Oral ingestion of a hydrolyzed gelatin meal in subjects with normal weight and in obese patients: Postprandial effect on circulating gut peptides, glucose and insulin

<body> <div style="position:absolute;left:50%;margin-left:-311px;top:0px;width:623px;height:796px;border-style:outset;overflow:hidden"> <div style="position:absolute;left:0px;top:0px"><img src="d607e6f4-2d3e-11e8-b174-0cc47a792c0a_id_d607e6f4-2d3e-11e8-b174-0cc47a792c0a_files/background1.jpg" width="623" height="796" /></div> <div style="position:absolute;left:155.76px;top:18.64px" class="cls_002"><span class="cls_002">Vol. 13: 48-53, March 2008</span></div> <div style="position:absolute;left:78.56px;top:55.74px" class="cls_003"><span class="cls_003">ORIGINAL</span></div> <div style="position:absolute;left:155.76px;top:53.78px" class="cls_004"><span class="cls_004">Oral ingestion of a hydrolyzed gelatin</span></div> <div style="position:absolute;left:72.30px;top:69.30px" class="cls_003"><span class="cls_003">RESEARCH</span></div> <div style="position:absolute;left:101.19px;top:82.86px" class="cls_003"><span class="cls_003">PAPER</span></div> <div style="position:absolute;left:155.76px;top:77.65px" class="cls_004"><span class="cls_004">meal in subjects with normal weight</span></div> <div style="position:absolute;left:155.76px;top:101.53px" class="cls_004"><span class="cls_004">and in obese patients: Postprandial</span></div> <div style="position:absolute;left:155.76px;top:125.40px" class="cls_004"><span class="cls_004">effect on circulating gut peptides,</span></div> <div style="position:absolute;left:155.76px;top:149.27px" class="cls_004"><span class="cls_004">glucose and insulin</span></div> <div style="position:absolute;left:155.76px;top:197.02px" class="cls_005"><span class="cls_005">I.G.S. Rubio, G. Castro, A.C. Zanini, and G. Medeiros-Neto</span></div> <div style="position:absolute;left:155.76px;top:216.65px" class="cls_006"><span class="cls_006">Department of Internal Medicine and Thyroid Unit (Lim-25), University of São Paulo Medical School, São</span></div> <div style="position:absolute;left:155.76px;top:226.41px" class="cls_006"><span class="cls_006">Paulo, Brazil</span></div> <div style="position:absolute;left:155.76px;top:262.58px" class="cls_007"><span class="cls_007">ABSTRACT.</span><span class="cls_008"> Gut hormones [ghrelin, peptide YY (PYY) and glucagon-like peptide-1 (GLP-1)]</span></div> <div style="position:absolute;left:155.76px;top:274.52px" class="cls_008"><span class="cls_008">are an important group of hormones that target appetite control. They are released from</span></div> <div style="position:absolute;left:155.76px;top:286.45px" class="cls_008"><span class="cls_008">endocrine L cells of the small bowel in proportion to the volume, components and calories in a</span></div> <div style="position:absolute;left:155.76px;top:298.39px" class="cls_008"><span class="cls_008">meal. In the current study, 20 g of gelatin (flavored and sweetened) were given to obese</span></div> <div style="position:absolute;left:155.76px;top:310.33px" class="cls_008"><span class="cls_008">patients (n=12) and lean subjects (n=10). Subsequently, plasma samples were collected at-30-</span></div> <div style="position:absolute;left:155.76px;top:322.27px" class="cls_008"><span class="cls_008">minute intervals up to 180 minutes and glucose, insulin, PYY, GLP-1 and ghrelin were assayed</span></div> <div style="position:absolute;left:155.76px;top:334.20px" class="cls_008"><span class="cls_008">using specific and sensitive immunofluorometric and radioimmunoassays. As expected, obese</span></div> <div style="position:absolute;left:155.76px;top:346.14px" class="cls_008"><span class="cls_008">patients had normal serum glucose levels, higher serum insulin, and lower plasma concentra-</span></div> <div style="position:absolute;left:155.76px;top:358.08px" class="cls_008"><span class="cls_008">tion of ghrelin at all times compared to lean subjects. GLP-1 plasma levels were significantly</span></div> <div style="position:absolute;left:155.76px;top:370.01px" class="cls_008"><span class="cls_008">elevated at 60 minutes, peaking at 120 minutes in obese patients and lean subjects. As a conse-</span></div> <div style="position:absolute;left:155.76px;top:381.95px" class="cls_008"><span class="cls_008">quence, there was a significant rise in serum insulin levels with a significantly higher peak</span></div> <div style="position:absolute;left:155.76px;top:393.89px" class="cls_008"><span class="cls_008">level at 60 min (obese) and 30 min (lean). There were no significant changes in PYY plasma</span></div> <div style="position:absolute;left:155.76px;top:405.83px" class="cls_008"><span class="cls_008">concentrations and no correlation was found between body mass index and concentrations of</span></div> <div style="position:absolute;left:155.76px;top:417.76px" class="cls_008"><span class="cls_008">ghrelin, PYY and GLP-1 in the group of obese patients. In conclusion, a single gelatin meal</span></div> <div style="position:absolute;left:155.76px;top:429.70px" class="cls_008"><span class="cls_008">induces a rise in plasma GLP-1 followed by an increase in serum levels of insulin. These find-</span></div> <div style="position:absolute;left:155.76px;top:441.64px" class="cls_008"><span class="cls_008">ings may be applied to maximize satiety in obese patients as a means of improving adherence</span></div> <div style="position:absolute;left:155.76px;top:453.57px" class="cls_008"><span class="cls_008">to calorie-controlled diets as well as provide better control of diabetic patients.</span></div> <div style="position:absolute;left:155.76px;top:465.41px" class="cls_009"><span class="cls_009">(Eating Weight Disord. 13: 48-53, 2008). ©2008, Editrice Kurtis</span></div> <div style="position:absolute;left:186.93px;top:499.12px" class="cls_010"><span class="cls_010">INTRODUCTION</span></div> <div style="position:absolute;left:381.79px;top:500.15px" class="cls_011"><span class="cls_011">to the type of meal (3). These hormones,</span></div> <div style="position:absolute;left:381.79px;top:512.09px" class="cls_011"><span class="cls_011">which include insulin, leptin, ghrelin, chole-</span></div> <div style="position:absolute;left:165.11px;top:524.03px" class="cls_011"><span class="cls_011">The alarming rise of obesity all over the</span></div> <div style="position:absolute;left:381.79px;top:524.02px" class="cls_011"><span class="cls_011">cystokinin (CCK), peptide YY (PYY) and</span></div> <div style="position:absolute;left:155.76px;top:535.97px" class="cls_011"><span class="cls_011">world, in both industrialized and emergent</span></div> <div style="position:absolute;left:381.79px;top:535.96px" class="cls_011"><span class="cls_011">glucagon-like peptide-1 (GLP-1), provide</span></div> <div style="position:absolute;left:155.76px;top:547.91px" class="cls_011"><span class="cls_011">countries, has contributed to an explosion</span></div> <div style="position:absolute;left:381.79px;top:547.90px" class="cls_011"><span class="cls_011">short-term information on hunger and sati-</span></div> <div style="position:absolute;left:155.76px;top:559.85px" class="cls_011"><span class="cls_011">in type 2 diabetes mellitus, predicted to</span></div> <div style="position:absolute;left:381.79px;top:559.84px" class="cls_011"><span class="cls_011">ety and influence hypothalamic, limbic and</span></div> <div style="position:absolute;left:155.76px;top:571.78px" class="cls_011"><span class="cls_011">afflict 210 million people worldwide by 2010</span></div> <div style="position:absolute;left:381.79px;top:571.77px" class="cls_011"><span class="cls_011">brainstem circuits that control appetite and</span></div> <div style="position:absolute;left:155.76px;top:583.72px" class="cls_011"><span class="cls_011">(1). Obesity is also associated with an</span></div> <div style="position:absolute;left:381.79px;top:583.71px" class="cls_011"><span class="cls_011">energy expenditure. They also modulate</span></div> <div style="position:absolute;left:30.49px;top:599.39px" class="cls_012"><span class="cls_012">Key words:</span></div> <div style="position:absolute;left:155.76px;top:595.66px" class="cls_011"><span class="cls_011">increased risk of cardiovascular disease,</span></div> <div style="position:absolute;left:381.79px;top:595.65px" class="cls_011"><span class="cls_011">short-term signals that determine meal ini-</span></div> <div style="position:absolute;left:30.49px;top:609.16px" class="cls_009"><span class="cls_009">Ghrelin, GLP-1, PYY, insulin,</span></div> <div style="position:absolute;left:155.76px;top:607.60px" class="cls_011"><span class="cls_011">hypertension, hyperlipemic disorders and</span></div> <div style="position:absolute;left:381.79px;top:607.58px" class="cls_011"><span class="cls_011">tiation and termination (4, 5).</span></div> <div style="position:absolute;left:30.49px;top:618.92px" class="cls_009"><span class="cls_009">glucose, gelatin, obesity.</span></div> <div style="position:absolute;left:155.76px;top:619.53px" class="cls_011"><span class="cls_011">osteoarthritis (2). Current pharmacologic</span></div> <div style="position:absolute;left:391.15px;top:619.52px" class="cls_011"><span class="cls_011">Batterham et al. (6) conducted a study on</span></div> <div style="position:absolute;left:30.49px;top:631.76px" class="cls_012"><span class="cls_012">Correspondence to:</span></div> <div style="position:absolute;left:155.76px;top:631.47px" class="cls_011"><span class="cls_011">treatments for obesity lead to temporary</span></div> <div style="position:absolute;left:381.79px;top:631.46px" class="cls_011"><span class="cls_011">PYY, a peptide secreted postprandially by</span></div> <div style="position:absolute;left:30.49px;top:641.53px" class="cls_009"><span class="cls_009">Geraldo Medeiros-Neto,</span></div> <div style="position:absolute;left:155.76px;top:643.41px" class="cls_011"><span class="cls_011">weight loss (with repeated recurrences) and</span></div> <div style="position:absolute;left:381.79px;top:643.40px" class="cls_011"><span class="cls_011">endocrine L cells that line the distal small</span></div> <div style="position:absolute;left:30.49px;top:651.30px" class="cls_009"><span class="cls_009">MD, MACP,</span></div> <div style="position:absolute;left:155.76px;top:655.34px" class="cls_011"><span class="cls_011">may sometimes not be well tolerated or</span></div> <div style="position:absolute;left:381.79px;top:655.33px" class="cls_011"><span class="cls_011">bowel and colon in proportion to the volume</span></div> <div style="position:absolute;left:30.49px;top:661.06px" class="cls_009"><span class="cls_009">Laboratório de Investigações</span></div> <div style="position:absolute;left:30.49px;top:670.83px" class="cls_009"><span class="cls_009">Médicas (LIM-25), Faculdade</span></div> <div style="position:absolute;left:155.76px;top:667.28px" class="cls_011"><span class="cls_011">even suitable for many obese patients.</span></div> <div style="position:absolute;left:381.79px;top:667.27px" class="cls_011"><span class="cls_011">of the meal and the calories ingested. A sin-</span></div> <div style="position:absolute;left:30.49px;top:680.60px" class="cls_009"><span class="cls_009">de Medicina da Universidade</span></div> <div style="position:absolute;left:165.11px;top:679.22px" class="cls_011"><span class="cls_011">Recent developments toward unraveling</span></div> <div style="position:absolute;left:381.79px;top:679.21px" class="cls_011"><span class="cls_011">gle infusion of PYY two hours before the</span></div> <div style="position:absolute;left:30.49px;top:690.36px" class="cls_009"><span class="cls_009">de São Paulo</span></div> <div style="position:absolute;left:155.76px;top:691.16px" class="cls_011"><span class="cls_011">the intricate physiology of appetite and</span></div> <div style="position:absolute;left:381.79px;top:691.14px" class="cls_011"><span class="cls_011">meal reduced appetite and food consump-</span></div> <div style="position:absolute;left:30.49px;top:700.13px" class="cls_009"><span class="cls_009">Av. Dr Arnaldo 455,</span></div> <div style="position:absolute;left:155.76px;top:703.09px" class="cls_011"><span class="cls_011">energy expenditure have paved the way for</span></div> <div style="position:absolute;left:381.79px;top:703.08px" class="cls_011"><span class="cls_011">tion (by about 30 percent) at a buffet lunch.</span></div> <div style="position:absolute;left:30.49px;top:709.90px" class="cls_009"><span class="cls_009">4º. andar, 01246-903,</span></div> <div style="position:absolute;left:30.49px;top:719.67px" class="cls_009"><span class="cls_009">São Paulo, Brazil</span></div> <div style="position:absolute;left:155.76px;top:715.03px" class="cls_011"><span class="cls_011">new pharmacological treatments. Gut hor-</span></div> <div style="position:absolute;left:381.79px;top:715.02px" class="cls_011"><span class="cls_011">The PYY response was diminished in obese</span></div> <div style="position:absolute;left:30.49px;top:729.43px" class="cls_009"><span class="cls_009">E-mail: medneto@uol.com.br</span></div> <div style="position:absolute;left:155.76px;top:726.97px" class="cls_011"><span class="cls_011">mones are an important group of hormones</span></div> <div style="position:absolute;left:381.79px;top:726.96px" class="cls_011"><span class="cls_011">subjects compared with the response</span></div> <div style="position:absolute;left:30.49px;top:742.27px" class="cls_012"><span class="cls_012">Received:</span><span class="cls_009"> May 31, 2007</span></div> <div style="position:absolute;left:155.76px;top:738.90px" class="cls_011"><span class="cls_011">that target appetite control and are released</span></div> <div style="position:absolute;left:381.79px;top:738.89px" class="cls_011"><span class="cls_011">observed in lean subjects. Other recent</span></div> <div style="position:absolute;left:30.49px;top:752.04px" class="cls_012"><span class="cls_012">Accepted:</span><span class="cls_009"> November 16, 2007</span></div> <div style="position:absolute;left:155.76px;top:750.84px" class="cls_011"><span class="cls_011">from the gastrointestinal tract in response</span></div> <div style="position:absolute;left:381.79px;top:750.83px" class="cls_011"><span class="cls_011">reports have indicated that GLP-1 and PYY</span></div> <div style="position:absolute;left:29.39px;top:777.73px" class="cls_013"><span class="cls_013">48</span></div> </div> <div style="position:absolute;left:50%;margin-left:-311px;top:806px;width:623px;height:796px;border-style:outset;overflow:hidden"> <div style="position:absolute;left:0px;top:0px"><img src="d607e6f4-2d3e-11e8-b174-0cc47a792c0a_id_d607e6f4-2d3e-11e8-b174-0cc47a792c0a_files/background2.jpg" width="623" height="796" /></div> <div style="position:absolute;left:354.37px;top:18.64px" class="cls_002"><span class="cls_002">Oral gelatin ingestion and gut peptides</span></div> <div style="position:absolute;left:74.49px;top:56.62px" class="cls_011"><span class="cls_011">are co-secreted by endocrine L cells of the small</span></div> <div style="position:absolute;left:351.97px;top:56.36px" class="cls_010"><span class="cls_010">METHODS</span></div> <div style="position:absolute;left:74.49px;top:68.56px" class="cls_011"><span class="cls_011">bowel, and that levels of both hormones are low</span></div> <div style="position:absolute;left:74.49px;top:80.50px" class="cls_011"><span class="cls_011">in the fasting state, increasing within 30 to 60</span></div> <div style="position:absolute;left:351.97px;top:81.27px" class="cls_008"><span class="cls_008">Study subjects</span></div> <div style="position:absolute;left:74.49px;top:92.43px" class="cls_011"><span class="cls_011">min after meals (7). A recent meta-analysis</span></div> <div style="position:absolute;left:330.14px;top:93.21px" class="cls_011"><span class="cls_011">Healthy obese patients (n=12) and lean sub-</span></div> <div style="position:absolute;left:74.49px;top:104.37px" class="cls_011"><span class="cls_011">reported that infusion of GLP-1 was associated</span></div> <div style="position:absolute;left:320.78px;top:105.14px" class="cls_011"><span class="cls_011">jects (n=10) were recruited from the outpatient</span></div> <div style="position:absolute;left:74.49px;top:116.31px" class="cls_011"><span class="cls_011">with dose-dependent reduction in energy intake</span></div> <div style="position:absolute;left:320.78px;top:117.08px" class="cls_011"><span class="cls_011">clinic and from the staff of Hospital das</span></div> <div style="position:absolute;left:74.49px;top:128.25px" class="cls_011"><span class="cls_011">(food) in both lean and obese subjects (8).</span></div> <div style="position:absolute;left:320.78px;top:129.02px" class="cls_011"><span class="cls_011">Clinicas, respectively. Clinical and laboratory</span></div> <div style="position:absolute;left:83.84px;top:140.18px" class="cls_011"><span class="cls_011">Consumption of dietary protein generally pro-</span></div> <div style="position:absolute;left:320.78px;top:140.96px" class="cls_011"><span class="cls_011">data are shown in Table 1. The body mass</span></div> <div style="position:absolute;left:74.49px;top:152.12px" class="cls_011"><span class="cls_011">duces greater satiety compared with carbohy-</span></div> <div style="position:absolute;left:320.78px;top:152.89px" class="cls_011"><span class="cls_011">index (BMI) for both genders in the obese</span></div> <div style="position:absolute;left:74.49px;top:164.06px" class="cls_011"><span class="cls_011">drate (9). Moreover, differences in gastrointesti-</span></div> <div style="position:absolute;left:320.78px;top:164.83px" class="cls_011"><span class="cls_011">group ranged from 34 to 50 kg/m</span><span class="cls_014"><sup>2</sup></span><span class="cls_011">. All obese</span></div> <div style="position:absolute;left:74.49px;top:176.00px" class="cls_011"><span class="cls_011">nal hormones response to liquid preloads con-</span></div> <div style="position:absolute;left:320.79px;top:176.77px" class="cls_011"><span class="cls_011">patients had stable weight over the 3 months</span></div> <div style="position:absolute;left:74.49px;top:187.93px" class="cls_011"><span class="cls_011">taining protein or glucose were also observed</span></div> <div style="position:absolute;left:320.79px;top:188.71px" class="cls_011"><span class="cls_011">preceding the study. Lean subjects of both</span></div> <div style="position:absolute;left:74.49px;top:199.87px" class="cls_011"><span class="cls_011">(10). The result of a recent study suggested that</span></div> <div style="position:absolute;left:320.79px;top:200.64px" class="cls_011"><span class="cls_011">genders had a BMI between 18.4 and 23.8</span></div> <div style="position:absolute;left:74.49px;top:211.81px" class="cls_011"><span class="cls_011">satiety signals from protein, but not from carbo-</span></div> <div style="position:absolute;left:320.79px;top:212.58px" class="cls_011"><span class="cls_011">kg/m</span><span class="cls_014"><sup>2</sup></span><span class="cls_011"> (Table 1). All subjects were between the</span></div> <div style="position:absolute;left:74.49px;top:223.74px" class="cls_011"><span class="cls_011">hydrate, are diminished in obese boys; however</span></div> <div style="position:absolute;left:320.79px;top:224.52px" class="cls_011"><span class="cls_011">ages of 19 and 48 years; the mean age for the</span></div> <div style="position:absolute;left:74.49px;top:235.68px" class="cls_011"><span class="cls_011">the metabolic explanation for this observation</span></div> <div style="position:absolute;left:320.79px;top:236.45px" class="cls_011"><span class="cls_011">obese group was 36.8 years and for lean sub-</span></div> <div style="position:absolute;left:74.49px;top:247.62px" class="cls_011"><span class="cls_011">needs further investigation (11).</span></div> <div style="position:absolute;left:320.79px;top:248.39px" class="cls_011"><span class="cls_011">jects was 27.1 years. Criteria for exclusion</span></div> <div style="position:absolute;left:83.84px;top:259.56px" class="cls_011"><span class="cls_011">The aim of our study was to investigate</span></div> <div style="position:absolute;left:320.79px;top:260.33px" class="cls_011"><span class="cls_011">were smoking, pregnancy, use of anorectic</span></div> <div style="position:absolute;left:74.49px;top:271.49px" class="cls_011"><span class="cls_011">whether the ingestion of a gelatin based meal</span></div> <div style="position:absolute;left:320.79px;top:272.27px" class="cls_011"><span class="cls_011">agents (phentermine, fenproporex, diethylpro-</span></div> <div style="position:absolute;left:74.49px;top:283.43px" class="cls_011"><span class="cls_011">was effective in inducing a rise in PYY and</span></div> <div style="position:absolute;left:320.79px;top:284.20px" class="cls_011"><span class="cls_011">pion, mazindol, sibutramine), and use of med-</span></div> <div style="position:absolute;left:74.49px;top:295.37px" class="cls_011"><span class="cls_011">GLP-1, and in affecting the concentration of</span></div> <div style="position:absolute;left:320.79px;top:296.14px" class="cls_011"><span class="cls_011">ications that would alter gastric secretion</span></div> <div style="position:absolute;left:74.49px;top:307.30px" class="cls_011"><span class="cls_011">ghrelin in normal lean subjects and in obese</span></div> <div style="position:absolute;left:320.79px;top:308.08px" class="cls_011"><span class="cls_011">(omeprazole and similar agents) or bowel</span></div> <div style="position:absolute;left:74.49px;top:319.24px" class="cls_011"><span class="cls_011">patients. Moreover, a rise in GLP-1 would sub-</span></div> <div style="position:absolute;left:320.79px;top:320.01px" class="cls_011"><span class="cls_011">movements (laxatives, orlistat, acarbose).</span></div> <div style="position:absolute;left:74.49px;top:331.18px" class="cls_011"><span class="cls_011">sequently increase plasma insulin levels, an</span></div> <div style="position:absolute;left:330.14px;top:331.95px" class="cls_011"><span class="cls_011">All subjects signed an informed consent for</span></div> <div style="position:absolute;left:74.49px;top:343.12px" class="cls_011"><span class="cls_011">effect that has a potential therapeutic applica-</span></div> <div style="position:absolute;left:320.79px;top:343.89px" class="cls_011"><span class="cls_011">the study and approval was obtained from the</span></div> <div style="position:absolute;left:74.49px;top:355.05px" class="cls_011"><span class="cls_011">tion in patients with diabetes.</span></div> <div style="position:absolute;left:320.79px;top:355.83px" class="cls_011"><span class="cls_011">Research Ethics Committee of the Hospital</span></div> <div style="position:absolute;left:296.13px;top:403.00px" class="cls_015"><span class="cls_015">TABLE 1</span></div> <div style="position:absolute;left:193.83px;top:413.85px" class="cls_015"><span class="cls_015">Obese patients and lean subjects: clinical and laboratory data.</span></div> <div style="position:absolute;left:81.82px;top:434.47px" class="cls_016"><span class="cls_016">Initials</span></div> <div style="position:absolute;left:179.16px;top:434.47px" class="cls_016"><span class="cls_016">Gender</span></div> <div style="position:absolute;left:251.69px;top:434.47px" class="cls_016"><span class="cls_016">Age (years)</span></div> <div style="position:absolute;left:329.40px;top:434.47px" class="cls_016"><span class="cls_016">BMI (kg/m</span><span class="cls_017"><sup>2</sup></span><span class="cls_016">)</span></div> <div style="position:absolute;left:403.58px;top:434.47px" class="cls_016"><span class="cls_016">Glucose (mg/dl)</span></div> <div style="position:absolute;left:484.52px;top:434.47px" class="cls_016"><span class="cls_016">Insulin (mU/l)</span></div> <div style="position:absolute;left:450.11px;top:450.39px" class="cls_016"><span class="cls_016">Basal levels</span></div> <div style="position:absolute;left:81.82px;top:466.31px" class="cls_016"><span class="cls_016">OBESE PATIENTS</span></div> <div style="position:absolute;left:81.82px;top:476.08px" class="cls_016"><span class="cls_016">RSR</span></div> <div style="position:absolute;left:190.00px;top:476.08px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.62px;top:476.08px" class="cls_016"><span class="cls_016">28</span></div> <div style="position:absolute;left:341.93px;top:476.08px" class="cls_016"><span class="cls_016">50.0</span></div> <div style="position:absolute;left:420.70px;top:476.08px" class="cls_016"><span class="cls_016">87.00</span></div> <div style="position:absolute;left:497.34px;top:476.08px" class="cls_016"><span class="cls_016">21.12</span></div> <div style="position:absolute;left:81.82px;top:485.84px" class="cls_016"><span class="cls_016">AMAC</span></div> <div style="position:absolute;left:190.01px;top:485.84px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:485.84px" class="cls_016"><span class="cls_016">46</span></div> <div style="position:absolute;left:341.94px;top:485.84px" class="cls_016"><span class="cls_016">34.0</span></div> <div style="position:absolute;left:418.42px;top:485.84px" class="cls_016"><span class="cls_016">102.00</span></div> <div style="position:absolute;left:497.35px;top:485.84px" class="cls_016"><span class="cls_016">11.63</span></div> <div style="position:absolute;left:81.82px;top:495.61px" class="cls_016"><span class="cls_016">MAB</span></div> <div style="position:absolute;left:190.01px;top:495.61px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:495.61px" class="cls_016"><span class="cls_016">48</span></div> <div style="position:absolute;left:341.94px;top:495.61px" class="cls_016"><span class="cls_016">34.0</span></div> <div style="position:absolute;left:420.71px;top:495.61px" class="cls_016"><span class="cls_016">75.00</span></div> <div style="position:absolute;left:497.35px;top:495.61px" class="cls_016"><span class="cls_016">30.58</span></div> <div style="position:absolute;left:81.82px;top:505.38px" class="cls_016"><span class="cls_016">MPRF</span></div> <div style="position:absolute;left:190.01px;top:505.38px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:505.38px" class="cls_016"><span class="cls_016">43</span></div> <div style="position:absolute;left:341.94px;top:505.38px" class="cls_016"><span class="cls_016">34.5</span></div> <div style="position:absolute;left:420.71px;top:505.38px" class="cls_016"><span class="cls_016">94.00</span></div> <div style="position:absolute;left:499.64px;top:505.38px" class="cls_016"><span class="cls_016">6.89</span></div> <div style="position:absolute;left:81.82px;top:515.14px" class="cls_016"><span class="cls_016">ABEP</span></div> <div style="position:absolute;left:190.01px;top:515.14px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:515.14px" class="cls_016"><span class="cls_016">47</span></div> <div style="position:absolute;left:341.94px;top:515.14px" class="cls_016"><span class="cls_016">50.0</span></div> <div style="position:absolute;left:420.71px;top:515.14px" class="cls_016"><span class="cls_016">85.00</span></div> <div style="position:absolute;left:499.64px;top:515.14px" class="cls_016"><span class="cls_016">9.53</span></div> <div style="position:absolute;left:81.82px;top:524.91px" class="cls_016"><span class="cls_016">MDL</span></div> <div style="position:absolute;left:190.01px;top:524.91px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:524.91px" class="cls_016"><span class="cls_016">25</span></div> <div style="position:absolute;left:341.94px;top:524.91px" class="cls_016"><span class="cls_016">43.5</span></div> <div style="position:absolute;left:420.71px;top:524.91px" class="cls_016"><span class="cls_016">82.00</span></div> <div style="position:absolute;left:497.35px;top:524.91px" class="cls_016"><span class="cls_016">20.67</span></div> <div style="position:absolute;left:81.82px;top:534.68px" class="cls_016"><span class="cls_016">FAO</span></div> <div style="position:absolute;left:188.51px;top:534.68px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:534.68px" class="cls_016"><span class="cls_016">31</span></div> <div style="position:absolute;left:341.94px;top:534.68px" class="cls_016"><span class="cls_016">38.1</span></div> <div style="position:absolute;left:420.71px;top:534.68px" class="cls_016"><span class="cls_016">79.00</span></div> <div style="position:absolute;left:497.35px;top:534.68px" class="cls_016"><span class="cls_016">30.76</span></div> <div style="position:absolute;left:81.82px;top:544.44px" class="cls_016"><span class="cls_016">CEAA</span></div> <div style="position:absolute;left:188.51px;top:544.44px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:544.44px" class="cls_016"><span class="cls_016">24</span></div> <div style="position:absolute;left:341.94px;top:544.44px" class="cls_016"><span class="cls_016">44.0</span></div> <div style="position:absolute;left:420.71px;top:544.44px" class="cls_016"><span class="cls_016">94.00</span></div> <div style="position:absolute;left:497.35px;top:544.44px" class="cls_016"><span class="cls_016">53.17</span></div> <div style="position:absolute;left:81.82px;top:554.21px" class="cls_016"><span class="cls_016">JDMP</span></div> <div style="position:absolute;left:188.51px;top:554.21px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:554.21px" class="cls_016"><span class="cls_016">42</span></div> <div style="position:absolute;left:341.94px;top:554.21px" class="cls_016"><span class="cls_016">34.5</span></div> <div style="position:absolute;left:420.71px;top:554.21px" class="cls_016"><span class="cls_016">87.00</span></div> <div style="position:absolute;left:497.35px;top:554.21px" class="cls_016"><span class="cls_016">14.87</span></div> <div style="position:absolute;left:81.82px;top:563.98px" class="cls_016"><span class="cls_016">DPLL</span></div> <div style="position:absolute;left:188.52px;top:563.98px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.64px;top:563.98px" class="cls_016"><span class="cls_016">26</span></div> <div style="position:absolute;left:341.95px;top:563.98px" class="cls_016"><span class="cls_016">45.1</span></div> <div style="position:absolute;left:418.43px;top:563.98px" class="cls_016"><span class="cls_016">127.00</span></div> <div style="position:absolute;left:497.36px;top:563.98px" class="cls_016"><span class="cls_016">62.01</span></div> <div style="position:absolute;left:81.82px;top:573.74px" class="cls_016"><span class="cls_016">WSQ</span></div> <div style="position:absolute;left:188.51px;top:573.74px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:573.74px" class="cls_016"><span class="cls_016">46</span></div> <div style="position:absolute;left:341.94px;top:573.74px" class="cls_016"><span class="cls_016">37.8</span></div> <div style="position:absolute;left:418.42px;top:573.74px" class="cls_016"><span class="cls_016">108.00</span></div> <div style="position:absolute;left:497.35px;top:573.74px" class="cls_016"><span class="cls_016">21.47</span></div> <div style="position:absolute;left:81.82px;top:583.51px" class="cls_016"><span class="cls_016">JB</span></div> <div style="position:absolute;left:188.52px;top:583.51px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.64px;top:583.51px" class="cls_016"><span class="cls_016">36</span></div> <div style="position:absolute;left:341.95px;top:583.51px" class="cls_016"><span class="cls_016">43.8</span></div> <div style="position:absolute;left:418.43px;top:583.51px" class="cls_016"><span class="cls_016">112.00</span></div> <div style="position:absolute;left:497.36px;top:583.51px" class="cls_016"><span class="cls_016">27.73</span></div> <div style="position:absolute;left:81.82px;top:599.43px" class="cls_016"><span class="cls_016">Mean</span></div> <div style="position:absolute;left:260.91px;top:599.43px" class="cls_016"><span class="cls_016">36.83</span></div> <div style="position:absolute;left:339.65px;top:599.43px" class="cls_016"><span class="cls_016">40.78</span></div> <div style="position:absolute;left:420.71px;top:599.43px" class="cls_016"><span class="cls_016">94.33</span></div> <div style="position:absolute;left:497.35px;top:599.43px" class="cls_016"><span class="cls_016">25.87</span></div> <div style="position:absolute;left:81.82px;top:609.20px" class="cls_016"><span class="cls_016">SD</span></div> <div style="position:absolute;left:263.20px;top:609.20px" class="cls_016"><span class="cls_016">9.11</span></div> <div style="position:absolute;left:341.94px;top:609.20px" class="cls_016"><span class="cls_016">5.79</span></div> <div style="position:absolute;left:420.71px;top:609.20px" class="cls_016"><span class="cls_016">14.66</span></div> <div style="position:absolute;left:497.35px;top:609.20px" class="cls_016"><span class="cls_016">16.13</span></div> <div style="position:absolute;left:81.82px;top:625.12px" class="cls_016"><span class="cls_016">LEAN PATIENTS</span></div> <div style="position:absolute;left:81.82px;top:634.88px" class="cls_016"><span class="cls_016">VLVP</span></div> <div style="position:absolute;left:190.01px;top:634.88px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:634.88px" class="cls_016"><span class="cls_016">29</span></div> <div style="position:absolute;left:341.94px;top:634.88px" class="cls_016"><span class="cls_016">18.5</span></div> <div style="position:absolute;left:420.71px;top:634.88px" class="cls_016"><span class="cls_016">72.00</span></div> <div style="position:absolute;left:499.64px;top:634.88px" class="cls_016"><span class="cls_016">6.02</span></div> <div style="position:absolute;left:81.82px;top:644.65px" class="cls_016"><span class="cls_016">MFG</span></div> <div style="position:absolute;left:190.01px;top:644.65px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:644.65px" class="cls_016"><span class="cls_016">24</span></div> <div style="position:absolute;left:341.94px;top:644.65px" class="cls_016"><span class="cls_016">18.4</span></div> <div style="position:absolute;left:420.71px;top:644.65px" class="cls_016"><span class="cls_016">77.00</span></div> <div style="position:absolute;left:499.64px;top:644.65px" class="cls_016"><span class="cls_016">2.51</span></div> <div style="position:absolute;left:81.82px;top:654.42px" class="cls_016"><span class="cls_016">JBF</span></div> <div style="position:absolute;left:190.01px;top:654.42px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:654.42px" class="cls_016"><span class="cls_016">24</span></div> <div style="position:absolute;left:341.94px;top:654.42px" class="cls_016"><span class="cls_016">20.9</span></div> <div style="position:absolute;left:420.71px;top:654.42px" class="cls_016"><span class="cls_016">70.00</span></div> <div style="position:absolute;left:499.64px;top:654.42px" class="cls_016"><span class="cls_016">4.23</span></div> <div style="position:absolute;left:81.82px;top:664.18px" class="cls_016"><span class="cls_016">JAB</span></div> <div style="position:absolute;left:190.01px;top:664.18px" class="cls_016"><span class="cls_016">F</span></div> <div style="position:absolute;left:266.63px;top:664.18px" class="cls_016"><span class="cls_016">24</span></div> <div style="position:absolute;left:341.94px;top:664.18px" class="cls_016"><span class="cls_016">21.1</span></div> <div style="position:absolute;left:420.71px;top:664.18px" class="cls_016"><span class="cls_016">77.00</span></div> <div style="position:absolute;left:499.64px;top:664.18px" class="cls_016"><span class="cls_016">5.78</span></div> <div style="position:absolute;left:81.82px;top:673.95px" class="cls_016"><span class="cls_016">MNR</span></div> <div style="position:absolute;left:188.51px;top:673.95px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:673.95px" class="cls_016"><span class="cls_016">19</span></div> <div style="position:absolute;left:341.94px;top:673.95px" class="cls_016"><span class="cls_016">23.8</span></div> <div style="position:absolute;left:420.71px;top:673.95px" class="cls_016"><span class="cls_016">87.00</span></div> <div style="position:absolute;left:497.35px;top:673.95px" class="cls_016"><span class="cls_016">10.82</span></div> <div style="position:absolute;left:81.82px;top:683.72px" class="cls_016"><span class="cls_016">RVA</span></div> <div style="position:absolute;left:188.51px;top:683.72px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:683.72px" class="cls_016"><span class="cls_016">26</span></div> <div style="position:absolute;left:341.94px;top:683.72px" class="cls_016"><span class="cls_016">21.3</span></div> <div style="position:absolute;left:420.71px;top:683.72px" class="cls_016"><span class="cls_016">92.00</span></div> <div style="position:absolute;left:499.64px;top:683.72px" class="cls_016"><span class="cls_016">8.78</span></div> <div style="position:absolute;left:81.82px;top:693.48px" class="cls_016"><span class="cls_016">JCC</span></div> <div style="position:absolute;left:188.51px;top:693.48px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:693.48px" class="cls_016"><span class="cls_016">23</span></div> <div style="position:absolute;left:341.94px;top:693.48px" class="cls_016"><span class="cls_016">21.1</span></div> <div style="position:absolute;left:418.42px;top:693.48px" class="cls_016"><span class="cls_016">100.00</span></div> <div style="position:absolute;left:497.35px;top:693.48px" class="cls_016"><span class="cls_016">12.33</span></div> <div style="position:absolute;left:81.82px;top:703.25px" class="cls_016"><span class="cls_016">FOR</span></div> <div style="position:absolute;left:188.51px;top:703.25px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:703.25px" class="cls_016"><span class="cls_016">47</span></div> <div style="position:absolute;left:341.94px;top:703.25px" class="cls_016"><span class="cls_016">20.6</span></div> <div style="position:absolute;left:420.71px;top:703.25px" class="cls_016"><span class="cls_016">87.00</span></div> <div style="position:absolute;left:497.35px;top:703.25px" class="cls_016"><span class="cls_016">10.82</span></div> <div style="position:absolute;left:81.82px;top:713.02px" class="cls_016"><span class="cls_016">GMG</span></div> <div style="position:absolute;left:188.51px;top:713.02px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.63px;top:713.02px" class="cls_016"><span class="cls_016">19</span></div> <div style="position:absolute;left:341.94px;top:713.02px" class="cls_016"><span class="cls_016">23.4</span></div> <div style="position:absolute;left:418.42px;top:713.02px" class="cls_016"><span class="cls_016">112.00</span></div> <div style="position:absolute;left:499.64px;top:713.02px" class="cls_016"><span class="cls_016">8.66</span></div> <div style="position:absolute;left:81.82px;top:722.78px" class="cls_016"><span class="cls_016">DG</span></div> <div style="position:absolute;left:188.52px;top:722.78px" class="cls_016"><span class="cls_016">M</span></div> <div style="position:absolute;left:266.64px;top:722.78px" class="cls_016"><span class="cls_016">36</span></div> <div style="position:absolute;left:341.95px;top:722.78px" class="cls_016"><span class="cls_016">22.5</span></div> <div style="position:absolute;left:420.72px;top:722.78px" class="cls_016"><span class="cls_016">80.00</span></div> <div style="position:absolute;left:499.65px;top:722.78px" class="cls_016"><span class="cls_016">8.89</span></div> <div style="position:absolute;left:81.82px;top:738.70px" class="cls_016"><span class="cls_016">Mean</span></div> <div style="position:absolute;left:260.91px;top:738.70px" class="cls_016"><span class="cls_016">27.10</span></div> <div style="position:absolute;left:339.65px;top:738.70px" class="cls_016"><span class="cls_016">21.16</span></div> <div style="position:absolute;left:420.71px;top:738.70px" class="cls_016"><span class="cls_016">85.40</span></div> <div style="position:absolute;left:499.64px;top:738.70px" class="cls_016"><span class="cls_016">7.88</span></div> <div style="position:absolute;left:81.82px;top:748.47px" class="cls_016"><span class="cls_016">SD</span></div> <div style="position:absolute;left:263.20px;top:748.47px" class="cls_016"><span class="cls_016">8.10</span></div> <div style="position:absolute;left:341.94px;top:748.47px" class="cls_016"><span class="cls_016">1.70</span></div> <div style="position:absolute;left:420.71px;top:748.47px" class="cls_016"><span class="cls_016">12.48</span></div> <div style="position:absolute;left:499.64px;top:748.47px" class="cls_016"><span class="cls_016">2.99</span></div> <div style="position:absolute;left:377.16px;top:777.50px" class="cls_018"><span class="cls_018">Eating Weight Disord., Vol. 13: N. 1 - 2008</span></div> <div style="position:absolute;left:581.47px;top:777.73px" class="cls_013"><span class="cls_013">49</span></div> </div> <div style="position:absolute;left:50%;margin-left:-311px;top:1612px;width:623px;height:796px;border-style:outset;overflow:hidden"> <div style="position:absolute;left:0px;top:0px"><img src="d607e6f4-2d3e-11e8-b174-0cc47a792c0a_id_d607e6f4-2d3e-11e8-b174-0cc47a792c0a_files/background3.jpg" width="623" height="796" /></div> <div style="position:absolute;left:74.49px;top:18.70px" class="cls_019"><span class="cls_019">I.G.S. Rubio, G. Castro, A.C. Zanini, et al.</span></div> <div style="position:absolute;left:74.49px;top:56.62px" class="cls_020"><span class="cls_020">das Clinicas, University of São Paulo Medical</span></div> <div style="position:absolute;left:351.97px;top:56.36px" class="cls_024"><span class="cls_024">RESULTS</span></div> <div style="position:absolute;left:74.49px;top:68.56px" class="cls_020"><span class="cls_020">School. The study was carried out in accor-</span></div> <div style="position:absolute;left:74.49px;top:80.50px" class="cls_020"><span class="cls_020">dance with the Declaration of Helsinki.</span></div> <div style="position:absolute;left:330.14px;top:81.27px" class="cls_020"><span class="cls_020">All the twenty-two subjects (obese n=12, lean</span></div> <div style="position:absolute;left:320.79px;top:93.21px" class="cls_020"><span class="cls_020">n=10) included in the study were evaluated for</span></div> <div style="position:absolute;left:105.67px;top:104.37px" class="cls_021"><span class="cls_021">Study protocol</span></div> <div style="position:absolute;left:320.79px;top:105.14px" class="cls_020"><span class="cls_020">their respective glucose and insulin curves as</span></div> <div style="position:absolute;left:83.84px;top:116.31px" class="cls_020"><span class="cls_020">Patients were asked to eat a light meal and</span></div> <div style="position:absolute;left:320.79px;top:117.08px" class="cls_020"><span class="cls_020">well as secretion of gut peptides (ghrelin, GLP-</span></div> <div style="position:absolute;left:74.49px;top:128.25px" class="cls_020"><span class="cls_020">refrain from drinking alcoholic beverages the</span></div> <div style="position:absolute;left:320.79px;top:129.02px" class="cls_020"><span class="cls_020">1 and PYY) before and after the gelatin meal.</span></div> <div style="position:absolute;left:74.49px;top:140.18px" class="cls_020"><span class="cls_020">night before the study. After this evening meal</span></div> <div style="position:absolute;left:74.49px;top:152.12px" class="cls_020"><span class="cls_020">(8:00 pm), they were only allowed to drink</span></div> <div style="position:absolute;left:351.97px;top:152.89px" class="cls_021"><span class="cls_021">Serum glucose and insulin levels</span></div> <div style="position:absolute;left:74.49px;top:164.06px" class="cls_020"><span class="cls_020">water. The following day, at 7:30 am, they</span></div> <div style="position:absolute;left:330.14px;top:164.83px" class="cls_020"><span class="cls_020">The results are shown in Table 1 and Figure 1.</span></div> <div style="position:absolute;left:74.49px;top:176.00px" class="cls_020"><span class="cls_020">arrived at the Central Laboratory of the</span></div> <div style="position:absolute;left:320.79px;top:176.77px" class="cls_020"><span class="cls_020">Serum glucose concentrations were similar in</span></div> <div style="position:absolute;left:74.49px;top:187.93px" class="cls_020"><span class="cls_020">Hospital das Clinicas and an intravenous line</span></div> <div style="position:absolute;left:320.79px;top:188.71px" class="cls_020"><span class="cls_020">both groups at baseline and remained</span></div> <div style="position:absolute;left:74.49px;top:199.87px" class="cls_020"><span class="cls_020">was established. Before the first blood collec-</span></div> <div style="position:absolute;left:320.79px;top:200.64px" class="cls_020"><span class="cls_020">unchanged after the meal. At all times, serum</span></div> <div style="position:absolute;left:74.49px;top:211.81px" class="cls_020"><span class="cls_020">tion (time -30 minutes), patients were allowed</span></div> <div style="position:absolute;left:320.79px;top:212.58px" class="cls_020"><span class="cls_020">insulin levels in obese patients were significantly</span></div> <div style="position:absolute;left:74.49px;top:223.74px" class="cls_020"><span class="cls_020">to relax on a comfortable couch for 30 min-</span></div> <div style="position:absolute;left:320.79px;top:224.52px" class="cls_020"><span class="cls_020">higher as compared to lean subjects (p&lt;0.05).</span></div> <div style="position:absolute;left:74.49px;top:235.68px" class="cls_020"><span class="cls_020">utes. Blood was also collected at time 0 and</span></div> <div style="position:absolute;left:320.79px;top:236.45px" class="cls_020"><span class="cls_020">After the gelatin meal, both obese patients and</span></div> <div style="position:absolute;left:74.49px;top:247.62px" class="cls_020"><span class="cls_020">subsequently at 30, 60, 90, 120, 150 and 180</span></div> <div style="position:absolute;left:320.79px;top:248.39px" class="cls_020"><span class="cls_020">lean subjects had a significantly rise in serum</span></div> <div style="position:absolute;left:74.49px;top:259.56px" class="cls_020"><span class="cls_020">minutes in serum-separating tubes and</span></div> <div style="position:absolute;left:320.79px;top:260.33px" class="cls_020"><span class="cls_020">insulin, peaking at 30 min (lean subjects) and at</span></div> <div style="position:absolute;left:74.49px;top:271.49px" class="cls_020"><span class="cls_020">heparin-coated tubes containing</span></div> <div style="position:absolute;left:273.59px;top:271.49px" class="cls_020"><span class="cls_020">5,000</span></div> <div style="position:absolute;left:320.79px;top:272.27px" class="cls_020"><span class="cls_020">60 min (obese patients) (p&lt;0.01 as compared to</span></div> <div style="position:absolute;left:74.49px;top:283.43px" class="cls_020"><span class="cls_020">kallikrein inhibitor units (0.2 ml) of aprotinin</span></div> <div style="position:absolute;left:320.79px;top:284.20px" class="cls_020"><span class="cls_020">basal). In both groups, insulin values returned to</span></div> <div style="position:absolute;left:74.49px;top:295.37px" class="cls_020"><span class="cls_020">(Bayer Chemical). All blood tubes were imme-</span></div> <div style="position:absolute;left:320.79px;top:296.14px" class="cls_020"><span class="cls_020">basal levels after 180 min.</span></div> <div style="position:absolute;left:74.49px;top:307.30px" class="cls_020"><span class="cls_020">diately placed on ice before centrifugation at</span></div> <div style="position:absolute;left:74.49px;top:319.24px" class="cls_020"><span class="cls_020">4</span><span class="cls_022">o</span><span class="cls_020">C for 10 minutes at 1550 g to separate the</span></div> <div style="position:absolute;left:351.97px;top:320.01px" class="cls_021"><span class="cls_021">Plasma values of ghrelin</span></div> <div style="position:absolute;left:74.49px;top:331.18px" class="cls_020"><span class="cls_020">serum at the end of the test. Samples were</span></div> <div style="position:absolute;left:330.14px;top:331.95px" class="cls_020"><span class="cls_020">Mean plasma ghrelin levels were consistent-</span></div> <div style="position:absolute;left:74.49px;top:343.12px" class="cls_020"><span class="cls_020">stored at -70°C until analysis. At time 0, all</span></div> <div style="position:absolute;left:320.79px;top:343.89px" class="cls_020"><span class="cls_020">ly higher at all times in lean subjects (values</span></div> <div style="position:absolute;left:74.49px;top:355.05px" class="cls_020"><span class="cls_020">subjects were instructed to eat a meal with 20</span></div> <div style="position:absolute;left:74.49px;top:366.99px" class="cls_020"><span class="cls_020">grams of hydrolyzed gelatin (86% of protein),</span></div> <div style="position:absolute;left:74.49px;top:378.93px" class="cls_020"><span class="cls_020">that contained gelatin 92.6%, fumaric acid</span></div> <div style="position:absolute;left:341.23px;top:388.96px" class="cls_023"><span class="cls_023">110</span></div> <div style="position:absolute;left:558.25px;top:387.30px" class="cls_023"><span class="cls_023">Obese</span></div> <div style="position:absolute;left:74.49px;top:390.87px" class="cls_020"><span class="cls_020">4.14%, sodium citrate 1.4%, sodium chloride</span></div> <div style="position:absolute;left:558.25px;top:399.24px" class="cls_023"><span class="cls_023">Lean</span></div> <div style="position:absolute;left:74.49px;top:402.80px" class="cls_020"><span class="cls_020">0.8%, and flavored with artificial sweeteners</span></div> <div style="position:absolute;left:341.23px;top:407.09px" class="cls_023"><span class="cls_023">100</span></div> <div style="position:absolute;left:74.49px;top:414.74px" class="cls_020"><span class="cls_020">(acesulfame K 0.31% and aspartame 0.75%).</span></div> <div style="position:absolute;left:346.12px;top:425.21px" class="cls_023"><span class="cls_023">90</span></div> <div style="position:absolute;left:105.67px;top:438.61px" class="cls_021"><span class="cls_021">Hormone assays</span></div> <div style="position:absolute;left:346.12px;top:443.33px" class="cls_023"><span class="cls_023">80</span></div> <div style="position:absolute;left:83.84px;top:450.55px" class="cls_020"><span class="cls_020">Serum glucose and serum insulin were</span></div> <div style="position:absolute;left:74.49px;top:462.49px" class="cls_020"><span class="cls_020">assayed by colorimetric and immunofluoromet-</span></div> <div style="position:absolute;left:346.12px;top:461.46px" class="cls_023"><span class="cls_023">70</span></div> <div style="position:absolute;left:74.49px;top:474.43px" class="cls_020"><span class="cls_020">ric standardized assays, respectively, by the</span></div> <div style="position:absolute;left:351.02px;top:479.58px" class="cls_023"><span class="cls_023">0</span></div> <div style="position:absolute;left:74.49px;top:486.36px" class="cls_020"><span class="cls_020">Central Laboratory of Hospital das Clinicas,</span></div> <div style="position:absolute;left:387.14px;top:489.80px" class="cls_023"><span class="cls_023">0</span></div> <div style="position:absolute;left:437.06px;top:489.80px" class="cls_023"><span class="cls_023">30</span></div> <div style="position:absolute;left:489.43px;top:489.80px" class="cls_023"><span class="cls_023">60</span></div> <div style="position:absolute;left:539.36px;top:489.80px" class="cls_023"><span class="cls_023">180</span></div> <div style="position:absolute;left:74.49px;top:498.30px" class="cls_020"><span class="cls_020">University of São Paulo Medical School. Plasma</span></div> <div style="position:absolute;left:418.62px;top:499.70px" class="cls_023"><span class="cls_023">Time of observation (min)</span></div> <div style="position:absolute;left:74.49px;top:510.24px" class="cls_020"><span class="cls_020">PYY, GLP-1 and total ghrelin were assayed in</span></div> <div style="position:absolute;left:346.11px;top:517.94px" class="cls_023"><span class="cls_023">60</span></div> <div style="position:absolute;left:74.49px;top:522.17px" class="cls_020"><span class="cls_020">duplicate using commercially available specific</span></div> <div style="position:absolute;left:557.99px;top:522.22px" class="cls_023"><span class="cls_023">Obese</span></div> <div style="position:absolute;left:74.49px;top:534.11px" class="cls_020"><span class="cls_020">and sensitive radioimmunoassays (PYY-67HK;</span></div> <div style="position:absolute;left:346.11px;top:534.22px" class="cls_023"><span class="cls_023">50</span></div> <div style="position:absolute;left:557.99px;top:534.16px" class="cls_023"><span class="cls_023">Lean</span></div> <div style="position:absolute;left:74.49px;top:546.05px" class="cls_020"><span class="cls_020">GLP1T-36HK; GHRT-89HK; Linco Research,</span></div> <div style="position:absolute;left:346.11px;top:550.49px" class="cls_023"><span class="cls_023">40</span></div> <div style="position:absolute;left:74.49px;top:557.99px" class="cls_020"><span class="cls_020">Missouri, USA) following the manufacturers’</span></div> <div style="position:absolute;left:346.11px;top:566.77px" class="cls_023"><span class="cls_023">30</span></div> <div style="position:absolute;left:74.49px;top:569.92px" class="cls_020"><span class="cls_020">protocols. All samples from a given subject</span></div> <div style="position:absolute;left:74.49px;top:581.86px" class="cls_020"><span class="cls_020">were analyzed using the same kit to avoid</span></div> <div style="position:absolute;left:346.11px;top:583.05px" class="cls_023"><span class="cls_023">20</span></div> <div style="position:absolute;left:74.49px;top:593.80px" class="cls_020"><span class="cls_020">inter-assay variation.</span></div> <div style="position:absolute;left:346.11px;top:599.33px" class="cls_023"><span class="cls_023">10</span></div> <div style="position:absolute;left:351.00px;top:615.61px" class="cls_023"><span class="cls_023">0</span></div> <div style="position:absolute;left:105.67px;top:617.67px" class="cls_021"><span class="cls_021">Statistical analysis</span></div> <div style="position:absolute;left:386.88px;top:624.72px" class="cls_023"><span class="cls_023">0</span></div> <div style="position:absolute;left:436.80px;top:624.72px" class="cls_023"><span class="cls_023">30</span></div> <div style="position:absolute;left:489.18px;top:624.72px" class="cls_023"><span class="cls_023">60</span></div> <div style="position:absolute;left:539.10px;top:624.72px" class="cls_023"><span class="cls_023">180</span></div> <div style="position:absolute;left:83.84px;top:629.61px" class="cls_020"><span class="cls_020">Plasma concentrations of ghrelin, GLP-1 and</span></div> <div style="position:absolute;left:418.37px;top:634.62px" class="cls_023"><span class="cls_023">Time of observation (min)</span></div> <div style="position:absolute;left:74.49px;top:641.55px" class="cls_020"><span class="cls_020">PYY were compared between groups (obese</span></div> <div style="position:absolute;left:74.49px;top:653.48px" class="cls_020"><span class="cls_020">versus lean) using analysis of variance for</span></div> <div style="position:absolute;left:438.47px;top:657.78px" class="cls_025"><span class="cls_025">FIGURE 1</span></div> <div style="position:absolute;left:74.49px;top:665.42px" class="cls_020"><span class="cls_020">repeated measures (ANOVA), as well as the</span></div> <div style="position:absolute;left:334.55px;top:668.63px" class="cls_025"><span class="cls_025">Mean and SD of serum glucose and insulin concentrations before</span></div> <div style="position:absolute;left:74.49px;top:677.36px" class="cls_020"><span class="cls_020">moment/time of observation (repetition factor),</span></div> <div style="position:absolute;left:341.56px;top:679.48px" class="cls_025"><span class="cls_025">and after the gelatin meal (</span><span class="cls_026">↓</span><span class="cls_025">) in both obese patients and lean</span></div> <div style="position:absolute;left:74.49px;top:689.30px" class="cls_020"><span class="cls_020">using a correlation matrix of symmetrical com-</span></div> <div style="position:absolute;left:330.95px;top:690.33px" class="cls_025"><span class="cls_025">subjects. Obese patients had a significantly higher concentration of</span></div> <div style="position:absolute;left:74.49px;top:701.23px" class="cls_020"><span class="cls_020">ponents. The Kolmogorov-Smirnov test indi-</span></div> <div style="position:absolute;left:336.25px;top:701.18px" class="cls_025"><span class="cls_025">serum insulin at all times (p&lt;0.05). Both obese patients and lean</span></div> <div style="position:absolute;left:74.49px;top:713.17px" class="cls_020"><span class="cls_020">cated that all gut hormones data were normally</span></div> <div style="position:absolute;left:327.12px;top:712.03px" class="cls_025"><span class="cls_025">subjects had a significant rise in insulin concentrations that peaked at</span></div> <div style="position:absolute;left:333.41px;top:722.88px" class="cls_025"><span class="cls_025">60 min (obese) and 30 min (lean) (p&lt;0.01) as compared to basal</span></div> <div style="position:absolute;left:74.49px;top:725.11px" class="cls_020"><span class="cls_020">distributed. For significance analysis, two by</span></div> <div style="position:absolute;left:343.19px;top:733.73px" class="cls_025"><span class="cls_025">levels. Glucose concentrations were similar in both groups at</span></div> <div style="position:absolute;left:74.49px;top:737.04px" class="cls_020"><span class="cls_020">two analysis using Tukey multiple comparison</span></div> <div style="position:absolute;left:362.96px;top:744.59px" class="cls_025"><span class="cls_025">baseline and remained unchanged after the meal.</span></div> <div style="position:absolute;left:74.49px;top:748.98px" class="cls_020"><span class="cls_020">procedure was employed.</span></div> <div style="position:absolute;left:30.84px;top:777.73px" class="cls_027"><span class="cls_027">50</span></div> <div style="position:absolute;left:80.72px;top:777.50px" class="cls_028"><span class="cls_028">Eating Weight Disord., Vol. 13: N. 1 - 2008</span></div> </div> <div style="position:absolute;left:50%;margin-left:-311px;top:2418px;width:623px;height:796px;border-style:outset;overflow:hidden"> <div style="position:absolute;left:0px;top:0px"><img src="d607e6f4-2d3e-11e8-b174-0cc47a792c0a_id_d607e6f4-2d3e-11e8-b174-0cc47a792c0a_files/background4.jpg" width="623" height="796" /></div> <div style="position:absolute;left:354.37px;top:18.64px" class="cls_019"><span class="cls_019">Oral gelatin ingestion and gut peptides</span></div> <div style="position:absolute;left:74.49px;top:56.62px" class="cls_020"><span class="cls_020">between 1,080.2±241 pg/ml and 1,271.66±</span></div> <div style="position:absolute;left:320.79px;top:56.62px" class="cls_020"><span class="cls_020">significant reduction of PYY levels at 150 and</span></div> <div style="position:absolute;left:74.49px;top:68.56px" class="cls_020"><span class="cls_020">385pg/ml) compared to values in obese</span></div> <div style="position:absolute;left:320.79px;top:68.56px" class="cls_020"><span class="cls_020">180 min compared to the levels before the</span></div> <div style="position:absolute;left:74.49px;top:80.50px" class="cls_020"><span class="cls_020">patients (values between 925.89±238.63 and</span></div> <div style="position:absolute;left:320.79px;top:80.50px" class="cls_020"><span class="cls_020">gelatin meal (time -30, p=0.015; and time 0,</span></div> <div style="position:absolute;left:74.49px;top:92.43px" class="cls_020"><span class="cls_020">1,155.74±596 pg/ml); however, it did not attain</span></div> <div style="position:absolute;left:320.79px;top:92.43px" class="cls_020"><span class="cls_020">p=0.009 respectively).</span></div> <div style="position:absolute;left:74.49px;top:104.37px" class="cls_020"><span class="cls_020">statistical significance (p=0.249) (Fig. 2). Mean</span></div> <div style="position:absolute;left:74.49px;top:116.31px" class="cls_020"><span class="cls_020">ghrelin values did not differ over time for</span></div> <div style="position:absolute;left:351.97px;top:116.31px" class="cls_021"><span class="cls_021">Correlation between BMI and basal mean</span></div> <div style="position:absolute;left:74.49px;top:128.25px" class="cls_020"><span class="cls_020">either group (p=0.052).</span></div> <div style="position:absolute;left:351.97px;top:128.25px" class="cls_021"><span class="cls_021">levels of ghrelin, GLP-1 and PYY</span></div> <div style="position:absolute;left:330.14px;top:140.18px" class="cls_020"><span class="cls_020">Spearman’s analysis showed no significant</span></div> <div style="position:absolute;left:105.67px;top:152.12px" class="cls_021"><span class="cls_021">Plasma concentrations of GLP-1</span></div> <div style="position:absolute;left:320.79px;top:152.12px" class="cls_020"><span class="cls_020">correlation between BMI (kg/m</span><span class="cls_022"><sup>2</sup></span><span class="cls_020">) and plasma lev-</span></div> <div style="position:absolute;left:83.84px;top:164.06px" class="cls_020"><span class="cls_020">GLP-1 concentrations are shown in Figure 3.</span></div> <div style="position:absolute;left:320.79px;top:164.06px" class="cls_020"><span class="cls_020">els of the three gut peptides at 0 and 30 minutes.</span></div> <div style="position:absolute;left:74.49px;top:176.00px" class="cls_020"><span class="cls_020">Analysis of variance indicated that both groups</span></div> <div style="position:absolute;left:74.49px;top:187.93px" class="cls_020"><span class="cls_020">(lean and obese) exhibited the same behavior</span></div> <div style="position:absolute;left:74.49px;top:199.87px" class="cls_020"><span class="cls_020">over time (p=0.119). A significant rise of GLP-1</span></div> <div style="position:absolute;left:351.97px;top:198.83px" class="cls_024"><span class="cls_024">DISCUSSION</span></div> <div style="position:absolute;left:74.49px;top:211.81px" class="cls_020"><span class="cls_020">after the gelatin meal was observed (p=0.012) in</span></div> <div style="position:absolute;left:74.49px;top:223.74px" class="cls_020"><span class="cls_020">both groups at 60 and 120 minutes compared</span></div> <div style="position:absolute;left:330.14px;top:223.74px" class="cls_020"><span class="cls_020">A growing number of gut-brain peptides</span></div> <div style="position:absolute;left:74.49px;top:235.68px" class="cls_020"><span class="cls_020">to the basal values (p=0.028 and p=0.02 in lean</span></div> <div style="position:absolute;left:320.79px;top:235.68px" class="cls_020"><span class="cls_020">have been shown to affect short-term food</span></div> <div style="position:absolute;left:74.49px;top:247.62px" class="cls_020"><span class="cls_020">and obese group, respectively). The highest</span></div> <div style="position:absolute;left:320.79px;top:247.62px" class="cls_020"><span class="cls_020">intake when administered acutely to experi-</span></div> <div style="position:absolute;left:74.49px;top:259.56px" class="cls_020"><span class="cls_020">GLP-1 plasma concentrations were observed at</span></div> <div style="position:absolute;left:320.79px;top:259.56px" class="cls_020"><span class="cls_020">mental animals and humans (12). It is known</span></div> <div style="position:absolute;left:74.49px;top:271.49px" class="cls_020"><span class="cls_020">120 minutes after the test meal.</span></div> <div style="position:absolute;left:320.79px;top:271.49px" class="cls_020"><span class="cls_020">that PYY and GLP-1 are released from the gut</span></div> <div style="position:absolute;left:320.79px;top:283.43px" class="cls_020"><span class="cls_020">in proportion to the volume, calories and com-</span></div> <div style="position:absolute;left:105.67px;top:295.37px" class="cls_021"><span class="cls_021">Plasma concentrations of PYY</span></div> <div style="position:absolute;left:320.79px;top:295.37px" class="cls_020"><span class="cls_020">position of nutrients in an ingested meal (3).</span></div> <div style="position:absolute;left:83.84px;top:307.30px" class="cls_020"><span class="cls_020">Mean PYY values were statistically higher in</span></div> <div style="position:absolute;left:320.79px;top:307.30px" class="cls_020"><span class="cls_020">The 28 amino acid peptide ghrelin stimulates</span></div> <div style="position:absolute;left:74.49px;top:319.24px" class="cls_020"><span class="cls_020">lean subjects than in obese patients at all</span></div> <div style="position:absolute;left:320.79px;top:319.24px" class="cls_020"><span class="cls_020">food intake, whereas other peptides including</span></div> <div style="position:absolute;left:74.49px;top:331.18px" class="cls_020"><span class="cls_020">times (p&lt;0.04) (range values for lean subjects</span></div> <div style="position:absolute;left:320.79px;top:331.18px" class="cls_020"><span class="cls_020">GLP-1, PYY, CCK, and amylin inhibit food</span></div> <div style="position:absolute;left:74.49px;top:343.12px" class="cls_020"><span class="cls_020">146.04±42 pg/ml and 162.26±50 pg/ml; for</span></div> <div style="position:absolute;left:320.79px;top:343.12px" class="cls_020"><span class="cls_020">intake (13). Furthermore, PYY infusion reduces</span></div> <div style="position:absolute;left:74.49px;top:355.05px" class="cls_020"><span class="cls_020">obese subjects 96.53±29 pg/ml and 105.21±18</span></div> <div style="position:absolute;left:320.79px;top:355.05px" class="cls_020"><span class="cls_020">cumulative 24 hours food intake both in lean</span></div> <div style="position:absolute;left:74.49px;top:366.99px" class="cls_020"><span class="cls_020">pg/ml). Analysis over time showed that obese</span></div> <div style="position:absolute;left:320.79px;top:366.99px" class="cls_020"><span class="cls_020">subjects and obese patients (6). In experimental</span></div> <div style="position:absolute;left:74.49px;top:378.93px" class="cls_020"><span class="cls_020">patients exhibited a significant attenuation of</span></div> <div style="position:absolute;left:320.79px;top:378.93px" class="cls_020"><span class="cls_020">animals, PYY and GLP-1 inhibit food intake</span></div> <div style="position:absolute;left:74.49px;top:390.86px" class="cls_020"><span class="cls_020">plasma PYY secretion 30 minutes after the</span></div> <div style="position:absolute;left:320.79px;top:390.86px" class="cls_020"><span class="cls_020">additively, being co-secreted after a meal (7).</span></div> <div style="position:absolute;left:74.49px;top:402.80px" class="cls_020"><span class="cls_020">ingestion of gelatin compared to values at</span></div> <div style="position:absolute;left:330.14px;top:402.80px" class="cls_020"><span class="cls_020">Several studies (10,11,14-17) have indicated</span></div> <div style="position:absolute;left:74.49px;top:414.74px" class="cls_020"><span class="cls_020">time 0 (p=0.034). Lean subjects also exhibited a</span></div> <div style="position:absolute;left:320.79px;top:414.74px" class="cls_020"><span class="cls_020">that consumption of dietary protein seems to</span></div> <div style="position:absolute;left:58.16px;top:465.39px" class="cls_023"><span class="cls_023">1500</span></div> <div style="position:absolute;left:513.14px;top:469.14px" class="cls_023"><span class="cls_023">Obese</span></div> <div style="position:absolute;left:513.14px;top:481.07px" class="cls_023"><span class="cls_023">Lean</span></div> <div style="position:absolute;left:58.16px;top:496.32px" class="cls_023"><span class="cls_023">1400</span></div> <div style="position:absolute;left:58.16px;top:527.25px" class="cls_023"><span class="cls_023">1300</span></div> <div style="position:absolute;left:58.16px;top:558.18px" class="cls_023"><span class="cls_023">1200</span></div> <div style="position:absolute;left:58.16px;top:589.11px" class="cls_023"><span class="cls_023">1100</span></div> <div style="position:absolute;left:58.16px;top:620.04px" class="cls_023"><span class="cls_023">1000</span></div> <div style="position:absolute;left:62.47px;top:650.96px" class="cls_023"><span class="cls_023">900</span></div> <div style="position:absolute;left:62.47px;top:681.89px" class="cls_023"><span class="cls_023">800</span></div> <div style="position:absolute;left:103.47px;top:691.69px" class="cls_023"><span class="cls_023">-30</span></div> <div style="position:absolute;left:161.21px;top:691.69px" class="cls_023"><span class="cls_023">0</span></div> <div style="position:absolute;left:212.34px;top:691.69px" class="cls_023"><span class="cls_023">30</span></div> <div style="position:absolute;left:265.36px;top:691.69px" class="cls_023"><span class="cls_023">60</span></div> <div style="position:absolute;left:317.82px;top:691.69px" class="cls_023"><span class="cls_023">90</span></div> <div style="position:absolute;left:368.96px;top:691.69px" class="cls_023"><span class="cls_023">120</span></div> <div style="position:absolute;left:421.72px;top:691.69px" class="cls_023"><span class="cls_023">150</span></div> <div style="position:absolute;left:475.31px;top:691.69px" class="cls_023"><span class="cls_023">180</span></div> <div style="position:absolute;left:246.96px;top:701.75px" class="cls_023"><span class="cls_023">Time of observation (min)</span></div> <div style="position:absolute;left:271.67px;top:720.72px" class="cls_025"><span class="cls_025">FIGURE 2</span></div> <div style="position:absolute;left:48.54px;top:731.57px" class="cls_025"><span class="cls_025">Mean and SD of plasma ghrelin levels before and after the gelatin meal (</span><span class="cls_026">↓</span><span class="cls_025">). Lean subjects had consistently more elevated plasma</span></div> <div style="position:absolute;left:185.98px;top:742.42px" class="cls_025"><span class="cls_025">ghrelin levels at all time as compared to obese patients.</span></div> <div style="position:absolute;left:377.16px;top:777.50px" class="cls_028"><span class="cls_028">Eating Weight Disord., Vol. 13: N. 1 - 2008</span></div> <div style="position:absolute;left:581.45px;top:777.73px" class="cls_027"><span class="cls_027">51</span></div> </div> <div style="position:absolute;left:50%;margin-left:-311px;top:3224px;width:623px;height:796px;border-style:outset;overflow:hidden"> <div style="position:absolute;left:0px;top:0px"><img src="d607e6f4-2d3e-11e8-b174-0cc47a792c0a_id_d607e6f4-2d3e-11e8-b174-0cc47a792c0a_files/background5.jpg" width="623" height="796" /></div> <div style="position:absolute;left:74.49px;top:18.70px" class="cls_019"><span class="cls_019">I.G.S. Rubio, G. Castro, A.C. Zanini, et al.</span></div> <div style="position:absolute;left:106.12px;top:66.24px" class="cls_023"><span class="cls_023">250</span></div> <div style="position:absolute;left:556.79px;top:70.50px" class="cls_023"><span class="cls_023">Obese</span></div> <div style="position:absolute;left:556.79px;top:82.44px" class="cls_023"><span class="cls_023">Lean</span></div> <div style="position:absolute;left:106.12px;top:109.65px" class="cls_023"><span class="cls_023">200</span></div> <div style="position:absolute;left:106.12px;top:153.06px" class="cls_023"><span class="cls_023">150</span></div> <div style="position:absolute;left:106.12px;top:196.47px" class="cls_023"><span class="cls_023">100</span></div> <div style="position:absolute;left:111.01px;top:239.87px" class="cls_023"><span class="cls_023">50</span></div> <div style="position:absolute;left:115.90px;top:283.28px" class="cls_023"><span class="cls_023">0</span></div> <div style="position:absolute;left:147.12px;top:293.05px" class="cls_023"><span class="cls_023">-30</span></div> <div style="position:absolute;left:204.86px;top:293.05px" class="cls_023"><span class="cls_023">0</span></div> <div style="position:absolute;left:255.99px;top:293.05px" class="cls_023"><span class="cls_023">30</span></div> <div style="position:absolute;left:309.01px;top:293.05px" class="cls_023"><span class="cls_023">60</span></div> <div style="position:absolute;left:361.47px;top:293.05px" class="cls_023"><span class="cls_023">90</span></div> <div style="position:absolute;left:412.60px;top:293.05px" class="cls_023"><span class="cls_023">120</span></div> <div style="position:absolute;left:465.36px;top:293.05px" class="cls_023"><span class="cls_023">150</span></div> <div style="position:absolute;left:518.95px;top:293.05px" class="cls_023"><span class="cls_023">180</span></div> <div style="position:absolute;left:290.60px;top:303.11px" class="cls_023"><span class="cls_023">Time of observation (min)</span></div> <div style="position:absolute;left:315.32px;top:321.63px" class="cls_025"><span class="cls_025">FIGURE 3</span></div> <div style="position:absolute;left:164.36px;top:332.48px" class="cls_025"><span class="cls_025">Mean and SD of plasma GLP-1 levels before and after the gelatin meal (</span><span class="cls_026">↓</span><span class="cls_025">) in both groups.</span></div> <div style="position:absolute;left:74.49px;top:379.54px" class="cls_020"><span class="cls_020">decrease postprandial appetite and subsequent</span></div> <div style="position:absolute;left:320.79px;top:379.54px" class="cls_020"><span class="cls_020">study that presented a rise in serum insulin lev-</span></div> <div style="position:absolute;left:74.49px;top:391.48px" class="cls_020"><span class="cls_020">food intake more intensively than carbohydrate</span></div> <div style="position:absolute;left:320.79px;top:391.48px" class="cls_020"><span class="cls_020">els after the gelatin meal due to incretin (GLP-1)</span></div> <div style="position:absolute;left:74.49px;top:403.42px" class="cls_020"><span class="cls_020">and fat meals. Moreover these reports empha-</span></div> <div style="position:absolute;left:320.79px;top:403.42px" class="cls_020"><span class="cls_020">release. This finding may be useful for type 2</span></div> <div style="position:absolute;left:74.49px;top:415.36px" class="cls_020"><span class="cls_020">size the importance of considering the impact</span></div> <div style="position:absolute;left:320.79px;top:415.36px" class="cls_020"><span class="cls_020">diabetic patients that are in need for incretins</span></div> <div style="position:absolute;left:74.49px;top:427.29px" class="cls_020"><span class="cls_020">of protein type on the appetite response to a</span></div> <div style="position:absolute;left:320.79px;top:427.29px" class="cls_020"><span class="cls_020">effect on insulin release to obtain a better con-</span></div> <div style="position:absolute;left:74.49px;top:439.23px" class="cls_020"><span class="cls_020">meal. For instance, whey protein produces a</span></div> <div style="position:absolute;left:320.79px;top:439.23px" class="cls_020"><span class="cls_020">trol of glycemic levels.</span></div> <div style="position:absolute;left:74.49px;top:451.17px" class="cls_020"><span class="cls_020">prolonged suppression of ghrelin and elevation</span></div> <div style="position:absolute;left:330.14px;top:451.17px" class="cls_020"><span class="cls_020">Although plasma ghrelin levels were consis-</span></div> <div style="position:absolute;left:74.49px;top:463.10px" class="cls_020"><span class="cls_020">of GLP-1 and CCK that is reduced when com-</span></div> <div style="position:absolute;left:320.79px;top:463.10px" class="cls_020"><span class="cls_020">tently lower in obese patients in comparison</span></div> <div style="position:absolute;left:74.49px;top:475.04px" class="cls_020"><span class="cls_020">bined with fructose (16). A high (30%) protein</span></div> <div style="position:absolute;left:320.79px;top:475.04px" class="cls_020"><span class="cls_020">with lean subjects, the variance analysis of the</span></div> <div style="position:absolute;left:74.49px;top:486.98px" class="cls_020"><span class="cls_020">diet induces a higher GLP-1 concentration as</span></div> <div style="position:absolute;left:320.79px;top:486.98px" class="cls_020"><span class="cls_020">data did not indicate statistical differences (p=</span></div> <div style="position:absolute;left:74.49px;top:498.92px" class="cls_020"><span class="cls_020">compared to adequate (10%) protein diet. This</span></div> <div style="position:absolute;left:320.79px;top:498.92px" class="cls_020"><span class="cls_020">0.052). Low ghrelin levels in obese subjects have</span></div> <div style="position:absolute;left:74.49px;top:510.85px" class="cls_020"><span class="cls_020">is accompanied by increase satiety (15).</span></div> <div style="position:absolute;left:320.79px;top:510.85px" class="cls_020"><span class="cls_020">been shown in previous studies (19). Plasma lev-</span></div> <div style="position:absolute;left:83.84px;top:522.79px" class="cls_020"><span class="cls_020">Our findings indicate that a simple protein</span></div> <div style="position:absolute;left:320.79px;top:522.79px" class="cls_020"><span class="cls_020">els of PYY were also consistently lower in obese</span></div> <div style="position:absolute;left:74.49px;top:534.73px" class="cls_020"><span class="cls_020">meal consisting of 20 g of gelatin may induce</span></div> <div style="position:absolute;left:320.79px;top:534.73px" class="cls_020"><span class="cls_020">patients compared to lean subjects (p=NS) but</span></div> <div style="position:absolute;left:74.49px;top:546.66px" class="cls_020"><span class="cls_020">an elevation of GLP-1 as early as 30 minutes</span></div> <div style="position:absolute;left:320.79px;top:546.66px" class="cls_020"><span class="cls_020">did not show significant changes over time.</span></div> <div style="position:absolute;left:74.49px;top:558.60px" class="cls_020"><span class="cls_020">after ingestion of the meal. The mean plasma</span></div> <div style="position:absolute;left:320.79px;top:558.60px" class="cls_020"><span class="cls_020">BMI (kg/m</span><span class="cls_022"><sup>2</sup></span><span class="cls_020">) did not correlate with any of the</span></div> <div style="position:absolute;left:74.49px;top:570.54px" class="cls_020"><span class="cls_020">level of GLP-1 was significantly higher at 60</span></div> <div style="position:absolute;left:320.78px;top:570.54px" class="cls_020"><span class="cls_020">three peptides studied at 0 and 30 minutes.</span></div> <div style="position:absolute;left:74.49px;top:582.48px" class="cls_020"><span class="cls_020">and 120 minutes compared to basal levels, with</span></div> <div style="position:absolute;left:330.14px;top:582.48px" class="cls_020"><span class="cls_020">Dietary manipulations that maximize satiety</span></div> <div style="position:absolute;left:74.49px;top:594.41px" class="cls_020"><span class="cls_020">a peak at 120 minutes, decreasing to basal val-</span></div> <div style="position:absolute;left:320.78px;top:594.41px" class="cls_020"><span class="cls_020">have obvious applications for the overweight</span></div> <div style="position:absolute;left:74.49px;top:606.35px" class="cls_020"><span class="cls_020">ues at 180 minutes.</span></div> <div style="position:absolute;left:320.78px;top:606.35px" class="cls_020"><span class="cls_020">population as a means of improving compli-</span></div> <div style="position:absolute;left:83.84px;top:618.29px" class="cls_020"><span class="cls_020">Protein ingestion (gelatin meal) requires a</span></div> <div style="position:absolute;left:320.78px;top:618.29px" class="cls_020"><span class="cls_020">ance with calorie-controlled diets. Therefore, a</span></div> <div style="position:absolute;left:74.49px;top:630.22px" class="cls_020"><span class="cls_020">longer time than carbohydrate (glucose, fruc-</span></div> <div style="position:absolute;left:320.78px;top:630.23px" class="cls_020"><span class="cls_020">simple gelatin based meal containing around 20</span></div> <div style="position:absolute;left:74.49px;top:642.16px" class="cls_020"><span class="cls_020">tose) to be digested and absorbed, presumably</span></div> <div style="position:absolute;left:320.78px;top:642.16px" class="cls_020"><span class="cls_020">g of gelatin ingested one hour before the main</span></div> <div style="position:absolute;left:74.49px;top:654.10px" class="cls_020"><span class="cls_020">reaching more distal regions in the small intes-</span></div> <div style="position:absolute;left:320.78px;top:654.10px" class="cls_020"><span class="cls_020">meals could be useful in reducing appetite and</span></div> <div style="position:absolute;left:74.49px;top:666.04px" class="cls_020"><span class="cls_020">tine. Gelatin protein is considered to be “rapid-</span></div> <div style="position:absolute;left:320.78px;top:666.04px" class="cls_020"><span class="cls_020">consequently, energy intake of the obese</span></div> <div style="position:absolute;left:74.49px;top:677.97px" class="cls_020"><span class="cls_020">ly” digested and absorbed relatively to other</span></div> <div style="position:absolute;left:320.78px;top:677.97px" class="cls_020"><span class="cls_020">patient. Thus, it is possible that the increase of</span></div> <div style="position:absolute;left:74.49px;top:689.91px" class="cls_020"><span class="cls_020">more complex proteins and similarly to whey</span></div> <div style="position:absolute;left:320.78px;top:689.91px" class="cls_020"><span class="cls_020">GLP-1 observed in obese patients could medi-</span></div> <div style="position:absolute;left:74.49px;top:701.85px" class="cls_020"><span class="cls_020">(18). Therefore we may assume that gelatin, like</span></div> <div style="position:absolute;left:320.78px;top:701.85px" class="cls_020"><span class="cls_020">ate a satiety signal in the complex hypothalamic</span></div> <div style="position:absolute;left:74.49px;top:713.79px" class="cls_020"><span class="cls_020">whey, is a potent insulinotropic dietary protein</span></div> <div style="position:absolute;left:320.78px;top:713.79px" class="cls_020"><span class="cls_020">centers, inducing a small but useful decrease in</span></div> <div style="position:absolute;left:74.49px;top:725.72px" class="cls_020"><span class="cls_020">through its stimulation of incretins such as</span></div> <div style="position:absolute;left:320.78px;top:725.72px" class="cls_020"><span class="cls_020">appetite. Moreover GLP-1 has insulinotropic</span></div> <div style="position:absolute;left:74.49px;top:737.66px" class="cls_020"><span class="cls_020">GLP-1. This effect was nicely demonstrated in</span></div> <div style="position:absolute;left:320.78px;top:737.66px" class="cls_020"><span class="cls_020">properties (incretin) that would favor the</span></div> <div style="position:absolute;left:74.49px;top:749.60px" class="cls_020"><span class="cls_020">both obese patients and lean subjects in our</span></div> <div style="position:absolute;left:320.78px;top:749.60px" class="cls_020"><span class="cls_020">release of insulin.</span></div> <div style="position:absolute;left:30.84px;top:777.73px" class="cls_027"><span class="cls_027">52</span></div> <div style="position:absolute;left:80.72px;top:777.50px" class="cls_028"><span class="cls_028">Eating Weight Disord., Vol. 13: N. 1 - 2008</span></div> </div> <div style="position:absolute;left:50%;margin-left:-311px;top:4030px;width:623px;height:796px;border-style:outset;overflow:hidden"> <div style="position:absolute;left:0px;top:0px"><img src="d607e6f4-2d3e-11e8-b174-0cc47a792c0a_id_d607e6f4-2d3e-11e8-b174-0cc47a792c0a_files/background6.jpg" width="623" height="796" /></div> <div style="position:absolute;left:354.37px;top:18.64px" class="cls_002"><span class="cls_002">Oral gelatin ingestion and gut peptides</span></div> <div style="position:absolute;left:83.84px;top:56.62px" class="cls_011"><span class="cls_011">In conclusion, we have observed that a</span></div> <div style="position:absolute;left:328.21px;top:57.14px" class="cls_006"><span class="cls_006">8. Verdich C., Flint A., Gutzwiller J.P., Noslund E.,</span></div> <div style="position:absolute;left:337.93px;top:66.91px" class="cls_006"><span class="cls_006">Beglinger C., Hellstrom P.M., Long S.J., Morjan L.M.,</span></div> <div style="position:absolute;left:74.49px;top:68.56px" class="cls_011"><span class="cls_011">gelatin meal offered to both obese and lean</span></div> <div style="position:absolute;left:337.93px;top:76.68px" class="cls_006"><span class="cls_006">Holst J.J., Astrup A.: A meta-analysis of the effect of</span></div> <div style="position:absolute;left:74.49px;top:80.50px" class="cls_011"><span class="cls_011">subjects induces a significant rise in GLP-1 lev-</span></div> <div style="position:absolute;left:337.93px;top:86.45px" class="cls_006"><span class="cls_006">glucagon-like peptide-1 (7-36) amide on ad libitum</span></div> <div style="position:absolute;left:74.49px;top:92.43px" class="cls_011"><span class="cls_011">els after 30 minutes, with a peak at 120 minutes.</span></div> <div style="position:absolute;left:337.93px;top:96.21px" class="cls_006"><span class="cls_006">energy intake in humans. J. Clin. Endocrinol. Metab.,</span></div> <div style="position:absolute;left:74.49px;top:104.37px" class="cls_011"><span class="cls_011">There was no effect on plasma concentrations</span></div> <div style="position:absolute;left:337.93px;top:105.98px" class="cls_006"><span class="cls_006">86, 4382-4389, 2001.</span></div> <div style="position:absolute;left:74.49px;top:116.31px" class="cls_011"><span class="cls_011">of ghrelin and PYY. A gelatin meal preprandial-</span></div> <div style="position:absolute;left:328.21px;top:119.19px" class="cls_006"><span class="cls_006">9. Latner J.D., Schwartz M.: The effects of a high-carbo-</span></div> <div style="position:absolute;left:74.49px;top:128.25px" class="cls_011"><span class="cls_011">ly could therefore be useful in maximizing sati-</span></div> <div style="position:absolute;left:337.93px;top:128.96px" class="cls_006"><span class="cls_006">hydrate, high-protein or balanced lunch upon later</span></div> <div style="position:absolute;left:337.93px;top:138.73px" class="cls_006"><span class="cls_006">food intake and hunger ratings. Appetite, 33, 119-128,</span></div> <div style="position:absolute;left:74.49px;top:140.18px" class="cls_011"><span class="cls_011">ety in the obese population as well as to provid-</span></div> <div style="position:absolute;left:337.93px;top:148.49px" class="cls_006"><span class="cls_006">1999.</span></div> <div style="position:absolute;left:74.49px;top:152.12px" class="cls_011"><span class="cls_011">ing a surge of insulin that may be helpful for a</span></div> <div style="position:absolute;left:323.81px;top:161.71px" class="cls_006"><span class="cls_006">10. Bowen J., Noakes M., Clifton P.M.: Appetite regulatory</span></div> <div style="position:absolute;left:74.49px;top:164.06px" class="cls_011"><span class="cls_011">better control of diabetic patients.</span></div> <div style="position:absolute;left:337.93px;top:171.47px" class="cls_006"><span class="cls_006">hormone responses to various dietary proteins differ</span></div> <div style="position:absolute;left:337.93px;top:181.24px" class="cls_006"><span class="cls_006">by body mass index status despite similar reductions in</span></div> <div style="position:absolute;left:337.93px;top:191.01px" class="cls_006"><span class="cls_006">ad libitum energy intake. J. Clin. Endocrinol. Metab.,</span></div> <div style="position:absolute;left:105.67px;top:198.83px" class="cls_010"><span class="cls_010">ACKNOWLEDGEMENTS</span></div> <div style="position:absolute;left:337.93px;top:200.77px" class="cls_006"><span class="cls_006">91, 2913-2919, 2006.</span></div> <div style="position:absolute;left:323.63px;top:213.99px" class="cls_006"><span class="cls_006">11. Bellissimo N., Desantadina M.V., Pencharz P.B.,</span></div> <div style="position:absolute;left:74.49px;top:223.70px" class="cls_029"><span class="cls_029">We are grateful to Suzimara Vicente Oliveira, RN and</span></div> <div style="position:absolute;left:337.93px;top:223.75px" class="cls_006"><span class="cls_006">Berall G.B., Thomas S.G., Anderson G.H.: A compari-</span></div> <div style="position:absolute;left:74.49px;top:234.55px" class="cls_029"><span class="cls_029">Jacyra M. Lima who supervised the tests in the</span></div> <div style="position:absolute;left:337.93px;top:233.52px" class="cls_006"><span class="cls_006">son of short-term appetite and energy intakes in nor-</span></div> <div style="position:absolute;left:337.93px;top:243.29px" class="cls_006"><span class="cls_006">mal weight and obese boys following glucose and</span></div> <div style="position:absolute;left:74.49px;top:245.40px" class="cls_029"><span class="cls_029">Central Laboratory of the Hospital das Clinicas. The</span></div> <div style="position:absolute;left:337.93px;top:253.05px" class="cls_006"><span class="cls_006">whey-protein drinks. Int. J. Obes., Epub. Aug 14, 1-</span></div> <div style="position:absolute;left:74.49px;top:256.25px" class="cls_029"><span class="cls_029">expert secretarial work of Margarida Lemos and the</span></div> <div style="position:absolute;left:337.93px;top:262.82px" class="cls_006"><span class="cls_006">10, 2007.</span></div> <div style="position:absolute;left:74.49px;top:267.10px" class="cls_029"><span class="cls_029">statistical analysis by Rogerio R. Prado are gratefully</span></div> <div style="position:absolute;left:323.81px;top:276.03px" class="cls_006"><span class="cls_006">12. Strader A.D., Woods S.C.: Gastrointestinal hormones</span></div> <div style="position:absolute;left:74.49px;top:277.95px" class="cls_029"><span class="cls_029">acknowledged. This work was supported by a</span></div> <div style="position:absolute;left:337.93px;top:285.80px" class="cls_006"><span class="cls_006">and food intake. Gastroenterology, 128, 175-191, 2005.</span></div> <div style="position:absolute;left:74.49px;top:288.80px" class="cls_029"><span class="cls_029">Research Grant from Gelita do Brasil, São Paulo,</span></div> <div style="position:absolute;left:74.49px;top:299.65px" class="cls_029"><span class="cls_029">Brazil.</span></div> <div style="position:absolute;left:323.81px;top:299.01px" class="cls_006"><span class="cls_006">13. van der Lely A.J., Tschop M., Heiman M.L., Ghigo E.:</span></div> <div style="position:absolute;left:337.93px;top:308.78px" class="cls_006"><span class="cls_006">Biological, physiological, pathophysiological, and</span></div> <div style="position:absolute;left:337.93px;top:318.55px" class="cls_006"><span class="cls_006">pharmacological aspects of ghrelin. Endocr. 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