aminoácidos livres no plasma, caracterizado por deficiência para a maioria destes após 12 meses de cirurgiaDue to changes in the anatomy and physiology of the gastrointestinal tract resulting from the surgical procedure, the postoperative period of bariatric surgery is accompanied by a significant weight loss and by improvement of the comorbidities associated with obesity. However, vitamin-mineral deficiencies and food intolerance are also observed, especially regarding foods that are protein sources. On the other hand, biochemical tests for total protein and albumin do not show any changes, and the presence of hypoalbuminemia reported in the literature is low. Thus, the objective of the present study was to assess the patients protein profile submitted to bariatric surgery by measuring free amino acids in plasma. 30 obese women before and 3, 6 and 12 months after bariatric surgery by Roux-en-Y gastric bypass were submitted to nutritional evaluation including anthropometry (weight, height, abdominal circumference, and body mass index calculation) and body composition (bioelectrical impedance), food intake evaluation (24-hour food recall), total protein and albumin serum concentrations and plasma amino acid concentrations by HPLC. Weight reduction was observed throughout the study, with the greatest loss occurring during the first trimester, when a loss of lean mass was also observed. There was a protein reduction intake during the postoperative period, which remained below recommended values (<0.8 g/kg/day). After 12 months, total protein and albumin concentrations were reduced, although their values were still within normal limits. The amino acid profile showed an increase in the concentrations of most amino acids by 3 months after surgery, whereas by 6 months there was a reduction of their concentrations which persisted up to 12 months. At the end of the study, most patients presented deficiencies of most amino acids, especially the essential ones. The low-calorie and low-protein postoperative diet, accompanied by the rapid early weight loss, may promote catabolism of skeletal muscles, increasing the levels of circulating amino acids in order to provide hepatic protein synthesis and neoglucogenesis. Thus, it can be seen that total protein and albumin measurements are questionable for the evaluation of the protein profile of patients after bariatric surgery because, despite normal values, there is a modification of the free amino acid profile in plasma, characterized by deficiency of most of them 12 months after surger

Guide and Position of the International Society of Nutrigenetics/Nutrigenomics on Personalized Nutrition : Part 2 - Ethics, Challenges and Endeavors of Precision Nutrition

Nutrigenetics considers the influence of individual genetic variation on differences in response to dietary components, nutrient requirements and predisposition to disease. Nutrigenomics involves the study of interactions between the genome and diet, including how nutrients affect the transcription and translation process plus subsequent proteomic and metabolomic changes, and also differences in response to dietary factors based on the individual genetic makeup. Personalized characteristics such as age, gender, physical activity, physiological state and social status, and special conditions such as pregnancy and risk of disease can inform dietary advice that more closely meets individual needs. Precision nutrition has a promising future in treating the individual according to their phenotype and genetic characteristics, aimed at both the treatment and prevention of disease. However, many aspects are still in progress and remain as challenges for the future of nutrition. The integration of the human genotype and microbiome needs to be better understood. Further advances in data interpretation tools are also necessary, so that information obtained through newer tests and technologies can be properly transferred to consumers. Indeed, precision nutrition will integrate genetic data with phenotypical, social, cultural and personal preferences and lifestyles matters to provide a more individual nutrition, but considering public health perspectives, where ethical, legal and policy aspects need to be defined and implemented

Food and Nutrition Public Policies in Brazil: From Malnutrition to Obesity

“Nutrition transition” describes the shifts in dietary consumption and energy expenditure influenced by economic, demographic, and epidemiological changes at a population level. This phenomenon has been associated with rising obesity rates worldwide, especially in developed countries. In Brazil, the historical analysis of temporal trends between malnutrition and obesity characterized the nutrition transition in the country and interweaved it with the formulation and implementation of public food and nutrition policies. Such analysis is crucial for understanding certain principles in each context. Thus, this review contextualized the consolidation of obesity as a critical health and public policy issue in Brazil. Our review suggested that the country may still be at the initial stage of care for obesity, and more efforts are needed to contain the advance of the disease in Brazil

Anthropometric and Body Composition Changes over Five Years after Bariatric Surgery in Patients with Obesity, Diagnosed or Not Diagnosed with Binge Eating Disorder (BED) in the Preoperative Period

Obesity is a complex disease with a multifactorial etiology and could be associated with psychiatric disorders, such as Binge Eating Disorder (BED), characterized by recurrent episodes of binge eating in the absence of compensatory behaviors. The present study aimed to analyze anthropometric and body composition changes over five years after bariatric surgery in patients diagnosed or not diagnosed with BED, depression, and anxiety in the preoperative period. One hundred and eighteen patients undergoing bariatric surgery were evaluated and divided into two groups according to the presence or absence of BED. The patients were submitted to anthropometric and body composition evaluation. We also analyzed BED diagnosis, depression, and anxiety according to the DSM-5 and validated questionnaires. The Kolmogorov–Smirnov, t-test, Fisher’s, and chi-square tests were used for statistical analysis. Over five years after bariatric surgery, only the BED group exhibited an increased weight and BMI (p p = 0.0079) and a higher frequency of moderate (22.95%, p p < 0.01) anxiety. In conclusion, patients with BED had more intense symptoms of depression and anxiety in the preoperative period, and this disorder may persist in the postoperative period of bariatric surgery, contributing to weight gain and increased BMI

Ability of Hypocaloric Diets to Change Nutrient–Phyla Associations after 8 Weeks of Intervention

Background: Previous studies have suggested that changes in the composition of intestinal microbiota may be influenced by dietary quality. Objective: This study aimed to assess the impact of a hypocaloric diet on the relationship between microbiota and clinical/dietary variables. Methods: This was a longitudinal study. Ten women with obesity (Obese Group, ObG) participated in an 8-week home-based hypocaloric diet intervention. Anthropometric, dietary intake, biochemical, and gut microbiota assessments were conducted before and after the intervention. Microbiota relative abundance was determined using real-time PCR in triplicate. Results: In the ObG, the hypocaloric diet intervention led to significant weight loss (before: 119.5 ± 10.3 kg; after: 114.9 ± 10.2 kg; p = 0.003). Following the intervention, positive correlations were observed between nutrient intake and phyla composition: Actinobacteria phylum with fibers (r = 0.787; p = 0.012), Firmicutes phylum with proteins (r = 0.736; p = 0.024), and Proteobacteria phylum with lipids (r = 0.669; p = 0.049). Conclusions: The hypocaloric diet intervention improved health parameters associated with obesity and its comorbidities, demonstrating associations between nutrient intake and specific phyla

Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder

Objective: Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF).Method: We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Diagnosis of the offspring was determined through the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) interview.Results: There were statistically significant differences between aBDF, uBDF and CF in cohesion (p = 0.003), intellectual-cultural orientation (p = 0.01), active-recreational orientation (p = 0.007), conflict (p = 0.001), control (p = 0.01), moral-religious emphasis (p = 0.01) and organization (p = 0.001). the aBDF showed higher levels of control (p = 0.02) when compared to the uBDF.Conclusions: Families with a BD parent presented more dysfunctional interactions among members. Moreover, the presence of BD or other psychiatric disorders in the offspring of parents with BD is associated with higher levels of control. These results highlight the relevance of psychosocial interventions to improve resilience and family interactions.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)National Alliance for Research on Schizophrenia and Depression (NARSAD)American Psychiatric Association/AstraZeneca Young Minds in Psychiatry International AwardsL'Oreal-ABC-Unesco - Para Mulheres na Ciencia, Brazil.Univ São Paulo, Sch Med, Dept Psychiat, Bipolar Res Program, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Psychiat, Lab Psychiat Neuroimaging LIM 21, São Paulo, BrazilUniv São Paulo, Ctr Support Res Appl Neurosci, NAPNA, São Paulo, BrazilUniv Texas Med Sch, Dept Psychiat & Behav Sci, Houston, TX USAFed Univ São Paulo UNIFESP, Dept Psychiat, Child & Adolescent Psychiat Unit UPIA, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Psychiat, Child & Adolescent Psychiat Unit UPIA, São Paulo, BrazilWeb of Scienc