Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A morbidade e mortalidade por doenças cardiovasculares demonstram tendência geral de declínio, mas, em países em desenvolvimento como o Brasil a ocorrência destes eventos é crescente. A obesidade e principalmente a localização intra-abdominal de gordura, relaciona-se com a ocorrência de doença crônica e diferentes tipos de dietas tem sido testados na busca pela efetiva redução da adiposidade. Fatores biológicos como a resistência à insulina pode interferir na resposta obtida com intervenções nutricionais. O objetivo deste estudo foi avaliar se a perda de peso e as mudanças ocorridas na composição corporal de mulheres saudáveis, eutróficas ou com sobrepeso, submetidas a um programa de prevenção de ganho de peso foram influenciadas pela resistência à insulina no inicio da intervenção. Trata-se de um estudo observacional prospectivo. 203 mulheres foram alocadas randomicamente para dieta de baixo e alto índice glicêmico. Destas, 185, foram avaliadas quanto a presença de resistência a insulina na linha de base, 34,6% foram classificadas como resistentes a insulina segundo o índice HOMA-IR, no ponto de corte 2,71. As medidas antropométricas de localização de gordura, circunferência da cintura (CC) e relação cintura quadril (RCQ) associaram-se com a resistência a insulina do inicio do estudo, sendo a RCQ a mais fortemente associada (razão de prevalência: 2,28; p=0,0005, enquanto que para CC o valor foi 1,53; p=0,04). A análise da modificação do peso e das medidas antropométricas de composição corporal ao longo dos 6 meses de acompanhamento não demonstrou diferença estatisticamente significante entre os grupos com e sem resistência a insulina. Em conclusão, embora a resistência à insulina tenha se correlacionado com a localização de gordura avaliada principalmente pela relação cintura quadril no inicio do estudo, ela não foi capaz de explicar mudanças na composição corporal e de peso em resposta a uma intervenção nutricional. / Pups leptin injection on the first 10 days of lactation programmes for higher food intake (FI), body mass (BM), lean mass, thyroid function, hyperleptinemia and resistance to its action and lower leptin receptor (ObRb) expression on 150 days-old rats. When mothers were leptin-treated on the last 3 days of lactation, it seems to reproduce partially this programming effect, except for higher visceral fat mass (VFM). So, we evaluated the offspring metabolic phenotype when the mothers were treated with leptin in the first 10 days of lactation. On birth, the lactating Wistar rats were divided into: Leptin (LEP) treated with recombinant leptin (8mg/100g, PC, sc) for the first 10 days of lactation and Control (C) saline-treated in the same conditions. The mothers BM and FI were monitored daily and they were milked at the 21st day of lactation. LEP mothers had lower BM during lactation (~6%, p <0.05) and normal FI. The mothers sacrifice occurred to the end of lactation. The leptin concentration of LEP mothers was normal in serum and milk, while T3 was normal in serum and higher in milk (+30%, p <0.05). The offspring BM and FI was monitored daily and accompanied by 4 on 4 days after weaning until 180 days of age. The LEP offspring had lower BM during lactation (~5%, p<0.05) and from the day 69 onward higher BM (+10%, p<0.05), while the FI was higher (+17%, p<0.05) at day 145 onward. The leptin resistance test was performed at 30 and 180 days. Both group was subdivided into: CLEP and LEPLEP treated with leptin (0.5 mg / kg / ip PC); CSAL and LEPSAL treated with saline. The animals were sacrificed at 21, 30 and 180 days. We collected the VFM, carcass, blood (glycemia, leptin, total T3 and T4, TSH, insulin) and liver (GPDm activity). LEP offspring had higher T3 at 21 days, but not significant (p = 0.06) and when they were 30 days-old they already present leptin resistance and lower serum T3 (-20%,p<0.05). At 180 days they had higher VFM (+57%, p<0.05), total body fat (+40%, p<0.05), leptin resistance, hyperleptinemia (+1,35x, p<0.05) with normal 125I thyroid uptake, serum T4 and TSH and lower GPDm activity at 30 and 180 day (-42% and -57%,p< 0.05 respectively). So, the mother's hyperleptinaemia in the beginning of lactation programs as early as the 30 days-old offspring: leptin resistance and hypothyroidism, probably by a higher leptin transfer through the milk. We suggested that the levels of leptin in early lactation are determinants of the physiological regulation of energy balance in adulthood. We suggest that the programming effects are dependent on the way that leptin reaches the offspring. The present study seems more physiological and reproduces almost completely the programming effect in the adulthood when the mothers were leptin-injected at the end of lactation and, partially reproduces the effects when leptin was directally injected in the pups.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / As complicações metabólicas constituem uma característica importante da doença renal crônica (DRC) e podem comprometer o estado nutricional. O objetivo da presente dissertação foi avaliar estado nutricional e inflamatório de pacientes com DRC em tratamento conservador bem como avaliar as repercussões da variação do peso corporal sobre esses parâmetros durante esse período. Foram acompanhados 56 pacientes clinicamente estáveis nos estágios 3 e 4 da DRC (57% do sexo masculino; idade: 62,3 14 anos) que já seguiam uma dieta hipoprotéica e faziam acompanhamento no Ambulatório Multidisciplinar de Doenças Renais do Hospital Universitário Pedro Ernesto. Não foram incluídos pacientes com doença maligna, em tratamento com drogas imunossupressoras e com diabetes mellitus descompensado. O tempo de seguimento foi de 12 2 meses. Os parâmetros avaliados no início e após 12 meses foram: peso corporal, composição corporal, níveis séricos de albumina, glicose, colesterol total, triglicerídeos, proteína C-reativa (PCR) e leptina. Após 1 ano nenhum paciente apresentou diagnóstico de desnutrição energético-protéica (DEP) no início e ao término do estudo. Além disso, 21 pacientes diminuíram de peso corporal e 35 aumentaram. No Grupo Perda de Peso (GPerdaP) o índice de massa corporal (IMC) mudou de sobrepeso para eutrofia e no Grupo Ganho de Peso (GGanhoP), o IMC aumentou significantemente, porém sem alterar o estado nutricional de sobrepeso. Em ambos os grupos, o compartimento que mais se modificou foi à gordura corporal. No GPerdaP ocorreu uma diminuição significante da gordura corporal e do perímetro da cintura (PC) em ambos os sexos. No GGanhoP, notou-se aumento do mesmo parâmetro, porém sendo de forma significante para gordura corporal no sexo feminino e PC no sexo masculino. Em ambos os grupos os parâmetros de massa corporal não se alteraram significantemente. Com relação aos parâmetros metabólicos, no GPerdaP houve uma diminuição significante da glicemia e perfil lipídio. A PCR reduziu em 17%, mas não de forma significante e se aproximou dos valores indicativos de condição não inflamatória. No GGanhoP, houve um aumento estatístico da leptina, enquanto que a PCR não se alterou. Além disso, ao avaliar a associações univariadas no grupo total, o delta PCR se associou com o delta peso (r=0,39; P<0,05), delta IMC (r=0,39; P<0,05) e delta perímetro da cintura (r=0,33; P<0,05). A magnitude da associação entre o delta PCR com delta peso foi de 0,8 mg/L (P=0,008), ou seja, a variação de cada 1 kg peso corporal levou uma variação de 0,8 mg/dL de PCR. Com base nos achados desse trabalho, pode-se concluir que durante um ano de seguimento pacientes nos estágios 3 e 4 da DRC em acompanhamento clínico e nutricional, não se observou desenvolvimento de DEP, mesmo nos pacientes que perderam peso. A gordura corporal foi o compartimento corporal que mais sofreu modificação e a leptina aumentou apenas no pacientes que ganharam peso. Ademais, a variação de peso corporal apresentou um efeito em modificar a PCR. / Metabolic disturbances resulting from the decline of renal function are a common feature of chronic kidney disease (CKD). These complications may lead to changes in the nutritional status. The aim of this study is to evaluate whether CKD patients under conservative treatment show changes in the nutritional status and inflammation and also to assess whether changes in body weight will change these parameters. Fifty-six clinically stable patients with CKD stages 3 and 4 (57% male, age: 62.3 14 years) following a low protein diet and under treatment in a multidisciplinary CKD outpatient clinic were included. Patients with malignant disease, acute inflammation, taking immunosuppressive drugs and with non stable diabetes mellitus were not included. The mean duration of follow-up was 12 2 months. Participants had the following parameters assessed at baseline and after 12 months: body weight, body composition, serum levels of albumin, glucose, total cholesterol, triglycerides, C-reactive protein (CRP) and leptin. None of the patients had protein energy wasting (PEW) neither at baseline nor at the end of the study. In addition, 21 patients lost body weight (-7.0 to -0.2kg) and 35 gained body weight (0.2 to +9.7kg). In the Loss Body Weight Group (LossBWG) the body mass index (BMI) changed from overweight to the normal range and, in the Gain Body Weight Group (GainBWG), BMI increased significantly, but without changing the nutritional status classification overweight. In both groups, body fat was the body compartment most susceptible to changes. In the LossBWG a significant decrease in body fat occurred in males and females. Similarly, in the GainBWG an increase in body fat was observed, being significantly only in females. In both groups the body cell mass and phase angle did not change during the study. Regarding the metabolic parameters, in the LossBWG serum glucose, total cholesterol and triglycerides decreased significantly.In the LossBWG, although not significantly, CRP reduced by 17% and became close to the values indicative of a non-inflammatory state. In the GainBWG, there was a statistical increase in leptin, whereas CRP did not change. Moreover in the total group (n=56) there was a significant association between delta CRP and delta body weight (r=0.39, P<0.05), delta BMI (r=0.39, P<0.05) and delta waist circumference (r=0.33, P<0.05). The magnitude of the association between delta body weight and delta CRP was 0.8 mg/L (P = 0.008), meaning that the change of 1 kg body weight is associated with a change of 0.8 mg/L CRP. To summarize, in clinically stable patients on CKD stages 3 and 4 followed by one year, PEW was not developed, even in patients who lost body weight. In addition, body fat was the body compartment that suffered most changes during the follow-up. The serum leptin increased in patients that gained body weight. Moreover, the variation in body weight had an effect in modifying the CRP.

Made available in DSpace on 2014-12-17T14:13:38Z (GMT). No. of bitstreams: 1 ErikaDMR.pdf: 1138296 bytes, checksum: 0a0b6c2daed88fef46a41da7760c0079 (MD5) Previous issue date: 2008-10-20 / Congenital generalized lipodystrophy is a rare genetic disease with autosomal recessive inheritance characterized by the generalized absence of subcutaneous adipose tissue and insulin resistance. The aim of our study was to determine the profile of patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) through their clinical history, eating habits, and socioeconomic and cultural aspects; assess food consumption and nutritional status of the study group; propose and evaluate a diet therapy model associated to oral supplementation with zinc to help in the control and prevention of metabolic complications associated to the pathology. Initial assessment of food consumption indicated a voracious appetite in all the patients studied. The introduction of zinc reduced appetite, contributing to patient adherence to the food plan proposed. It was also observed that the proposed diet contributed mainly to glycidic control, specifically with respect to HbA1c. The nutritional status of the patients investigated was adequate in terms of body mass index (BMI), arm muscle circumference (AMC), arm muscle area AMA, but triceps skinfold (TSF) indicated serious malnutrition. Our study is unique in the literature and provides important information to the field of nutrition and to individuals with this pathology. Furthermore, it contemplates the interdisciplinary and multidisciplinary requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte (UFRN), Natal, Brazil / A lipodistrofia generalizada cong?nita ? uma rara doen?a gen?tica com heran?a autoss?mica recessiva caracterizada por aus?ncia generalizada de tecido adiposo subcut?neo e resist?ncia insul?nica. O nosso estudo objetivou conhecer o perfil de portadores de lipodistrofia generalizada cong?nita mediante hist?ria cl?nica, h?bitos alimentares, aspectos s?cio-econ?micos e culturais; avaliar o consumo alimentar e o estado nutricional do grupo estudado; propor e avaliar um modelo de interven??o dietoter?pica associada ? suplementa??o oral com o elemento zinco para auxiliar o controle e a preven??o de complica??es metab?licas associada ? patologia. A avalia??o inicial do consumo alimentar indicou apetite voraz comum em todos os portadores investigados. Com a introdu??o do elemento zinco, verificou-se redu??o do apetite contribuindo para a ades?o dos mesmos ao plano alimentar proposto. Observou-se, tamb?m, que a dieta proposta contribuiu, principalmente, ao controle do metabolismo glic?dico, especificamente, em rela??o ? hemoglobina glicada (HbA1c). O estado nutricional dos portadores investigados revelou-se adequado em rela??o ao ?ndice de massa corporal (IMC), circunfer?ncia do m?sculo do bra?o (CMB) e ?rea da massa do bra?o (AMB), e indicou desnutri??o grave em rela??o ? prega cut?nea do tr?ceps (PCT). O nosso estudo ? ?nico na literatura e traz contribui??es importantes ao campo da nutri??o e ? popula??o portadora desta patologia. Al?m disto, contemplou os requisitos de interdisciplinaridade e multidisciplinaridade exigidos pelo Programa de P?sgradua??o em Ci?ncias da Sa?de

Made available in DSpace on 2014-12-17T15:34:45Z (GMT). No. of bitstreams: 1 MiguelASFC_DISSERT.pdf: 664410 bytes, checksum: ea1412fbbc90b4e28d5ec902a12a2ff5 (MD5) Previous issue date: 2011-08-29 / Universidade Federal do Rio Grande do Norte / The objective of this study was to identify DNA polymorphisms at the genes leptin, &#946;-lactoglobulin and pituitary-specific transcription factor in three genetic groups of Holstein x Guzerat dairy cows and investigate the relationship between their genotypes and the composition and quality of milk of dairy cows. Samples were collected in August 2009, being 113 blood samples from lactating crossbred cows and 58 milk samples. For analysis of DNA polymorphisms blood samples were collected, analyzed later in the Genetic Laboratory affiliated to the Zootechny Institute of S?o Paulo and individual milk samples were collected according to standards established by the laboratory of Management Program of Northeast Dairy Herds (PROGEN), at Federal Rural University of Pernambuco (UFRPE) for analysis of milk composition and quality. The characterization of genotypes was performed by PCR-RFLP, for which were designed specific primers for each studied gene and restriction enzymes Kpn2I, HaeIII and HinfI that cut the DNA of the following genes: leptin, &#946;-lactoglobulin and a PIT, respectively. The leptin estimate genotypic frequence were CC 0.112, TT 0.225 and CT 0.661, for &#946;-lactoglobulin were AA 0.136, AB 0.323 and BB 0.539, and for PIT were ++ 0.655, -- 0.311 and +- 0.032. The results show that the population is in Hardy-Weinberg disequilibrium for leptin, &#946;-lactoglobulin and a PIT due to excess of heterozygotes in the population, however, as these genes are associated with the milk production it is considered that the animals have genetic potential for milk production in the Brazilian semi-arid conditions. Through the characterization of the studied herd there were not found implications of the polymorphism of leptin, &#946;-lactoglobulin and PIT in the composition and quality of milk from cows in the different genetic groups 1/2, 3/4 and 7/8 Holstein x Guzerat. Key words: &#946;-lactoglobulin, crossbred cows, leptin, PCR-RFLP, PIT1, semi-arid. / O objetivo do presente estudo ? identificar os polimorfismos de DNA nos genes leptina, &#946;-lactoglobulina e fator de transcri??o pituit?rio espec?fico, em tr?s grupos gen?ticos de vacas leiteiras Holand?s x Guzer? e verificar a rela??o entre seus gen?tipos com a composi??o e qualidade do leite de vacas leiteiras. As amostras foram coletadas em agosto de 2009, sendo 113 amostras de sangue de vacas mesti?as em lacta??o e 58 amostras de leite. Para a an?lise do polimorfismo de DNA foram coletadas amostras de sangue, analisadas posteriormente no Laborat?rio de Gen?tica do Instituto de Zootecnia do Estado de S?o Paulo. As amostras individuais de leite foram coletadas segundo os padr?es estabelecidos pelo laborat?rio do Programa de Gerenciamento de Rebanhos Leiteiros do Nordeste (PROGENE), da Universidade Federal Rural de Pernambuco (UFRPE) para as an?lises de composi??o e qualidade do leite. A caracteriza??o dos gen?tipos foi realizada atrav?s da t?cnica de PCR-RFLP, em que foram utilizados primers espec?ficos para cada gene estudado e enzimas de restri??o Kpn2I, HaeIII e HinfI, promotoras de cortes nos genes leptina, &#946;- lactoglobulina e PIT1, respectivamente. A freq??ncia genot?pica estimada da leptina foi CC 0,112 , TT 0,225 e CT 0,661, da &#946;-lactoglobulina foi AA 0,136, BB 0,323 e AB 0,539 e PIT1 ++ 0,655, -- 0,311 e +- 0,032. Os resultados mostram que a popula??o se encontra em desequil?brio de Hardy-Weinberg para a leptina, &#946;-lactoglobulina e PIT1 devido ao excesso de heterozigotos presentes na popula??o, entretanto, como estes genes est?o associados ? produ??o de leite, considera-se que os animais t?m potencial gen?tico para a produ??o leiteira nas condi??es do semi?rido brasileiro. Atrav?s da caracteriza??o do rebanho estudado n?o foram encontradas implica??es referentes ao polimorfismo da leptina, &#946; lactoglobulina e PIT1 na composi??o e qualidade do leite de vacas nos grupos gen?ticos 1/2, 3/4 e 7/8 Holand?s x Guzer?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A morbidade e mortalidade por doenças cardiovasculares demonstram tendência geral de declínio, mas, em países em desenvolvimento como o Brasil a ocorrência destes eventos é crescente. A obesidade e principalmente a localização intra-abdominal de gordura, relaciona-se com a ocorrência de doença crônica e diferentes tipos de dietas tem sido testados na busca pela efetiva redução da adiposidade. Fatores biológicos como a resistência à insulina pode interferir na resposta obtida com intervenções nutricionais. O objetivo deste estudo foi avaliar se a perda de peso e as mudanças ocorridas na composição corporal de mulheres saudáveis, eutróficas ou com sobrepeso, submetidas a um programa de prevenção de ganho de peso foram influenciadas pela resistência à insulina no inicio da intervenção. Trata-se de um estudo observacional prospectivo. 203 mulheres foram alocadas randomicamente para dieta de baixo e alto índice glicêmico. Destas, 185, foram avaliadas quanto a presença de resistência a insulina na linha de base, 34,6% foram classificadas como resistentes a insulina segundo o índice HOMA-IR, no ponto de corte 2,71. As medidas antropométricas de localização de gordura, circunferência da cintura (CC) e relação cintura quadril (RCQ) associaram-se com a resistência a insulina do inicio do estudo, sendo a RCQ a mais fortemente associada (razão de prevalência: 2,28; p=0,0005, enquanto que para CC o valor foi 1,53; p=0,04). A análise da modificação do peso e das medidas antropométricas de composição corporal ao longo dos 6 meses de acompanhamento não demonstrou diferença estatisticamente significante entre os grupos com e sem resistência a insulina. Em conclusão, embora a resistência à insulina tenha se correlacionado com a localização de gordura avaliada principalmente pela relação cintura quadril no inicio do estudo, ela não foi capaz de explicar mudanças na composição corporal e de peso em resposta a uma intervenção nutricional. / Pups leptin injection on the first 10 days of lactation programmes for higher food intake (FI), body mass (BM), lean mass, thyroid function, hyperleptinemia and resistance to its action and lower leptin receptor (ObRb) expression on 150 days-old rats. When mothers were leptin-treated on the last 3 days of lactation, it seems to reproduce partially this programming effect, except for higher visceral fat mass (VFM). So, we evaluated the offspring metabolic phenotype when the mothers were treated with leptin in the first 10 days of lactation. On birth, the lactating Wistar rats were divided into: Leptin (LEP) treated with recombinant leptin (8mg/100g, PC, sc) for the first 10 days of lactation and Control (C) saline-treated in the same conditions. The mothers BM and FI were monitored daily and they were milked at the 21st day of lactation. LEP mothers had lower BM during lactation (~6%, p <0.05) and normal FI. The mothers sacrifice occurred to the end of lactation. The leptin concentration of LEP mothers was normal in serum and milk, while T3 was normal in serum and higher in milk (+30%, p <0.05). The offspring BM and FI was monitored daily and accompanied by 4 on 4 days after weaning until 180 days of age. The LEP offspring had lower BM during lactation (~5%, p<0.05) and from the day 69 onward higher BM (+10%, p<0.05), while the FI was higher (+17%, p<0.05) at day 145 onward. The leptin resistance test was performed at 30 and 180 days. Both group was subdivided into: CLEP and LEPLEP treated with leptin (0.5 mg / kg / ip PC); CSAL and LEPSAL treated with saline. The animals were sacrificed at 21, 30 and 180 days. We collected the VFM, carcass, blood (glycemia, leptin, total T3 and T4, TSH, insulin) and liver (GPDm activity). LEP offspring had higher T3 at 21 days, but not significant (p = 0.06) and when they were 30 days-old they already present leptin resistance and lower serum T3 (-20%,p<0.05). At 180 days they had higher VFM (+57%, p<0.05), total body fat (+40%, p<0.05), leptin resistance, hyperleptinemia (+1,35x, p<0.05) with normal 125I thyroid uptake, serum T4 and TSH and lower GPDm activity at 30 and 180 day (-42% and -57%,p< 0.05 respectively). So, the mother's hyperleptinaemia in the beginning of lactation programs as early as the 30 days-old offspring: leptin resistance and hypothyroidism, probably by a higher leptin transfer through the milk. We suggested that the levels of leptin in early lactation are determinants of the physiological regulation of energy balance in adulthood. We suggest that the programming effects are dependent on the way that leptin reaches the offspring. The present study seems more physiological and reproduces almost completely the programming effect in the adulthood when the mothers were leptin-injected at the end of lactation and, partially reproduces the effects when leptin was directally injected in the pups.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / As complicações metabólicas constituem uma característica importante da doença renal crônica (DRC) e podem comprometer o estado nutricional. O objetivo da presente dissertação foi avaliar estado nutricional e inflamatório de pacientes com DRC em tratamento conservador bem como avaliar as repercussões da variação do peso corporal sobre esses parâmetros durante esse período. Foram acompanhados 56 pacientes clinicamente estáveis nos estágios 3 e 4 da DRC (57% do sexo masculino; idade: 62,3 14 anos) que já seguiam uma dieta hipoprotéica e faziam acompanhamento no Ambulatório Multidisciplinar de Doenças Renais do Hospital Universitário Pedro Ernesto. Não foram incluídos pacientes com doença maligna, em tratamento com drogas imunossupressoras e com diabetes mellitus descompensado. O tempo de seguimento foi de 12 2 meses. Os parâmetros avaliados no início e após 12 meses foram: peso corporal, composição corporal, níveis séricos de albumina, glicose, colesterol total, triglicerídeos, proteína C-reativa (PCR) e leptina. Após 1 ano nenhum paciente apresentou diagnóstico de desnutrição energético-protéica (DEP) no início e ao término do estudo. Além disso, 21 pacientes diminuíram de peso corporal e 35 aumentaram. No Grupo Perda de Peso (GPerdaP) o índice de massa corporal (IMC) mudou de sobrepeso para eutrofia e no Grupo Ganho de Peso (GGanhoP), o IMC aumentou significantemente, porém sem alterar o estado nutricional de sobrepeso. Em ambos os grupos, o compartimento que mais se modificou foi à gordura corporal. No GPerdaP ocorreu uma diminuição significante da gordura corporal e do perímetro da cintura (PC) em ambos os sexos. No GGanhoP, notou-se aumento do mesmo parâmetro, porém sendo de forma significante para gordura corporal no sexo feminino e PC no sexo masculino. Em ambos os grupos os parâmetros de massa corporal não se alteraram significantemente. Com relação aos parâmetros metabólicos, no GPerdaP houve uma diminuição significante da glicemia e perfil lipídio. A PCR reduziu em 17%, mas não de forma significante e se aproximou dos valores indicativos de condição não inflamatória. No GGanhoP, houve um aumento estatístico da leptina, enquanto que a PCR não se alterou. Além disso, ao avaliar a associações univariadas no grupo total, o delta PCR se associou com o delta peso (r=0,39; P<0,05), delta IMC (r=0,39; P<0,05) e delta perímetro da cintura (r=0,33; P<0,05). A magnitude da associação entre o delta PCR com delta peso foi de 0,8 mg/L (P=0,008), ou seja, a variação de cada 1 kg peso corporal levou uma variação de 0,8 mg/dL de PCR. Com base nos achados desse trabalho, pode-se concluir que durante um ano de seguimento pacientes nos estágios 3 e 4 da DRC em acompanhamento clínico e nutricional, não se observou desenvolvimento de DEP, mesmo nos pacientes que perderam peso. A gordura corporal foi o compartimento corporal que mais sofreu modificação e a leptina aumentou apenas no pacientes que ganharam peso. Ademais, a variação de peso corporal apresentou um efeito em modificar a PCR. / Metabolic disturbances resulting from the decline of renal function are a common feature of chronic kidney disease (CKD). These complications may lead to changes in the nutritional status. The aim of this study is to evaluate whether CKD patients under conservative treatment show changes in the nutritional status and inflammation and also to assess whether changes in body weight will change these parameters. Fifty-six clinically stable patients with CKD stages 3 and 4 (57% male, age: 62.3 14 years) following a low protein diet and under treatment in a multidisciplinary CKD outpatient clinic were included. Patients with malignant disease, acute inflammation, taking immunosuppressive drugs and with non stable diabetes mellitus were not included. The mean duration of follow-up was 12 2 months. Participants had the following parameters assessed at baseline and after 12 months: body weight, body composition, serum levels of albumin, glucose, total cholesterol, triglycerides, C-reactive protein (CRP) and leptin. None of the patients had protein energy wasting (PEW) neither at baseline nor at the end of the study. In addition, 21 patients lost body weight (-7.0 to -0.2kg) and 35 gained body weight (0.2 to +9.7kg). In the Loss Body Weight Group (LossBWG) the body mass index (BMI) changed from overweight to the normal range and, in the Gain Body Weight Group (GainBWG), BMI increased significantly, but without changing the nutritional status classification overweight. In both groups, body fat was the body compartment most susceptible to changes. In the LossBWG a significant decrease in body fat occurred in males and females. Similarly, in the GainBWG an increase in body fat was observed, being significantly only in females. In both groups the body cell mass and phase angle did not change during the study. Regarding the metabolic parameters, in the LossBWG serum glucose, total cholesterol and triglycerides decreased significantly.In the LossBWG, although not significantly, CRP reduced by 17% and became close to the values indicative of a non-inflammatory state. In the GainBWG, there was a statistical increase in leptin, whereas CRP did not change. Moreover in the total group (n=56) there was a significant association between delta CRP and delta body weight (r=0.39, P<0.05), delta BMI (r=0.39, P<0.05) and delta waist circumference (r=0.33, P<0.05). The magnitude of the association between delta body weight and delta CRP was 0.8 mg/L (P = 0.008), meaning that the change of 1 kg body weight is associated with a change of 0.8 mg/L CRP. To summarize, in clinically stable patients on CKD stages 3 and 4 followed by one year, PEW was not developed, even in patients who lost body weight. In addition, body fat was the body compartment that suffered most changes during the follow-up. The serum leptin increased in patients that gained body weight. Moreover, the variation in body weight had an effect in modifying the CRP.

A hiperplasia prostática benigna (HPB) é a doença na qual a próstata demonstra um crescimento anormal e sua prevalência aumenta com o envelhecimento. Leptina, a adipocina mais notável, tem um importante papel na regulação do sistema reprodutivo. Esse trabalho tem por fim avaliar o papel da leptina no tecido prostático humano, utilizando a cultura de tecido in vitro, avaliando a proliferação celular e a expressão dos genes do fator de crescimento do fibroblasto 2 (FGF2), da enzima aromatase e dos genes apoptóticos. De 2009 a 2011, amostras de tecido hiperplásico humano foram obtidas pela prostatectomia transvesical em quinze pacientes com próstatas de volume aumentadas. Cada amostra foi dividida em quatro partes simétricas, mantidas no meio RPMI suplementado com soro fetal bovino a 10%, e 1ng/mL de gentamicina, adicionados a 16 ng/mL de leptina (Leptina) ou não (Controle). Após três horas a expressão dos genes de FGF2, aromatase, Bax, Bcl-x e Bcl-2 foram avaliados por RT-PCR em tempo real. A proliferação celular foi avaliada por imunohistoquímica para PCNA. O tratamento com leptina levou a um aumento na expressão de Bax (C=0.40.1; L=0.90.2; p<0.05), enquanto as expressões de Bcl-2 (C=19.95.6; L=5.61.8; p< 0.05) e Bcl-x (C=0.20.06; L=0.070.02; p<0.05) foram significativamente reduzidas. Não houve alteração significativa na expressão de FGF2, enquanto a expressão da aromatase foi significativamente (C=1.90.6; L=0.40.1; p<0.04) reduzida. A leptina também levou a um aumento na proliferação celular (C=21.80.5; L=64.80.9; p<0.0001). Dessa forma, concluímos que a leptina tem um importante papel na manutenção do crescimento fisiológico da próstata, desde que estimula tanto a proliferação celular como a apoptose, com diminuição na expressão do gene da aromatase. / The benign prostate hyperplasia (BPH) is the disease in which the prostate shows an abnormal growth and its prevalence rise up with aging. Leptin, the most well characterized adipokine, has an important role regulating the reproductive system. This paper aimed to evaluate the leptin role in the human prostate tissue, using an in vitro tissue culture system, on the cellular proliferation and the expression of fibroblast growth factor 2, aromatase enzyme and apoptotic genes. From 2009 to 2011, hyperplasic prostate tissue samples obtained by transvesical prostatectomy in fifteen patients with enlarged prostates were used. Each sample was divided in four symmetric parts which were maintained in RPMI medium supplemented with 10% fetal bovine serum, 1 ng/mL of gentamicin and added with 16 ng/mL leptin (L) or not (C). After 3 hours gene expression of FGF2, aromatase, Bax, Bcl-x and Bcl-2 were evaluated by Real Time RT-PCR. Cellular proliferation was evaluated by imunohistochemistry for PCNA. The leptin treatment led to an increase in the expression of Bax (C=0.40.1; L=0.90.2; p<0.05) while Bcl-2 (C=19.95.6; L=5.61.8; p< 0.05) and Bcl-x (C=0.20.06; L=0.070.02; p<0.05) expressions were significantly reduced. There was no significant alteration in the FGF2 expression, while the aromatase expression was significantly (C=1.90.6; L=0.40.1; p<0.04) reduced. Leptin also resulted in an increase in cellular proliferation (C=21.80.5; L=64.80.9; p<0.0001). The conclusion is that leptin has an important role in maintaining the physiological growth of the prostate since it stimulates both cellular proliferation and apoptosis, with the decrement in the aromatase gene expression

The impact was assessed of clinical and nutritional factors on prognosis of 107 oesophageal cancer patients treated with neoadjuvant chemoradiotherapy (CHRT) and surgery. Individualised nutritional support, according to grade of dysphagia was carried out in all the patients. Serum leptin, soluble leptin receptors (SLR), TNF, IGF and fatty acid (FA) profiles in plasma phosphatidylcholine (PC) were studied as well. Addition of paclitaxel to carboplatin and continual fluorouracil significantly increased toxicity without influencing efficacy of the treatment. Post-operative node negativity, grade of dysphagia, weight loss and serum albumin were proved to be prognostic factors of survival and time to progression. CHRT led to decrease of SLR, palmitoleic and oleic acid and increase of n-3 polyunsaturated FA in PC. Lower concentrations of SLR were associated with improved survival of the patients. Key words: oesophageal cancer, neoadjuvant chemoradiotherapy, weight loss, paclitaxel, albumin, soluble leptin receptor, fatty acids

Background: Excess white adipose tissue (WAT) in humans is considered as a harmful health index. However, increased brown adipose tissue (BAT) and brown-like adipose tissue activity are associated with increased resting energy expenditure (REE) that may help to control body weight. Exercise may enhance browning formation of WAT and reduce WAT that may lead to health improvements. Aims: a) to examine the effects of physical activity on the link between peroxisome proliferator-activated receptor gamma co-activator 1-alpha (PGC-1α) and fibronectin type III domaincontaining protein 5 (FNDC5) genes in muscle, circulating Irisin and uncoupling protein one (UCP1) of WAT in humans (study 1); b) to examine the relationship between UCP1 mRNA and protein expression as well as PGC-1α, peroxisome proliferatoractivated receptor alpha (PPARα) and PPARγ genes with physical activity levels in WAT of healthy men (study 2); c) to examine the effects of different types of exercise and de-training on the UCP1 mRNA and protein expression (study 3), and d) on leptin mRNA in WAT of healthy men (study 4). Method: Study 1: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses. Studies 2-4: The total of 46 healthy men subjected to measurements for physical activity levels, diet, anthropometry, body composition, REE, peak oxygen consumption, 1-repetition maximum and provided subcutaneous fat biopsies to determine mRNA and protein expression of six genes in one cross-sectional study and one randomized controlled trial. Results: Study 1: No link was found between PGC- 1α and FNDC5, circulating Irisin and UCP1 of WAT in response to physical activity. Study 2: The mRNA of, UCP1, PGC-1α, PPARα and PPARγ genes of WAT were not associated with physical activity levels. The UCP1 protein expression however, was negatively associated with physical activity levels. Studies 3-4: Different types of chronic exercise and de-training do not affect UCP1 mRNA and protein expression 3 and leptin mRNA in WAT. However, effect size analyses demonstrated increased UCP1 mRNA and protein expression, PPARγ and leptin in response to chronic exercise. Conclusions: There is no evidence to support the link between PGC-1α and FNDC5 in human muscle or the link between FNDC5 and circulating Irisin and UCP1 in WAT in response to exercise. There are no effects of exercise and de-training on browning formation of WAT and no link between browning formation indices and REE, body weight as well as leptin mRNA in healthy men. Further research is required to elaborate the aforementioned phenomena.

Introdução. A baixa capacidade aeróbia é um importante marcador de mau prognóstico e um forte preditor de risco de morte em pacientes encaminhados para o teste de esforço cardiopulmonar (TECP) por razões clínicas. O índice oxygen uptake efficiency slope (OUES), um novo índice de eficiência cardiorrespiratória, tem sido utilizado como marcador submáximo durante o TECP. Estudos recentes sugerem que a leptina pode desempenhar um papel importante na regulação da respiração e, consequentemente, o aumento dos níveis de leptina pode estar relacionado com a diminuição do OUES. No entanto, o impacto da síndrome metabólica (SMet) e da apneia obstrutiva do sono (AOS) no OUES é desconhecido. Objetivo. Investigar o comportamento do OUES em pacientes com SMet, associado ou não à AOS. Métodos. Foram estudados 73 pacientes com SMet (ATP-III), alocados em dois grupos de acordo com o índice de apneia/hipopneia (IAH) obtido na polissonografia noturna: SMet+AOS (IAH >= 15 eventos/hora, n=38, 49±1 anos, 33±0,6 kg/m2) e SMet-AOS (IAH < 15 eventos/hora, n=35, 46±1 anos, 31,8±0,6 kg/m2). Um grupo controle saudável (CS, n=20, 47±1 anos, 26,1±0,8 kg/m2), pareado por idade e gênero, foi também estudado. Os pacientes realizaram as seguintes avaliações: polissonografia; exames laboratoriais (glicemia, triglicérides, colesterol total e frações, leptina e proteína C-reativa); medidas antropométricas (altura, peso corporal, índice de massa corpórea, circunferência abdominal); composição corporal pela bioimpedância; medidas de pressão arterial; e TECP. Resultados. Ambos os grupos com SMet apresentaram prejuízo quando comparados ao grupo CS no peso, índice de massa corpórea e nos fatores de risco da SMet (circunferência abdominal, glicemia, triglicérides, HDL-c e pressão arterial sistólica e diastólica, P < 0,05). No TECP os grupos SMet+AOS e SMet-AOS apresentaram menores valores de consumo de oxigênio pico (VO2pico, 22,2±0,7; 21,7±0,9 e 28,0±1,1 ml/kg/min, respectivamente, Interação; P < 0,001) comparados com CS. Da mesma forma, os grupos SMet tiveram menores: VO2 no limiar anaeróbio (VO2LA), na relação VO2 e carga de trabalho (deltaVO2/deltaW) e no OUES (25,3±0,8; 25,0±0,9 e 31,1±1,2; Interação; P < 0.001) quando comparado com CS. Em análises posteriores, o OUES se correlacionou apenas com a massa gorda e com a leptina (R=-0,35; P=0,006). Conclusão. Independente da presença da AOS, pacientes com SMet apresentam diminuição da eficiência cardiorrespiratória. Os níveis elevados de leptina pode ser uma das explicações para essa diminuição nesses pacientes / Introduction. Low aerobic capacity is an important marker of poor prognosis and a strong predictor of risk of death in patients referred for cardiopulmonary exercise testing (CPET) for clinical reasons. The oxygen uptake efficiency slopes (OUES), a new cardiorespiratory efficiency index, has been used as a submaximal marker during CPET. Recent studies suggest that leptin may play an important role in regulating respiration, and consequently, increased levels of leptin may be related to decreased OUES. However, the impact of metabolic syndrome (MetS) and obstructive sleep apnea (OSA) in the OUES is unknown. Objective. To investigate the OUES in MetS patients with or without OSA. Methods. We studied 73 patients with MetS (ATP-III), allocated into two groups according to apnea/hypopnea index (AHI), assessed by nocturnal polysomnography: MetS+OSA (AHI >= 15 events/hour, n=38, 49±1 years, 33±0.6 kg/m2) and MetS-OSA (AHI < 15 events/hour, n=35, 46±1 years, 32±0.6 kg/m2). A healthy control group (CG, n=20, 47±1 years, 26.1±0.8 kg/m2), matched for age and gender, was also studied. The patients performed the following evaluations: polysomnography; Laboratory tests (glycemia, triglycerides, total cholesterol and fractions, leptin and C-reactive protein); Anthropometric measurements (height, body weight, body mass index, waist circumference); Body composition by bioimpedance; Blood pressure measurements; and CPET. Results. Both MetS groups had impairment in weight, body mass index, and MetS risk factors (waist circumference, glycemia, triglycerides, HDL-c and systolic and diastolic blood pressure, P < 0.05) compared with CG. MetS+OSA and MetS-OSA groups presented lower values of peak oxygen consumption (VO2peak, 22.2±0.7, 21.7±0.9 and 28.0±1.1 ml/kg/min, respectively; Interaction; P < 0.001) compared to CG. In the same way, MetS groups had lowest: VO2 at anaerobic threshold (VO2LA), ratio of VO2 and workload (deltaVO2/deltaW) and OUES (25.3±0.8, 25.0±0.9 and 31.1±1.2, Interaction; P < 0.001) compared with CG. In further analyzes, OUES correlated only with fat mass and leptin (R =-0.35, P =0.006). Conclusion. Regardless of the presence of OSA, MetS patients present decreased cardiorespiratory efficiency. Elevated levels of leptin may be one of the explanations for this decrease in these patients