Calorimetría indirecta versus Harris-Benedict para determinar gasto energético basal en pacientes ventilados

El inadecuado aporte nutricional en los pacientes con enfermedades criticas, ha llevado al desarrollo de complicaciones que incrementan la mortalidad y los costos de la atención en salud. Muchos factores están involucrados en el consumo de los nutrientes por el organismo, como: los traslados, las intervenciones quirúrgicas, el uso de vasopresores, la ventilación mecánica, entre otros. Si se presenta imprecisión en la de-terminación del gasto energético, puede conllevar a un sobre aporte alimenticio en el paciente el cual puede afectar la evolución y pronosti-co del individuo. Es de conocimiento universal que los costos en salud cada día se in-crementan, en especial cuando se presenta requerimiento del manejo de un paciente en la unidad de cuidados intensivos. Para predecir el gasto energético basal de los paciente en las UCI se cuentan con herramientas de evaluación sencillas, de fácil uso y económicas, como la ecuación de Harris-Benedict, o herramientas complejas y de difícil manejo como la Calorimetría Indirecta. El incremento en la demanda de servicios con mayor tecnología en el tratamiento de los pacientes, enfrenta al personal de salud para ser más crítico en el uso de la nueva tecnología, por tal motivo, se evaluó la presencia de correlación entre las ecuaciones de Harris-Benedict y Calorimetría Indirecta, encontrando que se presenta una buena correlación entre las ecuaciones, con un valor de Pearson de 0,700 y una p = 0.002. Por lo que se puede concluir que las ecuaciones pueden ser utilizadas para estimar el gasto energético basal de los pacientes en la UCI.

Factores asociados a calidad de vida en pacientes de hemodiálisis incidentes y prevalentes

Introducción: la insuficiencia renal crónica IRC ha aumentado su prevalencia en los últimos años pasando de 44.7 pacientes por millón en 1993 a 538.46 pacientes por millón en 2010, los pacientes quienes reciben terapia de remplazo renal hemodiálisis en Colombia cada vez tienen una mayor sobrevida. El incremento de los pacientes y el incremento de la sobrevida nos enfocan a mejorar la calidad de vida de los años de diálisis. Metodología: se comparó la calidad de vida por medio del SF-36 en 154 pacientes con IRC estadio terminal en manejo con hemodiálisis, 77 pacientes incidentes y 77 pacientes prevalentes, pertenecientes a una unidad renal en Bogotá, Colombia. Resultados: se encontró una disminución de la calidad de vida en los componentes físicos (PCS) y metales (MCS) de los pacientes de hemodiálisis en ambos grupos. En el modelo de regresión logística la incapacidad laboral (p=0.05), el uso de catéter (p= 0,000), el bajo índice de masa corporal (p=0.021), la hipoalbuminemia (p=0,033) y la anemia (p=0,001) fueron factores determinantes en un 78,9% de baja calidad de vida de PCS en los pacientes incidentes con respecto a los prevalentes. En el MCS de los pacientes incidentes vs. Prevalentes se encontró la hipoalbuminemia (p=0.007), la anemia (p=0.001) y el acceso por catéter (p=0.001) como factores determinantes en un 70.6% de bajo MCS Conclusiones: la calidad de vida de los pacientes de diálisis se encuentra afectada con mayor repercusión en el grupo de los pacientes incidentes, se debe mejorar los aspectos nutricionales, hematológicos y de acceso vascular en este grupo.

Reflections about physiotherapist professional performance in the field of physical activity

The physiotherapist professional activities, in the beginning were focused only in the clinical field, nowadays it has many different action fields including Physical Activity. Physical activity can be viewed from two dimensions: one biological, which is defined as any activity which requires energy expenditure involving the combined action of multiple systems; on the other side social, understood as a human activity concerning subjectivity conditions influenced by the environment where the individual and the community are developed. Given these dimensions as well as national and international benchmarks this paper’s objective is to present a series of reflections that the authors have done regarding the physiotherapist professional performance in the field of physical activity and the large possibilities derived from their practice in this field.

Factores socio-demográficos, laborales y factores de riesgo ergonómicos relacionados con la aparición de síntomas osteomusculares de la actividad del bicitaxismo en una localidad de la ciudad de Bogotá (2014)

Resumen Objetivo: Determinar los factores socio-demográficos, laborales y los factores de riesgo ergonómico, relacionados con la aparición de síntomas osteomusculares de la actividad del Bicitaxismo en el barrio Toberín de la Localidad de Usaquén de la Ciudad Bogotá, para recomendar estrategias de prevención. Materiales y métodos: Estudio observacional descriptivo de corte transversal en 150 personas que trabajan en el Bicitaxismo. Se realizó un muestreo simple y aleatorio. La identificación de los factores asociados con síntomas osteomusculares se hizo mediante la aplicación de la metodología Ergopar (Ergonomía Participativa para la prevención de trastornos musculoesqueléticos de origen laboral), en el grupo de personas que trabajan en el Bicitaxismo. Se estimó la proporción de personas con trastornos músculo esqueléticos en este grupo de trabajadores y se exploró asociación mediante la prueba Chi cuadrado de Pearson o prueba exacta de Fisher, usando nivel de significación del 5%, con el programa SPSS 20. Resultados: Los resultados sugirieron que en el bicitaxismo hay asociación estadísticamente significativa con los factores de edad y aparición de dolor en espalda lumbar valor p (0,009), manos/muñecas valor p (0,001), piernas con un valor p (0,022), rodillas valor p (0,001), tiempo de trabajo con la aparición de dolor en codos valor p (0,013), horas de trabajo con la aparición de molestias en codos valor p (0,000), y en piernas valor p (0,002), Días de trabajo, con la aparición de molestias en manos/muñecas valor p (0,003), dolor en piernas valor p (0), y dolor en rodillas valor p (0,014), e igualmente exigencias físicas con la aparición de molestias en manos/muñecas valor p (0,002) y dolor en piernas con un valor p (0,044) Conclusión: Se evidenció asociación entre la actividad del bicitaxismo y la aparición de síntomas osteomusculares de molestia/dolor en los diferentes segmentos musculares, tales como espalda lumbar, codos, manos/muñecas, piernas y rodillas

Caracterización del perfil nutricional de pacientes pediátricos hospitalizados en la Clínica Infantil Colsubsidio

Introducción: La desnutrición intrahospitalaria es variable en los estudios publicados. Tiene impacto en el curso tórpido de la enfermedad, en la prolongación de la estancia hospitalaria y en los altos costos subsecuentes. No existen estudios realizados en Colombia en relación al estado nutricional del paciente pediátrico hospitalizado. Por este motivo se decidió caracterizar el perfil nutricional de pacientes pediátricos hospitalizados en la Clínica Infantil Colsubsidio Materiales y métodos: Se desarrolló un estudio transversal en pacientes pediátricos hospitalizados en un periodo entre Junio 2014 – Marzo 2015. Se realizó descripción de las variables y análisis univariado. Resultados: Se analizaron 320 pacientes: 50% niños y 50% niñas. Edad promedio: 4.6 años, predominio del grupo de los lactantes. Media de estancia hospitalaria: 4,6 días. Baja ingesta, ayuno, dolor de moderada intensidad y factor de estrés grado I fueron las variables más frecuentemente relacionadas con desnutrición. Al ingreso a hospitalización el 57.5 % se encontraron eutróficos, el 17.19% con desnutrición crónica, el 8.44% con desnutrición aguda y el 16.88% con aumento anormal de peso. Al egreso, los eutróficos disminuyeron a 56.25 %, la desnutrición crónica y el aumento anormal de peso se mantuvieron igual y la desnutrición aguda aumento al 10%. Conclusión: Los hallazgos de este estudio están en concordancia con los hallazgos descritos en la literatura. El mayor compromiso nutricional se asoció a patologías respiratorias y gastrointestinales y a mayor estancia hospitalaria.

Efectos fisiológicos de la termorregulación en trabajadores expuestos a altas temperaturas en una Siderúrgica en Colombia.

La exposición a altas temperaturas en ambientes laborales conlleva a cambios fisiológicos que se manifiestan como mecanismos de compensación a la alteración del equilibrio homeostático corporal. El propósito del presente estudio fue determinar los cambios y el comportamiento de variables fisiológicas a través de frecuencia cardiaca, densidad urinaria, temperatura corporal y tasa de sudoración, en dos escenarios con condiciones térmicas ambientales diferentes definidas por la exposición (grupo expuesto y no expuesto). Adicional, en dos áreas de trabajo diferentes correspondientes al proceso de fundición del acero, una de ellas, Horno electrico donde se hace la fusión de la chatarra y demás materias primas, obteniendo así el acero liquido, el cual se vuelca en el Horno Cuchara y en este, libre ya de escoria se realiza el afino y ajuste definitivo de la composición química del acero. Objetivos: Identificar la relación de las respuestas fisiológicas a carga física y térmica, comparar las respuestas funcionales registradas en el grupo expuestos y no expuestos y contribuir a la introducción de nuevos indicadores para evaluar carga e intensidad de trabajo con fines de normalización ergonómica. Método: Investigación experimental en una muestra de 30 trabajadores evaluados en dos condiciones ambientales diferentes. La temperatura oral se registró al inicio de la jornada y con intervalos de toma de 3 horas. La frecuencia cardiaca (HR) se registró durante las 8 horas de trabajo continuas con pulsometría. Igualmente, se estimó la sudoración por pérdida de masa corporal entre el inicio y el final de la jornada laboral teniendo en cuenta ingestas y perdidas. El procesamiento estadístico se realizó con el programa SPSS v. 20.0, calculándose medidas de tendencia central y dispersión, prueba de wilconxon para las variables dependientes y correlación para identificar asociaciones. Para todos los cálculos se asumió p <0,05. Resultados: No se observaron diferencias significativas frente a la variación de la frecuencia cardiaca (media y máxima), la tasa de sudoración y la densidad urinaria. A pesar de que no hubo diferencias significativas en la variación de la temperatura corporal en horno cuchara, si se observó una diferencia significativa en el horno eléctrico Conclusión: Aunque no se encontraron diferencias estadísticamente significativas en la mayoría de las variables, es un hecho que la exposición a temperaturas elevadas extremas tiene un impacto en el comportamiento fisiológico del organismo. Futuros estudios deben considerar la posibilidad de estandarizar protocolos que permitan la exposición térmica basada en el perfil particular de cada trabajador.

Benefícios de uma intervenção com uma dieta do tipo mediterrânico e um programa de exercício físico em variáveis de composição corporal e factores de risco de doença cardiovascular

Introdução: Uma dieta do tipo mediterrânico associada a exercício físico pode ser uma estratégia eficaz na prevenção da obesidade e de co-morbilidades associadas. Objectivo: Este estudo pretendeu determinar a associação entre um programa de intervenção, constituído por uma dieta do tipo mediterrânico e exercício físico, com alterações em variáveis de composição corporal e metabólicas. Método: 12 mulheres e homens sedentários (32,5±8,74 anos, 1,69±0,11 cm), com excesso de peso (81,9±18,1 kg, 28,5±5,45 kg/m2, 36,1±8,56 % massa gorda) participaram num programa de intervenção de 12 semanas. Foi realizada avaliação da composição corporal, do dispêndio energético, da ingestão energética e de níveis séricos de lípidos em jejum. As sessões de nutrição foram realizadas semanalmente e a dieta apresentou uma distribuição de macronutrientes correspondente a 40-45% de hidratos de carbono, 15-20% de proteína e 30-35% de lípidos. As sessões de exercício foram realizadas 3 vezes por semana, com prescrição para as componentes cardiovascular e de força. Resultados: Os participantes tiveram alterações significativas nas variáveis de peso, perímetro da cintura, massa gorda, dispêndio energético e níveis séricos de colesterol e triglicéridos (p<0,05). A distribuição de macronutrientes da dieta não se alterou com a intervenção alimentar, contudo, o aumento significativo do consumo de PUFA’s revelou-se associado a menores valores de massa gorda e a maiores diferenças nos níveis de triglicéridos (p<0,05). Conclusão: O dispêndio calórico e o consumo de PUFA’s revelaram estar associados a melhorias da composição corporal (massa gorda). Este estudo também conduziu à melhoria das concentrações de colesterol e triglicéridos. No entanto, as melhorias nas concentrações de triglicéridos associaram-se apenas à dieta.

Dispositivos de iluminação natural: a sua evolução na arquitectura

Este estudo apresenta uma perspectiva da ‘janela’, como o dispositivo mais frequente de iluminação, na sua evolução e significado na arquitectura. A sua capacidade de caracterizar tendências e estilos arquitectónicos, permanece desde as primeiras referências históricas até aos elementos desenvolvidos e associados à iluminação natural dos dias de hoje. O interesse por este tema surgiu, principalmente, por ser o elemento arquitectónico que desde sempre permitiu a entrada de luz natural nas construções. Foi sempre um dos pontos de ligação e relação do interior com o exterior. Em determinadas situações tornou-se num elemento tão discreto, que nos passou despercebido, além de ter sido ocasionalmente desvalorizado. A janela ou dispositivo de iluminação natural, quando utilizado correctamente pode trazer muitos benefícios à arquitectura, assim como proporcionar conforto térmico sem necessidade de gastos energéticos excessivos.

Effect of acute administration of recombinant human leptin during the neonatal period on body temperature and endocrine profile of the piglet

Background: Leptin is produced predominantly by white adipocytes; in adults it regulates appetite and energy expenditure but its role in the neonate remains to be fully established. Objectives: To examine the effects of acute administration of recombinant human leptin on the endocrine profile and thermoregulation of neonatal pigs. Methods: 24 pairs of siblings (n = 48) were administered with either a single dose (4 mu g ml(-1) kg(-1) body weight) of leptin (L: n = 24) or a placebo (P: n = 24) on day 6 of neonatal life. Rectal temperature was recorded, and tissue samples were taken at 1 (n = 12), 2 (n = 12), 4 (n = 12) or 6 (n = 12) hours post-administration. Plasma concentrations of hormones and metabolites were determined in conjunction with messenger RNA (mRNA) for leptin and uncoupling protein-2. Results: Plasma leptin increased following leptin administration, and differences in concentrations of insulin, thyroxine and non-esterified fatty acids were observed between the two groups. Initially, rectal temperature decreased in L pigs but returned to start values by 1.5 h. This decline in rectal temperature was delayed in placebo animals, resulting in differences between treatments at 1.5 and 2 h. Conclusions: Acute leptin administration alters the endocrine profile of pigs and influences the thermoregulatory ability of the neonate. Copyright (C) 2007 S. Karger AG, Basel.

The potential role of the intestinal gut microbiota in obesity and the metabolic syndrome

The incidence of obesity has reached alarming levels worldwide, thus increasing the risk of development of metabolic disorders (e.g. type 2 diabetes, coronary heart disease (CHD) and cancer). Among the causes of obesity, diet and lifestyle play a central role. Although the treatment of obesity may appear quite straightforward, by simply re-addressing the balance between energy intake and energy expenditure, practically it has been very challenging. In the search for new therapeutic targets for treatment of obesity and related disorders, the gut microbiota and its activities have been investigated in relation to obesity. The human gut microbiota has already been shown to influence total energy intake and lipid metabolism, particularly through colonic fermentation of undigestible dietary constituents and production of short chain fatty acids (SCFA). Recent studies have highlighted the contribution of the gut microbiota to mammalian metabolism and energy harvested from the diet. A dietary modulation of the gut microbiota and its metabolic output could positively influence host metabolism and, therefore, constitute a potential coadjutant approach in the management of obesity and weight loss.

Thermogenic and metabolic consequences of thyroid hormone treatment in brown and white adipose tissue

Male rats were treated with triiodothyronine in the drinking water for 12 days. In vitro rates of isoprenaline stimulated lipolysis were significantly greater in brown but not white adipose tissue. Rates of [14C]glucose incorporation into triacylglycerols were significantly reduced in BAT (brown adipose tissue) and WAT (white adipose tissue) under basal and isoprenaline stimulated conditions. In a second experiment, hyperthyroid animals showed impaired weight gain, despite increased food intake during 19 days' treatment. Energy expenditure on days 5 and 12, and BAT core temperature differences (TBAT - TCORE) on day 19, were significantly greater than in control animals. Epididymal white fat pad weight was reduced and interscapular brown fat pad weight increased by triiodothyronine treatment.

A haplotype at the UCP1 gene locus contributes to genetic risk for type 2 diabetes in Asian Indians (CURES-72)

BACKGROUND: The gene encoding for uncoupling protein-1 (UCP1) is considered to be a candidate gene for type 2 diabetes because of its role in thermogenesis and energy expenditure. The objective of the study was to examine whether genetic variations in the UCP1 gene are associated with type 2 diabetes and its related traits in Asian Indians. METHODS: The study subjects, 810 type 2 diabetic subjects and 990 normal glucose tolerant (NGT) subjects, were chosen from the Chennai Urban Rural Epidemiological Study (CURES), an ongoing population-based study in southern India. The polymorphisms were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Linkage disequilibrium (LD) was estimated from the estimates of haplotypic frequencies. RESULTS: The three polymorphisms, namely -3826A-->G, an A-->C transition in the 5'-untranslated region (UTR) and Met229Leu, were not associated with type 2 diabetes. However, the frequency of the A-C-Met (-3826A-->G-5'UTR A-->C-Met229Leu) haplotype was significantly higher among the type 2 diabetic subjects (2.67%) compared with the NGT subjects (1.45%, P < 0.01). The odds ratio for type 2 diabetes for the individuals carrying the haplotype A-C-Met was 1.82 (95% confidence interval, 1.29-2.78, P = 0.009). CONCLUSIONS: The haplotype, A-C-Met, in the UCP1 gene is significantly associated with the increased genetic risk for developing type 2 diabetes in Asian Indians.

Lifestyle-induced metabolic inflexibility and accelerated ageing syndrome: insulin resistance, friend or foe?

The metabolic syndrome may have its origins in thriftiness, insulin resistance and one of the most ancient of all signalling systems, redox. Thriftiness results from an evolutionarily-driven propensity to minimise energy expenditure. This has to be balanced with the need to resist the oxidative stress from cellular signalling and pathogen resistance, giving rise to something we call 'redox-thriftiness'. This is based on the notion that mitochondria may be able to both amplify membrane-derived redox growth signals as well as negatively regulate them, resulting in an increased ATP/ROS ratio. We suggest that 'redox-thriftiness' leads to insulin resistance, which has the effect of both protecting the individual cell from excessive growth/inflammatory stress, while ensuring energy is channelled to the brain, the immune system, and for storage. We also suggest that fine tuning of redox-thriftiness is achieved by hormetic (mild stress) signals that stimulate mitochondrial biogenesis and resistance to oxidative stress, which improves metabolic flexibility. However, in a non-hormetic environment with excessive calories, the protective nature of this system may lead to escalating insulin resistance and rising oxidative stress due to metabolic inflexibility and mitochondrial overload. Thus, the mitochondrially-associated resistance to oxidative stress (and metabolic flexibility) may determine insulin resistance. Genetically and environmentally determined mitochondrial function may define a 'tipping point' where protective insulin resistance tips over to inflammatory insulin resistance. Many hormetic factors may induce mild mitochondrial stress and biogenesis, including exercise, fasting, temperature extremes, unsaturated fats, polyphenols, alcohol, and even metformin and statins. Without hormesis, a proposed redox-thriftiness tipping point might lead to a feed forward insulin resistance cycle in the presence of excess calories. We therefore suggest that as oxidative stress determines functional longevity, a rather more descriptive term for the metabolic syndrome is the 'lifestyle-induced metabolic inflexibility and accelerated ageing syndrome'. Ultimately, thriftiness is good for us as long as we have hormetic stimuli; unfortunately, mankind is attempting to remove all hormetic (stressful) stimuli from his environment.

A decade of plant proteomics and mass spectrometry: translation of technical advancements to food security and safety issues

Tremendous progress in plant proteomics driven by mass spectrometry (MS) techniques has been made since 2000 when few proteomics reports were published and plant proteomics was in its infancy. These achievements include the refinement of existing techniques and the search for new techniques to address food security, safety, and health issues. It is projected that in 2050, the world’s population will reach 9–12 billion people demanding a food production increase of 34–70% (FAO, 2009) from today’s food production. Provision of food in a sustainable and environmentally committed manner for such a demand without threatening natural resources, requires that agricultural production increases significantly and that postharvest handling and food manufacturing systems become more efficient requiring lower energy expenditure, a decrease in postharvest losses, less waste generation and food with longer shelf life. There is also a need to look for alternative protein sources to animal based (i.e., plant based) to be able to fulfill the increase in protein demands by 2050. Thus, plant biology has a critical role to play as a science capable of addressing such challenges. In this review, we discuss proteomics especially MS, as a platform, being utilized in plant biology research for the past 10 years having the potential to expedite the process of understanding plant biology for human benefits. The increasing application of proteomics technologies in food security, analysis, and safety is emphasized in this review. But, we are aware that no unique approach/technology is capable to address the global food issues. Proteomics-generated information/resources must be integrated and correlated with other omics-based approaches, information, and conventional programs to ensure sufficient food and resources for human development now and in the future.

Fetal programming of adipose tissue function: an evolutionary perspective

Obesity is an escalating threat of pandemic proportions and has risen to such unrivaled prominence in such a short period of time that it has come to define a whole generation in many countries around the globe. The burden of obesity, however, is not equally shared among the population, with certain ethnicities being more prone to obesity than others, while some appear to be resistant to obesity altogether. The reasons behind this ethnic basis for obesity resistance and susceptibility, however, have remained largely elusive. In recent years, much evidence has shown that the level of brown adipose tissue thermogenesis, which augments energy expenditure and is negatively associated with obesity in both rodents and humans, varies greatly between ethnicities. Interestingly, the incidence of low birth weight, which is associated with an increased propensity for obesity and cardiovascular disease in later life, has also been shown to vary by ethnic background. This review serves to reconcile ethnic variations in BAT development and function with ethnic differences in birth weight outcomes to argue that the variation in obesity susceptibility between ethnic groups may have its origins in the in utero programming of BAT development and function as a result of evolutionary adaptation to cold environments.