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Roux-en-Y gastric bypass (RYGB) limits food ingestion and may alter the intestinal expression of genes involved in the endogenous synthesis of polyunsaturated fatty acids (PUFAs). These changes may decrease the systemic availability of bioactive PUFAs after RYGB. AIM: To study the impact of RYGB on the dietary ingestion and plasma concentration of PUFAs and on the intestinal expression of genes involved in their endogenous biosynthesis in severely obese women with type 2 diabetes. METHODS: Before, and 3 and 12 months after RYGB, obese women (n=20) self-reported a seven-day dietary record, answered a food frequency query and provided plasma samples for alpha-linolenic (ALA), eicosapentaenoic (EPA), docosahexaenoic (DHA) and arachidonic (ARA) acid assessment by gas chromatography. Intestinal biopsies (duodenum, jejunum and ileum) were collected through double-balloon endoscopy before and 3 months after RYGB for gene expression analysis by microarray (Human GeneChip 1.0 ST array) and RT-qPCR validation. RESULTS: Compared to the preoperative period, patients had decreased intakes of PUFAs, fish and soybean oil (p<0.05) and lower plasma concentrations of ALA and EPA (p<0.001) 3 and 12 months after RYGB. FADS1 gene expression was lower in duodenum (RT-qPCR fold change=-1.620, p<0.05) and jejunum (RT-qPCR fold change=-1.549, p<0.05) 3 months following RYGB, compared to before surgery. CONCLUSION: RYGB decreased PUFA ingestion, plasma ALA and EPA levels, and intestinal expression of FADS1 gene. The latter encodes a key enzyme involved in endogenous biosynthesis of PUFAs. These data suggest that supplementation of omega-3 PUFAs may be required for obese patients undergoing RYGB.

Parenteral glutamine supplementation in acute inflammatory conditions is controversial. We evaluated the inflammatory and survival responses after parenteral glutamine infusion in sodium taurocholate-induced acute pancreatitis (AP) model. Lewis rats received 1 g/kg parenteral glutamine (n = 42), saline (n = 44), or no treatment (n = 45) for 48 h before AP induction. Blood, lung, and liver samples were collected 2, 12, and 24 h after AP to measure serum cytokines levels and tissue heat shock protein (HSP) expression. From each group, 20 animals were not sacrificed after AP for a 7-day mortality study. Serum cytokine levels did not differ among groups at any time point, but the intragroup analysis over time showed higher interferon-γ only in the nontreatment and saline groups at 2 h (versus 12 and 24 h; both p ≤ 0.05). The glutamine group exhibited greater lung and liver HSP90 expression than did the nontreatment group at 2 and 12 h, respectively; greater liver HSP90 and HSP70 expression than did the saline group at 12 h; and smaller lung HSP70 and liver HSP90 expression than did the nontreatment group at 24 h (all p ≤ 0.019). The 7-day mortality rate did not differ among groups. In experimental AP, pretreatment with parenteral glutamine was safe and improved early inflammatory mediator profiles without affecting mortality.

Introduction: Nutritional therapy is of fundamental importance in the care of critically ill patients, being part of the essential care in intensive care units (ICU), associated with evidence that proves that the nutritional status directly interferes in the clinical evolution of critically ill patients. Routine monitoring has the main objective of ensuring that the nutritional intervention is chosen and provided as planned and prescribed. This review sought to demonstrate the monitoring of enteral nutritional therapy (ENT) in critically ill patients in studies conducted in Brazil. Methods: A search was conducted in the PubMed, LILACS and SciELO databases, between 2014 and August 2019, on quality indicators in NET related to the adequacy of the administration of the infused volume, caloric and protein value, in adult patients (> 18 years) under intensive care. Results: On average, an adequacy of the infused volume of 74.1% was observed, a caloric adequacy of 71.8% and protein of 67.3% of the prescribed value. The most cited reasons for interrupting the administration of NET were gastrointestinal complications and fasting for procedures. Conclusions: The findings showed that, according to quality indicators, NET offered to critically ill patients did not reach the pre-established goal. However, they support the development of strategies to correct inadequacies of this therapy

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