Introduction: The presence of an endotracheal tube (ETT) increases the risk for microaspiration of secretions around the ETT. Biomarkers of pepsin and salivary amylase may be used to identify microaspiration in intubated patients because of their naturally occurring presence in the stomach or oral cavity and non-occurrence in the respiratory tract. Microaspiration may be difficult to detect until pulmonary complications, such as lung injury or infection, occur. This study assessed the presence of pepsin and salivary amylase in oral and tracheal secretions of ventilated adults. Method(s): This is a secondary analysis of data collected from 11 critically ill, adult patients on mechanical ventilation (MV) enrolled in a study to identify cues for ETT suctioning. Two paired samples of oral and tracheal secretions were suctioned when clinically indicated. Tracheal secretions were suctioned with a closed system, and oral secretions were obtained with an oropharyngeal catheter. Specimens were analyzed for total pepsin, pepsin A, pepsin C, and salivary amylase according to established assays. Results: Of 11 subjects, the majority were men (n=8), on enteral feedings (n=9) via a feeding tube placed in the stomach (n=7), and intubated with a continuous subglottic suction ETT (n=8). Median values: age, 62 years; duration of MV, 5.5 days; ETT cuff pressure 24 cm H2O; head of bed, 30degrees]. Pepsin was in measured in both oral (30.5 ng/mL; n=8) and tracheal secretions (11.1 ng/mL; n=7); Similar findings were noted for pepsin A (oral 14.7 ng/mL, n=7; sputum 7.4 ng/mL, n=6) and pepsin C (oral 14.7, n=7; tracheal 7.4, n=6). Salivary amylase (mean micro]mol/min/mL) was present in all oral secretions (359.8) and in the sputum of 6 subjects (1.8). Discussion & Conclusions: The majority of intubated patients on MV had both pepsin and salivary amylase in their sputum, likely due to microaspiration of secretions.; This finding suggests greater efforts are needed to reduce patients' risk. Ongoing strategies to prevent gastric reflux are important such as head of bed elevation and monitoring residuals. Presence of salivary amylase within tracheal secretions may indicate a need for more frequent oropharyngeal suctioning as part of routine care of intubated patients. Analysis shows no variations of the presence of pepsin or salivary amylase in relation to feeding tube placement or type of ETT. Generalizability is limited by the small sample size.

Submitted by CLAUDIA DE CARVALHO BRUNHOLI null (claudia_brunholi@hotmail.com) on 2017-08-03T17:03:48Z No. of bitstreams: 1 3.8.17 dissert completa ficha catal.pdf: 1962312 bytes, checksum: c5788b4c105c7e35db4b816e1ca7b9f0 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-08-03T18:04:44Z (GMT) No. of bitstreams: 1 brunholi_cc_me_rcla.pdf: 1962312 bytes, checksum: c5788b4c105c7e35db4b816e1ca7b9f0 (MD5) / Made available in DSpace on 2017-08-03T18:04:44Z (GMT). No. of bitstreams: 1 brunholi_cc_me_rcla.pdf: 1962312 bytes, checksum: c5788b4c105c7e35db4b816e1ca7b9f0 (MD5) Previous issue date: 2017-06-13 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / A obesidade é um problema de saúde pública mundial, caracterizada como uma doença crônica inflamatória e além de estar associada à diversas complicações, tem acometido cada vez mais crianças e adolescentes. A obesidade pode ser causada por fatores genéticos e comportamentais e, dentre os comportamentais, a ingestão alimentar inadequada e a pratica insuficiente de exercício físico são os mais comuns. Devido ao intenso desenvolvimento que ocorre durante a adolescência, os hábitos cotidianos podem ser influenciados, em especial, os hábitos alimentares. A amilase salivar é uma enzima que digere os carboidratos (CHO) em partículas menores ainda na cavidade oral e tem sido considerada um potente marcador biológico envolvido na ingestão alimentar devido sua ação sobre a percepção do gosto dos alimentos, as preferências alimentares e a resposta glicêmica e insulínica pós-prandial. Para tratar a obesidade, a orientação nutricional e a prática de exercício físico sistematizada é cada vez mais indicada e, dentre as modalidades de exercício, o intervalado de alta intensidade (high intensity interval training - HIIT) tem sido eficaz para reduzir gordura corporal. Dessa forma, o objetivo do presente estudo foi analisar e correlacionar a ingestão alimentar, a concentração de amilase salivar e gordura corporal de adolescentes obesos submetidos a um programa de tratamento para obesidade. Adolescentes obesos (IMC= 33,82 ±6,23 Kg/m2; n= 21, 13,83 ±1,85 anos) de ambos os gêneros realizaram avaliação da composição corporal e maturação sexual, exames bioquímicos de saliva e sangue, questionários alimentares e nível de escolaridade dos pais e teste de esforço máximo pré e pós programa. O programa de tratamento foi composto por 20 semanas de orientação nutricional e 16 semanas de HIIT. A ingestão alimentar (calorias, CHO, lipídios, ácido graxo polinsaturado, fibra) e o percentual de gordura corporal reduziram após a realização do programa, e se correlacionaram com a concentração de amilase salivar, tanto pré quanto pós programa. Conclui-se que, após a realização do programa de tratamento para obesidade, houve redução na ingestão alimentar e no percentual de gordura corporal de adolescentes obesos, e essas variáveis se correlacionam entre si e com a concentração de amilase salivar. / Obesity is a worldwide public health problem, characterized as a chronic inflammatory disease and in addition to being associated with several complications, has been affecting more and more children and adolescents. Obesity can be caused by genetic and behavioral factors and, among the behavioral ones, inadequate food intake and insufficient physical exercise are the most common. Due to the intense development that occurs during adolescence, daily habits can be influenced, especially, eating habits. Salivary amylase is an enzyme that digests carbohydrates (CHO) into smaller particles still in the oral cavity and has been considered a potent enzyme involved in food intake due to its action on the perception of food taste, food preferences and glycemic response, and Postprandial insulin. To address obesity, nutritional counseling and the practice of systematic exercise are increasingly indicated and, among the exercise modalities, high intensity interval training (HIIT) has been effective in reducing body fat. Thus, the objective of the present study was to analyze and correlate food intake, salivary amylase concentration and body fat of obese adolescents submitted to a treatment program. Obese adolescents (BMI= 33,82 ± 6,23 kg/m2 , n= 21, 13,83± 1,85 years) of both genders performed body composition and sexual maturation, biochemical saliva and blood tests, questionnaires food intake and parental education level and maximum pre and post-program effort test. The treatment program consisted of 20 weeks of nutritional counseling and 16 weeks of HIIT. Food intake (calories, CHO, lipids, polyunsaturated fatty acid, fiber) and body fat percentage decreased after the program was performed, and correlated with the salivary amylase concentration, both at the beginning and at the end of the program. It was concluded that, after the obesity treatment program, there was a reduction in dietary intake and body fat percentage of obese adolescents, and these variables correlate with each other and with the concentration of salivary amylase. / CNPq: 130853/2015-1

Digestion of starch in humans starts in the mouth and progresses to the small intestine. Structures from salivary and pancreatic amylases hydrolysis can impact subsequent steps of digestion at the mucosa of the small intestine. However, structures of the starch digestion products along the gut from the mouth to the small intestines – products that impact glucose homeostasis are not well understood. This thesis focuses on the luminal step of starch digestion, i.e. impact of salivary and pancreatic amylase on the structure of hydrolysis products obtained from cooked starches from different botanical sources. Normal corn (NCS), wheat (NWS) and potato (NPS) starches were cooked at 1:0.7 (T0.7) or 1:2 (T2) starch:water ratios. Cooked starches were subjected to salivary amylase at conditions mimicking oral digestion. The composition of the hydrolysates was characterised by gel-permeation chromatography. Extent of hydrolysis was lower at T0.7 compared to T2, but the amount of carbohydrates in different fractions and the molecular weight profiles within each treatment were not different between starches from different botanical sources. However, debranching of the hydrolysates revealed structural differences in extent of amylose hydrolysis and amount and profile of lower molecular weight fractions between different starches. Cooked starches were also subjected to salivary and pancreatic amylases hydrolysis. Extent of 20 min hydrolysis was lower at T0.7 compared to T2 for all the starches. Oligosaccharide composition of 120 min hydrolysates differed in amounts of DP 2, 3, 5, 6 and 7 between processing treatments and starches. NCS (T2) was treated with saliva from six participants at equal activity. Salivary amylase activities ranged from 470 x 103 to 118 x 103 U/mL among the participants. While saliva from participant 2 (high amylase activity) greatly reduced the high molecular weight fraction, saliva from participant 6 (low amylase activity) more extensively hydrolysed the starch to small molecular weight fractions of oligosaccharides. These results show that different starch hydrolysates are produced during oral digestion by saliva from different individuals and are also different based on cooking condition or botanical source of starch. Further research is therefore needed to understand how these hydrolysate structures, impact glucose homeostasis.

O diagnóstico do câncer, aliado ao órgão que este acomete, traz implicações significativas como no caso do câncer de mama para as mulheres, por apresentar relações com a feminilidade e sexualidade e ao processo de tratamento em busca da cura, destacando-se a radioterapia, indicada pelo menos para a metade das pacientes e que ocasiona efeitos colaterais que comprometem o bem estar. Diante dessa situação, pode existir sentimentos que propiciam conflitos existenciais, afetando tanto a dimensão espiritual, expresso pelo fenômeno angústia espiritual, quanto a dimensão emocional, que pode favorecer o aparecimento de morbidade psicológica. Para enfrentar tal situação, as mulheres podem fazer uso de estratégias cognitivas e comportamentais relacionadas à religiosidade e à espiritualidade, como a denominada coping religioso/espiritual. Ainda, como meio de enfrentar essa nova fase de vida, os recursos religiosos, como a oração podem se mostrar presentes. Entretanto, os efeitos que a oração pode proporcionar ainda são alvo de questionamentos, despertando, assim, motivos para investigá-la. O presente estudo teve por propósito avaliar o efeito da prece de intercessão na medida de angústia espiritual, de morbidade psicológica (ansiedade e depressão), de coping religioso/espiritual e de amilase salivar em pacientes com câncer de mama em tratamento radioterápico. Para tanto, realizou-se um ensaio clínico aleatorizado, duplo cego, no período de setembro de 2015 a maio de 2016. Participaram 31 pacientes, sendo 16 alocados no grupo intervenção e 15 no grupo controle; foi realizada coleta de dados em três tempos: antes da intervenção ser implementada (T0), na metade (T1) e no término das sessões do tratamento de radioterapia de cada paciente (T2), o qual inclui as doses de reforço (boost). No T0 houve coleta dos dados referentes às variáveis sociodemográficas, clínicas e de religiosidade, bem como das escalas de angústia espiritual, de ansiedade e depressão hospitalar e de coping religioso/espiritual e, ainda, da amilase salivar, que complementou a avaliação da ansiedade. Após o T0, um grupo de seis pessoas cristãs iniciaram uma oração, em ambiente extra hospitalar, com a frequência de uma hora por dia até o término do tratamento para as pessoas aleatorizadas no grupo intervenção. Nos demais tempos do estudo, T1 e T2, as avaliações foram realizadas por meio dos instrumentos já descritos e da amilase salivar. Identificou-se que a variável angústia espiritual apresentou mudanças significativas, tanto na fase do pós-teste T2 na análise intergrupo (p=0,021) com tamanho do efeito considerado de grande magnitude (ES=0,962) quanto nas fases entre o pós-teste T2 com T0 na análise intragrupo (p=0,004). Na análise intragrupo também se verificou mudanças significativas para as variáveis coping religioso/espiritual negativo, tanto nas fases entre T1 com T0 (p=0,049) quanto entre T2 com T0 (p=0,028), bem como para coping religioso/espiritual total entre as fases T2 e T0 (p=0,014). Conclui-se que a oração intercessória mostrou-se efetiva com relação à redução de angústia espiritual e teve efeito nos escores da escala coping religioso/espiritual, isto é, no modo de enfrentar a situação vivenciada, buscando estratégias religiosas e espirituais para resolver o problema / The diagnosis of cancer, together with the organ that it affects, has significant implications as in the case of breast cancer for women, because it presents relationships with femininity and sexuality and the treatment process in search of cure, especially radiotherapy, indicated for at least half of the patients causes side effects that compromise the well being. Given this situation, women can experience feelings that lead to existential conflicts, affecting both their spiritual dimension, expressed by spiritual anguish, and their emotional dimension, which may favor the appearance of psychological morbidity. To address such a situation, women can make use of cognitive and behavioral strategies related to religiosity and spirituality, such as religious / spiritual coping. Yet, prayer can be used as religious resource and a mean of facing this new phase of life. However, the effects of prayer remain under questioning, and require further research. The purpose of this study was to evaluate the effect of intercessory prayer in the measure of spiritual distress, psychological morbidity (anxiety and depression), religious / spiritual coping and salivary amylase patients with breast cancer undergoing radiotherapy. A randomized, double-blind clinical trial was conducted between September 2015 and May 2016. Participated 31 patients, being 16 allocated in the intervention group and 15 in the control group; was performed data collection in three times: before the intervention was implemented (T0), half (T1) and at the end of the sessions of the treatment of radiotherapy of each patient (T2), which includes the doses of reinforcement (boost). In the T0, data on sociodemographic, clinical and religious variables were collected, as well as on the spiritual distress, anxiety and hospital depression and religious / spiritual coping and salivary alpha-amylase scales, which complemented the assessment of anxiety. After T0, a group of six Christian individuals started a prayer in an extra-hospital environment at the frequency of one hour a day until the end of the treatment for those randomized in the intervention group. At the other times of the study, T1 and T2, the assessments were performed using the previously described instruments and salivary alpha-amylase. The variable spiritual anguish have presented significant changes, both in the post-test phase T2 in the intergroup analysis (p = 0.021) with size of the effect considered of great magnitude (ES = 0.962), and in the phases between post-test T2 with the T0 in the intragroup analysis (p = 0.004). Significant changes have been found in the religious / spiritual negative coping variables, both in the phases between T1 with T0 (p = 0.049) and between T2 with T0 (p = 0.028), as well as for total religious / spiritual coping between phases T2 and T0 (p = 0.014). Intercessory prayer was effective in decreasing spiritual distress and had effect on the scores of the religious / spiritual coping scale, that is, in the way of facing the lived experience, and using religious and spiritual strategies seeking to overcome the problem

Die vorliegende Arbeit befasst sich mit der Evaluierung einer neuen klinischen Handlungsempfehlung zur Rapid Sequence Induction (RSI) des nichtnüchternen Säuglings sowie eines neuen Modells zur simulatorbasierten Evaluation akutmedizinischer, klinischer Leitlinien.  Bei der klassischen RSI kommt es aufgrund der fehlenden Zwischenbeatmung während der Narkoseeinleitung zu hohem Zeitdruck. Sie ist technikbedingt assoziiert mit Hypoxämie beim Patienten und einem hohen Stresslevel beim Anwender (Eich et al. 2009a). Stress wiederum ist ein potentieller Trigger bei der Entstehung unsicherer Handlungen und kritischer Ereignisse. Aus diesem Grund gab der wissenschaftliche Arbeitskreis Kinderanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) im Jahre 2007 eine neue Handlungsempfehlung zur Narkoseeinleitung des nichtnüchternen Säuglings (kontrollierte RSI) heraus (Schmidt et al. 2007; Schreiber 2007).  Wesentliche Änderungen sind die geplante Durchführung einer sanften Zwischenbeatmung via Maske, der Verzicht auf Succinylcholin als Muskelrelaxans und das Weglassen des Krikoiddrucks. Dadurch sollten Zeitdruck und Stress vermindert sowie die Inzidenz der damit zusammenhängenden unsicheren Handlungen und kritischen Ereignisse reduziert werden. Für unsere Studie entwickelten wir ein simulatorbasiertes Modell, um die kontrollierte (neue) RSI-Technik mit der klassischen (bisherigen) RSI-Technik vergleichend zu evaluieren. Dabei kombinierten wir Methoden der Observation, der Stressmessung und der der Selbsteinschätzung. An der kontrollierten, randomisierten Studie nahmen 30 männliche Anästhesisten (Fachärzte und Weiterbildungsassistenten) teil. Sie absolvierten am Säuglingssimulator (SimBaby®) eine standardisierte Narkoseeinleitung bei einem vier Wochen alten Säugling mit obstruktiver Pylorusstenose. Jeweils 15 Probanden absolvierten die klassische und die kontrollierte RSI (Eich et al 2009a; Eich et al. 2009b). Das Szenario mit den Vitalzeichen und deren Trends wurden zuvor programmiert. Während des Versuchs beobachteten wir unsichere Handlungen und kritische Ereignisse wie Hypoxämie (SpO2 < 90%), forcierte Maskenbeatmung, Intubationsschwierigkeiten und -Komplikationen. Zusätzlich maßen wir den Stress der Probanden mithilfe der Ergospirometrie (Herz-, Atemfrequenz und Atemminutenvolumen sowie O2-Verbrauch und CO2-Produktion), der Analyse von Kortisol und α-Amylase im Speichel und eines Selbsteinschätzungsfragebogens (subjektives Stress- und Sicherheitsempfinden)  (Eich et al. 2009a; Eich et al. 2009b). Bei allen Probanden konnte im Verlauf des Szenarios ein deutlicher, reproduzierbarer Anstieg aller Stressparameter gemessen werden. Bei der kontrollierten RSI waren objektiv gemessene Stressparameter sowie das subjektive Stressempfinden niedriger als bei der klassischen RSI. Bei der klassischen RSI entwickelte sich, im Gegensatz zur kontrollierten RSI, immer eine Hypoxämie. Die Inzidenz der übrigen unsicheren Handlungen und kritischen Ereignisse war bei beiden Methoden relativ gering.  Unsere Daten zeigen, dass die kontrollierte RSI - im Vergleich zur klassischen RSI - den Stress bei den Anwendern und damit das Entstehen unsicherer Handlungen und kritischer Ereignisse zu reduzieren vermag (Eich et al 2009a). Das neuentwickelte simulatorbasierte Modell hat sich dabei als praktikabel und valide erweisen zur Evaluation akutmedizinischer, klinischer Leitlinien (Eich et al 2009b).

O diagnóstico do câncer, aliado ao órgão que este acomete, traz implicações significativas como no caso do câncer de mama para as mulheres, por apresentar relações com a feminilidade e sexualidade e ao processo de tratamento em busca da cura, destacando-se a radioterapia, indicada pelo menos para a metade das pacientes e que ocasiona efeitos colaterais que comprometem o bem estar. Diante dessa situação, pode existir sentimentos que propiciam conflitos existenciais, afetando tanto a dimensão espiritual, expresso pelo fenômeno angústia espiritual, quanto a dimensão emocional, que pode favorecer o aparecimento de morbidade psicológica. Para enfrentar tal situação, as mulheres podem fazer uso de estratégias cognitivas e comportamentais relacionadas à religiosidade e à espiritualidade, como a denominada coping religioso/espiritual. Ainda, como meio de enfrentar essa nova fase de vida, os recursos religiosos, como a oração podem se mostrar presentes. Entretanto, os efeitos que a oração pode proporcionar ainda são alvo de questionamentos, despertando, assim, motivos para investigá-la. O presente estudo teve por propósito avaliar o efeito da prece de intercessão na medida de angústia espiritual, de morbidade psicológica (ansiedade e depressão), de coping religioso/espiritual e de amilase salivar em pacientes com câncer de mama em tratamento radioterápico. Para tanto, realizou-se um ensaio clínico aleatorizado, duplo cego, no período de setembro de 2015 a maio de 2016. Participaram 31 pacientes, sendo 16 alocados no grupo intervenção e 15 no grupo controle; foi realizada coleta de dados em três tempos: antes da intervenção ser implementada (T0), na metade (T1) e no término das sessões do tratamento de radioterapia de cada paciente (T2), o qual inclui as doses de reforço (boost). No T0 houve coleta dos dados referentes às variáveis sociodemográficas, clínicas e de religiosidade, bem como das escalas de angústia espiritual, de ansiedade e depressão hospitalar e de coping religioso/espiritual e, ainda, da amilase salivar, que complementou a avaliação da ansiedade. Após o T0, um grupo de seis pessoas cristãs iniciaram uma oração, em ambiente extra hospitalar, com a frequência de uma hora por dia até o término do tratamento para as pessoas aleatorizadas no grupo intervenção. Nos demais tempos do estudo, T1 e T2, as avaliações foram realizadas por meio dos instrumentos já descritos e da amilase salivar. Identificou-se que a variável angústia espiritual apresentou mudanças significativas, tanto na fase do pós-teste T2 na análise intergrupo (p=0,021) com tamanho do efeito considerado de grande magnitude (ES=0,962) quanto nas fases entre o pós-teste T2 com T0 na análise intragrupo (p=0,004). Na análise intragrupo também se verificou mudanças significativas para as variáveis coping religioso/espiritual negativo, tanto nas fases entre T1 com T0 (p=0,049) quanto entre T2 com T0 (p=0,028), bem como para coping religioso/espiritual total entre as fases T2 e T0 (p=0,014). Conclui-se que a oração intercessória mostrou-se efetiva com relação à redução de angústia espiritual e teve efeito nos escores da escala coping religioso/espiritual, isto é, no modo de enfrentar a situação vivenciada, buscando estratégias religiosas e espirituais para resolver o problema / The diagnosis of cancer, together with the organ that it affects, has significant implications as in the case of breast cancer for women, because it presents relationships with femininity and sexuality and the treatment process in search of cure, especially radiotherapy, indicated for at least half of the patients causes side effects that compromise the well being. Given this situation, women can experience feelings that lead to existential conflicts, affecting both their spiritual dimension, expressed by spiritual anguish, and their emotional dimension, which may favor the appearance of psychological morbidity. To address such a situation, women can make use of cognitive and behavioral strategies related to religiosity and spirituality, such as religious / spiritual coping. Yet, prayer can be used as religious resource and a mean of facing this new phase of life. However, the effects of prayer remain under questioning, and require further research. The purpose of this study was to evaluate the effect of intercessory prayer in the measure of spiritual distress, psychological morbidity (anxiety and depression), religious / spiritual coping and salivary amylase patients with breast cancer undergoing radiotherapy. A randomized, double-blind clinical trial was conducted between September 2015 and May 2016. Participated 31 patients, being 16 allocated in the intervention group and 15 in the control group; was performed data collection in three times: before the intervention was implemented (T0), half (T1) and at the end of the sessions of the treatment of radiotherapy of each patient (T2), which includes the doses of reinforcement (boost). In the T0, data on sociodemographic, clinical and religious variables were collected, as well as on the spiritual distress, anxiety and hospital depression and religious / spiritual coping and salivary alpha-amylase scales, which complemented the assessment of anxiety. After T0, a group of six Christian individuals started a prayer in an extra-hospital environment at the frequency of one hour a day until the end of the treatment for those randomized in the intervention group. At the other times of the study, T1 and T2, the assessments were performed using the previously described instruments and salivary alpha-amylase. The variable spiritual anguish have presented significant changes, both in the post-test phase T2 in the intergroup analysis (p = 0.021) with size of the effect considered of great magnitude (ES = 0.962), and in the phases between post-test T2 with the T0 in the intragroup analysis (p = 0.004). Significant changes have been found in the religious / spiritual negative coping variables, both in the phases between T1 with T0 (p = 0.049) and between T2 with T0 (p = 0.028), as well as for total religious / spiritual coping between phases T2 and T0 (p = 0.014). Intercessory prayer was effective in decreasing spiritual distress and had effect on the scores of the religious / spiritual coping scale, that is, in the way of facing the lived experience, and using religious and spiritual strategies seeking to overcome the problem

Nous passons plus des trois quarts de notre vie dans l'état postprandial. Pourtant, une plus grande attention a été accordée à l'étude du métabolisme à jeun qu'à l'impact de l'état postprandial sur la santé.Il est prouvé scientifiquement qu'une alimentation optimale pour la santé passe par la prise en compte de l'impact glycémique des aliments au-delà de leur simple teneur en glucides. Un déterminant important de l'impact glycémique de notre alimentation est l'amidon, qui joue un rôle clé dans la nutrition humaine en fournissant jusqu'à 50% de l'apport énergétique total. S'il est établi que la cinétique de digestion des aliments riches en amidon est un élément essentiel de leur impact glycémique, les contributions de chaque étape digestive à ce processus restent un sujet de débats. Afin de mieux comprendre les facteurs qui peuvent influencer la réponse glycémique aux aliments riches en amidon, et d’identifier de nouvelles stratégies pour atténuer leur impact glycémique, il est essentiel d'élargir notre compréhension du processus digestif de l'amidon. Cette thèse visait à étudier la digestion de repasriches en amidon (pain et pâtes), à réévaluer la contribution l’amylase salivaire à l'aide de digestions semi-dynamiques in vitro, et à mener une étude chez l'Homme pour déterminer l'effet de boissons (jus de citron et thé) sur : la réponse glycémique au pain, l'apport ad libitum, et la digestion gastrique étudiée par imagerie par résonance magnétique (IRM). Nos résultats apportent une base scientifique à l'élaboration d'une stratégie simple et efficace pour réduire la réponse glycémique aux aliments riches en amidon dans des repas de tous les jours. / All of us spend over three quarters of our lives in the postprandial state. Still, more attention has been dedicated to the study of the fasting metabolism than to the impact of the postprandial state on health.Scientific evidence supports that an optimum diet for health requires consideration of the glycaemic impact of foods in preference to consideration of carbohydrate content alone. An important determinant of the glycaemic impactof our diets is starch, which plays a key role in human nutrition, supplying up to 50% of the total energy intake. If it is clear that the digestion rate of starch-rich foods is an important determinant of their glycaemic impact, the contribution of each digestive stage to this process remains controversy. To better understand the factors that can influence the glycaemic response to starch-rich foods, and to identify new strategies to attenuate the glycaemic impact of starch-rich diets, it is essential to expand our understanding of thedigestive process of starch. The aims of this PhD were to study the digestionof starch-rich meals (bread and pasta), to reevaluate the contribution of salivary amylase using semi-dynamic in vitro digestions, and to conduct a human study to determine the effect of drinks (lemon juice and tea) on: the glycaemic response to bread, ad libitum intake, and gastric digestion assessed by magnetic resonance imaging (MRI). Our results provide scientific rationale for the development of a simple and effective strategy to reduce the glycaemicresponse to starch-rich foods in everyday-life meals.