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Diri H, Aycicek B. A retrospective comparison between intensive and nonintensive insulin regimens in type 2 diabetes mellitus. Minerva Endocrinol (Torino) 2023; 48:311-317. [PMID: 33435647 DOI: 10.23736/s2724-6507.20.03323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND This study compared the outcomes between intensive and nonintensive insulin regimens and assessed the predictive factors for failing to achieve the glycated hemoglobin (A1C) goals in type-2-diabetes-mellitus (T2DM) patients requiring insulin therapy. METHODS A single-center, retrospective assessment of the medical records of 125 T2DM patients undergoing intensive (46 patients) and nonintensive insulin therapy (79 patients) were conducted. RESULTS No significant differences were found when the intensive and nonintensive insulin therapy groups were compared in terms of the percentage decreases of glucose and A1C levels. The mean A1C levels of the nonintensive and intensive groups declined from 11.15% and 11.30% to 7.97% and 8.06%, respectively. CONCLUSIONS Both intensive and nonintensive insulin therapies improved the baseline glycemic parameters but being overweight or obese and/or being reluctant to dietary recommendations led to treatment failures regardless of the insulin regimen.
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Affiliation(s)
- Halit Diri
- Department of Endocrinology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye -
| | - Bercem Aycicek
- Department of Endocrinology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
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Wasana KGP, Attanayake AP, Weerarathna TP, Amarasekera DABN, Jayatilaka KAPW. Association of dietary intake with body mass index and glycemic profile among newly diagnosed patients with type 2 diabetes mellitus. Am J Hum Biol 2023; 35:e23870. [PMID: 36695499 DOI: 10.1002/ajhb.23870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/25/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Dietary intake plays an important role in determining body mass index (BMI) and glycemic profile in patients with type 2 diabetes mellitus (T2DM). Our aim was to describe habitual dietary intake and its associations with BMI and glycemic profile in a cohort of patients with newly diagnosed T2DM in Sri Lanka. METHODS A cross-sectional study was carried out among 158 patients with newly diagnosed T2DM in Galle, Sri Lanka. Data on demographic, lifestyle, and family history of diabetes mellitus, and clinical measures were collected. The dietary information was collected using a 24-h dietary recall. RESULTS Among the total number of study subjects, only 12.0%, 5.7% and 1.3% met the recommended daily consumption value of protein, fat, and fiber, respectively, whereas 99.4% of subjects had taken carbohydrates that exceeded the recommended consumption. There was a positive association between carbohydrate intake and BMI (0.004, [0.002], p = .048) and carbohydrate intake and glycated hemoglobin (HbA1C ) (0.001, [0.000], p = .049). Fat intake showed positive associations with BMI (0.029, [0.011], p = .006) and HbA1C (0.005, [0.002], p = .050). Protein intake showed a positive association with HbA1C (0.006, [0.003], p = .023). The aforementioned associations were observed after adjusting for demographic, lifestyle, and history of diabetes among the first-degree family members. The carbohydrate intake was positively associated with BMI (0.010, [0.003], p = .003) and HbA1C (0.001, [0.000], p = .050) with further adjustment in nutrient intake (except when used as an independent variable). Furthermore, the fat intake was associated with BMI (0.031, [0.011], p = .004) and HbA1C (0.005 [0.002], p = .050) with additional adjustments. CONCLUSIONS The diet of the majority of newly diagnosed T2DM patients in this cohort consisted of a higher carbohydrate intake than the recommended level. However, they did not meet the recommended daily intake of protein, fat, and fiber. Both carbohydrate and fat intake were significantly and positively associated with BMI and HbA1C in patients with newly diagnosed T2DM.
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Osugi K, Kusunoki Y, Ohigashi M, Kusunoki K, Inoue C, Inoue M, Takagi A, Tsunoda T, Kadoya M, Konishi K, Katsuno T, Koyama H. Association between low-carbohydrate diets and continuous glucose monitoring-derived time in ranges. J Diabetes Investig 2023; 14:659-668. [PMID: 38078864 PMCID: PMC10119912 DOI: 10.1111/jdi.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
AIMS Low-carbohydrate diets have become popular in the general community. The mutual relationship between the percentage of total energy intake from carbohydrates (CHO/E), glycemic control indices, and diabetes complications remains unclear. MATERIALS AND METHODS This cross-sectional study included 177 patients with type 2 diabetes mellitus who regularly visited outpatient clinics. In this study, dietary questionnaires were used to assess the intake ratio of the three macronutrients, and the low-carbohydrate-diet score was calculated. We investigated the association between the low-carbohydrate-diet score, continuous glucose monitoring (CGM)-derived short-term glycemic control indices, and diabetes complications in patients with type 2 diabetes mellitus. RESULTS The results are presented as medians (interquartile ranges) unless otherwise stated. Hemoglobin A1c was 7.1% (6.6-7.7%), CGM-derived time in range (TIR) was 75.3% (62.8-87.0%), body mass index (BMI) was 24.0 (22.1-26.3) kg/m2, and CHO/E was 49.8% (44.8-55.6%). BMI, triglycerides, and CGM-derived time above range decreased significantly with increasing low-carbohydrate-diet scores. However, no significant association was found between the low-carbohydrate-diet score and glycemic control indices, including TIR, mean amplitude of glycemic excursions, and vascular complications of type 2 diabetes mellitus. CONCLUSION Moderate-carbohydrate diets positively impact weight control and lipid metabolism but may have a limited effect on short-term glycemic variability in Japanese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Keiko Osugi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Yoshiki Kusunoki
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
- Kusunoki ClinicNeyagawa, OsakaJapan
| | - Mana Ohigashi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | | | - Chikako Inoue
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Maki Inoue
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Ayako Takagi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Taku Tsunoda
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Manabu Kadoya
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Kosuke Konishi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Tomoyuki Katsuno
- Department of Occupational Therapy, School of RehabilitationHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
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Akiyama T, Yamakawa T, Orime K, Suzuki J, Sakamoto R, Matsuura-Shinoda M, Shigematsu E, Takahashi K, Kaneshiro M, Asakura T, Tanaka S, Kawata T, Yamada Y, Isozaki T, Takahashi A, Osada UN, Kadonosono K, Terauchi Y. Sleep duration and food intake in people with type 2 diabetes mellitus and factors affecting confectionery intake. J Diabetes Investig 2023; 14:716-724. [PMID: 36747481 PMCID: PMC10119919 DOI: 10.1111/jdi.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/28/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
AIMS/INTRODUCTION We carried out a cross-sectional study of people with type 2 diabetes mellitus to elucidate the association between sleep duration and food intake. MATERIALS AND METHODS Overall, 2,887 participants with type 2 diabetes mellitus (mean age 63.0 years; 61.1% men; mean glycated hemoglobin level 7.5%) were included in this study. The participants' self-reported dietary habits and sleep duration were evaluated using a brief self-administered dietary history questionnaire and Pittsburgh Sleep Quality Index, respectively. The participants were categorized into the following four groups based on sleep duration: <6, 6-6.9, 7-7.9 (reference) and ≥8 h. RESULTS No significant differences were observed between the groups regarding energy intake (kcal/day), absolute intake (g/day) or relative intake (% energy) of carbohydrates, total fat, proteins and fibers. However, confectionery intake was higher in the <6 h group and lower in the ≥8 h group than in the reference group after adjustment for confounding factors. In multivariate analysis, sleep durations <6 h and ≥8 h significantly correlated with increased (95% confidence interval 0.55 to 3.6; P = 0.0078) and decreased (95% confidence interval -4.0 to -0.32; P = 0.021) confectionery intake, respectively. Confectionery intake was positively correlated with female sex, glycated hemoglobin level and dyslipidemia, whereas it was negatively correlated with alcohol consumption and current smoking status. CONCLUSIONS Short sleep duration is associated with high confectionery intake in people with type 2 diabetes mellitus; this might disturb their glycemic control. Therefore, short sleepers with type 2 diabetes mellitus could improve their glycemic control by avoiding confectionery intake and maintaining adequate sleep duration.
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Affiliation(s)
- Tomoaki Akiyama
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Tadashi Yamakawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuki Orime
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Suzuki
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Rika Sakamoto
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Minori Matsuura-Shinoda
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Erina Shigematsu
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenichiro Takahashi
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | | | - Yoshihiko Yamada
- International University of Health and Welfare, Atami Hospital, Atami, Japan
| | | | | | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University School of Medicine, Yokohama, Japan
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Ohira A, Yamakawa T, Iwahashi N, Tanaka S, Sugiyama M, Harada M, Ichikawa M, Akiyama T, Orime K, Terauchi Y. Association of continuous positive airway pressure therapy on cardiac hypertrophy in patients with sleep apnea comorbid with type 2 diabetes mellitus. Endocr J 2023; 70:47-58. [PMID: 36089339 DOI: 10.1507/endocrj.ej22-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Previous reports indicated the therapeutic effect of chronic continuous positive airway pressure (CPAP) therapy on cardiac hypertrophy due to sleep apnea syndrome. However, little is known for cases involving diabetic complications. This retrospective observational study examined the effects of CPAP therapy on left ventricular hypertrophy (LVH) in patients with obstructive sleep apnea syndrome (OSAS) and type 2 diabetes mellitus (T2DM). For all cases, the observation period was 3 years from the time when the patient was introduced to CPAP therapy. Overall, 123 patients were divided into a good CPAP group (CPAP ≥4 h/day, n = 63) and non-adherence group (CPAP <4 h/day, n = 60). The mean CPAP usage times were 5.58 ± 1.23 and 1.03 ± 1.17 h/day in the good CPAP and non-adherence groups, respectively. Regression tendencies of the thickness of the left ventricular posterior (-0.30 ± 1.19 mm) and interventricular septal walls (-0.48 ± 1.22 mm) were observed in the good CPAP group. Hypertrophic tendencies of the left ventricular posterior wall (+0.59 ± 1.44 mm) and interventricular septal wall thickness (+0.59 ± 1.43) were observed in the non-adherence group. Left ventricular posterior wall thickness (coefficient: -0.254, p = 0.0376) and interventricular septal wall thickness (coefficient: -0.426, p = 0.0006) were more likely to be greater in the non-adherence group than in the good CPAP group. Patients in the non-adherence group with an apnea hypopnea index ≥30 had increased left ventricular posterior wall thickness (coefficient: -0.263, p = 0.0673) and interventricular septal wall thickness (coefficient: -0.450, p = 0.0011). In conclusion, appropriate CPAP therapy is an effective treatment for LVH in patients with T2DM and OSAS, especially for severe cases.
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Affiliation(s)
- Akeo Ohira
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Tadashi Yamakawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | | | - Mai Sugiyama
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Marina Harada
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masahiro Ichikawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Tomoaki Akiyama
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Kazuki Orime
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
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Kusakabe T, Yokota S, Shimizu M, Inoue T, Tanaka M, Ohue-Kitano R, Muranaka K, Yamakage H, Wada H, Hasegawa K, Satoh-Asahara N. Differential effects of sodium-glucose cotransporter 2 inhibitor and low-carbohydrate diet on body composition and metabolic profile in obese diabetic db/db mice. BMJ Open Diabetes Res Care 2020; 8:8/1/e001303. [PMID: 32883687 PMCID: PMC7473664 DOI: 10.1136/bmjdrc-2020-001303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/12/2020] [Accepted: 07/18/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Treatment using sodium-glucose cotransporter (SGLT) 2 inhibitor and low-carbohydrate diet (LCD) for obesity and type 2 diabetes are similar in terms of carbohydrate limitation. However, their mechanisms of action differ, and the effects on the body remain unclear. We investigated the effects of SGLT2 inhibitor and LCD on body composition and metabolic profile using the db/db mouse model for obesity and type 2 diabetes. RESEARCH DESIGN AND METHODS Eight-week-old male db/db mice were divided into four groups: mice receiving normal diet and vehicle or canagliflozin (Cana) administration and mice receiving LCD and vehicle or Cana administration for 8 weeks. Consumed calories were adjusted to be equal among the groups. RESULTS Both Cana administration and LCD feeding resulted in significant weight gain. Cana administration significantly decreased plasma glucose levels and increased plasma insulin levels with preservation of pancreatic β cells. However, LCD feeding did not improve plasma glucose levels but deteriorated insulin sensitivity. LCD feeding significantly reduced liver weight and hepatic triglyceride content; these effects were not observed with Cana administration. Combined treatment with LCD did not lead to an additive increase in blood β-ketone levels. CONCLUSIONS SGLT2 inhibitors and LCD exert differential effects on the body. Their combined use may achieve better metabolic improvements in obesity and type 2 diabetes.
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Affiliation(s)
- Toru Kusakabe
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Shigefumi Yokota
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Mika Shimizu
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Takayuki Inoue
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Masashi Tanaka
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Ryuji Ohue-Kitano
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Kazuya Muranaka
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Hajime Yamakage
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Hiromichi Wada
- Division of Translational Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Koji Hasegawa
- Division of Translational Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Noriko Satoh-Asahara
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
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Seino Y, Ueno S, Yabe D, Suzuki A. Dietary recommendations for type 2 diabetes patients: Lessons from recent clinical and basic research in Asia. J Diabetes Investig 2019; 10:1405-1407. [PMID: 31472101 PMCID: PMC6825937 DOI: 10.1111/jdi.13135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
Dishes containing dietary fibers are eaten first, and the protein and fat courses are then followed by the carbohydrate dishes.
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Affiliation(s)
- Yusuke Seino
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Japan
| | - Shinji Ueno
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Japan
| | - Daisuke Yabe
- Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, Gifu, Japan.,Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan.,Division of Molecular and Metabolic Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Suzuki
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Japan
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Lopes CDO, Barcelos MDFP, Vieira CNDG, de Abreu WC, Ferreira EB, Pereira RC, de Angelis-Pereira MC. Effects of sprouted and fermented quinoa ( Chenopodium quinoa) on glycemic index of diet and biochemical parameters of blood of Wistar rats fed high carbohydrate diet. Journal of Food Science and Technology 2018; 56:40-48. [PMID: 30728545 DOI: 10.1007/s13197-018-3436-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/22/2022]
Abstract
Sprouted and fermented foods have shown hypoglycemic effects on humans and animals, by reducing concentrations of soluble carbohydrates, and increasing dietary fiber and resistant starch content. In this study, diets with high levels of simple carbohydrates supplemented with toasted quinoa flour, sprouted and toasted quinoa flour, fermented and toasted quinoa flour or sprouted/fermented and toasted quinoa flour were given to Wistar rats. During the experiment, the glycemic index (GI) of the diets were measure and, at the end of 47 days of feeding, the effects of the diets on physical and biochemical parameters of the animals were evaluated. Results indicated that the processes of sprouting and/or fermentation potentiate the ability of quinoa to reduce GI of diets with high levels of simple carbohydrates. Moreover, food intake, blood glucose and lipid levels, and accumulation of epididymal adipose tissue were reduced in rats fed diets supplemented with quinoa. These effects may be due to the nutritional composition of the supplemented diets, besides the chemical changes promoted by processing quinoa. These results are particularly relevant once sprouted and fermented quinoa could be an alimentary source of interest, especially for disease risk prevention such as diabetes, obesity and dyslipidemias.
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Affiliation(s)
- Cristiane de Oliveira Lopes
- 1Department of Food Science, Federal University of Lavras (UFLA), University Campus, 3037, Lavras, MG CEP 37200-000 Brazil
| | | | - Cíntia Nayara de Goes Vieira
- 2Department of Nutrition, Federal University of Lavras (UFLA), University Campus, 3037, Lavras, MG CEP 37200-000 Brazil
| | - Wilson César de Abreu
- 2Department of Nutrition, Federal University of Lavras (UFLA), University Campus, 3037, Lavras, MG CEP 37200-000 Brazil
| | - Eric Batista Ferreira
- 3Institute of Exact Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva 700, Centro, Alfenas, MG CEP 37130-000 Brazil
| | - Rafaela Corrêa Pereira
- 2Department of Nutrition, Federal University of Lavras (UFLA), University Campus, 3037, Lavras, MG CEP 37200-000 Brazil
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