BackgroundType 2 diabetes mellitus (DM) globally affects 18–20 % of adults over the age of 65 years. Diabetic kidney disease (DKD) is one of the most frequent and dangerous complications of DM2, affecting about one-third of the patients with DM2. In addition to the pancreas, adipocytes, liver, and intestines, the kidneys also play an important role in glycemic control, particularly due to renal contribution to gluconeogenesis and tubular reabsorption of glucose.MethodsIn this review article, based on a report of discussions from an interdisciplinary group of experts in the areas of endocrinology, diabetology and nephrology, we detail the relationship between diabetes and kidney disease, addressing the care in the diagnosis, the difficulties in achieving glycemic control and possible treatments that can be applied according to the different degrees of impairment.DiscussionGlucose homeostasis is extremely altered in patients with DKD, who are exposed to a high risk of both hyperglycemia and hypoglycemia. Both high and low glycemic levels are associated with increased morbidity and shortened survival in this group of patients. Factors that are associated with an increased risk of hypoglycemia in DKD patients include decreased renal gluconeogenesis, deranged metabolic pathways (including altered metabolism of medications) and decreased insulin clearance. On the other hand, decrease glucose filtration and excretion, and inflammation-induce insulin resistance are predisposing factors to hyperglycemic episodes.ConclusionAppropriate glycaemic monitoring and control tailored for diabetic patients is required to avoid hypoglycaemia and other glycaemic disarrays in patients with DM2 and kidney disease. Understanding the renal physiology and pathophysiology of DKD has become essential to all specialties treating diabetic patients. Disseminating this knowledge and detailing the evidence will be important to initiate breakthrough research and to encourage proper treatment of this group of patients.
Childhood obesity is a major public health problem. It has a direct impact on the quality of life of children and adolescents, as well as on their future risk of developing chronic diseases. Dietary patterns rich in fats and sugars and lacking dietary fibers, vitamins, and minerals, as well as lack of physical exercise have been associated with the rise of obesity prevalence. However, factors that contribute to the preference for foods rich in these nutrients are not well established. Taste is recognized as an important predictor of food choices, and polymorphisms in taste-related genes may explain the variability of taste preference and food intake. The aim of this research is to evaluate the influence of polymorphisms of the sweet taste receptor gene TAS1R2 on diet and metabolic profile in obese children and adolescents. A cross-sectional study with 513 obese children and adolescents and 135 normal-weight children was carried out. A molecular study was performed for the single nucleotide polymorphisms (SNPs) rs9701796 and rs35874116 of TAS1R2, and dietary intake, anthropometric parameters (weight, height, waist circumference, waist-to-height ratio (WHtR)), and metabolic profile (including fasting glucose, insulin, triglyceride, high-density lipoprotein (HDL)–cholesterol, and leptin levels) were analyzed. The variant rs9701796 was associated with increased waist-height ratio, as well as with a higher chocolate powder intake in obese children. The variant rs35874116 was associated with a lower dietary fiber intake. In conclusion, there was no relationship between genotypes and risk of obesity. Obese adolescents carrying the serine allele of SNP rs9701796 in TAS1R2 showed higher waist-to-height ratio and chocolate powder intake, whereas those carrying the valine allele of SNP rs35874116 in TAS1R2 were characterized by lower dietary fiber intake.
Background/Aims: Taste is recognized as an important predictor of food choices. Thus, polymorphisms in genes encoding taste receptors may explain the variability in food preference and intake. Here, we aimed to determine whether genetic variation in the CD36 gene affects food intake and risk of obesity. Methods: A cross-sectional study was conducted with obese Brazilian children and adolescents (n = 466; BMI-for-age z-score [zBMI] 3.29 ± 0.61) and normal-weight children (n = 114; zBMI -0.11 ± 0.7). To assess the obesity risk according to genotypes, a logistic regression adjusted for age and gender was performed. Two 24-h food recalls assessed total energy (kcal/day) and macronutrient (% kcal and g/day) intake, consumption of sweet and fatty tasting foods (portion and g/day), as well as the most commonly consumed foods (mL or g/day). The food portion sizes were measured according to Brazilian guidelines. The genetic variant rs1761667 (A/G) in CD36 was genotyped by real-time PCR. Results: We found no relationship between rs1761667 genotypes and obesity risk. A significant genetic association between CD36 genotype and fat intake was observed for the A allele of rs1761667, which was associated with a decreased intake of total fat (g/day) (p = 0.01), polyunsaturated and monounsaturated fatty acids (% kcal and g/day), total sugars (g/day) (p = 0.01), fatty foods (portion and g/day) (p < 0.001 for both), and vegetable oils (mL/day) (p = 0.02) only in obese subjects. No differences were found between normal-weight children. Conclusion: The A allele of the rs1761667 single nucleotide polymorphism in CD36 is associated with decreased fat and sugar intake in obese children and adolescents.
We identified low energy and high protein intake in this population. Protein intake was inversely related to eGFR. Dietary patterns were associated with age, gender, schooling level, hypertension and diabetes.
Avaliar o consumo de energia, proteína, fósforo e potássio de pacientes com doença renal crônica em hemodiálise. Materiais e Métodos: Foi realizado um estudo transversal com 34 pacientes em hemodiálise. Foi aplicado, por meio de entrevista, um questionário para a identificação das características clínico-demográficas dos pacientes. O método utilizado para a avaliação do consumo alimentar foi o registro alimentar de 3 dias. Os níveis séricos de fósforo e potássio e o valor do Kt/V foram obtidos por meio de consulta ao prontuário dos pacientes. Resultados: O consumo médio de energia, proteína, fósforo e potássio correspondeu a 19,0 kcal/kg, 0,9 g/kg, 612,5 mg e 1400,2 mg, respectivamente, sendo inferior às recomendações estabelecidas. A diferença na ingestão foi observada apenas pela variável sexo (p<0,05). Não houve correlação estatisticamente significativa entre a inadequação da diálise e o baixo consumo de nutrientes e entre o consumo de fósforo e potássio e seus níveis séricos. Conclusão: O consumo alimentar dos pacientes apresentou-se inadequado, ressaltando a necessidade de realização de medidas de educação nutricional para que a ingestão dos mesmos se adeque às recomendações e as comorbidades decorrentes do consumo inadequado sejam evitadas.
Coronary artery calcification (CAC) is a widespread condition in chronic kidney disease (CKD). Diet may play an important role in CAC, but this role is not clear. This study evaluated the association between macro-and micronutrient intakes and CAC in non-dialysis CKD patients. We analyzed the baseline data from 454 participants of the PROGREDIR study. Dietary intake was evaluated by a food frequency questionnaire. CAC was measured by computed tomography. After exclusion of participants with a coronary stent, 373 people remained for the analyses. The highest tertile of CAC was directly associated with the intake of phosphorus, calcium and magnesium. There was a higher intake of pantothenic acid and potassium in the second tertile. After adjustments for confounding variables, the intake of pantothenic acid, phosphorus, calcium and potassium remained associated with CAC in the generalized linear mixed models. In order to handle the collinearity between these nutrients, we used the LASSO (least absolute shrinkage and selection operator) regression to evaluate the nutrients associated with CAC variability. In this approach, the nutrients that most explained the variance of CAC were phosphorus, calcium and potassium. Prospective studies are needed to confirm these findings and assess the role of interventions regarding these micronutrients on CAC prevention and progression.
Resumo As pandemias de desnutrição e obesidade, em conjunto com as mudanças climáticas, constituem uma sindemia global e apresentam um importante ponto de convergência, que é a insustentabilidade dos sistemas alimentares atuais. O objetivo deste artigo é discutir o papel de políticas públicas de saúde, particularmente do Sistema Único de Saúde (SUS) no âmbito da Atenção Primária à Saúde, no combate à sindemia global e no desenvolvimento de sistemas alimentares sustentáveis. Nesse contexto, a Política Nacional de Alimentação e Nutrição se destaca como uma importante ferramenta intersetorial para a alimentação adequada e saudável e à segurança alimentar e nutricional. Além disso, o Guia Alimentar se apresenta como um instrumento estratégico de apoio às ações de educação alimentar e nutricional. De modo essencial, destaca-se a necessidade de articulação das políticas de saúde, agricultura e meio ambiente para que o desenvolvimento sustentável possa ser efetivado. Assim, o SUS tem capacidade de ser palco das principais discussões sobre essa temática, atuando como um potencializador de ações individuais, coletivas e institucionais para promover um sistema alimentar mais justo, saudável e sustentável.
RESUMOIntrodução: A composição corporal e a alimentação de nadadores têm influência direta em seu desempenho esportivo. Objetivo: Avaliar a composição corporal e o consumo alimentar de nadadores adolescentes. Métodos: Estudo transversal realizado com 15 nadadores adolescentes, de ambos os sexos, de um clube de São Paulo, Brasil. Aplicou-se um questionário de identificação e houve aferição de peso, estatura, circunferências corporais e dobras cutâneas. Para a avaliação do consumo alimentar foi aplicado um recordatório de 24 horas. Resultados: A maioria dos atletas apresentou percentual de gordura corporal adequado. Houve ingestão de suplementos alimentares por todos os nadadores. Observou-se elevado consumo de proteínas e baixa ingestão de carboidratos. As maiores prevalências de inadequação de micronutrientes foram para vitamina B 9 , iodo e cálcio. Conclusão: Os resultados sugerem a necessidade de intervenção nutricional nesse grupo de atletas. Palavras
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