O objetivo deste estudo foi avaliar o efeito da suplementação com óleos essenciais e levedura viva Saccharomyces cerevisiae na dieta de equinos. Foi avaliada a digestibilidade aparente dos nutrientes da dieta, resposta glicêmica e insulinêmica pós-prandial, perfil plasmático de triglicerídeos, colesterol total, frações de colesterol ligado à lipoproteína de alta densidade (HDL-C), colesterol ligado à lipoproteína de baixa densidade (LDL-C), colesterol ligado à lipoproteína de muito baixa densidade (VLDL-C), pH fecal e população microbiana das fezes. Foram utilizados oito equinos da raça Mini-horse, machos, castrados, com idade de 48±6 meses e peso inicial de 147±15 kg, alimentados com dieta contendo 60% de concentrado comercial multiparticulado e 40% de feno de gramínea. Os tratamentos foram divididos em controle (sem adição de óleo essencial e levedura), levedura viva Saccharomyces cerevisiae (2 g/dia de produto comercial com concentração de 20x109 UFC/g de levedura), óleos essenciais (150 mg/dia de composto comercial de óleos essencias) e associação de Saccharomyces cerevisiae com óleos essenciais nas mesmas quantidades já mencionadas. O delineamento experimental utilizado foi em quadrado latino duplo 4x4 com medidas repetidas no tempo e os dados obtidos foram submetidos à análise de variância com nível de significância de 5%. Não foi observado efeito de tratamento (P>0,05) para os diferentes coeficientes de digestibilidade de matéria seca (63,92%), matéria orgânica (66,70%), proteína bruta (82,78%), extrato etéreo (71,38%), amido (95,24%), fibra em detergente neutro (47,50%) e fibra em detergente ácido (36,40%). Na avaliação da Área abaixo da curva (AAC), não foi observado efeito de tratamento (P>0,05) para glicose (579,75 mg/dL) e insulina (858,38 µU/dL). Na avaliação de gordura plasmática não foi encontrado efeito de tratamento (P>0,05) para triglicérides (43,79 mg/dL), colesterol total (111,21 mg/dL) e frações HDL (66,37 mg/dL), LDL (36,1 mg/dL) e VLDL (8,78 mg/dL). O valor de pH fecal observado (6,42) foi adequado para o equilíbrio da microbiota e não houve diferença entre os tratamentos (P=0,56). Avaliando-se a população microbiana das fezes não foi possível observar efeito para Fibrobacter succinogenes (P=0,08). Houve interação entre óleo e levedura para Ruminococcus flavefaciens (P=0,03). Observou-se também efeito de levedura para Lactobacillus genus (P=0,04). A inclusão de óleos essenciais e levedura Saccharomyces cerevisiae na dieta de equinos não tem efeito sobre a digestibilidade aparente dos nutrientes, resposta glicêmica e insulinêmica, perfil plasmático de triglicerídeos, colesterol e suas frações e pH fecal, porém a inclusão de levedura viva provoca alteração na população microbiana / The aim of this study was to evaluate the effect of supplementation of essential oils and live yeast Saccharomyces cerevisiae on the diet for horses. It was assessed apparent digestibility of nutrients, glucose and insulin postprandial responses, plasma levels of triglycerides, total cholesterol and its fractions high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), very low density lipoprotein (VLDL-C), fecal pH and microbial population in faeces. Eight horses were used, Mini-horse breed, geldings, aged 48±6 months, initial weight 147±15 kg, fed a diet containing high concentrate, consisting of 60% commercial concentrate and 40 % of grass hay. Treatments were divided in control (without essential oils and live yeast), live yeast Saccharomyces cerevisiae (2g/day of a commercial product with a concentration of 20x109 CFU/g of yeast), essential oils (150mg/day of a commercial product consisting of essential oils) and association of Saccharomyces cerevisiae with essential oils in the same quantity mentioned. The experimental design was 4x4 double Latin square with repeated measures over time and the data were subjected to analysis of variance with a significance level of 5%. It was not observed treatment effect (P>0.05) for the different digestibility coefficients of dry matter (63.92%), organic matter (66.70%), crude protein (82.78%), ether extract (71.38%), starch (95.24%), neutral detergent fiber (47.50%) and acid detergent fiber (36.40%). In evaluation of the area under the curve (AUC), wasn't observed effects of treatment (P>0.05) for values of glucose (579.75 mg/dL) and insulin (858.38 µU/dL). In the evaluation of plasma lipids weren't found effect of treatment (P>0.05) for values of triglyceride (43.79 mg/dL), total cholesterol (111.21 mg/dL) and fractions HDL (66.37 mg/dL), LDL (36.1 mg/dL) e VLDL (8.78 mg/dL). Fecal pH value (6.42) was found suitable to the balance of microorganisms, but there weren’t effect of treatment (P=0.56). In quantification of microbial population weren’t observed effect for Fibrobacter succinogenes (P=0.08), but were found effect for interaction of essential oils and live yeast for Ruminococcus flavefaciens (P=0.03) and effect for Lactobacillus genus with the inclusion of yeast (P=0.04). The inclusion of essential oil and live yeast has no effect on digestibility of nutrients, glycemic and insulinemic response, plasma levels lipids and pH of faeces, however the inclusion of live yeast causes alteration in the microbial population

Introdução: Os benefícios dos ácidos graxos poli-insaturados ômega 3 (w-3) no metabolismo lipídico e na saúde cardiovascular são amplamente aceitos. Entretanto, o impacto do w-3 na composição corpórea, na homeostase da glicose e consequente modificação do risco cardiovascular não tem sido foco dos desfechos primários da maioria dos estudos clínicos. Objetivo: Avaliar o impacto da suplementação de w-3 sobre a composição corporal, o controle glicêmico e o nível de risco cardiovascular em indivíduos adultos. Métodos: A partir de uma sub-amostra do estudo CARDIONUTRI (estudo clínico, randomizado, controlado e duplo cego com seguimento de 2 meses) foram selecionados 86 indivíduos (grupo w-6, 3g de óleo de girassol/d) e 88 indivíduos (grupo w-3, 3g de óleo de peixe/d 60 por cento EPA/DHA). O efeito das intervenções foi monitorado nos tempos basal e T=8 (oito semanas). Nestes períodos foram coletadas informações demográficas, clínicas, atividade física, dieta, antropométricas e de composição corporal. Amostras de sangue foram coletadas após jejum de 12h e a partir do plasma/soro foram avaliados glicemia, insulina, colesterol total e associado a LDL e HDL, triacilgliceróis e as apolipoproteína AI e B utilizando métodos comerciais. O nível de risco cardiovascular dos indivíduos foi estimado pelo Escore de Risco de Framingham (ERF). Os resultados do efeito do tempo, da intervenção e das interações entre parâmetros monitorados e os desfechos foram analisados por meio do programa SPSS 20.0, sendo o nível de significância adotado de p<0,05. Resultados: A maioria dos indivíduos inclusos era do sexo feminino e da raça branca, sem diferença entre os grupos. As doenças mais prevalentes em ambos os grupos foram a hipertensão arterial, o diabetes mellitus e as dislipidemias. Não foram observadas mudanças de glicemia e insulina de jejum, HOMA-IR e HOMA 2- por cento S, com a suplementação de w-3, exceto nos indivíduos com risco cardiovascular intermediário, segundo o ERF. Em relação aos parâmetros antropométricos e de composição corporal, a população feminina do grupo w-3 apresentou redução do percentual de massa gorda ao longo do tempo e intervenção, assim como, foi também observada tal redução entre os indivíduos com alto risco cardiovascular. Não foi contatada variação na distribuição do ERF, apesar da melhora de seus componentes (colesterol total e HDL-C). Conclusões: A suplementação com w-3 promoveu redução de insulina e HOMA-IR nos indivíduos com ERF intermediário. Observou ainda efeito benéfico na redução do percentual de gordura corporal entre as mulheres e indivíduos com ERF alto, assim como na diminuição do colesterol total e aumento da HDL-C. / Introduction: The benefits of polyunsaturated omega 3 (n-3) on lipid metabolism and cardiovascular health fatty acids are widely accepted. However, the impact of n-3 in body composition, glucose homeostasis and consequent modification of cardiovascular risk has not been the focus of the primary outcomes of most clinical trials. Aim: To evaluate the impact of n-3 supplementation on body composition, glycemic control and the level of cardiovascular risk in adults. Methods: From a subsample of CARDIONUTRI study were selected (clinical, randomized, controlled, double blind study with follow-up of 2 months) 86 patients (group n-6, 3g of sunflower oil/d) and 88 individuals (n-3 group, 3g fish oil/d - 60 per cent EPA/DHA ). The effect of the interventions was monitored at baseline and T = 8 (eight weeks). In these periods were collected demographic information, clinical, physical activity, diet, anthropometric and body composition. After 12h fasting, blood samples were collected and, from plasma/serum, were evaluated glucose, insulin, total cholesterol, cholesterol associated with LDL and HDL, triacylglycerol, apolipoprotein AI and B using standard methods. The level of cardiovascular risk of individuals was estimated by the Framingham Risk Score (FRS). The results of the effect of the time of the intervention and the interactions between monitored parameters and outcomes were analyzed using the SPSS 20.0 program and the level of significance of p < 0.05. Results: The majority of individuals included were female and white, with no difference between groups. The most prevalent diseases in both groups were hypertension, diabetes mellitus and dyslipidemia. No change was observed in glucose and fasting insulin, HOMA-IR and HOMA 2- per cent S, with supplementation with n-3, except in patients with intermediate cardiovascular risk, according to the FRS. Regarding the anthropometric and body composition parameters, the n-3 group showed a reduction in the percentage of fat mass among females over time and intervention, as was also observed that reduction among individuals at high cardiovascular risk. There was no variation in the distribution of the ERF, despite the improvement of its components (total cholesterol and HDL-C). Conclusions: Supplementation with n-3 promoted reduction of insulin and HOMA-IR in subjects with intermediate FRS. It noted beneficial effect in reducing the percentage of body fat among women and individuals with high FRS, as well as decreased total cholesterol and increased HDL-C.

Despite research showing the benefits of glycemic control, it remains suboptimal among adults with diabetes in the United States. Possible reasons include unaddressed risk factors as well as lack of awareness of its immediate and long term consequences. The objectives of this study were to, using cross-sectional data, 1) ascertain the association between suboptimal (Hemoglobin A1c (HbA1c) ≥7%), borderline (HbA1c 7-8.9%), and poor (HbA1c ≥9%) glycemic control and potentially new risk factors (e.g. work characteristics), and 2) assess whether aspects of poor health and well-being such as poor health related quality of life (HRQOL), unemployment, and missed-work are associated with glycemic control; and 3) using prospective data, assess the relationship between mortality risk and glycemic control in US adults with type 2 diabetes. Data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys were used. HbA1c values were used to create dichotomous glycemic control indicators. Binary logistic regression models were used to assess relationships between risk factors, employment status and glycemic control. Multinomial logistic regression analyses were conducted to assess relationships between glycemic control and HRQOL variables. Zero-inflated Poisson regression models were used to assess relationships between missed work days and glycemic control. Cox-proportional hazard models were used to assess effects of glycemic control on mortality risk. Using STATA software, analyses were weighted to account for complex survey design and non-response. Multivariable models adjusted for socio-demographics, body mass index, among other variables. Results revealed that being a farm worker and working over 40 hours/week were risk factors for suboptimal glycemic control. Having greater days of poor mental was associated with suboptimal, borderline, and poor glycemic control. Having greater days of inactivity was associated with poor glycemic control while having greater days of poor physical health was associated with borderline glycemic control. There were no statistically significant relationships between glycemic control, self-reported general health, employment, and missed work. Finally, having an HbA1c value less than 6.5% was protective against mortality. The findings suggest that work-related factors are important in a person’s ability to reach optimal diabetes management levels. Poor glycemic control appears to have significant detrimental effects on HRQOL.

Avaliando-se, em ratos a glicemia produzida pela ingestão de diferentes alimentos contendo carboidratos complexos e, através de ensaios \"in vitro\", observou-se que as sementes de leguminosas (feijão e lentilha) produziram menores respostas glicêmicas do que a dos cereais (arroz, pão, macarrão, farelo de trigo, polenta, farinha de milho e extrusado de milho) e dos tubérculos ( batata, mandioca, farinha de mandioca e beiju) (p<0,05). Observou-se, ainda correlação positiva entre as respostas \"in vivo\" e os ensaios de digestibilidde \"in vitro\" (r=0,95 p<0,0l). As causas das diferenças observadas não são ainda bem conhecidas. Nas análises \"in vitro\" com feijões que sofreram diferentes tratamentos e por observações ao microscópio óptico, verificou-se que com o aumento do tempo de cocção ocorreu descompactação celular, porém a parede celular que envolve os grânulos não sofreu ruptura. A resistência oferecida à desintegração parece ser um dos possíveis fatores responsáveis pela menor digestibilidade das sementes de leguminosas. / The determination of postprandial glycemia from ingest of different foods contained complex carbohydrates, \"in vivo\" and \"in vitro\" assays, showed that leguminous seeds (bean and lentil) produced lower glycemic responses than those from the cereals (rice, bread, macaroni, wheat bran, porridge corn, cornflakes and corn flour) and the tubercles (potato, cassava, cassava flour and \"beiju\") (p<0,05). positive relationship between the \"in vivo\" responses and the \"in vitro\" digestibility assays (r=0,95, p<0,0l) was observed. The causes of the observed differences werenot knomn yet. In the \"in vitro\" analysis, heat treatment and optical microscope with beans were applied. The results from optical microscope revealed that the longer the cooking time was the greater the cell separated. And no damages on bean cell walls were observed. The resistance of cell wall to heat damage could be one of possible factors for the lower digestibility of the leguminous seeds.

A prevalência de diabetes mellitus (DM) está aumentando constantemente em todo o mundo a uma taxa alarmante. Devido às suas complicações que causam uma maior morbidade, invalidez e mortalidade, o DM representa um enorme problema para a saúde pública. Com isso, ações, tanto em diagnóstico como em tratamento, são necessárias para desacelerar a tendência atual e prevenir o desenvolvimento das complicações do DM. Recentemente, a hemoglobina glicada (HbA1c) foi introduzida nos critérios diagnósticos de DM. Os resultados de HbA1c são igualmente apropriados para o diagnóstico, apesar de não necessariamente detectarem DM nos mesmos indivíduos detectados pelos critérios de glicemia. No entanto, os níveis de HbA1c podem ser influenciados por qualquer condição que altere a vida útil dos eritrócitos e metabolismo da hemoglobina, independentemente da glicemia, resultando em erro diagnóstico neste grupo da população com estas condições. Além disso, estudos epidemiológicos revelaram que a glicemia pós-prandial tem um maior risco de causar complicações cardiovasculares em relação à hiperglicemia persistente e pode ser acessada com precisão usando a albumina glicada (AG) e não a HbA1c. Nesse contexto, estudos recentes têm evidenciado que a AG pode ser um marcador para diagnóstico do DM e também ser utilizado como um marcador alternativo à HbA1c para o controle glicêmico. No entanto, esses estudos, foram realizados apenas na população asiática e podem não ser aplicáveis a outros grupos étnicos. Por isso, mais investigações para a validação do desempenho diagnóstico da AG na predição do DM em diferentes grupos etnicos são necessárias. Neste estudo avaliamos o desempenho da AG no diagnóstico do DM em 242 indivíduos brasileiros com idade média de 54,4 anos (+ 13,0). Baseando-se nos valores de glicose plasmática durante o teste oral de tolerância à glicose (TOTG), o DM foi detectado em 31,8%. AG ≥16,8% apresentou acurácia similar para a detecção de DM conforme definido por HbA1c >6,5%. O uso da razão glicemia de 2h pós-sobrecarga de 75g de glicose (2hPG) e AG (2hPG/AG) melhora a sensibilidade, reduz o número de diagnósticos incorretos por AG ou HbA1c >6,5% e possui um acurácia comparável ao TOTG, indicando que o uso de uma estratégia aplicando a razão da glicemia pós-prandial (GPP) real e AG (GPP/AG) pode ser mais conveniente para pacientes e aumentar o desempenho diagnóstico do teste. Estudos para validar esta estratégia são necessários. / The prevalence of diabetes mellitus (DM) is constantly increasing worldwide at an alarming rate. Due to its complications that cause greater morbidity, disability and mortality, DM represents a heavy burden on public health. Therefore, actions in both, diagnosis and treatment, are necessary to slow down the current tendency and avoid the development of DM complications. Recently, the glycated hemoglobin test (HbA1c) was introduced in the diagnostic criteria for DM. The HbA1c results are equally appropriate for diagnostic testing, though not necessarily detect DM in the same subjects detected by plasma glucose criteria. However, blood HbA1c levels may be influenced by any condition that changes the lifespan of erythrocytes and hemoglobin metabolism regardless of glycemia, resulting in the misdiagnosis of this population group. In addition, epidemiological studies have shown that postprandial glycemia has a higher risk of causing cardiovascular complications than chronic hyperglycemia and can be accurately assessed using the glycated albumin (GA) test rather than HbA1c. In this context, recent studies have shown that GA may be a marker for the diagnosis of DM and also be used as an alternative marker to HbA1c on many occasions. However, these studies have been conducted only in the Asian population and may not be applicable to other ethnic groups. Therefore, further investigations to validate the diagnostic performance of GA in the prediction of DM in different ethnic groups are necessary. In this study, we evaluated the GA performance in the diagnosis of DM in 242 Brazilian individuals with a mean age of 54.4 years (+ 13.0). Based on plasma glucose values during oral glucose tolerance test (OGTT), DM was detected in 31.8%. AG ≥16.8% presented similar accuracy for detecting DM as defined by a HbA1c >6.5%. The use of the 2-h plasma glucose after a 75-g OGTT and GA (2hPG/GA) ratio improves sensitivity, reduces the number of incorrect diagnoses by GA or HbA1c >6.5% and has an accuracy comparable to OGTT, indicating that the use of approach applying the postprandial glucose (PPG) and GA (PPG/GA) may be more convenient for patients and increase the diagnostic performance of the test. Studies to validate this approach are needed.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第22779号 / 工博第4778号 / 新制||工||1747(附属図書館) / 京都大学大学院工学研究科電気工学専攻 / (主査)教授 土居 伸二, 教授 萩原 朋道, 教授 小林 哲生, 教授 古谷 栄光 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Objetivo: Evaluar la asociación entre síndrome metabólico (SM) y carga glicémica (CG) de la ingesta alimentaria en niños y adolescentes obesos atendidos en consulta endocrinológica de un hospital de referencia pediátrica en Lima, Perú. Pacientes y método: Estudio transversal en niños y adolescentes obesos (IMC ≥ percentil 95) de 10 a 15 años. Se utilizó los criterios de la International Diabetes Federation (IDF) para la clasificación de SM. Se aplicó recordatorio de 24 horas y se calculó la CG total y por tiempos de comida. Se evaluó la asociación entre los terciles de CG (comparación contra el inferior) y SM usando razones de prevalencia ajustadas (RPa) por variables demográficas, familiares, actividad física y consumo total de carbohidratos en modelos de regresión de Poisson con varianza robusta. Resultados: De 273 niños y adolescentes obesos, 52,4% fueron varones, 94,9% fueron físicamente inactivos y el IMC promedio fue 27,2 kg/m2. La mediana de carga glicémica fue de 213,3 (p25-p75:164,8 – 287,35) y de 2275 kcal (p25-p75: 1851,05 – 3024) de ingesta calórica diaria, dado principalmente por carbohidratos (62%).La prevalencia de SM fue de 22,3%, los componentes más prevalentes fueron la obesidad abdominal (81,7%) y el HDL bajo (63,7%). Se encontró asociación entre el consumo elevado de CG y el riesgo a presentar SM (RPa: 4,5; IC95%:1,3-15,31). Conclusiones: Existe asociación entre el alto consumo de CG y la presencia de SM en niños y adolescentes con obesidad. / Objective: Evaluate the association between metabolic syndrome (MS) and glycemic load (GL) of the food intake in obese children and adolescents attended in endocrinology consultation of a pediatric referral hospital in Lima, Peru. Patients and methods: Cross-sectional study in obese (BMI ≥ 95 percentile) children and adolescents between 10 to 15 years old. MS was classified according to the International Diabetes Federation (IDF). 24- hours recall was applied and calculated the GL total and by meal. The association between the tertiles of GL (comparison against the lower) and MS was found using adjusted prevalence ratios (RPa) for demographic variables, family, physical activity and total carbohydrates intake by Poisson regression models with robust variance. Results: 273 obese children and adolescents were recruited, 52.4% were male and 94.9% were physically inactive and IMC average was 27, 2 kg/m2. The median of GL was 213, 3 (164, 8 – 287, 35: 122, 6) and 2275 kcal (1851, 05 – 3024: 1172, 9) for daily caloric intake, mainly due of carbohydrates (62%). The prevalence of MS was 22, 3%, the components more relevant were abdominal obesity (81,7%) and low HDL (63,7%). The association between a high consumption of CG and the risk having MS (Rpa: 4,5; IC95%: 1,3-15,31) Conclusions: There is an association between the high intake of GL and the presence of MS. / Tesis

Background: The most patients in intensive care experience hyperglycemia. These may include patients with pre-existing diabetes or stress hyperglycemia as an organism's offense reaction. Our aim is not only to correct this hyperglycemia early by a reserve, but also to prevent acceleration of hyperglycemia above their commended level. In addition to insulin, the correct choice of enteral nutrition can prevent not only hyperglycemia but also glycemic variability, which seems to be a much greater risk for these patients than stable tolerable hyperglycemia. In addition to diabetic-specific formulas, whey-based enteral nutrition can support our pursuit of optimal glycemia, due to its insulinotropic effect and its ability to stimulate incretin release. Much evidence will still be needed to confirm these benefits, but we can already look at whey not only as a source of quality protein, but also as a diet with a potential to limit glycemic variability. Objective: The aim of the study was to evaluate the effect of enteral nutrition based on whey (Peptamen Intense) on parameters associated with the assessment of glycemia in intensive care patients. Assess whether there is a relationship between the variables and draw conclusions with possible application in practice. Methods: Thirty-seven patients were...

Diabetes affects an estimated 29.1 million Americans, with approximately another 1/3 of Americans not yet diagnosed. Complications associated with diabetes include heart disease, stroke, hypertension, blindness, kidney disease, neuropathy and death. All of these complications can be prevented with optimal control of blood glucose levels. Advances in technology provide people living with diabetes (PLWD) a multitude of treatment options such as continuous subcutaneous insulin infusion (CSII) therapy. Unfortunately, sustained improvement in glycated hemoglobin A1c (HgA1c) is not always achieved even with this advanced therapy. The purpose of this doctoral project was to educate nurses on CSII therapy and promote improved patient compliance, knowledge and ultimately improve HgA1c control. This doctoral project is an evaluation of an Evidence-Based Quality Improvement Project (EB-QIP) that evaluated nurse-led educational sessions for PLWD using CSII therapy. The integrated theory of health behavior change was used to guide the project. The CDC process evaluation model was used to evaluate the outcomes of the education sessions. Results showed that patients who were instructed by the nurses who took part in the EB-QIP had a reduction in the overall HgA1c by an average of 1.1 points 3-months post-education. The project promotes positive social change through establishing the effectiveness of an EB-QIP that focused on the use of education on CSII therapy in improving outcomes for patients living with diabetes.

Diabetes mellitus (DM) is one of the most common chronic diseases affecting children under the age of 20, and it often leads to serious complications. In recent decades, there has been an increase in incidence of both types of DM among U.S. children. Having this chronic condition not only negatively impacts the health of these children but also their academic achievements. School health nurses struggle to manage these children appropriately and safely. The purpose of this project was to develop an evidence- based guideline for a standardized process in which school nurses coordinate the school and student health care teams to ensure a safe school environment for diabetic children. The Stevens star model of knowledge transformation was used to frame the development of this guideline. A team of experts, consisting of 10 ten school nurses, was assembled to provide formative and summative evaluations of the guidelines. Nine nurses completed and returned the questionnaires within the allotted time. The formative group feedback resulted in the revision of the guideline prior to distribution for the summative evaluation. The experts then participated in a summative evaluation using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. The revised guideline was approved and recommended for use by all of the experts without additional modification. Implementation of the guideline will result in social change by improving outcomes in students' health and academic achievement and in strengthening the role and autonomy of the school nurse. Dissemination will occur first in the school district through presentation and then to a larger audience through publication in journals focused on school nursing.