Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Background Patients with chronic renal failure must deal not only with the disease itself, but also have to follow a strict dietary regimen. In South Africa there is currently a great demand for new and updated recipes based on the South African Renal Exchange Lists. The focus of this research was the development and testing of recipes commonly used by renal patients following a westernised diet. Objectives The main objectives of the study were to develop and test recipes that meet the nutritional requirements of patients with chronic renal failure. The secondary objectives were to determine the gender and racial differences in participants’ responses during consumer sensory testing. Methodology The study population consisted of patients with chronic renal failure on hemodialysis and continuous ambulatory peritoneal dialysis from Tygerberg Academic Hospital (TAH). Data was collected in three phases, using census sampling: Phase 1 included the development and adaptation of recipes to suit the renal diet. Phase 2 included the consumer sensory testing of the recipes by the dialysis patients, using the 9-point hedonic scale. Phase 3 included the rating of the recipes, the final nutritional analysis and allocation of renal exchanges to one portion of each recipe, as well as the final formatting of the recipe to make it more user-friendly for the renal patient. Results In total, 45 patients took part in the sensory evaluation of 30 recipes. Eighty percent of the subjects were coloured, 4% were white while 16% were black. Fifty-one percent (n=23) were female and 49% (n=22) were male. Of the 30 recipes that were evaluated for overall acceptance, appearance, smell, texture and taste, only 7 were deemed unacceptable. Recipes were unacceptable when less than 80% of the study participants gave a mean overall score of more than 6. Significant differences in the overall acceptability scores were found between the male and female subgroups for the Fish and Vegetable Pie (p=0.031), Chicken Pilaf (p=0.008) and Date Fingers (p=0.002). The females showed a greater preference for these two main meals while the males showed a greater preference for the Date Fingers. Significant differences were found between the black and westernised subgroups for the Rice Salad (p=0.006), Wheat and Mushroom Casserole (p=0.022), Curried Wheat Salad (p=0.043) and the Coconut Ice (p=0.005), with the westernised subgroup showing a greater preference for the dishes than the black subgroup. Conclusion The 23 recipes that were acceptable to the study participants are recommended for inclusion in the RenalSmart Software programme. These recipes are suitable for patients following a westernised diet. It is proposed that recipes suitable for the black and Indian population must be developed in future research. / AFRIKAANSE OPSOMMING: Agtergrond Pasiënte met chroniese nierversaking moet nie net slegs die siektetoestand hanteer nie, maar moet ook ‘n streng dieet regime volg. Daar is huidiglik in Suid-Afrika ‘n groot behoefte vir nuwe en opgedateerde resepte gebasseer op die Suid-Afrikaanse Nier Ruillyste. Die fokus van hierdie navorsing was om resepte te ontwikkel en te toets wat algemeen ingeneem word deur nierversaking pasiënte wat ‘n westerse dieet volg. Doelwitte Die hoof doelwitte van die studie was om resepte te identifiseer en te toets wat voldoen aan die nutrisionele behoeftes van nierpasiënte met kroniese nierversaking. Die sekondêre doelwitte was om geslag en ras verskille in die deelnemers se reaksies tydens verbruiker sensoriese evaluering te bepaal. Metodologie Die studie populasie het bestaan uit pasiënte met chroniese nierversaking op hemodialise en aaneenlopende ambulatoriese peritoneale dialise van Tygerberg Akademiese Hospitaal (TAH). Data was versamel in drie fases deur gebruik te maak van sensus steekproeftrekking: Fase 1 het die ontwikkeling en aanpassings van die resepte, om dit toepaslik te maak vir die nier dieet, ingesluit. Fase 2 het die verbruiker sensoriese evaluering van die resepte deur die dialise pasiënte, met behulp van die 9-punt hedoniese skaal, ingesluit. Fase 3 het die klassifisering van die resepte, die finale nutrisionele analise en die toekenning van nier ruile per porsie van elke resep, sowel as die finale formatering om die resep meer gebruikersvriendelik te maak vir die nierpasiënt, ingesluit. Resultate In totaal het 45 pasiënte aan die sensoriese evaluering van die 30 resepte deelgeneem. Tagtig persent van die deelnemers was kleurling, 4% was wit en 16% was swart. Een en vyftig persent (n=23) was vroulik en 49% (n=22) was manlik. Van die 30 resepte wat geevalueer is vir algehele aanvaarding, voorkoms, reuk, tekstuur en smaak, was slegs 7 onaanvaarbaar gevind. Resepte is as onaanvaarbaar beskou indien minder as 80% van die deelnemers ‘n gemiddelde algehele telling van meer as 6 gegee het. Beduidende verskille in die algehele aanvaarbaarheid tellings is gevind tussen die mans en vroue vir die Vis en Groente Pastei (p=0.031), Hoender Pilaf (p=0.008) en Dadelvingers (p=0.002). Die vrouens het ‘n groter voorkeur vir die twee hoofgeregte getoon terwyl die mans ‘n groter voorkeur vir die Dadelvingers getoon het. Beduidende verskille is gevind tussen die swart en westerse sub-groepe vir die Rysslaai (p=0.006), Koring en Sampioen Kasserol (o=0.022), Kerrie Koringslaai (p=0.043) en die Klapperys (p=0.005), met die westerse sub-groep wat ‘n groter voorkeur vir dié geregte toon as die swartes. Gevolgtrekking Die 23 resepte wat aanvaarbaar gevind is sal voorgestel word om ingesluit te word in die RenalSmart Sagteware program. Die resepte is toepaslik vir pasiënte wat ‘n westerse dieet volg. Daar word voorgestel dat resepte toepaslik vir die swart en Indiër populasie ontwikkel word in toekomstige navorsing.

Hábitos de vida saudáveis e uma dieta balanceada aliados ao alto consumo de frutas e vegetais, estão associados à prevenção de doenças e à manutenção da saúde. A maçã possui em sua composição compostos bioativos que podem agir na prevenção e no controle das dislipidemias. Tendo em vista a preocupação da Saúde Pública em encontrar uma fonte alternativa na redução das doenças cardiovasculares, esse trabalho teve como objetivo analisar a composição química da maçã, variedade Gala, e estudar os efeitos do seu consumo no ganho de peso, consumo alimentar, níveis sanguíneos de colesterol total, HDL-C, LDL-C, triglicerídeos, colesterol hepático e colesterol excretado em ratos Wistar hipercolesterolêmicos. Foram utilizados 6 animais em cada grupo de tratamento (controle, 5%, 15% e 25% de maçã na dieta) durante 30 e 60 dias. Foi observado neste estudo, quanto a composição centesimal da maçã, que uma maçã (200g), é capaz de fornecer 14,5% das recomendações de fibras totais e 55% de vitamina C, além de quantidades consideráveis de compostos fenólicos (0,38g/100g em base fresca) e tanino (0,16g/100g em base fresca). No ensaio biológico, os animais de ambos os tempos, apresentaram uma redução não significativa no ganho de peso e no consumo de dieta com o aumento das concentrações de maçã. Ao final de 30 dias, todas as dietas proporcionaram uma redução significativa (p ≤ 0,05) nos níveis de triglicerídeos comparativamente ao grupo controle e não significativa com relação aos níveis de HDL-C. As dietas com 15% e 25% de maçã mostraram reduções significativas nos níveis sanguíneos de colesterol total e LDL-C e um aumento no teor de colesterol excretado em relação ao grupo controle. A dieta com 25% de maçã promoveu uma redução significativa nos níveis de colesterol hepático em comparação ao grupo controle. Aos 60 dias, os níveis sanguíneos de colesterol total, LDL-C, HDL-C e triglicerídeos de ratos alimentados com as dietas 5%, 15% e 25% de maçã foram semelhantes ao grupo controle.A partir desses resultados, pode-se concluir que a maçã Gala é um potente alimento no controle dirigido das dislipidemias em ratos. Uma dieta rica em verduras, legumes e frutas, inclusive a maçã, associado a um estilo de vida saudável, ao longo do tempo, podem ser considerados fundamentais na prevenção e redução do risco de doenças, principalmente as cardiovasculares. / Healthy life habits and an equilibrate diet, associated with a high fruit and vegetable intake, are joined with the prevention of diseases and health maintenance. The apple has in its composition bioactives compounds that can help in the prevention and control of hyperlipidemia. With the worry of Public Health to find an alternative source in the reduction of the cardiovasculars diseases, the objective of this work was to analyse the chemical composition of the Gala apple and to study the effects of its consumption in the gain of weigh, food intake, seric levels of total cholesterol, HDL-C, LDL-C, triglycerides, hepatic cholesterol and feces cholesterol in hypercholesterolemics Wistar rats. Six animals were distributed in each treatments (control, 5%, 15% and 25% apple diet) during 30 and 60 days. This study showed that one apple (200g) can provide 14,5% of the total fiber and 55% of the vitamin C within the recommendation, besides considerable quantities of phenolic compounds (0,38 g/100g wet weigh) and tannins (0,16 g/100g wet weigh). In the biological assay all the animals showed a non significative reduction in the gain of weigh and food intake with the increase of apple concentrations in the diets. At the end of 30 days, all the diets provided a significative reduction in the levels of tryglicerides comparable to the control group and non significative in relation to HDL-C levels. The 15% and 25% apple diets showed significatives reductions in the seric levels of total cholesterol and LDL-C and an increase in the level of feces cholesterol in relation to the control group. The 25% apple diet provided a significative reduction in the hepatic cholesterol levels comparable to the control group. After 60 days, the seric levels of total cholesterol, LDL-C, HDL-C and tryglicerides in rats fed with 5%, 15% and 25% apple diets were alike to the control group. These results confirm the importance of the Gala apple in the rats hyperlipidemia control. A diet rich in vegetables and fruits, including apple, associated with a healthy life habits, along the time, can be considered in the prevention and reduction against the risk of disease, mainly, the cardiovascular ones.

The present study sought to determine whether a dietary and multi-element psychological treatment (DMPT) approach in combination with standard medical treatment would offer a more efficacious therapeutic package to irritable bowel syndrome (IBS) patients than would standard medical treatment (SMT) employed alone. The DMPT group (N = 19) received a stress management training package for a 2 week period consisting of relaxation training, imagery, and bowel sound biofeedback training via a stethoscope, in addition to instructions to increase their daily consumption of dietary fiber. They also were to continue the implementation of whatever standard medical treatment they were currently receiving, be it a bulking agent, or anti-anxiety, anti-cholinergic, or anti-depressant medications, etc. The SMT group (N = 19) simply received whatever conventional medical treatment they had been prescribed.

Aging, obesity and increased waist circumference (WC) increases risk for metabolic syndrome (MetS). MetS is a cluster of symptoms (elevated WC, triglycerides, blood pressure, fasting glucose, and decreased high-density lipoprotein cholesterol [HDL-C]) increasing risk for chronic disease. Low-energy dense (LED) diets, emphasizing whole food eating patterns, have not been examined in combination with moderate (mod)/high-intensity physical activity (PA) or dietary protein levels to determine their impact on changes in body weight (BW) and WC in premenopausal, abdominally obese women. PURPOSE: To determine the effect of two 16-wk diet and PA interventions, differing in protein intake, on BW, WC, MetS risk factors, dietary patterns, energy density (ED), and min of Mod-Hi PA. METHODS: Healthy, abdominally obese (WC≥80cm) women (n=38; 34±10y) were randomly assigned to either a 15 or 25% (+18 g/d whey protein) en from protein diet. Individualized LED diets plans decreased energy intake (EI) by ~300kcal/d; PA 5 d/wk (30-60 min/d) consisted of supervised, high-intensity Zumba classes 3d/wk (≥65%HRmax; ≥6METs) and self-selected mod-intensity PA (≥3METs) 2d/wk. Servings of fruits/vegetables, whole grains, and low-fat/fat-free dairy (LFD), fiber, high calorie beverages (BEV), ED, and PA were monitored before (T1), during (T2) and after (T3) the intervention using repeated measures ANOVA. Bonferroni simultaneous testing procedure was used in analysis of multiple comparisons. RESULTS: At T1, groups did not differ in dietary patterns, PA, BW, WC, or MetS risk. Groups responded similarly to the interventions so data were combined, with BW and WC decreasing (p<0.0001) by -4.8±2.7kg and -7.1±3.6cm, respectively. Comparing T1 vs. T2, there were increases (p<0.0001) in fruits/vegetables, (Δ=+1.5 ser/d), whole grains (Δ=+1.0 ser/d), LFD (Δ=+0.5 ser/d), fiber (Δ=+5.7g/1000 kcal), and decreases in BEV (Δ=-165 kcal/d) and ED (Δ=-0.55 kcal/g). During the intervention high-intensity Zumba PA was 87min/wk; total min of all mod-intensity PA increased by 75 min/d (p<0.0001); VO2max improved from 29.3±4.7 (T1) to 34.4±5.3 (T3) mL/kg/min (p<0.0001). Triglycerides significantly decreased (-24±52 mg/dl; p=0.006), no other significant changes occurred in MetS risk factors. Exploratory analysis indicated that increases in fruits/vegetables and LFD, and decreases ED were associated with BW loss, while increases in whole grains, fiber, LFD, and min/wk of high-intensity PA (Zumba) were associated with WC reductions. CONCLUSION: For abdominally obese women, an intervention focused on LED foods and high-intensity PA significantly reduced BW and WC and improved dietary patterns regardless of protein intake. Helping clients identify a few key factors that positively promote reductions in BW and WC may improve weight loss success, while reducing MetS risk factors. / Graduation date: 2012

INTRODUÇÃO: A incidência de pacientes apresentando alergia à proteína do leite de vaca (APLV) após os 5 anos de idade vem crescendo. Definir se estes pacientes tolerariam a ingestão de alimento produzido com leite processado a altas temperaturas (LPAT) proporcionaria melhor qualidade de vida, definiria melhor prognóstico e possibilitaria avaliar a indicação de dessensibilização com muffin. OBJETIVO: (1) identificar quais pacientes com APLV persistente aos quatro anos poderiam tolerar a ingestão de LPAT, (2) descrever as características clínicas e laboratoriais dos grupos reativo e não reativo ao LPAT, e (3) compara-las entre os dois grupos. MÉTODOS: Estudo transversal, utilizando amostra de conveniência, incluindo todos os pacientes acompanhados no ambulatório de alergia alimentar do Instituto da Criança HCFMUSP que preenchiam os critérios de inclusão e que concordaram em realizar o TPO, entre janeiro/2013 e novembro/2014. Os pacientes foram admitidos em hospital-dia sob supervisão médica e submetidos à ingestão de um muffin contendo 2,8 gramas de proteína do leite de vaca. Foram definidos como tolerantes se não apresentassem nenhuma reação alérgica. Estes pacientes foram submetidos na sequência a novo TPO com leite de vaca in natura para excluir a tolerância ao leite de vaca. RESULTADOS: Foram realizados 38 TPO com LPAT, sendo que 30 pacientes (15 masculinos) preencheram todos os critérios de inclusão. A mediana da idade foi de 7 anos e 7 meses (4a10m -14a2m). 14 pacientes (46%) não apresentaram reação após a ingestão do muffin, sendo considerados como não reativos. A análise comparativa entre os grupos reativos e não reativos ao LPAT, não mostrou diferença estatisticamente significante quanto às características clínicas: idade (p=0,8), sexo (p=0,4), história pessoal de rinite (p=0,7), história pessoal de asma (p=0,7), história pessoal de outras alergias (p=0,6), história familiar de rinite (p=0,7), história familiar de asma (p=0,3), história familiar de outras alergias (p=0,1), relato de anafilaxia prévia (p=0,07), relato de ingestão de traços de leite previamente ao TPO (p=0,4), relato de reação alérgica no último ano antes da provocação (p=0,6), relato de anafilaxia no último ano antes do TPO (p=0,6). Não se observou diferença estatisticamente significante entre os dois grupos para IgE total (p=0,1) e eosinófilos (p=0,6). O teste de puntura para leite de vaca e frações mostrou diferença estatisticamente significante para ?-lactoalbumina (p= 0,01) e para a caseína (p = 0,004); em relação ao ImmunoCAP® apenas para a caseína (p= 0,05) essa diferença foi significante. Ao avaliar estes pacientes 1 ano após o TPO, nenhum dos 16 pacientes que foram reativos ao LPAT estava ingerindo leite de vaca, enquanto 28% dos pacientes que foram tolerantes ao LPAT estavam consumindo leite de vaca in natura sem reação (p=0,037). CONCLUSÃO: O estudo mostrou que os pacientes com APLV desta amostra brasileira apresentaram 2 diferentes fenótipos, sendo que aproximadamente metade tolerou o LPAT. Sendo assim, o TPO para LPAT deve ser considerado para pacientes com APLV, sempre sob supervisão médica e estrutura segura e adequada, pois pode contribuir para uma mudança no paradigma do seguimento destes pacientes. Teste de puntura e ImmunoCAP® para caseína podem sugerir quais pacientes estariam tolerantes ao TPO com LPAT, reforçando dados da literatura internacional / INTRODUCTION: The incidence of patients with cow\'s milk allergy (CMA) after the age of 5 has been growing. Defining whether these patients can tolerate the ingestion of food produced with baked milk without allergy reaction could provide a better quality of life, a better prognosis and would make it possible to evaluate indication of desensitization with baked milk. OBJECTIVE: (1) To identify which patients with persistent CMA at the age of four could tolerate the baked milk, (2) to describe the clinical and laboratory characteristics of the baked milk reactive group and the baked milk non-reactive group, and (3) to compare those two groups. METHODS: A cross-sectional study was conducted between January/2013 and November/2014. A convenience sample was applied, including all the patients followed in the Food Allergy Center of the Instituto da Criança HCFMUSP, who met inclusion criteria and agreed to carry out the oral food challenge (OFC). The patients were admitted to a day-hospital under medical supervision. They were submitted to a muffin intake containing 2.8 grams of cow\'s milk protein, and then classified as tolerant if they did not present any allergic reaction. To exclude cow\'s milk tolerance these patients were submitted to a new OFC with cow\'s milk in natura. RESULTS: 38 OFC with baked milk were performed, 30 patients (15 male) met all of the inclusion criteria. The median of age was 7 years and 7 months (4y10m -14y2m). 14 patients (46.6%) were considered as non-reactive because they did not present any reaction after the muffin intake. The comparative analysis between baked milk reactive group and baked milk non-reactive group did not show statistically significant difference in the clinical characteristics: age (p=0.8), gender (p=0.4), personal history of rhinitis (p=0.7), personal history of asthma (p=0.7), personal history of others allergies (p=0.6), family history of rhinitis (p=0.7), family history of asthma (p=0.3) family history of others allergies (p=0.1), previous anaphylaxis report (p=0.07), report of milk traits intake prior to OFC (p=0.4), allergic reaction in the last year before the OFC (p=0.6), anaphylaxis in the last year before the OFC (p=0.6). There was no statistically significant difference between the two groups for total IgE (p=0.1) and eosinophils (p=0.6). The Prick test for cow\'s milk and fractions showed statistically significant difference for ?-lactalbumin (p = 0.01) and for casein (p =0.004); in relation to the ImmunoCAP® only for casein (p=0.05) this difference was significant. After 1 year of the OFC, none of the patients which have been reactive to the baked milk were ingesting cow\'s milk, while 28% of the baked milk tolerant patients were consuming cow\'s milk in natura without reaction (p=0.037). CONCLUSION: The present study showed that patients with CMA of this brazilian sample presented 2 different phenotypes. Approximately half of them tolerated baked milk at age four. In conclusion, OFC for baked milk should be considered for patients with CMA, always under medical supervision and appropriate structure, so it could contribute for a change in these patients follow-up. Prick test and ImmunoCAP® for casein can suggest which patients would tolerate the OFC with baked milk, strengthening data of international literature

Introdução: A sitagliptina, inibidor da dipeptidil-peptidase IV, impede a degradação do GLP-1 (peptídeo-1 semelhante ao glucagon), um dos principais hormônios incretínicos. A dieta interfere na secreção de GLP-1, no entanto, a interação das drogas que aumentam o GLP-1 e os macronutrientes da dieta é pouco estudada. Objetivo e Métodos: Determinar o efeito da sitagliptina, na secreção de GLP-1, glucagon, insulina, peptídeo-C, ácidos graxos livres e na glicemia após três dietas, isocalóricas, de diferentes composições nutricionais em pacientes diabéticos tipo 2, recém-diagnosticados, virgens de tratamento, quando comparado a uso de placebo. Dezesseis indivíduos nessas condições foram submetidos a dietas hiperglicídica, hiperprotêica e hiperlipídica, isocalóricas entre si. Dosaram-se nos tempos 0, 30, 60, 120 e 180 minutos os parâmetros: glicose, insulina, peptídeo C, GLP-1, glucagon e AGL. Foi calculada média de área sob a curva e cálculo da área incremental, além de análise de variância para medidas repetidas. Resultados: Durante o teste de dieta hiperglicídica a glicemia foi maior em todos os tempos quando comparado aos testes com PTN e LPD independentemente do uso de sitagliptina (p<0,05). Sitagliptina diminuiu a glicemia em todos os tempos, quando comparado ao uso de placebo (p<0,05). Durante a dieta CHO, a secreção de glucagon foi menor que nas dietas LPD e PTN (p<0,05). Já a concentração de insulina foi maior com a dieta CHO em relação à dieta LPD (p<0,05). A concentração de insulina e peptídeo C foi maior em todos os tempos na dieta CHO (p<0,05). A concentração de GLP-1 foi significativamente maior durante o teste hiperlipídico em relação à dieta CHO. Durante a dieta LPD, a medida de GLP-1 foi maior em todos os tempos. A dieta CHO apresentou medida de GLP-1 menor em todos os tempos do que as outras dietas (p<0,05). A medida de GLP-1 no tempo foi maior (até 120\') com o uso de sitagliptina do que com o uso do placebo, apesar de não estatisticamente significativa. Os níveis de AGL no tempo foram maiores com o uso do placebo do que com o uso da sitagliptina, apesar de não estatisticamente significativo. Conclusão: Houve diminuição da glicemia em todos os tempos com sitagliptina, independentemente da dieta testada. Houve diminuição do efeito da sitagliptina durante o uso da dieta hiperglicídica / Background: Sitagliptin, a dipeptidil-peptidase IV inhibitor, prevents the degradation of GLP-1 (glucagon-like peptide 1), one of the incretin hormones. It is well-known that diet interferes in the GLP-1 secretion; however, the interaction between drugs that stimulates the release of GLP-1 and the macronutrients from diet is hardly studied. Objective and Methods: To demonstrate the effect of sitagliptin on glycemia, and on the secretion of GLP-1, glucagon, insulin, C-peptide, and free fatty acids after three isocaloric diets with different nutritional compositions, in drug-naïve patients, newly diagnosed with type 2 diabetes, when compared to the use of placebo. Sixteen individuals were subjected to a high-carbohydrate diet, a high-protein diet, and a high-fat diet, all of which with similar caloric values. At 0, 30, 60, 120 and180 minutes after the diet, glucose, insulin, C-peptide, GLP-1, glucagon, and AGL were measured. The mean area under the curve, the incremental area, and the variance for repeated measures were calculated. Results: During high-carbohydrate diet, glycemia was higher for all time points, when compared to the PTN and LPD diets, independently of sitagliptin (p<0,05). Sitagliptin reduced glycemia during three diets when compared to placebo (p<0,05). During CHO diet, secretion of glucagon was smaller than it was during the LDP and PTN diets (p<0,05). On the other hand, insulin concentration was higher than during the LPD diet (p<0,05). Concentrations of insulin and C-peptide were higher for all the time points during the CHO diet (p<0,05). GLP-1 concentration was significantly higher during the high-fat diet than during the high-carbohydrate diet. During the LPD diet, the quantity of the GLP-1 was larger for all time points. The CHO diet presented lower GLP-1 level, for all the time points, than the other diets (p<0,05). The GLP-1 level (up to 120min) with the use of sitagliptin was higher with LPD and PTN diet than it was with the CHO diet. The AGL levels for all time points were higher with placebo than with sitagliptin, although not statistically significant. Conclusion: There was a reduction in glycemia with sitagliptin, independently of the diet tested, for all time points. There was a reduction in sitagliptin effect during the use of the high-carbohydrate diet

INTRODUÇÃO: A incidência de pacientes apresentando alergia à proteína do leite de vaca (APLV) após os 5 anos de idade vem crescendo. Definir se estes pacientes tolerariam a ingestão de alimento produzido com leite processado a altas temperaturas (LPAT) proporcionaria melhor qualidade de vida, definiria melhor prognóstico e possibilitaria avaliar a indicação de dessensibilização com muffin. OBJETIVO: (1) identificar quais pacientes com APLV persistente aos quatro anos poderiam tolerar a ingestão de LPAT, (2) descrever as características clínicas e laboratoriais dos grupos reativo e não reativo ao LPAT, e (3) compara-las entre os dois grupos. MÉTODOS: Estudo transversal, utilizando amostra de conveniência, incluindo todos os pacientes acompanhados no ambulatório de alergia alimentar do Instituto da Criança HCFMUSP que preenchiam os critérios de inclusão e que concordaram em realizar o TPO, entre janeiro/2013 e novembro/2014. Os pacientes foram admitidos em hospital-dia sob supervisão médica e submetidos à ingestão de um muffin contendo 2,8 gramas de proteína do leite de vaca. Foram definidos como tolerantes se não apresentassem nenhuma reação alérgica. Estes pacientes foram submetidos na sequência a novo TPO com leite de vaca in natura para excluir a tolerância ao leite de vaca. RESULTADOS: Foram realizados 38 TPO com LPAT, sendo que 30 pacientes (15 masculinos) preencheram todos os critérios de inclusão. A mediana da idade foi de 7 anos e 7 meses (4a10m -14a2m). 14 pacientes (46%) não apresentaram reação após a ingestão do muffin, sendo considerados como não reativos. A análise comparativa entre os grupos reativos e não reativos ao LPAT, não mostrou diferença estatisticamente significante quanto às características clínicas: idade (p=0,8), sexo (p=0,4), história pessoal de rinite (p=0,7), história pessoal de asma (p=0,7), história pessoal de outras alergias (p=0,6), história familiar de rinite (p=0,7), história familiar de asma (p=0,3), história familiar de outras alergias (p=0,1), relato de anafilaxia prévia (p=0,07), relato de ingestão de traços de leite previamente ao TPO (p=0,4), relato de reação alérgica no último ano antes da provocação (p=0,6), relato de anafilaxia no último ano antes do TPO (p=0,6). Não se observou diferença estatisticamente significante entre os dois grupos para IgE total (p=0,1) e eosinófilos (p=0,6). O teste de puntura para leite de vaca e frações mostrou diferença estatisticamente significante para ?-lactoalbumina (p= 0,01) e para a caseína (p = 0,004); em relação ao ImmunoCAP® apenas para a caseína (p= 0,05) essa diferença foi significante. Ao avaliar estes pacientes 1 ano após o TPO, nenhum dos 16 pacientes que foram reativos ao LPAT estava ingerindo leite de vaca, enquanto 28% dos pacientes que foram tolerantes ao LPAT estavam consumindo leite de vaca in natura sem reação (p=0,037). CONCLUSÃO: O estudo mostrou que os pacientes com APLV desta amostra brasileira apresentaram 2 diferentes fenótipos, sendo que aproximadamente metade tolerou o LPAT. Sendo assim, o TPO para LPAT deve ser considerado para pacientes com APLV, sempre sob supervisão médica e estrutura segura e adequada, pois pode contribuir para uma mudança no paradigma do seguimento destes pacientes. Teste de puntura e ImmunoCAP® para caseína podem sugerir quais pacientes estariam tolerantes ao TPO com LPAT, reforçando dados da literatura internacional / INTRODUCTION: The incidence of patients with cow\'s milk allergy (CMA) after the age of 5 has been growing. Defining whether these patients can tolerate the ingestion of food produced with baked milk without allergy reaction could provide a better quality of life, a better prognosis and would make it possible to evaluate indication of desensitization with baked milk. OBJECTIVE: (1) To identify which patients with persistent CMA at the age of four could tolerate the baked milk, (2) to describe the clinical and laboratory characteristics of the baked milk reactive group and the baked milk non-reactive group, and (3) to compare those two groups. METHODS: A cross-sectional study was conducted between January/2013 and November/2014. A convenience sample was applied, including all the patients followed in the Food Allergy Center of the Instituto da Criança HCFMUSP, who met inclusion criteria and agreed to carry out the oral food challenge (OFC). The patients were admitted to a day-hospital under medical supervision. They were submitted to a muffin intake containing 2.8 grams of cow\'s milk protein, and then classified as tolerant if they did not present any allergic reaction. To exclude cow\'s milk tolerance these patients were submitted to a new OFC with cow\'s milk in natura. RESULTS: 38 OFC with baked milk were performed, 30 patients (15 male) met all of the inclusion criteria. The median of age was 7 years and 7 months (4y10m -14y2m). 14 patients (46.6%) were considered as non-reactive because they did not present any reaction after the muffin intake. The comparative analysis between baked milk reactive group and baked milk non-reactive group did not show statistically significant difference in the clinical characteristics: age (p=0.8), gender (p=0.4), personal history of rhinitis (p=0.7), personal history of asthma (p=0.7), personal history of others allergies (p=0.6), family history of rhinitis (p=0.7), family history of asthma (p=0.3) family history of others allergies (p=0.1), previous anaphylaxis report (p=0.07), report of milk traits intake prior to OFC (p=0.4), allergic reaction in the last year before the OFC (p=0.6), anaphylaxis in the last year before the OFC (p=0.6). There was no statistically significant difference between the two groups for total IgE (p=0.1) and eosinophils (p=0.6). The Prick test for cow\'s milk and fractions showed statistically significant difference for ?-lactalbumin (p = 0.01) and for casein (p =0.004); in relation to the ImmunoCAP® only for casein (p=0.05) this difference was significant. After 1 year of the OFC, none of the patients which have been reactive to the baked milk were ingesting cow\'s milk, while 28% of the baked milk tolerant patients were consuming cow\'s milk in natura without reaction (p=0.037). CONCLUSION: The present study showed that patients with CMA of this brazilian sample presented 2 different phenotypes. Approximately half of them tolerated baked milk at age four. In conclusion, OFC for baked milk should be considered for patients with CMA, always under medical supervision and appropriate structure, so it could contribute for a change in these patients follow-up. Prick test and ImmunoCAP® for casein can suggest which patients would tolerate the OFC with baked milk, strengthening data of international literature

Metabolic syndrome (MetS) and abdominal obesity (AbOb) increase the risk of developing cardiovascular disease and diabetes. Energy restriction (ER), highprotein (PRO) intake and high-intensity interval training (HIT) can independently improve MetS and AbOb. However, ER reduces metabolically active lean body mass (LBM) in addition to body fat (BF). Purpose: To determine the effects of a 16-wk ER diet with 2 levels of PRO (15% or 25% of energy), plus HIT, on MetS risk factors, AbOb, and body composition in women. Methods: Sedentary, premenopausal women (age=35±10y) with AbOb (waist circumference [WC] ≥80cm) were randomized to a 16-wk ER diet (-300kcals/d) with 15% (15PRO; n=17) or 25% (25PRO; n=18) of energy from PRO, plus 45min/d, 3d/wk HIT and 45min/d, 2d/wk continuous moderate-intensity exercise (CME) (-200kcals/d). Diet and physical activity (PA) were assessed using 4-d weighed food and PA records, respectively; diet and exercise compliance were assessed monthly with multiple-pass 24-h recalls and weekly tracking logs. Body weight (BW), WC, DXA-assessed body composition (BF [%], BF [kg], trunk fat [kg], and LBM [kg]), blood lipids (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], triglycerides [TG]), glycemic markers (fasting plasma glucose [FPG], insulin, and homeostatic model assessment for insulin resistance [HOMA-IR], beta cell function [HOMA-%β] and insulin sensitivity [HOMA-%S]) and resting blood pressure (BP) (systolic BP [SBP]; diastolic BP [DBP]) were assessed pre/post-intervention. Repeated measures analysis of variance and two sample t-tests were used at analyze the date. Results are reported as means±standard deviations. Results: There were significant time, but not group, differences in BW (-5.1±2.6kg, p=0.0141), WC (- 7.3±3.6cm, p<0.0001), TC (-18.1±17.4mg/dL, p<0.0001), LDL-C (12.2± 16.2mg/dL, p<0.0001), TG (-25.3±56.2mg/dL, p=0.0064), insulin (-2.1±4.2mg/dL, p=0.0048), HOMA-IR (-0.2±0.5, p=0.0062), HOMA-%β (-12.1±35.2%, p=0.0497), HOMA-%S (28.5±78.4%, p=0.0357), and SBP (-3±9mmHg, p=0.214). There were significant group x time differences in DBP (15PRO=-5±8mmHg, 25PRO=- 2±8mmHg; p=0.0024). There were no time or group differences in FPG or HDLC. There were significant time, but not group, effects on changes in BW (-5.1kg± 2.6, p<0.0001), BF (-3.3±1.6%, p<0.0001), and LBM (-0.6kg±1.5, p=0.0283). The 15PRO group lost more absolute whole BF (-5.2kg vs. -3.9kg, p=0.0355) and trunk fat (-3.1kg vs. -2.2kg) vs. the 25PRO group. Conclusion: Both diets significantly improved BW, AbOb, MetS risk factors, glycemic control, and BF (%); LBM (kg) loss was similar in both groups. Compared to the 15PRO diet had significantly greater absolute BF-kg and trunk fat-kg losses. Increased PRO intake did not improve AbOb or MetS risk beyond ER and HIT/CME. The impact of HIT/CME and the greater (-1.3kg) changes in BW in the 15PRO group may have contributed significantly to the changes in absolute BF and trunk fat. More research is needed to separate the impact of HIT/CME and weight loss from the impact of PRO during ER. / Graduation date: 2013 / Access restricted to the OSU Community at author's request from March 28, 2013 - March 28, 2014

The aim of this study was to assess the dietary intake, diet-related knowledge and metabolic control in children with Type 1 Diabetes Mellitus between the ages of 6-10 years attending the Paediatric Diabetic Clinics at Grey’s Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal. This was a cross sectional observational study that was carried out in a total of 30 subjects out of a possible 35 subjects that qualified for inclusion in the study from both the Grey’s Hospital clinic (n=8) and IALCH clinic (n=22). The dietary intake was assessed in a total of 25 subjects using a three day dietary record (n=20) and a 24 hour recall of the third day of the record (n=16). Diet-related knowledge was assessed using a multiple choice questionnaire. Metabolic control was assessed using the most recent HbA1c and the mean HbA1c results over the previous 12 months from the date of data collection. Height and weight measurements were also carried out. Information on socioeconomic status and education status of the caregivers was obtained from 22 caregivers through follow-up phone calls. All measurements except for dietary intake were obtained from all subjects participating in the study. The mean percentage contribution of macronutrients to total energy was very similar to the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2002). The mean percentage contribution of macronutrients to total energy from the 3 day dietary records and the 24 hour recalls were as follows: carbohydrate (52% and 49%); sucrose (2% and 2%); protein (16% and 17%); fat (32% and 34%). Micronutrient intake was adequate for all micronutrients except for calcium and vitamin D which showed low intakes. The mean diet-related knowledge score for the sample was 67% with significantly higher scores in children older than 8 years of age. The latest HbA1c for the sample was 9.7% and the mean HbA1c over the previous 12 months from the date of data collection was 9.6%. There was a significant positive correlation between age of the participant and the latest HbA1c (r = 0.473; p=0.008) and a significant negative correlation between the education level of the caregivers and the latest HbA1c (r = - 0.578; p=0.005) and the mean HbA1c over 12 months (r = - 0.496; p=0.019). Significant differences were found between African and Indian children respectively for HbA1c, with higher values in African children. There was no correlation between BMI for age and latest HbA1c (r = 0.203, p=0.282) or mean HbA1c over 12 months (r = 0.101, p=0.594). Z score for BMI for age was also not correlated with latest HbA1c (r = 0.045, p=0.814) or mean HbA1c over 12 months (r = - 0.012, p=0.951). Children from the Grey’s Hospital Clinic were found to have higher HbA1c values (p=0.001) and lower diet-related knowledge scores as compared to the children from the IALCH Clinic (p=0.038). It should be noted that the ethnic and racial composition of the children attending these two clinics differed. In conclusion the macronutrient intake in this sample was found to be similar to the ISPAD Consensus Guidelines (2002) while calcium and vitamin D intakes were low. Overall this sample displayed good diet-related knowledge while metabolic control was found to be poor. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / O cálcio tem se mostrado útil na regulação do metabolismo energético, favorecendo a perda de peso. Visto que tanto o desmame precoce como a exposição materna à nicotina na lactação são fatores condicionantes para o desenvolvimento de obesidade, hiperleptinemia e resistência à insulina, além de outras alterações endócrinas na idade adulta, decidimos avaliar os possíveis efeitos da suplementação dietética com cálcio sobre as disfunções apresentadas pelos seguintes modelos experimentais: 1) Desmame precoce (DP): ratas lactantes foram envolvidas com atadura para interromper o acesso da prole ao leite nos 3 últimos dias da lactação. As proles das ratas controles tiveram livre acesso ao leite materno durante todo o período da lactação (21 dias). 2) Exposição materna à nicotina (N): Dois dias após o nascimento, ratas lactantes receberam implantes de minibombas osmóticas contendo solução de nicotina (6 mg/kg/dia, 14 dias) ou salina (C), nas mesmas condições. Aos 120 dias de idade, as proles de ambos os modelos de obesidade experimental receberam dieta padrão ou dieta suplementada com cálcio (10g de carbonato de cálcio/kg de ração). O sacrifício ocorreu aos 180 dias de idade. Os dados foram considerados significativos quando p<0,05. Corroborando dados anteriores do nosso grupo, as proles de ambos os modelos de programação (N e DP) apresentaram maior gordura corporal total e visceral, hiperleptinemia, resistência hipotalâmica a leptina e distúrbios na homeostase glicêmica. Além disto, verificamos que as proles N e DP também exibiram aumento dos níveis séricos de 25-hidroxivitamina D3. Todos essas alterações endócrino-metabólicas foram corrigidas pelo tratamento com suplementação com cálcio. Além disso, a prole DP aos 180 dias mostrou hiperfagia e hipertrigliceridemia, que também foram normalizados pela suplementação dietética com cálcio. A prole N apresentou hipotireoidismo, maior conteúdo de catecolaminas e maior expressão de tirosina hidroxilase (TH). A terapia com cálcio reverteu a disfunção adrenal, embora não tenha sido eficaz para normalizar a hipofunção tireoideana. Assim, a suplementação dietética com cálcio normalizou a maioria dos parâmetros da síndrome metabólica observadas nos dois modelos de plasticidade ontogenética. É possível que a redução da adiposidade central induzida pela terapia com cálcio, por si, tenha sido o principal mecanismo que resultou na melhora dos parâmetros estudados. Uma vez que a suplentação de cálcio reverteu as concentrações séricas de 25-hidroxivitamina D3 dos animais obesos, é possível que o efeito anti-obesidade do cálcio também ocorra via ação do calcitriol sobre o adipócito. / Calcium influences energy metabolism regulation and causes body weight loss. Since early weaning and maternal nicotine exposure during lactation programs for obesity, hyperleptinemia, insulin resistance and others endocrine dysfunctions, we studied the possible effect of dietary calcium supplementation on endocrine dysfunctions in these two experimental model of obesity: 1) Early Weaning (EW): lactating rats were involved with a bandage to interrupt the lactation during the last 3 days of standard lactation, and C (control) - dams whose pups had free access to milk during all lactation (21 days). 2) Maternal nicotine exposure (N): Two days after birth, it was implanted on the mothers, osmotic minipumps containing nicotine solution (6 mg/Kg/day, 14 days) or saline (C) in the same condition. At 120 days-old, all offspring received dietary calcium supplementation (10g of calcium carbonate/Kg of rat chow) or standard diet. Rats were killed at 180 days-old. Significant data were p<0.05. As expected, N and DP offspring showed higher visceral and total body fat mass, hyperleptinemia, hypothalamic leptin resistance and insulin resistance. In addition they presented higher serum 25-hydroxyvitamin D3. All these disturbances were corrected after calcium supplementation. Besides, adult EW offspring displayed hyperphagia and hypertriglyceridemia that was normalized with calcium therapy. Also, N offspring presented hypothyroidism, higher tyrosine hydroxylase expression and higher adrenal catecholamine content. Despite calcium treatment have normalized adrenal dysfunction, it did not reverse the hypothyroidism. So, dietary calcium supplementation seems to revert most of the metabolic syndrome parameters observed in our two developmental plasticity models. It is conceivable that the reduction in fat mass per se, induced by calcium therapy, is the main mechanism that improves all parameters. Because serum 25-hydroxyvitamin D3 levels were corrected by calcium supplementation in obese offspring, it is possible that the anti-obesity effect of calcium occurs through calcitriol action on the adipocyte.