Laura Mihalache

Effects of ghrelin in energy balance and body weight homeostasis.

Ghrelin is a gut peptide composed of 28 amino acids mostly secreted in the gastric fundus mucosa. It was isolated and described in 1999 by Kojima et al. and only three years later its specific receptor, GHSR1a, was also identified. Ghrelin, the endogenous ligand for the GH secretagogue receptor, is the only peripheral orexigenic hormone that activates the receptors to be found especially in the appetite center (hypothalamus and pituitary gland). Ghrelin is present in human plasma in two forms: an inactive form known as deacylated ghrelin, and an active form called acylated ghrelin synthesized under the action of ghrelin O-acyltransferase enzyme (GOAT). The literature even mentions an extremely complex ghrelin/GOAT/GHSR system involved in the regulation of human energy, metabolism and adaptation of energy homeostasis to environmental changes. In humans, there is a preprandial rise and a postprandial fall in plasma ghrelin levels, which strongly suggest that the peptide plays a physiological role in meal initiation and may be employed in determining the amount and quality of ingested food. Besides the stimulation of food intake, ghrelin determines a decrease in energy expenditure and promotes the storage of fatty acids in adipocytes. Thus, in the human body ghrelin induces a positive energy balance, an increased adiposity gain, as well as an increase in caloric storage, seen as an adaptive mechanism to caloric restriction conditions. In the current world context, when we are witnessing an increasing availability of food and a reduction of energy expenditure to a minimum level, these mechanisms have become pathogenic. As a consequence, the hypothesis that ghrelin is involved in the current obesity epidemic has been embraced by many scholars and researchers

The pathogenesis of non-alcoholic fatty liver disease is closely related to the metabolic syndrome components

Abstract Non-alcoholic fatty liver disease (NAFLD) is closely associated with all features of the metabolic syndrome (MS). This strongly supports the notion that NAFLD may be the hepatic manifestation of the MS. NAFLD is currently the most common cause of abnormal liver function tests and affects approximatively 15-25% of the general population. NAFLD covers a spectrum of liver disease, from steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Insulin resistance (IR) has central etiologic roles in the development of MS and NAFLD, usually related to obesity. MS is frequently associated with chronic inflammation, having as principal mediators the adipocytokines and free fatty acids (FFA), but also CRP, TNF-a and IL-6. Chronic inflammation results in more IR and lipolysis of adipose tissue triglyceride stores, in enhanced hepatic glucose and VLDL production. The steatotic liver is thought to be vulnerable to secondary injuries including adipocytokines, mitochondrial dysfunctions, oxidative stress which lead to hepatocellular inflammation and fibrosis.

Assessment of preoperative and postoperative prealbumin in thoracic surgery – a two months experience in a Romanian university hospital / Evaluarea preoperatorie şi postoperatorie a prealbuminei în chirurgia toracică - experiența de 2 luni a unui spital universitar din România

Abstract Malnutrition is a frequent and serious finding in surgical departments. Although its consequences include postoperative complications and higher costs, nutritional assessment is not part of the routine preoperative protocols. Nutritional assessment involves clinical and biological parameters and is vital in order to start treatment and improve outcome. Prealbumin is currently recognized as a faithful marker of malnutrition being introduced in practice guidelines. One of the most important aspects about prealbumin is the fact that its variations in time are more valuable than the absolute values. The aim of this study was to assess and compare the perioperative nutritional evolution of patients requiring thoracic surgery, with and without cancer, using prealbumin - preoperative and postoperative - as main marker. Thirty six patients from the Thoracic Surgery Department were assessed prior to surgery by body mass index, Subjective Global Assessment nutrition risk score and routine biochemical parameters. Prealbumin was assessed prior to surgery and 3 days after surgery. The age, length of postoperative stay and the presence was complications was noted. Patients with cancer (n=19) were significantly older than patients without cancer (p=0.007) and were more frequently, but not significantly, evaluated as malnourished through SGA (42.1% compared to 11.6%). Preoperative prealbumin and other parameters did not differ significantly between groups. However, there was a significant postoperative decrease in prealbumin only in patients with cancer. Therefore, prealbumin has been found to be valuable in assessing acute malnutrition in cancer patients, especially if variations are monitored in time, which could be useful in planning nutritional treatment Rezumat Malnutriția este o constatare frecventă și importantă în secțiile chirurgicale. Deşi consecințele sale includ complicații postoperatorii și costuri mai mari, evaluarea nutrițională nu face parte din protocoalele preoperatorii de rutină. Evaluarea nutriţională include parametri clinici și biologici și este vitală pentru a începe tratamentul și a îmbunătăți rezultatele. Prealbumina este în prezent recunoscută ca un marker fidel al malnutriției şi este inclusă în ghidurile de practică. Unul dintre cele mai importante aspecte legate de prealbumină este faptul că variațiile sale în timp sunt mai valoroase decât valorile absolute. Scopul acestui studiu a fost de a evalua și compara evoluția nutrițională perioperatorie a pacienţilor care necesită intervenţii de chirurgie toracică, cu şi fără cancer, folosind prealbumina - preoperator și postoperator - ca marker principal. Treizeci şi şase de pacienţi de la Clinica de Chirurgie Toracică au fost evaluaţi înainte de intervenţia chirurgicală, prin indicele de masă corporală, scorul de risc nutriţional Subjective Global Assessment (SGA) și parametri biochimici de rutină. Prealbumina a fost evaluată înainte de intervenţia chirurgicală şi la 3 zile după operaţie.Vârstă, durata spitalizării postoperatorii și prezența complicaţiilor au fost notate. Pacienții cu cancer (n = 19) au fost semnificativ mai în vârstă decât pacienții fără cancer (p = 0,007) și au fost mai frecvent, dar nu în mod semnificativ, evaluaţi prin SGA ca fiind malnutriţi (42,1% față de 11,6%). Prealbumina preoperator și alți parametri nu diferă semnificativ între grupuri. Cu toate acestea, a existat o scădere semnificativă a prealbuminei postoperator doar la pacienții cu cancer. Prin urmare, prealbumina s-a dovedit a fi valoroasă în evaluarea malnutriţiei acute la pacienţii cu cancer, în special prin monitorizarea variaţiilor în timp, ceea ce ar putea fi util în planificarea tratamentului nutriţional.

Assessing Intake of Water and Sugar-Sweetened Beverages in Adolescents: its Relationship with Weight Status

Abstract Background and aims. The aim of the study is to evaluate fluid intake during adolescence and correlate it with weight status. Material and methods. We assessed fluid intake using a validated questionnaire in a group of 106 adolescent students (22 boys - 20.8%), aged 15-19 years. Weight status was evaluated with the BMI-for-age values,using growth normograms. Results. There were no statistically significant differences in the frequency of water intake between sexes (p>0.05). Water intake at least 3 times a day was declared by 72.16% of normal weight students and in 66% of overweight and obese, the difference being statistically significant (p=0.003). Boys consumed larger amounts of water (p=0.042) than girls. Intake of 100% natural fruit juice was significantly higher in boys compared to girls (p=0.002). A significantly higher percentage of normal weight adolescents consumed≤500 mL/day non-carbonated (p=0.004) and carbonated (p<0.001) sugar-sweetened beverages compared to the overweight or obese, who consumed ≥500 mL/day. Conclusions. The quantitative and qualitative assessment of fluid intake among adolescents is a mandatory step in the assessment of calorie and nutritional intake. Promoting low-calorie fluid intake in this age group, along with the principles of healthy eating, could contribute to achieving an optimal weight status.

Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural Population

Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural Population Objective. To evaluate which anthropometric parameter better predicts the high risk of obstructive sleep apnea syndrome (OSA) in a rural population. Material and Method. 254 subjects were enrolled. We measured weight, height, waist circumference (WC) and neck circumference (NC) and calculated body mass index (BMI), waist-to-height ratio (WHtR) and neck circumference/height ratio (NC/Height). The risk of OSA was assessed by using Berlin Questionnaire. Results. Subjects with high risk of OSA had a significant higher BMI, WC, WHtR, NC, and NC/Height. A higher percentage of those with large WC (≥80cm and ≥94cm for women and men, respectively) (p<0.001), WHtR ≥0.5 (p<0.001), NC ≥40cm (p=0.004), NC/Height ratio ≥0.23 (p=0.002) had a high risk of OSA. Using ROC curves of anthropometric parameters studied we found that WHtR was the best predictor for high risk of OSA, with AUC of 0.760, 95% CI: 0.699 to 0.815. Conclusions. WHtR was the best predictor for high risk of OSA as assessed by the Berlin Questionnaire.