RESUMO
Glycine is a non-essential amino acid with many functions and effects. Glycine can bind to specific receptors and transporters that are expressed in many types of cells throughout an organism to exert its effects. There have been many studies focused on the anti-inflammatory effects of glycine, including its abilities to decrease pro-inflammatory cytokines and the concentration of free fatty acids, to improve the insulin response, and to mediate other changes. However, the mechanism through which glycine acts is not clear. In this review, we emphasize that glycine exerts its anti-inflammatory effects throughout the modulation of the expression of nuclear factor kappa B (NF-κB) in many cells. Although glycine is a non-essential amino acid, we highlight how dietary glycine supplementation is important in avoiding the development of chronic inflammation.
Assuntos
Glicina , Oligoelementos , Humanos , Glicina/farmacologia , Glicina/uso terapêutico , Micronutrientes/uso terapêutico , Citocinas/metabolismo , NF-kappa B/metabolismo , Aminoácidos , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Oligoelementos/uso terapêuticoRESUMO
Sepsis is a life-threatening condition characterized by multiorgan dysfunction due to an exaggerated host response to infection associated with a homeostatic failure. In sepsis, different interventions, aimed at improving clinical outcomes, have been tested over the past decades. Among these most recent strategies, intravenous high-dose micronutrients (vitamins and/or trace elements) have been investigated. According to current knowledge, sepsis is characterized by low thiamine levels, which are associated with illness severity, hyperlactatemia, and poor clinical outcomes. However, caution is needed about the clinical interpretation of thiamine blood concentration in critically ill patients, and the inflammatory status, based on C-reactive protein levels, should always be measured. In sepsis, parenteral thiamine has been administered as monotherapy or in combination with vitamin C and corticosteroids. Nevertheless, most of those trials failed to report clinical benefits with high-dose thiamine. The purpose of this review is to summarize the biological properties of thiamine and to examine current knowledge regarding the safety and efficacy of high-dose thiamine as pharmaconutrition strategy when administering singly or in combination with other micronutrients in critically ill adult patients with sepsis or septic shock. Our examination of the most up-to-date evidence concludes that Recommended Daily Allowance supplementation is relatively safe for thiamine-deficient patients. However, current evidence does not support pharmaconutrition with high-dose thiamine as a single therapy or as combination therapy aimed at improving clinical outcomes in critically ill septic patients. The best nutrient combination still needs to be determined, based on the antioxidant micronutrient network and the multiple interactions among different vitamins and trace elements. In addition, a better understanding of the pharmacokinetic and pharmacodynamic profiles of intravenous thiamine is needed. Future well-designed and powered clinical trials are urgently warranted before any specific recommendations can be made regarding supplementation in the critical care setting.
Assuntos
Sepse , Choque Séptico , Oligoelementos , Adulto , Humanos , Tiamina/uso terapêutico , Oligoelementos/uso terapêutico , Estado Terminal/terapia , Sepse/complicações , Sepse/tratamento farmacológico , Sepse/diagnóstico , Vitaminas/uso terapêutico , Ácido Ascórbico/uso terapêutico , Micronutrientes/uso terapêuticoRESUMO
INTRODUCTION: Diabetes mellitus (DM), an important public health problem worldwide, can cause imbalances in the homeostasis of trace elements such as zinc (Zn). It is possible that an adequate nutritional status related to nutrients is essential for the normal functioning of antioxidant defense systems, and any change in the concentration of these substances could increase the chances of DM complications. OBJECTIVE: To present a review on the effect of zinc supplementation on glycemic control and oxidative stress in experimental diabetes. METHODS: This is a systematic review of articles that investigated the effects of zinc supplementation on glycemic control and oxidative stress in diabetic rats. The PICOS strategy was used for the development of the research question, and the Syrcle tool for the quality assessment of the studies included in the review. Articles available in the PubMed, Scopus, and Web of Science databases were included without restriction on year of publication. The Syrcle tool was used to assess the risk of bias of the included studies. RESULTS: Fifteen studies were included in the review, seven of which evaluated glycemic control and oxidative stress after zinc supplementation, five only oxidative stress and three only glycemic control after zinc treatment. In all the studies included, diabetes was induced by the administration of streptozotocin (STZ) at doses ranging from 40 to 100 mg/kg. Zinc supplementation was made in the diet or drinking water or by gavage or intraperitoneal injection. The most used doses were 100 mg/kg of body weight by gavage and 0.32 and 0.64 g/kg in diet. The supplementation period ranged from 14 days to 8 weeks. Six studies revealed that zinc supplementation decreased fasting blood glucose as well as insulin resistance; nine studies included in this review reported decreased MDA concentration; in five studies, there was an increase in the activity of antioxidant enzymes (GPx, SOD, GSH and catalase); and one of the studies reported a reduction in glycated hemoglobin. CONCLUSION: Zinc supplementation improved hyperglycemia and revealed a protective potential against oxidative stress associated with experimental diabetes.
Assuntos
Diabetes Mellitus Experimental , Água Potável , Oligoelementos , Animais , Antioxidantes , Glicemia , Catalase/metabolismo , Catalase/farmacologia , Catalase/uso terapêutico , Diabetes Mellitus Experimental/tratamento farmacológico , Suplementos Nutricionais , Hemoglobinas Glicadas , Controle Glicêmico , Estresse Oxidativo , Ratos , Estreptozocina/farmacologia , Estreptozocina/uso terapêutico , Superóxido Dismutase/metabolismo , Superóxido Dismutase/farmacologia , Oligoelementos/uso terapêutico , ZincoRESUMO
Malnutrition among patients with chronic liver disease (CLD) is a common complication with significant prognostic implications for patients with liver cirrhosis. Micronutrient deficiency has been associated with an increased risk of hepatic decompensation and is an independent risk factor for mortality among cirrhotic patients. Micronutrient deficiencies in patients with CLD include zinc, vitamin A, vitamin D and selenium. This review article aims to evaluate the literature to date on the complications of zinc deficiency in patients with CLD. A management algorithm for zinc replacement has also been proposed.
Assuntos
Suplementos Nutricionais , Hepatopatias/terapia , Oligoelementos/uso terapêutico , Zinco/uso terapêutico , Doença Crônica , Humanos , Hepatopatias/diagnóstico , Hepatopatias/etiologiaRESUMO
INTRODUCTION AND OBJECTIVES: Zinc deficiency has been associated with poor prognosis in chronic liver disease. This systematic review and meta-analysis aimed to evaluate the role of zinc supplementation in the management of chronic liver diseases. MATERIALS AND METHODS: We searched MEDLINE, LILACS, EMBASE, and Cochrane CENTRAL databases from inception to August 2018. We included randomized controlled trials evaluating adult patients with chronic liver disease of any etiology receiving zinc supplementation. Studies with other designs or evaluating chronic conditions other than liver disease were excluded. Two reviewers independently screened and extracted data from eligible studies. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomized studies. RESULTS: Of 1315 studies screened, 13 were included. Six assessed chronic hepatitis C treatment, with a relative risk of 0.83 indicating no protective effect of zinc supplementation on the improvement of sustained virological response. Three evaluated response to hepatic encephalopathy treatment, with a relative risk of 0.66 indicating a favorable effect of zinc supplementation on clinical improvement of this condition. Of four studies evaluating the management of cirrhosis, two analyzed the effect of zinc supplementation on serum albumin levels, with no statistical difference between zinc and placebo groups. CONCLUSIONS: Clinical trials assessing zinc supplementation in liver diseases do not show benefits in terms of clinical improvement or disease halting. There are possible benefits of zinc supplementation on hepatic encephalopathy, however, this is based on limited evidence. This research question is still open for evaluation in larger, well-designed, clinical trials.
Assuntos
Encefalopatia Hepática/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Cirrose Hepática/tratamento farmacológico , Oligoelementos/uso terapêutico , Zinco/uso terapêutico , Doença Crônica , Encefalopatia Hepática/fisiopatologia , Humanos , Cirrose Hepática/metabolismo , Hepatopatias/tratamento farmacológico , Hepatopatias/metabolismo , Hepatopatias/fisiopatologia , Albumina Sérica/metabolismo , Resposta Viral SustentadaAssuntos
Acidentes por Quedas , Disartria/etiologia , Degeneração Hepatolenticular/diagnóstico , Encéfalo/diagnóstico por imagem , Quelantes/uso terapêutico , Criança , Degeneração Hepatolenticular/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Masculino , Distúrbios da Fala/etiologia , Oligoelementos/uso terapêutico , Tremor/etiologia , Trientina/uso terapêutico , Zinco/uso terapêuticoRESUMO
Zinc (Zn) plays crucial roles in mammalian metabolism. There is increasing interest about the potential beneficial effects of Zn on the prevention or treatment of non-communicable diseases. This review critically analyzes the information related to the role of Zn on the metabolic syndrome (MetS) as well as type 2 diabetes (T2D), and summarizes the biological basis of these potential effects of Zn. There are several mechanisms by which Zn may help to prevent the development or progression of MetS and T2D, respectively. Zn is involved in both insulin secretion and action in peripheral tissues. Specifically, Zn has insulin-mimetic properties that increase the activity of the insulin signaling pathway. Zn modulates long-chain polyunsaturated fatty acids levels through its action on the absorption of essential fatty acids in the intestine and its subsequent desaturation. Zn is also involved in both the assembly of chylomicrons and lipoproteins as well as their clearance, and thus, plays a role in lipolysis regulation. Finally, Zn has been found to play a role in redox metabolism, and in turn, on blood pressure. The evidence related to the association between Zn status and occurrence of MetS is inconsistent. Although there are several studies reporting an inverse relationship between Zn status or dietary Zn intake and MetS prevalence, others found a direct relationship between Zn status and MetS prevalence. Intervention studies also provide confusing information about this issue, making it hard to reach firm conclusions. Zn as part of the treatment for patients with T2D has been shown to have positive responses in terms of glucose control outcomes, but only among those with Zn deficiency.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Síndrome Metabólica/tratamento farmacológico , Estado Nutricional , Oligoelementos/deficiência , Oligoelementos/uso terapêutico , Zinco/deficiência , Zinco/uso terapêutico , Dieta , Suplementos Nutricionais , HumanosRESUMO
OBJECTIVE: To evaluate associations between iron supplementation and iron deficiency in infancy and internalizing, externalizing, and social problems in adolescence. STUDY DESIGN: The study is a follow-up of infants as adolescents from working-class communities around Santiago, Chile who participated in a preventive trial of iron supplementation at 6 months of age. Inclusionary criteria included birth weight ≥3.0 kg, healthy singleton term birth, vaginal delivery, and a stable caregiver. Iron status was assessed at 12 and 18 months of age. At 11-17 years of age, internalizing, externalizing, and social problems were reported by 1018 adolescents with the Youth Self Report and by parents with the Child Behavior Checklist. RESULTS: Adolescents who received iron supplementation in infancy had greater self-reported attention-deficit/hyperactivity disorder but lower parent-reported conduct disorder symptoms than those who did not (Ps < .05). Iron deficiency with or without anemia at 12 or 18 months of age predicted greater adolescent behavior problems compared with iron sufficiency: more adolescent-reported anxiety and social problems, and parent-reported social, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, oppositional defiant, conduct, aggression, and rule breaking problems (Ps < .05). The threshold was iron deficiency with or without anemia for each of these outcomes. CONCLUSIONS: Iron deficiency with or without anemia in infancy was associated with increased internalizing, externalizing, and social problems in adolescence.
Assuntos
Anemia Ferropriva/prevenção & controle , Ansiedade/etiologia , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno da Conduta/etiologia , Suplementos Nutricionais , Ferro/uso terapêutico , Oligoelementos/uso terapêutico , Adolescente , Anemia Ferropriva/psicologia , Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/prevenção & controle , Criança , Transtorno da Conduta/diagnóstico , Transtorno da Conduta/prevenção & controle , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pais , Fatores de Risco , Autorrelato , Resultado do TratamentoRESUMO
BACKGROUND: Iron deficiency and iron deficiency anemia affect billions of people worldwide. Infants and young children are the most vulnerable. The Niños Primeros en Salud pediatric clinic aims to follow the American Academy of Pediatrics (AAP) recommendation to screen all children at 12 months of age, a vital period for development and the time of greatest risk. OBJECTIVES: To evaluate the clinic's performance screening for, diagnosing, and treating iron deficiency anemia; and to describe the prevalence and severity of anemia in infants and children attending a perirural clinic in the Dominican Republic. METHODS: A total of 293 charts were reviewed for hemoglobin tests performed between 9 and 15 months of age. If a hemoglobin screening was performed, then sociodemographic characteristics, medical history, and laboratory data were collected. If blood tests revealed anemia, then the presence or absence of documented anemia diagnosis as well as the presence or absence of documented provision of iron therapy were recorded. FINDINGS: Less than one-third (87, 29.7%) of patients had a documented hemoglobin test performed in this age range. Of these, 89.6% indicated anemia and nearly half (48.6%) revealed moderate anemia. One-third (34%) of hemoglobin results revealing anemia were not accompanied by a documented diagnosis. The vast majority (86.5%) of results indicated microcytosis, yet just more than half (50.8%) of anemic patients received iron therapy. CONCLUSIONS: Many children at the clinic were not screened for iron deficiency anemia during the period of highest risk. In the participants screened, iron deficiency anemia was underdiagnosed and often untreated. Anemia is a significant burden in this community-one demanding reliable screening and universal supplementation.
Assuntos
Anemia Ferropriva/diagnóstico , Deficiências de Ferro , Programas de Rastreamento/métodos , Assistência Ambulatorial , Anemia/sangue , Anemia/diagnóstico , Anemia/epidemiologia , Anemia Ferropriva/sangue , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/epidemiologia , Suplementos Nutricionais , República Dominicana/epidemiologia , Índices de Eritrócitos , Feminino , Recursos em Saúde , Hemoglobinas/metabolismo , Humanos , Lactente , Ferro/uso terapêutico , Masculino , Guias de Prática Clínica como Assunto , Prevalência , Índice de Gravidade de Doença , Oligoelementos/uso terapêuticoRESUMO
Resumen Introducción: la anemia ferropénica es un problema de salud nacional. Existen recomendaciones para su prevención. Para su diagnóstico temprano se incorporó a partir de 2014 la medición de la hemoglobina por punción digital entre los 8-12 meses de edad. Objetivo: determinar la prevalencia de anemia en lactantes usuarios de CASMU-IAMPP e identificar factores asociados. Material y métodos: se estudiaron lactantes entre 8-12 meses, a quienes se realizó medición de hemoglobina por punción digital, entre julio-diciembre 2014. Se describió la prevalencia de anemia. Se describieron las características de los niños con anemia y se compararon con las de un grupo control de niños sin anemia. Resultados: en el período evaluado se realizó hemoglobina digital a 95% de los lactantes entre 8-12 meses, 18,3% presentaba anemia. El 65,9% incorporó carne a la alimentación en forma tardía, 28,6% recibía dosis incorrecta de hierro suplementario y 23,4% no adhería al tratamiento. Los niños con anemia, en comparación con el grupo control, no presentaron mayor prevalencia de prematurez, peso al nacer menor a 3000 g, embarazo gemelar, anemia en el embarazo, suplementación con hierro en el embarazo, pecho directo exclusivo durante 6 meses, o inicio adecuado de alimentación complementaria. En los niños con anemia se detectó una falla en el inicio oportuno de la suplementación con hierro en dosis adecuada así como una mala adherencia al tratamiento. Discusión: debe alertar un 20% de niños con anemia en una población seleccionada en general con recursos económicos adecuados. Se debe insistir en la incorporación temprana de carne a la alimentación e inicio adecuado de la suplementación con hierro en dosis adecuada recomendando una buena adherencia al tratamiento.
Summary Introduction: iron deficiency anemia is a health problem in Uruguay. In 2014, hemoglobin measurement by digital puncture in infants between 8 and 12 months was introduced as a screening method for early diagnosis. Objective: to determine anemia prevalence in infants between 8 and 12 months in the institution (CASMU-IAMPP), and to identify associated factors. Method: infants between 8 and 12 months were studied with hemoglobin measurement by digital puncture from July to December of 2014. The characteristics of the children with anemia were described and compared with the control group. The data were obtained from the medical record and by means of a telephone survey. Results: 804 children were evaluated with hemoglobin measurement by digital puncture, 145 presented anemia (18.03%). The characteristics presented by children with anemia (n=143) were compared with the control group of children without anemia (n=143). There was no significant difference in the distribution by sex, prematurity prevalence, weight under 3.000 g, twin pregnancy, exclusive breastfeeding, and adequate initiation of replacement treatment. Children with anemia presented problems in the initiation of iron supplementation, doses of supplementary iron were adequate, although adherence to treatment was bad (p<0.05). Discussion: the fact that 20% of children from a socio-economic sector with adequate resources have anemia is rather alarming. Early consumption of meat and adequate initiation of iron supplementation in the right doses must be encouraged, as well as a good adherence to treatment.