RAQUEL SUSANA MATOS DE MIRANDA TORRINHAS

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Departamento de Gastroenterologia, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina

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  • article 76 Citação(ões) na Scopus
    Effect of synbiotic in constipated adult women - A randomized, double-blind, placebo-controlled study of clinical response
    (2013) WAITZBERG, Dan L.; LOGULLO, Luciana C.; BITTENCOURT, Amanda E.; TORRINHAS, Raquel S.; SHIROMA, Glaucia M.; PAULINO, Natalia P.; TEIXEIRA-DA-SILVA, Maria L.
    Background & aims: Synbiotic intake may selectively change microbiota composition, restore microbial balance in the gut and improve gastrointestinal functions. We have assessed the clinical response of chronically constipated women to a commercially available synbiotic, combining fructooligosaccharides with Lactobacillus and Bifidobacterium strains (LACTOFOS (R)). Methods: Following 1 week of non-interventional clinical observation, 100 constipated adult women, diagnosed by ROME III criteria, were randomized to receive two daily doses (6 g) of synbiotic or maltodextrin (placebo group), for 30 days. Treatment response was evaluated by patient's daily record of evacuation (stool frequency, consistency and shape, according to Bristol scale), abdominal symptoms (abdominal pain, bloating and flatulence) and constipation intensity (Constipation Scoring System AGACHAN). Results: Patients treated with synbiotic had increased frequency of evacuation, as well as stool consistency and shape nearer normal parameters than the placebo group, with significant benefits starting during the second and third weeks, respectively (interaction group/time, P < 0.0001). There were no significant differences in abdominal symptoms, but AGACHAN score was better in the synbiotic than in the placebo group. Conclusions: Dietary supplementation with a synbiotic composed of fructooligosaccharides with Lactobacillus and Bifidobacterium improved evacuation parameters and constipation intensity of chronically constipated women, without influencing abdominal symptoms. NCT01286376 (C) 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
  • article 18 Citação(ões) na Scopus
    Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass
    (2017) SALA, Priscila; BELARMINO, Giliane; TORRINHAS, Raquel S.; MACHADO, Natasha M.; FONSECA, Danielle C.; RAVACCI, Graziela R.; ISHIDA, Robson K.; GUARDA, Ismael F. M. S.; MOURA, Eduardo G. de; SAKAI, Paulo; SANTO, Marco A.; SILVA, Ismael D. C. G. da; PEREIRA, Claudia C. A.; LOGULLO, Angela F.; HEYMSFIELD, Steven; GIANNELLA-NETO, Daniel; WAITZBERG, Dan L.
    OBJECTIVES: Vitamin B12 (B12) deficiency after Roux-en-Y gastric bypass (RYGB) is highly prevalent and may contribute to postoperative complications. Decreased production of intrinsic factor owing to gastric fundus removal is thought to have a major role, but other components of B12 metabolism may also be affected. We evaluated changes in the expression levels of multiple B12 pathway-encoding genes in gastrointestinal (GI) tissues to evaluate the potential roles in contributing to post-RYGB B12 deficiency. METHODS: During double-balloon enteroscopy, serial GI biopsies were collected from 20 obese women (age, 46.9 +/- 6.2 years; body mass index, 46.5 +/- 5.3 kg/m(2)) with adult-onset type 2 diabetes (fasting plasma glucose >= 126 mg/dl; hemoglobin A1c >= 6.5%) before and, at the same site, 3 months after RYGB. Gene expression levels were assessed by the Affymetrix Human GeneChip 1.0 ST microarray. Findings were validated by real-time quantitative PCR (RT-qPCR). RESULTS: Gene expression levels with significant changes (P <= 0.05) included: transcobalamin I (TCN1) in remnant (-1.914-fold) and excluded (-1.985-fold) gastric regions; gastric intrinsic factor (GIF) in duodenum (-0.725-fold); and cubilin (CUBN) in duodenum (+0.982-fold), jejunum (+1.311-fold), and ileum (+0.685-fold). Validation by RT-qPCR confirmed (P <= 0.05) observed changes for TCN1 in the remnant gastric region (-0.132-fold) and CUBN in jejunum (+2.833-fold). CONCLUSIONS: RYGB affects multiple pathway-encoding genes that may be associated with postoperative B12 deficiency. Decreased TCN1 levels seem to be the main contributing factor. Increased CUBN levels suggest an adaptive genetic reprogramming of intestinal tissue aiming to compensate for impaired intestinal B12 delivery.
  • article 25 Citação(ões) na Scopus
    Partial Replacement of omega-6 Fatty Acids With Medium-Chain Triglycerides, but Not Olive Oil, Improves Colon Cytokine Response and Damage in Experimental Colitis
    (2012) BERTEVELLO, Pedro L.; NARDI, Leticia De; TORRINHAS, Raquel S.; LOGULLO, Angela F.; WAITZBERG, Dan L.
    Background: Soybean oil is rich in omega-6 fatty acids, which are associated with higher incidence and more severe cases of inflammatory bowel diseases. The authors evaluated whether partial replacement of soybean oil by medium-chain triglycerides (MCTs) or olive oil influenced the incidence and severity of experimental ulcerative colitis by using different parenteral lipid emulsions (LEs). Methods: Wistar rats (n = 40) were randomized to receive parenteral infusion of the following LE: 100% soybean oil (SO), 50% MCT mixed with 50% soybean oil (MCT/SO), 80% olive oil mixed with 20% soybean oil (OO/SO), or saline (CC). After 72 hours of infusion, acetic acid experimental colitis was induced. After 24 hours, colon histology and cytokine expression were analyzed. Results: SO was not significantly associated with overall tissue damage. MCT/SO was not associated with necrosis (P < .005), whereas OO/SO had higher frequencies of ulcer and necrosis (P < .005). SO was associated with increased expression of interferon-gamma (P = .005) and OO/SO with increased interleukin (IL)-6 and decreased tumor necrosis factor-alpha expression (P < .05). MCT/SO appeared to decrease IL-1 (P < .05) and increase IL-4 (P < .001) expression. Conclusions: Parenteral SO with high concentration of omega-6 fatty acids was not associated with greater tissue damage in experimental colitis. SO partial replacement with MCT/SO decreased the frequency of histological necrosis and favorably modulated cytokine expression in the colon; however, replacement with OO/SO had unfavorable effects. (JPEN J Parenter Enteral Nutr. 2012; 36: 442-448)
  • article 16 Citação(ões) na Scopus
    Body adiposity index performance in estimating body fat in a sample of severely obese Brazilian patients
    (2015) BELARMINO, Giliane; HORIE, Lilian Mika; SALA, Priscila Campos; TORRINHAS, Raquel S.; HEYMSFIELD, Steven B.; WAITZBERG, Dan L.
    Background/objectives: The body adiposity index (BAI) estimates the amount of body fat (BF) in humans. In Mexican-American and African-American populations, BAI has performed better than body mass index (BMI). The aim of this study was to evaluate the performance of BAI in estimating percentage (BF%) in severely obese Brazilian patients, with air displacement plethysmography (ADP) used as the reference method. Subjects/methods: Estimation of BF% by ADP, anthropometric measurements (height, abdominal and hip circumferences, body weight, and BMI) and BAI calculation were performed in 72 obese subjects (BMI >= 30 kg/m(2)) aged 30-55 years. Results: The mean BF% estimates +/- standard deviation were 52.1 +/- 5.7 % for ADP and 47.7 +/- 7.4 % for BAI, with a positive Pearson correlation (r(p) = 0.66) and a positive Lin's concordance correlation (r(c) = 0.479) observed between these methods. The 95 % limits of individual agreement between BAI and ADP ranged from -5.769 % to 16.036 %, with BAI exhibiting an average positive bias of 5.13 % compared to the reference method. For each studied variable, BAI exhibited a systematic bias, as evidenced by a tendency for low BF% values to be overestimated. Conclusion: For Brazilian patients with severe obesity, BAI does not provide an accurate estimate of BF%.
  • article 40 Citação(ões) na Scopus
    Diagnosing Sarcopenia in Male Patients With Cirrhosis by Dual-Energy X-Ray Absorptiometry Estimates of Appendicular Skeletal Muscle Mass
    (2018) BELARMINO, Giliane; GONZALEZ, Maria Cristina; SALA, Priscila; TORRINHAS, Raquel Susana; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Augusto Carneiro; PEREIRA, Rosa Maria R.; CAPARBO, Valeria F.; FERRIOLI, Eduardo; PFRIMER, Karina; DAMIANI, Lucas; HEYMSFIELD, Steven B.; WAITZBERG, Dan L.
    Background: Ascites in cirrhotic patients interfere with accurate assessment of skeletal muscle when diagnosing sarcopenia. We hypothesized measurement of appendicular skeletal muscle index (ASMI) with dual-energy x-ray absorptiometry (DXA) improves the diagnosis of sarcopenia in cirrhotic patients as ASMI does not include the fluid-filled abdominal compartment. Objective: To evaluate if ASMI is influenced by ascites, lower limb edema (LLE) and predicts mortality alone or combined with handgrip strength (HGS) in cirrhotic patients. Design: ASMI, HGS, and 36-month mortality were obtained in 144 men with cirrhosis. ASMI was compared before and after paracentesis in 20 men with ascites and to results from 20 matched controls. The prognostic value of ASMI alone and with HGS was tested in a survival. Survival probabilities were obtained for sarcopenia diagnosed by standard ASMI and HGS European Working Group on Sarcopenia in Older People (EWGSOP) cutoffs and a new cutoff calculated from our ASMI + HGS tertiles. Results: ASMI did not change after paracentesis, was lower in patients than in controls (P < .001), and was not influenced by LLE (D = 0.30 kg/m2, P = .068; R-2 = 2.40%). Mortality was influenced by ASMI and HGS (P-interaction = 0.028). Sarcopenia diagnosed by EWGSOP was also diagnosed by our new cutoff; both predicted mortality with the latter more sensitive for mortality risk prediction (P = .011). Conclusions: DXA-measured ASMI is not influenced by ascites or LLE in cirrhotic patients; can diagnose low skeletal muscle/sarcopenia; and predicts mortality, particularly when combined with HGS.
  • article 3 Citação(ões) na Scopus
    New anthropometric and biochemical models for estimating appendicular skeletal muscle mass in male patients with cirrhosis
    (2021) BELARMINO, Giliane; TORRINHAS, Raquel Susana; V, Natalia Magalhaes; HEYMSFIELD, Steven B.; WAITZBERG, Dan L.
    Objectives: The use of easily accessible methods to estimate skeletal muscle mass (SMM) in patients with cirrhosis is often limited by the presence of edema and ascites, precluding a reliable diagnosis of sarcopenia. The aim of this study was to design predictive models using variables derived from anthropometric and/or biochemical measures to estimate SMM; and to validate their applicability in diagnosing sarcopenia in patients with cirrhosis. Methods: Anthropometric and biochemical data were obtained from 124 male patients (18-76 y of age) with cirrhosis who also underwent dual-energy x-ray absorptiometry (DXA) and handgrip strength (HGS) assessments to identify low SMM and diagnose sarcopenia using reference cutoff values. Univariate analyses for variable selection were applied to generate predictive decision tree models for low SMM. Model accuracy for the prediction of low SMM and sarcopenia (when associated with HGS) was tested by comparison with reference cutoff values (appendicular SMM index, obtained by DXA) and clinical sarcopenia diagnoses. The prognostic value of the models for the prediction of sarcopenia and mortality at 104 wk of follow up was further tested using Kaplan-Meier graphics and Cox models. Results: The models with anthropometric variables, alone and combined with biochemical variables, showed good accuracy (0.89 [0.83; 0.94] and 0.90 [0.84; 0.95], respectively) and sensitivity (0.72 [0.56; 0.85] and 0.74 [0.59; 0.86], respectively) and excellent specificity (0.96 [0.90; 0.99] and 0.97 [0.92; 0.99], respectively) in predicting SMM. Both models showed excellent accuracy (0.94 [0.89; 0.98], good sensitivity (0.68 [0.45; 0.86]), and excellent specificity (1.00 [0.96; 1.00]) in predicting sarcopenia. The models predicted mortality in patients with sarcopenia, with the likelihood of death sixfold greater relative to patients not predicted to have sarcopenia. Conclusions: Our simple and inexpensive models provided a practical and safe approach to diagnosing sarcopenia patients with cirrhosis along with an estimate of their mortality risk when other reference methods are unavailable.
  • article 18 Citação(ões) na Scopus
    Fecal bile acid profile after Roux-en-Y gastric bypass and its association with the remission of type 2 diabetes in obese women: A preliminary study
    (2019) CARDINELLI, Camila de Siqueira; TORRINHAS, Raquel Susana; SALA, Priscila; PUDENZI, Marcos Albieri; ANGOLINI, Celio Fernando F.; SILVA, Mariane Marques da; MACHADO, Natasha Mendonca; RAVACCI, Graziela; EBERLIN, Marcos N.; WAITZBERG, Dan L.
    Objective: To assess the influence of Roux-en-Y gastric by-pass (RYGB) on fecal bile acid (BA) profile and its relationship with postoperative remission of type 2 diabetes (T2D). Methods: Fecal samples were collected 3 and 12 months after RYGB from diabetic obese women who were responsive (n = 12) and non-responsive (n = 8) to postoperative remission of T2D. Fecal BA profile was accessed by liquid chromatography coupled to tandem mass spectrometry in a targeted approach. Results: Relative to pre-operative levels, a total of 10 fecal BA profiles decreased after RYGB (ANOVA, p <= 0.05) with significant fold-changes for glycochenodeoxycholic, glycocholic, taurocholic, and taurochenodeoxycholic acids at 3-months postoperatively, and for glycochenodeoxycholic, glycocholic and taurocholic acids at 12 months postoperatively (Benjamini-Hochberg, p < 0.05). Postoperative changes in fecal BA were different between responsive and non-responsive women, with a significant reduction in more sub-fractions of BA in responsive women than in non-responsive women, and a marked difference in the temporal behavior of cholic acid (CA) and chenodeoxycholic acid (CDCA), thus reflecting changes in CA/CDCA ratio, and tauroursodeoxycolic (TUDCA) levels between these responsiveness groups (ANOVA, p <= 0.05). Conclusion: RYGB induces a marked reduction in the concentration of fecal BA, which is heterogeneous according to T2D responsiveness.
  • article 0 Citação(ões) na Scopus
    Infusion time for fish oil-containing parenteral emulsions in surgery: A study on omega-3 fatty acid dynamics in rats
    (2021) ANTUNES, Marcia S.; WAITZBERG, Dan L.; TESSER, Alweyd; GUTIERRES, Felipe A.; TAMANAHA, Erika M.; OLIVEIRA, Ronaldo; SAMPAIO, Geni; TORRES, Elizabeth A.; GARLA, Priscilla C.; CALDER, Phillip C.; TORRINHAS, Raquel S.
    Objectives: The aim of this study was to contribute to the design of specialized parenteral nutrition protocols in surgery by evaluating the dynamics of polyunsaturated fatty acid (PUFA) concentrations in different body pools after the infusion of fish oil-containing lipid emulsion (FOLE) in rats that had undergone surgical central venous catheterization (CVC). Methods: After 5-d adaptation in metabolic cages, 78 male Lewis rats (300-450 g) fed a standard diet were sacrificed (baseline control) or had only CVC (surgical control) or also received a 72-h infusion of a parenteral lipid emulsion with or without fish oil. The catheterized animals were sacrificed 0 (T0), 2 (T2), 6 (T6), and 12 h (T12) after the infusion ended. Gas chromatography was used to determine the concentrations of eicosapentaenoic (EPA), docosahexaenoic (DHA), and arachidonic (ARA) acids and the omega-3 to omega-6 ratio in plasma, liver, and blood leukocytes. Kruskal-Wallis and Wilcoxon tests were applied to plasma and liver data and descriptive analysis to leukocyte data. Results: Plasma, liver, and leukocytes exhibited almost undetectable EPA and DHA and detectable ARA concentrations at baseline. Immediately after FOLE infusion (T0), these PUFAs changed in all pools, resulting in a higher ratio of omega-3 to omega-6 compared with rats with no FOLE infusion (P < 0.05). All these changes decreased over time, with residual effects remaining until T6 in plasma, T12 in liver, and only until T2 in leukocytes. Conclusion: Data from this study suggest that omega-3 PUFAs are cleared early after the end of FOLE infusion, mainly in leukocytes. This should be considered when FOLEs are applied for immunomodulatory purposes in surgery.
  • article 45 Citação(ões) na Scopus
    Influence of Intestinal Microbiota on Body Weight Gain: a Narrative Review of the Literature
    (2015) CARDINELLI, Camila S.; SALA, Priscila C.; ALVES, Claudia C.; TORRINHAS, Raquel S.; WAITZBERG, Dan L.
    In recent decades, experimental and clinical studies have associated the development of obesity with the composition of the gut microbiota. Mechanisms potentially involved in the contribution of gut microbiota to body weight gain include changes in energy extraction from the diet and the modulation of lipid metabolism, endocrine functions, and the immune system. The host's specific genetic heritage, the type and amount of food intake, chronic inflammation, reduced body energy expenditure, and exposure to obesogenic pollutants are also potential contributing factors. The pathophysiological processes involved in the relationship between gut microbiota and obesity are not fully understood, and further studies are needed to establish whether differences in gut bacterial diversity between obese and normal body weight individuals are the cause or a consequence of obesity.
  • article 8 Citação(ões) na Scopus
    Effects of parenteral fish oil lipid emulsions on colon morphology and cytokine expression after experimental colitis
    (2013) GARIB, Ricardo; GARLA, Priscila; TORRINHAS, Raquel S.; BERTEVELLO, Pedro L.; LOGULLO, Angela F.; WAITZBERG, Dan L.
    Aim: To study the effects of different protocols of fish oil lipid emulsion (FOLE) infusion on acute inflammation in a rat model of colitis. Methods: Adult male Wistar rats (n = 51) were randomized into 5 groups to receive parenteral infusion of saline (SS) or soybean oil lipid emulsion (SO), as controls, and FOLE composed of: fish oil alone (FO); a mixture (9:1 v/v) of SO with FO (SO/FO); or 30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil (SMOF). After 72 h of intravenous infusion, experimental colitis was induced with acetic acid. After 24 h, colonic samples were analyzed for histological and cytokine changes. Results: In relation SS group, macroscopic necrosis was less frequent in the FO group and histological necrosis was more frequent in the SMOF group. There was a direct and inverse relation of colon interleukin (IL)-1 and IL-4 respectively, with histological necrosis. In comparison to the SS group, FO increased IL-4 and IFN-gamma and decreased TNF-alpha, SO/FO decreased TNF-alpha, and SMOF increased IL-1 and decreased IL-4. Conclusion: In acetic acid-induced colitis, the isolate infusion of FOLE composed of fish oil alone was more advantageous in mitigating inflammation than the infusion of FOLE containing other oils, and this difference may be due the influences of their different fatty acid contents.