OBJETIVO: Esse estudo teve como objetivo verificar as associações entre dispêndio energético (Kcal), perfil antropométrico (índice de massa corporal (IMC) e relação cintura/quadril (RCQ)), idade e condição socioeconômica (grau de escolaridade e renda per capita) de mulheres, na faixa etária de 40 a 64 anos, cadastradas no Programa de Saúde da Família. METODOLOGIA: A amostra contituiu-se de 147 mulheres, que responderam a um inquérito domiciliar, com intuito de avaliar o dispêndio energético e as condições socioeconômicas e em seguida foram realizadas as medidas antropométricas. Com exceção do dispêndio energético, as demais variáveis foram categorizadas para processar o teste de Kruskal-Wallis, adotando um nível de significância de 5% (α=0,05) para as tomadas de decisão. RESULTADOS: O dispêndio energético apresentou relação direta ao IMC (p=0,0001) e inversa aos graus de escolaridade (p=0,0407) e idade (p=0,0417), mas não se verificou associação em relação à RCQ (p=0,1288) e renda per capita (p=0,1984). Também não foram encontradas associações para as análises entre IMC e renda per capita (p=0,8263), grau de escolaridade (p=0,1326) e idade (p=0,7423). Na avaliação da RCQ foi observada uma relação inversa à renda per capita (p=0,0163), não se apresentou associação com a idade (p=0,5985) e embora tenha demonstrado diferença estatística (p=0,0126) em relação aos graus de escolaridade, os resultados foram discordantes da literatura. CONCLUSÃO: As mulheres estudadas apresentaram alta prevalência de sedentarismo (57,8%), sobrepeso (31,3%) e obesidade (36,0%). Possuem RCQ inadequada e baixo nível socioeconômico. Propõe-se que os resultados sejam discutidos no Programa de Saúde da Família, com o intuito de promover políticas públicas de saúde para reverter esse quadro. / OBJECTIVE: The purpose of this study was to verify the associations between energy expenditure (Kcal), anthropometric profile (body mass index (BMI) and waist to hip ratio (WHR), socioeconomic status (education degrees and income per capita) and age of women (aged 40-64 years) registered in the Family Health Program. METHODS: A sample of 147 women answered a domiciliary inquiry, with the aim of evaluating the energy expenditure and the socioeconomic status. After that they were submitted to the anthropometric measures. Except for the energy expenditure, the other variables were categorized to process the test of Kruskal-Wallis, adopting a level of significance of 5% (α=0.05) to take the decision. RESULTS: The energy expenditure presented direct relation to BMI (p=0.0001) and inverse to the education degrees (p=0.0407) and the age (p=0.0417), but no correlation was observed to the WHR (p=0.1288) and per capita income (p=0.1984). Correlations between BMI and income per capita (p=0.8263), education degree (p=0.1326) and age (p=0.7423) were not found. In the evaluation of the WHR, we observed an inverse relation to the income per capita (p=0.0163), and no relation with the age (p=0.5985). Although there is statistic difference (p=0.0126) in relation to the education degrees, the results are in discordance with the literature. CONCLUSION: The women presented high prevalence of sedentarism (57.8%), overweight (31.3%) and obesity (36.0%). They have inadequate WHR and low socioeconomic level. These results should be argued in the Family Health Program with the aim of promoting health public politics to revert this situation.

O exercício físico e a alimentação adequada apresentam estreita relação. O triatlon é uma modalidade que apresenta elevada demanda energética por associar três diferentes tipos de exercício. Objetivos -Verificar a adequação do valor energético total em relação ao dispêndio energético diário, a adequação de macronutrientes da alimentação em relação à recomendação e a contribuição de complemento nutricional. Métodos - Foi mensurado peso corporal de triatletas adultos, de ambos os sexos, a fim de predizer o dispêndio energético diário. Para análise da alimentação foi utilizado diário alimentar de três dias e, para obtenção do dispêndio energético diário, optou-se pelo diário de atividade física de três dias, proposto por Bouchard et al. (1983). Análise estatística - Para análise dos dados utilizou-se estatística descritiva com medidas de tendência central (média e mediana) e dispersão (desvio-padrão, valores mínimos e máximos), teste de Wilcoxon e t-Student. Os resultados foram analisados ao nível de 5% de significância. Resultados - Os 22 triatletas avaliados apresentam idade entre 20 e 45 anos (33±6 anos). O complemento nutricional foi utilizado por 95,4% dos atletas. Dentre os complementos, 76,2% eram compostos à base de carboidrato, 71,4% bebida esportiva, 33,3% compostos protéicos, 9,5% vitamínico-minerais e lipídicos. A alimentação forneceu, em média, 2.800 kcal/dia e, a alimentação associada ao complemento nutricional, representou 3.000 kcal/dia. A maioria dos atletas (90,9%) consumiu proteína em quantidades elevadas, 72,7% ingeriram carboidratos em quantidades inferiores ao recomendado e, 57,7% ingeriram lipídios adequadamente, considerando-se somente a alimentação. Com complemento nutricional, observa-se o mesmo desequilíbrio de macronutrientes. O dispêndio energético diário médio foi de 3.490 kcal, sendo que 83,4% dos atletas apresentam dispêndio maior do que a ingestão alimentar, na ausência de complemento. Conclusões - A alimentação destes triatletas é insuficiente para atender o dispêndio energético diário; o consumo de proteína é superior ao recomendado; o consumo de carboidratos é inferior ao recomendado; o consumo de lipídios é adequado; o uso de complemento nutricional é pratica habitual por triatletas e não contribui de forma estatisticamente significativa para atingir às necessidades energéticas e recomendações de carboidratos (p>0,05), embora contribua para o aumento das proteínas e, alteração do percentual de lipídios de forma significativa (p≤0,05). / Physical exercise and proper diet are closely related, since what is eaten influences physical performance. Triathlon has a high energy demand as it is associated to three types of exercise. Objectives - To find the suitability of the energy intake in relation to the daily energy expenditure, suitability of macronutrients in food in relation to the recommendation of and the contribution of nutritional supplements. Methods - The body weight of adult triathletes of both sexes was measured in order to forecast the daily energy expenditure. A daily food intake of a three day period was used for diet analysis. The daily physical activity of a three day period was used to obtain the daily energy expenditure as proposed by Bouchard et al. (1983). Statistical Analysis - For the analysis of data, descriptive statistics was used with center tending measurements (average and median) and dispersion (standard deviation, minimum and maximum values), Wilcoxon and t-Student tests. The results were analyzed at the level of 5% significance. Results - The 22 triathletes were aged between 20 and 45 (age 33±6). Nutritional supplements were used by 95.4% of the athletes, of which: 76.2% of carbohydrates base compound, 71.4% sport drinks, 33.3% protein compound, 9,5% vitamin-minerals and lipids. The diet supplied on average 2.800 kcal/day and, with the nutritional supplements, 3.000 kcal/day. Of all the triathletes, 90,9% consumed high quantities of protein, 72,7% had intake of carbohydrates below the recommended level and 57,7% ingested lipids in adequate quantities, taking only food into account. With nutritional supplements, the same unbalance of macronutrients was observed. The average daily energy expenditure was 3.490 kcal, with 83,4% of the athletes showing a higher consumption than food intake in the absence of the supplements. Conclusions - The diet of these triathletes is insufficient to meet the daily energy expenditure; consumption of protein is higher than the recommended quantity; consumption of carbohydrates is lower than the recommended quantity; consumption of lipids is adequate; use of nutritional supplements is habitual to the triathletes and do not contribute in a statistically significant manner to achieve the energy requirements and carbohydrates recommendation (p>0,05), although they contribute to an increase of proteins and a change of the lipid percentage (p≤0,05).

OBJETIVO: Esse estudo teve como objetivo verificar as associações entre dispêndio energético (Kcal), perfil antropométrico (índice de massa corporal (IMC) e relação cintura/quadril (RCQ)), idade e condição socioeconômica (grau de escolaridade e renda per capita) de mulheres, na faixa etária de 40 a 64 anos, cadastradas no Programa de Saúde da Família. METODOLOGIA: A amostra contituiu-se de 147 mulheres, que responderam a um inquérito domiciliar, com intuito de avaliar o dispêndio energético e as condições socioeconômicas e em seguida foram realizadas as medidas antropométricas. Com exceção do dispêndio energético, as demais variáveis foram categorizadas para processar o teste de Kruskal-Wallis, adotando um nível de significância de 5% (α=0,05) para as tomadas de decisão. RESULTADOS: O dispêndio energético apresentou relação direta ao IMC (p=0,0001) e inversa aos graus de escolaridade (p=0,0407) e idade (p=0,0417), mas não se verificou associação em relação à RCQ (p=0,1288) e renda per capita (p=0,1984). Também não foram encontradas associações para as análises entre IMC e renda per capita (p=0,8263), grau de escolaridade (p=0,1326) e idade (p=0,7423). Na avaliação da RCQ foi observada uma relação inversa à renda per capita (p=0,0163), não se apresentou associação com a idade (p=0,5985) e embora tenha demonstrado diferença estatística (p=0,0126) em relação aos graus de escolaridade, os resultados foram discordantes da literatura. CONCLUSÃO: As mulheres estudadas apresentaram alta prevalência de sedentarismo (57,8%), sobrepeso (31,3%) e obesidade (36,0%). Possuem RCQ inadequada e baixo nível socioeconômico. Propõe-se que os resultados sejam discutidos no Programa de Saúde da Família, com o intuito de promover políticas públicas de saúde para reverter esse quadro. / OBJECTIVE: The purpose of this study was to verify the associations between energy expenditure (Kcal), anthropometric profile (body mass index (BMI) and waist to hip ratio (WHR), socioeconomic status (education degrees and income per capita) and age of women (aged 40-64 years) registered in the Family Health Program. METHODS: A sample of 147 women answered a domiciliary inquiry, with the aim of evaluating the energy expenditure and the socioeconomic status. After that they were submitted to the anthropometric measures. Except for the energy expenditure, the other variables were categorized to process the test of Kruskal-Wallis, adopting a level of significance of 5% (α=0.05) to take the decision. RESULTS: The energy expenditure presented direct relation to BMI (p=0.0001) and inverse to the education degrees (p=0.0407) and the age (p=0.0417), but no correlation was observed to the WHR (p=0.1288) and per capita income (p=0.1984). Correlations between BMI and income per capita (p=0.8263), education degree (p=0.1326) and age (p=0.7423) were not found. In the evaluation of the WHR, we observed an inverse relation to the income per capita (p=0.0163), and no relation with the age (p=0.5985). Although there is statistic difference (p=0.0126) in relation to the education degrees, the results are in discordance with the literature. CONCLUSION: The women presented high prevalence of sedentarism (57.8%), overweight (31.3%) and obesity (36.0%). They have inadequate WHR and low socioeconomic level. These results should be argued in the Family Health Program with the aim of promoting health public politics to revert this situation.

A acidose metabólica é um achado comum em pacientes portadores de Doença Renal Crônica (DRC). Acredita-se que a dieta pode afetar o equilíbrio ácidobase do corpo por meio do fornecimento de precursores ácidos ou de base. No entanto, os resultados inconclusivos apontados na literatura indicam que ainda são necessários estudos bem delineados para comprovar a existência dessa associação. O principal objetivo desse estudo foi determinar o potencial de carga ácida renal (PRAL) proveniente da dieta e avaliar a sua associação com o bicarbonato sérico (HCO3) em pacientes com DRC enquanto em suas dietas habituais. Associações do HCO3 com o gasto energético de repouso (GER) e com oxidações proteicas e lipícas também foram estudadas. Trata-se de um estudo transversal realizado com 100 pacientes distribuídos igualmente nos estágios 3 e 4 da DRC entre 20 e 69 anos. Avaliação do estado nutricional foi feita por meio da antropometria, registro alimentar e exames bioquímicos, o qual incluiu os produtos proteicos de oxidação avançada e os isoprostanos. O HCO3 foi determinado por meio da gasometria venosa. GER foi medido pela calorimetria indireta. O PRAL foi determinado por meio do registro alimentar usando um algoritmo que inclui dados dietéticos da ingestão de proteína, fósforo, magnésio, cálcio e potássio descritos por Remer e Manz (1995). Também foi feita a diferenciação no consumo de proteína animal e vegetal. A análise dos resultados foi feita em quartis de HCO3 para as variáveis GER e parâmetros de oxidação, o restante das análises foram feitas por quartis de PRAL. Para comparação das variações médias dos quartis foi utilizado o teste one-way ANOVA. A associação entre a estimativa do PRAL e o HCO3 foi avaliada por modelos de regressão linear ajustados. A maior parte dos nossos pacientes portadores de DRC encontravam-se com excesso de peso associado a um aumento da circunferência abdominal e da porcentagem de gordura corporal. A mediana do PRAL foi de 6,8 mEq/dia com uma variação entre -24 a 52 mEq/dia. O PRAL mais elevado foi associado com o HCO3 mais baixo de uma forma graduada (p < 0.02). Encontramos uma diferença de 2,07 mmol/L no HCO3 entre o primeiro e o último quartil, sendo o valor do último quartil de PRAL menor em relação ao primeiro. A proteína animal apresentou uma correlação inversa com o bicarbonato sérico. O GER e os marcadores de oxidação lipíca e proteica não apresentaram associações com os níveis de HCO3. Esses resultados reforçam a possibilidade de que dietas com alto teor de carga ácida podem desempenhar um papel relevante no equilíbrio ácidobase em pacientes portadores de DRC, além de consolidar o uso da carga ácida da dieta como uma abordagem diferencial e complementar às outras estratégias no tratamento dietético da DRC. / Metabolic acidosis is a common complication in patients with chronic kidney disease (CKD). Acid-inducing diets are believed to impact on acid-base balance. However, well-designed studies are still needed to prove the association between dietary acid load and serum bicarbonate. The main aim of this study was to calculate the potential renal acid load (PRAL) of selected, frequently consumed foods and to evaluate its association with serum bicarbonate (HCO3) in patients with CKD. Associations of HCO3 with resting energy expenditure (REE) and with protein and lipid oxidation were also studied. It is a cross-sectional study with 100 patients equally distributed in stages 3 and 4 of CKD between 20 and 69 years. Nutritional status was assessed by anthropometric measurements, 3-day food recall, biochemical analysis including advanced oxidation protein products and isoprostanes. Venous blood gases was used to measure HCO3. GER was measured by indirect calorimetry. PRAL was determined by food record using an algorithm that includes protein, phosphorus, magnesium, calcium and potassium intake described by Remer and Manz (1995). Dietary intake of animal and vegetable protein were also evaluate. For analysis, we used quartiles of HCO3 for GER and oxidation parameters and for the others variables we used quartilhes of PRAL. ANOVA one-way test was used to compare the mean of the quartiles. The association between PRAL and HCO3 was assessed by linear regression models. Most of the patients were overweight with increased waist circumference and body fat. The median PRAL was 6.8 mEq/day with a variation between -24 to 52 mEq/day. Higher PRAL was associated with lower serum bicarbonate in a graded fashion (P trend 0.02). Serum bicarbonate was 2.07 mEq/L lower among those in the highest compared with the lowest quartile of PRAL. Animal protein was inversely correlated with serum bicarbonate. REE and lipid and protein oxidation markers showed no association with HCO3 levels. These results reinforce the possibility that diets with high dietary acid load may play a relevant role in the acid-base balance in CKD patients. In addition to consolidating the use of PRAL as a differential and complementary approach to other strategies in the nutritional treatment of CKD.

L’augmentation de la dépense énergétique (DE) par une augmentation de l'activité physique (AP) participe au maintien et à l’amélioration de la santé. La mesure à grande échelle de la DE totale (DET) en général et AP en particulier se heurte à des difficultés pratiques de recueil de données, de validité et aux coûts. Bien que dans la littérature de nombreux accéléromètres permettent d’estimer la DET, il y a encore des limites quant à la mesure de l’intensité de l’AP, élément qui influence l’état de la balance énergétique et le bénéfice pour la santé de l’AP. De plus, peu de comparaisons entre les différents accéléromètres sont disponibles. La présente étude avait pour but d’évaluer la capacité de deux accéléromètres (Actical et Sensewear Armband) pour estimer la DET en comparaison avec la technique de l’eau doublement marquée (EDM) ; d’évaluer la concordance entre les accéléromètres dans la mesure de la DE au repos (DER) en comparaison avec la technique de la calorimétrie indirecte (CI) et d’évaluer la DE liée à l’AP en comparaison avec la technique de la CI. Les résultats montrent qu’il y a une très bonne corrélation entre la CI et les accéléromètres dans la mesure de la DER(r > 0.80, p<0.001) et une bonne corrélation entre les accéléromètres et l’EDM dans la mesure de la DET(r>0.75, p<0.001). Pour la mesure de l’intensité de l’AP, l’ACT est plus précis (r=0.80, p<0.001)) que le SWA à la marche, le SWA est meilleur(r=0.80, p<0.001) au vélo. Cette étude permet d’affirmer que le SWA et l’ACT sont des alternatives valables pour mesurer la DE. / The increase in energy expenditure by the increase of physical activity contributes to maintaining and improving health. The large-scale measurement of total energy expenditure in general and physical activity in particular, is faced with difficulties of data collection, validity and cost. Although literature suggests that many accelerometers are used to estimate total energy expenditure, there are still limits as to the measurement of the intensity of physical activity, which is one of the factors that influences the energy balance and health benefits of physical activity. In addition, few comparisons between the different accelerometers are available. This study aimed to evaluate the ability of two accelerometers (Actical and SensWear Armband) to estimate total energy expenditure compared with the technique of doubly labelled water; to assess the correlation between the two accelerometers in the measurement of resting energy expenditure, compared with the technique of indirect calorimetry and finally to assess energy expenditure linked to physical (walking and cycling) at different intensities, in comparison with the indirect calorimetry technique. The results show a very good correlation between indirect calorimetry and the two accelerometers(r > 0.80, p<0.001) in the measurement of resting energy expenditure and a good correlation between accelerometers and the gold standard technique (doubly labeled water) in the measurement of total energy expenditure(r>0.75, p<0.001). To measure the intensity of physical activity, Actical is more accurate than SensWear Armband(r=0.80, p<0.001) at low intensity while the SensWear Armband is better at higher intensity (r=0.80, p<0.001). This study provides evidence that these two accelerometers are suitable alternatives for measuring energy expenditure.

Le risque cardiométabolique (RCM) représente l’ensemble de tous les facteurs de risque pour les maladies cardiovasculaires et le diabète de type 2, incluant les facteurs de risque traditionnels et ceux émergents. Les évidences indiquent que la résistance à l’insuline, l’inflammation et le stress oxydant jouent un rôle clé dans le RCM, bien que l’acteur initiateur des altérations métaboliques caractéristiques du RCM reste encore à définir. Les femmes post-ménopausées constituent un sous-groupe important de la population puisque le risque de complications cardiométaboliques augmente après la ménopause. Les facteurs de RCM peuvent être modulés par l’alimentation, l’activité physique et la perte de poids. Alors que l’étude de nutriments / aliments spécifiques a permis de mieux comprendre l’implication de l’alimentation dans le RCM, celle de la qualité de l’alimentation est prometteuse. L’activité physique a des effets bénéfiques sur le RCM bien démontrés chez des personnes actives. Cependant, la relation entre la dépense énergétique et le RCM chez des individus sédentaires a été moins investiguée. De même, peu ou pas de données existent quant à une interaction synergique possible entre l’alimentation et l’activité physique sur le RCM. L’objectif de la présente thèse est d’investiguer les relations entre l’alimentation, l’activité physique, le stress oxydant et le RCM chez des femmes post-ménopausées en surpoids ou obèses, sédentaires et sans autres complications métaboliques. Les résultats montrent que d’une part, chez ces femmes sédentaires, une dépense énergétique active (DÉAP) élevée est associée à un meilleur profil inflammatoire, indépendamment de l’adiposité. D’autre part, il existe une relation synergique entre la qualité alimentaire et la DÉAP associée à un meilleur RCM. Une qualité alimentaire élevée combinée à une DÉAP élevée est associée à un meilleur profil lipidique et lipoprotéique et à une inflammation sub-clinique moindre, indépendamment de l’adiposité. Par ailleurs, dans une étude pilote, seuls des effets indépendants des changements de la qualité alimentaire et de la DÉAP sur les changements dans les facteurs de RCM ont été observés suite à cette diète hypocalorique de 6 mois, indépendamment du changement de l’adiposité encouru. En effet, au-delà de la réduction de l’adiposité et de l’amélioration du profil lipoprotéique induites par l’intervention, l’amélioration de la qualité alimentaire et de la DÉAP est associée, indépendamment l’une de l’autre, à une meilleure pression artérielle et un meilleur profil lipidique. Par ailleurs, une modification du système glutathion, un des systèmes antioxydants les plus communs de l’organisme, est associée à un RCM élevé. Une activité élevée de la glutathion peroxydase est associée à une résistance à l’insuline et à une épaisseur plus importante de l’intima-media de la carotide. Ces relations pourraient être médiées par un stress réducteur. En conclusion, l’adoption d’une saine alimentation et la pratique d’activités physiques doivent être encouragées dans les interventions visant à contrer l’obésité et ses complications, même en absence d’un changement d’adiposité. D’autre part, l’activité de la glutathion peroxydase pourrait être un paramètre impliqué dans le développement de désordres cardiométaboliques sub-cliniques et asymptomatiques chez des femmes obèses. D’autres investigations sont requises pour confirmer ces observations et élucider les mécanismes d’action impliqués. / The cardiometabolic risk represents all risk factors for cardiovascular diseases and type 2 diabetes, including the traditional and the emerging risk factors. Accumulating evidences indicate that insulin resistance, inflammation and oxidative stress are key players in the cardiometabolic risk, although the main cause initiating the metabolic alterations associated with the cardiometabolic risk has to be identified. Postmenopausal women are an important sub-group of the general population because the risk of developing cardiometabolic complications increases after menopause. The cardiometabolic risk factors can be modulated by dietary intake, physical activity and weight loss. Despite the fact that the study of specific nutrients or foods provided a better understanding of the implication of nutrition in the cardiometabolic risk, the relationship between diet quality and cardiometabolic risk has been less studied. Beneficial effects of physical activity on the cardiometabolic risk have been demonstrated in physically active individuals. However, the relationship between energy expenditure and the cardiometabolic risk in sedentary individuals has been less investigated. Similarly, it is unknown whether dietary intake interacts with physical activity in order to have greater beneficial effects on the cardiometabolic risk. The objective of this thesis is to determine the relationships between diet quality, physical activity and oxidative stress on the cardiometabolic risk in sedentary postmenopausal overweight and obese women without cardiometabolic complications. The results showed that, in these sedentary women, physical activity energy expenditure is associated with reduced inflammation, independently of adiposity. Moreover, there is a synergistic relationship between quality and physical activity energy expenditure (PAEE) which is associated with a reduced cardiometabolic risk compared to their separate effects. Indeed, high diet quality combined to high PAEE levels is associated with a better lipid and lipoprotein profile and a lower inflammatory status, independently of adiposity. However, in a pilot study, only independent effects of changes in diet quality and PAEE on the changes in cardiometabolic risk factors was observed following a 6-month hypocaloric diet. Indeed, beyond the reduction of adiposity and improvement of the lipoprotein profile induced by this diet, improved diet quality and increased PAEE are associated with beneficial changes in blood pressure and lipid profile. On the other hand, modification in the glutathione system, which is one of the most common antioxidant systems in the body, is associated with a higher cardiometabolic risk. Greater glutathione peroxidase activity is associated with insulin resistance and greater intima-media thickness of blood vessels. These relationships may be mediated through a reductive stress. In conclusion, a healthy diet and physical activity should be emphasized in interventions aimed to reduce obesity and its related complications, even in absence of change in adiposity. Moreover, glutathione peroxidase activity may be a parameter contributing to the development of sub-clinical but clinically relevant asymptomatic cardiometabolic abnormalities in obese women. Further investigations are needed to confirm these results and to elucidate the underlying mechanisms.

The primary objective of this PhD program was to investigate the impact of training at a constant-load moderate-intensity (FATmax) compared to work-matched high-intensity intervals (HIIT) on the metabolic, physiological and psychosocial health profiles of sedentary overweight and obese men. This study was unique in that it was the first time the effect of exercise intensity had been investigated to examine concurrently the components of whole-body energy metabolism and body composition as measured using gold standard techniques. Based upon the positive alterations in blood lipids, body composition, cardiorespiratory fitness and substrate oxidation, it appears that training at FATmax can positively impact health parameters as well as, or if not better than, high-intensity training. Furthermore, there are ramifications for public health messages and obesity management strategies arising from these findings, primarily attributable to the increased exercise adherence and the reduction in health risks stemming from the significant loss of abdominal visceral adipose tissue after FATmax training.

Introduction Optimal nutrition is vital in the management of infants born preterm. Dietary fat in infancy is fundamental for the provision of energy for growth and development. Essential fatty acids, specifically Long Chain Polyunsaturated Fatty Acids (LC-PUFAs) such as docosahexaenoic acid (DHA), have been under investigation by several international research groups in the past decade. Essential fatty acids are critical in neurodevelopment as DHA is found in high proportions in structural lipids of cell membranes, particularly in the central nervous system (CNS). The accumulation of essential fatty acids and particularly DHA in the brain and retina occurs most rapidly during the perinatal period, therefore preterm infants are of particular concern (Singer, 2001). Current scientific consensus is that the optimum growth rate for preterm infants is equal to the in utero growth rate throughout the last trimester, however, failure to achieve the optimum intrauterine growth rate is common in preterm infants (Olhager and Forsum, 2003). Preterm infants require large amounts of energy and nutrients with which many infants are not provided or are not able to absorb, due to immature gastrointestinal and metabolic systems and other medical complications (Olhager and Forsum, 2003). There are a number of unresolved issues regarding optimal growth rate and total energy requirements (ER) for preterm infants. Hypotheses/Objectives This study is a “side study” to a double blind randomised controlled trial (RCT) of DHA supplementation in preterm infants. The hypothesis of this “side study” is that increased DHA during the neonatal period would increase total energy expenditure (TEE) and improve neurodevelopmental outcome. Specifically, at term postconceptual age (PCA) it was hypothesised that preterm infants receiving higher intake of DHA would have higher TEE’s due to the acceleration in brain maturation. Also, it was hypothesised that preterm infants receiving high levels of DHA would have TEE’s equivalent to term born infants due to their same brain maturation status. Other hypothesised effects of DHA supplementation include an accelerated maturation of the visual cortical pathways, and accelerated white matter (WM) tract development aiding in brain maturation. The first objective of this study was to measure TEE and ER in very preterm infants when they reached an age of 31-33 weeks post conceptional age (PCA). The effects of DHA supplementation on TEE, at simulated in utero levels, in very preterm infants (born < 33 weeks PCA), when assessed at term equivalent (40 weeks PCA) were studied. Another objective was to compare WM brain tissue volume at term PCA between two preterm groups and then with the term born infants. Visual latency was also compared between the two preterm infant groups and then with the term born infants. Methods TEE was measured using the doubly labelled water (DLW) method which is based on the differential elimination of 2H (deuterium) and 18O from the body subsequent to a loading dose of these isotopes. TEE was measured at the preterm age between 31-33 weeks PCA and again at term PCA. TEE measurements are made at term PCA in a term born control group. Brain assessment was by Magnetic Resonance Imaging and (MRI) and Visual Evoked Potential (VEP). Magnetic resonance imaging quantitatively measured brain volumes and WM. Visual evoked potential would provide information on visual latency and amplitude. Results The cohort consisted of 38 infants. The TEE of the very preterm infant group was measured at 31-33 weeks PCA. The mean (±standard deviation) (SD) TEE was calculated at 80(±27) kcal/kg/d, and using data in the literature for foetal energy accretion of 28kcal/kg/d, the mean ER was calculated to be 108(±27) kcal/kg/d. At term PCA TEE was calculated for the preterm DHA supplemented group to be 56(±19) kcal/kg/d and for the non-DHA supplemented group 70(±39) kcal/kg/d. These measurements were not statistically different. Flash VEP conducted on preterm given different amounts of DHA tested at term PCA found no statistically different measurements. When combining these results and comparing them to measurements of term born infants at term PCA, the right eye measurements showed that preterm infants had statistically greater latencies than term infants. When combining the left and right eye measurements the latencies no statistical significance was found. Amplitude was also not statistically significant between the groups. MRI measures at term PCA were not statistically different DHA supplemented and the non-DHA supplemented preterm infant group. When the preterm infant cohort was combined and compared to the term born infant group, the results showed that preterm infants imaged at term PCA had reduced WM development in a number of frontal lobe projections, and anterior and posterior commissarial pathways of the corpus callosum and corona radiata. Discussion The TEE and ER measurements in this study represent the largest preterm infant cohort to date. The ER values reported here are of value in allowing the calculation of appropriate feeding and nutritional strategies for preterm infants. Although no differences in TEE between the DHA and non DHA supplemented groups were found this may have been due to the small sample size. With regard to the latency outcomes, it can be speculated that if measurements were conducted at a later PCA the correlations may have been stronger and significant. Several other factors may have also affected the results, including alertness of the infant at the time of testing, thickness of the cranium, and other health factors could not be controlled for. This study contains the youngest cohort to be compared via Flash VEP. The MRI data did not find significant differences in brain volume and WM between the DHA supplemented and the non-DHA supplemented groups. The infant CNS is rapidly developing and there are multiple environmental factors which may have affected outcomes. The data did however find differences in WM development between the preterm and term infants. The reduced WM development found in the preterm infants compared to term born infants may provide some explanation for the correlation between preterm birth and poorer cognitive and functional outcomes. Larger studies which extend beyond the first months of life are recommended in order to investigate the long-term relationships between DHA supplementation, TEE and brain maturation.

A acidose metabólica é um achado comum em pacientes portadores de Doença Renal Crônica (DRC). Acredita-se que a dieta pode afetar o equilíbrio ácidobase do corpo por meio do fornecimento de precursores ácidos ou de base. No entanto, os resultados inconclusivos apontados na literatura indicam que ainda são necessários estudos bem delineados para comprovar a existência dessa associação. O principal objetivo desse estudo foi determinar o potencial de carga ácida renal (PRAL) proveniente da dieta e avaliar a sua associação com o bicarbonato sérico (HCO3) em pacientes com DRC enquanto em suas dietas habituais. Associações do HCO3 com o gasto energético de repouso (GER) e com oxidações proteicas e lipícas também foram estudadas. Trata-se de um estudo transversal realizado com 100 pacientes distribuídos igualmente nos estágios 3 e 4 da DRC entre 20 e 69 anos. Avaliação do estado nutricional foi feita por meio da antropometria, registro alimentar e exames bioquímicos, o qual incluiu os produtos proteicos de oxidação avançada e os isoprostanos. O HCO3 foi determinado por meio da gasometria venosa. GER foi medido pela calorimetria indireta. O PRAL foi determinado por meio do registro alimentar usando um algoritmo que inclui dados dietéticos da ingestão de proteína, fósforo, magnésio, cálcio e potássio descritos por Remer e Manz (1995). Também foi feita a diferenciação no consumo de proteína animal e vegetal. A análise dos resultados foi feita em quartis de HCO3 para as variáveis GER e parâmetros de oxidação, o restante das análises foram feitas por quartis de PRAL. Para comparação das variações médias dos quartis foi utilizado o teste one-way ANOVA. A associação entre a estimativa do PRAL e o HCO3 foi avaliada por modelos de regressão linear ajustados. A maior parte dos nossos pacientes portadores de DRC encontravam-se com excesso de peso associado a um aumento da circunferência abdominal e da porcentagem de gordura corporal. A mediana do PRAL foi de 6,8 mEq/dia com uma variação entre -24 a 52 mEq/dia. O PRAL mais elevado foi associado com o HCO3 mais baixo de uma forma graduada (p < 0.02). Encontramos uma diferença de 2,07 mmol/L no HCO3 entre o primeiro e o último quartil, sendo o valor do último quartil de PRAL menor em relação ao primeiro. A proteína animal apresentou uma correlação inversa com o bicarbonato sérico. O GER e os marcadores de oxidação lipíca e proteica não apresentaram associações com os níveis de HCO3. Esses resultados reforçam a possibilidade de que dietas com alto teor de carga ácida podem desempenhar um papel relevante no equilíbrio ácidobase em pacientes portadores de DRC, além de consolidar o uso da carga ácida da dieta como uma abordagem diferencial e complementar às outras estratégias no tratamento dietético da DRC. / Metabolic acidosis is a common complication in patients with chronic kidney disease (CKD). Acid-inducing diets are believed to impact on acid-base balance. However, well-designed studies are still needed to prove the association between dietary acid load and serum bicarbonate. The main aim of this study was to calculate the potential renal acid load (PRAL) of selected, frequently consumed foods and to evaluate its association with serum bicarbonate (HCO3) in patients with CKD. Associations of HCO3 with resting energy expenditure (REE) and with protein and lipid oxidation were also studied. It is a cross-sectional study with 100 patients equally distributed in stages 3 and 4 of CKD between 20 and 69 years. Nutritional status was assessed by anthropometric measurements, 3-day food recall, biochemical analysis including advanced oxidation protein products and isoprostanes. Venous blood gases was used to measure HCO3. GER was measured by indirect calorimetry. PRAL was determined by food record using an algorithm that includes protein, phosphorus, magnesium, calcium and potassium intake described by Remer and Manz (1995). Dietary intake of animal and vegetable protein were also evaluate. For analysis, we used quartiles of HCO3 for GER and oxidation parameters and for the others variables we used quartilhes of PRAL. ANOVA one-way test was used to compare the mean of the quartiles. The association between PRAL and HCO3 was assessed by linear regression models. Most of the patients were overweight with increased waist circumference and body fat. The median PRAL was 6.8 mEq/day with a variation between -24 to 52 mEq/day. Higher PRAL was associated with lower serum bicarbonate in a graded fashion (P trend 0.02). Serum bicarbonate was 2.07 mEq/L lower among those in the highest compared with the lowest quartile of PRAL. Animal protein was inversely correlated with serum bicarbonate. REE and lipid and protein oxidation markers showed no association with HCO3 levels. These results reinforce the possibility that diets with high dietary acid load may play a relevant role in the acid-base balance in CKD patients. In addition to consolidating the use of PRAL as a differential and complementary approach to other strategies in the nutritional treatment of CKD.

Uma sessão de exercício aeróbio provoca queda da pressão arterial (PA) e aumento da freqüência cardíaca (FC) pós-exercício. Diversos fatores, como a massa muscular, a intensidade e o gasto energético total do exercício podem influenciar esta resposta. Este estudo verificou as respostas pós-exercício da PA, da FC e de seus mecanismos, avaliando a influência dos fatores citados. Vinte e quatro jovens submeteram-se a quatro sessões: controle(C); exercício com um membro inferior (mmii) em 50% do VO2pico(E1); exercício com dois mmii em 50% do VO2pico (E2); e exercício com dois mmii com a mesma potência de E1(E2/1). As PA sistólica (PAS), média (PAM) e diastólica (PAD), o débito cardíaco (DC), a resistência vascular periférica (RVP), o volume sistólico (VS), a FC e a modulação autonômica cardíaca foram medidos. Após o exercício, a PAS e o DC diminuíram e a RVP aumentou em E2. A PAD e PAM não se alteraram. A FC aumentou e o VS e o componente de alta freqüência da variabilidade da FC diminuíram em E1 e E2 (maior em E2). Concluindo: o exercício aeróbio promove hipotensão pós-exercício, devido à queda do DC pela redução do VS. O gasto energético total do exercício é o principal determinante desta resposta. A FC permanece elevada pós-exercício devido ao retardo da reativação vagal. A intensidade e o gasto energético do exercício são os principais determinantes desta resposta / A single bout of aerobic exercise reduces blood pressure (BP) and increases heart rate (HR) during the recovery period. Many factors, such as exercise intensity, muscle mass and total energy expenditure might influence this response. This study verified post-exercise responses of BP, HR and their mechanisms, evaluating the influence of previous factors. Twenty-four subjects underwent four sessions: control (C); exercise with one leg at 50% of VO2peak (E1); exercise with two legs at 50% of VO2peak (E2); and exercise with two legs and the same workload employed in E1 (E2/1). Systolic, mean, and diastolic BPs (SBP, MBP, DBP), systemic vascular resistance (SVR), cardiac output (CO), stroke volume (SV), HR, and cardiac autonomic modulations were measured before and after interventions. After exercise, SBP and CO decreased, while SVR increased in E2. DBP and MBP did not change. HR increased, while SV and the high frequency band of HR variability decreased in E1 and E2 (more in E2). In conclusion: aerobic exercise produced post-exercise hypotension by a decrease in CO, via a decrease in SV. This response is determined by the exercise total energy expenditure. HR is elevated after exercise due to a delay in the restoration of vagal activity to the heart. Exercise intensity and total energy expenditure influence this response. Key-words: aerobic exercise, muscle mass, total energy expenditure, relative intensity, blood pressure, heart rate, autonomic modulation