Submitted by MARCOS LEANDRO TEIXEIRA DE OLIVEIRA (marcosteixeira@ufv.br) on 2018-08-14T18:54:20Z No. of bitstreams: 1 texto completo.pdf: 1093335 bytes, checksum: 662a9948cc7097cfc6db182da9f1540a (MD5) / Made available in DSpace on 2018-08-14T18:54:20Z (GMT). No. of bitstreams: 1 texto completo.pdf: 1093335 bytes, checksum: 662a9948cc7097cfc6db182da9f1540a (MD5) Previous issue date: 2016-12-22 / INTRODUÇÃO: Sugere-se que o consumo de laticínios desnatados e de cálcio (Ca) dietético possa favorecer o controle glicêmico e do peso corporal, atuando na prevenção e tratamento do diabetes mellitus tipo 2 (DM2). Entretanto, não encontramos na literatura nenhum estudo em que se avaliou o efeito do aumento do consumo de leite desnatado no controle metabólico de individíduos com T2DM. OBJETIVO: Avaliar os efeitos do aumento da ingestão de leite desnatado no peso e composição corporal, nos componentes da síndrome metabólica e nas medidas de risco cardiometabólico em indivíduos portadores de DM2. MÉTODOS: Foram realizados dois ensaios clínicos randomizados com delineamento cruzado (N=14) (Artigos 1 e 2) e um com delineamento paralelo (N=36) (Article3). Indivíduos com DM2 e baixa ingestão habitual de Ca (< 600 mg/dia) participaram de duas fases com 12 semanas cada: rica em Ca proveniente de leite desnatado (MD) ou controle pobre em Ca (CD). Nos estudos cruzados (Artigos 1 e 2), as fases foram separadas por um intervalo de 8 semanas. Durante a intervenção, os participantes ingeriram diariamente em laboratório uma bebida contendo 700 mg de Ca proveniente de leite desnatado (MD) (equivalente a aproximadamente 3 porções de leite desnatado) ou 6.4 mg (CD) de Ca no desjejum. Além disso, foram prescritas dietas com restrição energética (-500 kcal/d) contendo 800 mg de Ca dietético/dia. RESULTADOS: Artigo 1: Fat-free milk enhances weight loss, improves body composition, and promotes glycemic control in adults with type 2 diabetes mellitus – a randomized clinical trial. O consumo de Ca foi equivalente a 1,200 mg/dia durante a fase MD e 525 mg/dia durante a fase CD. Observou-se maior redução do peso corporal, gordura corporal, perímetro da cintura (PC) e relação cintura-quadril após a fase MD. As concentrações séricas de 25- hidroxivitamina D e HOMA2-B% aumentaram, enquanto as concentrações séricas de ácido úrico, paratormônio e hemoglobina glicada reduziram após a fase MD. Concluímos que o consumo de cerca de 3 porções de leite desnatado (700 mg de Ca adicional) exacerbou a perda de peso, melhorou a composição corporal e promoveu maior controle glicêmico em indivíduos diabéticos tipo 2 com baixo consumo habitual de Ca. Artigo 2: Increased fat-free milk consumption, metabolic syndrome, and cardiometabolic outcomes in adults with type 2 diabetes mellitus. Houve maior redução do PC, pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e índice do produto da acumulação lipídica (LAP) após a fase MD em relação à fase CD. Houve aumento da razão HDL (lipoproteína de alta densidade)/LDL (lipoproteína de baixa densidade) e redução do colesterol total, LDL-c, PAS, PAD e índice LAP apenas na fase MD. Concluímos que o consumo de cerca de 3 porções de leite desnatado (700 mg de Ca adicional) reduziu alguns componentes da síndrome metabólica e medidas cardiometabólicas em adultos diabéticos. Artigo 3: Dietary calcium from dairy, body composition and glycemic control in patients with type 2 diabetes: a parallel group randomized clinical trial. O peso corporal, índice de massa corporal (IMC), PC, relação cintura-quadril e gordura corporal reduziram no grupo MD comparados ao início do estudo. Houve maior redução do PC no grupo MD em relação ao grupo CD. A glicemia de jejum reduziu no grupo CD. Ambos os grupos apresentaram redução na hemoglobina glicada. O consumo de dieta hipocalórica rica em Ca durante 12 semanas foi efetivo na redução da adiposidade abdominal, mas não promoveu efeito adicional no controle glicêmico de pacientes com DM2. CONCLUSÃO: O aumento do consumo de leite desnatado (700 mg de Ca adicional por dia) parece contribuir o controle metabólico de portadores de DM2. / INTRODUCTION: It has been suggested that the consumption of fat-free dairy and of dietary calcium (Ca) seem to act on glycemic and body weight control, favoring type 2 diabetes mellitus (T2DM) prevention and treatment. However, to our knowledge, the effects of increased fat-free milk consumption on metabolic control of individuals with T2DM have not been assessed in any other study. OBJECTIVE: To evaluate the effects of fat-free milk consumption on body weight, body composition, metabolic syndrome (MetS) components, and cardiometabolic outcomes in aldults with T2DM. METHODS: Two randomized crossover clinical trials (N = 14) (Articles 1 and 2), and one randomized parallel design clinical trial (N = 36) (Article 3) were performed. Subjects with T2DM and low habitual Ca consumption (< 600 mg/d) participated of two 12-week experimental phases: high-Ca fat-free milk (MD) or low-Ca control diet (CD). In the crossover studies (Articles 1 and 2) there was an 8-week washout between experimental phases. Subjects daily consumed a breakfast shake containing 700 mg of Ca from fat-free milk (MD) (~3 servings of fat-free milk) or 6.4 mg of Ca (CD). Energy restricted diets (-500 kcal/d) containing 800 mg of Ca/d were prescribed. RESULTS: Article 1: Fat-free milk enhances weight loss, improves body composition, and promotes glycemic control in adults with type 2 diabetes mellitus – a randomized clinical trial - Dietary records data indicated the consumption of 1,200 mg of Ca/d during MD and of 525 mg of Ca/d during CD. There was a greater reduction in body weight, body fat mass, waist circumference (WC) and waist-hip ratio after MD. Serum 25- hydoxyvitamin D and HOMA2-B% increased and serum uric acid, parathormone, and glycated hemoglobin concentrations reduced after MD. The consumption of approximately 3 servings of fat-free milk (700 mg of additional Ca) enhanced weight loss, improved body composition, and promoted glycemia control in individuals with T2DM and low habitual Ca consumption. Article 2: Increased fat-free milk consumption, metabolic syndrome, and cardiometabolic outcomes in adults with type 2 diabetes mellitus. There was a greater reduction in WC, systolic (SBP) and diastolic blood pressure (DBP), and lipid accumulation product (LAP) index after MD compared with CD. Only MD phase increased HDL (high-density lipoprotein cholesterol) / LDL (low- density lipoprotein cholesterol) ratio and decreased total cholesterol, LDL-c, SBP and DBP, and LAP index. We conclude that the consumption of approximately 3 servings of fat-free milk (700 mg of additional Ca) decreased some MetS components and cardiometabolic measures adults with T2DM. Article 3: Dietary calcium from dairy, body composition and glycemic control in patients with type 2 diabetes: a parallel group randomized clinical trial. MD group final anthropometric measures (body weight, body mass index (BMI), WC, waist-hip ratio, and fat mass) decreased compared to baseline. MD group showed greater decrease in WC compared to CD group. Fasting glucose decreased in CD group. Both groups reduced glycated hemoglobin. Consumption of high-Ca diet from fat-free milk for 12 weeks was effective in reducing abdominal adiposity, but provided no additional effect on glycemic control in patients with T2DM. CONCLUSION: The increased consumption of fat-free milk (700 mg of additional Ca/d) seems to improve metabolic control of T2DM subjects.