Lúcia Dantas Leite

Positive effects of zinc supplementation on growth, GH, IGF1, and IGFBP3 in eutrophic children.

Abstract Zinc is an essential micronutrient for growth and development. Its deficiency causes growth retardation in children and adolescents. The present study analyzes the effect of zinc on growth hormone (GH) secretion, insulin-like growth factor 1 (IGF1), and insulin-like growth factor-binding protein 3 (IGFBP3) in normal children before puberty. Thirty normal children were studied, 15 boys and 15 girls, aged 6–9 years. They were orally supplemented with 5 mg Zn/day for 3 months and 0.06537 mg Zn/kg body weight was injected before and after oral supplementation. Dietary intake and anthropometric measurements were assessed at baseline and end of study. Plasma GH levels increased during intravenous zinc administration and IGF1 and IGFBP3 increased after oral zinc supplementation. There was a positive correlation between the areas under the curves of GH and zinc after oral supplementation. Zinc supplementation was possibly effective in improving the body zinc status of the children, secretory levels of IGF1 and IGFBP3, GH potentialization, and height.

Sensitivity of zinc kinetics and nutritional assessment of children submitted to venous zinc tolerance test.

Objective: The purposes of this study were to investigate the kinetics of zinc in schoolchildren between the ages of 6 and 9 years, of both sexes, and to verify its sensitivity in detecting alterations in body zinc status. Methods: Nutritional assessment was performed by body mass index. Food intake, venous zinc tolerance test, and zinc kinetics were carried out before and after 3-month oral zinc supplementation. Results: Of the 42 children studied, 76.2% had healthy weight. Only energy, calcium, and fiber intake were suboptimal before and after oral zinc supplementation. Serum zinc and total-body zinc clearance, although at normal levels, increased significantly after zinc supplementation. Conclusion: We concluded, therefore, that kinetics is a sensitive tool for detecting changes in body zinc status, even in children without a deficiency of this mineral. Furthermore, kinetics showed a positive response to supplementation and may be a sensitive parameter for evaluating the efficacy of this therapy.

Effect of Diet Intervention and Oral Zinc Supplementation on Metabolic Control in Berardinelli-Seip Syndrome

Background/Aims: Berardinelli-Seip syndrome (BSS), also termed congenital generalized lipodystrophy or congenital generalized lipoatropic diabetes, is a rare autosomal recessive disease characterized by the nearly complete absence of metabolically active adipose tissue from birth, extreme insulin resistance, diabetes mellitus, and hepatomegaly. The aim of this study was to evaluate the effect of diet intervention and oral zinc supplementation on the metabolic control of BSS patients. Methods: During a 3-month period, 10 BSS patients received individualized diets and oral zinc supplementation. Food intake, clinical laboratory parameters, serum zinc and leptin, and plasma C-peptide concentrations were evaluated at the beginning of the study and after 3 months. Results: At the beginning of the study, all patients had elevated energy, protein, total fat, carbohydrate, calcium, iron, and zinc intakes. After 3 months, all of these parameters had decreased. Total fiber intakes remained low before and after diet intervention and oral zinc supplementation, and plasma levels of fasting glucose remained high. In contrast, glycated hemoglobin decreased significantly. Plasma leptin, C-peptide, and serum zinc levels increased during venous zinc tolerance testing, but there were no significant differences between the 2 curves obtained before and after diet intervention and oral zinc supplementation. Conclusions: Diet intervention and oral zinc supplementation were effective at controlling energy consumption, macronutrients, and glycated hemoglobin. Zinc likely acts as an adjunct therapy, thereby improving the effectiveness of leptin.

Zinc pharmacokinetic parameters in the determination of body zinc status in children

Background/Objectives:Serum or tissue zinc concentrations are often used to assess body zinc status. However, all of these methods are relatively inaccurate. Thus, we investigated three different kinetic methods for the determination of zinc clearance to establish which of these could detect small changes in the body zinc status of children.Subjects/Methods:Forty apparently healthy children were studied. Renal handling of zinc was investigated during intravenous zinc administration (0.06537 mg Zn/kg of body weight), both before and after oral zinc supplementation (5 mg Zn/day for 3 months). Three kinetic methods were used to determine zinc clearance: CZn-Formula A and CZn-Formula B were both used to calculate systemic clearance; the first is a general formula and the second is used for the specific analysis of a single-compartment model; CZn-Formula C is widely used in medical practices to analyze kinetic routine.Results:Basal serum zinc values, which were within the reference range for healthy children, increased significantly after oral zinc supplementation. The three formulas used gave different results for zinc clearance both before and after oral zinc supplementation. CZn-Formula B showed a positive correlation with basal serum zinc concentration after oral supplementation (R2=0.1172, P=0.0306). In addition, CZn-Formula B (P=0.0002) was more effective than CZn-Formula A (P=0.6028) and CZn-Formula C (P=0.0732) in detecting small variations in body zinc status.Conclusions:All three of the formulas used are suitable for studying zinc kinetics; however, CZn-Formula B is particularly effective at detecting small changes in body zinc status in healthy children.

Kinetics of zinc status and zinc deficiency in Berardinelli-Seip syndrome.

Berardinelli-Seip syndrome (BSS) is a very rare disorder characterized by near-complete absence of adipose tissue from birth or early infancy, hypoleptinemia, hypertriglyceridemia, insulin resistance, diabetes mellitus, and other clinical signals. It is caused by mutations in AGPAT2 or Gng3lg. We evaluated 10 BSS patients and 10 healthy subjects. A single dose of 382.43 μmol zinc was administered intravenously before and after 3 months of oral zinc supplementation. Blood samples were collected from the contralateral arm at 0, 30, 60, 90, and 120 min after zinc injection. Plasma and serum were obtained to measure hematological and biochemical parameters. Urine was collected to measure creatinine, protein, and zinc. Basal serum zinc levels were similar in controls and BSS patients. However, serum zinc profiles were significant reduced in BSS patients in comparison with controls. The change in total-body zinc clearance was more significant in BSS patients, indicating that these patients had suboptimum zinc deficiency.

Influence of basal energy expenditure and body composition on bone mineral density in postmenopausal women

Background The aim of this study was to investigate the influence of body mass index, body weight, lean mass, fat mass, and basal energy expenditure on bone mineral density in postmenopausal women. Methods This was a cross-sectional, descriptive study of a sample of 50 women, with minimum time since menopause between 1 and 10 years. Bone mineral density was assessed at the lumbar spine (L2–L4), femoral neck, Ward’s triangle, and trochanter using dual-energy X-ray absorptiometry. Body mass index, lean mass, fat mass, and basal energy expenditure were measured by bioimpedance. Results The mean age of the women was 51.49 ± 3.86 years and time since menopause was 3.50 ± 2.59 years. Significant negative correlations were found between chronological age and lumbar spine, femoral neck, Ward’s triangle, and trochanteric bone mineral density. In regard to time since menopause, we also observed significant negative correlations with bone mineral density at the lumbar spine and Ward’s triangle. The following significant positive correlations were recorded: body mass index with bone mineral density at the femoral neck and trochanter; fat mass with bone mineral density at the femoral neck and trochanter; lean mass with bone mineral density at the lumbar spine, femoral neck, and trochanter; and basal energy expenditure with bone mineral density at all sites assessed. On the other hand, the multiple linear regression model showed that: 20.2% of bone mineral density variability at the lumbar spine is related to lean mass and time since menopause; 22.3% of bone mineral density variability at the femoral neck is related to body weight and age; 18.9% of bone mineral density variability at Ward’s triangle is related to age and basal energy expenditure; and 39% of bone mineral density variability at the trochanter is related to body mass index, age, and menarche. Conclusion Changes in bone mineral density, specific for each skeletal site, are influenced by age, time since menopause, body weight, body mass index, lean mass, and basal energy expenditure. Lean mass and basal energy expenditure positively influenced bone mineral density at the lumbar spine and Ward’s triangle, with a predominance of trabecular bone.

Aplicação de instrumentos de triagem nutricional em hospital geral: um estudo comparativo

Introducao: Com inumeros instrumentos de triagem nutricional existentes, e dificil eleger o mais adequado para os protocolos de nutricao hospitalar. Objetivo: Comparar cinco instrumentos de triagem nutricional (MST, NRS-2002, MUST, MNA e MNA-SF) em adultos e idosos hospitalizados. Materiais e Metodos: Nesse estudo transversal, cinco instrumentos de triagem nutricional foram aplicados aos pacientes nas primeiras 48 horas de internacao hospitalar. A ocorrencia de risco nutricional entre adultos e idosos foi comparada. Para analise estatistica, os dados foram descritos e o teste nao parametrico de Man Whitney foi aplicado. Resultados: Foram avaliados 77 pacientes, sendo 51 (66,2%) adultos e 26 (33,8%) idosos, com media de idade de 53,6 (desvio padrao de 17,9) anos e predominância do genero feminino (53,2%). Os principais motivos de internacao foram neoplasia e nefrolitotripsia. De forma geral, um quarto dos pacientes estava em risco nutricional. O risco nutricional em pacientes adultos foi mais detectado pelo MUST e MST, com resultados semelhantes. Porem, esse parâmetro foi pouco detectado pelo NRS-2002. Nos idosos, o MNA e MNA-SF foram os instrumentos que mais detectaram risco nutricional. Quanto ao tempo medio gasto para a aplicacao dos instrumentos, observou-se certa concordância entre eles, todavia a MNA foi o instrumento que requereu maior tempo para aplicacao. Conclusao: Considerando maior deteccao de pacientes em risco nutricional, melhor praticidade e menor tempo, sugere-se o MUST e a MNA-SF para serem utilizados em pacientes adultos e idosos, respectivamente, admitidos no referido hospital.

PROTOCOLO DIFERENCIADO PARA TERAPIA NUTRICIONAL NA ESCLEROSE LATERAL AMIOTRÓFICA

Objective: To discuss the nutritional therapy in Amyotrophic Lateral Sclerosis (ALS), sharing a protocol performed and used by a specialized ambulatory care service. Material and Methods: The theoretical foundation of this paper was based on the literature published in both PubMed and ISI Web of Science, using “amyrotrophic lateral sclerosis” and “nutrition” as key-words. Results and Discussion: In brief, ALS is a rare neurodegenerative disease with poor prognosis and palliative treatment. Malnutrition is very common in these patients and increases the risk of death among them. Nutritional therapy is essential and must be integrated into a multidisciplinary care. Nutritional monitoring is recommended at least once every three months. Nutritional assessment, high-calorie and high-protein diet with an adequate amount of water and fiber are recommended. In addition, micronutrients, especially antioxidants, must reach the Recommended Dietary Allowances. A diet texture modification for dysphagia is indicated and enteral nutrition should be demystified to patients and care givers during the follow-up care. ALS patients are potential candidates to use enteral nutrition, which should be indicated in cases of significant dysphagia or impaired respiratory function associated with low food intake, body mass index less than 18.5 or 22.0 kg/m² (for adults or elderlies, respectively), and/or body weight loss above 10%. Conclusion: We suggest the standardization of nutritional therapy in ALS and the establishment of a distinct protocol in clinical practice. Thus, malnutrition can be avoided or minimized, contributing to a better quality of life and survival of these patients. DESCRIPTORS: Amyotrophic Lateral Sclerosis. Nutrition Therapy. Recommended Dietary Allowances.

Uso de simbiótico no tratamento de pacientes obstipados com esclerose lateral amiotrófica

Introduction: The use of synbiotic in the management of constipation seems to be promising, particularly in patients with amyotrophic lateral sclerosis (ALS) which have constipation as a frequent symptom. Objective: To evaluate the effect of synbiotic supplementation on intestinal function of constipated patients with ALS. Materials and Methods: This interventional study was performed with ALS patients followed at the ALS multidisciplinary ambulatory of Hospital Universitario Onofre Lopes (HUOL) at the Federal University of Rio Grande do Norte (UFRN). Subjects were arranged in three groups: 10 healthy controls (group 1), 10 ALS constipated patients (group 2), and 10 ALS non-constipated patients (group 3). All subjects received synbiotic supplementation (6g/day) during 15 days and their intestinal function was monitored daily. Results: We studied 30 subjects (13 male and 17 female) with mean age 54.3 ± 10.6 years. Group 1 didn’t show major modifications in the parameters observed. Nevertheless, groups 2 and 3 improved the intestinal function, with increased frequency of bowel movements, improved stool consistency and less evacuation effort. These benefits were observed after one-week of synbiotic supplementation. Conclusion: Regular use of synbiotic can improve intestinal function in both constipated and non-constipated ALS patients.