RESUMO
Exercise in cirrhosis of the liver is an emerging topic in hepatology. Despite the known benefits of exercise in the general population, there are currently few studies addressing that issue in relation to cirrhosis and more evidence is still needed. Even though some studies have reported an acute, exercise-induced increase in the hepatic venous pressure gradient (HVPG), the opposite (a decrease in the HVPG) has been shown by recent data after an exercise program carried out for>14 weeks. In addition to that benefit, improvement has been described in the metabolic profile, quality of life, muscle mass, cardiopulmonary function, and nutritional status. Together, those features make exercise in cirrhosis a very attractive intervention. However, certain aspects must be taken into account before prescribing exercise in that population and they include cardiovascular risk, musculoskeletal disorders, and complications related to cirrhosis. After considering those factors, an individually tailored exercise program should be developed for each patient, according to the points stated above and the desired goal. Information about exercise-limiting factors, type of exercise prescribed, monitoring methods, and concomitant nutritional therapy is provided in the present review.
Assuntos
Terapia por Exercício/estatística & dados numéricos , Cirrose Hepática/terapia , Prescrições , Humanos , Medicina de PrecisãoRESUMO
Resumen Esta investigación se realizó en el municipio de Villavicencio, en la Universidad de los Llanos, cuyo objetivo fue determinar la digestibilidad de tres forrajes para bovinos mediante cuatro técnicas diferentes: una in situ y tres in vitro (inoculación con líquido ruminal, producción de gas, y enzimática) con el fin de validar las técnicas y los equipos que se están usando para estos procedimientos; se evaluaron las especies forrajeras y arbóreas: Pennisetum purpureum (PP), Hibiscus rosa-sinensis (HR) y Gliricidia sepium (GS), además se valoró en todas las técnicas, la curva y tasa de degradación de la materia seca (MS), fibra detergente neutro (FDN) y proteína cruda (PC) (0 a 72 horas). Se utilizó un diseño completamente al azar con arreglo de medidas repetidas, bajo el cual se realizó el análisis de varianza para determinar los rangos de desviación entre las técnicas y así establecer la tendencia de los datos; las variables evaluadas fueron las digestibilidades de la MS, FDN y PC de los tres forrajes de las cuatro técnicas; luego de verificar las diferencias entre las varianzas de las digestibilidades, y comprobar el supuesto de esfericidad con el test de Mauchly, se realizó la comparación múltiple con la prueba de Bonferroni. La digestibilidad de la MS, FDN y PC varió entre 39.89-44.22, 54.18-64.26 y 47.54-57.05%; 79.29-84.18, 76.30-86.95 y 72.81-89.03%; 32.52-62.14, 69.12-76.52 y 42.00-66.54% respectivamente en los forrajes PP, HR y GS, en función de la técnica empleada para su estimación. A pesar de encontrar diferencias estadísticamente significativas entre varias de las comparaciones realizadas en las técnicas de digestibilidad, se encontró un alto coeficiente de determinación y alta correlación entre las estimaciones in vitro: inoculación con líquido ruminal, producción de gas y enzimática con respecto a la estimación in situ.
Abstract This research was conducted in the Villavicencio city, at the Universidad de los Llanos, whose objective was to determine the digestibility of three forages for cattle through four different techniques: one in situ and three in vitro (inoculation with ruminal fluid, gas production, and enzymatic), in order to validate the techniques and equipment that are being used for these procedures; the forage species were evaluated: Pennisetum purpureum, Hibiscus rosa-sinensis y Gliricidia sepium, in addition it was evaluated both in all techniques: the curve and rate of degradation of dry matter (DM), neutral detergent fiber (NDF) and crude protein (PC) (0 to 72 hours). A repeated measures design was used, under which the analysis of variance was performed to determine the ranges of deviation between the techniques and thus establish the trend of the data; the variables evaluated were the digestibilities of DM, NDF and PC of the three forages of the four techniques; after verifying the differences between the variances of the digestibilities, and check the assumption of sphericity with the Mauchly test, the multiple comparison was performed with the Bonferroni test. The digestibility of DM, NDF and PC varied between 39.89-44.22, 54.18-64.26 and 47.54-57.05%; 79.29-84.18, 76.30-86.95 and 72.81-89.03%; 32.52-62.14, 69.12-76.52 and 42.00-66.54% respectively in the PP, HR and GS forages, depending on the technique used for their estimation. Despite finding statistically significant differences among several of the comparisons made in the techniques of digestibility, it was found a high determination coefficient and correlation between estimates in vitro: inoculation with ruminal fluid, gas production and enzymatic with respect to the in situ estimate.
Resumo Esta pesquisa foi realizada na cidade de Villavicencio, na Universidad de los Llanos, cujo objetivo foi determinar a digestibilidade de três forragens em bovinos através de quatro técnicas in vitro diferentes: um in situ e três in vitro (inoculação com fluido ruminai, produção de gás, e enzimática), com a fim de validar as técnicas e equipamentos que estão sendo usados para estes procedimentos; foram avaliadas espécies forrageiras e árvore: Pennisetum purpureum (PP), Hibiscus rosa-sinensis (HR) y Gliricidia sepium (GS), além disso foi avaliado em todas as técnicas: curva e a taxa de degradação de matéria seca (MS), fibra em detergente neutro (FDN) e proteína bruta (PB) (0 a 72 horas). Utilizou-se um desenho de medidas repetidas, sob as quais foi realizado o análise de variância para determinar as gamas de desvio entre as técnicas e assim estabelecer a tendência dos dados; as variáveis avaliadas foram a digestibilidade da MS, FDN e PB dos três forragens das quatro técnicas; depois de verificar as diferenças entre as variâncias de digestibilidade, e verificar a hipótese de esfericidade com o teste de Mauchly, foi realizado a comparação múltipla com o teste de Bonferroni. A digestibilidade de MS, FDN e PB variou entre 39,89-44,22, 54,18-64,26 e 47,54-57,05%; 79,29-84,18, 76,30-86,95 e 72,81-89,03%; 32,52-62,14, 69,12-76,52 e 42,00-66,54%, respectivamente nas forragens PP, HR e GS, dependendo da técnica utilizada para sua estimação. Apesar de encontrar diferenças estatisticamente significativas entre varios das comparações realizadas nas técnicas de digestibilidade, foi encontrado un alto coeficiente de determinação y uma elevada correlação entre as estimativas in vitro: inoculação líquido ruminal, produção de gás e enzimática com respeito à estimativa in situ.
RESUMO
It is estimated that at least one third of patients with moderate to severe Chronic Obstructive Pulmonary Disease (COPD) have a significant alteration of their body composition, which is associated with deleterious clinical effects and higher mortality. However, there is a lack of evidence to support that dietary, pharmacological or both nutritional interventions have significant clinical benefits in COPD patients who are participating in a pulmonary rehabilitation program. At the present time the recommendation is to establish a nutritional diagnosis of the COPD patients from the beginning of the pulmonary rehabilitation program using the measurement of body mass index (BMI) and the estimation of the nutritional risk, which means a significant weight loss during a given period of time, followed by an individualized dietary and educational supplementation guide during at least 12 weeks.
Se estima que al menos un tercio de los pacientes con enfermedad pulmonar obstructiva crónica moderada y severa tienen una alteración significativa en su composición corporal, lo cual se asocia con efectos clínicos deletéreos y con una mayor mortalidad. Sin embargo, hay evidencia insuficiente para respaldar que los pacientes que participan en un programa de rehabilitación respiratoria se beneficien en forma significativa de las intervenciones nutricionales dietarias, farmacológicas o la asociación de ambas, aunque aparentemente los últimos estudios publicados parecen sugerirlo. La recomendación actual es establecer desde que el paciente ingresa a un programa de rehabilitación respiratoria tanto el diagnóstico nutricional mediante la determinación del índice de masa corporal como el riesgo nutricional que corresponde a una baja involuntaria significativa de peso en determinado intervalo de tiempo, entregando al paciente un plan de alimentación y educación individualizado que debiera tener una duración mínima de 12 semanas.