Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / The monoterpenes &#945;- and &#946;-pinene are constituents commonly found in several essential oils obtained from plants in Brazilian northeast such as âmalva-santaâ and âeucaliptoâ, which are used in folk medicine to treat respiratory and gastrointestinal dysfunctions. Myorelaxant actions are due to the presence of these constituents in their essential oils. The present work aimed to further study the pharmacological effects of these compounds on smooth muscle gastrointestinal contractility as well as on liquid gastric emptying in rats. Wistar rats (200-250 g) were used, sacrificed by cervical dislocation. Strips were carefully obtained from gastric fundus, duodenum and ileum, and were maintained in Tyrodeâs solution. Isometric contractions were recorded through force transducers coupled to a computerized data acquisition system. Solutions containing &#945;- or &#946;-pinene were prepared with Tween 80 (final concentration &#8804; 0,2% v/v). Solely used, &#945;- or &#946;-pinene decreased duodenal basal tonus with IC50 value corresponding to 655.1 ÂM and 810.2 ÂM, respectively. Submaximal contractions induced by K+ (60 mM, K60) or acetylcholine (ACh, 3 ÂM) were inhibited, in a concentration-dependent manner (p < 0.001, ANOVA), with IC50 values of 790.0 [580.2-1007.4] e 760.0 [650.6-870.8] ÂM, respectively to &#945;-pinene and 770.1 [500.3-1180.5] e 620.7 [520.9-750.2] ÂM, respectively to &#946;-pinene. In tissues pre-treated with &#945;- (1 mM) or &#946;-pinene (1 mM) in medium without Ca2+ with EGTA (0.2 mM), ACh (3 ÂM)-induced phasic contractions were inhibited from 18.4  3.3% to 7.7  1.5% and 5.0  1.2% of K60, respectively. In tissues maintained under Ca2+-free conditions (in medium containing EGTA 0.2 mM) and in presence of K+ (60 mM) or ACh (3 ÂM), tonic contractions induced by Ca2+ addition were reduced from 50.2  3.3% and 53.9  5.2%, respectively to values corresponding to 10.6  2.6 % and 24.4  4.1 % to experiments with &#945;-pinene and 6.6  1.1 % and 10.9  3.5 % to experiments with &#946;-pinene, respectively. In tissues pre-treated with &#945;- (1 mM) or &#946;-pinene (1 mM), ACh (60 ÂM)-induced tonic contractions, in verapamil (3 ÂM)-containing medium, were inhibited from 29.0  4.1 % to 10.6  2.7 % and 12.5  2.2 % of the K60, respectively. The caffeine (20 mM)-induced contractile response in normal Tyrodeâs solution was potentiated from 47.8  3.2 % to 72.1  9.0 and 88.8  10.6 % of the control response in virtue of &#945;- (1 mM) or &#946;-pinene (1 mM) presence, respectively. In EGTA-containing Ca2+-free medium, the contractile response to caffeine was reduced to 9.5  3.5%. Under these conditions, and in presence of &#945;- (1 mM) or &#946;-pinene (1 mM), this response was not significantly altered, with values corresponding to 7.2  2.2 e 4.7  1.3 %, respectively. In verapamil- and EGTA-containing Ca2+-free medium, after depletion of the intracellular Ca2+ stores by CCh (100 ÂM), the contractions induced by Ca2+ addition were potentiated by the presence of &#945;- (1 mM) or &#946;-pinene (1 mM) from 30.7  2.1 % to 80.6  4.7 and 51.3  7.6 %, respectively (p < 0.05, Bonferroniâs test). In gastrointestinal dye fractional retention studies, &#945;- or &#946;-pinene increased the rat liquid gastric emptying. On the other hand, they did not alter the ACh-induced contractions on gastric fundus strips. Our study firstly shows that, both &#945;- and &#946;-pinene have prokinetic properties in rats. In isolated tissues, they did not affect cholinergic contractions on gastric fundus strips, but are myorelaxant compounds on rat duodenal preparations, probably by an interference with cellular mechanisms mediated by IP3 release. Moreover, &#945;- and &#946;-pinene activate capacitative Ca2+ entry to intracellular milieu after Ca2+ stores depletion / &#945;- e &#946;-pineno sÃo monoterpenos constituintes do Ãleo essencial de plantas encontradas no Nordeste do Brasil como a malva-santa e o eucalipto que, na medicina popular, sÃo usadas no tratamento de distÃrbios intestinais e respiratÃrios. As aÃÃes miorrelaxantes desses Ãleos essenciais sÃo atribuÃdas à presenÃa de &#945;- e de &#946;-pineno. Nosso objetivo foi estudar mais detalhadamente os efeitos desses constituintes sobre a contratilidade do mÃsculo liso gastrintestinal e sobre o esvaziamento gÃstrico de lÃquido em ratos. No presente estudo, foram usados ratos Wistar machos (200-250g) sacrificados por deslocamento cervical. Tiras de duodeno, Ãleo e fundo de estÃmago foram cortados e mantidos em Tyrode. As contraÃÃes isomÃtricas foram registradas atravÃs de transdutores de forÃa conectados a sistema computadorizado. SoluÃÃes contendo &#945;- ou &#946;-pineno foram preparadas em Tween 80 (concentraÃÃo final &#8804; 0,2% v/v). Usados isoladamente, &#945;- e &#946;-pineno diminuÃram o tÃnus basal em duodeno com CI50 de 655,1 e 810,2 ÂM, respectivamente. ContraÃÃes submaximais induzidas por K+ (60 mM, K60) ou acetilcolina (ACh, 3 ÂM) foram inibidas, de maneira concentraÃÃo-dependente (p < 0,001, ANOVA), com valores de CI50 correspondentes a 790,0 [580,2-1007,4] e 760,0 [650,6-870,8] ÂM, respectivamente, para o &#945;-pineno e 770,1 [500,3-1180,5] e 620,7 [520,9-750,2] ÂM para o &#946;-pineno, respectivamente. Em preparaÃÃes prÃ-tratadas com 1 mM de &#945;- ou &#946;-pineno, a contraÃÃo fÃsica induzida por ACh (3 ÂM) em meio sem Ca2+ contendo EGTA (0,2 mM) foi reduzida de 18,4  3,3 % para 7,7  1,5 % e 5,0  1,2 % da contraÃÃo K60, respectivamente. A contraÃÃo tÃnica induzida por adiÃÃo de Ca2+ (2 mM) em preparaÃÃes mantidas na presenÃa de K+ (60 mM) ou ACh (3 ÂM), em meio sem Ca2+ contendo EGTA (0,2 mM), foi reduzida de 50,2  3,3 % e de 53,9  5,2 % para 10,6  2,6 % e 24,4  4,1 % pelo &#945;-pineno e 6,6  1,1 % e 10,9  3,5 % pelo &#946;-pineno, respectivamente. Em preparaÃÃes prÃ-tratadas com 1 mM de &#945;- ou &#946;-pineno, a contraÃÃo tÃnica induzida por ACh (60 ÂM) em Tyrode normal contendo verapamil (3 ÂM) foi reduzida de 29,0  4,1 % para 10,6  2,7 % e 12,5  2,2 % da K60, respectivamente. A resposta contrÃtil induzida pela cafeÃna (20 mM) em Tyrode normal foi potencializada de 47,8  3,2 % para 72,1  9,0 e 88,8  10,6 % da resposta controle pelo prÃ-tratamento da preparaÃÃo com &#945;- ou &#946;-pineno, respectivamente. Em meio sem Ca2+ com EGTA, a resposta contrÃtil da cafeÃna (20 mM) foi reduzida para 9,5  3,5 %. Sob essa condiÃÃo e, na presenÃa de &#945;- ou &#946;-pineno, a resposta nÃo foi alterada significativamente, correspondendo a 7,2  2,2 e 4,7  1,3 %, respectivamente. ApÃs esgotamento dos estoques intracelulares com CCh (100 mM), a contraÃÃo induzida por adiÃÃo de Ca2+ (2 mM), em meio sem Ca2+ com EGTA (0,2 mM) e verapamil (3 ÂM), foi potencializada pela adiÃÃo prÃvia de &#945;- ou &#946;-pineno de 30,7  2,1 % para 80,6  4,7 e 51,3  7,6 %, respectivamente (p < 0,05, teste de Bonferroni). Em estudos de retenÃÃo fracional de corante no trato gastrintestinal, o &#945;- e o &#946;-pineno aumentaram o esvaziamento gÃstrico, porÃm, a contratilidade induzida por ACh (3 ÂM) em tiras de fundo de estÃmago in vitro nÃo foi alterada pela presenÃa prÃvia de &#945;- e &#946;-pineno. O presente trabalho demonstra, pela primeira vez, que os monoterpenos &#945;- e &#946;-pineno apresentam efeito procinÃtico em ratos. Em tecidos isolados, nÃo afetam a contraÃÃo colinÃrgica em tiras de estÃmago, mas apresentam atividade miorrelaxante em tecido duodenal, por provÃvel interferÃncia com os mecanismos celulares mediados pela formaÃÃo de IP3. AlÃm disso, como demonstrado em Ãleo de rato, esses monoterpenos provavelmente ativam as vias de entrada de Ca2+ para a cÃlula em situaÃÃes de depleÃÃo dos estoques intracelulares

Orientadores: Maria Aparecida Mesquita, Elizabeth João Pavin / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T12:16:52Z (GMT). No. of bitstreams: 1 Cunha_MarizaFaria_D.pdf: 3547651 bytes, checksum: e7cc833c52849656bf197cafac84bfeb (MD5) Previous issue date: 2013 / Resumo: Os objetivos deste estudo foram investigar a motilidade gastrintestinal e a sensibilidade gástrica em pacientes com diabetes mellitus tipo 1 (DM1), e as relações desses fatores com sintomas gastrintestinais, infecção pelo Helicobacter pylori, controle glicêmico, e características psicológicas e nutricionais desses pacientes. Foram estudados 33 pacientes com DM1 com idade média de 39 ± 9 anos, sendo 26 do sexo feminino e 7 do sexo masculino. O tempo desde o diagnóstico do diabetes era de 23±7 anos. Um questionário padronizado foi usado para obter informações sobre dados sóciodemográficos e presença de sintomas gastrintestinais. Foram também registrados os dados laboratoriais e os dados referentes às complicações do diabetes, incluindo a neuropatia periférica. O controle glicêmico foi avaliado de acordo com os valores da hemoglobina glicada (HbA1c). A avaliação nutricional foi realizada através de antropometria e inquéritos alimentares (registro alimentar de 3 dias e questionário de frequência alimentar). A presença de ansiedade e depressão foi avaliada pela Escala Hospitalar de Ansiedade e Depressão (HAD). Os pacientes foram submetidos ao exame de endoscopia digestiva alta, com biópsias gástricas para a pesquisa do Helicobacter pylori e biópsias duodenais para a pesquisa de doença celíaca. O esvaziamento gástrico e a distribuição intragástrica de uma refeição sólida foram avaliados pela cintilografia gástrica. O estudo do tempo de trânsito orocecal (TTOC) foi realizado pelo teste do H2 expirado com lactulose. A sensibilidade gástrica foi avaliada pelo teste de saciedade com água. Nossos resultados mostraram a presença de sintomas gastrintestinais em 75,7% dos pacientes, ansiedade e/ou depressão em 61,3% e infecção pelo H. pylori em 34,4%. Houve uma associação estatisticamente significativa entre sintomas gastrintestinais e ansiedade e/ou depressão. O valor médio da HbA1c foi 9,1±1,7%, indicando controle glicêmico inadequado no grupo estudado. A avaliação dos dados do IMC mostrou que 43,3% dos pacientes estava com sobrepeso e 3,3% eram obesos. Por outro lado, a avaliação dos outros parâmetros antropométricos mostrou que 15% dos pacientes apresentavam-se desnutridos ou com risco nutricional. Além disso, foi observado que a dieta de muitos pacientes era deficitária em termos de consumo calórico e de vitaminas e sais minerais. Entre os pacientes com DM1, 37,9% apresentaram esvaziamento gástrico lento e 30,8% prolongamento do TTOC. Não houve correlação entre os valores do TTOC e do T½ do esvaziamento gástrico. A análise da distribuição intragástrica demonstrou que o esvaziamento gástrico lento estava relacionado com uma maior retenção do conteúdo gástrico no compartimento proximal. Não houve diferença entre os pacientes com DM1 e o grupo-controle quanto aos parâmetros avaliados no teste da saciedade com água. Entretanto, dentro do grupo de pacientes diabéticos, aqueles que apresentavam esvaziamento gástrico mais prolongado ou maiores valores nos escores de ansiedade/depressão apresentaram aumento na sensibilidade gástrica em relação aos outros pacientes do grupo. A ansiedade e depressão ainda estavam relacionadas com a presença de sintomas gastrintestinais, pior controle glicêmico e diminuição da ingestão calórica. Não houve relação entre ansiedade/depressão e alterações no esvaziamento gástrico ou no TTOC. Nenhum dos parâmetros avaliados estava associado com a infecção pelo H. pylori ou com a presença de neuropatia periférica. Nesse estudo também não houve evidência de associação do esvaziamento gástrico lento com a presença de sintomas gastrintestinais, controle glicêmico, consumo energético ou parâmetros nutricionais. Por outro lado, os valores de todos os parâmetros antropométricos estavam significativamente diminuídos nos pacientes com TTOC prolongado, indicando que essa anormalidade afeta negativamente o estado nutricional dos pacientes com DM1. Em conclusão, os resultados desse estudo demonstraram uma interação complexa entre sintomas gastrintestinais, controle glicêmico, alterações motoras e sensoriais, fatores psicológicos e fatores nutricionais em pacientes com DM1, com destaque para a presença de ansiedade e depressão como ligação entre vários desses parâmetros. Nossos dados também reforçam a necessidade de uma abordagem mais abrangente e efetiva dos aspectos psicológicos e nutricionais nesses pacientes / Abstract: The aim of this study was to assess gastrointestinal motility and gastric sensitivity in long-standing type 1 diabetes mellitus (DM1) patients, and the relationships of these factors with gastrointestinal symptoms, Helicobacter pylori infection, glycemic control, and psychological and nutritional features. Thirty-three type 1 DM patients, mean age of 39 ± 9 years, 26 females and 7 males, were included. Diabetes duration was 23±7 years. A standardized questionnaire was used to obtain information about sociodemographic data and chronic GI symptoms. Laboratory data and parameters related to DM complications, including peripheral neuropathy, were recorded. Glycemic control was assessed by glycated hemoglobin (HbA1c). Nutritional evaluation was performed by the assessment of anthropometric indices and from the data of the three-day food diary and food frequency questionnaire. The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. During endoscopy gastric and duodenal biopsies were taken for the assessment of H. pylori infection and celiac disease. Gastric emptying and intragastric distribution of a solid meal were evaluated by scintigraphy. The lactulose hydrogen breath test was used to determine OCTT. Gastric sensitivity was assessed by the water load test. Our results im DM1 showed gastrointestinal symptoms in 75.7%, H. pylori infection in 34.4% and anxiety and/or depression in 61.3%. There was a statistically significant association between gastrointestinal symptoms and anxiety/depression. Mean HbA1c was 9.1±1.7%, indicating poor glycemic control in our study group. According to BMI, 44.6% of DM1 were overweight or obese. On the other hand, the analysis of the other anthropometric parameters showed malnutrition or risk of malnutrition in 15% of DM1. In addition, many patients have diets deficient in calories, vitamins, and minerals. Delayed gastric emptying was found in 37.9% and prolonged OCTT in 30.8% of patients. No significant correlation was found between OCTT and T½ values. Intragastric distribution analysis showed that delayed gastric emptying was related to increased proximal retention of the meal. The assessment of gastric sensitivity by the water load test showed no difference between type 1 DM patients and controls. However, within the patients group increased gastric sensitivity was associated with delayed gastric emptying and also with anxiety/depression. Anxiety and depression were also linked to gastrointestinal symptoms, poorer glycemic control and reduced caloric intake. There was no evidence of a relationship between anxiety/depression and delayed gastric emptying or prolonged OCTT.None of the above parameters were related to H. pylori infection or peripheral neuropathy. We found no evidence of association between delayed gastric emptying and gastrointestinal symptoms, glycemic control, caloric intake or nutritional parameters. In contrast, the values of all anthropometric parameters measured in the present study were significantly decreased in patients with prolonged OCTT, indicating that this abnormality may have a negative effect on nutritional status in type 1 DM. In conclusion, our results showed a complex interaction between gastrointestinal symptoms, glycemic control, upper gastrointestinal sensory-motor dysfunction, and psychological and nutritional factors, in which anxiety and depression appear to play a special role, since these disturbances were linked to several of the above parameters. Our results reinforce the need for a more effective and comprehensive approach to the psychological and nutritional features in these patients / Doutorado / Clinica Medica / Doutora em Clínica Médica

Orientador: Eros Antonio de Almeida / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:20:03Z (GMT). No. of bitstreams: 1 RamirezNunez_WilsonRanu_D.pdf: 1943462 bytes, checksum: 1cb7938d9770774612068d3048db5b0e (MD5) Previous issue date: 2012 / Resumo: O esvaziamento gástrico (EG) consiste na transferência ordenada do conteúdo do estômago para o duodeno, Situações patológicas como alterações hemodinâmicas modificam a velocidade do E.G. e função motora do trato gastrointestinal. O infarto do miocárdio determina retarde do E.G. em ratos, possivelmente pelo estresse causado pela ligadura da artéria coronária. O sistema nervoso central (SNC) afeta as funções motora e secretora gastrintestinais, frente a uma situação de estresse existe aumento da retenção gástrica (RG) induzindo o retarde do E.G. O sistema parassimpático pode estar envolvido neste fenômeno. Por outro lado o sistema simpático controla o E.G., interrompendo a motilidade e a secreção, frente a uma situação de estresse como a do infarto do miocárdio o retarde do E.G., pode estar relacionado à atuação desse sistema. O objetivo deste trabalho foi Avaliar complacência gástrica (CG) em ratos submetidos a infarto recente do miocárdio, participação do nervo vago, sistema nervos simpático, efeito da injeção intra-cerebro-ventricular de GABAb e efeito da lesão do núcleo paraventricular no retarde do EG observado no infarto recente do miocárdio em ratos. Utilizados ratos Wistar, machos, entre 220 - 300g, adaptados ás condições do laboratório, divididos em 3 grupos: grupo INF; grupo SH e grupo NA. Infarto realizado por ligadura da artéria coronária descendente anterior esquerda. Animais após cirurgia permaneceram em jejum alimentar recebendo água ad libitum. Vinte e quatro horas após foi avaliado EG de 1,5 ml/100g de peso do animal de uma refeição de prova (RP) salina marcada com fenol vermelho. EG foi avaliado indiretamente, através da determinação da % de retenção gástrica (RG) da RP, 10 min. após administração orogástrica. Resultados mostraram que para o estudo da complacência gástrica não houve diferença significativa de pressão intragástrica entre os três grupos, nos três pontos de medida da pressão intragástrica (PIG) e em complementação as CGs não apresentaram diferenças significativas quando comparados entre si. No estudo da Vagotomia subdiafragmatica houve diferença significativa das RG (%) entre os subgrupos SH+Sh vs SH+Inf, o subgrupo Vgx+Inf apresentou diferença significativa em relação ao subgrupo SH+Inf e não diferiu do subgrupo Vgx+Sh. Para o estudo do efeito da injeção intra-cerebro-ventricular de GABAb houve diferença significativa entre os grupos SH+Sal e SH+Bac e Inf+Sal e Inf+Bac. No estudo da Simpatectomia química, grupo Inf+Sal apresentou diferença significativa quando comparados aos ratos SH+Sal, e grupo Inf+Pra com grupo SH+Sal não apresentaram diferenças significativas. O grupo Inf+Pra e Inf+Sal apresentaram diferença significativa e ratos SH+Pra e SH+Sal apresentaram diferença significativa quando comparados, No estudo da lesão do Núcleo paraventricular houve diferença significativa das RG (%) entre os subgrupos SH+Sh vs SH+Inf, os grupos PVN+Inf e SH+Inf apresentaram diferença significativa. Conclusões: 1) infarto recente do miocárdio não induz modificações no tônus gástrico em ratos, 2) Existe participação do nervo vago no retarde do EG causado pelo infarto recente do miocárdio, 3) Retardo EG mostrado pelos ratos infartados tem participação, pelo menos em parte, dos receptores alpha-1 adrenérgicos do sistema nervos simpático. 4) Existe participação do núcleo paraventricular no retardo do EG induzido pelo infarto recente do miocárdio / Abstract: Gastric emptying (GE) is the orderly transfer of stomach contents into the duodenum, pathological situations as hemodynamic changes modify GE speed and motor function of the gastrointestinal tract. Myocardial infarction determines GE delayed in rats, possibly due to stress caused by coronary artery ligation. Central nervous system (CNS) affects gastrointestinal secretory and motor functions, in a stressful situation there is increased gastric retention (GR) inducing GE delay. Parasympathetic system may be involved in this phenomenon. On the other hand sympathetic nervous system controls GE, disrupting motility and secretion, compared to a stressful situation such as myocardial infarction, GE delay, may be related to performance of this system. The objective of this study was to evaluate gastric compliance (GC) in rats submitted to recent myocardial infarction, involvement of vagus nerve, sympathetic nervous system, intra-cerebro-ventricular of GABAb injectin effect and paraventricular nucleus lesion effect on GE delay observed in recent myocardial infarction in rats. Used male Wistar rats, between 220-300g, adapted to laboratory conditions, divided into three groups: INF, SH and NA groups. Infarction performed by left anterior descending coronary artery ligation. After surgery, animals were fasted receiving water ad libitum. Twenty four hours after was evaluated GE of 1.5ml/100g body weight of a saline test meal (TM) labeled with red phenol. GE was indirectly estimated by determining % of gastric retention (GR) of test meal. 10 min. after orogastric administration. Results showed that gastric compliance study there was no significant difference in intragastric pressure between the three groups, in the three points of measurement of intragastric pressure (IGP) and complementation in GC showed no significant differences when compared with each other. In subdiaphragmatic vagotomy study, significant difference of GR (%) between subgroups SH+Sh vs SH+Inf, subgroup Vgx+Inf significant difference in the subgroup SH+Inf and did not differ in subgroup Vgx+Sh. To study the effect of intracerebroventricular injection of GABAb significant difference between groups SH+Sal vs SH+Bac and Inf+Sal vs Inf+Bac. To study the chemical simpatectomy by prazosin, the Inf+Sal group showed significant difference when compared to SH+Sal rats, and the group Inf+Pra with SH+Sal group showed no significant difference. The group Inf+Pra and Inf+Sal showed significant differences and the rats SH+Pra and SH+Sal showed significant difference when compared, for the study of the lesion of paraventricular nucleus of GR significant difference (%) between subgroups SH+Sh vs SH+Inf, the group PVN+Inf and SH+Inf showed significant difference. Conclusions: 1) recent myocardial infarction does not induce changes in gastric tone in rats, 2) there is involvement of the vagus nerve in GE delay caused by recent myocardial infarction, 3) GE delayed in infracted rats have participation, at least in part, of alpha-1 adrenergic receptors of the sympathetic nervous system, 4) there is participation of the paraventricular nucleus of GE delayed induced by recent myocardial infarction / Doutorado / Ciencias Basicas / Doutor em Clínica Médica

<p>Obesity and nutrition-related non-communicable diseases continue to be major challenges that are increasing in severity worldwide. Science-centered carbohydrate dietary strategies may be a viable approach to help address such challenges. Recent reports from our laboratory indicate that certain carbohydrates with slow digestion profiles have the ability to trigger the gut-brain axis and reduce food intake and to slow gastric emptying and potentially affect appetite. Slow carbohydrate digestion may have other impacts on energy metabolism that have not been explored. In the current investigations, we sought to better understand the delayed gastric emptying profile of pearl millet-based foods as well as to understand how altering carbohydrate digestion rate impacts substrate utilization for energy.</p> <p>In the first study, the physical breakdown of pearl millet couscous particles in a simulated gastric environment (Human Gastric Simulator) was studied compared to wheat couscous matched in particle size, and select physicochemical properties of each type of couscous were characterized. Because we previously showed that pearl millet couscous had a marked delay in gastric emptying compared to white rice, boiled potatoes, and pasta in a human study in Mali, the objective of the first investigation was to test the hypothesis that pearl millet couscous was more resistant to breakdown in the stomach than wheat couscous and would take longer to empty. Our findings indicated that pearl millet couscous instead broke down into smaller, more numerous particles than wheat couscous. However, pearl millet had a slower starch hydrolysis property compared to wheat couscous per unit surface area. Pearl millet also had a smaller amylose chain length (839-963 DP) compared to wheat (1225-1563 DP), which may enable a denser packing of millet starch molecules that hinders hydrolysis. We also visually observed that the pearl millet particles formed a paste while breaking down that could reasonably generate viscosity in the stomach to potentially delay gastric emptying. </p> <p>Based off the findings from simulated gastric digestion, we next conducted a human study (<i>n</i>=14) in the U.S. to test the hypothesis that pearl millet-based foods (couscous – commercial and self-made, thick porridge) would reduce glycemic response, increase satiety, and delay gastric emptying compared to wheat couscous and white rice. We complemented this human study with additional <i>in vitro </i>work using an advanced gastrointestinal digestion system (TIMagc) to determine if the viscosity of pearl millet couscous particles as they were breaking down in the stomach was contributing to a decrease in gastric emptying. Our findings indicated that all the pearl millet-based foods and wheat couscous had lower overall glycemic response than white rice, but only the self-made millet couscous showed higher satiety through subjective appetitive response ratings. Surprisingly, there were no differences in gastric emptying among the foods. Additionally, the half-emptying times for these foods were all ~3 h, which is similar to the comparably low half-emptying times observed for white rice, boiled potatoes, and pasta in the previous Mali study. We now hypothesize that there may be diet-induced changes in gut-brain axis signaling when slowly digestible carbohydrates are consumed repeatedly over time, perhaps through modulating the number or sensitivity of small intestinal L-cells. We also found that millet couscous did not exhibit high viscosity in the TIMagc, suggesting that viscosity was not impacting its rate of gastric emptying. We conclude that at least some pearl millet-based foods possess a slow digestion property that may act to trigger the gut-brain axis or ileal brake to increase feelings of satiety or slow gastric emptying, but the discrepancy between U.S. and Malian populations requires further study. </p> <p>In the final investigation, we examined how altering carbohydrate digestion affected partitioning of carbohydrate versus fat for oxidation as well as the efficiency of switching oxidation between these two substrates (termed “metabolic flexibility”) in mice. Metabolic flexibility has been associated with good health related to decreased adipose tissue in the body and improved insulin sensitivity and may have implications on weight management. Carbohydrate digestion was adjusted by: (1) testing mice that lacked a complete set of enzymes by knocking out maltase-glucoamylase (Mgam; null) for moderating starch digestion versus testing wild-type mice; (2) using diets in these two groups of mice to moderate starch digestion that had different levels of resistant starch (53%, 35%, and 18%), had only raw corn starch or sucrose, or were high in fat; and (3) providing a supplement of fungal amyloglucosidase (AMG) to the mice treatment groups to increase starch digestion. Respiratory exchange ratio (RER) was measured through indirect calorimetry and mathematical modeling was used to characterize the diurnal shifts in RER (sine equation) as well as carbohydrate versus fat oxidation and metabolic flexibility (percent relative cumulative frequency [PRCF] with Weibull and Mixed Weibull Cumulative Distribution functions). Our results suggest that null mice lacking Mgam had somewhat increased metabolic flexibility than wild-type mice despite exhibiting minimal to no effects on carbohydrate oxidation. Intriguingly, the raw corn starch diet increased fat oxidation and generally promoted metabolic flexibility, although it did not increase carbohydrate oxidation relative to the other carbohydrate-predominant diets. Increasing carbohydrate digestion through AMG supplementation increased carbohydrate oxidation, and generally prompted earlier shifts to carbohydrate oxidation than without AMG supplementation. These findings provide a basis for better understanding the metabolic consequences of altering carbohydrate digestion and establish novel tools that can be utilized in future investigations. Overall, we propose that moderating carbohydrate digestion provides the ideal combination of balancing carbohydrate and fat oxidation while promoting metabolic flexibility. </p> <p>In conclusion, a slow digestion property may enable some types of pearl millet to trigger the ileal brake and gut-brain axis feedback systems to decrease glycemic response and increase satiety. Moreover, consuming carbohydrates with slow digestion may optimize substrate utilization for energy by the body. In addition to triggering the ileal brake and gut-brain axis, modulating carbohydrate digestion to more effectively switch between carbohydrate and fat for oxidation may be beneficial for weight management and metabolic disease prevention.</p>

Background: Diet may play an important role in the management of patients with short bowel syndrome who have colon in continuity. However, macronutrient absorption has not been well characterized, and the most appropriate dietary constituents have not been well defined. Objective: To define carbohydrate absorption characteristics in patients with short bowel syndrome and determine the potential role of pectin as a dietary substrate. Methods: The authors studied the effect of a custom pectin-based supplement in 6 subjects (3 male/3 female) aged 29-67 years with jejunocolonic anastomosis, 4 of whom required long-term parental nutrition. Small intestinal absorption capacity, macronutrient and fluid balance, gastrointestinal transit time, and energy consumption were measured. Results: Data showed that 53% nitrogen, 50% fat, and 32% total energy were malabsorbed. In contrast, the majority (92%) of total carbohydrate was utilized. Fecal short-chain fatty acids (SCFAs) were increased, an indication of increased fermentation. Although only 4% of starch was recovered in stool, it is indicative of considerable starch malabsorption, thus providing the main carbohydrate substrate, for colonic bacterial fermentation. In contrast, non-starch polysaccharide was a relatively minor fermentation substrate with only 49% utilized. Eighty percent of the pectin was fermented. Supplementation was associated with increased total SCFAs, acetate, and propionate excretion. There was a trend observed toward greater fluid absorption (-5.9% ± 25.2%) following pectin supplementation. Nonsignificant increases in gastric emptying time and orocolonic transit time were observed. Conclusion : Despite malabsorption, starch is the primary carbohydrate substrate for colonic bacterial fermentation in patients with short bowel syndrome, although soluble fiber intake also enhances colonic SCFA production.

INTRODUÇÃO: Obesidade é, hoje, considerada uma pandemia, com cerca de 500 milhões de obesos no mundo, com cerca de 2,8 milhões de mortes por ano. A cirurgia de bypass gástrico é um importante tratamento para obesidade, porém, não é isenta de riscos. O dispositivo temporário de exclusão duodeno jejunal - DTED (EndoBarrier Gastrointestinal Liner® GIDynamics, Inc. Lexington, MA), apresenta-se como uma nova forma de tratamento endoscópico da obesidade. Apesar dos bons resultados, os mecanismos de ação do DTED ainda não foram estudados, podendo as alterações humorais e do esvaziamento gástrico promovidas, ser os principais responsáveis pelos resultados obtidos. OBJETIVO: Estudar as alterações promovidas pelo DTED no esvaziamento gástrico, e a relação destas alterações com os resultados clínicos de perda de peso e controle do diabetes tipo 2. MÉTODOS: Vinte e cinco obesos e com diabetes tipo 2, que fizeram uso do DTED por período mínimo de 16 semanas e máximo de 24 semanas, realizaram teste de esvaziamento gástrico cintilográfico, antes, durante a 16ª semana de uso e após 4 semanas de retirada do DTED. Foram obtidas medidas de peso e hemoglobina glicada. As médias e desvio-padrão de retenção gástricas foram obtidas e comparadas entre os três exames realizados, e, após, comparados entre os pacientes que obtiveram e os que não obtiveram melhora no parâmetro clínico selecionado (perda de peso maior que 10%, e hemoglobina glicada menor que 7%). Também se avaliou subjetivamente a sensação de saciedade e quantidade de alimento ingerido durante a 16ª semana de uso do dispositivo. RESULTADOS: Quando avaliadas médias de retenção, nota-se que, na 16ª semana de uso, há maior retenção para a primeira, segunda e quarta horas quando comparados ao baseline (1ª h 74 ± 16,3 % p=0,001, 2ª h 45 ± 25% p < 0,001; 4ª 15 ± 15,8% p < 0,001). Não há diferença estatística entre as retenções na 16ª semanas entre os pacientes que atingiram e os que não atingiram o controle do diabetes (p=0,73), entre os que perderam mais de 10% de peso e os que não perderam (p=0,275). Durante a 16ª semana de uso, 23 pacientes (92%) referiram maior sensação de saciedade precoce e maior saciação, e todos referiram comer em menor volume de em relação ao período prévio à colocação do dispositivo. CONCLUSÕES: O DTED causa lentificação no esvaziamento gástrico, reversível após sua retirada, porém esta alteração no esvaziamento gástrico, mesmo sendo sintomática, com aumento de saciedade e saciação, e com diminuição do volume de alimento ingerido, não tem relação com a perda de peso e melhora do diabetes / INTRODUCTION: Obesity is now considered a pandemic, with about 500 million obese worldwide, with about 2.8 million deaths per year. The gastric bypass surgery is an important treatment for obesity, however, not without risks. The temporary duodenal jejunal exclusion device - DTED (EndoBarrier ® Gastrointestinal Liner GIDynamics, Inc. Lexington, MA), presents itself as a new form of endoscopic treatment of obesity. Despite the good results, the mechanisms of action of DTED have not been studied, and the humoral changes and changes in gastric emptying promoted by the device maybe are the main mechanisms of action of the device. OBJECTIVE: To study the changes introduced by DTED in gastric emptying, and the relationship of these changes with clinical outcomes of weight loss and control of type 2 diabetes. METHODS: Twenty five obese patients with type 2 diabetes who used the DTED for a minimum of 16 weeks and maximum 24 weeks underwent a scintigraphic gastric emptying test, before, during the 16th week of treatment and after 4 weeks of withdrawal the DTED. Measurements of weight, glycated hemoglobin were obtained. The mean and standard deviation of gastric retention were obtained and compared between the three tests, and after, compared between patients who were and those who showed no improvement in selected clinical parameters (weight loss greater than 10%, and lower glycated hemoglobin 7%). Also, a subjective evaluation of the feeling of satiety and amount of food ingested during the 16 weeks of device use was done. RESULTS: When evaluated average retention , we note that in the 16th week of use there is greater retention for the first, second and fourth hour compared to baseline (1st h 74 ± 16.3 % p = 0.001, 2nd h 45 ± 25 % p < 0.001 4th 15.8 ± 15 %, p < 0.001). There is no statistical difference among patients who achieved and those who have not reached the control of diabetes (p = 0.73) or among those who lost more than 10 % by weight and not lost (p = . 0.275) during the 16th week of treatment , 23 patients (92%) reported greater sense of early satiety and satiation greater, and all reported eating less volume of food in relation to the period prior to devide placement. CONCLUSIONS: The DTED cause delay in gastric emptying, reversible after withdrawal, though this change in gastric emptying, even being symptomatic with increased satiety and satiation , decreasing the volume of food ingested , has no relation to weight loss and improved diabetes

Dissertation (Ph.D.)--University of South Florida, 2008. / Includes vita. Includes bibliographical references (leaves 102-128).

Dissertation (Ph.D.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 132 pages. Includes vita. Includes bibliographical references.

The thesis reports on 6 studies (2 of which were part of a multi-centre trial) examining hydration and fluid balance. The first study described in this thesis investigated the impact of hydration status on Dual energy x-ray absorptiometry (DXA) and other methods that are popular tools to determine body composition in athletes. We observed that it is important to ensure a euhydration when assessing body composition, particularly when considering changes associated with nutritional or exercise interventions. The second and third studies reported identified beverages that promote longer term fluid retention and maintenance of fluid balance in adults. We investigated the effects of 13 different commonly consumed drinks on urine output and fluid balance when ingested in a euhydrated state, with a view to establishing a beverage hydration index (BHI), i.e., the volume of urine produced after drinking expressed relative to a standard treatment (still water) for each beverage. The beverages with the highest BHI were oral rehydration solution, full fat milk and skimmed milk. BHI may be a useful measure to identify the short term hydration potential of different beverages when ingested in a euhydrated state. The fourth study aimed to systematically examine the influence of carbohydrate, sodium and caffeine content of beverages on the BHI. The BHI was greater in beverages with higher carbohydrate or higher sodium content, but not influenced by caffeine. The carbohydrate content of beverages has no effect on BHI at concentration up to 10% carbohydrate. Sodium content of beverages in concentrations of 27mmol/L and higher can improve the hydration potential of beverages. Caffeine doses in beverages up to 400mg/L do not have an impact upon diuresis when ingested in a euhydrated state. The fifth study compared net fluid balance (NFB) responses to the ingestion of commonly consumed drinks in young and older men. We observed that in young adults milk helps to maintain positive net fluid balance for longer than other drinks. In older adults this effect of milk is not observed despite similar net electrolyte balance responses. Future work should more fully explore these potential differences in fluid balance responses to drink ingestion between young and older adults. The final study investigated the hydration habits of Scottish young and older adults (+50 years old), identifying their fluid choices, volume, and preferences in relation to time of day. The results showed that 26.1% of the young females, 30.3% of the young males, 25.8% of the older females and 50.4% of the older males did not meet the European (EU) Food Safety Authority (EFSA) fluid intake recommendations. We also observed that the difference between those who met and those who did not meet the EFSA adequate intake could be attributed to differences in water ingestion, mainly during the mid-morning (after breakfast until 11 am) and during the early-afternoon (after lunch time up to 5 pm). It was concluded that these moments might be key when implementing interventions to improve hydration status especially in the older population.

Made available in DSpace on 2016-06-02T19:22:09Z (GMT). No. of bitstreams: 1 5394.pdf: 2154328 bytes, checksum: 49114074adb778dc78d219f32b8ee5b4 (MD5) Previous issue date: 2013-03-22 / Sodium intake is induced by facilitatory signals, like angiotensin II and aldosterone Cell dehydration, a classical inhibitory signal for sodium intake, may also induce paradoxical sodium intake if the sodium intake inhibition by the ocitocinergic hypothalamic mechanism or by the lateral parabraquial nucleus (LPBN) is absent. Thus, the LPBN deactivation could modify the activity of hypothalamic oxytocinergic pathways or the gastric emptying control system, another inhibitory system, as well as facilitatory areas and the reward system. The aim of this study was to investigate the effect of LPBN injections of methysergide (4 &#956;g/0.2 &#956;l, serotonergic antagonist) in cell dehydrated animals on: activity of brain areas involved in ingestive behavior by measuring c-Fos protein immunoreactivity and tissue levels of dopamine, serotonin and metabolites or plasma hormone levels; pre-systemic satiety involving gastric emptying; selectivity of paradoxical sodium intake. The effect of disinhibition of the natriorexigenesis on the reward system was tested by repeated deactivations of the LPBN with muscimol (2 nmol/0.2 &#956;l; GABAA agonist) and its effect on ingestive behavior sensitization and water deprivation with partial rehydration followed by sodium access (WD-PR protocol) on the lateral hypothalamus self-stimulation (LHSS). Holtzman or Sprague-Dawley rats (280-320 g), intacts or operated (femoral vein cannulation and/or guide cannulas implanted in direction to the LPBN or bipolar electrode implanted in the hypothalamus), were used in the experiments. Animals treated with methysergide and hyperosmotic by gavage of 2 M NaCl (2 ml) compared to the control treatment (vehicle) showed: (a) increase in ir-Fos in the area postrema and intermediate nucleus of the solitary tract, subfornical organ and non-oxytocinergic neurons of the ventral portion of the paraventricular nucleus of the hypothalamus; (b) increase in tissue levels of dopamine in the amygdala, but not in the accumbens; (c) unchanged activity of oxytocinergic system (ir-Fos in oxytocinergic neurons and oxytocin plasma levels similar to control group). Hyperosmotic rats (iv infusion of 2 ml of 2 M NaCl) treated with methysergide and a gavage of 0.3 M NaCl (3 ml) showed a hypertonic gastric and intestinal content similar to the control group (vehicle) after gavage. In hydrated animals with a history of two previous treatments of muscimol into the LPBN, the hypertonic NaCl intake induced by muscimol was higher than the control animals pretreated with vehicle. The LHSS was not altered at any stage of WD-PR protocol, as well as in cell dehydrated animals in comparison with hydrated control group. The results demonstrate that the deactivation of the LPBN enhances specifically the intake of solutions containing sodium and suggest the involvement of the brain stem and the amygdala during the appetitive phase of the paradoxical sodium intake, while the deactivation of other inhibitory mechanisms (oxytocin and gastric retention) seems not to be essential. Furthermore, the repetition of LPBN deactivation sensitizes hydrated animals for sodium intake. Removing the inhibition of sodium appetite by partial rehydration in WD-PR does not change the LHSS reward. / A ingestão de sódio é induzida por sinais facilitadores, como a angiotensina II e a aldosterona. Apesar de classicamente considerada antinatriorexigênica, a desidratação celular também se mostra facilitadora da ingestão paradoxal de sódio quando a inibição da ingestão de sódio pelo mecanismo ocitocinérgico do hipotálamo ou pelo núcleo parabraquial lateral (NPBL) está desativada. A desativação do NPBL poderia, então, atuar sobre o mecanismo ocitocinérgico ou de controle do esvaziamento gástrico, ambos inibidores, ou ainda modificar a atividade de áreas facilitadoras ou envolvidas na recompensa. O objetivo deste estudo foi investigar o efeito da injeção de metisergida (4 &#956;g/0,2 &#956;l, antagonista serotonérgico) no NPBL em animais com desidratação celular sobre a: atividade de áreas encefálicas envolvidas no comportamento ingestivo, medindo-se imunorreatividade para proteína c-Fos e dosagem tecidual de dopamina, serotonina e metabólitos em áreas de interesse ou dosagem hormonal; saciedade pré-sistêmica envolvendo esvaziamento gástrico; seletividade da ingestão paradoxal de sódio. Também foi avaliado o possível efeito da desinibição da natriorexigênese sobre o sistema de recompensa através da sensibilização por desativações repetidas do NPBL pelo muscimol (2 nmol/0,2 &#956;l; agonista GABAA) e na privação hídrica com reidratação parcial e posterior acesso ao sódio (modelo PH-RP) sobre a autoestimulação elétrica do hipotálamo lateral (AEHL). Ratos (280-320 g) Holtzman ou Sprague-Dawley, intactos ou operados (canulação da veia femoral e/ou cânulas-guia direcionadas ao NPBL ou eletrodo bipolar no hipotálamo), foram utilizados nos experimentos. Animais tratados com metisergida e hiperosmóticos por gavagem de NaCl 2 M (2 ml) apresentaram, em relação ao tratamento controle (veículo): (a) aumento da ir-Fos na área postrema e núcleo do trato solitário intermediário, no órgão subfornical e em neurônios não ocitocinérgicos da porção ventral do núcleo paraventricular do hipotálamo; (b) aumento da concentração tecidual de dopamina na amígdala, mas não no accumbens; (c) atividade do sistema ocitocinérgico inalterada (ir-Fos em neurônios ocitocinérgicos e ocitocina plasmática semelhantes ao controle). Ratos tratados com metisergida e hiperosmóticos por infusão iv de NaCl 2 M (1,5 ml), que receberam uma gavagem de NaCl 0,3 M (3 ml) apresentaram conteúdo gástrico e intestinal hipertônico semelhantes ao controle (veículo) após a gavagem. Em animais hidratados com histórico de dois tratamentos prévios de muscimol no NPBL, a ingestão de NaCl hipertônico induzida por muscimol foi superior aos animais controle tratados previamente com veículo. A AEHL não foi alterada em nenhuma fase do protocolo PH-RP, assim como em animais com desidratação celular, em relação aos controles hidratados. Os resultados demonstram que a desativação do NPBL potencializa especificamente a ingestão de solução contendo sódio e sugerem a participação do tronco encefálico e da amígdala na fase apetitiva da ingestão paradoxal de sódio, enquanto a desativação de outros mecanismos inibidores (ocitocina e retenção gástrica) parece não ser essencial. Ainda, a repetição da desativação do NPBL sensibiliza a ingestão de sódio em animais hidratados. A remoção da inibição ao apetite ao sódio pela reidratação parcial na PHRP não altera a recompensa na AEHL.