RESUMEN
Glucids are ubiquitous and yet controversial components of our nutrition. This narrative review focuses on the potential harmful effects of sugars on health, particularly as a risk factor for overweight, obesity or diabetes mellitus. Current guidelines recommend a daily limit of intake, and notably a restriction on added sugars. « Keto ¼ diets and intermittent fasting are trending in this era of sugar mistrust. However, the metabolic benefits are not yet clearly established, and the underlying risks should restrain the prescription of these diets to a population of carefully selected patients.
Les glucides sont des composants ubiquitaires et pourtant controversés de notre alimentation. Cette revue narrative s'intéresse aux éventuels méfaits des sucres sur la santé, plus particulièrement sur le risque de développer un surpoids ou une obésité, ainsi qu'un diabète sucré. Les recommandations actuelles préconisent ainsi une limitation journalière des apports, et notamment une restriction des sucres ajoutés. Les régimes dits « Keto ¼ et de jeûne intermittent se sont récemment popularisés dans ce contexte de conjuration des sucres. Leurs bénéfices métaboliques ne sont cependant pas clairement démontrés à ce jour, et les risques encourus devraient limiter les praticiens à les recommander à une population de patients sélectionnés.
Asunto(s)
Azúcares de la Dieta , Ingestión de Energía , Obesidad , Sobrepeso , Dieta , Azúcares de la Dieta/efectos adversos , HumanosRESUMEN
Obesity is a chronic, complex and relapsing disease. Because of this complexity, work up and follow up of affected patients implicate different specialists, working in synergy to diagnose and treat obesity and its complications. This follow up is specialized, and should be available in integrated centers of bariatric medicine offering all modalities of treatments with proven efficacy, whether medical, surgical or psychotherapeutical.
L'obésité est une maladie chronique, complexe et récidivante. Du fait de cette complexité, la prise en charge clinique des patients affectés doit impliquer différents spécialistes, travaillant en synergie pour diagnostiquer et traiter les différentes facettes de l'obésité et de ses complications. L'organisation de cette prise en charge spécialisée devrait s'articuler autour de centres intégrés de médecine bariatrique offrant tous les traitements reconnus efficaces, qu'ils soient médicaux, chirurgicaux ou psychothérapeutiques.
Asunto(s)
Medicina Bariátrica , Cirugía Bariátrica , Obesidad , Humanos , Obesidad/cirugía , EspecializaciónRESUMEN
The light exposure of parenteral nutritive solutions generates peroxides such as H(2)O(2) and ascorbylperoxide [2,3-diketo-4-hydoxyperoxyl-5,6-dihydroxyhexanoic acid]. This absence of photoprotection is associated with higher plasma triacylglycerol (TG) concentration in premature infants and oxidative stress and H(2)O(2)-independent hepatic steatosis in animals. We hypothesized that ascorbylperoxide is the active agent leading to high TG. The aim was to investigate the role of ascorbylperoxide in glucose and lipid metabolism in an animal model of neonatal parenteral nutrition. Three-day-old guinea pigs received through a catheter in the jugular solutions containing dextrose plus 0, 90, 225, or 450 microM ascorbylperoxide. After 4 days, blood and liver were sampled and treated for determinations of TG, cholesterol, markers of oxidative stress (redox potential of glutathione and F(2alpha)-isoprostane), and activities and protein levels of acetyl-CoA carboxylase (ACC), glucokinase, and phosphofructokinase (PFK). Ascorbylperoxide concentration was measured in urine on the last day. Data were compared by analysis of variance (p < 0.05). Plasma TG and cholesterol and hepatic PFK activity increased (200% of control), whereas ACC activity decreased (66% of control) in the function of the amount of ascorbylperoxide infused. Both markers of oxidative stress were higher in animals receiving the highest amounts of ascorbylperoxide. The logarithmic relations between urinary ascorbylperoxide and plasma TG (r(2) = 0.69) and hepatic PFK activity (r(2) = 0.26) were positive, whereas they were negative with ACC activity (r(2) = 0.50). In conclusion, ascorbylperoxide contaminating parenteral nutrition stimulates glycolysis, allowing higher availability of substrates for lipid synthesis. The logarithmic relation between urinary ascorbylperoxide and plasma TG suggests a very low efficient concentration.