14° EVENTO DA SÉRIE DE WORKSHOPS INTERNACIONAIS SOBRE ALIMENTOS
COM ALEGAÇÕES DE PROPRIEDADES FUNCIONAIS E/OU DE SAÚDE
14TH ILSI BRASIL INTERNATIONAL WORKSHOP ON FUNCTIONAL FOODS
1 E 2 DE DEZEMBRO DE 2015 / DECEMBER 1 - 2, 2015
NEUROCIÊNCIA, CÉREBRO
E
NUTRIÇÃO
RESPOSTA GLICÊMICA E FUNÇÃO COGNITIVA
- FOCO NO CAFÉ DA MANHÃ NEUROSCIENCE, BRAIN
AND
NUTRITION
1 de dezembro – Terça-feira
December 1st – Tuesday
Ômegas ao longo da vida
8h30 – 8h40
16h40 – 17h20
Abertura / Opening
Aldo Baccarin (ILSI Brasil)
8h40 – 9h10
Introdução /
16h00 – 16h40
Omegas throught lifecycle
Satya Jonnalagadda (Kerry)
Luteína e zeaxantina
Lutein and zeaxanthin
Elizabeth Johnson (Tufts University, USA)
Local / Venue
Maksoud Plaza Hotel
Alameda Campinas, 150
Bela Vista – São Paulo – SP
Prof. Dr. Carlos Alberto Nogueira-de-Almeida
17h20 – 17h30
Introduction
Franco Lajolo (FCF/ USP)
Perguntas /
Q&A
Universidade
de Ribeirão
2 de dezembro
– Quarta-feira Preto
9h10 – 9h50
Mecanismos relacionados ao
envelhecimento normal do cérebro
December 2nd – Wednesday
9h50 – 10h00
Polyphenols
David Vauzour (University of East Anglia, UK)
Inscrições e Informações /
Registration and Information
11 3035-5585
Associação
Brasileira
de
Nutrologia
Polifenois
Mechanisms related to normal brain aging
Paulo Henrique Ferreira Bertolucci (UNIFESP)
Perguntas /
Q&A
9h10 – 9h50
Controle glicêmico e cognição
10h00 – 10h30
Intervalo /
8h30 – 9h10
Coffee Break
Glycemic control and Cognition
Carlos Nogueira de Almeida (UNAERP)
09h50 – 10h00
[email protected]
www.ilsi.org.br
até 30/10: R$ 500,00
até 27/11: R$ 550,00
no local: R$ 600,00
1
Nutrição cerebral
2
Hipoglicemia e
cognição
3
Hiperglicemia e
cognição
4
Controle Glicêmico
e cognição
5
Conclusões
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
1
Nutrição cerebral
2
Hipoglicemia e
cognição
3
Hiperglicemia e
cognição
4
Controle Glicêmico
e cognição
5
Conclusões
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
1
Nutrição cerebral
2
Hipoglicemia e
cognição
3
Hiperglicemia e
cognição
4
Controle Glicêmico
e cognição
5
Conclusões
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
journal homepage: www.elsevier.com/locate/nci
NCI 3428
2
Invited review
6
4
7
Neuronal damage and cognitive impairment associated with
hypoglycemia: An integrated view
5
No. of Pages 13, Model 5G
25Languren,
July 2013G., et al. Neuronal damage and cognitive impairment associated with hypoglycemia: An integrated view. Neurochem. Int. (2013)
⇑
8 Q2 Gabriela Languren, Teresa Montiel, Alberto Julio-Amilpas, Lourdes Massieu
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Departamento de Neuropatología Molecular, División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México (UNAM), CP 04510, AP 70-253,
G. Languren et al. / Neurochemistry International xxx (2013) xxx–xxx
México, D.F., Mexico
a r t i c l e
i n f o
Article history:
Received 1 March 2013
Received in revised form 28 June 2013
Accepted 30 June 2013
Available online xxxx
Keywords:
Cognitive impairment
Excitotoxicity
Hypoglycemia
Insulin
Selective neuronal death
Oxidative stress
5
a b s t r a c t
The aim of the present review is to offer a current perspective about the consequences of hypoglycemia
and its impact on the diabetic disorder due to the increasing incidence of diabetes around the world. The
main consequence of insulin treatment in type 1 diabetic patients is the occurrence of repetitive periods
of hypoglycemia and even episodes of severe hypoglycemia leading to coma. In the latter, selective neuronal death is observed in brain vulnerable regions both in humans and animal models, such as the cortex
and the hippocampus. Cognitive damage subsequent to hypoglycemic coma has been associated with
neuronal death in the hippocampus. The mechanisms implicated in selective damage are not completely
understood but many factors have been identified including excitotoxicity, oxidative stress, zinc release,
PARP-1 activation and mitochondrial dysfunction. Importantly, the diabetic condition aggravates neuronal damage and cognitive failure induced by hypoglycemia. In the absence of coma prolonged and severe
hypoglycemia leads to increased oxidative stress and discrete neuronal death mainly in the cerebral cortex. The mechanisms responsible for cell damage in this condition are still unknown. Recurrent moderate
hypoglycemia is far more common in diabetic patients than severe hypoglycemia and currently important efforts are being done in order to elucidate the relationship between cognitive deficits and recurrent
hypoglycemia in diabetics. Human studies suggest impaired performance mainly in memory and attention tasks in healthy and diabetic individuals under the hypoglycemic condition. Only scarce neuronal
death has been observed under moderate repetitive hypoglycemia but studies suggest that impaired hippocampal synaptic function might be one of the causes of cognitive failure. Recent studies have also
implicated altered mitochondrial function and mitochondrial oxidative stress.
! 2013 Published by Elsevier Ltd.
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52
51
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Counterregulatory endocrine response to hypoglycemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
55
Severe hypoglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
56
3.1.
Factors involved in neuronal damage induced by severe hypoglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
57
3.2.
Effects of alternative energy substrates on hypoglycemic brain damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
58
3.3.
Impaired cognitive function associated with severe hypoglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
59
4.
Hypoglycemia without isoelectricity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
60
4.1.
Recurrent hypoglycemia: neuronal death and oxidative stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
61
Fig. 1. Factors involved in neuronal
death
severe hypoglycemia
and their. .time-course
4.2.associated
Recurrentwith
hypoglycemia
and cognitive impairment
. . . . . . . . . . . .of
. . occurrence.
. . . . . . . . . . . .Reactive
. . . . . . . . .Oxygen
. . . . . . . Species
. . . . . . . . (ROS),
. . . . . . .Poli-(ADP
. . . . . . . . . .ribose)
00
62
5.
Treatments
for glycemic
control
strategies
to prevent
. . . . . . . 3-Nitrotyrosine
. . . . . . . . . . . . . . . . (3-NT),
. . . . . . . . 4-Hydroxinonenal
. . . . . . . . . . . . . . . . . . (4-HNE),
. . . . . . . . 00
polymerase-1 (PARP-1), Mitochondrial
permeability
transition
poreand(MPT),
Nitric
Oxidehypoglycemia
Synthase (NOX),
Lipid
63
6.
Conclusions.
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peroxidation (LPx), Apoptosis Inducing Factor (AIF).
64
7.
Uncited references . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
65
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
53
54
1.
2.
3.
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Hypoglycemia Induced by Insulin as a Triggering Factor of Cognitive Deficit in Diabetic Children
The Scientific World Journal Volume 2014
4
The Scientific World Journal
Diabetes mellitus
(DM)
Type 1
diabetes
Insulin therapy
Type 2
diabetes
Gestational
diabetes
Hypoglycemia
Early onset of
appearance
Secondary
diabetes
Intensity
Neuronal
death
Cognitive
deficit
Duration
Mental
processes
Thought
Memory
Learning
Intelligence
Reasoning
Frequency
Attention
Decisionmaking
Visual
perception
Figure 1: Insulin-induced hypoglycemia and its correlations with neuronal death and cognitive alterations.
[3] A. E. Gold, K. M. MacLeod, I. J. Deary, and B. M. Frier,
The association between the history of IIH and cogin diabetes melnitive deficit
involves
multiple
especially
intensity,Christiano “Hypoglycemia-induced
Vanessa
Rodrigues
Vilela, factors,
Any de Castro
Ruiz Marques,
Rodrigues Schamber, andcognitive
Roberto dysfunction
Barbosa Bazotte
litus: effect of hypoglycemia unawareness,” Physiology and
frequency, and duration of IIH. Additionally, it was noted
Behavior, vol. 58, no. 3, pp. 501–511, 1995.
that the earlier theCarlos
appearance
of diabetes
in children, the
Alberto
Nogueira-de-Almeida
- www.clinicanutre.com
[4]
B.
Schultes,
W. Kern, K. Oltmanns et al., “Differential adaptation
greater the tendency towards hypoglycemia episodes and
1
Nutrição cerebral
2
Hipoglicemia e
cognição
3
Hiperglicemia e
cognição
4
Controle Glicêmico
e cognição
5
Conclusões
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Trajectories in Glycemic Control over Time Are Associated with Cognitive
Performance in Elderly Subjects with Type 2 Diabetes
Ravona et al 2014. PLOS On Line, v9, I6, e97384
•
Objetivo: estudar a trajetória de longo prazo da
glicemia em relação à cognição
•
Avaliados 835 idosos (média 72,8 anos)
diabéticos e suas dosagens de Hb-glicada
•
Aqueles com melhor controle glicêmico e
menos períodos de hiperglicemia
apresentaram melhor performance cognitiva.
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
The Association of Duration of Type 2 Diabetes with Cognitive Performance is Modulated by
Long-Term Glycemic Control
West at el, Am J Geriatr Psychiatry. 2014 October ; 22(10): 1055–1059
•
Objetivo: avaliar se os prejuízos cognitivos a longo
prazo do diabetes mellitus tipo 2 podem estar
associados à manutenção da glicemia elevada
•
897 idosos diabéticos (média 72 anos) em Israel,
avaliados por hemoglobina glicada e 5 diferentes
testes cognitivos
•
Aqueles que mantiveram glicemia menos
controlada (mais elevada mas não mais baixa),
apresentaram piores respostas nos testes
cognitivos.
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
The Negative Effects of Obesity and Poor Glycemic Control on Cognitive Function: A
Proposed Model for Possible Mechanisms
Michael L. Alosco & John Gunstad; Curr Diab Rep (2014) 14:495
495, Page 2 of 7
Curr Diab Rep (2014) 14:495
Medical Comorbidities
Genetics
Fat mass and
obesity gene
(FTO)
Obesity
Type 2 Diabetes Mellitus
Poor glycemic control
Hypertension
Sleep Apnea
Weight Loss
Clinical Factors
Adverse Brain Changes
Cognitive Dysfunction in:
Sedentary Behaviors
Reduced Physical Fitness
Psychosocial and
Psychological Factors
Cerebral Hypoperfusion
Brain Atrophy
White Matter Damage
Impaired Neuronal Function
Attention
Executive Function
Memory
Psychomotor Speed
Novel Risk Factors
Altered Biomarkers
Inflammation
Weight Loss
Fig. 1 Proposed model for mechanisms of obesity associated cognitive
other genetic markers have been linked with obesity, only the FTO is
impairments. The displayed medical, clinical comorbidities, and novel
displayed given evidence of it being one of the strongest genetic risk
risk factors represent the most common factors in obese individuals.
factors for obesity and its close link with cognitive outcomes. Altered
Weight loss may attenuate cognitive dysfunction in obesity via resolution
biomarkers refer to disturbed levels of adipokines and appetite hormones
of comorbid medical and clinical conditions, and improvements in novel
such as leptin and ghrelin
risk factors stemming from
substantial
adiposity loss.
Of note, although
Carlos
Alberto
Nogueira-de-Almeida
- www.clinicanutre.com
The Negative Effects of Obesity and Poor Glycemic Control on Cognitive Function: A
Proposed Model for Possible Mechanisms
Michael L. Alosco & John Gunstad; Curr Diab Rep (2014) 14:495
Adverse Brain Changes
Cerebral Hypoperfusion
Brain Atrophy
White Matter Damage
Impaired Neuronal Function
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
The Negative Effects of Obesity and Poor Glycemic Control on Cognitive Function: A
Proposed Model for Possible Mechanisms
Michael L. Alosco & John Gunstad; Curr Diab Rep (2014) 14:495
495, Page 2 of 7
Curr Diab Rep (2014) 14:495
Medical Comorbidities
Genetics
Fat mass and
obesity gene
(FTO)
Obesity
Type 2 Diabetes Mellitus
Poor glycemic control
Hypertension
Sleep Apnea
Weight Loss
Clinical Factors
Adverse Brain Changes
Cognitive Dysfunction in:
Sedentary Behaviors
Reduced Physical Fitness
Psychosocial and
Psychological Factors
Cerebral Hypoperfusion
Brain Atrophy
White Matter Damage
Impaired Neuronal Function
Attention
Executive Function
Memory
Psychomotor Speed
Novel Risk Factors
Altered Biomarkers
Inflammation
Weight Loss
Fig. 1 Proposed model for mechanisms of obesity associated cognitive
other genetic markers have been linked with obesity, only the FTO is
impairments. The displayed medical, clinical comorbidities, and novel
displayed given evidence of it being one of the strongest genetic risk
risk factors represent the most common factors in obese individuals.
factors for obesity and its close link with cognitive outcomes. Altered
Weight loss may attenuate cognitive dysfunction in obesity via resolution
biomarkers refer to disturbed levels of adipokines and appetite hormones
of comorbid medical and clinical conditions, and improvements in novel
such as leptin and ghrelin
risk factors stemming from
substantial
adiposity loss.
Of note, although
Carlos
Alberto
Nogueira-de-Almeida
- www.clinicanutre.com
Glycemic control, inflammation, and cognitive function in older patients with type
2 diabetes
Akrivos et al; Int J Geriatr Psychiatry 2015
Utilizando PCR, verificaram que o prejuízo
cognitivo causado pela hiperglicemia de
longo prazo não é intermediado por
processo inflamatório
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
1
Nutrição cerebral
2
Hipoglicemia e
cognição
3
Hiperglicemia e
cognição
4
Controle Glicêmico
e cognição
5
Conclusões
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
A OMISSÃO DO CAFÉ DA MANHÃ LEVA A PREJUÍZO
COGNITIVO NO DECORRER DA MANHÃ.
1. Smith AP, Kendrick A & Maben A (1994) Effects of breakfast and caffeine on cognitive performance, mood
and cardiovas- cular functioning. Appetite 22, 39–55. 2. Benton D, Slater O & Donohoe RT (2001) The influence of breakfast and a snack on psychological
functioning. Physiol Behav 74, 559–571. 3. Hoyland A, Dye L & Lawton CL (2009) A systematic review of the effect of breakfast on the cognitive
performance of chil- dren and adolescents. Nutr Res Rev 22, 220–243. 4. Widenhorn-Müller K, Hille K, Klenk J, et al. (2008) Influence of having breakfast on cognitive performance
and mood in 13- to 20-year-old high school students: results of a crossover trial. Pediatrics 122, 279–284. 5. Cooper SB, Bandelow S & Nevill ME (2011) Breakfast consumption and cognitive function in adolescent
school- children. Physiol Behav 103, 431–439. Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
O CARBOIDRATO É O PRINCIPAL COMPONENTE
QUE DETERMINA O PREJUÍZO COGNITIVO DA
OMISSÃO DO CAFÉ DA MANHÃ
1. Dye L & Blundell J (2002) Functional foods: psychological and behavioural functions. Br J
Nutr 88, Suppl. 2, S187–S211.
2. Gibson EL & Green MW (2002) Nutritional influences on cog- nitive function: mechanisms of
susceptibility. Nutr Res Rev 15, 169 – 206.
3. Messier C (2004) Glucose improvement of memory: a review. Eur J Pharmacol 490, 33–57.
4. Riby LM (2004) The impact of age and task domain on cognitive performance: a metaanalytical review of the glucose facilitation effect. Brain Impairment 5, 145–165.
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
✓ A OMISSÃO DO CAFÉ DA MANHÃ LEVA A PREJUÍZO COGNITIVO
NO DECORRER DA MANHÃ.
✓
O CARBOIDRATO É O PRINCIPAL COMPONENTE QUE
DETERMINA O PREJUÍZO COGNITIVO DA OMISSÃO DO CAFÉ
DA MANHÃ
Sendo assim, do
ponto de vista dos
carboidratos, como deve
ser o café da
manhã?
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
time interaction (F(1.905, 118.137) ¼ 3.833, p ¼ 0.026,
There was aand
significant
main effect
of assessment
time
attention
secondary
memory
are constructed
of diverse
following Huynh-Feldt correction). Paired samples
(F(2, 62) ¼ 6.57, p ¼ 0.002). Bonferroni pairwise compartasks it is unlikely that the treatments used here are
t-tests showed that the significant interaction was the
isons revealed a significant decline in performance from
affecting
a (pcommon
latent
result of a significant decline in performance at 11:40 am,
9:40
to 11:40 am
¼ 0.002). There
wasfactor.
no effect Hence,
of gender it appears that
following the consumption of the high GI cereal as
(F(1,
62)and
¼ 0.098,
0.756)
on secondary
memory.
high
lowp ¼GI
meals
may differentially
affect cognitive
A
low
glycaemic
index
breakfast
cereal
preferentially
prevents
children’s
cognitive
performance
compared with the low GI cereal (t(63) ¼ "2.374,
functions
in
children.
p ¼ 0.021) (see Fig. 1a).
memory the morning
from decliningWorking
throughout
a
5
0
-5
-10
CHANGE FROM BASELINE
-15
-20
b
The results in the present study have been interpreted as
Ingwersen et al; Appetite
49 (2007)
240–244
Whilst
there
was
significant
effects
of GI (F(1,
the
product
of no
differing
GIs.
However,
it is important to
62) ¼ 0.123, p ¼ 0.727) or gender (F(1, 62) ¼ 0.97,
note that there were compositional differences other than
p
¼ 0.328), there was a significant main effect of assessment
ACCURACY OF ATTENTION
GI
between
the two
cereals
Tablepairwise
1). Previous research
time (F(2,
62) ¼ 10.274,
p¼
0.000). (see
Bonferroni
High GI
comparisons
showed
that there
was a significant such
decline in
has shown
that
macronutrients
as protein may
Low GI
performance from 9:40 to 10:40 am (p ¼ 0.000).
influence cognitive performance (Dye, Lluch, & Blundell,
2000). Due to the differing amounts of protein and other
Discussion
*
components of All Bran and Coco Pops, it is possible that
Consistent
with previous
resultscould be due to
the
observed
results research
in the findings,
presentthestudy
from the present study suggest that a low GI breakfast
factors
other than
GI.performance from declining
cereal
may prevent
children’s
throughout
the morning
on investigation
certain measures is
of needed
attention into the effects
Although
further
Breakfast
and
Following the
consumption
of a low
GI on research to
of memory.
GI on children’s
cognitive
function,
based
9.30 am
breakfast cereal compared with a high GI breakfast cereal,
date,
seems that
only
it important
for children
there
wasit significantly
less not
decline
in is
performance
on
accuracy
attention and
secondary
memory
throughout
9.00 am
9.40 am
10.40 am
11.40 am
to eat ofbreakfast
in the
morning,
but
it is also important to
the
morning. These
are comparable to the findings
consider
whatfindings
they eat.
SECONDARY MEMORY
0
*
-20
*
-40
-60
Breakfast
9.30 am
-80
9.00 am
9.40 am
10.40 am
11.40 am
ASSESSMENT TIME
Fig. 1. Effects of a low and high GI breakfast consumed at 09.30 am on
subsequent attention and memory in school children. Graphs depict mean
(7SEM) change from 9.00 am baseline in (a) ‘accuracy of attention’
(% # 2) and (b) ‘secondary memory’ (% # 4). Asterisks denote significant
of those of Wesnes et al. (2003), where a significantly
smaller decline occurred in performance for secondary
memory following the consumption of the two breakfast
cereals compared with the consumption of the glucose
drink and no breakfast. Like Wesnes et al. (2003) the
current study also found an effect on attention, although
it is worth noting that this was manifested in accuracy of
attention compared with speed of attention in Wesnes
et al.’s study (2003). The reason for this discrepancy is
unknown but may be due to slight differences in task
instruction or in participants understanding of how to
prioritise speed of accuracy.
Given that the current study employed a different
battery of tests to that of Mahoney et al. (2005), it is
noteworthy that similarities can be drawn in that GI was
found to have differential effects on particular attention
and memory processes. Mahoney et al. found that GI
selectively had an effect on short-term memory and
auditory attention. Extending these findings, the present
results suggest that GI has an effect on children’s
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
scho
Martin,
dem
Ramper
J. D
acad
Ame
Scholey,
and
Scholey,
effec
gluco
176,
Sünram
effec
mem
Rese
Wesnes,
Brea
in sc
Wesnes,
enha
healt
The influence of carbohydrate on cognitive performance: a critical evaluation from
the perspective of glycaemic load
a
v
i
t
a
n
i
Gilsenan et al; British Journal of Nutrition (2009), 101, 941–949
p
o
Atispresent,
there is insufficient
ão
v
e
R
evidence to demonstrate a
consistent directional effect of GL
on short-term cognitive
performance.
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Britis
possible confounders strengthened the findings, suggesting
that individual differences in these measures are important
confounding factors that should be taken into account.
Performance on four out of seven tests was predicted by GI,
possibly mediated through its effects on mood, glucose and
cortisol levels before CF administration. Specifically, low GI
improved performance on a word generation task (declarative
suggesting that high-GL and low-GI meals decrease fatigue
and increase alertness are in agreement with what has been
previously hypothesised(15).
CF was particularly unaffected by GL, and the observed GI
effects were valid across GL groups, not supporting a potential
role for energy and macronutrient content on the specific
measures of cognitive performance. The addition of baseline
Glycaemic index and glycaemic load of breakfast predict cognitive
function and mood in school children: a randomised controlled trial
Micah et al; British Journal of Nutrition (2011), 106, 1552–1561
Table 5. Cognitive function test scores in seventy-four children participating in the study, in the four glycaemic index (GI) and glycaemic load (GL)
breakfast meals
(Mean values with their standard errors)
Breakfast meals
High GL
Low GI
Low GL
High GI
Low GI
High GI
P*
Cognitive function tests
Mean
SE
Mean
SE
Mean
SE
Mean
SE
GI
GI £ GL interaction
GL
Word generation task (no. of words)
Word recall, immediate (no. of words)
Time of completion in Stroop task† (s)
Matrices (no. of matrices)
Speed of information processing (no. of hits)
Serial sevens (no. of subtractions)
Word recall, delayed (no. of words)
16·0
6·7
47·3
11·8
12·7
16·3
4·5
0·8
0·4
2·0
0·4
0·7
1·8
0·4
15·2
6·6
44·9
12·2
13·8
17·2
4·8
0·8
0·3
1·7
0·4
0·7
1·7
0·3
15·2
7·2
47·2
12·3
12·4
15·1
5·1
0·7
0·3
1·5
0·4
0·7
1·9
0·4
14·1
7·3
47·5
12·0
13·9
16·2
5·4
0·8
0·3
1·6
0·4
0·7
1·8
0·4
0·03
0·93
0·19
0·77
0·01
0·03
0·30
0·36
0·55
0·03
0·18
0·20
0·71
0·88
0·66
0·14
0·58
0·76
0·71
0·56
0·19
* P values for repeated-measures ANOVA analysis with GI as the within-subject factor and GL as the between-subject factor. Potential confounders included: the order of
administration of the breakfast meals, sex, age, height, weight, BMI, mood, glucose and cortisol levels at baseline.
† For the Stroop task, lower scores represent better performance, as performance was measured in seconds; therefore, the quicker the completion, the better the
performance.
Analisados em conjunto, dados apontam para que um café da
manhã de baixo índice glicêmico mas carga glicêmica
elevada pode melhorar o aprendizado
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Response time (ms)
vided with an opportunity to familiarise themselves with the
methods involved. Participants were allowed to repeat the
cognitive function
tests until they felt comfortable with
740
them, to negate any potential learning effects.
The study employed a randomised cross-over design and
was order balanced, with participants blind until arrival at
school on each day of testing. The experimental trials con720
sisted of a high-GI breakfast trial, a low-GI breakfast trial
and breakfast omission trial (where breakfast was provided
Waist circumference was measured at the narrowest point of
the torso between the xiphoid process of the sternum and
the iliac crest, to the nearest 0·1 cm. Table 1 provides the physiological characteristics of the participants.
Breakfast glycaemic index and cognitive function in adolescent school children
Dietary control
Cooper et al; British Journal of Nutrition
Participants (2012),
were asked to 107,
consume 1823–1832
a meal of their choice
700
680
Breakfast
consumption
Time (min)
Capillary
blood sample
Fig. 1. Experimental protocol.
0
15
the evening before their first experimental trial and then to
Cognitive
function tests
30
Cognitive
function tests
60
90
120
30
120
Time post-breakfast consumption (min)
(b) 1000
Response time (ms)
980
960
Omissão do CM
940
920
CM elevado IG
900
CM baixo IG
880
860
Melhor resultado quanto menor o tempo de resposta
30
120
Time post-breakfast consumption (min)
Response times across the high-glycaemic index (HGI,
), low-GI (LGI,
) and breakfast omission (NBF,
x levels of the Stroop test (n 41). LGI v. NBF: P¼ 0·009; trial £ session time £ test level interaction.
) trials on the (a) baseline and (
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
A low glycaemic load breakfast can attenuate cognitive impairments
observed in middle aged obese females with impaired glucose tolerance
Lamport et al; Nutrition, Metabolism and Cardiovascular Diseases (2014)
➡Sessenta e cinco mulheres com idades entre 30-50 anos foram
avaliadas
➡Intolerância à glicose foi associada com perturbações da memória
verbal e espacial e função psicomotora
➡ O consumo do café da manhã de baixo índice glicêmico atenuou a
diminuição da memória verbal nas mulheres com intolerância à
glicose.
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
The glycemic load of meals, cognition and mood in middle and older
aged adults with differences in glucose tolerance: A randomized trial
H.Young, D. Benton / e-SPEN Journal 9 (2014) e147ee154
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
The glycemic load of meals, cognition and mood in middle and older
aged adults with differences in glucose tolerance: A randomized trial
H.Young, D. Benton / e-SPEN Journal 9 (2014) e147ee154
Pacientes com melhor tolerância à
glicose se beneficiaram mais de
dietas com IG baixo no sentido de
melhor performance cognitiva
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Dietary glycemic load and risk of cognitive impairment in
women: findings from the EPIC-Naples cohort
Findings from the EPIC-Naples cohort
Simeon et al; Eur J Epidemiol, online, March 2015
Fig. 1 Study plan flow chart
To assess the total impact of physical activity and enA score of Mediterranean dietary pattern developed in
Carlos
Alberto
Nogueira-de-Almeida
- www.clinicanutre.com
ergy expenditure (occupational, housework and recreEPIC by Agnoli et al. [28] was used. The average dietary
0–8
724 (47.82)
380 (72.52)
240 (45.80)
104 (22.32)
8–12
571 (37.71)
117 (22.33)
215 (41.03)
239 (51.29)
[12
219 (14.46)
27 (5.15)
69 (13.17)
123 (26.39)
\0.001
Dietary glycemic load and risk of cognitive impairment in
women: findings from the EPIC-Naples cohort
Diabetes [n (%)]
No
Yes
1453 (95.97)
61 (4.03)
492 (93.89)
32 (6.11)
506 (96.56)
18 (3.44)
455 (97.64)
11 (2.36)
\0.01
BMI body mass index, Tot. Col. total cholesterol, HDL high density lipoprotein, LDL low density lipoprotein, PAS systolic pressure, PAD
diastolic pressure
Simeon et al; Eur J Epidemiol, online, March 2015
Table 2 Distribution lifestyle and diet variables in all subjects and by TICS score
This study indicates that GL and
Variables
All subjects
TICS score
1–15
Low score
16–21
Medium score
22–39
High score
1514
524 (34.6)
524 (34.6)
466 (30.8)
No smokers
795 (52.51)
298 (56.87)
269 (51.34)
228 (48.93)
Light smokers
435 (28.73)
138 (26.34)
139 (26.53)
158 (33.91)
Moderate smokers
217 (14.33)
71 (13.55)
86 (16.41)
60 (12.88)
Heavy smokers
67 (4.43)
17 (3.24)
30 (5.73)
20 (4.29)
\0.05
2.22 ± .77
2.28 ± .69
2.23 ± .77
2.14 ± .85
\0.01
Coffee (cup/day)
2.78 ± 1.73
2.65 ± 1.7
2.76 ± 1.65
2.95 ± 1.84
\0.01
Glycemic load (GL) [g/d]
166.8 ± 47.05
171.78 ± 46.66
168.21 ± 49.3
159.61 ± 44.03
\0.001
Glycemic index (GI)
53 ± 3
54 ± 2.7
54 ± 2.8
54 ± 2.7
Tot. carbohydrates
High GI carbohydrates
308.67 ± 82.68
140.7 ± 60.46
317.15 ± 81.87
147.83 ± 59.74
311.13 ± 87.12
142.24 ± 61.4
296.37 ± 77.01
130.95 ± 59.04
\0.001
\0.001
Low GI carbohydrates
146.5 ± 42.36
148.13 ± 43.01
147.79 ± 44.69
143.22 ± 38.67
0.33
Alcohol (g/day)
6.9 ± 11.1
6.88 ± 11.49
6.75 ± 10.97
7.08 ± 10.82
0.8
Mediterranean index
5.41 ± 1.59
5.43 ± 1.55
5.44 ± 1.67
5.35 ± 1.55
0.5
Energy (kcal)
2355.5 ± 522.5
2314.1 ± 493.5
0.19
No. of subjects (%)
p
GI may play a role in determining
Smoke habit [n (%)]
PALs
risk of cognitive impairment,
besides age, BMI, education and
diabetes.
2368.1 ± 528.03
2379.7 ± 540.7
PALs physical activity level, Tot. total, GL glycemic load, GI glycemic index
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
0.18
inconsistent, with some studies showing benefits toward either the high-GI or the low
meals, and other studies showing a positive or negative effect on performance on only
1 of the 2 meals. A number of methodologic and confounding factors were identified t
study design, the selected sample (size, age, blood glucose regulation), the timing of te
and type of cognitive tests used, the meals provided (composition, size), the timing o
because participants and investigators were not blinded to randomization. A low-GI m
The Influence of Glycemic Index on Cognitive
1
inconclusive. On the basis of this review, it isFunctioning:
suggested
that future
studies
address
t
A Systematic
Review of
the Evidence
recommendations are proposed to this effect. Adv. Nutr. 5: 119–130, 2014.
REVI
Elena Philippou2* and Marios Constantinou3
2
Department of Life and Health Sciences, School of Sciences and Engineering, and 3Department of Social Sciences, Psychology Program, School o
Humanities, Social Sciences, and Law, University of Nicosia, Nicosia, Cyprus
FIGURE 1 Study selection process.
carbohydrate; GI, glycemic index; GL
The impact of the rate of carbohydrate absorption, as measured by the carbohydrate’s glycemic index (GI) on cognitive performance, is not cle
The aim of this review was to systematically assess the relevant research load.
studies. A systematic review of English-language articles using Medli
ABSTRACT
Introduction
Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, and PsycARTICLES (up to July 2012) using the search terms “glyc(a)emic ind
or “glycaemic load” combined with “cognitive function” or “cognition” or “memory” was carried out. Inclusion and exclusion criteria were
prespecified. Eligibility of the identified studies was assessed independently by the 2 reviewers. Independent extraction of data was carried o
by the 2 authors using predefined data fields. The primary outcome measure was the effect on cognitive function (CF) after the consumption
meals varying in GI. Eleven eligible studies were identified. The age range of the participants varied from 6 to 82 y old. Overall, the findings we
inconsistent, with some studies showing benefits toward either the high-GI or the low-GI meal, others not finding any differences between th
meals, and other studies showing a positive or negative effect on performance on only some cognitive domain or domains after consumption
1 of the 2 meals. A number of methodologic and confounding factors were identified that could explain these inconsistencies. These include t
study design, the selected sample (size, age, blood glucose regulation), the timing of testing, the cognitive domain being examined, the numb
and type of cognitive tests used, the meals provided (composition, size), the timing of blood samples collected, as well as the possibility of b
because participants and investigators were not blinded to randomization. A low-GI meal may favor CF in adults, but the findings at present a
inconclusive. On the basis of this review, it is suggested that future studies address the identified methodologic issues and some
recommendations are proposed to this effect. Adv. Nutr. 5: 119–130, 2014.
with poor
Glucose is the main energy source for the brain and thus es- for enhan
sential for its function (1). Human studies have shown that elderly pa
the performance of difficult tasks requiring intensive cogni- tion of ~8
tive resources results in a measurable decline in peripheral the optim
4
blood glucose (BG) concentration, which is suggested to weight (9)
Study characteristics
the GI of theIn
mealanprovided with the exception o
be due to Carlos
increased
neural
energy expenditure
(2–4).
Alberto
Nogueira-de-Almeida
www.clinicanutre.com
It is w
Table 1 shows the data extracted from each study. In sum- by Micha et al. (28) in which both participants a
Introduction
Glucose is the main energy source for the brain and thus essential for its function (1). Human studies have shown that
the performance of difficult tasks requiring intensive cognitive resources results in a measurable decline in peripheral
blood glucose (BG)4 concentration, which is suggested to
be due to increased neural energy expenditure (2–4). In animals, it has been shown that at a high cognitive load, hippocampal glucose demand exceeds supply, whereas exogenous
glucose supply enhances performance (5). This is also supported by a number of human studies that have shown that
glucose consumption, compared with placebo or breakfast
omission, enhances cognitive performance both in healthy participants and in participants with memory deficits and those
with poor glucose regulation (6,7). The optimal glucose d
for enhancing verbal episodic memory, relative to placebo
elderly participants, was found to be 25 g, or a BG concen
tion of ~8–10 mmol/L (8), whereas in healthy young wom
the optimal glucose dosage was found to be 300 mg/kg b
weight (9).
It is worth noting that the glucose-enhancing effect
memory is more consistent in healthy elderly participa
(10) and in patients with Alzheimer disease (11) who p
sent with memory decline (12) than in healthy young par
ipants. In the latter group, glucose reliably facilit
memory when the cognitive demand of the task is high
under conditions of divided attention (13). In addition
is now well established that poor glucose regulation
risk factor for impaired cognitive functioning (CF)
•
•
•
Dietas de menor IG podem favorecer a função cognitiva
… mas os estudos ainda não são conclusivos
Novos estudos deveriam:
➡
padronizar instrumentos de medida de função cognitiva
➡
utilizar instrumentos com maiores sensibilidade e especificidade
➡
testar um domínio cognitivo por vez
➡
utilizar dieta em que apenas e tão somente IG ou CG sejam
diferentes, preservando as demais caraterísticas nutricionais
➡
padronizar os fatores ambientais no momento de teste, incluindo os
dias anteriores
➡
controlar todos os fatores de confusão
➡
levar em conta o padrão habitual do café da manhã dos
R
participantes
The Influence of Glycemic Index on Cognitive
Functioning: A Systematic Review of the Evidence1
Elena Philippou2* and Marios Constantinou3
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
2
Department of Life and Health Sciences, School of Sciences and Engineering, and 3Department of Social Sciences, Psychology Program, Sch
Humanities, Social Sciences, and Law, University of Nicosia, Nicosia, Cyprus
1
Nutrição cerebral
2
Hipoglicemia e
cognição
3
Hiperglicemia e
cognição
4
Controle Glicêmico
e cognição
5
Conclusões
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
Take home…
✓
✓
A glicose é a principal fonte energética para o cérebro
✓
Em indivíduos diabéticos, o controle glicêmico inadequado, independente
de processo inflamatório, parece ser a principal causa da perda cognitiva
que se observa ao longo dos anos
✓
A omissão do café da manhã leva a prejuízo cognitivo no decorrer da
manhã, especialmente no que se refere ao aprendizado escolar,
possivelmente devido à oferta inadequada de glicose para o SNC
✓
Refeições em geral, mas especialmente o café da manhã, parecem
permitir melhor performance cognitiva quando estão presentes alimentos
de menor resposta glicêmica
✓
Estudos com melhor padronização são necessários para melhorar o grau
de evidência científica das observações que têm sido feitas na relação
entre a resposta glicêmica e a função cognitiva
Tanto a hipoglicemia como a hiperglicemia crônicas podem levar a
prejuízos cognitivos
Carlos Alberto Nogueira-de-Almeida - www.clinicanutre.com
14° EVENTO DA SÉRIE DE WORKSHOPS INTERNACIONAIS SOBRE ALIMENTOS
COM ALEGAÇÕES DE PROPRIEDADES FUNCIONAIS E/OU DE SAÚDE
14TH ILSI BRASIL INTERNATIONAL WORKSHOP ON FUNCTIONAL FOODS
1 E 2 DE DEZEMBRO DE 2015 / DECEMBER 1 - 2, 2015
NEUROCIÊNCIA, CÉREBRO
NEUROSCIENCE, BRAIN
AND
E
NUTRIÇÃO
NUTRITION
Prof. Dr. Carlos Alberto Nogueira-de-Almeida
1 de dezembro – Terça-feira
December 1st – Tuesday
Ômegas ao longo da vida
8h30 – 8h40
16h40 – 17h20
16h00 – 16h40
Omegas throught lifecycle
Satya Jonnalagadda (Kerry)
Universidade de Ribeirão Preto
Abertura /
Opening
Aldo Baccarin (ILSI Brasil)
Luteína e zeaxantina
8h40 – 9h10
Lutein and zeaxanthin
Elizabeth Johnson (Tufts University, USA)
Introdução /
17h20 – 17h30
Introduction
Franco Lajolo (FCF/ USP)
Perguntas /
Q&A
Local / Venue
Maksoud Plaza Hotel
Alameda Campinas, 150
Bela Vista – São Paulo – SP
Associação Brasileira de Nutrologia
9h10 – 9h50
Mecanismos relacionados ao
envelhecimento normal do cérebro
Mechanisms related to normal brain aging
Paulo Henrique Ferreira Bertolucci (UNIFESP)
9h50 – 10h00
Perguntas /
Q&A
Coffee Break
Protegendo a saúde mental através
da prática de exercícios e nutrição
Protecting brain health through exercise practicing
and nutrition
Fábio Henrique Porto (Clínica Neurológica Nitrini e Associados)
11h10 – 11h50
Microbiota e eixo intestino-cérebro
Microbiota and gut brain axis
Dan Waitzberg (HC-USP /GANEP)
11h50 – 12h00
Perguntas /
Q&A
Polyphenols
David Vauzour (University of East Anglia, UK)
9h10 – 9h50
Glycemic control and Cognition
Carlos Nogueira de Almeida (UNAERP)
Perguntas /
Q&A
10h00 – 10h30
Intervalo /
Coffee Break
10h30 – 11h10
Desafiando o cérebro para obter
proteção através da curcumina e
dieta intermitente
Challenging the brain to induce protection by
curcumin and intermittent fasting
Cristoforo Scavone (ICB/USP)
11h10 – 11h50
12h20 – 14h00
Lunch
14h00 – 14h40
Minerais e cérebro, com foco no
selênio em relação com o declínio
cognitivo
Minerals and brain, focus on Selenium status in
elderly: Relation to cognitive decline
Silvia Cozzolino (FCF/USP)
14h40 – 15h20
O papel das vitaminas no cérebro e
cognição
The role of vitamins in brain and cognition
Hector Cori (DSM)
15h20 – 15h30
Perguntas /
Q&A
15h30 – 16h00
Intervalo /
Polifenois
09h50 – 10h00
10h30 – 11h10
Almoço /
8h30 – 9h10
Controle glicêmico e cognição
10h00 – 10h30
Intervalo /
2 de dezembro – Quarta-feira
December 2nd – Wednesday
Coffee Break
Como traduzir e incorporar a ciência
na área cognitiva em todos os
estágios da vida
Translating Science into Cognitive Health Across the
Continuum of Life Stages
Satya Jonnalagadda (Kerry)
Inscrições e Informações /
Registration and Information
11 3035-5585
[email protected]
www.ilsi.org.br
até 30/10: R$ 500,00
até 27/11: R$ 550,00
no local: R$ 600,00
Desconto de 50%
para sócios do ILSI Brasil.
Cortesia para representantes
do governo e da academia
Haverá tradução simultânea
Translation available
Coordenação Científica
Prof. Dr. Franco Lajolo
Força-Tarefa Funcionais
ILSI Brasil
(com colaboração das outras
Forças-Tarefa do Comitê de Nutrição)
11h50 - 12h30
Mesa-redonda
Discussão, conclusões
e encerramento
Round Table
Discussion, conclusions and closing
SIGA-NOS
NO TWITTER OU NO
FACEBOOK E GANHE
20% DE DESCONTO
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