Submitted by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2015-11-18T19:21:29Z No. of bitstreams: 1 Patricia Martinez.pdf: 1740129 bytes, checksum: 2e78fca15b7342e0463a1eb9c89b943a (MD5) / Made available in DSpace on 2015-11-18T19:21:30Z (GMT). No. of bitstreams: 1 Patricia Martinez.pdf: 1740129 bytes, checksum: 2e78fca15b7342e0463a1eb9c89b943a (MD5) Previous issue date: 2015-08-14 / As doenças cardiovasculares (DCV) lideram as causas de morte em todo o mundo, sendo a dislipidemia o principal fator de risco. A alimentação é reconhecida como a intervenção mais importante na prevenção de patologias e as plantas são consideradas a melhor fonte de antioxidantes naturais. Entre elas, um alimento funcional que tem se destacado é o Yacon, uma raiz tuberosa, originária da região Andina que possui frutooligossacarídeos (FOS) como principal carboidrato de reserva, diferenciando-se da maioria das espécies tuberosas que estocam energia na forma de amido. Além desses compostos, o Yacon apresenta polifenóis em quantidade significativa tanto nas raízes como nas folhas. Estudos demonstram que o Yacon possui atividade hipoglicêmica, entretanto pouco se sabe sobre outras propriedades. Assim, o objetivo deste estudo foi investigar os efeitos hipolipêmico e antioxidante in vivo dos extratos hidroalcoólicos da folha e raiz do Yacon (Smallanthus sonchifolius). Foram utilizados ratos Wistar, machos, divididos em: G1 (controle dieta normal), G2 (controle dieta hipercalórica) (NaCl 0,9%), G3: suspensão oral de sinvastatina 10 mg/Kg (SIM), G4: extrato folha Yacon 20 mg/kg (EFY20), G5: extrato folha Yacon 40 mg/kg (EFY40), G6: extrato folha Yacon 20 mg/kg + sinvastatina (EFY20+SIM), G7: extrato folha Yacon 40 mg/kg + sinvastatina (EFY40+SIM), G8: extrato raiz Yacon 20 mg/kg (ERY20), G9: extrato raiz Yacon 40 mg/kg (ERY40), G10: extrato raiz Yacon 20 mg/kg + sinvastatina (ERY20+SIM) e G11: extrato raiz Yacon 40 mg/kg + sinvastatina (ERY40+SIM). As formulações foram administradas uma vez ao dia por gavage durante 14 dias consecutivos. Os parâmetros hematológicos, bioquímicos e de estresse oxidativo foram determinados através de metodologias clássicas. Os grupos que receberam o extrato de Yacon apresentaram melhora do perfil glicêmico e lipídico. A dieta hipercolesterolêmica aumentou os níveis séricos da creatina-quinase, CK-MB, homocisteína e LDH porém a administração do extrato diminuiu significativamente os níveis destes marcadores quando comparado ao grupo não tratado. Além disso, o extrato, reduziu a peroxidação lipídica, a carbonilação proteica, e frequência de micronúcleos induzida por hipercolesterolemia e aumentou as defesas antioxidantes (CAT, SOD, GPx, GSH, vitamina C e polifenóis) no sangue. Verificou-se ainda que, a suplementação do Yacon não mostrou efeito hepatotóxico ou nefrotóxico. A dieta hipercolesterolêmica aumentou o processo inflamatório, avaliado através de seus marcadores, e a administração do extrato melhorou esse parâmetro. Além disso, a suplementação com a raiz do Yacon controlou o ganho de peso dos animais. Assim, os resultados sugerem que o extrato liofilizado do Yacon apresentou uma atividade hipoglicêmica, hipolipêmica e antioxidante, possivelmente devido ao seu alto conteúdo de compostos fenólicos. / Cardiovascular diseases (CVD) are the leading cause of death worldwide, and dyslipidemia a major risk factor. Feeding is recognized as the most important intervention in the prevention of diseases and plants are considered the best source of natural antioxidants. Among them, a functional food that has been highlighted is the Yacon, a tuberous root, originate in the Andean region with fructooligosaccharides (FOS) as the main reserve carbohydrate, differing from most tuberous species which store energy in the form of starch. In addition to these compounds, Yacon presents significant amount of polyphenols in both roots and leaves. Studies show that Yacon has hypoglycemic activity, however little is known about other properties. The objective of this study was to investigate the hypolipemic and antioxidant effects in vivo of hydroalcoholic extracts of leaf and root of Yacon (Smallanthus sonchifolius). Male Wistar rats were used, divided into: G1 (normal control diet), G2 (control calorie diet) (NaCl 0.9%), group 3: oral suspension of simvastatin 10 mg/kg (SIM), group 4: Yacon leaf extract 20 mg/kg (YLE20), group 5: Yacon leaf extract 40 mg/kg (YLE50), group 6: Yacon leaf extract 20 mg/kg and simvastatin 10 mg/kg (YLE20+SIM), group 7: Yacon leaf extract 40 mg/kg and simvastatin 10 mg/kg (YLE40+SIM), group 8: Yacon root extract 20 mg/kg (YRE20), G9: Yacon root extract 40 mg/kg (YRE40), G10: Yacon root extract 20 mg/kg and simvastatin 10 mg/kg (YRE20+SIM), G11: Yacon root extract 40 mg/kg and simvastatin 10 mg/kg (YRE40+SIM), The formulations were administered once daily by gavage for 14 consecutive days. Hematological, biochemical and oxidative stress parameters were determined by classical methods. The groups that received the Yacon extract showed improvement of glycemic and lipid profile. The hypercholesterolemic diet increased serum levels of creatine kinase, CK-MB, homocysteine and LDH, but the extract administration decreased the levels of these markers significantly when compared to the untreated group. Moreover, the extract, reduced lipid peroxidation, protein carbonylation and frequency of micronucleus induced by hypercholesterolemia and increase antioxidant defenses (CAT, SOD, GPx, GSH, vitamin C, polyphenols) in the blood. Moreover, supplementation of Yacon showed no hepatotoxic or nephrotoxic effect. The hypercholesterolemic diet increased the inflammatory process, evaluated through your markers, and extract administration has improved this parameter. Furthermore, supplementation with the root of Yacon controlled weight gain of animals. Thus, the results suggest that the lyophilized Yacon extract showed a hypoglycemic, hypolipemic and antioxidant activity, possibly due to its high content of phenolic compounds.

published_or_final_version / Public Health / Master / Master of Public Health

Incorporating the best findings from current, high-quality research into routine clinical practice is the basis of evidence-based care. Chapter 1: "Systematic Review and Meta-Analysis in Evidence-Based Care" is a review of the systematic review process, including meta-analysis, aimed at clinical professionals with limited statistical training. It advocates the use of the systematic review process, outlines some general techniques, and provides selected resources where individuals can acquire additional assistance. The typical steps involved include: formulating a clear research question, defining inclusion and exclusion criteria, extracting the data and assessing the study quality, summarizing and synthesizing the evidence, and then interpreting the findings. When effort is made to minimize bias and locate as many articles on a particular topic as possible, systematic reviews and meta-analyses can produce invaluable findings for evidence-based care. Chapter 2: "The Effect of Macronutrient Distribution on the Lipid Profile in Adults: A Systematic Review and Meta-Analysis" describes a systematic review and meta-analysis that examined the impact total macronutrients had on blood lipid levels. This chapter builds upon the concepts introduced in chapter one, and assesses the effect of manipulating macronutrient distribution on the lipid profile of adults, and compares these effects to recommendations regarding macronutrients, such as the Acceptable Macronutrient Distribution Ranges (AMDRs). Suggestions related to improving the quality of meta-analyses are also outlined, and supplemental analyses are provided at the end of the dissertation.

Bakgrund: Antalet personer med diabetes i världen ökar ständigt. Dåliga levnadsvanor ökar risken för diabeteskomplikationer. Vården har ett ansvar att stärka patientens motivation och förmåga till egenvård.  Syfte: Undersöka effekten av MI som behandlingsmetod för att hjälpa diabetespatienter till förbättrad egenvård.    Metod: Litteraturstudie. Artikelsökningar gjordes i de medicinska databaserna Pubmed, Cinahl och Scopus. I studien inkluderades 10 originalartiklar varav fem var av medelkvalitet och fem av hög kvalitet. Dessa delades in i två grupper vilka var effekt på HbA1c och blodfetter samt effekt på egenvård.    Resultat: Utifrån inkluderade studier kunde ingen signifikant effekt påvisas i HbA1c och blodfetter eller gällande kost, fysisk aktivitet eller medicinsk följsamhet. Däremot sågs positiv effekt vid mätningar av upplevd kompetens, kunskap och egenkontroll. En studie visade positiv effekt på HbA1c av MI i kombination med KBT.  De effekter som kunde påvisas avtog kort tid efter behandlingssessionerna upphört. Studiernas utformning och mätmetoder ifrågasattes.    Slutsats: I nuläget finns få studier inom området därför är det för tidigt att rekommendera MI som metod inom diabetesvården. Mer forskning behövs om MI med tydligare fokus på personalens relation med patienten och personalens MI-färdigheter om man syftar till att mäta effekten av MI-samtalet. / Background: The number of people with diabetes in the world is constantly increasing. Bad food habits increase the risk of diabetes complications. Healthcare has a responsibility to enhance the patient's motivation and ability for self-care. Objective: Investigate the impact of MI as a treatment to help patients with diabetes to better self-care. Method: Literature review. The search for articles were made in the medical databases Pubmed , Cinahl and Scopus. The study included 10 original articles of which five were medium and five high quality. These were divided into two groups, effect on HbA1c and blood lipids and effect on self-care. Results: Based on the included studies, no significant effect is demonstrated in HbA1c and blood lipids or current diet, physical activity or medical adherence. There was however a positive effect in measurements of perceived competence, knowledge and self-control. One study demonstrates a positive effect on HbA1c of MI in combination with CBT. The effects found subsided shortly after the treatment sessions ended. Study design and measurement methods were questioned. Conclusion: Few studies exist in the field, therefore, it is too early to yet recommend the MI-method in diabetes care. More research is needed on MI with a clearer focus on the interviewers relationship with the patient and the MI skills of the interviewers if one aims to measure the effect of the MI-sessions.

Localised accumulation of body fat significantly influences the development of obesity related co-morbidities and cardiovascular disease (CVD) risk. Medium chain triglycerides (MCT) have been suggested to modulate body fat distribution. Phytosterols (PS) have demonstrated unequivocal cholesterol-lowering effects. A healthy dietary solution combining MCT and PS could thus become first-line obesity and CVD prevention. The aim of this study was therefore to investigate the effects of a functional oil (FctO) rich in MCT and PS on blood lipid levels and body adiposity, compared to olive oil. Twenty-three hypercholesterolemic, overweight men, were randomly assigned, in a single-blind crossover study, to consume a FctO, or olive oil, incorporated into a 40% fat diet for 6 wks. Blood lipid levels were measured and body composition was assessed. Total and LDL cholesterol were significantly reduced in subjects consuming the FctO versus the control oil. No significant differences for weight or adiposity loss of subjects were observed between the two oils. Results support the cardio-protective role of this FctO.

Cardiovascular disease (CVD) risk can be lowered by introduction of plant sterols (PS) in the diet, since PS have been shown to reduce low-density lipoprotein cholesterol (LDL-C). Given that the efficacy of PS as cholesterol-lowering agents depends on their appropriate solubilization, the cholesterol-lowering efficacy of PS in non-traditional matrices needs to be determined. The primary aim of this thesis was to examine the consumption of PS (a) in an oil rich in medium chain triglycerides (MCT) or (b) low-fat yogurt with or without a meal, on changes in lipid parameters. Additional objectives were: (1) to assess the effects of MCT with PS on body composition and energetics, (2) to compare the effects of PS in low-fat matrix consumed with or without a meal on cholesterol synthesis, (3) to evaluate the risks of PS in low-fat matrix on blood levels of carotenoids and fat-soluble vitamin, and (4) to investigate the relationship between the response to PS, cholesterol kinetics and genotyping. For this purpose two randomized, controlled, crossover-feeding trials were conducted. First, 23 overweight, hyperlipidemic men consumed PS in MCT or olive oil control for six weeks each. In the second trial, 26 hyperlipidemic subjects consumed a placebo yogurt, a PS-enriched yogurt consumed with a meal, or afternoon PS-enriched yogurt as a snack for four weeks each. PS, mixed within a MCT matrix, lower plasma total cholesterol (TC) and LDL-C without changing the high-density-lipoprotein cholesterol concentrations. However, no changes in body composition or energetics were observed. Secondly, a PS-enriched low-fat yogurt as snack lowered TC, along with a lowering trend in LDL-C, to greater extent compared to when consumed with a meal without any risk of deficiency in fat-soluble antioxidants. An increase in cholesterol biosynthesis was also observed in both PS phases compared to control phase. In addition, three non-responsive subjects to PS intervention who had higher cholesterol absorption rates were observed; however, no recognizable pattern of genetic polymorphisms was detected. Overall, these novel matrices for PS incorporation consumed with or between meals may be an effective way of decreasing the risk of CVD; however, some individuals respond better to PS intervention.

The current study examined the impact of plant sterols, stanols, sterol esters, and stanol esters on (i) cholesterol-lowering efficiency, (ii) gene expression of ABCG5 and ABCG8 sterol transporters in the liver and small intestine, and (iii) colon mucosal cell proliferation in hamsters. After 5 weeks on experimental diets, plasma total cholesterol levels were reduced ( P<0.05) by stanols, sterol esters and stanol esters compared to cholesterol-control diet. Different PS analogs did not alter ABCG5 and ABCG8 mRNA levels in small intestine and liver as compared to cholesterol control. In addition, colon mucosal cell proliferation was 21.4% lower (P<0.01) in group fed 0.7% stanol esters relative to cholesterol control. Results suggest that hypocholesterolemic effects of PS analogs are not associated with changes of liver and small intestine ABCG5 and ABCG8 sterol transporters. Data also indicated that plant stanol ester may possess anticarcinogenic properties.

The cholesterol-lowering effect of corn fiber oil, obtained from the seed coats of corn kernels, has been reported previously. Corn fiber oil contains phytosteryl fatty acyl esters, ferulate phytostanyl esters, and free phytosterols. To date, however, no studies have examined the cholesterol-lowering efficacy of ferulate phytostanyl esters. Moreover, although plant stanols and sterols have been established as cholesterol-lowering agents over the past five decades, their exact mechanisms of action are not clearly understood. One of the possible mechanism is that plant sterols/stanols disrupts the normal sub-cellular cholesterol absorption by down-regulation of the influx sterol transporters such as the Niemann pick C1 like 1(NPC1L1) protein and/or up-regulation of efflux sterol transporters such as the ATP binding cassette (ABC) G5 and ABCG8 protein. Hence, the objectives of this thesis were to assess the efficacy of corn fiber oil, ferulate phytostanyl esters and their parent compounds including sitostanol and ferulic acid, on plasma cholesterol levels. Further, objectives were to investigate their impact on parameters of cholesterol kinetics and gene expression of sterol transporters to obtain insight into their role in genetic control of regulation of cholesterol flux. Results of this experiment demonstrate that the hypocholesterolemic effect of corn fiber oil is mostly due to sitostanol, while esterification of ferulic acid and sitostanol yields no apparent synergistic cholesterol lowering effect. Present data exhibited a cholesterol absorption lowering effect of corn fiber oil and sitostanol and suggest that this effect may be due to up-regulation of intestinal enterocyte efflux sterol transporters such as ABCG5 and ABCG8.

The aim of this study was to examine whether vitamins E (200 IU) and C (1 g) in combination would influence exercise-induced lipid peroxidation to a greater extent than vitamin E (400 IU) alone. A placebo-controlled study was carried out on 7 collegiate cyclists who were supplemented with 1) vitamin C (1 g); 2) vitamins E (200 IU) and C (1 g); and vitamin E (400 IU) during 3 treatments, each 3 weeks in duration. The serum concentrations of hematocrit and MDA, one marker of lipid peroxidation, were measured immediately before, immediately after, and 24 hours after each exercise bout. After the vitamin C treatment, MDA serum concentration of the athletes (n=7) increased 85% above the baseline values of the placebo values, the vitamin E/C treatment showed a 29% increase, and the vitamin E treatment showed a 39% decrease. Pre- to post-exercise serum MDA levels increased 64% in the placebo group, a 29% increase in the vitamin C treatment group, a 23.2% increase in the vitamins E/C treatment group, and a 46.9% increase in the vitamin E treatment group. It is concluded that exercise-induced lipid peroxidation is more greatly influenced post-exercise by a combination of vitamins E (200 IU) and C (1 g), than by either vitamin C (1 g) alone, or vitamin E (400 IU) alone. / Department of Family and Consumer Sciences

Medium chain triglycerides (MCT) have long been advocated as potential weight-lowering agents or potential tools in the treatment and prevention of human obesity. These statements have been made after findings from human and animal trials that consumption of MCT increases energy expenditure and fat oxidation compared to long chain triglycerides (LCT). In addition, animal studies have resulted in lower body weight gain and smaller fat depots when animals were fed MCT compared to those fed LCT. However, long-term controlled trials studying the effects of consumption of MCT in humans have not been conducted and the longest trial to date, 14 d of duration, has shown that the effect of MCT on energy expenditure may be transient. Therefore, we aimed to determine whether, in controlled feeding conditions, consumption of MCT for 4 wk would lead to differences in energy expenditure and substrate oxidation versus consumption of an isocaloric diet rich in LCT. Furthermore, our aim was to establish whether consumption of MCT for 4 wk would lead to greater changes in body composition than would LCT consumption. We conducted two randomized, controlled, crossover feeding trials involving overweight women and men to test our objectives. A secondary objective was to examine the potential satiating effect of MCT, and this was tested in men. Finally, a third objective was to determine whether, when combined with phytosterols and flaxseed oil, MCT consumption would result in different blood lipid profile compared to LCT. Nineteen healthy overweight women and 24 healthy overweight men participated in two separate randomized controlled trials to test these objectives. Energy expenditure and body composition were assessed at the beginning and end of each experimental phases, which differed only in the type of fat included in the controlled diets. Blood samples were also taken at baseline and endpoint of each phase to determine plasma lipid concentrations. Result