Milk whey protein isolate as a perspective on nutritional care for amyotrophic lateral sclerosis patients

Orientador: Jaime Amaya-FarfanTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de AlimentosResumo: A Esclerose Lateral Amiotrófica (ELA) é uma doença progressiva neurodegenerativa que envolve, neurônios motores do córtex cerebral, cérebro e medula espinhal. Em aproximadamente 50% dos pacientes, a doença afeta inicialmente os braços. Em 25%, a doença afeta as pernas e, em 25%, o início da doença é bulbar. Ocorre desnutrição em 16%- 50% dos pacientes com ELA, principalmente pela disfunção da deglutição. Para 50% dos casos, a ELA é comumente fatal dentro de 3-4 anos a partir da ocorrência de pneumonia. Muitas complicações nutricionais que acontecem com o paciente com ELA, geralmente se devem à viscosidade da dieta. Os líquidos de baixa viscosidade dificultam a deglutição de pacientes que apresentam controle laríngeo reduzido. O objetivo do presente trabalho foi diagnosticar o estado nutricional, bem como avaliar o efeito da suplementação com isolado protéico do soro de leite aglomerado com polissacarídeo no estado nutricional e condições gerais de pacientes com ELA. A investigação da ingestão alimentar se deu por meio da avaliação do consumo alimentar, qualitativo e quantitativo, de pacientes com ELA. Aplicou-se o questionário de freqüência de consumo alimentar e o recordatório de 24 horas. Todos os pacientes apresentaram inadequação para energia, fibras, cálcio e vitamina E. Considerando-se a predominância topográfica do comprometimento muscular na doença, foram observadas diferenças significativas entre pacientes predominantemente bulbares e de predomínio apendicular. Nos pacientes com maior envolvimento apendicular (GA) houve maior ingestão energética (p=0,02), de gordura saturada (p=0,03), monoinsaturada (p=0,04) e polinsaturada (p=0,001), além de colesterol (p=0,001) e fibras (p=0,001). Nos pacientes com predominância bulbar (GB) houve dificuldade no manejo da consistência da dieta. A partir daí, foram elaborados suplementos a base de proteínas do soro de leite e polissacarídeo. O aglomerado contendo 70% de isolado protéico do soro de leite e 30% de amido modificado (70%WPI:30%AM) na concentração de 28g em 250mL em todos os sistemas avaliados, suco de laranja e leite integral, exibiu viscosidade entre 2122,66 e 5110,60 centipoises, além de maior nota, nos testes sensoriais, 6,97 (± 0,15), quando comparado aos outros produtos, não diferindo (p=0,681) do espessante comercial, que obteve nota 6,91 (± 0,38). Baseando-se nestes resultados, sugeriu-se a utilização do aglomerado 70%WPI:30%AM para terapia nutricional de pacientes com ELA. Previamente à administração do suplemento, em função dos poucos dados sobre as técnicas de avaliação nutricional em ELA, foram correlacionados os indicadores mais comuns na avaliação nutricional, funcional e respiratória dos pacientes. No GA, observou-se correlação entre: Pressão inspiratória máxima (Pimax) e expiratória máxima (Pemax) (r=-0,76); Pemax e oximetria de pulso (r=0,58); Pimax e porcentagem de perda de peso (%PP) (r=0,59); e entre Pimax, escore total e subescala respiratória (ALSFRS) com %PP (r=0,59). No GB, houve correlação entre Pemáx e IMC (r=0,97). Em ambos GA e GB, observaram-se correlação entre índice de massa corporal (IMC) e as variáveis: massa (kg), gordura (%), circunferência braquial e punho (cm), pregas cutâneas tricipital, subescapular e supra-ilíaca (mm), circunferência muscular do braço (cm), área muscular e gordurosa do braço (mm2). Definidas as técnicas de avaliação, 16 pacientes foram divididos em dois grupos: suplementado (70%WPI:30%AM) e controle (maltodextrina) e submetidos a avaliação nutricional, respiratória e funcional durante 4 meses. No grupo suplementado verificou-se melhora do estado nutricional geral, aumento do peso e Índice de Massa Corporal-IMC, circunferência e área muscular do braço (CMB e AMB), albumina, linfócitos e leucócitos, diminuindo os marcadores do catabolismo muscular, creatina quinase, aspartato-aminotransferase e alanina-amino-transferase. No grupo controle, observou-se diminuição do peso, IMC, CMB e AMB e aumento da área gordurosa do braço, sem alterações significativas nos parâmetros bioquímicos. O presente estudo mostrou que o suplemento 70%WPI:30%AM melhorou o estado nutricional e condições gerais pacientes com ELA, podendo ser utilizado na prática clínicaAbstract: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that involves, motor neurons in the cerebral cortex, brainstem, and spinal cord. In approximately 50% of the patients, the disease first affects the arms, in 25% the legs and in 25% the onset is bulbar. Malnutrition occurs in 16%-50% of patients with ALS, mainly for swallowing difficulty. For 50% of the cases, ALS is frequently fatal inside of 3-4 years from the pneumonia occurrence. Many of the nutritional complications that occur with ALS sufferers are due to the low viscosity of the diet. Fluid liquids are difficult to swallow by patients with reduced deglutition control. The objective of the present work was to diagnosis the nutricional state as well as evaluating the effect of the supplementation with milk whey protein isolate agglomerated with modified starch in the nutricional state and general conditions of patients with ALS. The investigation of the alimentary intake was evaluate quantitatively and qualitatively food intake in patients with ALS. We employed the frequency questionnaire and the 24h-diet history. All patients presented inadequate energy, fibers, calcium and vitamin E intake. Taking into account predominantly affected muscle groups, we found significant differences between patients with bulbar or appendicular onset. Patients with appendicular ALS had higher intake of energy (p=0.02), saturated fat (p=0.03), monounsaturated fat (p=0.04), polyunsaturated fat (p=0.001), as well as cholesterol (p=0.001) and fibers (p=0.001). In the patients with predominance to bulbar (GB) had difficulty in the handling of the consistency of the diet. From there, supplements had been elaborated from protein base of whey milk and modified starch. The agglomerate contend 70% whey protein isolate and 30% modified starch (70%WPI:30%MS), in all the systems evaluated, at a concentration of 112g/L showed a viscosity between 2,122 and 5,110cP. In the sensory tests, the 70%WPI:30%MS in orange juice obtained the highest score, 6.97 (± 0.15), in relation to the other agglomerates, not differing (p=0.681) from the commercial thickener, 6.91 (p=0.380). Based on these results, the agglomerate 70%WPI:30%MS was suggested for use in the nutritional therapy of patients with ALS. Previously the administration of the supplement, in function of the few data on the techniques of nutricional evaluation in ALS, had been correlated the pointers most common in the nutricional, functional and respiratory evaluation of the patients. Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r=-0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and BMI (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and fist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm2). After defined the evaluation techniques, 16 patients were randomized to two groups, treatment (70%WPI:30%MS) and placebo (maltodextrin). They underwent prospective nutritional, respiratory and functional assessment for 4 months. Patients in the treatment group presented weight gain, increased BMI, increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced markers of skeletal muscle turnover (creatine-kinase, aspartate transferase and alanine transferase). In the placebo group, biochemical measures did not change, but weight and BMI declined. Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALSDoutoradoNutrição Experimental e Aplicada à Tecnologia de AlimentosDoutor em Alimentos e Nutriçã

Rheological behavior and labels of texture-modified foods and thickened fluids as used for dysphasia's services

PURPOSE: to study the aspects of rheological behavior and labels of texture-modified foods and thickened fluids as used by teams of speech-language pathologist of dysphasia's services of São Paulo based on Australian standardized labels and definitions and rheological behavior. METHOD: quantitative and descriptive study. Data were collected from semi-structured questionnaires with speech-language pathologists in dysphasia teams. The questions were about foods used in clinical practice and the form of classification, and included the number of levels and labels used, and information on the interdisciplinary performance. The viscosities were measured in centipoises (cP) and the foods and fluids were classified according to rheological behavior. The last step was food classification, professionals reported using foods of the same rheological behavior in their practices. RESULTS: speech-language pathologists related 33 different labels to 07 levels of food textures and fluid thickness based on Australian standardized. The main topics were: liquid, pasty and solid, followed by grades and specifications. Speech pathologists from different dysphasia care services use different terminologies in order to designate the same preparation in the Sate of São Paulo. CONCLUSION: larger studies are needed to enable us to set out unified terminology in Brazil.OBJETIVO: estudar o comportamento reológico e a forma de classificação e nomeação das diferentes preparações utilizadas nas intervenções com pacientes disfágicos, realizada por fonoaudiólogos do estado de São Paulo, tendo como referência a proposta australiana de padronização da nomenclatura. MÉTODO: estudo quantitativo descritivo e qualitativo. Os dados foram coletados por meio da aplicação de questionários semi-estruturados com fonoaudiólogos de serviços de disfagia no estado de São Paulo. Os fonoaudiólogos relataram os alimentos utilizados em sua prática por meio de exemplos de preparações bem como exemplos comerciais. Os profissionais classificaram os alimentos em diferentes níveis e relataram a nomenclatura utilizada para cada nível. A viscosidade das preparações foi medida em viscosímetro e agrupadas de acordo com os valores obtidos. Em seguida foram classificados de acordo a proposta australiana de unificação da nomenclatura. RESULTADOS: foram analisados 18 questionários. Os profissionais utilizaram alimentos de comportamento reológico próximo em sua prática. Os fonoaudiólogos apresentaram, em sua maioria, 06 formas de agrupamento dos alimentos baseados em suas características reológicas, principalmente a viscosidade. Foram apontados 33 termos para nomear 07 classes de alimentos segundo a proposta australiana. Os principais termos foram: líquido, pastoso e sólido, seguidos de graduações e especificações. CONCLUSÃO: fonoaudiólogos de diferentes serviços de atenção em disfagia utilizam diferentes terminologias para designar a mesma preparação no estado de São Paulo. São necessários maiores estudos para que se possa estabelecer uma nomenclatura unificada no Brasil.92593

Acceptability Of An Alimentary Supplement Of Whey-protein Concentrate And Tgf- β In Patients With Crohn's Disease.

The objective of this study was to evaluate the acceptability of an alimentary supplement of bovine whey-protein concentrate (WPC) and TGF- β , unavailable commercially, by patients with Crohn's disease (CD) and determine the chemical composition, solubility, and total amino acids content. The supplement was diluted in water, and an acceptance test was done to evaluate the aroma, flavour, and viscosity of the product using facial hedonic scale (nine-point scale), applied on 54 CD patients. The supplement composition indicated 73.3% protein, 10.5% fat, 2.2% ash, 6.3% water, and 7.7% carbohydrate. The supplement is presented as a good protein source and high content of essential amino acids. The average acceptance for all the attributes was between 5.0 and 6.0, and the flavour was mainly associated with soybean/grain, sour milk, and sweet/vanilla flavour. The results indicated that the supplement provided important nutritional properties for CD patients; however, for a large number of individuals to be encouraged to perform supplementation, it is essential to improve the sensory quality of the product. In order to do so, additional research is necessary to prevent the formation of volatiles which cause off-flavours or to mask undesirable aromas/flavours found in it.201394786

Aedes fluviatilis cell lines as new tools to study metabolic and immune interactions in mosquito‑Wolbachia symbiosis

In the present work, we established two novel embryonic cell lines from the mosquito Aedes fluviatilis containing or not the naturally occurring symbiont bacteria Wolbachia, which were called wAflu1 and Aflu2, respectively. We also obtained wAflu1 without Wolbachia after tetracycline treatment, named wAflu1.tet. Morphofunctional characterization was performed to help elucidate the symbiont-host interaction in the context of energy metabolism regulation and molecular mechanisms of the immune responses involved. The presence of Wolbachia pipientis improves energy performance in A. fluviatilis cells; it affects the regulation of key energy sources such as lipids, proteins, and carbohydrates, making the distribution of actin more peripheral and with extensions that come into contact with neighboring cells. Additionally, innate immunity mechanisms were activated, showing that the wAflu1 and wAflu1.tet cells are responsive after the stimulus using Gram negative bacteria. Therefore, this work confirms the natural, mutually co-regulating symbiotic relationship between W. pipientis and A. fluviatilis, modulating the host metabolism and immune pathway activation. The results presented here add important resources to the current knowledge of Wolbachia-arthropod interactions

Seahorse (Hippocampus reidi) as a bioindicator of crude oil exposure

This study explored the suitability of the seahorse Hippocampus reidi (Ginsburg, 1933) for assessing biomarkers of genotoxic effects and its use as a sentinel organism to detect the effects of acute exposure to petroleum hydrocarbons. Fish were exposed to three concentrations of crude oil (10, 20 and 30. g/kg) for 96. h, and the activity of phase II biotransformation enzyme glutathione S-transferase (GST) was measured. In addition, we performed genotoxicity assays, such as comet assay, micronucleus (MN) test and nuclear abnormalities (NA) induction, on the erythrocytes of the fish species. Our results revealed that the inhibition of hepatic GST activity in H. reidi was dependent on increasing crude oil concentrations. In contrast, an increase in the damage index (DI) and MN frequency were observed with increased crude oil concentrations. These results indicate that the alkaline comet assay and micronucleus test were suitable and useful in the evaluation of the genotoxicity of crude oil, which could improve determinations of the impact of oil spills on fish populations. In addition, H. reidi is a promising "sentinel organism" to detect the genotoxic impact of petroleum hydrocarbons. © 2015

CARACTERIZAÇÃO ANATÔMICA E DESCRIÇÃO FÍSICO-QUÍMICA E MECÂNICA DA MADEIRA DE Mimosa schomburgkii

O uso de madeira de espécies alternativas na construção civil é uma alternativa para reduzir a utilização concentrada em poucas espécies e evitar a falta de matéria prima no mercado. Diante do exposto, o objetivo deste estudo foi avaliar propriedades físicas, químicas, anatômicas e mecânicas da madeira de Mimosa schomburgkii visando identificar o seu potencial para o uso na construção civil. Foi utilizada a madeira de Mimosa schomburgkii, com idade de 33 anos. As características anatômicas avaliadas foram as dimensões dos elementos de vasos (diâmetro e frequência), dos raios (altura e largura) e das fibras (comprimento, largura total, espessura de parede e de lume). Foi determinada a constituição química com a quantificação do teor de extrativo, lignina e holocelulose.  Para a caracterização físico-mecânica, foram avaliadas a densidade básica e aparente, contrações, o coeficiente de anisotropia, a resistência à flexão estática, à compressão paralela às fibras, à tração paralela às fibras, ao cisalhamento e a dureza Janka (paralela e perpendicular às fibras). A madeira possui fibras libriformes, com comprimento médio de 1180 μm, sendo classificadas como curtas. A densidade básica da madeira é em média 0,80 g.cm-3 (alta densidade), o coeficiente de anisotropia, em média 1,74. A madeira apresenta elevada resistência mecânica, sendo classificada como pertencente à classe C 60. Pelos resultados obtidos no estudo, a madeira de jurema (Mimosa schomburgkii) apresenta aspectos estéticos atrativos e elevada resistência mecânica, sendo, portanto, indicada para uso na construção civil.Palavras–chave: Propriedades da madeira, construção civil, elevada resistência mecânica, alta densidade básica. AbstractAnatomical characterization and physical-chemical and mechanical description of Mimosa schomburgkii wood. The use of wood of alternative species in civil construction has been an option to reduce the concentrated use of few species and to avoid the lack of raw material in the market. The objective of this study was to evaluate the physical, chemical, anatomical and mechanical properties of Mimosa schomburgkii wood, in order to identify its potential use in civil construction. Mimosa schomburgkii wood, at the age of 33 years, was used. The anatomical characteristics evaluated were the dimensions of vessel elements (diameter and frequency), rays (height and width) and fibers (length, width, wall thickness and lumen thickness). The chemical constitution was determined with the quantification of extractive content, lignin and holocellulose. For the physical-mechanical characterization, it was evaluated the specific gravity and apparent density, contractions, anisotropy coefficient, static bending strength, compression strength parallel to grain, traction strength parallel to grain, shear strength and Janka hardness (parallel and perpendicular to grain). The wood has libriform fibers, average length of 1180 μm, and it is classified as short. The wood basic density is on average of 0.80 g.cm-3 (high density). The anisotropy coefficient is on average of 1.74. The wood presents high mechanical strength, being classified as C 60 class. From the results obtained in this study, the Mimosa schomburgkii wood presents attractive aesthetic aspects and high mechanical resistance. Therefore, this wood is indicated for use in civil construction.Keywords: Wood properties, civil construction, high mechanical strength, high specific gravity

Tradução e validação da versão brasileira da escala de gravidade na esclerose lateral amiotrófica (Egela)

O objetivo do trabalho foi traduzir a Amyotrophic Lateral Sclerosis Severity Scale para o português, como Escala de gravidade da esclerose lateral amiotrófica (Egela), além de validar e estudar sua confiabilidade. A escala foi submetida à versão e retroversão por tradutores bilíngües e três fisioterapeutas treinaram para padronizar sua aplicação. Foram avaliados 22 pacientes (5 mulheres, 17 homens, média de idade 45,9 anos) pela Egela e pela medida de independência funcional (MIF); 11 foram examinados para classificação de disfagia. Os coeficientes de correlação intraclasse dos domínios da Egela foram acima de 0,89. Foi constatada alta consistência interna em todos os seus domínios e para cada avaliador; foram encontradas fortes correlações entre a MIF motora e o escore espinhal da Egela (r=0.87 e pThe purpose was to translate the Amyotrophic Lateral Sclerosis Severity Scale (ALSSS) into Portuguese, to validate it and assess its reliability. The scale was submitted to bilingual translators, its abbreviation in Portuguese being Egela; three physical therapists were trained for its application. Twenty-two patients (5 women, 17 men, mean age 45.9) were evaluated by the Egela and by the functional independence measure (FIM); 11 of them were assessed for dysphagia classification. In all ALSSS domains the intraclass correlation coefficients were over 0.89; high internal consistency was found in all scale domains and for each examiner. Strong correlations were found between motor FIM and spinal ALSSS (r=0.87;

Atividade anticolinesterásica e perfil químico de uma fração cromatográfica ativa do extrato etanólico das flores Bellis perennis L. (Asteraceae)

This work describes the isolation of an active flavonoid fraction and identification of isorhamnetin 3-O-β-D-(6''-acetyl)-galactopyranoside from flowers of B. perennis, and also the evaluation of anticholinesterase (AChE) activity of ethanolic extract from flowers (EEF) and the active fraction. The chemical structure of the flavonoid was defined on the basis of spectroscopic ¹H NMR, IR and UV data. EEF or flavonoid reduces AChE activity in vivo, while flavonoid also reduces AChE activity in vitro, showing a value of 1.49 mM for 50% inhibitory concentration (IC50), suggesting potential use as an insecticide or in the treatment of neurodegenerative diseases such as Alzheimer's disease

Population-based seroprevalence of SARS-CoV-2 and the herd immunity threshold in Maranhão

OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon.OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon