abstract: The effects of aging on muscular efficiency are controversial. Proponents for increased efficiency suggest that age-related changes in muscle enhance efficiency in senescence. Exercise study results are mixed due to varying modalities, ages, and efficiency calculations. The present study attempted to address oxygen uptake, caloric expenditure, walking economy, and gross/net cycling efficiency in young (18-59 years old) and older (60-81 years old) adults (N=444). Walking was performed at three miles per hour by 86 young (mean = 29.60, standard deviation (SD) = 10.50 years old) and 121 older adults (mean = 66.80, SD = 4.50 years old). Cycling at 50 watts (60-70 revolutions per minute) was performed by 116 young (mean= 29.00, SD= 10.00 years old) and 121 older adults (m = 67.10 SD = 4.50 years old). Steady-state sub-maximal gross/net oxygen uptake and caloric expenditures from each activity and rest were analyzed. Net walking economy was represented by net caloric expenditure (kilocalories/kilogram/min). Cycling measures included percent gross/net cycling efficiency (kilo-calorie derived). Linear regressions were used to assess each measure as a function of age. Differences in age group means were assessed using independent t-tests for each modality (alpha = 0.05). No significant differences in mean oxygen uptake nor walking economy were found between young and older walkers (p>0.05). Older adults performing cycle ergometry demonstrated lower gross/net oxygen uptakes and lower gross caloric expenditures (p< 0.05). / Dissertation/Thesis / Masters Thesis Exercise and Wellness 2014

Sabe-se que as diferentes respostas metabólicas advindas da realização de um exercício físico são influenciadas por fatores como idade, gênero, estado nutricional, assim como pelas próprias variáveis do exercício físico, em especial a intensidade e duração. Embora estas últimas variáveis sejam bastante estudadas, há uma lacuna na literatura sobre o comportamento do consumo de oxigênio (\'VO IND.2\'), gasto energético e lactacidemia quando diferentes exercícios são realizados na intensidade do limiar anaeróbio (AT). Além disso, não há relatos sobre uma possível fase estável do lactato em exercício resistido. Desta forma, a proposta deste estudo foi primeiramente verificar a possibilidade de identificação do AT em oito exercícios resistidos e posteriormente analisar o \'VO IND.2\', gasto energético e lactacidemia durante e após os exercícios em esteira, circuito, circuito/esteira e esteira/circuito, ambos realizados na intensidade do AT e com similar duração de execução de movimento. Para tanto, foram avaliados oito indivíduos do gênero feminino, saudáveis e fisicamente ativas, submetidas aos testes de determinação de uma repetição máxima (1RM), identificação do AT em oito exercícios resistidos, identificação do AT no exercício em esteira e realização dos protocolos de exercícios em esteira, circuito, circuito/esteira e esteira/circuito. Os resultados demonstraram a possibilidade de identificação do AT em todos os exercícios propostos. Durante o exercício, as variáveis metabólicas (\'VO IND.2\' e gasto energético) no exercício em esteira foram significativamente maiores quando comparadas aos exercícios em circuito, circuito/esteira e esteira/circuito. Nenhuma diferença significante foi constatada entre os protocolos circuito/esteira e esteira/circuito, para ambas as variáveis mencionadas. Já o exercício em circuito mostrou ser estatisticamente menor que os demais protocolos. No componente rápido do excess postexercise oxygen consumption (EPOC), o \'VO IND.2\' e gasto energético no exercício em esteira foram significativamente diferentes dos exercícios em circuito e em esteira/circuito. O exercício em circuito mostrou ser estatisticamente diferente do circuito/esteira, assim como também foi verificada uma diferença entre os protocolos mistos, para \'VO IND.2\' e gasto energético (p < 0,05). A duração e magnitude do \'VO IND.2\' no componente lento do EPOC não foram estatisticamente diferentes entre os protocolos, porém uma diferença foi constatada (p < 0,05) na magnitude da produção calórica entre os protocolos esteira e esteira/circuito, neste mesmo período de tempo. Nossos resultados não encontraram nenhuma diferença na duração total do EPOC entre os protocolos estudados. Ao computar o gasto energético total da sessão, somente o exercício em circuito apresentou um dispêndio significativamente maior em relação às calorias dispendidas apenas durante a realização deste exercício. Em relação à lactacidemia, foi possível identificar uma fase estável do lactato nos exercícios em esteira e em circuito. Conclusões: a realização de diferentes tipos de exercício exerce influência sobre o \'VO IND.2\' e gasto energético durante e após o exercício, ao passo que a ordem de execução dos mesmos em uma única sessão, para essas mesmas respostas metabólicas, só é influenciada no período pós-exercício. A duração total do EPOC independe da realização de diferentes tipos de exercícios, assim como da ordem de execução. Além disso, há a existência de uma fase estável do lactato em exercício resistido, quando realizado em forma de circuito. / It\'s known that differents metabolic responses that come from the practice of physical exercises are influenced by factors, such as age, gender, nutritional condition, as well as by their own exercise variable, in especially the intensity and duration. Although the latter variables are well studied, there is a gap in the literature about the behavior of oxygen consumption (\'VO IND.2\'), the energy expenditure and \"lactacidemia\" when different exercises are performed in the intensity of the anaerobic threshold (AT). In addition, there is no account about a possible stable phase of the lactate in a resistance exercise. This way, the proposal of this study was first to verify the possibility of identification of the AT in eight resistance exercises and then to analyze the \'VO IND.2\', the energy expenditure and the \"lactacidemia\" during and after the exercises at a treadmill, at a circuit, at a circuit/treadmill and at a treadmill/circuit, all done in the intensity of the AT and with similar duration of the movement execution. For this, eight female participants, healthy and physically active, were evaluated, submitted to tests of determination of a maximum repetition (1RM), identification of the AT in eight resistance exercises, identification of the AT in a treadmill exercise and the development of the protocols of exercise at a treadmill, at a circuit, at a circuit/treadmill and at a treadmill/circuit. The results demonstrated the possibility of identification of AT in all exercises. During exercise, the metabolic variables (\'VO IND.2\' and energy expenditure) in the exercise at the treadmill were significantly higher when compared to the exercises in circuit, circuit/treadmill and treadmill/circuit. No significant differences were found between the protocols circuit/treadmill and treadmill/circuit, for both variables mentioned. When it concerns the exercise in the circuit, it showed to be statistically lower than the other protocols. In the fast component of the excess postexercise oxygen consumption (EPOC), the \'VO IND.2\' and the energy expenditure at the treadmill exercise were significantly different when compared to the exercises at the circuit and at the treadmill/circuit. The exercise at the circuit was statistically different from the circuit/treadmill, and it was also verified a difference between the mixed protocols for the \'VO IND.2\' and the energy expenditure (p < 0,05). The duration and the magnitude of the \'VO IND.2\' in the slow component of the EPOC were not statistically different between the protocols, but there was a difference (p < 0,05) in the magnitude of the calorific production between the treadmill and the treadmill/circuit protocols. Our results didn\'t find any difference in the total duration of the EPOC in the protocols analyzed. When determining the total energy expenditure of the session, only the exercise at the circuit showed a significantly bigger energy expenditure in comparison with the expended calories just during the exercise. Concerning the \"lactacidemia\", it was possible to identify a stable phase of the lactate in the exercises at the treadmill and at the circuit. Conclusions: the performance of different types of exercise influences the \'VO IND.2\' and the energy expenditure during and after the exercise, while the order of the exercise practice in a single session, concerning the same metabolic answers, is just influenced in the period after the exercise. However, the total duration of the EPOC has nothing to do with the development of the different kinds of exercise, nor with the practice order. Besides, there is existence of a stable phase of the lactate in the resistance exercise, when performed in circuit.

Objetivo: O objetivo do presente estudo foi determinar o Gasto Energético Basal (GEB) através da Calorimetria Indireta (CI) em pacientes com carcinoma epidermóide de esôfago (CEE). Métodos: Estudo transversal com 30 pacientes internados com diagnóstico de CEE submetidos à CI antes de iniciar a terapia oncológica. A avaliação nutricional foi realizada a partir de parâmetros antropométricos (Índice de Massa Corporal, Circunferência do Braço, Dobra Cutânea Triciptal, Circunferência Muscular do Braço e Percentual de Perda de Peso), parâmetros bioquímicos (albumina, transferrina e Proteína C Reativa) e bioimpedância tetrapolar. Além disso, foram determinados a capacidade pulmonar e o estadiamento clínico. A CI foi realizada depois de uma noite de jejum. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: A média do GEB pela CI foi de 1.421,8 ± 348,2 kcal e pela Equação de Harris e Benedict (EHB) de 1.310,6 ± 215,1 kcal. A EHB subestimou o GEB comparado com a CI (p= 0,014). Foi encontrada diferença significativa no GEB entre os pacientes desnutridos (1.181,7 ± 278,1 kcal) e bem nutridos (1.509,1 ± 334,1 kcal) pelo IMC (p=0,020). Pelo %PP não foram encontradas diferenças significativas entre o GEB dos pacientes com PP significativa e não significativa (p=0,526). Entre os pacientes que apresentavam o percentual de massa magra abaixo do esperado, foi encontrada GEB de 1.408,9 ± 364,3 kcal, enquanto que os que tinham o percentual de massa magra adequado o GEB foi de 1.538,4 ± 97,5 kcal (p=0,550). Não houve associação entre o GEB pela CI e o estadiamento (p=0,255) e o Índice de Tiffeneau (p=0,946). Na associação entre os exames laboratoriais e o GEB pela CI, não foram encontradas associações significativas entre os que tinham alteração e os que não a tinham (p= 0,364, 0,309 e 0,780, respectivamente). Conclusões: O GEB de pacientes com CEE foi subestimado pela EHB sem fator injúria e superestimado pela EHB com fator injúria de 1,3 quando comparado ao GEB medido pela CI. / Expenditure (BEE) of patients with squamous cell carcinoma (SCC) of the esophagus by indirect calorimetry (IC). Methods: Cross-sectional study involving 30 patients admitted with a diagnosis of SCC who underwent IC before starting cancer therapy. Nutritional assessment was conducted using anthropometric parameters (body mass index, arm circumference, triceps skinfold thickness, arm muscle circumference and percentage weight loss), biochemical parameters (albumin, transferrin and Creactive protein) and tetrapolar bioimpedance analysis. Additionally, lung capacity and clinical staging were determined. IC was carried out after overnight fasting. P values <0.05 were considered statistically significant. Results: The mean of the BEE for IC and Harris-Benedict equation were 1421.8 ± 348.2 kcal/day and 1310.6 ± 215.1 kcal/day, respectively. The HBE underestimated the BEE when compared with IC (p=0.014). A significant difference was found in the BEE between malnourished (1181.7 ± 278.1 kcal/day) and well-nourished (1509.1 ± 334.1 kcal/day) patients by BMI (p=0.020). In terms of percentage weight loss, no significant difference was found in BEE between patients with significant or non-significant weight loss (p=0.526). BEE for patients presenting with a lower than expected lean body mass was 1408.9 ± 364.3 kcal/day, whereas for those with an adequate lean body mass it was 1538.4 ± 97.5 kcal/day (p=0.550). No association was found between BEE measured by IC and clinical staging (p=0.255) or the Tiffeneau Index (p=0.946). Additionally, when comparing laboratory examinations with BEE measured by IC, no significant association was found between those with and those without alterations (p=0.364, 0.309 and 0.780 respectively). Conclusion: When compared to BEE measured by IC of patients with SCC, it was found that the HBE without injury factor underestimated, whereas the HBE with an injury factor of 1.3 overestimated BEE.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Context: The GH/IGF-I axis has important interactions with the alimentary system and the balance between estimated energy intake (EEI) and estimated energy requirement (EER). Reduced EEI has been described in adult onset acquired GH deficiency, associated to other pituitary deficits. Individuals with isolated growth hormone deficiency (IGHD) due to a homozygous mutation (c.57+1G→A) in the GHRH receptor gene, living in Itabaianinha County in Brazil Northeastern, have abdominal obesity, without insulin resistance. EEI and EER are unknown in this unique cohort. Objectives: To evaluate EEI and EER in this IGHD cohort. Methods: Cross-sectional study of 24 IGHD individuals and 23 adult controls from the same region, matched for age and gender. IEE was evaluated by three food 24-hour recalls and EER by the equation of the Dietary Reference Intakes. Fat mass was assessed by DXA. Results: Both EEI and EER in absolute values were lower in IGHD. However, when corrected by body weight, EEI was higher in IGHD (p=0.005). IGHD individuals consume in percentage more proteins (p<0.0001), less carbohydrates (p=0.013) and equal lipids in comparison to controls. Conclusions: The higher estimated energy intake per body weight indicates a possible increase of orexigenic mechanisms in IGHD individuals, ensuring greater caloric intake, which would have adaptive advantages for small sized individuals, in environment with limited access to food. IGHD individuals seem have a healthier dietary pattern than CO. / Introdução: O eixo do hormônio de crecimento (GH) / fator de crescimento semelhante a isulina tipo I (IGF-I) tem interações importantes no consumo alimentar e no equilíbrio entre a ingestão energértica estimada (IEE) e a necessidade energética estimada (NEE). A baixa IEE é comum na deficiência de GH de início na idade adulta, associada a outras deficiências adquiridas da pituitária. Indivíduos com deficiência isolada de GH (DIGH), devido à mutação homozigótica c.57 + 1G → A no gene do receptor do GHRH, residentes em Itabaianinha no Nordeste do Brasil, apresentam obesidade abdominal, sem resistência à insulina. Nesta coorte a IEE e NEE são desconhecidos. Objetivos: Avaliar IEE e NEE neste modelo de DIGH. Casuística e Métodos: Estudo transversal em 24 indivíduos com DIGH e 23 controles adultos normais da mesma região, pareados por idade, gênero e percentual de massa gorda. Foi avaliada IEE por três recordatórios alimentares de 24 horas e NEE pela equação das Dietary Reference Intakes. A massa gorda foi avaliada por absorciometria de raios X de dupla energia (DXA). Resultados: Em valores absolutos a IEE e NEE foram menores nos indivíduos com DIGH. No entanto, quando corrigido pelo peso corporal, IEE foi maior no grupo com DIGH (p = 0,005). Os Indívuos com DIGH consomem em valores percentuais mais proteínas (p<0,0001), menos carboidratos (p = 0,013) e mesma quantidade de lípideos em comparação aos controles. Conclusões: A maior ingestão calórica por peso corporal indica um possível aumento dos mecanismos orexígenos nos indivíduos com DIGH, garantindo uma maior ingestão calórica, o que propiciaria vantagem adaptativa para pessoas de tamanho reduzido em um ambiente com acesso limitado a alimentos. Indivíduos com DIGH parecem ter um hábito alimentar mais saudável que os controles.

The rupture of an aneurysm in subarachnoid hemorrhage (SAH) is a dramatic event causing a severe impact on the brain and a transient or permanent ischemic condition. Several types of responses to meet the challenges of SAH have been found in the acute phase, including activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, elevated levels of brain natriuretic peptide (BNP), and disturbances in cerebral and systemic metabolism. Cerebral metabolism and the endocrine stress response in the ultra-early phase was investigated in a novel porcine model of SAH in which autologous blood was injected to the anterior skull base. Early activation of the HPA axis was found with rapid elevation of adrenocorticotrophic hormone, cortisol and aldosterone. The peak values of these hormones were early and may be impossible to catch in patients. There were indications of a sympathetic nervous response with excretion of catecholamines in urine as well as plasma chromogranin-A elevation. Cerebral microdialysis suggested immediate substrate failure followed by hypermetabolism of glucose. The animal model seems suited for further studies of aneurysmal SAH. NT-proBNP was investigated in 156 patients with SAH, there was a dynamic course with increasing levels during the first 4 days of the disease. Factors predicting high NT-proBNP load included female sex, high age, high Troponin-I at admission, angiographic finding of an aneurysm and worse clinical condition at admission. High levels of NT-proBNP were correlated to factors indicating a more severe disease, suggesting the initial injury in aneurysmal SAH is an important factor in predicting high NT-proBNP during the acute stage of the disease. Measurements with indirect calorimetry were performed daily during the first week after SAH on 32 patients with SAH. There was a dynamic course with increasing energy expenditure (EE) the first week after SAH. Comparisons with three predictive equations indicated that measured EE generally is higher than predicted, but considerable variation exists within and between patients, indicating that prediction of EE in SAH is difficult. Altogether, the studies demonstrate a complicated response in acute SAH that needs to be further studied to increase possibility of good outcome in SAH patients.

There is a high prevalence in malnutrition among traumatic brain injury (TBI) due to the hypermetabolism and hypercatabolism which develop post injury. Traumatic brain injury patients are different, even among themselves, in their energy requirements and response to nutritional therapy. This implies that there are other factors that affect the energy intake of these patients and enhance the incidence of malnutrition. This dissertation study examines the nutritional status of TBI patients upon admission to the intensive care unit (ICU) and during their hospital stay to describe baseline status, detect changes in nutritional status over 7 days, and identify the factors affecting the adequacy of energy intake and the change in nutritional status as a consequence. Anthropometric measurements, biomedical measurements, measures of severity of illness, daily health status, level of brain injury severity, and other data were collected from the medical records of 50 patients, who were ≥ 18 years old, mechanically ventilated in the first 24 hours of ICU admission, and had a Glasgow Coma Scale score between 3-12. These data were used to examine the previous relationships. Although there was no statistically significant change found in body mass index and weight, there was a significant change detected in other nutritional markers, including hemoglobin, albumin, and total lymphocyte levels over the 7 days of ICU and hospital stay. No significant relationship was found between the adequacy of energy intake and total prescribed energy, severity of illness, level of brain injury severity, daily health status, patient age, intracranial pressure, or time of feeding initiation. Findings may be used to develop and test interventions to improve nutritional status during the acute phase of TBI. This will lay a foundation for health care providers, including nurses, to establish standards for practice and nutrition protocols to assure optimal nutrition assessment and intervention in a timely manner.

Obezita představuje ve vyspělých zemích závažný zdravotní problém a hlavní rizikový faktor rozvoje kardiovaskulárních onemocnění, cukrovky 2. typu, nemocí pohybového aparátu a některých nádorových onemocnění. Je také provázena řadou komplikací a výrazně zhoršuje kvalitu života. 27 pacientů, kteří byli hospitalizováni za účelem redukce hmotnosti na oddělení D3 III. interní kliniky Všeobecné fakultní nemocnice v Praze v období ledna až počátku dubna roku 2017 byli sledováni z hlediska výskytu komorbidit a příjmu a výdeje energie za použití aplikace kaloricketabulky.cz, portálu casprozdravi.cz a krokoměrů Garmin Vivofit. Byla hodnocena vhodnost bioimpedanční metody pro sledování změn složení těla pacientů během redukčních pobytů za použití přístroje InBody S10. V souladu s teorií se ve sledované skupině pacientů vyskytovala v důsledku extrémní obezity celá řada komplikací. Diagnostická kritéria pro metabolický syndrom splňovalo 23 (85%) pacientů. Rozdílné hodnoty obsahu energie a jednotlivých živin v aplikacích kaloricketabulky.cz a Nutriservis jsou příčinou průměrného denního rozdílu 717 kJ mezi záznamy pacientů a nemocničním rozpisem. Průměrně pacienti ušli denně 4713 kroků. Pacienti průměrně zredukovali hmotnost o 7,6 kg (SD ±3,54). Bioimpedanční metoda vykazuje příliš vysokou variabilitu a není...

Introduction: Weight loss programs are based on inducing a negative energy balance by decreasing energy intake while increasing energy expenditure. Energy needs of obese patients are difficult to determine. The value of resting energy expenditure, as the largest component of the energy needs, is usually calculated to asses an adequate energy intake for obese patient. In clinical practice, predictive equations are most commonly used for this purpose, because of their simplicity, although many clinical studies have shown that in obese individuals they may generate errors large enough to impact the outcome of treatment. It leads to the prescription of an inadequate diet that does not meet the criterion of long-term sustainability. Objective: The aim of the thesis is to compare the values of resting energy expenditure (REE) measured by indirect calorimetry with values calculated with Harris-Benedict predictive equation in a selected group of obese individuals. Methods: The sample includes 38 subjects, 28 women and 10 men, patients of the General University Hospital in Prague. The average age is 48 ± 11,71 years, the mean BMI is 42,88 ± 9,09 kg/m2 . For each subject, resting energy expenditure was measured by indirect calorimetry and calculated by the Harris-Benedict predictive equation. Indirect...

Being able to effectively match energy intake to energy expenditure (EE) is an important aspect in preventing weight re-gain in the post-obese. Although it is generally agreed upon that resting EE decreases concomitantly with weight loss, there is no set standard comparing the deviations with differing weight loss protocols and additionally, controversy remains as to whether this decrease is greater than can predicted. In order to address these issues 2977 subjects were analyzed using a systematic review and the differences of both the protocol and length of various interventions in addition to sex were compared. Next, data was selected from this systematic review and 815 subjects were analyzed for weight loss-induced changes in resting EE, FM and FFM. Another subgroup of studies (n = 1450) was analyzed and compared against the Harris-Benedict prediction equation to determine whether the changes in resting EE were greater than what was expected. Finally, in order to determine which factors may be involved in regulating changes in resting EE during weight loss, a secondary analysis was performed on 28 post-menopausal women (age= 50.4 ± 2.0 yrs; BMI= 32.4 ± 5.2 kg/m²) who were submitted to a 6-month caloric restriction. Body composition (DXA), resting EE (indirect calorimetry), physical activity EE (PAEE) and total EE (TEE) (doubly-labelled water) were measured before and after the 6 month weight loss. Blood samples were collected before and after to measure leptin and peptide YY. The results indicate that there was indeed a depression in resting EE during weight loss regardless of the type of intervention utilized. Furthermore, these findings suggest that the changes could not fully be explained by changes of FM and FFM alone and that leptin may be an important contributor to the changes of resting EE during weight loss.

The main objective of this thesis was to examine the independent effects of sleep duration and timing on appetite, food reward and energy balance. Study 1 investigated the associations between satiety quotient (SQ) with habitual, self-reported sleep duration, quality and timing. No significant associations were noted between SQ and sleep parameters. Short-duration sleepers had a lower mean SQ vs. those with ≥7h sleep/night (P=0.04). Study 2 evaluated associations between changes in sleep duration, efficiency and timing with changes in next day food reward. Greater sleep duration and earlier wake-times were associated with greater food reward (P=0.001). However, these associations were no longer significant after controlling for elapsed time between awakening and completion of the food reward task. Study 3 examined the effects of 50% sleep restriction (SR) anchored during the first (delayed bedtime) or second (advanced wake-time) half of the night on appetite, SQ, food reward, energy intake (EI) and energy expenditure (EE). Greater appetite ratings and explicit high-fat food reward were noted following SR with an advanced wake-time vs. control and SR with a delayed bedtime (P=0.03-0.01). No difference in SQ was noted between sessions. Energy and carbohydrate intakes were greater on day 2 and over 36h in the delayed bedtime vs. control session (P=0.03). Activity EE and moderate-intensity physical activity (PA) time were greater following delayed bedtime vs. control and advanced wake-time on day 1, whereas vigorous-intensity PA time was greater following advanced wake-time vs. delayed bedtime on day 1 (P=0.01-0.04). Greater sleep quality and slow-wave sleep duration between SR sessions were associated with lower EI and increased vigorous-intensity PA time, respectively (P=0.01-0.04). Collectively, these findings suggest that appetite, SQ and food reward are influenced by sleep parameters, but these changes may not alter EI. These findings also suggest that individuals with greater sleep quality in response to SR had greater vigorous-intensity activity time and lower EI.