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RESUMEN Objetivo: Comparar los efectos agudos del ejercicio aeróbico en ayuno y postprandial sobre la utilización de carbohidratos y grasas de hombres sedentarios con sobrepeso y obesidad. Métodos: Diseño cuantitativo, experimental, randomizado, cruzado. Siete hombres adultos (37,9 ± 2,4 años), sedentarios, con sobrepeso u obesidad (índice de masa corporal= 29,3 ± 1,9 kg/m2). Todos realizaron 60 min de ejercicio aeróbico al 50% de potencia aeróbica máxima tanto en ayuno (FASTED) como postprandial (FED), iniciando aleatoriamente. En cada oportunidad se midieron la tasa de intercambio respiratorio (RER) mediante calorimetría indirecta basal, durante, y después del ejercicio; glicemia, cuerpos cetónicos, lactato capilares basales, pre-inicio, post inmediato, y 40 minutos post ejercicio. La utilización de carbohidratos y grasas fue estimada desde el RER según ecuaciones estequiométricas. Resultados: Durante el ejercicio no hubo diferencias significativas en utilización de sustratos entre FASTED y FED. Posterior al ejercicio sólo FASTED tuvo aumento (p<0,05) en oxidación de grasas relativo al peso corporal (Pre 0,010 ± 0,006 kJ/min/kg vs Post 0,020 ± 0,014 kJ/min/kg), oxidación de carbohidratos (Pre 0,060 ± 0,010 kJ/min/kg vs Post 0,070 ± 0,012 kJ/min/kg), y gasto energético total (Pre 0,070 ± 0,017 kJ/min/kg vs Post 0,090 ± 0,028 kJ/min/kg). No hubo diferencias en FED, ni entre FASTED y FED. Conclusión: El ejercicio aeróbico moderado en ayuno aumenta la oxidación de grasas y carbohidratos posterior a la sesión en hombres con sobrepeso y obesidad. Esto podría ser útil para su prescripción en pacientes sedentarios con exceso de peso.
ABSTRACT Purpose: To compare the acute effects of fasting and postprandial aerobic exercise on carbohydrate and fat utilization in sedentary overweight and obese men. Methods: Quantitative, experimental, randomized, crossover design. Seven sedentary, overweight or obese (body mass index [BMI]= 29.3 ± 1.9 kg/m2) adult men (37.9 ± 2.4 years) performed 60 min of aerobic exercise at 50% of maximal aerobic power both fasting (FASTED) and postprandial (FED). The first exercise type was randomly assigned. We measured the respiratory exchange ratio (RER) by basal indirect calorimetry during and after exercise; glycemia, ketone bodies and capillary lactate at baseline, pre-start, immediately and 40 minutes post exercise were measured in each exercise protocol. Oxidation of carbohydrates and fats was estimated from the RER according to stoichiometric equations. Results: During exercise there were no significant differences in the use of substrates between FASTED and FED. After exercise, only FASTED had an increase (p<0.05) in fat oxidation relative to body (Pre 0.010 ± 0.006 kJ/min/kg vs Post 0.020 ± 0.014 kJ/min/kg), carbohydrate oxidation (Pre 0.060 ± 0.010 kJ/min/kg vs Post 0.070 ± 0.012 kJ/min/kg), and total energy expenditure (Pre 0.070 ± 0.017 kJ/min/kg vs Post 0.090 ± 0.028 kJ/min/kg). There were no differences in FED, nor significant differences between FASTED and FED. Conclusion: Moderate aerobic fasting exercise increases post-session fat and carbohydrate oxidation in overweight and obese men. This could be useful for application in sedentary patients with excess weight.
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INTRODUCTION: Gallstones are a very common disease in our area, with a prevalence of 21.9%. Among the most common complications, choledocholithiasis is associated in about 3% to 10% of cases. The treatment may be performed by minimally invasive laparoscopy, endoscopy or a combination of both. There is no current consensus on what is the best strategy for treatment. We aimed to review the evidences of highest quality available, comparing two therapeutic strategies for cholelithiasis. Choledocholithiasis is divided into that in patients who underwent a cholecystectomy and that in patients with associated cholelithiasis. In the first group we have three subgroups: a) patients in whom gallstones remained intraoperatively, b) patients with bile duct lithiasis and biliary drainage, and c) patients with bile duct lithiasis without biliary drainage. In the first case can be performed a laparoscopic treatment at one or two times; in the second, a transfistular approach; and in the third, an endoscopic treatment. If the endscopic tretament fails, percutaneous or laparoscopic reoperation can be done. The treatment of a cholelithiasis associated with choledocholithiasis can be performed by laparoscopy, endoscopy or a combination of both. We conclude that the innovation of minimally invasive techniques has revolutionized the management of bile duct stones. The treatment in one time is possible in patients with adequate operative risk and in the hands of trained surgeons. Multidisciplinary approach is mandatory, according to the diagnostic and therapeutic method, depending on the means available in each institution.