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Rôle du récepteur nucléaire d'activation et de prolifération des péroxysomes (PPAR-alpha) dans la modulation de l'inflammation et l'activation des cellules T / Role of nuclear peroxisome proliferator-activation receptor alpha in the modulation of inflammation and activation of T cellsAttakpa, Eugène Sèlidji 28 September 2010 (has links)
Notre étude a montré l’implication de la déficience de PPARα dans la modulation de latranscription des gènes de l’insuline et de l’inflammation des adipocytes chez les sourisadultes C57BL/6J (WT) et PPARα-null. A jeun, les souris PPARα-null sont hypoglycémiquespar rapport aux animaux témoins WT. La concentration en insuline et l’expression de sesARNm pancréatiques, par rapport aux animaux témoins, sont diminuées chez les sourisPPARα-null, suggérant que la suppression du gène de PPARα contribuait à la faibletranscription de ces gènes. De plus, la suppression du gène de PPARα aboutit à la diminutiondes facteurs de transcription des gènes de l’insuline comme Pdx-1, Nkx6.1 et MafA. En outre,la capacité pancréatique fonctionnelle est aussi détériorée par la suppression du gène dePPARα puisque le pancréas des souris PPARα-null exprime de faibles taux de Glut2 et deglucokinase. Les souris PPARα-null expriment des taux élevés d’adiponectine et de leptinecomparées aux souris témoins. Dans les tissus adipeux, les souris PPARα-null présentent uneaugmentation de l’expression de CD14 et CD68 généralement exprimés par les macrophages.La suppression du gène de PPARα diminue, au niveau des adipocytes, l’expression de MCP-1, TNFα, IL-1β, IL-6 et RANTES, alors que l’expression de TLR-2 et de TLR-4 (récepteurspro-inflammatoires) était élevée dans les tissus adipeux. Ces résultats suggèrent qu’encondition normale, la déficience en PPARα, chez les souris est impliquée dans la modulationde la transcription des gènes de l’insuline et le statut inflammatoire du tissu adipeux.En outre, l'invalidation du gène de PPARα dans les cellules T a abouti àl'augmentation de T-bet et la diminution de GATA-3 tant aux niveaux de la protéine que del’ARNm. Comme prévu, l’acide Docosahexaénoïque (DHA) a exercé non seulement un effetinhibiteur sur la prolifération des cellules T, mais aussi a diminué la sécrétion d’IFN-γ etstimulé la sécrétion de l’IL-4 dans les deux types cellulaires. Le DHA a aussi diminué T-bet etaugmenté GATA-3 tant au niveau de la transcription qu’au niveau de la protéine. Quoique lescellules T des souris PPARα-null ont exprimé un plus fort niveau de phosphorylation de p38MAP kinase que les cellules T de WT, le DHA a diminué la phosphorylation des MAPkinases (p38 et ERK1/2) dans tous les deux les types cellulaires. Les inhibiteurspharmacologiques des MAP kinases ont aussi diminué T-bet et augmenté GATA-3 dans lescellules T. Ces résultats démontrent que le DHA, via son action sur les MAP kinases, modulel'expression des facteurs de transcription. Ces résultats expliquent aussi le mécanisme d'actionde cet acide gras sur la différenciation des cellules T dans la maladie et la santé / We assessed, in this study, the effects of PPARα deficiency on the expression of mRNAencoding for insulin gene transcription factors in pancreatic β-cells along with thoseimplicated in inflammation in adipose tissues. On fasting, the adult PPARα-null mice werehypoglycemic. Serum insulin concentrations and its pancreatic mRNA transcripts weredownregulated in PPARα-null mice, suggesting that PPARα gene deletion contributes to lowinsulin gene transcription. The PPARα gene deletion downregulates the mRNA expression ofinsulin gene transcription factors, i.e., Pdx-1, Nkx6.1 and MafA. Besides, the pancreaticfunction was diminished by PPARα deficiency as PPARα-null mice expressed low pancreaticGlut2 and glucokinase mRNA. PPARα-null mice also expressed high adiponectin and leptinmRNA levels compared to wild type animals. Adipose tissues of PPARα-null mice exhibitedupregulation of CD14 and CD68 mRNA, generally expressed by macrophages. PPAR-a genedeletion downregulates the adipocyte mRNA of certain pro inflammatory agents, like MCP-1,TNF-a, IL-1b, IL-6, and RANTES, though pro-inflammatory TLR-2 and TLR-4 mRNAswere upregulated in the adipose tissues. Our results suggest that PPAR-a deficiency, in mice,is implicated in the modulation of insulin gene transcription and inflammatory status inadipose tissues.The another part of the study was conducted on CD4+ T-cells, isolated from wild type(WT) and PPARα-null mice, in order to assess the mechanismof action of docosahexaenoicacid (DHA), an n-3 fatty acid, in the modulation of two transcription factors, i.e., T-bet andGATA-3, implicated in T-cell differentiation towards, respectively, TH1 and TH2 phenotype.The T-cells from PPARα-null mice secreted higher IFN-γ and lower IL-4 concentrations thanWT T-cells. Furthermore, the deletion of PPAR-α gene in T-cells resulted in the upregulationof T-bet and downregulation of GATA-3 both at mRNA and protein levels. DHA exerted notonly an inhibitory effect on T-cell proliferation, but also diminished IFN-γ and stimulated IL-4 secretions in both cell types. DHA also downregulated T-bet and upregulated GATA-3 bothat transcription and protein levels. Though the T-cells from PPARα-null mice expressedhigher p38 phosphorylation than WT T-cells, DHA diminished the MAP kinasephosphorylation (p38 and ERK1/2) in both the cell types. The pharmacological inhibitors ofMAP kinases also downregulated T-bet and upregulated GATA-3 in T-cells. Altogether, theseresults demonstrate that DHA, via its action on MAP kinases, modulates the expression oftranscription factors. These results also explain the mechanism of action of this fatty acid onT-cell differentiation in disease and health
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Measurement and Evaluation of Antioxidant Status and Relation to Oxidative Stress in HumansNälsén, Cecilia January 2006 (has links)
<p>Numerous diseases are associated with reduced antioxidant defence and oxidative stress. The antioxidant defence includes dietary and endogenous antioxidants and involves complex interactions between them. The effects of dietary factors on antioxidant status and oxidative stress of healthy humans were investigated in the studies described in this thesis. Assays of plasma antioxidant capacity encompass interactions between various antioxidants. Although uric acid has an unclear function as an antioxidant, it is a major determinant of antioxidant capacity. We measured antioxidant capacity in the presence and absence of uric acid to provide more information on the application of measures of antioxidant capacity. Individuals with high dietary intakes of various antioxidants and antioxidant rich foods, especially when combined, had higher plasma antioxidant capacities than those with lower antioxidant intakes. However, there were no associations between dietary intake of antioxidants or antioxidant rich foods and the plasma concentration of F<sub>2</sub>-isoprostanes, which is considered a reliable biomarker for oxidative stress. Intakes of various doses of a mixture of bilberry juice and black tea, rich in flavonoids for four weeks, increased antioxidant capacity in some groups, but urine levels of F<sub>2</sub>-isoprostanes were not affected. There were substantial individual variations in responses to the drinks related to baseline antioxidant capacity. Supplementation with eicosapentaenoic acid and docosahexaenoic acid decreased the plasma levels of F<sub>2</sub>-isoprostanes, but not prostaglandin F<sub>2α</sub> formation or antioxidant capacity. </p><p>It was concluded that a high intake of foods rich in antioxidants is related to improved antioxidant status. After intake of foods rich in antioxidants, the antioxidant status may increase, but with considerable individual variation in the responses, which warrants further investigation. Lipid peroxidation <i>in vivo</i> is not easily affected by dietary antioxidants in healthy humans. Although n-3 fatty acids are highly unsaturated, they reduce nonenzymatic free radical-catalyzed lipid peroxidation, but not enzymatic lipid peroxidation.</p>
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Measurement and Evaluation of Antioxidant Status and Relation to Oxidative Stress in HumansNälsén, Cecilia January 2006 (has links)
Numerous diseases are associated with reduced antioxidant defence and oxidative stress. The antioxidant defence includes dietary and endogenous antioxidants and involves complex interactions between them. The effects of dietary factors on antioxidant status and oxidative stress of healthy humans were investigated in the studies described in this thesis. Assays of plasma antioxidant capacity encompass interactions between various antioxidants. Although uric acid has an unclear function as an antioxidant, it is a major determinant of antioxidant capacity. We measured antioxidant capacity in the presence and absence of uric acid to provide more information on the application of measures of antioxidant capacity. Individuals with high dietary intakes of various antioxidants and antioxidant rich foods, especially when combined, had higher plasma antioxidant capacities than those with lower antioxidant intakes. However, there were no associations between dietary intake of antioxidants or antioxidant rich foods and the plasma concentration of F2-isoprostanes, which is considered a reliable biomarker for oxidative stress. Intakes of various doses of a mixture of bilberry juice and black tea, rich in flavonoids for four weeks, increased antioxidant capacity in some groups, but urine levels of F2-isoprostanes were not affected. There were substantial individual variations in responses to the drinks related to baseline antioxidant capacity. Supplementation with eicosapentaenoic acid and docosahexaenoic acid decreased the plasma levels of F2-isoprostanes, but not prostaglandin F2α formation or antioxidant capacity. It was concluded that a high intake of foods rich in antioxidants is related to improved antioxidant status. After intake of foods rich in antioxidants, the antioxidant status may increase, but with considerable individual variation in the responses, which warrants further investigation. Lipid peroxidation in vivo is not easily affected by dietary antioxidants in healthy humans. Although n-3 fatty acids are highly unsaturated, they reduce nonenzymatic free radical-catalyzed lipid peroxidation, but not enzymatic lipid peroxidation.
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Establishing the anti-cancer effects of unsaturated fatty acids and a novel oil on human breast cancer cellsYu, Howe-Ming Unknown Date
No description available.
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Fatty Acids and Risk of Fracture in Postmenopausal WomenOrchard, Tonya Sue 25 July 2011 (has links)
No description available.
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Envolvimento dos PPARγ nas ações metabólicas dos ácidos graxos ômega-3. / PPARγ involvement in the metabolic actions of ômega-3 fatty acids.Oliveira, Thiago Belchior de 25 November 2015 (has links)
O consumo de ácidos graxos n-3 tem sido associado à proteção contra a obesidade, inflamação e resistência à insulina. Os n-3 são ligantes fracos dos receptores nucleares PPARγ, e pela ativação deste podem exercer suas ações metabólicas e anti-inflamatórias. No presente trabalho, foi investigado se o aumento da disponibilidade dos n-3 geneticamente ou por dieta, via ativação de PPARγ, protege camundongos do desenvolvimento da obesidade, intolerância a glicose e inflamação do tecido adiposo. Foi visto em um modelo com camundongos fat-1 (elevados níveis endógenos de n-3) que dentre as ações dos ácidos graxos n-3, a proteção contra o aumento de peso/adiposidade associada à obesidade, bem como a melhora da intolerância à glicose são dependentes de PPARγ. Além disso, por meio da utilização de camundongos com deleção de PPARγ em hepatócitos os dados desse trabalho mostram que os PPARγ são, ao menos em parte, essenciais ao aumento da oxidação de ácidos graxos induzida pelos n-3 devido à modulação da expressão gênica e protéica de enzimas mitocondriais e peroxissomais. / The intake of n-3 fatty acids have been associated to the protection against obesity, inflammation and insulin resistance. The n-3 fatty acids are ligands of the nuclear receptor PPARγ, and by the activation of this receptor can promote their metabolic and anti-inflammatory effects. Herein, we investigated whether increasing body n-3 fatty acids levels either genetically or by a n-3 enriched diet protects mice from diet-induced obesity, glucose intolerance and adipose tissue inflammation through PPARγ activation. Fat-1 mice were protected from diet-induced obesity, glucose intolerance and adipose tissue inflammation. To better investigate PPARγ involvement in n-3 beneficial actions, mice with genetic deletion of PPARγ specifically in hepatocytes. In spite of the absence of changes in body weight and glucose homeostasis PPARγ deletion in hepatocytes completely abolished the increase in liver fatty acid oxidation and hepatic gene expression of genes associated to mitochondrial and peroxisomal activity.
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INFLUÊNCIA DE DIFERENTES ÁCIDOS GRAXOS SOBRE PARÂMETROS COMPORTAMENTAIS E OXIDATIVOS EM RATOS SUBMETIDOS AO ESTRESSE AGUDO / INFLUENCE OF DIFFERENT FATTY ACID ON BEHAVIORAL PARAMETERS AND OXIDATIVE STRESS IN RATS AFTER ACUTE STRESSPase, Camila Simonetti 30 August 2013 (has links)
Conselho Nacional de Desenvolvimento Científico e Tecnológico / The fatty acids (FA) are important constituents of brain phospholipid membranes and play important roles in the central nervous system (CNS) may modify the plasticity and fluidity, and act decisively in the development of cognitive and neuropsychiatric disorders. During the last decades, we observed changes in eating habits, which enabled increased consumption of trans fatty acids at the expense of consumption of polyunsaturated fatty acids (PUFA), especially omega-3. Furthermore, frequent situations of stress due to pressure of the outside world may also be associated with the development of diseases involving CNS and changes in metabolic function, particularly in the metabolism of fatty acids. In this study, two sequential generations of rats were supplemented with soybean oil (C-SO), fish oil (FO) and hydrogenated vegetable fat (HVF) during pregnancy and lactation. At 41 days of age, half of the male animals of each group were exposed to acute stress (AE-2h) and evaluated in the open field and elevated plus maze, followed by euthanasia for biochemical analysis. The HVF supplemented group had higher anxiety symptoms, while groups C-SO and FO did not show these behaviors. Among the groups exposed to AE, the HVF showed greater locomotion and symptoms similar to anxiety, but this was not observed in the FO. Biochemical analyzes showed higher levels of lipid peroxidation and reduced cell viability in the cortex of HVF group. Furthermore, the HVF treated rats showed reduced catalase activity in the striatum and hippocampus, and increased generation of reactive species in the striatum, while FO was associated with increased cell viability in the hippocampus. Among the groups exposed to AE, the HVF group showed increased generation of reactive species in the brain, decreased cell viability in the cortex and striatum, and decreased catalase activity in the striatum and hippocampus. The results show that the presence of FA for the development and growth over two generations is capable of modifying parameters of oxidative status and behavior of the brain. Taken together, our data support the idea that regular consumption of a diet rich in monounsaturated fatty acids (MUFA) and PUFA, and particularly low in processed foods, can help prevent the development of emotional disorders, and suggest the influence harmful consumption of trans fat over generations, which is able to increase parameters of emotion and nervousness after stressful situations of everyday life can trigger neurological and neuropsychiatric conditions more severe. / Os ácidos graxos (AG) são constituintes importantes das membranas fosfolipídicas cerebrais e desempenham importantes funções no sistema nervoso central (SNC) podendo modificar a plasticidade e fluidez, além de atuar de forma decisiva no desenvolvimento de patologias cognitivas e neuropsiquiátricas. Durante as últimas décadas, foram observadas mudanças nos hábitos alimentares, as quais possibilitaram o aumento do consumo de ácidos graxos trans, em detrimento do consumo de ácidos graxos poliinsaturados (AGPI), principalmente o ômega-3. Além disso, situações frequentes de estresse devido a pressão do mundo exterior também podem estar associadas com o desenvolvimento de doenças que envolvem o SNC e alterações na função metabólica, particularmente no metabolismo dos ácidos graxos. Neste estudo, duas gerações sequenciais de ratas foram suplementadas com óleo de soja (C-OS), óleo de peixe (OP) e gordura vegetal hidrogenada (GVH) durante a gestação, lactação e após o desmame. Aos 41 dias de idade, parte dos animais machos, da segunda geração, foram expostos ao estresse agudo (EA-2h), enquanto a outra metade foi utilizada como controles, e avaliados em campo aberto e labirinto em cruz elevado, seguido por eutanásia para análises bioquímicas. O grupo suplementado com GVH, não expostos ao estresse, apresentou maiores sintomas de ansiedade, enquanto os grupos C-OS e OP não mostraram esses comportamentos. Entre os grupos expostos ao EA, o GVH mostrou maior locomoção e sintomas semelhantes à ansiedade, mas isso não foi observado no grupo OP. As análises bioquímicas mostraram níveis mais elevados de peroxidação lipídica e menor viabilidade celular no córtex do grupo GVH. Além disso, os ratos tratados com GVH mostraram reduzida atividade da catalase no estriado e hipocampo, bem como aumento da geração de espécies reativas no estriado, ao passo que OP foi associado com aumento da viabilidade celular no hipocampo. Entre os grupos expostos ao EA, o grupo GVH mostrou aumento da geração de espécies reativas no cérebro, diminuição da viabilidade celular no córtex e estriado, e diminuição da atividade da catalase no estriado e hipocampo. Os resultados mostram que a presença de AG durante o desenvolvimento e crescimento ao longo de duas gerações é capaz de modificar parâmetros de comportamento e status oxidativo do cérebro. Tomados em conjunto, nossos dados suportam a ideia de que o consumo regular de uma dieta rica em ácidos graxos monoinsaturados (AGM) e AGPI, e particularmente pobre em alimentos processados, pode ajudar a prevenir o desenvolvimento de distúrbios emocionais, além de sugerir a influência nociva do consumo de gordura trans ao longo de gerações, a qual é capaz de aumentar parâmetros de emocionalidade e ansiedade após situações estressantes da vida
cotidiana podendo desencadear condições neurológicas e neuropsiquiátricas mais graves.
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Envolvimento dos PPARγ nas ações metabólicas dos ácidos graxos ômega-3. / PPARγ involvement in the metabolic actions of ômega-3 fatty acids.Thiago Belchior de Oliveira 25 November 2015 (has links)
O consumo de ácidos graxos n-3 tem sido associado à proteção contra a obesidade, inflamação e resistência à insulina. Os n-3 são ligantes fracos dos receptores nucleares PPARγ, e pela ativação deste podem exercer suas ações metabólicas e anti-inflamatórias. No presente trabalho, foi investigado se o aumento da disponibilidade dos n-3 geneticamente ou por dieta, via ativação de PPARγ, protege camundongos do desenvolvimento da obesidade, intolerância a glicose e inflamação do tecido adiposo. Foi visto em um modelo com camundongos fat-1 (elevados níveis endógenos de n-3) que dentre as ações dos ácidos graxos n-3, a proteção contra o aumento de peso/adiposidade associada à obesidade, bem como a melhora da intolerância à glicose são dependentes de PPARγ. Além disso, por meio da utilização de camundongos com deleção de PPARγ em hepatócitos os dados desse trabalho mostram que os PPARγ são, ao menos em parte, essenciais ao aumento da oxidação de ácidos graxos induzida pelos n-3 devido à modulação da expressão gênica e protéica de enzimas mitocondriais e peroxissomais. / The intake of n-3 fatty acids have been associated to the protection against obesity, inflammation and insulin resistance. The n-3 fatty acids are ligands of the nuclear receptor PPARγ, and by the activation of this receptor can promote their metabolic and anti-inflammatory effects. Herein, we investigated whether increasing body n-3 fatty acids levels either genetically or by a n-3 enriched diet protects mice from diet-induced obesity, glucose intolerance and adipose tissue inflammation through PPARγ activation. Fat-1 mice were protected from diet-induced obesity, glucose intolerance and adipose tissue inflammation. To better investigate PPARγ involvement in n-3 beneficial actions, mice with genetic deletion of PPARγ specifically in hepatocytes. In spite of the absence of changes in body weight and glucose homeostasis PPARγ deletion in hepatocytes completely abolished the increase in liver fatty acid oxidation and hepatic gene expression of genes associated to mitochondrial and peroxisomal activity.
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Influência dos diferentes ácidos graxos da dieta sobre um modelo animal de mania induzido por anfetamina em ratos / Influence different fatty acid of the diet on an animal model of mania induced by amphetamine in ratsTrevizol, Fabíola 22 April 2010 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fatty acids (FA) are constituent important of the neuronal phospholipids membranes and they carry out important functions in the development and function of the brain During the last decades changes were observed in the feeding habits of western countries, with an increase of the trans FA and omega-6 (n-6) and detriment of omega-3 fatty acids (n-3) consumption, contributing to increase the oxidative stress (OS) generation and development of neuropsychiatric disorders. The influence of FA supplementation containing n-6 (soybean oil-SO), trans (hydrogenated vegetable fat-HVF) and n-3 (fish oil-FO) on behavioral parameters and OS were studied in an animal model of mania. Rats were orally treated for 8 weeks with suspensions of SO, HVF and FO in place of drinking water, and treated with seven daily administrations of amphetamine (AMPH-mg/kg, ip) or vehicle, in the last week of oral treatment. Locomotor activity, vitamin C (VIT C) levels, protein oxidation and mitochondrial slices in striatum and cortex were evaluated. HVF supplemented rats showed an increase in the locomotor activity, higher levels of carbonyl protein in the cortex, and lower mitochondrial viability in the striatum and cortex, showing harmful effects per se. AMPH treatment increased the locomotor activity of all groups, but this effect showed greater intensity in the rats orally treated with HVF (456%). Similarly, AMPH increased the carbonyl
protein levels in striatum (39.5%) and cortex (78%) of the animals orally treated with HVF, while SO and FO prevented it in the cortex. AMPH treatment decreased the mitochondrial viability in cortex and striatum of supplemented rats with all the FA; however the HVF group
showed greater damage (46 and 44% of viability in the striatum and cortex, respectively). AMPH reduced the VIT C plasma levels of the HVF and SO groups (22.5 and 22.4%
respectively), and this antioxidant parameter has not been changed in the FO treated rats. Here, we suggest that the trans FA contained in the HVF may increase the oxidative damages per se, leaving the rats more vulnerable to AMPH damage. FA n-3 contained in the FO showed subtle protecting effects, which were observed by preservation of the VIT C levels and lower levels of carbonyl protein in the cortex. Further studies should be conducted to
evaluate the influence of the trans fatty acids consumption on neuronal activity, and consequently on the susceptibility to psychiatric disorders development among them the bipolar disorder. / Ácidos graxos (AG) são constituintes importantes das membranas fosfolipídicas neuronais e desempenham importantes funções no desenvolvimento e funcionamento do
cérebro. Durante as últimas décadas foram observadas mudanças nos hábitos alimentares de países ocidentais, com aumento do consumo de AG trans e ômega-6 (n-6) em detrimento do consumo de ácidos graxos ômega-3 (n-3), cujas conseqüências podem estar relacionadas a um
aumento dos danos oxidativos, facilitando o desenvolvimento de doenças neuropsiquiátricas. A influência da suplementação com AG n-6 (óleo de soja-OS), trans (gordura vegetal
hidrogenada-GVH) e n-3 (óleo de peixe-OP) sobre parâmetros comportamentais e de estresse oxidativo (EO) foram estudados em um modelo animal de mania. Ratos tratados oralmente com suspensões de OS, GVH e OP, junto à água de beber durante 8 semanas, receberam nos últimos sete dias administrações diárias de anfetamina (ANF-4mg/kg, ip) ou veículo. Atividade locomotora, os níveis de vitamina C (VIT C) plasmático, marcadores de oxidação de proteínas e a viabilidade de fatias do estriado e córtex foram determinados. Animais suplementados com GVH mostraram um aumento da atividade locomotora, maior nível de proteínas carbonil no córtex, e menor viabilidade nas fatias do estriado e córtex,
demonstrando efeitos prejudiciais per se. O tratamento com ANF aumentou a atividade locomotora dos animais de todos os grupos experimentais, porém este efeito mostrou maior
intensidade nos animais que receberam a suplementação com GVH (456%). Semelhante, a ANF aumentou a carbonilação de proteínas no estriado (39.5%) e córtex (78%) dos animais
suplementados com GVH, enquanto OS e OP preveniram o dano causado pela ANF no córtex. O tratamento com ANF diminuiu a viabilidade mitocondrial nos tecidos cerebrais de
todos os grupos, entretanto o grupo suplementado com GVH apresentou maiores danos (46 e 44% de viabilidade no estriado e córtex, respectivamente). A ANF diminuiu os níveis de VIT C no plasma dos animais suplementados com OS e GVH (22.5 e 22.4%, respectivamente), e este parâmetro antioxidante não foi alterado nos ratos tratados com OP. Os resultados do presente estudo sugerem que os ácidos graxos trans presentes na GVH podem aumentar os danos oxidativos per se, deixando os animais mais expostos aos danos da ANF. A suplementação com ácidos graxos n-3 presentes no OP mostraram efeitos protetores sutis, representados pela preservação dos níveis de VIT C plasmático e menor oxidação de proteínas no córtex. Maiores estudos devem ser realizados para determinar a influência do consumo de ácidos graxos trans sobre a atividade neuronal, e conseqüentemente sobre a suscetibilidade para o desenvolvimento de desordens psiquiátricas entre estas, o transtorno bipolar.
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