Nassib Bezerra Bueno

Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials

The role of very-low-carbohydrate ketogenic diets (VLCKD) in the long-term management of obesity is not well established. The present meta-analysis aimed to investigate whether individuals assigned to a VLCKD (i.e. a diet with no more than 50 g carbohydrates/d) achieve better long-term body weight and cardiovascular risk factor management when compared with individuals assigned to a conventional low-fat diet (LFD; i.e. a restricted-energy diet with less than 30% of energy from fat). Through August 2012, MEDLINE, CENTRAL, ScienceDirect,Scopus, LILACS, SciELO, ClinicalTrials.gov and grey literature databases were searched, using no date or language restrictions, for randomised controlled trials that assigned adults to a VLCKD or a LFD, with 12 months or more of follow-up. The primary outcome was bodyweight. The secondary outcomes were TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), systolic and diastolic blood pressure,glucose, insulin, HbA1c and C-reactive protein levels. A total of thirteen studies met the inclusion/exclusion criteria. In the overall analysis,five outcomes revealed significant results. Individuals assigned to a VLCKD showed decreased body weight (weighted mean difference -0·91 (95% CI -1·65, -0·17) kg, 1415 patients), TAG (weighted mean difference -0·18 (95% CI -0·27, -0·08) mmol/l, 1258 patients)and diastolic blood pressure (weighted mean difference -1·43 (95% CI -2·49, -0·37) mmHg, 1298 patients) while increased HDL-C(weighted mean difference 0·09 (95% CI 0·06, 0·12) mmol/l, 1257 patients) and LDL-C (weighted mean difference 0·12 (95% CI 0·04,0·2) mmol/l, 1255 patients). Individuals assigned to a VLCKD achieve a greater weight loss than those assigned to a LFD in the longterm; hence, a VLCKD may be an alternative tool against obesity.

Curcumin or combined curcuminoids are effective in lowering the fasting blood glucose concentrations of individuals with dysglycemia: Systematic review and meta-analysis of randomized controlled trials

&NA; Curcuminoids have received considerable attention as therapeutical adjuvants in the treatment of dysglycemia. The purpose of this meta‐analysis was to evaluate whether the supplementation of turmeric extract, curcuminoids and/or isolated curcumin is more effective than placebo in decreasing fasting blood glucose (FBG) in adults. MEDLINE, CENTRAL, ScienceDirect and gray literature databases were searched. Randomized controlled trials with the following criteria were included: (1) studied individuals older than 18 years, supplemented with curcumin, curcuminoids and/or turmeric extract (2) had a follow‐up ≥4 weeks (3) used a placebo group. Titles and abstracts were screened and potentially eligible articles were retrieved. The primary outcome was FBG. The secondary outcomes were HbA1c and HOMA‐IR. Eleven studies were included. In the overall analysis, turmeric, curcuminoids and curcumin supplementation led to a decrease in FBG (−8.88, 95% CI: [−5.04 to −2.72] mg/dL, p = 0.005). Supplementation of curcuminoids and/or curcumin decreased the concentrations of HbA1c (−0.54, 95% CI: [−1.09 to −0.002] %, p = 0.049) but were not able to decrease HOMA‐IR (−1.26, 95% CI: [−3.71 to −1.19], p = 0.31). Sensitivity analyses revealed that baseline FBG was an important covariate. Heterogeneity was high in the overall analyses and there was evidence of publication bias. Supplementation of isolated curcumin or combined curcuminoids were both effective in lowering the FBG concentrations of individuals with some degree of dysglycemia, but not in non‐diabetic individuals. Isolated curcumin lead to significant decreases of the HbA1c compared to placebo. Graphical abstract Figure. No caption available.

Energy Intake in Socially Vulnerable Women Living in Brazil: Assessment of the Accuracy of Two Methods of Dietary Intake Recording Using Doubly Labeled Water

BACKGROUND Diet is related to the prevention of chronic diseases, but assessing dietary intake is a complex task, especially in socially vulnerable populations. OBJECTIVES To assess the accuracy of the 24-hour food recall (24HFR) and the food frequency questionnaire (FFQ) methods in socially vulnerable women in Brazil and compare these methods against doubly labeled water (DLW). DESIGN Cross-sectional study. Energy intake (EI) was measured using 3 24HFRs and 1 FFQ. Total energy expenditure (TEE) was measured using DLW. Cutoff points were calculated to assess underreporting and overreporting using both the difference and the ratio between the EI and TEE. PARTICIPANTS/SETTING Sixty-seven socially vulnerable, nondieting adult women with stable body weight and mothers of malnourished children. MAIN OUTCOME MEASURES EI, in kilocalories, derived from 24HFR and FFQ. STATISTICAL ANALYSES Repeated measures analysis of variance was used to compare EI and TEE and Bland-Altman graphs were plotted to assess the agreement between these variables. Spearman correlation coefficient between the ratio of EI to TEE and socioeconomic or anthropometric variables was calculated. RESULTS Mean TEE was 2,186 kcal (95% CI 2,063 to 2,309 kcal). EI obtained through 24HFR (mean=1,848.6 kcal [95% CI 1,737.5 to 1,959.7 kcal]) was significantly lower than TEE (P=0.01), and significantly lower than the EI obtained through FFQ (mean=2,084.5 [95% CI 1,929.0 to 2,240.0 kcal]; P<0.01). There were no statistically significant differences between the EI values of FFQ and TEE (P=0.89). The distribution of underreporters, nonunderreporters, and overreporters were more homogenous in the FFQ method. There was a positive correlation between body fat percentage and underreporting in the FFQ method (r=0.245; P=0.046). CONCLUSIONS The methods of assessing dietary intake in our study showed poor agreement with TEE obtained by DLW. These may, therefore, not be the most suitable methods for assessing EI in this population.

LA INGESTA DE LA DIETA ESTÁNDAR AIN-93 INDUCE ESTEATOSIS HEPÁTICA CON ALTERADO PERFIL DE ÁCIDOS GRASOS EN RATONES WISTAR

BACKGROUND There are several standard diets for animals used in scientific research, usually conceived by scientific institutions. The AIN-93 diet is widely used, but there are some reports of fatty liver in Wistar rats fed this diet. OBJECTIVE We aimed to evaluate the hepatic repercussions of the AIN-93 diet intake in Wistar rats. METHODS Forty newly-weaned 21-day-old male Wistar rats were fed either the AIN-93 diet or a commercial diet for either 1 month or 4 months. Weight gain, serum biochemistry, hepatic histology, and hepatic fatty acid profile were analyzed. RESULTS Hepatic steatosis was observed, especially in the group fed the AIN-93 diet. Serum blood glucose, absolute and relative liver weight and hepatic levels of oleic, palmitoleic, stearic, and palmitic fatty acids were related to the observed steatosis, while lipidogram and serum markers of liver function and injury were not. CONCLUSION AIN-93 diet induced acute hepatic steatosis in Wistar rats, which may compromise its use as a standard diet for experimental studies with rodents. The hepatic fatty acid profile was associated with steatosis, with possible implications for disease prognosis.

Hepatic fatty acid profile of rats with AIN-93 diet-induced steatosis attenuated by the partial substitution of soybean oil by diheptanoin and triheptanoin

Nassib Bezerra BuenoLaboratorio de Nutricao Experimental, Faculdade de Nutricao, Universidade Federal de Alagoas, UFAL, Campus A. C. Simoes, Cidade Universitaria, BR 104 Norte, Km 97 57.072-970 – Tabuleiro dos Martins, Maceio, Brasil nassibbb@hotmail.comRecebido em 12/Fev/2010Aceito em 25/Maio/2010

Higher central fat and poor self-body image in short-stature overweight/obese women living in Brazilian shantytowns

Background Short stature in adult life, a possible consequence of poor perinatal conditions, is associated with higher risk of mortality and social disabilities. We aimed to determine whether low-income, overweight/obese, short-stature (SS) women show alterations in body composition, self-body-image perception, and biochemical profile compared to their non-short (NS) counterparts. Methods A cross-sectional study was conducted with women living in shantytowns and mother or relatives to undernourished children treated in a center for recuperation and nutritional education. Inclusion criteria were: (1) age, 19–45 years; (2) stature < 152.3 cm or > 158.7 cm; and (3) body mass index > 25 kg/m2. Socioeconomic, anthropometric, biochemical, and body image data were collected. We analyzed 56 SS and 57 NS women. Results The SS group showed a higher waist-to-height ratio (WHtR) (mean: 0.63; standard deviation: 0.06 for SS and mean: 0.60; standard deviation: 0.07 for the NS group; p = 0.02), and, in the adjusted analysis, showed lower fat-free mass (Estimated Marginal Mean for the SS group: 45.7 kg 95% confidence intervals (CI) (45.2–46.2) and for the NS group: 46.9 kg 95% CI (46.4–47.4); p < 0.01) and higher fat mass (Estimated Marginal Mean for the SS group: 32.5 95% CI (31.9–33.0) and for the NS group: 31.4 kg 95% CI (30.9–31.9); p < 0.01). Body mass index was a better predictor of current self-body-image perception for NS women. The SS coefficient values were β = 0.141, SE = 0.059, and R2-Nagelkerke = 0.107, and the NS coefficients values were β = 0.307, SE = 0.058, and R2-Nagelkerke = 0.491 (Z = 2.006; p < 0.05). Considering the obese subgroup, six out of 32 (18.8%) SS women and 14 out of 33 (42.4%) NS women perceived themselves as obese (χ2 = 4.27; p = 0.03). This difference remained significant even after adjustment by age, schooling, and number of children (p = 0.04). Only the total thyroxin showed significant differences between groups, lower in SS women (p = 0.04). Discussion Overweight/obese, low-income SS women have more central adiposity and impaired self-body image perception, and the body mass index is a weaker predictor of it, compared to NS women. Misperception about body size may be linked with an overestimation of health and underestimation of risk, which may lead to a lower utilization of the health care system and inadequate physician counseling. These features may account, at least partially, for the higher mortality risk seen in SS adults.

Hepatic fatty acid profile of rats fed a triheptanoin-based ketogenic diet

OBJECTIVE the aim of this study was to evaluate the influence of consumption of a ketogenic diet supplemented with triheptanoin, a medium-chain anaplerotic triacylglycerol, on the liver fatty acid profile of Wistar rats. METHODS three groups of male Wistar rats (n = 10) were submitted to an AIN-93 control diet, a triheptanoin- based ketogenic diet, or a soybean oil-based ketogenic diet for 60 days. Excised livers were subjected to lipid extraction and methylation to obtain fatty acids methyl esters, which were subjected to gas chromatography- mass spectrometry. RESULTS AND DISCUSSION compared to the rats fed the control diet, those fed ketogenic diets showed a significant reduction in the concentrations of 9-hexadecenoic and 9-octadecenoic acids, whereas those fed triheptanoin showed increased levels of octadecanoic acid. CONCLUSION changes in the liver fatty acid profiles of the rats fed a triheptanoin-based or a soybean oil-based ketogenic diet did not seem to be related to the dietary fat source, but rather to the characteristics of the ketogenic diets themselves.

Effectiveness of a stunting recovery program for children treated in a specialized center

BackgroundStunting is still very prevalent in many poor and developing regions in the world. This study assessed the effectiveness of a stunting recovery program in children and its associated factors.MethodsThe retrospective study was conducted in a center of stunting recovery. There, children stayed in a day-hospital system (9 h per day; 5 days per week), and received five meals per day, providing 80% of their energetic daily needs. The main outcome was the stunting recovery rate (i.e., the child present a height-for-age index (HAZ) >−1.0 at the time of data collection). A total of 75 children treated for at least 24 months, aged between 6 and 48 months and with an HAZ <−2.0 at the time of admission were included.ResultsThe average treatment time was 41 months. About 18 children (24.0%) recovered from stunting. The variable “age at admission >24 months” (prevalence rate (PR)=0.39, 95% confidence interval (CI): 0.15–0.99; P=0.04) and the variable “Household crowding index” (PR=0.65, 95% CI: 0.44–0.95; P=0.03) were associated with the success of the treatment.ConclusionThe environmental conditions in which the children live in their households and late admission to the center negatively influenced the success of stunting recovery, even with an intensive treatment.

Ketogenic Diet Based on Extra Virgin Coconut Oil Has No Effects in Young Wistar Rats With Pilocarpine-Induced Epilepsy

This study evaluated the effects of a ketogenic diet (KD) based on extra virgin coconut oil (Cocos nucifera L., VCO), on the treatment of epileptic rats. Two sets of experiments were conducted. First, male Wistar rats underwent induction of status epilepticus (SE) with the administration of pilocarpine intraperitoneally 21 animals reached spontaneous recurrent seizures (SRS) and were randomly allocated to the dietary regimens and video-monitored for 19 days. In the second experiment, 24 animals were randomized immediately after the induction of SE and followed for 67 days. Diets were as follows: Control (AIN-93G; 7% lipid), KetoTAGsoya (KD based on soybean oil; 69.79% lipid), and KetoTAGcoco (KD based on VCO; 69.79% lipid). There were no differences in the latency to the first crisis, total frequency, and duration of the SRS between groups in 2 experiments. The data suggest no effects of KD, with or without VCO, in rats with pilocarpine-induced epilepsy.

Effects of iron supplementation versus dietary iron on the nutritional iron status: Systematic review with meta-analysis of randomized controlled trials

ABSTRACT This meta-analysis compared the effects of dietary intervention versus iron supplementation on biochemical parameters related to the iron nutritional status in humans. The PubMed, CENTRAL, LILACS, SCIELO, OPENGREY.EU and ClinicalTrials.gov databases were searched for randomized clinical trials that assigned individuals to a dietary intervention or to an iron supplementation regimen, for 12 weeks or more. The primary outcome was the hemoglobin concentration, and secondary outcomes were ferritin, RDW, mean corpuscular volume, soluble transferrin receptor, total iron binding capacity, serum iron, and transferrin saturation. From the 6095 records identified, twelve studies were included, six with children, five with adolescents/adults, and one with pregnant women. In the subgroup of studies that included anemic/iron deficient children, supplementation significantly increased the hemoglobin concentration (weighted mean difference (WMD): 3.19 g/L [95% CI: 1.31, 5.07]) and induced a significantly greater reduction of the soluble transferrin receptor (WMD: −0.46 mg/L [95% CI: −0.70, −0, 21]), when compared to dietary intervention. It also induced a greater reduction of the total binding capacity of iron in adolescents/adults (WMD: −6.96 μmol/L [95% CI: −12.70, −1.21]). Supplementation showed a better effect on hemoglobin recovery in anemic/iron deficient children, while no differences were observed between supplementation and dietary intervention in treating adolescents/adults.