Monounsaturated fat-rich diet reduces body adiposity in women with obesity, but does not influence energy expenditure and substrate oxidation: a parallel randomized controlled clinical trial

BACKGROUND

Obesity is an important and growing health problem whose treatment involves dietary changes. In this context, studying the role of macronutrients in weight loss is required in order to understand which strategies may be applied for weight loss. We aimed to evaluate the effects of diets rich in polyunsaturated (PUFAs) and monounsaturated fatty acids (MUFAs) on resting energy expenditure (REE), substrate oxidation, and weight loss in women with obesity.

METHODS

Randomized, controlled, single blind, parallel-group clinical trial was conducted for 60 days. Participants (n = 32) were divided into three groups: G1= normocaloric PUFAs-rich diet (12% of total energy expenditure (TEE), 10% of n-6 and up to 2% of n-3); G2= normocaloric MUFAs-rich diet (15-20% TEE); and G3= maintenance of the usual diet. Anthropometric and metabolic variables (REE and substrate oxidation by indirect calorimetry) were evaluated.

RESULTS

G2 decreased body weight (-1.92 ± 1.99 kg, P = 0.02), body mass index (BMI) (-0.69 ± 0.70 kg/m2; P = 0.02), waist circumference (WC) (-1.91 ± 1.82 cm; P = 0.02), and body fat (-1.14 ± 1.53 kg; P = 0.04).

CONCLUSION

MUFAs-rich diet reduces body weight, BMI, body fat, and WC.

CLINICAL TRIALS

NCT02656940.

CLINICAL TRIAL REGISTRATION

Clinical Trials: NCT02656940.

What Do We Know about Neonatal Diabetes Caused by PDX1 Mutations?

INTRODUCTION

Neonatal diabetes mellitus (NDM) is characterized by severe hyperglycemia, usually diagnosed in the first few months of an individual's life. It is a genetic disease and one of the main forms of monogenic diabetes. Changes in different genes have already been associated with NDM, including changes in the gene PDX1.

METHODS

In this review, we intend to summarize all neonatal diabetes cases caused by PDX1 mutations reported in the literature. For this purpose, we searched keywords in the literature from PubMed and articles cited by the HGMD database. The search retrieved 84 articles, of which 41 had their full text accessed. After applying the study exclusion criteria, nine articles were included.

RESULTS

Of those articles, we detected thirteen cases of NDM associated with changes in PDX1; the majority in homozygous or compound heterozygous patients. Until now, variants in the PDX1 gene have been a rare cause of NDM; however, few studies have included the screening of this gene in the investigation of neonatal diabetes.

CONCLUSION

In this review, we reinforce the importance of the PDX1 gene inclusion in genetic NGS panels for molecular diagnosis of NDM, and systematic morphological and functional exams of the pancreas when NDM is present.

Chia Flour (Salvia hispanica L.) Intake Does Not Affect Weight Loss and Lipid Profile but Improve Systolic Blood Pressure Control in Obesity

BACKGROUND

Obesity is an epidemic, multifactorial and difficult-to-control disease, besides being a risk factor for cardiovascular diseases. Among the multiple intervention proposals, the addition of chia in meals has been considered due to its composition and possible effects on weight loss and cardiovascular parameters.

OBJECTIVE

We evaluate the influence of chia flour (Salvia hispanica L.) intake on body weight, body composition, energy expenditure (EE) and cardiovascular risk in obese women.

METHODS

This study is a clinical trial performed with 20 adult women with obesity randomized into experimental (chia flour) and control (placebo) groups. We assessed anthropometric and biochemical measurements, as well as clinical, dietary and EE variables before intervention and 90 days later.

RESULTS

There were no differences in anthropometric indicators, body composition or EE between groups, but a decrease in HDL-c (p = 0.049) and a trend towards the reduction of systolic blood pressure (SBP) (p = 0.062) was observed in the experimental group.

CONCLUSION

Chia flour had a possible positive effect on SBP control, but negatively affected the lipid profile and did not seem to influence obesity control.

A Pilot Study of Dietetic, Phenotypic, and Genotypic Features Influencing Hypertensive Disorders of Pregnancy in Women with Pregestational Diabetes Mellitus

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbimortality. Dietetic, phenotypic, and genotypic factors influencing HDP were analyzed during a nutrigenetic trial in Rio de Janeiro, Brazil (2016-2020). Pregnant women with pregestational diabetes mellitus (n = 70) were randomly assigned to a traditional or DASH diet group. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured during prenatal visits and HDP were diagnosed using international criteria. Phenotypic data were obtained from medical records and personal interviews. Genotyping for FTO and ADRB2 polymorphisms used RT-PCR. Linear mixed-effect models and time-to-event analyses were performed. The variables with significant effect on the risk for progression to HDP were: black skin color (adjusted hazard ratio [aHR] 8.63, p = 0.01), preeclampsia in previous pregnancy (aHR 11.66, p < 0.01), SBP ≥ 114 mmHg in the third trimester (aHR 5.56, p 0.04), DBP ≥ 70 mmHg in the first trimester (aHR 70.15, p = 0.03), mean blood pressure > 100 mmHg (aHR 18.42, p = 0.03), and HbA1c ≥ 6.41% in the third trimester (aHR 4.76, p = 0.03). Dietetic and genotypic features had no significant effect on the outcome, although there was limited statistical power to test both.

Profile of Gut Microbiota of Adults with Diabetes Mellitus Type 1: A Systematic Review

BACKGROUND

Type 1 diabetes mellitus (T1DM) is a chronic disease of clinical importance, whose prevalence has increased in Brazil and worldwide. Among the possible factors involved in the genesis and control of the disease, the intestinal microbiota (IM) deserves to be highlighted, but studies that report differences between the IM of patients with T1DM and those who are healthy are still contradictory and scarce.

OBJECTIVE

The objective of this paper was to evaluate the IM profile of T1DM and healthy patients, in order to verify possible differences and to evaluate the possibility of the influence of IM on glycemic control in T1DM.

METHODS

Of the 2716 articles found, nine were included in this review, and all of which were randomized, observational, cross-sectional, cohort and case-control studies that characterized the composition of IM in adults with T1DM and healthy adults.

RESULTS

Studies are very diverse, which makes it difficult to associate the IM profile with T1DM etiology and control, however it was found that there was a prevalence of the phylum Firmicutes in the IM of individuals with T1DM and that there was no significant difference in the relative abundance of Bacteroidetes in both populations.

CONCLUSION

It was also possible to identify an inverse relationship of the genus Bifidobacterium and a positive relationship of the genera Bacteroidetes and Prevotella with the concentration ofglycated hemoglobin. More studies are needed to contemplate the characterization of IM in healthy and T1DM individuals.

Intestinal Microbiota and Sclerosis Lateral Amyotrophic

The human gastrointestinal tract contains numerous microorganisms. This intestinal microbiota (IM) has a mutualistic relationship with the human organism, and it plays a fundamental role in regulating metabolic, endocrine, and immunological functions. Intestinal dysbiosis is associated with phenotypes of many chronic and inflammatory diseases. This association is explained by the functions of the IM and the existing bi-directional communication of the microbiota-intestine-brain axis. Studies have uncovered new evidence between the IM and neurodegenerative diseases recently, including amyotrophic lateral sclerosis (ALS). Given this, the present narrative review discusses didactically about IM, its functions, its relationship with the neuroimmune-endocrine system, and its association with neurodegenerative diseases, with emphasis on ALS.

Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial

OBJECTIVE

 To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM).

METHODS

 Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose.

RESULTS

 Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2^nd (p = 0.00) and 3^rd (p = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2^nd trimester (p = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p = 0.047).

CONCLUSION

 Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention.

REBEC CLINICAL TRIALS DATABASE

 The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).

Hypocaloric diet with lower meal frequency did not affect weight loss, body composition and insulin responsiveness, but improved lipid profile: a randomized clinical trial

Dietary approaches are essential to control obesity, but the effectiveness of changes in meal frequency (MF) as a strategy for body weight loss or maintenance remain unclear. This study aimed to evaluate the influence of MF of a hypocaloric diet on weight loss, body composition, active ghrelin levels and metabolic indicators of obese women. This is a randomized, parallel clinical trial, including 40 women divided into two groups that received a hypocaloric diet with different MFs: MF6: six meals per day, and MF3: three meals per day. Dietary, laboratory, anthropometric and body composition indicators were assessed, as well as energy expenditure (EE), before and after the 90 days of the intervention. Dietary consumption did not differ between groups, before or after intervention. The two groups reduced their energy intake after intervention, but there were no differences between the groups. Waist circumference (WC) was reduced and resting metabolic rate had increased in the MF3 group at the end compared to baseline. Moreover, there was a significant difference in the triglyceride levels between groups after intervention, with an important reduction in the MF3 group, although changes in body composition, blood glucose, plasma ghrelin levels and EE variables did not differ between the groups at the end. It is concluded that, the hypocaloric diet with different MF each day did not change weight loss, body composition or insulin responsiveness, but there was an improvement of triglyceridemia in the MF3 group. The present study suggests that eating snacks between meals is not an important factor for weight loss and improvement of metabolic health in women with obesity.

Modulation of the gut microbiota by probiotics and symbiotics is associated with changes in serum metabolite profile related to a decrease in inflammation and overall benefits to metabolic health: a double-blind randomized controlled clinical trial in women with obesity

Modulation of the gut microbiota may help in treating obesity by improving host metabolic health. We aimed to evaluate the effects of probiotics or symbiotics on body weight and serum metabolite profile in women with obesity. A double-blind, parallel, randomized, controlled clinical trial was conducted with 32 adult women with body mass index ranging from 30 to 34.9 kg m-2. Volunteers followed a low-energy diet and were subjected to 8 weeks intervention: probiotic group (PG - Bifidobacterium lactis UBBLa-70, n = 10), symbiotic group (SG - Bifidobacterium lactis UBBLa-70 and fructooligosaccharide, n = 11), or control group (CG - placebo, n = 11). Analyses of anthropometric variables, gut microbiota and serum metabolites by 1H nuclear magnetic resonance (NMR) were performed at baseline and after the intervention. Multivariate statistics showed that all groups presented a decrease in glycerol and increase in arginine, glutamine and 2-oxoisovalerate. Therefore, a low-energy diet per se promoted changes in the metabolite profile related to decreased inflammation and positive effects on body weight. SG presented unique changes in metabolites (increase in pyruvate and alanine and decrease in citrate and BCAA). Negative correlations between arginine and glutamine with fat mass were observed in the SG. PG presented a decrease in 1H NMR lipid signals and negative correlation between Verrucomicrobia and Firmicutes with (CH2)n lipids. Both probiotics and symbiotics promoted changes in metabolites related to improved metabolic health. Specific metabolite changes following symbiotic intervention might suggest some advantage in providing Bifidobacterium lactis in combination with fructooligosaccharide in a low-energy diet, rather than probiotics or diet alone. Clinical trial: NCT02505854.

A Rare Potential Pathogenic Variant in the BDNF Gene is Found in a Brazilian Patient with Severe Childhood-Onset Obesity

BACKGROUND

Brain-derived neurotrophic factor (BDNF) is a pro-survival factor in the brain that also regulates energy balance. BDNF loss-of-function point mutations are responsible for haploinsufficiency, causing severe early-onset obesity. Up to date, only a few studies have sequenced this gene to search for rare mutations related to obesity. In this study, we aimed to investigate the prevalence of BDNF variants in a cohort of adults with severe obesity from Brazil.

MATERIAL AND METHODS

This study comprised 201 adults with severe obesity (BMI ≥ 35.0 kg/m²) with onset during childhood- or adolescence/youth. As controls, 73 subjects with normal weight (18.5 ≤ BMI ≤ 24.9 kg/m²) were selected. The exclusion criteria were pregnancy, lactation, the use of medication to lose or gain weight, and the presence of symptoms suggestive of syndromic obesity (only for the case group). The coding region of the BDNF gene was screened by Sanger sequencing. Demographic, anthropometric, and blood pressure parameters were obtained from the participants as well as serum hormone and cytokines concentrations and biochemical values.

RESULTS

As a result, three missense variants [p.(Thr2Ile), p.(Val66Met), and p.(Arg209Gln)] and four synonymous variants (p.Leu107=, p.Thr149=, p.Ala150=, and p.Ser213=) were identified. The p.(Arg209Gln) was predicted as pathogenic by all in silico algorithms used and was not observed in the control group. The individuals carrying the p.(Val66Met) mutated allele had higher waist circumference, HDL-cholesterol and MCP1 levels, and reduced risk of developing metabolic syndrome.

CONCLUSION

We observed that the common BDNF p.(Val66Met) variant has influenced waist circumference, HDL-cholesterol, and MCP1 levels. This polymorphism has also a protective effect on metabolic syndrome susceptibility. Additionally, we described for the first time a rare potentially pathogenic BDNF variant in a Brazilian patient with severe obesity and childhood-onset.

Metabolic and Appetite Effects of Fructose and Glucose in Subjects with Type 1 Diabetes: A Randomized Crossover Clinical Trial

BACKGROUND

Fructose has been widely used for producing lower post-infusion glucose increase than other carbohydrates, but it seems that it promotes an increase in post-infusion triglycerides.

OBJECTIVE

The present study investigated the effects of fructose and glucose in metabolic variables and appetite sensations in patients with type 1 diabetes mellitus (T1DM).

METHODS

This is a single-blind, randomized, and crossover study (washout of 1-5 weeks), which evaluated 16 adult T1DM patients, accompanied at University Hospital. After eight hours of overnight fasting, there was an assessment of capillary blood glucose, anthropometric variables, appetite sensations, and laboratory tests (glycemia, lipemia, leptin and glucagon) were conducted. Subsequently, they received 200mL of solutions with water and 75g of crystal fructose or glucose. Appetite sensations and capillary blood glucose were evaluated in different post-infusion times. Blood was drawn after 180 minutes for the laboratory tests.

RESULTS

Blood glucose increased after the intake of both solutions, but glucose induced a higher elevation. None of them increased triglycerides or glucagon. Glucagon maintenance was similar among the solutions. Furthermore, both solutions reduced leptin and increased fullness, but only fructose increased the lack of interest in eating sweets.

CONCLUSION

Fructose induced a smaller increase in postprandial blood glucose than glucose, without changes in triglycerides and glucagon. In addition, leptin levels and appetite sensations were similar to glucose. Other studies are needed in order to confirm these findings, especially in the long term, so that their use becomes really reliable.

Identification of a Rare and Potential Pathogenic MC4R Variant in a Brazilian Patient With Adulthood-Onset Severe Obesity

Background

The melanocortinergic pathway orchestrates the energy homeostasis and impairments in this system often lead to an increase in body weight. Rare variants in the melanocortin 4 receptor (MC4R) gene resulting in partial or complete loss of function have been described with autosomal co-dominant inheritance. These mutations are the most common cause of non-syndromic monogenic obesity. In this context, this study aimed to sequence the MC4R gene in a Brazilian cohort of adults with severe obesity.

Methods

This study included 163 unrelated probands with Body Mass Index (BMI) ≥ 35 kg/m², stratified into three groups, according to the period of obesity onset. From the total sample, 25 patients were enrolled in the childhood-onset group (0–11 years), 19 patients in the adolescence/youth-onset group (12–21 years), and 119 patients in the adult-onset group (>21 years). Blood pressure, anthropometric and biochemical characteristics were obtained, and the MC4R coding region of each subject’s DNA was assessed using automated Sanger sequencing.

Results

Significant anthropometric differences between the groups were observed. Higher body weight and BMI medians were found in patients with childhood-onset or adolescence/youth-onset when compared to the adulthood-onset obesity group. A total of five mutations were identified, including four missense variants: p.Ser36Thr, p.Val103Ile, p.Ala175Thr, and p.Ile251Leu. Additionally, we observed one synonymous variant (p.Ile198=). The p.Ala175Thr variant was identified in a female case with severe obesity and adulthood-onset. This variant was previously described as a partial loss-of-function mutation, in which the minor allele poses dominant-negative effect, probably resulting in reduced cAMP activity.

Conclusion

This study showed a prevalence of common and rare variants in a cohort of Brazilian adults with severe obesity and candidates to bariatric surgery. We have identified a rare potentially pathogenic MC4R variant in a Brazilian patient with severe and adulthood-onset obesity.

Effect of coconut oil on weight loss and metabolic parameters in men with obesity: a randomized controlled clinical trial

Coconut oil appears to help in weight loss and improve metabolic parameters associated with obesity. We evaluate the influence of coconut oil on the body composition, lipid profile and glycemia in men with obesity. A controlled, randomized clinical trial was performed with 29 adult men affected by obesity. They were randomized between two groups receiving a daily intake of 1 tablespoon (12 mL) of extra virgin coconut oil (CO, n = 15) or soybean oil (SO, n = 14), and an isoenergetic balanced diet. The anthropometric profile, lipid profile and glycaemia were evaluated at the baseline and 45 days after intervention. The Mann-Whitney test was performed to compare the groups, and the Wilcoxon test was performed to compare the times. We considered a value of p < 0.05 as significant. There was no difference in anthropometric variables between the groups before and after intervention. The level of HDL cholesterol increased (3.67 ± 8.08 versus-3.79 ± 10.98, p = 0.02) and the TC/HDL cholesterol ratio decreased (-0.63 ± 0.82 versus 0.23 ± 0.80, p = 0.03) in the CO group, compared to the SO group. Coconut oil included in the isoenergetic balanced diet could increase HDL cholesterol and decrease the TC/HDL cholesterol ratio in men with obesity.

Profile of the gut microbiota of adults with obesity: a systematic review

Recently, relationship between gut microbiota composition and development of obesity has been pointed. However, the gut microbiota composition of individual with obesity is not known yet. Therefore, this systematic review aimed to evaluate differences in profile of gut microbiota between individuals with obesity and individuals with normal weight. A search performed on August 2019 in the databases Pubmed, Scopus, Web of Science, Cochrane library, Lilacs and gray literature using the terms: "microbiota", "microbiome", "obesity", "obesity morbid", and "humans". Studies assessing the gut microbiota composition in adults with obesity and lean were included. Quality assessment was performed by Newcastle-Ottawa Quality Assessment Scale. Of the 12,496 studies, 32 were eligible and included in this review. Individuals with obesity have a greater Firmicutes/Bacteroidetes ratio, Firmicutes, Fusobacteria, Proteobacteria, Mollicutes, Lactobacillus (reuteri), and less Verrucomicrobia (Akkermansia muciniphila), Faecalibacterium (prausnitzii), Bacteroidetes, Methanobrevibacter smithii, Lactobacillus plantarum and paracasei. In addition, some bacteria had positive correlation and others negative correlation with obesity. Individuals with obesity showed profile of gut microbiota different than individual lean. These results may help in advances of the diagnosis and treatment of obesity.

Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial

OBJECTIVE

To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients.

SUBJECTS AND METHODS

The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels.

RESULTS

Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change.

CONCLUSIONS

Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.

Macro e micronutrientes na orientação nutricional para obesidade

A obesidade é uma doença crônica e tem se tornado uma epidemia em todo o mundo. Sua etiologia é multifatorial e o tratamento complexo, envolvendo dieta, exercícios físicos, fármacos e, em casos mais graves, cirurgia. De acordo com os guias e consensos, nacionais e internacionais, a distribuição dos macronutrientes fica em torno de 35% a 65% do valor energético total (VET) de carboidratos, 15 a 25% do VET de proteínas e 20 a 40% do VET de lipídios. Por meio de uma revisão de literatura, foram encontradas recomendações controversas. Conforme análise crítica dos pesquisadores envolvidos e de acordo com resultados de pesquisas recentes, concluiu-se que dieta hipocalórica (restrição de 500 a 750 kcal/dia), hiperproteica (>25% do VET), hipoglicídica e normolipídica foi eficaz na perda e manutenção do peso a longo prazo. Em relação aos lipídios, verificou-se que a dieta deve ser mais qualitativa, com a redução na ingestão de colesterol, gorduras saturadas e trans. O consumo de fibras deve ser estimulado. Dietas restritivas não se mostraram sustentáveis por um longo período, mas podem ser usadas em um período determinado. Além disso, a alta prevalência de deficiência de micronutrientes em indivíduos com obesidade foi consensual entre os autores, inclusive antes da cirurgia bariátrica. Concluiu-se que a adesão dietética e, consequentemente, o balanço negativo são fatores decisivos para a promoção da perda de peso.  O planejamento alimentar deve ser flexível e individualizado e o contato entre o nutricionista e o paciente deve ser constante, visando a reeducação alimentar. O presente artigo realizou uma análise crítica das recomendações de macro e micronutrientes na obesidade visando contribuir para o tratamento dietético dessa população.

Identification of the MC4R start lost mutation in a morbidly obese Brazilian patient

BACKGROUND

Melanocortin 4 receptor gene (MC4R) is an important regulator of food intake, body weight, and blood pressure. Mutations in MC4R are associated with the most common form of nonsyndromic monogenic obesity. MC4R variations have an autosomal co-/dominant model of inheritance. MC4R screening could reveal individuals previously unrecognized with Mendelian form of obesity for further clinical management and genetic counseling. However, there are limited data regarding MC4R variants in patients with obesity from Brazil. The aim of this study was to screen the coding region of the MC4R gene in a Brazilian cohort of severely obese adults and to investigate the phenotype-genotype correlation within MC4R variant carriers.

METHODS

This study comprised 157 adult participants, stratified according to the period of obesity onset. The first group included 97 patients with childhood-onset obesity (0-11 years) and the second group comprised 60 subjects with adolescence/youth-onset obesity (12-21 years). The entire coding region of MC4R gene was screened by Sanger sequencing.

RESULTS

As a result, five previously described variants (Met1?, Ser36Thr, Val103Ile, Ile98=, and Phe202Leu) were identified. Met1? is a start lost codon variant, which affects the translation of MC4R. It was found in a female patient with childhood-onset obesity. We also compared the anthropometric and metabolic parameters between patients with MC4R missense variants (Ser36Thr, Val103Ile, and Phe202Leu) and noncarriers. Patients carrying MC4R variants had higher median of waist-hip ratio when compared to noncarriers (P=0.048). These missense variants were also associated with hypertension (P=0.014). Additionally, Val103Ile carriers had lower diastolic blood pressure and lower systolic blood pressure compared to noncarriers (P=0.020 and P=0.065, respectively). Val103Ile was also associated with hypertension (P=0.003).

CONCLUSION

This study showed the prevalence of MC4R variants in a cohort of Brazilian adults with severe obesity. We also identified significant phenotype differences between carriers and noncarriers of missense variants in our sample, suggesting an important role of MC4R on body fat distribution and blood pressure.

Does sucrose affect the glucose variability in patients with type 1 diabetes? a pilot crossover clinical study

OBJECTIVE

The aim of this study was to compare the effects of a sucrose-free diet with a sucrose-added diet on glucose variability in patients with type 1 diabetes.

METHODS

This was a two-way crossover design study in which patients with type 1 diabetes were monitored by blinded continuous glucose monitoring and were selected to receive a sucrose-free diet (<30 g/d), followed by a sucrose-added diet (>80 g/d) for 2 d each. Intra-day glucose variability was assessed by the mean amplitude of glycemic excursions (MAGE), the M-value, J-index, glycemic risk assessment in diabetes equation (GRADE), and continuous overlapping net glycemic action (CONGA_1-3). Between-day variability was determined by mean of daily difference (MODD). Statistical analyses were performed with a significance level of 5%.

RESULTS

Ten patients with type 1 diabetes were evaluated. The participants were a mean of 26.1 ± 7.1 y of age. The mean duration of disease was 16.5 ± 10.5 y, and patients' mean glycated hemoglobin was 7.4% ± 0.8%. The intra- and inter-day glucose variability indexes did not differ between the diet periods (MAGE: 10.2 ± 5.1 and 10.4 ± 6.8mmol/L, P = 0.98; M-value: 12.9 ± 2 and 15.6 ± 1.3mmol/L, P = 0.29; J-index: 50.9 ± 4.4 and 57.7 ± 3.3mmol/L, P = 0.41; GRADE: 7.2 ± 1 and 4.7 ± 5.3mmol/L, P = 0.07; and MODD: 3.9 ± 1 and 4.3 ± 1.5mmol/L, P = 0.28; for the sucrose-free and sucrose-added diets, respectively). CONGA_1-3 were similar for both diet periods (P > 0.05).

CONCLUSIONS

The use of a moderate amount of sucrose, as part of a balanced diet, did not affect the glucose variability or insulin requirements in patients with type 1 diabetes.

Long term maintenance of glucose and lipid concentrations after Roux-en-Y gastric bypass

OBJECTIVE

Roux-en-Y gastric bypass (RYGB) reduces body weight and the comorbidities associated with obesity. The aim of this study was to evaluate whether glucose and lipid profiles were maintained during a 5-year follow-up period after RYGB.

SUBJECTS AND METHODS

Anthropometric and laboratory data from 323 patients who had undergone this operation were analyzed. Differences in laboratory variables between the baseline and 12, 24, 36, 48 and 60 months postoperatively (PO) were assessed using a one-way ANOVA test to compare the three groups. Delta significance using one-way ANOVA was performed to assess anthropometric variable in the postoperative period (p < 0.05).

RESULTS

77 patients (24%) were included in Group 1 (G1), 101 (32%) in Group 2 (G2), and 141 (44%) in Group 3 (G3). The majority of patients, 71.7% in G1, 82.8% in G2, and 70% in G3, showed high triglycerides (TG) before surgery. A decrease in weight loss was observed in all groups followed by an increase in body weight in G2 and G3 at 36, 48 and 60 months. Laboratory results for G1, G2 and G3 showed no significant differences between groups at baseline and during the post-operative period.

CONCLUSION

Our results suggest that weight regain after RYGB has no significant impact on the long-term evolution of the lipid profile and glycemia.

Influence of FTO rs9939609 polymorphism on appetite, ghrelin, leptin, IL6, TNFα levels, and food intake of women with morbid obesity

BACKGROUND

The fat mass and obesity-related (FTO) gene has a strong relationship with obesity, extreme obesity and inflammatory state, and may also be associated with food intake regulation.

OBJECTIVE

The aim of the present study was to evaluate the influence of the rs9939609 single-nucleotide polymorphism of the FTO gene on appetite, ghrelin, leptin, interleukin 6 (IL6), tumor necrosis factor α (TNFα) levels and food intake of morbidly obese women.

MATERIALS AND METHODS

The study comprised 70 women, aged between 20 and 48 years, from Rio de Janeiro, Brazil. The participants were selected according to the body mass index between 40 and 60 kg/m². Anthropometric and biochemical data were measured during fasting. Hormones and inflammatory data were measured before and after the participants ate an isocaloric meal. Dietary records were calculated and analyzed using a nutritional assessment program. Visual analog scales were used for behaviors of the sensations of appetite and food preferences. The FTO rs9939609 variant was genotyped using real-time polymerase chain reaction.

RESULTS

Participants with the AA genotype had lower values of ghrelin and IL6 and higher values of leptin than those with TT and TA in the postprandial period. Comparing the plasma concentrations of ghrelin, insulin, IL6 and TNFα intragenotypes, it was observed that those with TT had decreased leptin and increased IL6 at the postprandial period. Subjects with TA showed increased postprandial IL6, and those with AA had decreased postprandial ghrelin. There was no difference in TNFα intra- and intergenotypes. The postprandial sensations of hunger were lower in AA than those with TT. There were differences between genotypes regarding ingested grams of protein by weight, cholesterol, B3, B5, B6 and B12 vitamins, and selenium potassium and sodium minerals.

CONCLUSION

These findings suggest that genetics may exert an influence on physiologic factors and might alter eating behavior.

Effect of Lactobacillus on body weight and body fat in overweight subjects: a systematic review of randomized controlled clinical trials

Gut microbiota is important for maintaining body weight. Modulation of gut microbiota by probiotics may result in weight loss and thus help in obesity treatment. The aim of this systematic review was to evaluate the effects of Lactobacillus on weight loss and/or fat mass in overweight adults. A search was performed on the Medline (PubMed) and Scopus electronic databases using the search terms: 'probiotics', 'Lactobacillus, 'obesity', 'body weight changes', 'weight loss', 'overweight', 'abdominal obesity', 'body composition', 'body weight', 'body fat' and 'fat mass'. In the total were found 1567 articles, but only 14 were included in this systematic review. Of these nine showed decreased body weight and/or body fat, three did not find effect and two showed weight gain. Results suggest that the beneficial effects are strain dependent. It can highlight that Lactobacillus plantarum and Lactobacillus rhamnosus when combined with a hypocaloric diet, L. plantarum with Lactobacillus curvatus, Lactobacillus gasseri, Lactobacillus amylovorus, Lactobacillus acidophilus and Lactobacillus casei with phenolic compounds, and multiple species of Lactobacillus.

EFFECTS OF LONG-TERM ROUX-EN-Y GASTRIC BYPASS ON BODY WEIGHT AND CLINICAL METABOLIC COMORBIDITIES IN BARIATRIC SURGERY SERVICE OF A UNIVERSITY HOSPITAL

Background

Due to the high failure rate observed in the clinical treatment of morbid obesity an increase in bariatric surgery indications, as an alternative for the control of obesity and comorbidities, is noticeable.

Aim

To evaluate the performance of type 2 diabetes mellitus, high blood pressure and dyslipidemia in patients submitted to Roux-en-Y gastric bypass in late follow-up.

Methods

Retrospective analysis of 59 patients included in the bariatric surgery program. Anthropometric (height and body weight) and laboratory (LDLc, HDLc, VLDLc, triglyceride -TG - and glucose) data were collected on pre- and postoperative stages, through medical records.

Results

Among the patients, 86% were female aged 43±11, of whom 52% had attended high school. The average postoperative time was 7±3 years. During the postoperative period, there were decreases of weight and body mass index, respectively (133±06 kg vs 91±04 kg p<0.05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0.05). In comparison to the preoperative stage, lower concentrations of glucose (101.00±26.99 vs 89,11±15.19, p=0.014), total cholesterol rates (179.00±37,95 vs 167.48±28,50, p=0.016), LDLc (104.30±33.12 vs 91.46±24.58, p=0.016), VLDLc (25.40±11,12 vs 15.68±7.40, p<0.01), and TG (143.35±86.35 vs 82.45±37.39, p<0.01) and higher concentrations of HDLc (43.53±8.23 vs 57.90±15.60, p<0.01) were identified in the postoperative stage. 40% of hypertensive patients were still undergoing high blood pressure treatment during the postoperative stage. There was remission of type 2 diabetes mellitus and dyslipidemia on 81% and 94% of the cases, respectively.

Conclusion

Roux-en-Y gastric bypass has proven itself to be an effective long term procedure, promoting weight loss, remission of DM2 and dyslipidemia.

Weight loss and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation

BACKGROUND

Obesity is a chronic disease with high growth in population and bariatric surgery is currently considered the most effective treatment for weight reduction; on the other hand, nutritional deficiencies are observed after this procedure.

AIM

To analyze weight loss progression and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation.

METHODS

Retrospective analysis of 137 patients of both sexes, aged between 18-60 years, using supplemental multivitamins and minerals, were included; personal information, anthropometric and laboratory data in the preoperative, 12, 24, 36 and 48 months postoperatively were collected.

RESULTS

Postoperatively, in both sexes, occurred weight loss compared to the pre-operative weight gain at 48 months and maintenance of body mass index. There was a decrease in the percentage of excess weight loss at 48 months postoperatively compared to the time of 12, 24 and 36 months in men and decreased at 48 postoperative months compared to the time of 24 months in females. There was a decreased in serum ferritin in both sexes and increased serum iron at 48 months postoperatively in males. There was a decreased in vitamin B12 and folic acid increased serum at 48 postoperative months in females.

CONCLUSIONS

Surgical treatment was effective for reducing weight, body mass index reduction and achievement of success in the late postoperative period along with multivitamin and mineral supplementation on prevention of serious nutritional deficiencies and anemia.

Influence of the body mass and visceral adiposity on glucose metabolism in obese women with Pro12Pro genotype in PPARgamma2 gene

INTRODUCTION

Glucose metabolism may be altered in obesity and genotype for PPAR 2 can influence this variable.

OBJECTIVE

To evaluate the influence of body mass (BM) and visceral adiposity (VA) in glucose metabolism in morbid obese women with Pro12Pro genotype.

METHODS

Were selected 25 morbidly obese women. Groups were formed according to body mass index (BMI) [G1: 40-45 kg/m² (n = 17); G2: > 45 kg/m² (n = 8)]. Anthropometric, glycemia and insulinemia assessments (fasting, 60 and 120 minutes after high polyunsaturated fatty acids meal) were carried out. The insulin resistance (IR) and insulin sensitivity (IS) were assessed by HOMA-IR and QUICKI respectively.

RESULTS

G2 had higher BMI and waist circumference, compared to G1, impaired fasting glucose, low IS and higher IR. The postprandial glucose was normal, but there was a higher insulin peak one hour after the meal in G2.

CONCLUSION

Increased BM and VA were associated with worse glucose metabolism suggesting metabolic differences between morbid obese with Pro12Pro genotype.

Effectiveness of prediction equations in estimating energy expenditure sample of Brazilian and Spanish women with excess body weight

OBJECTIVE

To assess the adequacy of predictive equations for estimation of energy expenditure (EE), compared with the EE using indirect calorimetry in a sample of Brazilian and Spanish women with excess body weight.

METHODS

It is a cross-sectional study with 92 obese adult women [26 Brazilian -G1- and 66 Spanish - G2- (aged 20-50)]. Weight and height were evaluated during fasting for the calculation of body mass index and predictive equations. EE was evaluated using the open-circuit indirect calorimetry with respiratory hood.

RESULTS

In G1 and G2, it was found that the estimates obtained by Harris-Benedict, Shofield, FAO/WHO/ ONU and Henry & Rees did not differ from EE using indirect calorimetry, which presented higher values than the equations proposed by Owen, Mifflin-St Jeor and Oxford. For G1 and G2 the predictive equation closest to the value obtained by the indirect calorimetry was the FAO/WHO/ONU (7.9% and 0.46% underestimation, respectively), followed by Harris-Benedict (8.6% and 1.5% underestimation, respectively).

CONCLUSION

The equations proposed by FAO/WHO/ ONU, Harris-Benedict, Shofield and Henry & Rees were adequate to estimate the EE in a sample of Brazilian and Spanish women with excess body weight. The other equations underestimated the EE.

Impact of advanced and basic carbohydrate counting methods on metabolic control in patients with type 1 diabetes

OBJECTIVE

Diets based on carbohydrate counting remain a key strategy for improving glycemic control in patients with type 1 diabetes. However, these diets may promote weight gain because of the flexibility in food choices. The aim of this study was to compare carbohydrate counting methods regarding anthropometric, biochemical, and dietary variables in individuals with type 1 diabetes, as well as to evaluate their knowledge about nutrition.

METHODS

Participants were allocated in basic or advanced groups. After 3 mo of the nutritional counseling, dietary intake, anthropometric variables, lipemia, and glycemic control were compared between groups. A questionnaire regarding carbohydrate counting, sucrose intake, nutritional knowledge, and diabetes and nutrition taboos also was administered.

RESULTS

Ten (30%) participants had already used advanced carbohydrate counting before the nutritional counseling and these individuals had a higher body mass index (BMI) (P < 0.01) and waist circumference (WC) (P = 0.01) than others (n = 23; 69.7%). After 3 mo of follow-up, although participants in the advanced group (n = 17; 51.52%) presented higher BMI (P < 0.01) and WC (P = 0.03), those in the basic group (n = 16; 48.48%) showed a higher fat intake (P < 0.01). The majority of participants reported no difficulty in following carbohydrate counting (62.5% and 88% for basic and advanced groups, respectively) and a greater flexibility in terms of food choices (>90% with both methods).

CONCLUSIONS

Advanced carbohydrate counting did not affect lipemic and glycemic control in individuals with type 1 diabetes, however, it may increase food intake, and consequently the BMI and WC, when compared to basic carbohydrate counting. Furthermore, carbohydrate counting promoted greater food flexibility.

Does sucrose intake affect antropometric variables, glycemia, lipemia and C-reactive protein in subjects with type 1 diabetes?: a controlled-trial

BACKGROUND

It is unclear if the sugar intake may affect metabolic parameters in individuals with type 1 diabetes. Therefore, the purpose of this study was to evaluate the effects of sucrose intake in glycemic, lipemic, anthropometric variables, as well as in C-reactive protein (CRP) levels in these individuals.

METHODS

Thirty-three subjects with type 1 diabetes were evaluated at baseline and 3-months after intervention. Volunteers were randomized into groups: sucrose-free (diet without sucrose) or sucrose-added (foods containing sucrose in composition). Both groups received the same macronutrient composition and used the carbohydrate counting methods. All underwent an interview and anthropometric evaluation. Blood was drawn for glycated haemoglobin, glucose, total cholesterol, HDL, and CRP measurement, and the medical charts were reviewed in all cases.

RESULTS

At baseline, anthropometric, clinical and laboratory variables did not differ between groups, except for the triglycerides. Although at baseline triglycerides levels were higher in the sucrose-added group (p = 0.01), they did not differ between groups after the intervention (p = 0.92). After 3-months, CRP was higher in the sucrose-added than in the sucrose-free group (p = 0.04), but no further differences were found between the groups, including the insulin requirements, anthropometric variables, body composition, and glycemic control. Both groups showed sugars intake above the recommendations at baseline and after intervention.

CONCLUSIONS

Sucrose intake, along with a disciplined diet, did not affect insulin requirements, anthropometric variables, body composition, lipemic and glycemic control. However, although the sucrose intakes increase CRP levels, the amount of sugar in the diet was not associated with this inflammatory marker.

Systematic review; Nutritional therapy in gestational diabetes mellitus

INTRODUCTION

Several methods of dietetic counseling can be used in the nutritional therapy in gestational diabetes mellitus (GDM). The main methods are the traditional method (TM) and the carbohydrate counting (CCM).

OBJECTIVE

Presenting a systematic review of the literature on the impact of nutritional therapy in GDM, through TM and CCM, evaluating the results for maternal and child health.

METHODS

We searched databases PubMed, Scopus, Web of Science, Lilacs and CAPES Digital Bank of Thesis. The methodological quality of all the studies included was made using the Jadad score.

RESULTS AND CONCLUSION

We have found five studies that evaluated the effects of nutritional therapy, through the TM, on the maternal and child health. None study evaluating the CCM was detected in pregnant women with GDM Nutritional therapy given during antenatal care was effective in reducing pregnancy complications (preeclampsia, excessive gestational weight gain, necessity for cesarean delivery, for insulin therapy and for shoulder dystocia), perinatal complications (macrosomia, neonatal hypoglycemia, and birth weight) and also in better glycemic control. The use of nutritional therapy should be highlighted within the antenatal care for pregnant women with GDM, giving the satisfactory results on metabolic control and on pregnancy outcomes. Studies examining the CCM to GDM patients should be conducted to show its effects on maternal and child health.

Influence of the dietary intake of medium chain triglycerides on body composition, energy expenditure and satiety: a systematic review

Increased prevalence of obesity is associated with the growth of chronic degenerative diseases. One of the main factors associated with this increase is the change in nutritional status of individuals. Medium chain triglycerides (MCT) are rapidly metabolized and less stored in the adipose tissue, being a possible tool for weight control. In order to analyze the influence of consumption of this lipid on satiety, body composition and energy expenditure (EE), a literature review was performed of controlled clinical studies reported in PUBMED and ELSEVIER between the years 2000 and 2010. Fourteen articles were selected presenting short and long-term intervention. Among these, six showed a decrease in body mass of individuals, with consequent loss of weight. Only one showed a positive effect on satiation and four showed an increase in EE. Thus the results are inconclusive and there is a need for further controlled studies with standardized amounts of MCT, so that its use can become an alternative for obesity nutritional treatment.

ω-3 polyunsaturated fatty acid supplementation does not influence body composition, insulin resistance, and lipemia in women with type 2 diabetes and obesity

To evaluate the influence of ω-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation on body composition, insulin resistance, and lipemia of women with type 2 diabetes, the authors evaluated 41 women (60.64 ± 7.82 years) with high blood pressure and diabetes mellitus in a randomized and single-blind longitudinal intervention study. The women were divided into 3 groups: GA (2.5 g/d fish oil), GB (1.5 g/d fish oil), and GC (control). The capsules with the supplement contained 21.9% of eicosapentaenoic acid and 14.1% of docosapentaenoic acid. Biochemical (glucose, glycated hemoglobin, total and fractional cholesterol, triglycerides, and insulin) and anthropometric (body mass, stature, waist circumference [WC], and body composition) evaluations were performed before and after the 30 days of intervention. Homeostasis model assessment-insulin resistance and the Quantitative Insulin Sensitivity Check Index were used to evaluate the insulin resistance and insulin sensitivity (IS), respectively. GB presented a greater loss of body mass and WC (P < .05), greater frequency of glycemic and total cholesterol reduction, and an increase of high-density lipoprotein cholesterol compared with GA. Thus, a high dose of ω-3 PUFA can reduce IS. A lower dose of ω-3 PUFA positively influenced body composition and lipid metabolism.

Polymorphism in the PPARgamma2 and beta2-adrenergic genes and diet lipid effects on body composition, energy expenditure and eating behavior of obese women

In order to evaluate the effect of polymorphism in the PPARgamma2 and beta2-adrenergic genes and diet lipids on body composition, energy expenditure and eating behavior of obese women, 60 subjects were submitted to anthropometric, biochemical, dietary, molecular, basal and postprandial metabolism (indirect calorimetry) and eating behavior (visual analog scale) evaluation. Fat and saturated fatty acid (SFA) high diet was used to assess postprandial metabolism. The frequency of Pro12Pro/Gln27Gln, Pro12Pro/Gln27Glu, Pro12Pro/Glu27Glu and Pro12Ala/Gln27Glu genotypes was 35.71%, 30.37%, 23.21% and 10.71%, respectively. These values were not significant (p>0.05) for the dietary, anthropometric, biochemical and metabolic parameters. The Pro12Ala/Gln27Glu group was found to present greater energy used in postprandial period (EUPP). The presence of the PPARgamma2 gene variant, independent of beta2-adrenergic gene polymorphism, resulted in fat oxidation increase. Also, this group presented higher satiety, compared to the Pro12Pro/Gln27Gln group. The presence of the variant alleles in the PPARgamma2 gene suggests benefits in food intake control.

[Effect of leptin in the treatment of obesity and influences of diet in the secretion and action of hormone]

The obesity is a multicausal disease that includes exogenous and endogenous factors. We emphasized the leptin, a hormone produced by adipose tissue, whose receiver is in the hypothalamus. The leptin has been considered important in the development of the obesity, because it influences in the energy intake and expenditure. In the revision one sets out to evaluate the leptin like factor related to the development of the obesity, as well as the influence of diet in the secretion and action of leptin. In the human obesity, the deficiency of functional leptin is rare, nevertheless, can exist leptin resistance. After the loss weight it happens reduction in the leptin levels, which can be in the recovery of body weight. The leptin is regulated by food intake and their circulating levels and potential of action are associated with content of macronutrients of the diet and the body composition individually. Nevertheless, studies demonstrated the high and the low food intake can influence in the leptin secretion, independent of the effect on adiposity. In addition, the fat of diet presents important effect in secretion and action of leptin. Also the zinc deficiency has been associated with the reduced levels of leptin. Several experimental studies have been made to evaluate the effect of the administration of leptin in treatment of obesity, by means of injections, inhalation or more active forms of leptin. Nevertheless, we need similar studies with humans. Is important the development of studies that associate the environmental factors, particularly the diet, with regulation of serum levels and action of leptin in humans.

[Effect of diet and PPARgamma2 and beta2-adrenergic receptor genes on energy metabolism and body composition in obese women]

OBJECTIVE

To evaluate the effect of diet and PPARgamma2 and beta2-adrenergic receptor genes on energy metabolism and body composition in obese women.

MATERIAL AND METHODS

60 obese women, aged 34.59 +/- 7.56 years were studied at the Department of Physiology and Nutrition at Navarra University. Anthropometric, biochemical, metabolic and molecular evaluations were carried out, and the women were submitted to short-term and long-term hypocaloric diets, varying the macronutrients. The groups were formed according to gene polymorphism, as follows: Pro12Pro(PPARgamma2)/Gln27Gln (beta2-adrenergic receptor genes) - A, Pro12Pro (PPARgamma2)/Gln27Glu (beta2-adrenergic receptor genes) - B, Pro12Pro (PPARgamma2)/ Glu27Glu (beta2-adrenergic receptor genes)-C and Pro1Ala (PPARgamma2)/Gln27Glu beta2-adrenergic receptor genes) - D.

RESULTS

In group A, fat oxidation was correlated positively with body mass index (BMI), but an increase in fat and saturated fatty acids (SFA) in the diet did not reflect in increased oxidation. In group B, total fat and SFA intake did not lead to fat oxidation increase. In group C, fat and complex carbohydrates (CHO) resulted in lower fat oxidation, and long-term increase of monounsaturated fatty acid (MUFA) intake resulted in increase of CHO oxidation and smaller weight loss. In group D, greater energy expenditure was obtained after diet high in SFA in a short-term, and fat basal and postprandial oxidation correlated positively with its intake. Hypocaloric diet high in polyunsaturated fatty acid (PUFA) resulted in increase of fat oxidation.

CONCLUSIONS

Polymorphism in PPARgamma2 gene resulted in increased fat oxidation, regardless of genotype of beta2-adrenergic receptor gene. It is recommended control of the total intake of fats and SFA in Pro12Pro/Gln27Gln and Pro12Pro/Gln27Glu, and complex CHO and MUFA in Pro12Pro/Glu27Glu. In Pro12Ala/Gln27Glu, AGPI intake can result in greater body weight loss.