Avaliação de parâmetros de sarcopenia em pacientes com esteato-hepatite não-alcoólica pré e pós suplementação de probióticos

Existe uma associação clínica entre sarcopenia e esteatose e sua progressão para esteato hepatite não-alcoólica (EHNA). A disbiose da microbiota intestinal pode promover inflamação crônica e resistência anabólica, consequentemente levando a perda de massa muscular esquelética e função muscular prejudicada. Assim, o objetivo do presente trabalho foi avaliar o efeito da suplementação de probióticos sobre os parâmetros de sarcopenia, massa muscular esquelética, força e desempenho físico, em pacientes com EHNA. Trata-se de um ensaio clínico duplo-cego, randomizado, que incluiu pacientes adultos ambulatoriais com diagnóstico de EHNA confirmado por biópsia. A intervenção consistiu em 24 semanas de suplementação com mix de probióticos (Lactobacillus acidophilus NCFM + Lactobacillus rhamnosus HN001 + Lactobacillus paracasei LPC-37 + Bifidobacterium lactis HN019 1x109CFU para cada) ou placebo, e os pacientes foram orientados a consumir dois sachês/dia. Foram avaliadas as alterações nos seguintes parâmetros: massa muscular por de bioimpedância elétrica (BIA) e absortometria de raios-X de dupla energia (DXA), força muscular pela força do aperto de mão (FAM) e teste de sentar e levantar da cadeira, desempenho físico pelo teste de velocidade de marcha e biomarcadores (testosterona, fator de crescimento semelhante à insulina tipo 1 (IGF-1) e miostatina).There is a clinical association between sarcopenia and nonalcoholic fatty liver (NAFL) and its progression to nonalcoholic steatohepatitis (NASH). Gut microbiota dysbiosis could promote chronic inflammation and anabolic resistance causing skeletal muscle mass loss,and impaired muscle function. Therefore the objective of this study was to evaluate the effect of probiotics supplementation on sarcopenia parameters, skeletal muscle mass, strength, and physical performance, in patients with NASH. This double-blind, randomized clinical trial included adult outpatients with a diagnosis of NASH confirmed by biopsy. The intervention consisted of 24 weeks of supplementation with probiotic mix (Lactobacillus acidophilus NCFM + Lactobacillus rhamnosus HN001 + Lactobacillus paracasei LPC-37 + Bifidobacterium lactis HN019, 1x109CFU for each) or placebo, and patients were instructed to consume two sachets/day. Changes in the following parameters were evaluated: muscle mass by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), muscle strength by the handgrip strength and chair stand test, the physical performance by the gait speed test and serum biomarkers (testosterone, insulin-like growth factor 1 (IGF1), and myostatin)

A construção do Jornal do Centro de Atenção Psicossocial II: desenvolvendo habilidades específicas e relacionais

Objective: to demonstrate the possibilities of a multidisciplinary workshop on developing hard and soft skills to improve rehabilitation. Methods: experience’s description of conducting a working group aimed to writing and editing a newspaper. Through such specific task, different hard and soft skills are developed. Hard skills are specific abilities, such as using the computer and the internet, whereas soft skills are social skills, such as how to relate to others and negotiate. Results: empowerment of the clients by enhancing abilities with tools like the computer and the internet; Development of relational capacities, such leadership and group working. Final considerations: this multidisciplinary therapeutic workshop is useful to enhance clients’ work and social skills and improve their rehabilitation process

Effect of probiotic supplementation in nonalcoholic steatohepatitis patients : PROBILIVER TRIAL protocol

Background: Recently factors in the relationship between gut microbiota, obesity, diabetes and the metabolic syndrome have been suggested in the development and progression of nonalcoholic steatohepatitis (NASH). In this sense, this work aims to evaluate the effects of probiotic supplementation on intestinal microbiota modulation, degree of hepatic steatosis and fibrosis, inflammation, gut permeability, and body composition. Methods: This double-blind, randomized clinical trial will include adult outpatients with a diagnosis of NASH confirmed by biopsy with or without transient elastography. All patients will undergo a complete anamnesis to investigate their alcohol consumption, previous history, medications, nutritional assessment (dietary intake and body composition), sarcopenia, physical activity level and physical and functional capacity, cardiovascular risk, biochemical parameters for assessment of inflammatory status, lipid profile, hepatic function, gut permeability, and assessment of microbiota. These procedures will be performed at baseline and repeated after 24 weeks (at the end of the study). Through the process of randomization, patients will be allocated to receive treatment A or treatment B. Both patients and researchers involved will be blinded (double-blind study). The intervention consists of treatment with a probiotic mix (Lactobacillus acidophillus + Bifidobacterium lactis + Lactobacillus rhamnosus + Lactobacillus paracasei, 1 x 109 CFU for each) and the placebo which is identical in all its characteristics and packaging. Patients will be instructed to consume two sachets/day during 24 weeks and to report any symptoms or side effects related to the use of the sachets. Adherence control will be carried out through the patient’s notes on a form provided, and also by checking the number of sachets used. Discussion: The final results of study will be analyzed and disseminated in 2020

Probiotic supplementation for 24 weeks in patients with non-alcoholic steatohepatitis: the PROBILIVER randomized clinical trial

Background and aimConsidering the increasing prevalence of non-alcoholic steatohepatitis (NASH) and treatment gaps, this study aimed to evaluate the effect of probiotic supplementation on liver function markers, nutritional status, and clinical parameters.MethodsThis double-blind, randomized clinical trial (ClinicalTrials.gov ID: NCT0346782) included adult outpatients with biopsy-proven NASH. The intervention consisted of 24 weeks of supplementation with the probiotic mix Lactobacillus acidophilus (1 × 109 CFU) + Lactobacillus rhamnosus (1 × 109 CFU) + Lactobacillus paracasei (1 × 109 CFU) + Bifidobacterium lactis (1 × 109 CFU), or placebo, twice a day. The following parameters were evaluated: demographic and clinical data, transient elastography (FibroScan), liver enzymes, NAFLD fibrosis score, fatty liver index, laboratory assessment, serum concentration of toll-like receptor-4 (sTLR-4) and cytokeratin 18 (CK-18), anthropometric data, dietary intake, and physical activity. Regarding data analysis, the comparison between the groups was based on the delta of the difference of each variable analyzed (value at the end of treatment minus the baseline value) using the t-test for independent samples or the Mann–Whitney U-test.ResultsForty-four patients with NASH completed the trial (51.4 ± 11.6 years). At baseline, 87% of participants had a mild liver fibrosis degree on biopsy, normal values of liver enzymes, transient elastography values consistent with grade 1 fibrosis in both groups, increased waist circumference (WC), a BMI of 30.97 kg/m2, and 76% presented with metabolic syndrome (MetS). After the intervention, no differences were observed between the probiotic and placebo groups in terms of MetS, WC, BMI scores, or liver enzyme levels (p > 0.05 for all). The elastography values remained consistent with grade 1 fibrosis in both groups. Although CK-18 was reduced in both groups, a larger effect size was noted in the probiotic group (D = 1.336). sTLR-4 was also reduced in both groups, with no difference between groups (p = 0.885).ConclusionIntervention with probiotics in the early stages of NASH demonstrated no significant change in hepatic and clinical parameters.Clinical trial registrationClinicalTrials.gov, identifier NCT0346782