No description available.

No description available.

No description available.

Postprandial urea production in subjects with insulin dependent diabetes mellitus (IDDM) on conventional insulin therapy is normal when the previous diet is high in protein, but there is an incomplete adaptive reduction in urea production following protein restriction. To evaluate the nutritional implications of restricted protein intake in human diabetes mellitus, it is first necessary to establish a reliable method to measure changes in urea production and amino acid catabolism in response to changes in dietary protein intake. We therefore tested (1) the accuracy of the urea production rate (Ra) to depict changes in urea production, (2) whether sulfate production can be accurately depicted using tracer or nontracer approaches, after establishing the use of electrospray tandem mass spectrometry to measure sulfate concentrations and 34SO4 enrichments following administration of the stable isotope tracer sodium [34S]sulfate, (3) the reproducibility of urea and sulfate measurements following a test meal low in protein (0.25 g/kg) in subjects previously adapted to high (1.5 g/kg.d) and low (0.3 g/kg.d) protein intakes, and compared the metabolic fate of [ 15N]alanine added to the test meal with that of [15N] Spirulina platensis, a 15N-labeled intact protein, and (4) whether we could identify the differences in postprandial urea and sulfate productions between normal subjects and persons with IDDM receiving conventional insulin therapy previously adapted to high protein intake, when the test meal was limiting in protein. Under basal conditions, steady state urea Ra is an accurate measure of urea production. Following changes in urea production, both the tracer and nontracer methods seriously underestimated total urea Ra. The tracer method overestimated sulfate production by 20%, but the nontracer method provided an accurate measure of sulfate production and, hence, sulfur amino acid catabolism. Postprandial changes in urea and sulfate productions following normal ada

No description available.

Carcass composition of male Sprague-Dawley rats, aged 11 and 18 months, in response to varying levels of dietary protein was determined. Groups varying of ten rats of each age were fed diets containing from 1.53 to 8.05 percent protein as casein supplemented with d-1-methionine for five weeks. The 8.05% protein groups were used as controls. Carcasses were analyzed for total nitrogen and percent protein, fat, and water. Liver composition and total serum protein values were also determined. Two-way analysis of variance and Student's t-tests were used to determine significant age and diet effects. Differences in the response of the two age groups of rats were evident. Eighteen-month-old rats required more protein than the younger animals for the maintenance of body weight. When compared to control values, older rats also needed a higher level of dietary protein to maintain normal total carcass nitrogen. Fatty livers in older rats persisted at higher dietary protein levels than fatty livers in 11-month-old rats, indicating that 18-month-old rats required more protein to support adequate liver lipoprotein synthesis. These findings suggest that 18-month-old rats have a higher dietary protein requirement than 11-month-old rats. High serum protein values for older rats at lower protein levels, however, do not support this conclusion. The increased body weight and proportionally greater fat mass of older animals was a complicating factor in this study. Further research is needed to more clearly define changes in protein requirements during aging. For future studies, using rats of a more advanced age and three, rather than two, different age groups is recommended. / Master of Science

Pacientes com doença renal crônica (DRC) na fase não dialítica são normalmente orientados a seguir uma dieta hipoproteica e hipossódica. Estudos nacionais e internacionais mostram que a adesão a essa dieta tem sido baixa e difícil de ser mantida, pois requer mudanças importantes no hábito alimentar. O objetivo do presente estudo foi avaliar o impacto de um programa de educação nutricional sobre a adesão à dieta hipoproteica em pacientes com DRC em tratamento conservador. Trata-se de um ensaio clínico randomizado, prospectivo com duração de 5 1,5 meses. Foram acompanhados 85 pacientes com DRC na fase não dialítica, atendidos em dois Ambulatórios de Nutrição e Doenças Renais do Hospital Universitário Pedro Ernesto. Os pacientes foram divididos de forma aleatória em 2 grupos: Intervenção (n=39) e Controle (n=46). Os pacientes do Grupo Intervenção foram submetidos a um programa de educação nutricional, além da orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). Os pacientes do Grupo Controle foram submetidos apenas à orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). A avaliação da adesão foi feita a partir da estimativa do consumo de proteína por recordatório alimentar de 24 horas. Adotou-se como critério de adesão apresentar ao final do estudo redução de ao menos 20% da ingestão proteica inicial. A avaliação nutricional e laboratorial foi realizada no início e no término do estudo. Os parâmetros antropométricos avaliados foram peso, estatura, dobras cutâneas do tríceps, bíceps, subescapular e supra-ilíaca e perímetro da cintura e do braço. As laboratoriais foram creatinina, uréia, potássio, fósforo, glicose e albumina no plasma e sódio e uréia na urina de 24 horas. Ao avaliar o amostra total, 51,8% dos pacientes eram do sexo masculino, com média de idade de 63,4 11,0 anos, IMC indicativo de sobrepeso (28,8 5,4 kg/m2) e filtração glomerular estimada (FGe) de 32,6 12,2 mL/mim/1,73m2. As características iniciais não diferiram entre os Grupos Intervenção e Controle. Ambos os grupos apresentaram melhora dos parâmetros laboratoriais e antropometricos, com redução significante da uréia plasmática e da glicemia no Grupo Controle (P < 0,05 vs início do estudo) e do IMC em ambos os grupos (P < 0,05 vs início do estudo). Após o período de acompanhamento, o Grupo Intervenção e o Grupo Controle apresentaram ingestão proteica significantemente diferente (0,62 0,2 vs 0,77 0,26 g/kg/dia, respectivamente). A ingestão de sódio não mudou de forma significante em ambos os grupos no inicio e término do acompanhamento. A Adesão à ingestão proteica foi observada em 74,4% do Grupo Intervenção e em 47,8% do Grupo Controle (P < 0,05). A análise de regressão logística multivariada revelou que pertencer ao Grupo Intervenção e sexo masculino se associaram com a Adesão (P <0,05), mesmo após corrigir para outras variáveis testadas. Com base nos achados desse estudo, pode-se concluir que o programa de educação nutricional foi uma ferramenta eficaz no tratamento dietoterápico do paciente com DRC na pré-diálise, pois promoveu melhora na adesão à dieta hipoproteica, além de ter promovido melhora dos parâmetros antropométricos e laboratoriais. / Nondialyzed chronic kidney disease (CKD) patients are normally counseled to follow a low protein and sodium diet. Nationals and internationals surveys have shown a low adherence to such diet. In addition, it has been also demonstrated that maintaining a low protein and sodium intake is difficult, because it requires important changes in eating habits. The objective of the present study was to evaluate the impact of a nutritional education program on the adherence to the low protein diet in CKD patients being followed in a conservative outpatient clinic. Study design: clinical, randomized, controlled and prospective essay (follow-up of 5 1.5 months (mean SD)). Eighty five nondialyzed CKD patients, under treatment in two CKD outpatient clinics from Pedro Ernesto University Hospital, were included in this study. These patients were randomized in two groups: Intervention (n=39) and Control (n=46). The patients of the Intervention Group were submitted to a nutritional education program, besides the low protein diet prescription (0.6 to 0.75 g/kg/day). The patients from the Control Group were submitted only to the low protein diet prescription (0.6 to 0.75 g/kg/day). The evaluation of the adherence was done by estimating the protein intake from the 24 hour food recall. The adherence criterion adopted was to present, at the end of the study, a reduction of at least 20% of the initial protein intake. The nutritional and laboratorial assessments were made at the beginning and at the end of the follow-up period. The anthropometric parameters assessed were body weight, height, triceps, biceps, subscapulars and suprailiacs skinfolds thicknesses and waists and arms circumferences. The laboratorial parameters included plasma creatinine, urea, potassium, phosphate, glucose and albumin and 24 hour urines sodium and urea. In the total studied sample, 51.8% of the patients were male, with an mean age of 63.4 11.0 years, mean BMI indicating overweight (28.8 5.4 kg/m) and a mean glomerular filtration rate (GFR) of 32.6 12.2 mL/mim/1,73m. The main characteristics at the beginning of the follow-up were not different between Intervention and Control Groups. Both groups presented an improvement on the laboratorial and anthropometrical parameters, with significant reduction of plasma urea and glucose in the Control Group (P < 0.05 vs baseline) and BMI in both groups (P < 0.05 vs baseline). After the follow-up period, the Intervention and Control Groups showed a significant decrease in the protein intake (0.62 0.2 vs 0.77 0.26 g/kg/day, respectively). The sodium intake did not significantly change in both groups at the beginning and end of the study. A higher degree of adherence to the low protein diet was observed in Intervention Group (74.4%) than in Control Group (47.8%) (P < 0.05). The multivariate logistic regression analysis revealed that belonging to the Intervention Group and male gender were significantly associated with Adherence (P < 0.05), even after controlling to others tested variables. Based on these findings, it can be concluded that the nutritional education program was an effective tool to reduce the protein intake of nondialyzed CKD patients, as it has leaded to an improvement in the adherence to the low protein diet, and promoted an amelioration of anthropometric and laboratorial parameters.

Submitted by ADRIANA FERRARI (acferrari89@yahoo.com.br) on 2016-05-04T22:01:49Z No. of bitstreams: 1 Dissertação_Adriana_Cristina_Ferrari..doc: 882688 bytes, checksum: 7a66b0730bd654d377806bbf785e4d6d (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-09T20:20:24Z (GMT) No. of bitstreams: 1 ferrari_ac_me_jabo.pdf: 1181979 bytes, checksum: b7810dc7c548584eba9c83abc239347d (MD5) / Made available in DSpace on 2016-05-09T20:20:24Z (GMT). No. of bitstreams: 1 ferrari_ac_me_jabo.pdf: 1181979 bytes, checksum: b7810dc7c548584eba9c83abc239347d (MD5) Previous issue date: 2016-01-18 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do trabalho foi verificar se o histórico de recria no período das águas influenciou a qualidade da carne de tourinhos Nelore terminados no período seco em pasto ou confinamento. Durante a fase de recria os animais foram mantidos, em pasto de capim Marandu manejados em diferentes alturas de pastejo (15; 25 e 35 cm) em lotação continua e taxa de lotação variável, combinado com estratégias de suplementação e terminados no período seco, em pastagens com a dieta suplementada ou confinamento. O trabalho foi constituido de dois experimentos, do ano de 2012/2013, capitulo 2 e ano de 2013/2014, capítulo 3. No primeiro experimento, capitulo 2, foram coletadas amostras de carne de animais provenientes de seis tratamentos: ABSA- recria em pasto de 15 cm de altura e suplemento de 0,6% PC; AMSM- recria em pasto 25 cm de altura e suplemento de 0,3% PC; AASM- recria em pasto de 35 cm de altura e suplemento mineral, cada tratamento com terminação em pasto ou confinamento com nove repetições (animais). Foram utilizadas amostras do M. longissimus thoracis et lumborum (LTL), retiradas da meia-carcaça esquerda, entre a 12ª e 13ª costelas, posteriormente embaladas em filme plástico e, após 24 horas de resfriamento as amostras foram congeladas a -20ºC. Procedeu-se as determinações da maciez (força de cisalhamento) e perdas por cocção, coloração da carne e da gordura subcutânea, pH, composição centesimal, teor de colágeno e porcentagem de gordura intramuscular avaliados em Espec¬trofotômetro Infravermelho Próximo (NIR) FOSS FoodScan™ e o perfil de ácidos graxos. O experimento foi conduzido de acordo com o delineamento inteiramente casualizado em arranjo fatorial (3 x 2), sendo três sistemas de recria (ABSA, AMSM ou AASS) e dois sistemas de terminação (pastagens ou confinamento), com nove repetições (animais) por tratamento (n = 54), foram aplicados testes de normalidade e análise de variância (P<0,05), usando os procedimentos PROC MIXED do software SAS®. O sistema de terminação influenciou a cor da gordura. Os tratamentos de menor nível de suplementação produziram animais com carne com menor intensidade de vermelho e maior intensidade de amarelo. Os tratamentos resultaram em carnes escuras, com baixa intensidade de vermelho e amarelo, estes resultados foram em função do pH final da carcaça dos animais, média de 6,23, o que caracteriza uma carne DFD (dark, firm and dry) o que mascarou o efeito do tratamento nas variáveis de cor da carne, maciez e perdas por cocção. A concentração do ácido miristico (C14:0) foi maior em animais terminados em confinamento. No segundo experimento, capitulo 3, foram coletadas amostras de carne de animais provenientes de 4 tratamentos: AMSA- recria em pasto 25 cm de altura e suplemento de 0,3% PC; AASB- recria em pasto de 35 cm de altura e suplemento mineral, na fase de transição águas-seca (meses de abril, maio e junho), aumentou o nível de suplemento, ou seja, suplemento multiplo na quantidade de 0,6% do PC e proteinado de baixo consumo de 0,1% do PC, para as altura 25 cm e 35 cm respectivamente, metade dos animais de cada tratamento foram terminados em pasto e outra metade no confinamento com seis repetições (animais) cada. Além das variáveis analisadas no primeiro experimento, neste estudo também foram quantificadas a frequência e área das fibras musculares, o comprimento de sarcômero, o índice de fragmentação miofibrilar e a oxidação lipídica. Na análise dos dados foi adotado o delineamento experimental inteiramente casualizado em arranjo fatorial (2 x 2), sendo dois sistemas de recria (AMSA ou AASB) e dois sistemas de terminação (pastagens ou confinamento), com seis repetições (animais) por tratamento (n = 24) Foram aplicados testes de normalidade e análise de variância (P<0,05), usando os procedimentos PROC MIXED do software SAS®. Animais terminados em pasto apresentaram maiores concentrações dos ácidos linileico, ácidos poliinsaturados e relação poliinsaturados: saturados e ω6:ω3. A terminação em confinamento proporcionou concentrações superiores de ácido palmitico e α linilenico. Não houve diferença significativa quanto a frequência e área das fibras musculares, cor e composição química. / The objective of this study was to verify if the growing phase influenced the meat quality of Nelore (bos indicus) beef finished on pasture or feedlot systems. The animals were kept during the growing phase, in Marandu grass pasture managed at different grazing height (15, 25 and 35 cm) in continuous grazing and variable stocking rate associated with supplementation strategies, and finished in the dry season in pastures with supplemented diet or feedlot system. The research was composed of two experiments, 2012/2013, Chapter 2 and year 2013/2014, chapter 3. In the first experiment, chapter 2, six treatments were evaluated: LHHS) growing on pasture of 15 cm height and 0.6% body weigt-BW supplementation; MHMS) rearing on pasture of 25 cm height and supplement 0 3% PC; HHLS) growing on pasture of 35 cm height and mineral, half os animals of each rearing treatment were finished on pastured associated with supplementation and other half finished on feedlot system with nine replications (animals) in each treatment. Samples of the M. longissimus thoracis et lumborum (LTL), from the left half carcass between the 12th and 13th ribs were removed, then packed in plastic film, refrigerated for 24 hours and then frozen at -20 ° C. The samples were analyzed for softness determinations (shear force) and cooking losses, the color of the meat and subcutaneous fat, pH, chemical composition, collagen content and the percentage of intramuscular fat in Spec-trofotômetro Near Infrared (NIR) FOSS FoodScan ™ and the fatty acid profile. The experiment was conducted according to a completely randomized design in a factorial arrangement (3 x 2), with three growing strategies (LHHS, MHMS or HHLS) and two finishing systems (pasture or feedlot) with nine replicates (animals) by treatment (n = 54), normality and variance analysis tests were applied (P <0.05), using the procedures PROC MIXED of SAS ® software. The finishing system influencied the fat color. Treatments with lower levels os supplementation produced meats with lower intensity of redness and higher intensity of yellowness. The average of pH were 6,23, that characterizes a meat DFD (dark, firm and dry) and masks the effect of treatment in the meat color, shear force, and cooking losses variables. Animal finished in feedlot system had more meristic acid than pasture finish In the second experiment, chapter 3, animal meat samples were collected from four treatments: MHHS- recreates in pasture 25 cm and 0.3% PC supplement; HHLS- recreates in pasture 35 cm and mineral supplement, finishing in pasture or confinement with six replications (animals) each treatment. On the transition phase water-dry (April, May and June), the supplementation level were increased, ie, multiplo supplement in the amount of 0.6% of the PC and protein of low consumption of 0.1% of the PC, to the height 25 cm and 35 cm respectively. In addition to the variables evaluated in the first experiment, this were also quantified the frequency and area of muscle fibers, the sarcomere length, the myofibril fragmentation and lipid oxidation. The data were analysed according a completely randomized design in a factorial arrangement (2 x 2), with two rearing systems (MHHS or HHLS) and two finishing systems (pasture or feedlot) with six replicates (animals) by treatment (n = 24) to evaluate the effect of rearing historic and finishing system on meat quality. Normality and variance analysis tests were used (P <0.05) using the PROC MIXED procedure of SAS ® software. Animals finished in pasture had higher concentration of linolenic acid, polyunsaturated acids and relation of ω6:ω3. Feedlot finishing had more palmitic acid and α linolenic acid than pasture. There was no significant diference on muscle fiber frequency and area, fat and meat color and chemistry composition. / CNPq: 131972/2014-6 / FAPESP: 2014/09932-6

Submitted by Valquíria Barbieri (kikibarbi@hotmail.com) on 2018-04-18T21:12:08Z No. of bitstreams: 1 DISS_2015_Deise Fátima Mezaroba.pdf: 1567664 bytes, checksum: 67bbe66382033d0b60709a1c450df069 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2018-04-27T17:30:42Z (GMT) No. of bitstreams: 1 DISS_2015_Deise Fátima Mezaroba.pdf: 1567664 bytes, checksum: 67bbe66382033d0b60709a1c450df069 (MD5) / Made available in DSpace on 2018-04-27T17:30:42Z (GMT). No. of bitstreams: 1 DISS_2015_Deise Fátima Mezaroba.pdf: 1567664 bytes, checksum: 67bbe66382033d0b60709a1c450df069 (MD5) Previous issue date: 2015-04-30 / CAPES / A dieta hipoproteica-hiperglicídica (LPHC), administrada a ratos machos por 15 ou 45 dias, logo após o desmame, altera vários parâmetros metabólicos e hormonais. Sabe-se também que os hormônios produzidos pela glândula tireoide têm um papel fundamental a nível tecidual para a manutenção da homeostase do organismo. Diante disto, o objetivo deste trabalho foi investigar os efeitos da dieta LPHC a longo prazo e da troca da dieta LHPC por dieta balanceada sobre o metabolismo desiodativo em diferentes tecidos, assim como algumas das ações atribuídas aos hormônios tireóideos. Ratos Wistar machos (~100g) foram randomicamente divididos em grupos conforme segue: 1) controles - alimentados com uma dieta com 17% de proteínas e 63% de carboidratos por 45 dias (C45); 2) LPHC - alimentados com dieta contendo 6% de proteínas e 74% de carboidratos por 45 dias (LPHC45) e; 3) reversão - alimentados por 15 dias com a dieta LPHC e por mais 30 dias com a dieta controle (R) (ANOVA-1 via; p<0,05). A quantificação da concentração do hormônio tireoestimulante no sangue dos animais do grupo R mostrou um aumento de 11,7% e 11,6%, se comparado ao grupo C45 e ao grupo LPHC45, respectivamente (C45: 8439,58 ± 59,46; LPHC45: 8448,06 ± 105,86; R: 9428,39 ± 48,96 pg/mL). A análise da expressão proteica da iodotironina desiodase 1 em fígado, rins e tireoide e da iodotironina desiodase 2 em tecido adiposo marrom, músculos extensor digital longo e sóleo, hipotálamo e hipófise mostrou alteração somente no fígado do grupo LPHC45, com aumento de 17,38% da isoforma 1, em relação aos animais controles. Este grupo também apresentou aumento de 27,02% no conteúdo do receptor hepático para hormônio tireóideo β1, comparando-se ao grupo C45. A avaliação do perfil lipídico de jejum mostrou redução do colesterol total (C45: 97,35 ± 7,87; LPHC45: 65,41 ± 4,78; R: 94,32 ± 5,25 mg/dL), colesterol HDL (C45: 56,58 ± 3,90; LPHC45: 36,74 ± 1,28; R: 54,21 ± xvii 4,30 mg/dL), colesterol VLDL (C45: 22,92 ± 1,44; LPHC45: 15,89 ± 1,50; R: 22,07 ± 1,70 mg/dL) e triglicerídeos (C45: 114,61 ± 7,18; LPHC45: 79,46 ± 7,49; R: 110,36 ± 8,48 mg/dL) nos animais submetidos à dieta LPHC por 45 dias. A expressão hepática da enzima 7α-hidroxilase e da proteína de ligação ao elemento de resposta aos esteróis aumentou 43,96% e 36,27%, respectivamente, no grupo LPHC45, quando comparadas ao grupo C45. A atividade das enzimas málica (C45: 85,92 ± 9,01; LPHC45: 171,63 ± 14,98; R: 159,09 ± 13,16 nmol.mg prot-1.min-1) e ATP-citrato liase (C45: 290,88 ± 11,57; LPHC45: 444,98 ± 20,79; R: 386,75 ± 23,47 nmol.mg prot-1.min-1) foi maior nos grupos LPHC45 e R, em relação ao grupo C45. A análise conjunta destes dados demonstra que a dieta hipoproteica-hiperglicídica administrada por 45 dias leva a alterações no metabolismo desiodativo hepático, modulando o perfil lipídico e que talvez possam resultar em um futuro quadro de esteatose hepática. / The low-protein, high-carbohydrate diet (LPHC) administered to male rats for 15 or 45 days after weaning, change various metabolic and hormonal parameters. It is also known that the hormones produced by the thyroid gland have a key role to tissue level to maintain body’s homeostasis. Thus, the objective of this study was to investigate the effects of the LPHC diet long-term and exchange of LHPC diet for balanced diet on the deiodinative metabolism in different tissues, as well as some of the actions attributed to thyroid hormone. Male Wistar rats (~100g) were randomly divided into the following groups: 1) controls - fed a diet containing 17% protein and 63% carbohydrates for 45 days (C45 group); 2) LPHC - fed a diet containing 6% protein and 74% carbohydrates for 45 days (LPHC45 group), and 3) reversal - fed for 15 days with LPHC diet and for 30 days with the control diet (R group) (ANOVA-one way; p<0.05). The quantification of the concentration of thyroid-stimulating hormone in the blood of the animals of the R group showed an increase of 11.7% and 11.6%, compared with the C45 group and LPHC45 group, respectively (C45: 8439.58 ± 59.46; LPHC45: 8448.06 ± 105.86; R: 9428.39 ± 48.96 pg/mL). Analysis of protein expression of iodothyronine deiodinase 1 in liver, kidney and thyroid, and protein expression of iodothyronine deiodinase 2 in brown adipose tissue, long digital extensor and soleus muscles, hypothalamus, and pituitary only showed alteration in liver of the LPHC45 group, with an increase of 17.38% in the isoform 1, compared with the control animals. This group also showed an increase of 27.02% in the content of liver receptor for thyroid hormone β1 compared with the C45 group. The fasting lipid profile showed a reduction in total cholesterol (C45: 97.35 ± 7.87; LPHC45: 65.41 ± 4.78; R: 94.32 ± 5.25 mg/dL), in HDL cholesterol (C45: 56.58 ± 3.90; LPHC45: 36.74 ± 1.28, R: 54.21 ± 4.30 mg/dL), in VLDL (C45: 22 92 ± 1.44; LPHC45: 15.89 ± 1.50; R: 22.07 ± 1.70 mg/dL), xix and triglycerides (C45: 114.61 ± 7.18; LPHC45: 79.46 ± 7 49; R: 110.36 ± 8.48 mg/dL) in animals subjected to LPHC diet for 45 days. The hepatic expression of 7α-hydroxylase enzyme and the binding protein sterol response element had an increase of 43.96% and 36.27%, respectively, in LPHC45 group when compared with the C45 group. The activity of malic enzyme (C45: 85.92 ± 9.01; LPHC45: 171.63 ± 14.98; R: 159.09 ± 13.16 nmol.mg prot-1 .min-1) and ATP-citrate lyase (C45: 290.88 ± 11.57; LPHC45: 444.98 ± 20.79; R: 386.75 ± 23.47 nmol.mg prot-1 .min-1) was higher in LPHC45 and R groups, compared with C45 group. The analysis of these data shows that the low-protein, high-carbohydrate diet administered for 45 days leads to alterations in hepatic deiodinative metabolism by modulating the lipid profile and that may perhaps result in a future framework of hepatic steatosis.

Pacientes com doença renal crônica (DRC) na fase não dialítica são normalmente orientados a seguir uma dieta hipoproteica e hipossódica. Estudos nacionais e internacionais mostram que a adesão a essa dieta tem sido baixa e difícil de ser mantida, pois requer mudanças importantes no hábito alimentar. O objetivo do presente estudo foi avaliar o impacto de um programa de educação nutricional sobre a adesão à dieta hipoproteica em pacientes com DRC em tratamento conservador. Trata-se de um ensaio clínico randomizado, prospectivo com duração de 5 1,5 meses. Foram acompanhados 85 pacientes com DRC na fase não dialítica, atendidos em dois Ambulatórios de Nutrição e Doenças Renais do Hospital Universitário Pedro Ernesto. Os pacientes foram divididos de forma aleatória em 2 grupos: Intervenção (n=39) e Controle (n=46). Os pacientes do Grupo Intervenção foram submetidos a um programa de educação nutricional, além da orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). Os pacientes do Grupo Controle foram submetidos apenas à orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). A avaliação da adesão foi feita a partir da estimativa do consumo de proteína por recordatório alimentar de 24 horas. Adotou-se como critério de adesão apresentar ao final do estudo redução de ao menos 20% da ingestão proteica inicial. A avaliação nutricional e laboratorial foi realizada no início e no término do estudo. Os parâmetros antropométricos avaliados foram peso, estatura, dobras cutâneas do tríceps, bíceps, subescapular e supra-ilíaca e perímetro da cintura e do braço. As laboratoriais foram creatinina, uréia, potássio, fósforo, glicose e albumina no plasma e sódio e uréia na urina de 24 horas. Ao avaliar o amostra total, 51,8% dos pacientes eram do sexo masculino, com média de idade de 63,4 11,0 anos, IMC indicativo de sobrepeso (28,8 5,4 kg/m2) e filtração glomerular estimada (FGe) de 32,6 12,2 mL/mim/1,73m2. As características iniciais não diferiram entre os Grupos Intervenção e Controle. Ambos os grupos apresentaram melhora dos parâmetros laboratoriais e antropometricos, com redução significante da uréia plasmática e da glicemia no Grupo Controle (P < 0,05 vs início do estudo) e do IMC em ambos os grupos (P < 0,05 vs início do estudo). Após o período de acompanhamento, o Grupo Intervenção e o Grupo Controle apresentaram ingestão proteica significantemente diferente (0,62 0,2 vs 0,77 0,26 g/kg/dia, respectivamente). A ingestão de sódio não mudou de forma significante em ambos os grupos no inicio e término do acompanhamento. A Adesão à ingestão proteica foi observada em 74,4% do Grupo Intervenção e em 47,8% do Grupo Controle (P < 0,05). A análise de regressão logística multivariada revelou que pertencer ao Grupo Intervenção e sexo masculino se associaram com a Adesão (P <0,05), mesmo após corrigir para outras variáveis testadas. Com base nos achados desse estudo, pode-se concluir que o programa de educação nutricional foi uma ferramenta eficaz no tratamento dietoterápico do paciente com DRC na pré-diálise, pois promoveu melhora na adesão à dieta hipoproteica, além de ter promovido melhora dos parâmetros antropométricos e laboratoriais. / Nondialyzed chronic kidney disease (CKD) patients are normally counseled to follow a low protein and sodium diet. Nationals and internationals surveys have shown a low adherence to such diet. In addition, it has been also demonstrated that maintaining a low protein and sodium intake is difficult, because it requires important changes in eating habits. The objective of the present study was to evaluate the impact of a nutritional education program on the adherence to the low protein diet in CKD patients being followed in a conservative outpatient clinic. Study design: clinical, randomized, controlled and prospective essay (follow-up of 5 1.5 months (mean SD)). Eighty five nondialyzed CKD patients, under treatment in two CKD outpatient clinics from Pedro Ernesto University Hospital, were included in this study. These patients were randomized in two groups: Intervention (n=39) and Control (n=46). The patients of the Intervention Group were submitted to a nutritional education program, besides the low protein diet prescription (0.6 to 0.75 g/kg/day). The patients from the Control Group were submitted only to the low protein diet prescription (0.6 to 0.75 g/kg/day). The evaluation of the adherence was done by estimating the protein intake from the 24 hour food recall. The adherence criterion adopted was to present, at the end of the study, a reduction of at least 20% of the initial protein intake. The nutritional and laboratorial assessments were made at the beginning and at the end of the follow-up period. The anthropometric parameters assessed were body weight, height, triceps, biceps, subscapulars and suprailiacs skinfolds thicknesses and waists and arms circumferences. The laboratorial parameters included plasma creatinine, urea, potassium, phosphate, glucose and albumin and 24 hour urines sodium and urea. In the total studied sample, 51.8% of the patients were male, with an mean age of 63.4 11.0 years, mean BMI indicating overweight (28.8 5.4 kg/m) and a mean glomerular filtration rate (GFR) of 32.6 12.2 mL/mim/1,73m. The main characteristics at the beginning of the follow-up were not different between Intervention and Control Groups. Both groups presented an improvement on the laboratorial and anthropometrical parameters, with significant reduction of plasma urea and glucose in the Control Group (P < 0.05 vs baseline) and BMI in both groups (P < 0.05 vs baseline). After the follow-up period, the Intervention and Control Groups showed a significant decrease in the protein intake (0.62 0.2 vs 0.77 0.26 g/kg/day, respectively). The sodium intake did not significantly change in both groups at the beginning and end of the study. A higher degree of adherence to the low protein diet was observed in Intervention Group (74.4%) than in Control Group (47.8%) (P < 0.05). The multivariate logistic regression analysis revealed that belonging to the Intervention Group and male gender were significantly associated with Adherence (P < 0.05), even after controlling to others tested variables. Based on these findings, it can be concluded that the nutritional education program was an effective tool to reduce the protein intake of nondialyzed CKD patients, as it has leaded to an improvement in the adherence to the low protein diet, and promoted an amelioration of anthropometric and laboratorial parameters.