Type 2 diabetes mellitus (T2DM) is a global health concern affecting six to ten percent of adults worldwide, with the number of diagnosed individuals projected to double in the next 25 years. However, effective public health strategies can help mitigate its impact on quality of life, morbidity, mortality and the associated social and economic burden. In Sweden, screening programs classify individuals with Impaired fasting glucose (IFG) as high-risk individuals, however scholars argue that preventative measures should also include those at lower fasting plasma glucose (FPG) concentrations as some evidence suggests that the disease begins developing several years before the current threshold. A systematic review and meta-analysis of cohort and case-control studies was conducted with the purpose of exploring the IFG threshold from a longitudinal perspective. Eleven studies on the incidence rates of T2DM in normoglycemic individuals and seven studies on pre-diagnostic trajectories of FPG concentrations were analyzed. Incidence rates increased progressively across the normoglycemic range, with a twelve-fold difference between the low and high end. FPG concentrations in eventual progressors and non-diabetic controls were significantly different twelve years prior to diagnosis. Mildly increasing FPG concentrations were observed in eventual progressors until three years before diagnosis, at which a larger increase followed. In the last year before diagnosis, FPG concentrations rose dramatically in this group. The findings imply that a lowering of the threshold would extend the time spent in the IFG state, allowing for earlier identification of at-risk individuals. In addition, further stratification of normoglycemic range may enhance the accuracy of T2DM risk assessment.

Background Type 2 diabetes mellitus (T2DM) is a globally prevalent disease anticipated to double from 500 million diagnosed cases in 2021 to more than one billion by 2050. The investigation of the potentially protective effects of skeletal muscle mass on glucose intolerance may lead to the development of more precise screening protocols. Purpose This thesis aimed to address the lack of clear consensus in existing literature by exploring the relationship between skeletal muscle mass and glucose intolerance. Methods Fifteen healthy young adults were recruited to partake in a prospective correlational study. The participants underwent anthropometric measurements and an oral glucose tolerance test (OGTT). Anthropometric data was collected using an bioelectrical impedance analysis (BIA) scale. Blood glucose levels were measured using capillary sampling before and after ingestion of a 75 g/200 mL glucose solution. Statistical analysis included Spearman’s rank correlation test and Pearson’s correlation coefficient test. Results All associations between skeletal muscle mass and glucose intolerance were of moderate strength. Skeletal muscle mass (SMM) correlated significantly with glucose concentrations two hours (2hPG) following ingestion of the glucose solution and an adjusted measure of SMM was significantly associated with glucose area under the curve (AUC). Statistical significance was also found between Sex and incremental glucose area under the curve (iAUC). Conclusion This thesis suggests an inverse relationship between skeletal muscle mass and glucose intolerance in a group of healthy young adults. The results imply the potential usefulness of incorporating muscle mass when determining the glucose load during an OGTT, especially in preventive contexts. Nevertheless, further research with larger samples is crucial to establish precise cutoff levels for clinical applications. / Bakgrund Typ 2 diabetes mellitus (T2DM) är en global sjukdom och antalet diagnostiserade individer förväntas fördubblas från 500 miljoner fall 2021 till över en miljard år 2050. En undersökning av muskelmassans potentiellt skyddande effekt på glukostolerans kan leda till utvecklandet av noggrannare screeningmetoder. Syfte Syftet med denna uppsats var att bemöta den bristfälliga konsensus som råder bland befintlig forskning genom att undersöka sambandet mellan muskelmassa och glukosintolerans. Metod Femton friska yngre vuxna rekryterades för att delta i en prospektiv korrelationsstudie. Deltagarna genomgick antropometriska mätningar samt ett oralt glukostoleranstest (OGTT). Antropometriska värden mättes med hjälp av en bioelektrisk impedansanalysvåg. Blodglukosnivåer mättes kapillärt före och efter intag av en 75 g/200 mL glukoslösning. Statistisk analys inkluderade Spearmans rangkorrelationstest och Pearsons korrelationskoefficientstest. Resultat Alla samband mellan muskelmassa och glukosintolerans var av måttlig styrka. Muskelmassa (SMM) korrelerade signifikant med blodglukos två timmar (2hPG) efter intag av glukoslösningen och ett justerat SMM-mått (adjSMM) var signifikant associerat med arean under glukoskurvan (AUC). Statistisk signifikans hittades även mellan kön och den inkrementella arean under glukoskurvan (iAUC). Slutsats Resultaten från denna uppsats antyder att ett omvänt samband existerar mellan muskelmassa och glukosintolerans hos en grupp friska yngre vuxna. Resultatet innebär en potentiell möjlighet att använda muskelmassan vid bestämmandet av mängden glukos som administreras vid ett OGTT, särskilt i preventiva syften. Ytterligare forskning med fler studiedeltagare är avgörande för att fastställa exakta gränsvärden för klinisk tillämpning.

This thesis examines the depiction of saintly figures within the Latin vitae of twelfth-century England (1066–c.1215). It tests the extent to which these depictions are homogeneous and examines what factors may have shaped representations. Analysis focuses on vitae of twelfth-century saints, a sample of texts that have not previously been examined as a corpus in this way. By encompassing a range of different types of saint, authors and contexts, utilising this corpus allows a comparative examination of how different facets of sainthood could be expressed in hagiography. The textual analysis at the heart of this study aims to unpick individual texts' ideals of saintly behaviour. Whilst hagiographers functioned within a well-established genre, considering a wide range of saints' vitae allows scrutiny of the impact of context in shaping depictions. It will be argued that these portrayals of saintly figures demonstrate thematic harmony which is tempered by individuality and context to form recognisable and yet distinctive depictions of sainthood. The analysis is structured around four common hagiographical themes, each worthy of detailed examination: Outer Appearance, Sexuality and Chastity, Food and Fasting, and Death. Chapter 1 investigates how saintly figures are described in terms of physical appearance, deportment and demeanour, and clothing. Chapter 2 focuses upon sexuality, exploring the manifestations of chastity and virginity within the Lives and testing how this might vary from saint to saint and between the sexes. Chapter 3 examines food and food abstention, previously under-represented in secondary literature on twelfth-century hagiography and on male saints. The thesis ends with a consideration of death, a surprisingly understudied theme in Anglophone scholarship. By examining the process of dying and the moment of mortality, this chapter will fill an important analytical vacuum between lived sanctity and sanctity in death.

As is well-known, fasting is one of the 'Pillars of Islam'. It might therefore be expected that as such, it would already have been extensively investigated. But this is not the case, for, besides the many minor points of interest which still require elucidation, it is not an exaggeration to say that even the broadest facts about the beginnings and early development of the Islamic fast have not hitherto been conclusively established. Theoretically, the fast is based in the Quran, yet part of the relevant section in the Quran is consciously ignored by most Muslims, while many of their conceptions as regards the rest are at best ill-founded. It should be stressed from the outset that there is no intention here of implying any conscious perversion in this; the reasons underlying the Muslim view of the fast are expounded later.

O presente estudo teve por objetivo investigar os efeitos do jejum de 48 horas sobre o metabolismo do músculo cardíaco e sobre a função cardíaca. Para isso, ratos machos com 60 dias foram separados em dois grupos: jejuados por 48 h (grupo experimental) e alimentados (grupo controle). Após eutanásia, sangue e coração foram coletados. O coração foi excisado e a aurícula do átrio direito (AAD), a aurícula do átrio esquerdo (AAE), parede do ventrículo direito (PVD), septo interventricular (SIV) e parede do ventrículo esquerdo (PVE) foram separadas e analisadas individualmente. Análises de parâmetros bioquímicos plasmáticos, dosagem de metabólitos, atividade máxima de enzimas, assim como expressão gênica e proteica foram realizadas. O jejum promoveu alterações metabólicas em todas as regiões, sendo mais intensas na PVE. Registros ventriculares e hemodinâmicos também foram obtidos. O jejum diminuiu a força de contração (dP/dt+), a força de relaxamento (dP/dt-) e a frequência cardíaca (FC), aumentou o tempo de enchimento diastólico e o hematócrito. Apesar de observamos aumento do potencial oxidativo e aumento da concentração disponível de ATP, é possível que 48h de jejum comprometa a volemia e por consequência a função cardíaca. / The present study aimed to investigate the effects of 48-hour fasting on cardiac muscle metabolism and cardiac function. For this, male rats with 60 days were separated into two groups: fasted for 48 h (experimental group) and fed (control group). After euthanasia, blood and heart were collected. The heart was excised and the right atrial atrium (RAA), left atrial atrium (LAA), right ventricular wall (RVW), interventricular septum (IVS) and left ventricular wall (LVW) were separated and analyzed individually. Analyzes of plasma biochemical parameters, dosage of metabolites, maximum activity of enzymes, as well as gene and protein expression were performed. Fasting promoted metabolic alterations in all regions, being more intense in PVE. Ventricular and hemodynamic records were also obtained. Fasting decreased contraction force (dP / dt +), relaxation force (dP / dt-) and heart rate (HR), increased diastolic filling time and hematocrit. Although we observed an increase in the oxidative potential and an increase in the available ATP concentration, it is possible that 48h-fasting compromises blood volume and, consequently, cardiac function.

A ausência de nutrientes durante o jejum leva a intensa mobilização de ácidos graxos (AG) do adipócito. A intensidade deste fenômeno deve ser controlada, pois o excesso de AG está associado a condições patológicas. Nestas condições, a lipogênese torna-se útil e a Gliceroneogênese indispensável. Nesta via, o lactato seria um substrato fisiológico e provável. Metodologia. Ratos machos Wistar foram divididos em grupos, Alimentado (Al) e Jejum (J) e os coxins subcutâneo (SC) e visceral retroperitoneal (RP) submetidos aos testes biológicos e moleculares. No Teste de Incorporação de [14C]-Acido Lático em Glicerol e no teste de captação de [14C]-Acido Lático o grupo Al mostrou maior capacidade (Al > J; *p<0.05; [N=8]). Nestes testes, a glicose (1 ou 4 mM) foi fundamental e a presença de insulina (10 nM) ampliou estes resultados em ambos os tecidos. Na expressão do transportador de monocarboxilatos 1 (MCT1) e da enzima fosfoenol piruvato carboxiquinase (PEPCK), não houve diferenças entre Al e J. Concluímos que a alimentação promove aumento da Glicroneogênese a partir do ácido lático e a expressão da PEPCK não exerceu influencia neste processo. No entanto, a glicose e a insulina, mostraram-se como potencializadores da Gliceroneogênese. / The absence of nutrients during fasting leads to intensive mobilization of adipocyte fatty acids (FA). The intensity of this phenomenon should be controlled because excess of the AG is associated with pathological conditions. Under these conditions, the lipogenesis and gliceroneogenesis are useful and indispensable. In this pathway, the lactate and likely would be a physiological substrate. Methodology. Male Wistar rats were divided into groups: (Al) and Fasting (J) and fat pad subcutaneous (SC) and visceral retroperitoneal (RP) subject to biological and molecular assays. The Test of Incorporation of [14C]-Latic Acid into Glycerol and test of uptake lactic-acid, Al group showed greater capacity (Al> J; * p <0.05; [N = 8]). In these tests, glucose (1 or 4 mM) was fundamental and the presence of insulin (10 nM) extended these findings in both tissues. In monocarboxylate transporter 1 expression (MCT1) and the enzyme phosphoenol pyruvate carboxykinase (PEPCK), there was no difference between Al and J. We concluded that feeding promotes increased Glicroneogênese from lactic acid and expression of PEPCK did not exercised influence in this process. However, glucose and insulin appeared as potentiators of Gliceroneogênese.

A dieta intermitente (DI) estimula mecanismos de defesa do organismo, tornando-o mais resistente a estímulos tóxicos. A DI parece atuar em vias associadas à resposta inflamatória, autofagia, sobrevivência celular e aumenta a resistência contra estresse oxidativo. No entanto, pouco se sabe sobre o papel dos receptores TLR4 e TLR2 nos efeitos da DI. Este trabalho avaliou a influência do TLR4 e TLR2 nos efeitos da DI sobre a memória e a sinalização associada aos fatores de transcrição NF-&#954;B, NRF2 e FOXO em camundongos nocaute para TLR4 ou TLR2. Os resultados sugerem que o TLR4 e TLR2 participam da modulação pela DI dos níveis de estresse oxidativo, biomarcadores periféricos e do NF-&#954;B, CREB, AP1, NRF2, além das proteínas moduladas por esses fatores de transcrição como o BDNF, HO1, enzimas antioxidantes, chaperonas e citocinas. Esses resultados permitem um maior entendimento dos processos fisiológicos que visam o desenvolvimento de novas intervenções farmacológicas para a promoção da longevidade, envelhecimento saudável e o tratamento de distúrbios neurodegenerativos. / Intermittent fasting (IF) stimulates the body\'s defense mechanisms, making it more resistant to toxic stimuli. IF seems to act by mechanisms associated with cell survival, autophagy, inflammation and enhancing oxidative stress resistance, thereby involving the modulation of transcription factors. However, little is known about the involvement of TLR4 and TLR2 on IF effects. The present work investigated the influence of TLR2 and TLR4 on IF effects on memory and on signaling mechanisms associated with the transcription factors NF-&#954;B, NRF2 and FOXO in TLR2 KO or TLR4 KO mice. The results suggest that TLR4 and TLR2 participate in the effects of IF on oxidative stress levels, peripheral biomarkers, and on NF-&#954;B, CREB, AP1 and NRF2, as well as proteins modulated by these transcription factors such as BDNF, HO1, antioxidant enzymes, chaperones and cytokines. These results allow a better understanding of physiological processes that aim at developing new pharmacological interventions to promote longevity, healthy aging, and the treatment of neurodegenerative disorders.

Avaliamos importância da NADPH oxidase 2 (NOX2) na produção de espécies reativas de oxigênio (EROs) em ilhotas de ratas alimentadas ou em jejum, incubadas na presença de 2,8 mM ou 16,7 mM de glicose, associada ou não a leucina, com ou sem inibição da NOX2. As ilhotas dos animais alimentados ou em jejum apresentaram reduzida secreção de insulina e altas concentrações de EROs na presença de 2,8 mM de glicose. Esses parâmetros foram invertidos pela adição de inibidores da NOX2. A leucina, que é metabolizada no Ciclo dos Ácidos Tricarboxílicos, também aumentou a secreção de insulina por aumento de ATP, e diminuiu as EROs, devido ao aumento de NADPH, um substrato do sistema antioxidante. Desse modo, quando as ilhotas são submetidas ao jejum, a diminuição da atividade secretória é fundamental para impedir que quantidades maiores de hormônio sejam secretadas, podendo levar a uma hipoglicemia. Porém, na presença de alta concentração de glicose, a ativação das defesas antioxidantes da célula b atenua o excesso de EROS, liberando a secreção de insulina. / We sought to evaluate the importance of NADPH oxidase 2 (NOX2) in the production of reactive oxygen species (ROS) in islets from rats fed or fasted, incubated in the presence of glucose 2.8 mM or 16.7 mM, with or without leucine or inhibition of NOX2. Islets of fed or fasted animals showed reduced insulin secretion and high concentration of ROS in the presence of 2.8 mM glucose. These parameters were reversed by addition of inhibitors NOX2. Leucine that is metabolized in the cycle of Tricarboxylic Acids (TCA) also increased insulin secretion, by increasing ATP, and ROS decreased due to the increase of NADPH, a substrate of the antioxidant system. Thus, when the islets are subjected to fasting, decreased secretory activity is essential to prevent amounts of the hormone be secreted and may lead to hypoglycaemia. However, in the presence of high glucose levels, activation of antioxidant defenses of b cell attenuates the excess of ROS, releasing insulin secretion.

Bakgrund: Preoperativ fasta är nödvändigt innan anestesi för att reducera magsäckens innehåll och därmed minska risken för aspiration. Trots att internationella riktlinjer rekommenderar två timmars fasta för klar vätska är det många sjukhus som fortfarande använder sig av rutinmässig praxis att låta patienter fasta från midnatt. Detta kan innebära en onödigt lång fasta som ger patienten komplikationer i form av sekundära biverkningar och insulinresistens. Syfte: Att undersöka preoperativ omvårdnad i samband med fasta inför kirurgi. Metod: En litteraturstudie med beskrivande design bestående av 14 utvalda originalartiklar från databaserna Pubmed och Cinahl användes. Den teoretiska referensramen för denna studie var Katie Erikssons omvårdnadsteori gällande förståelse av lidande och lidandets drama. Resultat: Många patienter fastade längre än American Society of anesthesiologists (ASAs) rekommenderade riktlinjer. Att fasta längre än två timmar innan operation minskade inte risken för aspiration och gav inte någon mindre volym av magsäckens innehåll hos patienterna. Att ge patienter kolhydratrik dryck innan operation ökade patienternas pre- och postoperativa välbefinnande och innebar inga risker. Slutsats: Genom ett mer flexibelt arbetssätt vid planerad operation kan längden på fastan anpassas efter patientens individuella behov. I samband med planerad kirurgi kan kolhydratrik dryck vara ett bra komplement vid fasta för att minska patientens lidande. Sjuksköterskan är omvårdnadsansvarig och ska arbeta evidensbaserat samt se till patienternas bästa och tillgodose deras behov. Sjuksköterskan kan använda detta som underlag för att minska lidandet i samband med fastan. / Background: Preoperative fasting is necessary before anesthesia to reduce gastric contents and decrease the risk of aspiration. Although international guidelines recommend two hours fasting of liquids, many hospitals still practice nil-by-mouth after midnight. This might give an unnecessarily prolonged fasting which give the patient discomfort and insulin resistance. Aim:  To examine preoperative care in connection with fasting prior to surgery. Method: A literature study with descriptive design based on 14 original articles selected from the databases Pubmed and Cinahl was used. The theoretical frame of reference for this study was Katie Eriksson's nursing theory regarding understanding of suffering and the drama of suffering. Results: Many patients fast longer than American Society of anesthesiologists (ASAs) recommended guidelines. Fasting more than two hours before surgery did not decrease the risk of aspiration and did not decrease the gastric volume. To give patients a high carbohydrate drink before surgery increased the patient's pre- and postoperative comfort. Conclusion: Through a more flexible working method during the planned operation, the length of the fast can be adapted to the patient's individual needs. In conjunction with planned surgery, carbohydrate-rich beverages can be a good complement to fasting to reduce the patient's suffering. The nurse is responsible for nursing care and should work evidence-based and ensure the patients' best and meet their needs. The nurse can use this as a basis for reducing the suffering associated with fasting.

abstract: Objectives: To investigate the potential of vinegar supplementation as a means for reducing visceral fat in healthy overweight and obese adults, and to evaluate its effects on fasting blood glucose and fasting insulin. Subjects and Methods: Forty-five sedentary overweight and obese adult participants with a waist circumference greater than 32 inches for women and 37 inches for men were randomly assigned to one of two groups, the vinegar group (VIN, n=21) or the control group (CON, n=24), and instructed to consume either two tablespoons of liquid red wine vinegar (3.6g acetic acid) or a control pill (0.0225g acetic acid) twice daily at the beginning of a meal for 8 weeks. Participants were also instructed to maintain normal diet and physical activity levels. Anthropometric measures, dual-energy x-ray absorptiometry (DXA) scans, blood samples, and 24-hour dietary recalls were collected at baseline and at end of trial. A compliance calendar was provided for daily tracking of vinegar supplementation. Results: Compliance to vinegar supplementation averaged 92.7 ±13.3% among the VIN group and 89.1 ±18.9% among the CON group. There were no statistically significant differences in anthropometric measurements between baseline and week 8: weight (P=0.694), BMI (P=0.879), and waist circumference (P=0.871). Similarly, DXA scan data did not show significant changes in visceral fat (P=0.339) or total fat (P=0.294) between baseline and week 8. The VIN group had significant reductions in fasting glucose (P=0.003), fasting insulin (P <0.001), and homeostatic model assessment of insulin resistance scores (P <0.001) after treatment. Conclusions: These data do not support the findings from previous studies that indicated a link between vinegar supplementation and increased fat metabolism, specifically visceral fat reduction. / Dissertation/Thesis / Masters Thesis Nutrition 2019