DSpace Collection:http://hdl.handle.net/1843/12102024-03-28T11:53:37Z2024-03-28T11:53:37ZEffect of beta-hydroxy-beta-methylbutyrate (HMB) supplementation with nutritional counselling in patients on the waiting list for liver transplantation.http://hdl.handle.net/1843/621522023-12-26T11:54:46Z2023-03-21T00:00:00ZTitle: Effect of beta-hydroxy-beta-methylbutyrate (HMB) supplementation with nutritional counselling in patients on the waiting list for liver transplantation.
Abstract: Objetivo: O objetivo primário deste estudo foi avaliar os efeitos da suplementação de betahidroxi-beta-metilbutirato (HMB) com intervenção nutricional por 12 semanas na massa muscular, força, funcionalidade e qualidade de vida em pacientes na lista de espera para o transplante hepático (TxH). O objetivo secundário foi avaliar a ingestão alimentar durante 12 semanas de intervenção nutricional e avaliar os fatores independentemente associados à diferença entre ingestão calórica e proteica (final-início) em pacientes em lista de espera para transplante hepático. Métodos: Estudo duplo-mascarado, randomizado e prospectivo com suplementação de 3,0g de HMB ou controle (3,0g de maltodextrina) por 12 semanas em pacientes com idade superior a 18 anos em lista de espera para o TxH. Os participantes foram avaliados em cinco momentos: Avaliação inicial; Semana 0 (T0), início da intervenção; Semana 4 (T4); Semana 8 (T8) e após 12 semanas (T12). Todos os pacientes receberam intervenção nutricional de acordo com as diretrizes para doença hepática crônica avançada. Dados sociodemográficos, clínicos e de estilo de vida foram coletados. A composição corporal e os dados antropométricos [resistência, reatância, ângulo de fase, peso, índice de massa corporal (IMC), circunferência do braço (CB), área muscular do braço e espessura do músculo adutor do polegar] foram coletados. A força muscular foi avaliada por meio da dinamometria e a função muscular pelo índice de fragilidade (IF). A qualidade de vida foi avaliada. Recomendações dietéticas para pacientes com cirrose foram usadas para prescrever o plano alimentar (35kcal/kg; 1,5g/kg de peso seco de proteína; outros nutrientes de acordo com Dietary Recommendation Allowances - DRIs; lanche noturno) e avaliar as metas nutricionais (30kcal/ kg; 1,2g/kg de peso seco de proteína). A ingestão alimentar foi avaliada e quantificada por meio do recordatório de 24 horas e registro alimentar de 3 dias em seis momentos: Baseline, Semana 0 (S0), Semana 2 (S2), Semana 4 (S4), Semana 8 (S8) e Semana 12 (S12). Os dados foram avaliados no SPSS 22.0. As diferenças entre semanas e suplementos foram realizadas usando o teste de Equação de Estimativa Generalizada (GEE). O consumo dietético foi avaliado ao longo das semanas por meio do teste t pareado ou teste de Wilcoxon. Modelos de regressão linear foram realizados para identificar fatores independentemente associados com a diferença entre ingestão calórica (kcal/kg) e de proteína (g/kg) na S12-Baseline. O nível de significância foi de 5%. Resultados: Quarenta e sete pacientes foram incluídos [HMB: 23; controle ativo: 24]. Houve diferença significativa em ambos os grupos para CB (p=0,03), dinamometria (p=0,02) e IF (p=0,01). Houve aumento da dinamometria entre T0 e T12 em ambos os grupos [HMB (Δdinamometria: 10,1±16,4%; p<0,05); controle ativo (Δdinamometria: 23,0±70,3%; p<0,05)]. A CB aumentou em ambos os grupos entre T0 e T4 [HMB (ΔCB: 0,9±2,8%; p<0,05); controle ativo (ΔCB: 1,6±3,6%; p<0,05)] e entre T0 e T12 [HMB (ΔCB: 3,2±6,7%; p<0,05); controle ativo (ΔCB: 2,1±6,6%; p<0,05)]. O IF diminuiu em ambos os grupos, entre T0 e T4 [HMB (ΔIF: -4,2±6,9%; p<0,05); controle ativo (ΔIF: -3,2±9,6%; p<0,05)] e entre T0 e T12 [HMB (ΔIF: -4,4±11,2%; p<0,05); controle ativo (ΔIF: -5,5±11,3%; p<0,05)]. As demais variáveis não se alteraram (p>0,05). Sobre a ingestão alimentar, apenas 25,5%(n=12) dos pacientes consumiram mais de 30kcal/kg, e 36,2% (n=17) mais de 1,2g/kg de proteína em 12 semanas de acompanhamento. A ingestão energética média no Baseline foi de 1782±784kcal (27,6±13,2kcal/kg), e na S12, 1695±413kcal (26,9±7,7kcal/kg; p>0,05), sem diferença entre os tempos. A média de ingestão de proteína no início do estudo foi de 70,4±38,4g [1,0 (0,2 – 3,1g/kg)] e 67,5±22,7g [1,0 (0,3 – 2,5 g/kg)] na S12. A ingestão total de proteína g/kg aumentou entre a semana S0 [63,4±29,8g; 0,8 (0,2 – 2,2g/kg)] e S8 [72,0±28,0g; 1,0 (0,4 – 2,6g/kg; p=0,026; p=0,032, respectivamente). O consumo de colesterol, cálcio, fósforo, magnésio, ferro e niacina aumentou (p<0,05) durante o acompanhamento, assim como o consumo de leguminosas, raízes e tubérculos, laticínios e grupos das carnes, aves e peixes ao longo do tempo (p<0,05). A presença de ascite, a classificação da avaliação global subjetiva, a classificação do índice de fragilidade, a pontuação do teste de desempenho físico, sintomas sistêmicos e função emocional foram associados independentemente com a diferença de ingestão calórica entre S12-Baseline (p<0,05). Diabetes mellitus, a classificação da avaliação global subjetiva, baixo desempenho, fadiga, sintomas sistêmicos e função emocional foram associados independentemente com a diferença na ingestão de proteínas entre S12-Baseline (p<0,05). Conclusão: A intervenção nutricional com suplementação com HMB ou controle ativo em pacientes em lista de espera para o transplante hepático melhorou a circunferência do braço e a dinamometria e reduziu o índice de fragilidade em ambos os grupos. Em relação à ingestão alimentar, os pacientes em lista de espera para o transplante hepático melhoraram sutilmente a ingestão alimentar durante o acompanhamento nutricional, mas apenas alguns pacientes conseguiram atingir as recomendações nutricionais das diretrizes atuais. Algumas variáveis clínicas e nutricionais influenciaram independentemente a ingestão calórica e proteica nas semanas S12-Baseline.
Type: Tese2023-03-21T00:00:00ZPlantas alimentícias não convencionais (PANC) como alternativa dietética para fenilcetonúricos.http://hdl.handle.net/1843/618732023-12-11T16:44:33Z2023-08-30T00:00:00ZTitle: Plantas alimentícias não convencionais (PANC) como alternativa dietética para fenilcetonúricos.
Abstract: Phenylketonuria is an autosomal recessive inborn error in the amino acid phenylalanine (Phe) metabolism caused by gene variants encoding phenylalanine hydroxylase. The main form of treatment is dietary Phe restriction, associated with using protein substitutes and low-protein foods such as fruits and vegetables, making the diet monotonous. Considering the incredible biodiversity of Brazil, studies that explore this potential, with the indication of new plant food options, such as Unconventional Food Plants (UFP), which may contribute to the diversification and supplementation of these patients' diets, become attractive. In this context, the objective was to select and characterize UFP with low protein content (< 5%), quantifying the Phe content. Fifteen UFP samples were selected, distributed in nine botanical families and 12 species. Of which 11 are leafy (almeirão-de-árvore, azedinha, bertalha, capiçoba, capuchinha, jambu, ora-pro-nóbis com e sem espinho, peixinho, taioba, vinagreira-roxa), one fruit (chuchu-de-vento), one flower (capuchinha), one sepal (vinagreira) and one stalk (taioba). At first, these samples were characterized by chemical composition and minerals. It was observed representative contents of the minerals potassium, calcium, magnesium, and iron, as well as contents of soluble fibers. The content of total phenolic compounds, the antioxidant capacity, and the chemical profile before and after the samples' in vitro gastrointestinal digestion process were also evaluated. The results showed relevant levels of total phenolic compounds and antioxidant capacity compared to some conventional vegetables. Regarding the chemical profile, it was possible to identify compounds from different chemical classes, emphasizing the class of flavonoids with the highest number of identified compounds. Furthermore, it was found that there was a difference in the constitution of these compounds before and after the digestion process. A chromatographic method using high-performance liquid chromatography with an ultraviolet detector (HPLC/UV) was validated in two matrices to determine the Phe content of the UFP samples. The performance parameters (linearity, selectivity, matrix effect, limit of detection and quantification, recovery, repeatability, and intermediate precision) studied in the validation indicated the method's suitability for quantification of Phe in plant matrix. Regarding the Phe content of the samples, it was observed that the leafy samples had a higher Phe content in the fruit, flower, sepal, and stem samples. The data presented in the study indicate that the UFP samples are suitable for use in the diet of patients with phenylketonuria. Thus, including these vegetables in the treatment can help with dietary diversity and nutrient intake, making them less monotonous and more palatable.
Type: Tese2023-08-30T00:00:00ZImpacto do uso de simbióticos na microbiota intestinal de pacientes com neoplasia colorretal submetidos a tratamento cirúrgico: ensaio clínico randomizado.http://hdl.handle.net/1843/595242023-10-17T13:41:11Z2023-05-29T00:00:00ZTitle: Impacto do uso de simbióticos na microbiota intestinal de pacientes com neoplasia colorretal submetidos a tratamento cirúrgico: ensaio clínico randomizado.
Abstract: Surgery is often used to treat colorectal cancer (CRC). Patients undergoing major operations, such as intestinal resections, demonstrate an increased risk for the development of intestinal dysbiosis. The administration of biotherapeutic agents, such as the symbiotic, can maintain intestinal homeostasis, modulate the immune system, and, consequently, reduce the risk of complications. Thus, the present study aimed to evaluate the impact of preoperative symbiotic supplementation on the intestinal microbiota of patients with colorectal cancer undergoing surgical treatment. Methods: This is a unicentric parallel triple masked randomized clinical trial, carried out at the Hospital das Clínicas of the Federal University of Minas Gerais. The study included patients diagnosed with CRC, candidates for tumor resection surgery, of both sexes, aged ≥ 18 years, who agreed to participate and signed the Informed Consent Form. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (CEP/UFMG), under process number CAAE 24375713.0.0000.5149 and registered in Clinical Trials under number NCT04874883. Patients were randomized to receive supplementation with symbiotic or maltodextrin (control), twice a day, for a minimum of four and a maximum of ten days. The patients allocated in the treatment group received the symbiotic Simbioflora® (commercial preparation containing 5.5g of fructooligosaccharides (FOS) added with four species of probiotic (Lactobacillus paracasei LPC-31; Lactobacillus rhamnosus HN001; Lactobacillus acidophilus NCFM; Bifidobacterium lactis HN019, at a concentration of 109 CFU per strain), while the patients in the control group received 6 grams of maltodextrin. In the pre- and postoperative periods, all patients underwent nutritional, anthropometric, food consumption, bowel function and complaints assessment. during hospitalization until discharge to investigate complications. In addition, feces were collected, before treatment (T1) and operation (T2) and, at hospital discharge (T3), to assess the intestinal microbiota and fatty acids of short chain (AGCC) During the operation, fragments of normal (TN) and tumor (TT) tissue were collected for evaluation of cytokine expression, mucus production and proliferation of the tumor marker Ki67. Statistical analyzes were performed using (Statistical Package for the Social Sciences for Windows Student) SPSS and PRISMA programs. The significance level adopted was 5%. Results: In all, 46 patients completed the study, 23 in the symbiotic group and 23 in the control group. Statistical similarity was identified between the groups, in the pre- and postoperative periods, in relation to general and clinical characteristics, as well as nutritional, anthropometric and food consumption status (p>0.05), except for protein consumption, which was higher in the symbiotic group at baseline (p<0.05). No statistical differences were identified between the two groups regarding the first evacuation, flatus elimination, digestive complaints, length of stay, postoperative complications and in-hospital mortality (p>0.05). However, the analysis of the intestinal microbiota of the feces collected in T2 showed a significant increase in the Firmicutes phylum, the Bacillaceae family and the Blautia genus after symbiotic supplementation compared to the control group (p<0.05). In addition, symbiotic supplementation contributed to the modulation of the intestinal microbiota of patients who did not have infectious complications (p<0.05). An increase in the Lachnospiraceae family and in the Faecalibacterium, Lachnospira, Clostridium, Bilophila, Slakia and Selenomomonas genera at T2 was identified in these patients (p<0.05). Greater production of butyrate in T2 and T3, and of acetate and propionate in T2, were demonstrated in the symbiotic group, compared to the control group (p<0.05). No significant differences were identified between groups in cytokine expression, TN mucus production and Ki67 expression (p>0.05). However, increased mucus production in TT was identified in the symbiotic group, compared with the control (p>0.05), as well as increased expression of Ki67 in the TN of both groups (p>0.05). Conclusion: The results of the present study demonstrated that preoperative symbiotic supplementation of patients with RCC undergoing tumor resection was able to modulate the intestinal microbiota, the production of SCFA and mucus, however, without repercussions on clinical outcomes.
Type: Tese2023-05-29T00:00:00ZResíduos de medicamentos veterinários em músculo bovino: otimização e validação de métodos analíticos qualitativos por cromatografia líquida de ultra eficiência acoplada à espectrometria de massas Q-Orbitraphttp://hdl.handle.net/1843/583602023-08-31T12:51:11Z2023-06-06T00:00:00ZTitle: Resíduos de medicamentos veterinários em músculo bovino: otimização e validação de métodos analíticos qualitativos por cromatografia líquida de ultra eficiência acoplada à espectrometria de massas Q-Orbitrap
Abstract: The presence of residues of veterinary drugs in food can compromise not only public health, but also the participation of a country in the world economy. In this context, two multiclass screening methods in bovine serum muscle tissue were optimized and validated, based on the combination of ultra-performance liquid chromatography and hybrid sequential high-resolution mass spectrometry of the quadrupole-Orbitrap type with heated electrospray ionization in positive and negative modes. In these methods, we adopted a strategy aimed at detecting a wide range of drugs regulated in Brazil, as well as prospecting those antimicrobials not yet monitored, which brings unprecedented advances to food science. Two different sample preparation were evaluated, method A: comprehensive solid-liquid extraction with 0.1% formic acid in an aqueous solution of EDTA 0.1% (w/v)/acetonitrile/methanol (1:1:1, v/v/v), with further extraction assisted by ultrasound; and method B (QueEChERS). In relation to the selectivity, regardless of the methods, the results showed satisfactory results. On the other hand, the detection capability for screening (CCβ), defined as ½ maximum residue limit, above 34% of the analytes showed a rate of false positives results of up to 5% (error β), and the QuEChERS method provided better detection in number of residues (n = 68). Thus, we emphasize that such procedures showed promising potential for application in routine analyses, providing new perspectives in the analysis of residues, in addition to subsidies for a constant direction of the scope of the analytes monitored in this matrix.
Type: Tese2023-06-06T00:00:00Z