RESUMO
Intermittent fasting (IF) has gained increasing scientific and general attention. Most studied forms of IF include alternate-day fasting, modified alternate-day fasting, and time-restricted eating (TRE). Several cardiometabolic effects of IF have been described in animal models and, to a lesser extent, in humans. This review analyzes the impact of IF on weight loss, glucose metabolism, blood pressure, and lipid profile in humans. A literature search was conducted in the Pubmed/Medline, Scopus, and Google Scholar databases. Controlled observational or interventional studies in humans, published between January 2000 and June 2021, were included. Studies comparing IF versus religious fasting were not included. Most studies indicate that the different types of IF have significant benefits on body composition, inducing weight loss and reducing fat mass. Changes in cardiometabolic parameters show more divergent results. In general, a decrease in fasting glucose and insulin levels is observed, together with an improved lipid profile associated with cardiovascular risk. High heterogeneity in study designs was observed, particularly in studies with TRE, small sample sizes, and short-term interventions. Current evidence shows that IF confers a range of cardiometabolic benefits in humans. Weight loss, improvement of glucose homeostasis and lipid profile, are observed in the three types of IF protocols evaluated.
Assuntos
Doenças Cardiovasculares , Jejum Intermitente , Humanos , Doenças Cardiovasculares/prevenção & controle , Jejum/fisiologia , Glucose/metabolismo , Lipídeos , Redução de PesoRESUMO
Intermittent fasting (IF) has gained increasing scientific and general attention. Most studied forms of IF include alternate-day fasting, modified alternate-day fasting, and time-restricted eating (TRE). Several cardiometabolic effects of IF have been described in animal models and, to a lesser extent, in humans. This review analyzes the impact of IF on weight loss, glucose metabolism, blood pressure, and lipid profile in humans. A literature search was conducted in the Pubmed/Medline, Scopus, and Google Scholar databases. Controlled observational or interventional studies in humans, published between January 2000 and June 2021, were included. Studies comparing IF versus religious fasting were not included. Most studies indicate that the different types of IF have significant benefits on body composition, inducing weight loss and reducing fat mass. Changes in cardiometabolic parameters show more divergent results. In general, a decrease in fasting glucose and insulin levels is observed, together with an improved lipid profile associated with cardiovascular risk. High heterogeneity in study designs was observed, particularly in studies with TRE, small sample sizes, and short-term interventions. Current evidence shows that IF confers a range of cardiometabolic benefits in humans. Weight loss, improvement of glucose homeostasis and lipid profile, are observed in the three types of IF protocols evaluated.
Assuntos
Humanos , Animais , Doenças Cardiovasculares/prevenção & controle , Jejum Intermitente , Redução de Peso , Jejum/fisiologia , Glucose/metabolismo , LipídeosRESUMO
Introducción: La población chilena, al igual que la mundial, ha presentado un importante envejecimiento en los últimos 25 años. El cáncer gástrico ocupa la primera causa de mortalidad por tumores malignos en Chile. Objetivo: Determinar la mortalidad operatoria de la gastrectomía total o subtotal en pacientes con cáncer gástrico de 80 o más años y la sobrevida a 5 años. Material y método: Estudio retrospectivo y prospectivo de todos los pacientes sometidos a resección gástrica por cáncer gástrico entre 1988 y 2016, con 80 o más años. Se excluyeron los pacientes sometidos a técnicas quirúrgicas no resectivas. Se analizaron las siguientes variables: síntomas y signos, comorbilidades, características anatomopatológicas, mortalidad según el tipo de gastrectomía y sobrevida global a 5 años. Resultados: En el periodo de tiempo analizado hubo 70 pacientes con cáncer gástrico y edad igual o mayor de 80 años, que representan al 7,4% del total de pacientes con resección gástrica. Los síntomas más frecuentes fueron dolor, baja de peso y anemia crónica microcítica. Hubo un 66% de pacientes con comorbilidades. El cáncer se ubicó preferentemente en el tercio superior, siendo un adenocarcinoma en 66 pacientes. En 4 pacientes hubo 2 linfomas, un GIST maligno y un carcinoide maligno. El carcinoma incipiente correspondió al 12% de los adenocarcinomas. La mortalidad global de la gastrectomía fue del 17%, siendo el 5% para la subtotal y el 22% para la total. La sobrevida promedio a 5 años fue del 26%. Conclusiones: La gastrectomía subtotal o total en pacientes con cáncer gástrico sobre 80 años es factible de realizar en pacientes seleccionados, pero el riesgo de mortalidad operatoria es de 7 a 10 veces mayor que en pacientes bajo los 75 años.
Introduction: The longevity of Chilean population has increased greatly in the last 25 years, similar to world population. Gastric cancer in Chile is the first cause of death due to malignant tumors. Purpose: To determine operative mortality of subtotal or total gastrectomy in patients with gastric cancer older than 80 years, and the rate 5 year-survival. Material and method: This is an retrospective-prospective study of all patients with 80 years of age or more submitted to gastric resection due to gastric cancer between 1988 and 2016. Patients submitted to non-resective procedures were excluded. The following parameters were analized: symptoms and signs, comorbidities, pathologic features of the gastric cancer, operative mortality according to the gastrectomy and 5-year survival rate. Results: There were 70 patients with gastric cancer older than 80 years of age, which represented 7.4% of all patients with gastric cancer submitted to gastric resection in the same period of time. Most frequent symptoms were epigastric pain, loss of weight and chronic microcitic anemia. There were 66% of the patients with comorbidities. The tumor was located mainly in the upper third of the stomach, being an adenocarcinoma in 66 patients (94%). There were also 2 linfomas, one GIST and one patient with a malignant carcinoid. Early cancer was observed in 12% of the adenocarcinomas. Global operative mortality was 17% being 5% for subtotal and 22% for total gastrectomy. Mean 5-year survival rate was 26%. Conclusions: Subtotal or total gastrectomy in patients with gastric cancer with 80 years of age or more is possible to perform in selected patients, but the risk of operative mortality is 7 to 10 times greater than below 75 years of age.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Neoplasias Gástricas/cirurgia , Gastrectomia/mortalidade , Neoplasias Gástricas/mortalidade , Análise de Sobrevida , Estudos Prospectivos , Estudos Retrospectivos , Seguimentos , Fatores Etários , Gastrectomia/métodosRESUMO
BACKGROUND: The mechanism leading to the development of metabolic complications in obese individuals is not fully understood. Thus, the objective of this study was to examine differences in insulin resistance, inflammation, cytokine and adipokine levels, and expression of selected genes across obese individuals with different number of metabolic syndrome (MetS) components. METHODS: Forty obese individuals who underwent bariatric surgery, divided in three groups based on the number of components of MetS, in addition to abdominal obesity (0, 1, and 2-3 additional components), were studied. Levels of inflammatory proteins, insulin resistance, cytokines, adipokines, and gene expression in subcutaneous (SAT) and visceral adipose tissue (VAT) were compared. RESULTS: There was a significantly higher expression of MYD88 in SAT among those with more components of MetS (P = 0.008). In SAT, but not in VAT, MYD88 expression was significantly correlated with toll-like receptor 4 expression (r = 0.7, P < 0.05). Expression of adipsin in SAT was also associated with the presence of more components of MetS, but with borderline statistical significance (P = 0.05). There were no significant differences in insulin resistance, inflammation, and cytokine and adipokine levels by the number of components of MetS. CONCLUSIONS: Our study suggests that MYD88 expression in SAT of obese subjects could be associated with the development of components of MetS.
Assuntos
Tecido Adiposo/metabolismo , Síndrome Metabólica/genética , Fator 88 de Diferenciação Mieloide/genética , Obesidade Abdominal/genética , Tecido Adiposo/patologia , Adulto , Feminino , Expressão Gênica , Predisposição Genética para Doença , Humanos , Gordura Intra-Abdominal/metabolismo , Gordura Intra-Abdominal/patologia , Masculino , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Fator 88 de Diferenciação Mieloide/metabolismo , Obesidade Abdominal/metabolismo , Obesidade Abdominal/patologia , Fatores de Risco , Gordura Subcutânea/metabolismo , Gordura Subcutânea/patologiaRESUMO
OBJECTIVES: Weight regain after bariatric surgery may be associated with behavioral, metabolic, or mechanical factors alone or in combination. The aim of this study was to investigate which factors are related to weight regain in the long-term after sleeve gastrectomy (SG). METHODS: A retrospective case-control study with 40 patients undergoing SG (32 women, 8 men; age 42.9 ± 10.7 y; preoperative body mass index 35 ± 2.8 kg/m(2)), was performed. Patients were grouped according percentile->50% (cases) or <50% (controls)-of weight regain (%WR cutoff: 25% of weight loss). Weight history, anthropometry, glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), thyroid-stimulating hormone, resting energy expenditure, body composition, dietary survey, psychological test, and physical activity were recorded. Residual gastric capacity was estimated using a radiologic method. RESULTS (MEDIAN [P25-P75]): The evaluation was conducted 38.5 mo (34-41 mo) after SG. Percent weight regain ranged from 2.7% to 129.2% (25.4% [13-37.1]). Patients in the higher %WR group had a greater residual gastric volume (252.7 ± 108.4 versus 148.5 ± 25.3; P < 0.05) and the estimated volume was significantly correlated with %WR (r = 0.673; P = 0.023). Significantly higher body mass index (P = 0.001), resting energy expenditure (P = 0.04), fasting insulin (P = 0.01), and HOMA-IR (P = 0.02) were observed in the higher %WR group. A higher fat intake and a trend toward higher total energy intake were observed in the group with greater %WR. Clinical or borderline levels of anxiety were more frequently observed in the higher %WR group (70% versus 30%; P = 0.01). CONCLUSIONS: Results from the present study demonstrated that the most important factor associated with long-term weight regain after SG was residual gastric volume. Additional prospective studies with larger numbers of patients are necessary to confirm our results.
Assuntos
Gastrectomia , Aumento de Peso , Adiposidade , Adulto , Glicemia/metabolismo , Composição Corporal , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Ingestão de Energia , Metabolismo Energético , Feminino , Humanos , Insulina/sangue , Resistência à Insulina , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Atividade Motora , Obesidade/cirurgia , Cuidados Pós-Operatórios , Estudos Retrospectivos , Tireotropina/sangueRESUMO
Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: (1) Gallbladder cancer and cholangiocarcinoma--are they the same disease?; (2) Palliative chemotherapy: indications, drugs and schedules; (3) Palliative radiotherapy; (4) Palliative Surgery; (5) Management of malignant biliary obstruction.
Assuntos
Colangiocarcinoma/tratamento farmacológico , Neoplasias da Vesícula Biliar/tratamento farmacológico , Cuidados Paliativos , Neoplasias da Vesícula Biliar/secundário , Humanos , América Latina , Sociedades MédicasRESUMO
BACKGROUND: Bariatric surgery is increasingly being performed and sleeve gastrectomy (SG) has proved to be effective and safe. Among its complications, leaks are the most serious and life threatening. METHODS: The focus of the study is nine patients who underwent a SG and developed a gastric leak after surgery. Our data were obtained from the clinical charts of the patients and through interviews with the surgeon who performed the index surgery. RESULTS: Eight patients underwent SG at outside institutions while one was operated at Clinica Alemana. Three patients developed symptoms within 5 days after surgery, while the rest were diagnosed after 10 days from the surgery. A CT scan was the method used to confirm the diagnosis in all patients. The three patients who had a leak detected during the immediate postoperative period underwent laparoscopic reoperation. Among the rest of the patients, percutaneous drainage was employed in one patient as the primary procedure while the other underwent surgical drainage. An esophageal endoluminal stent was employed in four patients. The leak closed in all patients with the healing time ranging from 21 to 240 days. CONCLUSIONS: Diagnosis of a leak after a SG required a greater index of suspicion in order to perform an early diagnosis. Sepsis control and nutritional support are the cornerstones of this treatment. Evolution is characterized by longer periods of time that are necessary in order to wait until the leak closes. Management must be tailored to each patient.
Assuntos
Fístula Anastomótica/terapia , Gastrectomia , Obesidade Mórbida/cirurgia , Adulto , Fístula Anastomótica/diagnóstico por imagem , Fístula Anastomótica/cirurgia , Drenagem/instrumentação , Drenagem/métodos , Nutrição Enteral , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Stents , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: 1.- Gallbladder Cancer and Cholangiocarcinoma -are they the same disease?; 2. - Palliative Chemotherapy: Indications, Drugs and Schedules; 3. - Palliative Radiotherapy; 4.- Palliative Surgery; 5.-Management of Malignant Biliary Obstruction.
Assuntos
Humanos , Colangiocarcinoma/tratamento farmacológico , Neoplasias da Vesícula Biliar/tratamento farmacológico , Cuidados Paliativos , Neoplasias da Vesícula Biliar/secundário , América Latina , Sociedades MédicasRESUMO
BACKGROUND: The different bariatric surgery techniques that alter the digestive anatomy also modify the gastric absorption surface. Since alcohol is a substance that is mainly metabolized in the stomach, the goal of this study was to determine alcohol absorption before and after a laparoscopic sleeve gastrectomy (LSG) in the same patients. METHODS: Studies were carried out on 12 morbidly obese patients who underwent a LSG (eight men and four women). Each patient was given 3.6 ml of red wine to drink at 14% for each liter of body water mass. Alcotest values (Alcoscan Alcomate AL-6000) were measured 10 min after the wine dose had been consumed. Measurements were then repeated every 5 min until the alcohol had been completely eliminated from the bloodstream. During the postoperatory period (median of 2.3 months), the measurement was repeated with the total dose per kg adjusted to the new water body mass. The results were measured with a nonparametric analysis for repeated samples. RESULTS: The maximum average peak of the Alcotest was 2.02 g/l during the postoperative period compared to 0.87 g/l during the preoperative period (p = 0.001 Wilcoxon). At 175 min, the blood alcohol level value reaches zero (0) in all pre-operatory patients, while after surgery, an average value of 0.26 g/l was observed (p = 0.027 Wilcoxon). After 4 h, an Alcotest average of 0.20 g/l was observed in these patients. CONCLUSION: Alcohol absorption was considerably modified after LSG with higher and longer blood alcohol values for equivalent amounts of alcohol.
Assuntos
Consumo de Bebidas Alcoólicas/metabolismo , Gastrectomia/efeitos adversos , Obesidade Mórbida/metabolismo , Adulto , Etanol/sangue , Etanol/farmacocinética , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Fatores de Tempo , Resultado do Tratamento , VinhoRESUMO
BACKGROUND: The aim of this study was to evaluate the role that laparoscopy plays in the management of gallbladder cancer. METHOD: From August 2005 to March 2009, 23 patients affected by gallbladder cancer detected after the study of a cholecystectomy specimen underwent laparoscopy as part of their management. RESULTS: Among the patients, 5 underwent only an exploratory laparoscopy, while 11 were converted due to the existence of dense adhesions that precluded a complete exploration. Of the patients with adhesions who underwent conversion, three were unresectable. The remainder underwent a lymphadenectomy and liver resection after conversion. Of the seven who underwent a complete laparoscopic exploration, five had a lymphadenectomy and liver resection done completely by laparoscopy while conversion was needed for two. Conversion was required due to lymphatic metastasis at the hepatic pedicle and the presence of a bile leak. Postoperative time was uneventful, with patients discharged within 3 days of the operation. CONCLUSIONS: Laparoscopy may be employed in the management of patients with early forms of gallbladder cancer undergoing reoperation. Although the presence of adhesions may result in inadequate exploration, there is a subset of patients for whom it is possible to perform a complete exam. Furthermore, laparoscopic lymphadenectomy and gallbladder bed resection is a promising technique in well-selected patients.