Vários genes já foram descritos com a capacidade de intervir na regulação do metabolismo energético, perda de peso, além da manutenção e estabilidade da gordura corporal, atuando no controle de diferentes vias metabólicas. Estudos têm mostrado claramente que a restrição energética é capaz de alterar a expressão gênica, influenciando a perda ponderal em pessoas com obesidade após diferentes tratamentos. Devido a maior facilidade no acesso por meio de biópsia, foi optado para o presente estudo a coleta de tecido adiposo subcutâneo. Portanto, o objetivo do presente estudo foi verificar a expressão dos genes ADRB3, UCPs, PLIN1, PPARG2 em tecido adiposo subcutâneo abdominal de mulheres com obesidade grau III, antes e após intervenção dietética hipocalórica e associar com variáveis antropométricas, taxa metabólica de repouso (TMR) e oxidação de substratos. A amostra foi composta por 11 mulheres com obesidade grau III submetidas à intervenção dietética por seis semanas e 10 mulheres eutróficas. Tratou-se de um estudo longitudinal, no qual foram coletadas medidas antropométricas de peso, estatura, índice de massa corporal (IMC) e circunferência abdominal (CA), composição corporal (massa corporal magra e massa gorda) por bioimpedância elétrica, TMR por calorimetria indireta e análise de expressão gênica por PCR em tempo real. Houve diminuição significante de peso, IMC, massa corporal magra, massa gorda e TMR após intervenção dietética, porém, não verificou-se diferença estatisticamente significante quando a taxa metabólica de repouso foi ajustada pelo peso e massa corporal magra. Ao comparar os dois grupos do estudo, verificou-se diferença significante para os indicadores de peso, IMC, CA, massa corporal magra, massa gorda, TMR e oxidação de lipídio, tanto no momento pré como no pósintervenção dietética. A expressão do gene UCP3 apresentou redução significante após 6 semanas de intervenção dietética hipocalórica (p=0,004). Houve correlação positiva entre a expressão do gene UCP2 e perda de peso em quilogramas (r=0,645, p=0,032) e porcentagem (r=0,727, p=0,011) no grupo de mulheres que receberam dieta hipocalórica. Já a análise da correlação entre a expressão dos genes do estudo com a oxidação de substratos antes e após intervenção dietética, verificou-se resultados positivos dos genes UCP3, PLIN1 e PPARG2 na oxidação de carboidrato e negativos dos genes PLIN1 e PPARG2 na oxidação de lipídios. Conclui-se que a intervenção dietética hipocalórica proporciona perda de peso, diminuição de medidas antropométricas e influencia na expressão dos genes estudados em mulheres com obesidade grau III. / Several genes have been described with the ability to intervene in the regulation of energy metabolism, loss of weight and stability in addition to maintaining body fat, acting on the control of different metabolic pathways. Studies have clearly shown that caloric restriction can alter gene expression influencing the weight loss in people with obesity after different treatments. Due to easier access through biopsy was chosen for this study collecting subcutaneous adipose tissue. Therefore, the aim of this study was to investigate the expression of genes ADRB3, UCPs, PLIN1, PPARG2 in abdominal subcutaneous adipose tissue of women with obesity grade III before and after hypocaloric dietary intervention and associate with anthropometric, metabolic rate (RMR) and substrate oxidation. The sample consisted of 11 women with obesity grade III submitted to dietary intervention for six weeks and 10 healthy women. This was a longitudinal study in which anthropometric measurements were taken of weight, height, body mass index (BMI) and waist circumference (WC), body composition (lean body mass and fat mass) by bioelectrical impedance, TMR calorimetry indirect and gene expression analysis by real-time PCR. There was a significant decrease in weight, BMI, lean body mass, fat mass and TMR after dietary intervention, however, there was no statistically significant difference when the resting metabolic rate was adjusted for weight and lean body mass. When comparing the two study groups, there was difference for weight indicators, BMI, WC, lean body mass, fat mass, TMR and lipid oxidation in both the pre and post time dietary intervention. The expression of UCP3 gene showed a significant reduction after 6 weeks of hypocaloric dietary intervention (p=0,004). There was a positive correlation between the expression of UCP2 gene and loss of weight in kilograms (r=0,645, p=0,032) and percentage (r=0,727, p=0,011) in the group of women who received low-calorie diet. However, the analysis of the correlation between the expression of genes to study the oxidation of substrates before and after dietary intervention, there were positive results of UCP3 gene, PLIN1 and PPARG2 in carbohydrate oxidation and the negative PLIN1 and PPARG2 genes in lipid oxidation. We conclude that hypocaloric dietary intervention provides weight loss, reduction of anthropometric measures and influences the expression of genes studied in women with morbid obesity.

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No description available.

Background Type 2 diabetes is a common disease and the prevalence has increased in large parts of the world. In treatment of diabetes the type of diet is of great importance considering metabolic factors such as glucose level and blood lipids. Which diet that is most beneficial to avoid diabetic complications has been heavily debated in recent decades. This thesis is based on two clinical studies designed to compare the effects of different macronutrients. Methods A clinical trial was designed to compare a low-carbohydrate diet (LCD) to a low-fat diet (LFD) in treatment of patients with type 2 diabetes. Sixty-one patients at two health care centres were included and randomized to get advice to eat a LCD or a LFD. The LCD had an energy content where 50 energy percent (E%) where from fat, 20 E% from carbohydrates and 30 E% from protein. For the LFD the nutrient composition was similar to what is traditionally recommended for treatment of type 2 diabetes in Sweden. Metabolic factors, anthropometrics and questionnaires were analysed. To study postprandial effects a trial was designed to compare three different diets. Twentyone patients with type 2 diabetes were included to in randomized order test the three types of diets on separate test days. On each test day the patients were served breakfast and lunch and blood samples were taken at six times these days. Glucose, lipids and hormones were analysed. Results There were equal weight reduction in the two groups in the first trial during the two-year study period. At six month when compliance was good according to diet-records, the glucose level (HbA1c) was lowered and the HDL-cholesterol was increased in the LCD group. The inflammatory markers IL-6 and IL-1Ra were significantly lower in the LCD group than in the LFD group. At 12 months the physical function, bodily pain and general health  scores improved within the LCD group only. In the second trial the postprandial glucose and insulin levels were lower on the LCD compared to the LFD. However, the LCD resulted in a tendency to higher postprandial triglyceride levels. The Mediterranean type of diet with all energy intake at lunch resulted in a more pronounced insulin response and a glucose level at lunch similar to that of the low-fat diet. The increase-ratio of insulin correlated to the elevation of the incretin glucose-dependent insulinotropic peptide (GIP). Conclusions In the two-year study we found benefits for the LCD group regarding glucose control and insulin doses. Furthermore, only the LCD was found to improve the subclinical inflammatory state and there were some aspects of improved well-being in this group. Aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk factors  compared with the traditional LFD and this approach could constitute a treatment alternative. In the postprandial state, the LCD induced lower insulin and glucose excursions than the LFD but at the same time a tendency of higher triglycerides. The long-term significance needs to be further examined. The accumulation of caloric intake from breakfast to lunch to a single large Mediterranean-style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

Objective The main objective of this thesis was to explore the effects of diet on gastrointestinal symptoms in prostate cancer patients treated with local curative radiotherapy, by evaluating dietary intake prior to treatment (Study I), the psychometric properties of a new questionnaire on patient-reported gastrointestinal side effects (Study II), and the effect of a dietary intervention on acute and long-term gastrointestinal symptoms up to 2 years after radiotherapy completion (Study III-IV). Methods A total of 130 men with localized prostate cancer referred to dose-escalated radiotherapy (ED2 87-102 Gy, α/β=3 Gy) were recruited to a dietary intervention trial. Patients were randomized to receive either standard care plus the dietary intervention of a fibre- and lactose-restricted diet (intervention group, IG; n=64) or standard care alone (standard care group, SCG; n=66). Data on gastrointestinal symptoms and dietary intake were collected pre-treatment and at seven time points during a follow-up period of 26 months. Results Prior to treatment, grain products and milk products were major sources of energy. Unbalanced fatty acid intake and low intake of selenium were observed (Study I). Validation of the Gastrointestinal Side Effects Questionnaire (GISEQ) revealed satisfactory internal consistency, moderate concurrent validity and adequate responsiveness (Study II). There were no significant effects of the intervention on acute or long-term gastrointestinal symptoms, but a tendency towards lower prevalence and severity of bloating and diarrhoea in the IG compared to the SCG during radiotherapy. Gastrointestinal symptoms were predominantly mild, and the frequency of clinically relevant symptoms was merely a few percent. Dietary adherence in the IG was initially good, but tended to decline beyond 12 months post-radiotherapy (Study III-IV). Conclusions A fibre- and lactose-restricted diet was not superior to the habitual diet in reducing gastrointestinal symptoms in patients undergoing high-dose, small-volume radiotherapy for localized prostate cancer. The GISEQ enables assessment of patient-perceived change in symptoms, but further work is needed to strengthen its psychometric qualities. It is suggested that continued research in this area target patient categories referred to irradiation of larger pelvic volumes with a higher risk of gastrointestinal symptoms, and that dietary interventions incorporate established strategies to enhance adherence and effectiveness.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objetivo: Avaliar o efeito da intervenção dietética individualizada sobre o diagnóstico nutricional e controle metabólico em diabéticos tipo 2 sedentários Casuística e Métodos: Trata-se de um ensaio clínico controlado e prospectivo com 80 adultos, de ambos dos sexos, com Diabetes Mellitus tipo 2 divididos em GI (grupo intervenção: 40 indivíduos submetidos à intervenção dietética e a utilização de hipoglicemiante) e GC (grupo controle: 40 indivíduos submetidos à medicação hipoglicemiante). Foi realizada intervenção dietética individualizada por três meses baseando-se nas recomendações da American Diabetes Association (2002). Foram analisadas as variáveis antropométricas: massa corporal total (MCT), estatura com determinação do Índice de Massa Corporal (IMC) e perímetro da cintura (PC); as variáveis bioquímicas glicemia, colesterol total, LDL-colesterol, HDL-colesterol, triglicerídeos (TG) e hemoglobina glicada (HbA1c) e as variáveis dietéticas energia, proteínas, carboidratos, lipídeos, colesterol e fibras alimentares. Para estatística inferencial foi utilizado o Anova two-way com nível de significância de 95%. Resultados: Na análise intergrupos, o GC apresentou aumento nas variáveis: MCT (&#916;%=0,78; p=0,014), IMC (&#916;%=0,76; p=0,012), PC (&#916;%=0,75; p=0,019) enquanto que o GI apresentou redução nas variáveis: MCT (&#916;%=-3,71; p<0,001), IMC (&#916;%=-3,77; p<0,001), PC (&#916;%=-3,98; p<0,001). Na comparação da média do IR intergrupos, observou-se diferença nas variáveis: energia (p<0,001), lipídeos (p=0,012), gorduras saturadas (p<0,001); colesterol dietético (p=0,006); fibras alimentares (p=0,001); glicemia (p<0,001), colesterol total (p<0,001), LDL-colesterol (p<0,001) e HbA1c (p<0,001).Conclusão: A intervenção dietética foi eficiente em melhorar o perfil antropométrico e o controle metabólico dos diabéticos tipo 2 sedentários. / Objective: To evaluate the effect of individualized dietary intervention on nutritional diagnosis and metabolic control in sedentary subjects with type 2 diabetes. Materials and methods: This controlled clinical trial, investigated 80 adults, of both sexes, with type 2 diabetes. Patients were divided into intervention group (IG: 40 individuals subjected to intervention and hypoglycemic drug) and control group (CG: 40 individuals subjected only hypoglycemic drug). Individualized dietary intervention was conducted, for three months, based on the American Diabetes Association (2002). The anthropometric variables evaluated included: total body mass (TBM) and height to calculate body mass index (BMI), and waist circumference (WC): biochemical variables assessed were: blood glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides (TG), and glycated hemoglobin (HbA1c): In addition, the intake of energy, protein, carbohydrate, lipid, cholesterol, and dietary fibers. For inferential statistics two-way ANOVA was used with significant level of 95%.Results: In the intergroup analysis, the CG showed increase in TBM (&#916;%=0.78; p=0.014), BMI (&#916;%=0.76; p=0.012), WC (&#916;%=0.75; p=0.019); whereas IG decreased TBM (&#916;%=-3.71; p<0.001), BMI (&#916;%=-3.77; p<0.001), WC (&#916;%=-3.98; p<0.001). In comparing the mean RI intergroups, there was difference in the variables: energy/day (p<0.001), lipids (p=0.012), saturated fats (p<0.001), cholesterol (p=0.006), dietary fibers (p=0.001); blood glucose (p<0.001), total cholesterol (p<0.001), LDL-cholesterol (p<0.001), and HbA1c (p<0.001). Conclusions: The dietary intervention was efficiently the improvement the anthropometric and metabolic control of type 2 sedentary diabetics.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objetivo: Avaliar o efeito da intervenção dietética individualizada sobre o diagnóstico nutricional e controle metabólico em diabéticos tipo 2 sedentários Casuística e Métodos: Trata-se de um ensaio clínico controlado e prospectivo com 80 adultos, de ambos dos sexos, com Diabetes Mellitus tipo 2 divididos em GI (grupo intervenção: 40 indivíduos submetidos à intervenção dietética e a utilização de hipoglicemiante) e GC (grupo controle: 40 indivíduos submetidos à medicação hipoglicemiante). Foi realizada intervenção dietética individualizada por três meses baseando-se nas recomendações da American Diabetes Association (2002). Foram analisadas as variáveis antropométricas: massa corporal total (MCT), estatura com determinação do Índice de Massa Corporal (IMC) e perímetro da cintura (PC); as variáveis bioquímicas glicemia, colesterol total, LDL-colesterol, HDL-colesterol, triglicerídeos (TG) e hemoglobina glicada (HbA1c) e as variáveis dietéticas energia, proteínas, carboidratos, lipídeos, colesterol e fibras alimentares. Para estatística inferencial foi utilizado o Anova two-way com nível de significância de 95%. Resultados: Na análise intergrupos, o GC apresentou aumento nas variáveis: MCT (&#916;%=0,78; p=0,014), IMC (&#916;%=0,76; p=0,012), PC (&#916;%=0,75; p=0,019) enquanto que o GI apresentou redução nas variáveis: MCT (&#916;%=-3,71; p<0,001), IMC (&#916;%=-3,77; p<0,001), PC (&#916;%=-3,98; p<0,001). Na comparação da média do IR intergrupos, observou-se diferença nas variáveis: energia (p<0,001), lipídeos (p=0,012), gorduras saturadas (p<0,001); colesterol dietético (p=0,006); fibras alimentares (p=0,001); glicemia (p<0,001), colesterol total (p<0,001), LDL-colesterol (p<0,001) e HbA1c (p<0,001).Conclusão: A intervenção dietética foi eficiente em melhorar o perfil antropométrico e o controle metabólico dos diabéticos tipo 2 sedentários. / Objective: To evaluate the effect of individualized dietary intervention on nutritional diagnosis and metabolic control in sedentary subjects with type 2 diabetes. Materials and methods: This controlled clinical trial, investigated 80 adults, of both sexes, with type 2 diabetes. Patients were divided into intervention group (IG: 40 individuals subjected to intervention and hypoglycemic drug) and control group (CG: 40 individuals subjected only hypoglycemic drug). Individualized dietary intervention was conducted, for three months, based on the American Diabetes Association (2002). The anthropometric variables evaluated included: total body mass (TBM) and height to calculate body mass index (BMI), and waist circumference (WC): biochemical variables assessed were: blood glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides (TG), and glycated hemoglobin (HbA1c): In addition, the intake of energy, protein, carbohydrate, lipid, cholesterol, and dietary fibers. For inferential statistics two-way ANOVA was used with significant level of 95%.Results: In the intergroup analysis, the CG showed increase in TBM (&#916;%=0.78; p=0.014), BMI (&#916;%=0.76; p=0.012), WC (&#916;%=0.75; p=0.019); whereas IG decreased TBM (&#916;%=-3.71; p<0.001), BMI (&#916;%=-3.77; p<0.001), WC (&#916;%=-3.98; p<0.001). In comparing the mean RI intergroups, there was difference in the variables: energy/day (p<0.001), lipids (p=0.012), saturated fats (p<0.001), cholesterol (p=0.006), dietary fibers (p=0.001); blood glucose (p<0.001), total cholesterol (p<0.001), LDL-cholesterol (p<0.001), and HbA1c (p<0.001). Conclusions: The dietary intervention was efficiently the improvement the anthropometric and metabolic control of type 2 sedentary diabetics.

No description available.

Adipocytokines released by the adipose tissue play an important role in the regulation of immune and inflammatory responses. In obesity their production is dysregulated, which is one of the major factors contributing to the onset of a chronic low-grade systemic inflammation representing a risk factor for the progression of other diseases, such as atherosclerosis or type-2 diabetes. The main goal of this thesis was to analyze the secretion of selected adipocytokines (adiponectin, IL6 and MCP1) by in-vitro differentiated adipocytes, isolated from the adipose tissue prior to and after a dietary intervention, and this under basal conditions and during stimulated lipolysis. In case of adiponectin, the secretion of its isoforms was analyzed too. The concentration of adiponectin, IL6 and MCP1 was determined by the ELISA method, the Western Blot method was used to determine the distribution of the adiponectin isoforms. The thesis also concentrates on the gene expression of ATF3, ATF4 and HSPA5, factors engaged in the ER stress in the course of the differentiation of adipocytes. The changes in the gene expression were measured by the quantitative Real Time PCR method. At the same time the development of the endoplasmic reticulum (ER) in the course of adipogenesis was monitored by indirect...

La grossesse est une période de la vie d’une femme qui s’accompagne d’une augmentation des besoins nutritionnels dont la satisfaction est nécessaire à la bonne santé de la mère et de l’enfant à naître. Durant cette période, les femmes seraient plus enclines à l’adoption de pratiques alimentaires plus saines. L’objectif de ce travail de thèse était d’étudier ces différents aspects de la nutrition pendant la grossesse puis d’élaborer et d’évaluer une méthode de conseils alimentaires personnalisés et pas-à-pas afin d’améliorer l’adéquation nutritionnelle des femmes enceintes en France. Un indice de qualité nutritionnelle de l’alimentation existant : le PANDiet, a été adapté à la période de la grossesse en tenant compte des références nutritionnelles spécifiquement définies pour cette période. Il a été montré qu’en l’absence de modifications qualitatives du régime en début de grossesse, l’adéquation nutritionnelle ne pouvait pas être maintenue. Trois types de conseils alimentaires personnalisés ont alors été élaborés et se sont révélés efficaces pour améliorer la qualité nutritionnelle de l’alimentation. Cependant, plus les conseils étaient efficaces moins ils étaient acceptables par les femmes enceintes. Un compromis a donc été trouvé pour sélectionner les deux types de conseils les plus acceptables par les femmes enceintes tout en étant efficaces pour améliorer la qualité nutritionnelle de leur alimentation. Ces deux types de conseils alimentaires personnalisés, fondés respectivement sur des modifications des quantités consommées d’aliments et sur des substitutions au sein du même sous-groupe d’aliments, ont été proposés à des femmes enceintes françaises lors d’un essai randomisé contrôlé. Par ailleurs, des données qualitatives, ont permis d’identifier que ces dernières étaient à la recherche d’informations positives et crédibles concernant l’alimentation pour contribuer au bien-être de leur bébé mais aussi au leur. Durant l’essai randomisé contrôlé, l’approche proposant des recommandations alimentaires génériques associées aux conseils alimentaires personnalisés, générés pas-à-pas par notre algorithme, s’est révélée plus efficace pour améliorer la qualité nutritionnelle de l’alimentation de femmes enceintes qu’une approche proposant uniquement les recommandations génériques. Par ailleurs, selon l’étude qualitative menée auprès de participantes à l’essai randomisé contrôlé il apparaît que proposer des conseils alimentaires pendant la grossesse permet de résoudre la cacophonie informationnelle. / Pregnancy is a specific period in life characterized by an increase in nutrient needs that should be met for the health of both the mother and her baby. During this period, women would be keener on adopting healthier dietary practices. The objective of this thesis was to study these different aspects of nutrition during pregnancy and to design and evaluate a tailored, stepwise dietary advice method which aims to improve the nutrient adequacy of the diet of French pregnant women. The PANDiet score, a diet quality index, has been adapted to pregnancy by using the nutrient requirements established for this period. It has been shown that the absence of qualitative changes in a woman’s diet in the beginning of pregnancy prevented the maintenance of the nutrient adequacy. Three types of tailored dietary changes were then designed. They proved to be efficient in improving the nutrient adequacy of the diet. The more efficient the type of dietary changes was, the less acceptable it was by pregnant women. Thus, a trade-off has been considered to select the two types of dietary changes that were the most acceptable by pregnant women while showing efficiency in the improvement of the nutrient adequacy of their diet. These two types of tailored dietary changes, which respectively involved modifications of the amount consumed of foods and substitutions of foods within the same food subgroup, have been proposed to French pregnant women during a randomized controlled trial. Furthermore, qualitative data revealed that pregnant women sought for positive and trustworthy information about nutrition-related in order to contribute towards the well-being of both their baby and themselves. In the randomized controlled trial, the approach proposing tailored dietary advice, generated in a stepwise process, in addition to generic dietary guidelines proved to be more efficient in improving the nutrient adequacy of the diet of pregnant women than the approach using only generic dietary guidelines. Furthermore, according to semi-directive interviews led with some women included in the randomized controlled trial, it appeared that dietary counseling during pregnancy resulted in solving the confusion related to nutrition issues.