Dentre a gama de estudos existentes acerca das respostas de plantas ao incremento de CO2 atmosférico associado às mudanças climáticas, são poucas as investigações que contemplam espécies amazônicas frente à relevância desse ecossistema, e se desconhecem estudos desse aspecto com palmeiras. O açaí (Euterpe oleracea Mart., Arecaceae) é uma espécie típica de planícies da Floresta Amazônica sujeitas ao regime anual de inundação e, além de ser extremamente tolerante à anóxia, apresenta elevado valor comercial e um potencial para a produção de energia a partir de biomassa, gerando uma exploração economicamente sustentável. Este trabalho buscou caracterizar o crescimento inicial de plântulas de açaí quanto à fotossíntese, crescimento e metabolismo de carboidratos e investigar as respostas desses parâmetros ao incremento de CO2 atmosférico (de 380ppm - ambiente para 760ppm - elevado) em duas escalas temporais: ao longo do desenvolvimento das plântulas (entre 105 e 195 dias após a germinação, período de desenvolvimento da segunda folha) e ao longo de 24 horas (aos 175 dias após a germinação). Foram analisadas medidas de altura, área foliar, acúmulo e alocação de biomassa, curvas de resposta da fotossíntese à luz, conteúdo de clorofila e concentração de carboidratos não-estruturais. Foi verificado que o período de estabelecimento das plântulas se estende até cerca de 150 dias após a germinação e se sobrepôs ao experimento com elevado CO2. A presença de outra via de entrada de carbono além da fotossíntese tamponou mas não inibiu os efeitos do aumento de CO2 atmosférico. Foram observadas ao longo do experimento reduções na área foliar, condutância estomática e respiração no escuro e aumentos na fotossíntese e eficiência de uso da água, além de aumento na concentração de carboidratos não-estruturais e na biomassa. Os dados obtidos após o esgotamento das reservas do endosperma não apresentaram sinais de que a planta aclimatará ao incremento de CO2, pois aos 90 dias de experimento foram observadas as maiores porcentagens de aumento na fotossíntese, 89%, e no teor de amido, 300%. Esses resultados indicam que essa espécie apresenta uma grande capacidade de aumento da força de dreno, o que diminui a sinalização por açúcares possibilitando a manutenção de uma resposta positiva ao incremento de CO2 atmosférico / Despite all knowledge available nowadays on plant responses to increasing atmospheric CO2, few are the studies that focus on Amazonian species in contrast to the biological relevance of this ecosystem, and no record has been found of Palm species analysis on this area of research. Açaí palm (Euterpe oleracea Mart., Arecaceae) is a typical species of Amazon plains subjected to annual periods of flooding. Apart from being extremely anoxia tolerant, this species presents high commercial value and a potential of energy production through biomass utilization, counting towards a sustainable economic exploitation. This study aimed to characterize the initial growth of açaí palm seedlings as for photosynthesis, growth and carbohydrate metabolism and to investigate these parameters\' responses to an increase on atmospheric CO2 (from 380ppm - ambient to 760ppm - elevated) on two temporal scales: throughout seedling development (from 105 to 195 days post germination, time span of second leaf development) and throughout 24 hours (at 175 days post germination). Analysis included: height, leaf area, biomass increase and allocation, light-response curves, chlorophyll content and non-structural carbohydrate concentration. It was observed that the seedling establishment period extends to 150 days post germination and overlapped the elevated CO2 experiment. The presence of another carbon entry pathway besides photosynthesis buffered the effects of elevated CO2, but did not inhibit them. Results observed were reductions on leaf area, stomatal conductance and dark respiration and increases on photosynthesis, water use efficiency, non-structural carbohydrate content and biomass. The results obtained after seed reserves were depleted did not seem to indicate that this species will present acclimation to elevated CO2, since the greater percentages of increase on photosynthesis (89%) and starch content (300%) occurred at the end of the experiment (90 days on elevated CO2). These results indicate that açaí palm seedlings have a large capacity of sink strenght increase, which reduces sugar signaling and maintains a positive response to the increase on atmospheric CO2

A manga é um fruto ainda considerado exótico, onde quase tudo relativo ao seu amadurecimento está por ser esclarecido. Pouco se conhece da sua fisiologia e bioquímica pós colheita. Os objetivos deste trabalho foram avaliar algumas variedades de mangas durante o crescimento e amadurecimento; quanto aos açúcares solúveis, amido e ácido ascórbico; a atividade das enzimas sacarose-fosfato sintase e sacarose sintase durante este mesmo período na manga Van Dyke e o perfil de respiração e etileno das variedades Van Dyke, Tommy Atkins e Haden após a colheita. Os resultados mostraram que os perfis dos açúcares solúveis relativos ao adoçamento e seu metabolismo são altamente dependentes do cultivar e da maturidade fisiológica da manga. A sacarose foi o açúcar predominante em todas as variedades analisadas, sendo que o maior valor encontrado foi de aproximadamente 5% na manga Van Dyke. A frutose foi a hexose predominante na manga madura, e sua relação com a glicose variou de 2,5 a 48 vezes. Os teores de amido existentes quando a manga é colhida, independente da variedade, são muito baixos, menores que 3,0%. As enzimas ligadas ao metabolismo da sacarose, saca rose-fosfato sintase (SPS) e sacarose sintase (SS), tiveram a atividade aumentada na fase de amadurecimento pós colheita no cultivar Van Dyke. O teor de ácido ascórbico, na maioria das variedades diminuiu antes da colheita, exceto a manga Keitt e a manga Tommy Atkins, sendo esta a que apresentou maior teor de ácido ascórbico no fruto maduro. Não houve produção de etileno após o ponto de colheita, e foi encontrado mais de um pico de respiração nas mangas Haden e Van Dyke, resultado atípico de outros frutos climatéricos. / The mango ripening process and the associated physiological and biochemical changes is still poorly known. Also is unknown if the bulk of sugar is accumulated prior or after the onset of ripening. The aim of this work was to evaluate the soluble sugars, starch and ascorbic acid content during the growth and ripening of several mango varietes. The sucrose-phosphate synthase (SPS) and sucrose synthase (SS) activities were evaluated in Van Dyke mango variety. The post harvest respiration and ethylene profiles of the Van Dyke, Tommy Atkins and Haden varieties were analyzed after harvesting. The results shown that the changes on total sugar profiles were highly dependent on the cultivar and physiogical maturity. Sucrose was the predominant sugar in ali analyzed varieties. The fructose amount was 2,5 to 48 times higher than glucose being the predominant hexoses in ripe fruit. The starch content of any variety of harvested mango is too low, with values under 3,0%. The sucrose related enzymes (SPS and SS), showed an increasing activity during the post-harvest ripening of Van Dyke\'s cultivar. For most varieties, the ascorbic acid content decreased before the harvest point, except for Keitt and Tommy Atkins mangos. The highest ascorbic acid content was found in the ripened Tommy fruit. One increase in the ethylene was not detected after harvesting. More than one respiration peak was detected for Haden and Van Dyke\'s varieties, this result is different of the other climacteric fruit\'s one.

A banana é considerada um bom modelo de estudo para a transformação amido-sacarose, já que acumula um teor alto de amido durante o desenvolvimento, que é degradado durante o amadurecimento. Já foram detectadas em polpa de banana atividade e proteína relativa a várias enzimas supostamente envolvidas no processo de degradação do amido. Entre elas, a α-amilase, a β-amilase, a amido fosforilase e as glucano-água-diquinases (GWD). Estas enzimas estão envolvidas em dois processos distintos de degradação de amido em plantas: o dependente da ação inicial da α-amilase e o dependente da fosforilação do grânulo pela GWD e PWD e posterior ação da β-amilase. A dificuldade do estabelecimento da participação efetiva de cada enzima no processo de degradação do amido está associada a muitos fatores, entre eles a não-correlação entre atividade e real envolvimento em um processo, e a acessibilidade da enzima ao seu substrato. Aliado ao estudo da morfologia do grânulo de amido e suas modificações sofridas durante o processo de degradação que ocorre durante o amadurecimento do fruto, estudos in vitro que simulem a ação da enzima sobre o seu substrato poderiam ser mais efetivos no estabelecimento da real ação de dada enzima sobre o suposto substrato. Tentativas no sentido de obter as proteínas relativa à degradação não foram bem sucedidas. Assim, os ensaios de grânulos de amido isolados versus enzimas foram feitos com α-amilase e β-amilase comerciais. O grau de fosforilação da amilopectina nas posições Glic-6 e Glic-3 foi determinado, condição necessária para o início da degradação do grânulo pela β-amilase. Os resultados mostraram que os grânulos de amido isolados de bananas recém colhidas, ou verdes, já estão fosforilados e as enzimas responsáveis por esta fosforilação estão associadas aos grânulos. Após 72 h de incubação dos grânulos de amido com as enzimas hidrolítica, os grânulos foram separados do tampão contendo as enzimas e os produtos de hidrólise. Os sobrenadantes foram analisados por cromatografia líquida acoplada a detector amperométrico e os grânulos por Microscopia Eletrônica de Varredura (MEV) e microscopia de força atômica (MFA). Os resultados mostraram que a α-amilase hidrolisa preferencialmente regiões amorfas dos grânulos, com predominância de amilose, expondo as regiões mais cristalinas dos anéis de crescimento, enquanto que a β-amilase parece atuar preferencialmente nas regiões cristalinas dos grânulos, degradando os bloquetes, que são formados por amilopectina. Pode-se concluir que ambas as enzimas parecem ser importantes no processo de degradação do amido da banana, com diferentes especificidades. / Banana is considered a good model to study the starch-sucrose metabolism, since it accumulates a high starch content during development, which is degraded during fruit ripening. It have been detected in banana pulp some proteins and activities of several enzymes supposedly involved in starch degradation process. Among them, α-amylase, β-amylase, starch phosphorylase and glucan-water-diquinases (GWD). These enzymes are involved in two separate processes of starch degradation in plants: the initial action of α-amylase dependent, and the starch granule phosphorylation by GWD and PWD enzymes and subsequent action of β-amylase. The difficulty of establishing the effective participation of each enzyme in the starch degradation process is associated with many factors, including the lack of correlation between real activity and involvement in the process, and accessibility of the enzyme to its substrate. Allied to study the morphology of the starch granule and its modifications suffered during the process of degradation, which occurs during the fruit ripening, in vitro studies that simulate the action of the enzyme on its substrate could be more effective in establishing the real action of a given enzyme on the argued substrate. However, attempts to obtain the proteins related to the degradation process were unsuccessful. Thus, assays of isolated starch granules versus enzymes were made with commercial α-amylase and β-amylase enzymes. The degree of phosphorylation of amylopectin in the Gluc-6 and Gluc-3 positions was determined, a necessary condition for the start of degradation by β-amylase enzyme. The results showed that the starch granules isolated from freshly harvested bananas, or green, are already phosphorylated and the enzymes responsible for this phosphorylation is associated with the starch granules surface. After 72 h incubation of the starch granules with the hydrolytic enzymes, the granules were separated from the buffer containing the enzymes and the hydrolysis products. The supernatants were analyzed by liquid chromatography coupled with amperometric detector and the granules were visualized by scanning electron microscopy (SEM) and atomic force microscopy (AFM). The results showed that the α-amylase preferentially hydrolyzes amorphous regions of the granule, especially amylose, exposing more crystalline regions of the growth rings, whereas β-amylase appears to act preferentially on crystalline regions of the granule, degrading blocklets that consist of amylopectin. It can be concluded that both enzymes appear to be important in the banana starch degradation process, with different specificities.

O presente estudo teve como objetivo a caracterização das frações protéicas e de carboidratos em pastagem de capim-elefante (Pennisetum purpureum cv. Cameroon), manejada com altas taxas de lotação no período das águas. O experimento foi realizado nas instalações do Departamento de Zootecnia da Esalq/USP. A forragem foi coletada nas estações do outono/2006, primavera/2006 e verão/2006-07, adotando-se intervalos de desfolhação fixos de 27 dias e variáveis, onde a entrada dos animais ocorreu quando o capim atingiu 1,05 m de altura (95 % IL). Foi determinada a composição bromatológica, frações protéicas e de carboidratos tanto por métodos químicos quanto pelo método de degradação in situ da forragem. A pastagem também foi avaliada quanto à massa de forragem (kg de MS por ha-1), composição morfológica e alturas do dossel na entrada e saída dos animais. Para as determinações no pasto utilizou-se o delineamento inteiramente aleatorizado com medidas repetidas no tempo. Para as frações protéicas A, B e C, foi realizado ensaio de degradabilidade in situ utilizando-se 4 garrotes castrados e canulados no rúmen. As amostras de forragem secas e moídas a 5 mm foram acondicionadas em sacos de nylon e incubadas no rúmen por 0, 3, 6, 12, 24, 48, 60, 72, 96 e 120 horas. O delineamento experimental foi em quadrados latinos 2x2 replicados. A duração do intervalo entre desfolhas não diferiu entre os tratamentos (P>0,05), em nenhuma das estações avaliadas. As alturas do dossel no pré-pastejo foram maiores (P<0,05) nos tratamentos com ID variável. Para altura do dossel em pós-pastejo, houve efeito somente da estação (P<0,05), com menores alturas na primavera (0,43 e 0,51 m), e maiores no verão (0,56 e 0,57 m) para os tratamentos com ID fixo e variável. Não foi verificada diferença (P>0,05) para produção de forragem entre os tratamentos. Apenas os teores de PB da forragem foram afetados pelos tratamentos (P<0,05), com menores valores para ID variável. Os teores de MS, FDN, FDA, lignina e PIDA não diferiram (P>0,05) entre os tratamentos. Somente a fração protéica B2 foi afetada, com maiores valores para ID variável (P<0,05). As frações A e B3 diferiram nas estações do ano (P<0,05), com o outono apresentando menores valores de A e maiores da B3. Não houve diferença para as frações B1 e C (P>0,05). No verão, a fração A+B1 dos carboidratos apresentou os menores valores dentre as estações (13,80 e 16,22 % para ID fixo e variável), e a fração B2, os maiores valores (76,59 e 73,42 %) (P<0,05). Não houve diferenças (P>0,05) para as variáveis de degradabilidade da MS e MO. Na degradabilidade da FDN, diferenças significativas foram observadas apenas para variável de DP e DE com taxa de passagem de 2 %/h no tratamento com ID fixo. A correção da contaminação microbiana resultou em aumento nos valores da fração protéica A e redução na B. Não houve efeito (P>0,05) para as variáveis da PB corrigida pela contaminação, exceto para a fração B, onde os valores foram maiores no outono (73,3 e 73,69%) e menores na primavera com ID variáveis (55,87%). / The present study designed to characerize the protein and carbohydrate fractions of elephant grass pasture (Pennisetum purpureum) cv. Cameroon, intensively grazed at high stocking rate during the rainy season. The experiment was carried in the Animal Sciences Department of the University of São Paulo (USP/ESALQ). Forage samples were collected during autumn and spring/2006 and summer/2006-07. Two defoliation intervals (DI) were adopted, fixed and variable. For the fixed DI treatment experimental animals had access to the paddocks every 27 days, and for the variable DI treatment experimental animals had access to the paddocks when the sward reached 1,05m height, corresponding to 95% light interception. Forage samples were analyzed for chemical composition and protein and carbohydrate fractions by chemical methods and with \"in situ\" degradation technique. Pasture was also analyzed for pre-grazing forage mass (kg DM ha-1) , morphologic composition, pre and post grazing sward heights. A completely randomized design with repeated measures was used for pasture determinations. For protein fractions (A, B, C) determinations, an in situ trial was developed using four rumen canulated steers. 5mm ground forage samples were conditioned in nylon bags and incubated in the rumen for 0, 3, 6, 12, 24, 48, 60, 72, 96 and 120 hours. The experimental design was a replicated 2x2 Latin square. The defoliation interval length did not differ (P>0,05) among treatments, in any season. Pre-grazing sward heights were higher (P<0,05) for the variable DI treatment. A season effect (P<0,05) was observed for post-grazing heights, with lower values observed on spring (0,43 and 0,51m) and higher on summer (0,56 and 0,57m) for both treatments. No differences (P>0,05) were observed among treatments for total forage mass. Only forage CP content was affected by treatments, with lower values (P<0,05) for variable DI. DM, NDF, ADF, lignin and ADIN were not different (P>0,05) among treatments. Protein B2 fraction was affected, showing higher values (P<0,05) for variable DI treatment. Fractions A and B3 were different among seasons, with lower fraction A and higher fraction B3 values during autumn (P<0,05). No differences were observed for fractions B1 and C (P>0,05). During summer carbohydrate fractions A + B1 showed the lowest values among seasons (13,80 and 16,22% for fixed and variable DI), and B2 fraction showed the highest values (76,59 and 73,42 %) (P<0,05). No differences were observed for DM and OM degradabilities variables (P>0,05). For NDF degradability significant differences were observed only PD and ED variables with 2%/h passage rate for fixed DI treatment. Microbial contamination adjustment resulted in higher protein A and lower protein B fraction values. No effects were observed (P>0,05) for microbial contamination adjusted CP variables, except for B fraction that showed higher values during autumn (73,3 and 73,69%) and lower during spring with variable DI (55,87%).

Bakgrund: Diagnostiserade fall av personer med typ 1-diabetes ökar globalt och komplikationer kan uppstå i samband med sjukdomen. Lågkolhydratkost har visat sig vara en potentiell metod för att förbättra blodsockerreglering. Sjuksköterskor ansvarar för kostrådgivning och därav behövs mer kunskap om ämnet då det vetenskapliga underlaget är otillräckligt. Syfte: Uppsatsens syfte var att undersöka påverkan av lågkolhydratkost hos personer med typ 1-diabetes. Metod: En litteraturstudie av 10 vetenskapliga artiklar genomfördes med en induktiv ansats. Resultat: Följande huvudkategorier presenterades i studiens resultat: kroppsliga förändringar och upplevelser. Underkategorierna var: blodsocker, insulin, blodfetter, ketoner, vikt och BMI, vitalparametrar, positiva erfarenheter och utmaningar. Effekter av lågkolhydratkost varierade avseende blodsocker, insulin, blodfetter, vikt och blodtryck. BMI förbättrades, ketonnivåer höjdes och diabetes ketoacidos förekom i samband med lågkolhydratkost. Erfarenheter av lågkolhydratkost varierade. Konklusion: Sjuksköterskor och sjuksköterskestudenter behöver information om lågkolhydratkost och typ 1-diabetes. På så sätt kan adekvat information, evidensbaserad vård och personcentrerad vård erbjudas till personer med typ 1- diabetes. / Background: Diagnosed cases of people with type 1 diabetes are growing globally and complications can occur in correlation with the disease. Low carbohydrate diets have shown to be a potential method to improve blood sugar regulation. Nurses are responsible for dietary advice and therefore more knowledge is needed on the subject as the scientific basis is insufficient. Aim: The aim of this thesis was to examine the impact of a low carbohydrate diet for people with type 1 diabetes. Method: A literature study of 10 scientific articles was conducted with an inductive approach. Results: The following main categories was presented: bodily changes and experiences. The subcategories were: blood sugar, insulin, blood fats, ketones, weight and BMI, vital parameters, positive experiences and challenges. The effects of low carbohydrate diets varied regarding blood sugar, insulin, blood fats, weight and blood pressure. BMI improved, ketone levels were raised, diabetic ketoacidosis occurred and experiences with a low-carbohydrate diet varied. Conclusion: Nurses and nursing students need information about low carbohydrate diets and type 1 diabetes. In this way adequate information, evidence-based care and person-centered care can be offered to people with type 1 diabetes.

The purpose of this study was to examine the effects of a recovery supplement compared with a placebo on muscle morphology in trained weightlifters. Vastus lateralis and muscle fiber cross sectional area of type I and type II fibers were compared between groups using a series of 2 × 2 (group × time) repeated measure ANOVAs. Both groups on average improved cross-sectional area of the vastus lateralis, type I and type II muscle fibers from pre-to-post but individual response varied within both groups. Greater magnitude of changes in type I and type II muscle fibers were observed for the placebo group but not for vastus lateralis cross sectional area. Additionally, subjects were divided into large and small fiber groups based on combined fiber size at the start of the investigation. These findings indicate that the recovery supplement utilized provided no greater effect compared with a placebo in a 12-week block periodization protocol in trained weightlifters. The primary determinate of fiber size changes in the study was determined to be the initial fiber size of muscle fibers with larger practical changes observed in the small fiber group compared with the large fiber group in type I, II, and ultrasound cross-sectional area (CSA).

<p>As obesity has become one of the most prevalent metabolic diseases, and diabetes mellitus has become the seventh leading causes of death in the United States, alternative food/nutrition-based approaches to tackle obesity that are both efficacious and cost effective are in high demand. Since starch and its derived products are the principal dietary supply of glucose, strategies of using slowly digestible starch to achieve moderated glycemic response and prolonged glucose delivery, as well as to locationally digest starch into the ileum, have shown successful results such as moderation of insulinemia and reducing food intake in obese animals. An important regulator of appetite suppression is the neuroendocrine system of the gut-brain axis. Glucagon-like peptide-1 (GLP-1), oxyntomodulin (OXM), and peptide YY (PYY) are the main anorexigenic peptide products of the intestinal enterendocrine L-cells that regulate postprandial insulin levels as well as satiety signals. The stimulation of the enteroendocrine L-cells throughout the gastrointestinal tract through glucose, fatty acids and proteins has been extensively studied and confirmed. However, the stimulatory effect of complex dietary carbohydrates on L-cells is not described. In this dissertation, we investigated the <i>in vitro</i> intestinal cell chemosensation of L-cells to α-amylase starch digestion products, named maltooligosaccharides (MOS), and in the possible application of using slowly digestible starch delivery of MOS <i>in vivo</i>.</p> <p>In Chapter II of this dissertation, we reported a significantly higher stimulatory effect of MOS on GLP-1 and OXM secretion compared to glucose in mouse and human L-cells, respectively. Additionally, maltotriose enhanced the relative expression of the gastrointestinal peptide, cholecystokinin. Moreover, MOS exhibited protective effects on barrier function and monolayer integrity of intestinal epithelial cells. </p> <p>In Chapters III and IV, we performed a multiomics approach where transcriptomic analysis and global protein profiling of mouse L-cells treated with different types of MOS showed that the carbohydrates exhibit their effects through the induction of exocytosis of GLP-1- or OXM-containing vesicles and not through a positive regulation of the proglucagon gene expression. It is suggested that MOS induce higher secretion, but not higher synthesis, of the proglucagon gene products. In addition, maltotriose treatment downregulated the relative expression of the glucotoxicity marker, thioredoxin-interacting protein, and upregulated the relative expression of tight junction proteins supporting a role of MOS in barrier function integrity.</p> <p>Translating the <i>in vitro</i> findings into an <i>in vivo</i> application that is beneficial for human health required the use of controllable tool for the delivery of MOS throughout the small intestine for sensing by a higher number of L-cells. Slowly digestible starch (SDS), compared to rapidly digestible starch, provided such a tool. For this purpose, we used alginate-entrapped SDS microspheres that digest distally into the ileum to examine the role of SDS in the intervention and prevention of obesity in C57BL/6J diet-induced obese (DIO) and lean mice models.</p> <p>Results showed that 20% SDS in low-fat diets significantly improved weight loss and food intake reduction in DIO mice converted to low-fat diet for 12 weeks. Similarly, 15% SDS in high-fat diets showed significant reduction in body fat percent and significant increase in lean body mass as well as considerable reduction in weight gain rate and food intake in lean mice fed on 45% of calories high-fat diet. Immunohistochemistry of small intestine of mice in both the intervention and prevention studies revealed an even and thorough distribution of GLP-1 positive L-cells.</p> <p>Overall, this dissertation proposes several insights into L-cell sensation of dietary starch-degraded MOS delivered by the consumption of slowly digestible starch. MOS exhibit unique influences on L-cell sensitivity and gut hormone productivity. Future research investigating the mechanisms of intestinal sensing of MOS, as well as the development of bioactive carbohydrate structures that could preserve body weight and modulate glucose tolerance <i>in vivo</i> is needed to translate these findings into nutritional recommendations and food products beneficial for human health. The intricate role of dietary carbohydrates on gut physiological response, related to satiety and food intake could be a new approach for design of foods for health applications.</p>

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Bakgrund: Illamående, kräkningar, smärta, muntorrhet, törst och hunger är vanliga postoperativa komplikationer som patienter upplever obehagliga och påfrestande vilket leder till lidande och försämrat välbefinnande. Preoperativ fasta är rutin i många verksamheter trots att forskning visar att det inte är nödvändigt. I riktlinjer för nutrition i samband med kirurgi beskrivs att preoperativ kolhydratrik dryck kan användas för att minska katabolism och insulinresistens postoperativt. Syfte: Att beskriva om, och i så fall i vilken utsträckning, preoperativ kolhydratrik dryck kan förbättra välbefinnandet postoperativt hos vuxna efter elektiv kirurgi. Metod: En litteraturöversikt med deskriptiv design som presenterar 13 randomiserade kontrollerade studier.  Resultat: Effekten av interventionen vid postoperativt illamående och kräkningar kunde inte helt klargöras. Muntorrhet, törst och hunger visade sig minska signifikant i flertalet studier bland patienter som intagit en kolhydratrik dryck preoperativt. Inget tydligt resultat kunde påvisas vid smärta eller övriga utfall för välbefinnande som översikten undersökt.  Slutsats: Preoperativ kolhydratrik dryck kan bidra till bättre välbefinnande postoperativt gällande muntorrhet, törst och hunger hos kirurgiska patienter. Däremot kan interventionens effekt på postoperativt illamående, kräkningar och smärta inte helt klargöras då endast en tredjedel av inkluderade studier visar på signifikant minskning i interventionsgruppen. Sammantaget kan det konstateras att preoperativ kolhydratrik dryck bör administreras inför kirurgi då det till viss del kan öka välbefinnandet och minska lidandet postoperativt. / Background: Nausea, vomiting, pain, mouth dryness, and hunger are common postoperative complications that patients experience as unpleasant and testing. These variables are connected to suffering and decreased wellbeing. Standardised fasting routine is commonly used in a large number of areas despite the fact that research has proven this to be an unnecessary practice. Nutritional guidelines in surgery describe that preoperative oral carbohydrate drinks can be used to decrease catabolism and insulin resistance postoperatively. Aim: The purpose of this study aims to investigate whether, and to what extent, preoperative oral carbohydrate drinks can improve postoperative well-being in adults undergoing elective surgery. Method: A descriptive literature review of thirteen randomised control trials. Results: The influence of intervention in postoperative nausea and vomiting could not be determined. The symptoms of mouth dryness, thirst, and hunger were significantly lower in several studies among patients who received preoperative oral carbohydrate drinks. Examination of pain and other potential variables of well-being showed no conclusive results. Conclusion: Preoperative carbohydrate drinks can improve postoperative well-being significantly, particularly in mouth dryness, thirst, and hunger for surgical patients. The influence of intervention on postoperative nausea, vomiting and pain could not be determined since only one-third of the included studies presented a significant decrease in the aforementioned variables. Therefore, preoperative carbohydrate drinks should be administered preoperatively as a procedure in order to increase well-being and reduce suffering postoperatively to some extent.

Low carbohydrate diets have been studied for many years as nutritional therapy for treating patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes is an inflammatory disease that is defined by high blood glucose and HbA1c, lipid levels, BMI, central adiposity, and cholesterol levels, are some among the many indicators that can signal risk for diabetes or help to diagnose diabetes. These indicators are used in studies to evaluate the effectiveness of the nutritional therapy in producing positive health outcomes. Many medications are available for the treatment of T2DM; however, they have a host of side effects, and nutritional therapy has been shown to at least help reduce the dosage of these medications needed by the patients. There are other forms of nutritional therapy besides low carbohydrate diets, and some controversy remains about low carbohydrate diets that in the long term, replacing carbohydrates with fats and proteins could result in increased cholesterol and lipid levels, creating an increased risk for cardiovascular disease. Although some studies have found that low carbohydrate diets, especially very low carbohydrate ketogenic diets (VLCK), do result in increased cholesterol, it is generally an increase in HDL, which is considered good cholesterol and not harmful. Overall weight loss benefits from reduced central adiposity, BMI, and reduced HbA1c levels outweigh the increase in HDL as a side effect. A few different variations of low carbohydrate diets are compared in this review, such as very low carbohydrate ketogenic diets, moderate carbohydrate calorie restricted diets, and moderate carbohydrate low (MCD) Glycemic Index (GI) diets. Due to the ability to exchange carbohydrates with high GI for carbohydrates with low GI, the MCD with low GI sounds promising for good adherence and positive health outcomes in the long run. Although very low carbohydrate ketogenic diets produce many positive health outcomes, the nutritional therapy must be very well designed and followed up, and care must be taken that fiber and nutrients are maintained in the diet. Adherence is a key part of the success of nutritional therapy and a study design plays a major role in that. Providing behavioral development classes, nutritional information classes, and intermittent classes focused on physical activity and healthy habit formation leads to overall increased positive affect which is better for the patient and thus, for the study as well. The easier the nutritionist or dietician can make the therapy transition for the participant, the more likely they are also to stay and try to stick with it. For example, in the studies where the study coordinator provided some small food provisions at the beginning or throughout the study seemed to be successful because the patients were less likely to fall to making their own choices poorly and being inconsistent. Although there were many diets that resulted in many positive health outcomes, ultimately a well-designed, adherence focused, very low carbohydrate ketogenic diet seemed to be the most effective at decreasing HbA1c and producing other positive health outcomes as well. In the long term however, a VLCKD, may be unsustainable for the patient and the body, given the extreme reduction in important carbohydrates.