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Č A S O P I S D R U Š T V A Z A I S H R A N U S R B I J ET H E J O U R N A L O F S E R B I A N N U T R I T I O N S O C I E T Y

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FOOD AND NUTRITION ПИЩА И ПИТАНИЕ LES ALIMENTS ET L’ALIMENTATION NAHRUNG UND ERNÄHRUNG

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МИНИСТАРСТВО ПРОСВЕТЕ, НАУКЕ И ТЕХНОЛОШКОГ

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Alfi eri Simone, MS• Correlation between bone and glucide metabolism depending on the nutritional

status in diabetic patients ............................................................................... 37

Luketina – Šunjka Marina• Efekti primene redukcione niskoproteinske ishrane kod pacijenata sa

dijabetesom complicate tip I i hipertenzijom ........................................ 42• The eff ects inclusion of Reducing Low Protein diet in patients with

Diabetes complicate type 1 and hipertensionm

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Jelena Golijan, Aleksandar Ž. Kostić• Značaj polifenola iz žitarica u ljudskoj ishrani .................................... 47• Polyphenolic from grains – importance for human nutrition

Despotovic M Milena, Despotovic Mile, Ilic Biljana, Stanojevic Cedomirka, Stanojevic Vojislav, Urosevic Jadranka• The impact of nutrition on the health of the elderly ........................... 53• Uticaj ishrane na zdravlje starih

Obaveštenja o skupovima / Featured Meetings.................................................... 58

Uputstvo autorima / Instruction to Authors ............................................................. 59

VOL. 57 BEOGRAD, 2016. BROJ 2

UDK:613.2 CODENHRIS-A ISSN 0018-68727

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DRUŠTVO ZA ISHRANU SRBIJE, ČASOPIS ˝HRANA I ISHRANA˝ SERBIAN NUTRITION S0CIETY, JOuRNAL ˝FOOD AND NuTRITION˝

Beograd, Savska 9/II, tel: 011/ 420 2998; p. fah: 333Žiro račun: 355-1032408-17

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 37-41, 2016. Alfieri Simone, MS: Correlation between bone and glucide metabolism depending on the nutritional status in diabetic patients 37

Correlation between bone and glucide metabolism depending on the nutritional status in diabetic patients

ABSTRACTIntroduction: The risk of osteoporotic fractures is increased in

patients with either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM)

Aim: Evaluate the relationship between nutritional status, dairy calcium intake, serum levels of vitamin D, glycemic control, the onset of osteoporosis and/or bone fractures predisposition in diabetic patients.

Methods: The sample consists of 1151 patients (350 men and 801 women) divided into three groups: 400 patients with T1DM of which 19 with osteoporosis (age 42,39±13.66 yo; BMI 23,88±3,28), 401 patients with T2DM of which 64 with osteoporosis (age 62.01±13.21 yo; BMI 30,25±8,83), 350 non-diabetic patients with osteoporosis (NDP) (age 64.59±10.45 yo; BMI 25,64±4,17). In all subjects nutritional status, anthropometric, metabolic and glycemic control parameters, BMD (as T- score) at the lumbar spine (LSBMD), femoral neck (FN-BMD) and total femur (Ftot-BMD) were measured. Prevalence of bone fractures between the different groups were determined.

Results and Discussion: Low vitamin D levels were found in both T1DM (16.38±2.74ng/mL) and T2DM (15.04±9.35ng/mL) as well as low daily calcium intake (634.84±159.97mg/day and 649.43±189.86mg/day, respectively). About 89% of T1DM and 37,5% of T2DM had T-score ≥-2,5; T1DM had also a FN-BMD (Tscore: -2.373±0.68 vs -1.91±0.72; p=0.016) and Ftot-BMD (T-score: -2.368±0.79 vs -1.60±0.96; p=0.003) significantly lower than T2DM and a LS-BMD significantly lower compared to NDP (T- score: -2.26±0.79 vs -2.91±0.86). Instead, T2DM had a LS-BMD, FN-BMD and Ftot-BMD significantly higher than those of NDP (p=0.0001, p=0.004, p=0.007). We didn’t found a positive correlation between BMD and HBA1c. 1% of TIDM, 3.2% of T2DM and 14.8% of NDP had vertebral fractures; 22.7%, 9.2% and 14% had nonvertebral fractures. T2DM had 38% reduction in risk of non-vertebral fractures (OR 0.62, 95% CI=0.39- 0.98) compared with controls; instead, T1DM had an increased risk of non-vertebral fractures (OR 1.81, 95% CI 1.24-2.66).

Conclusions: We confirm that T1D had an increased risk of fractures. Calcium intake and vitamin D resulted insufficient in all groups. HBA1c did not affect BMD or risk of fractures in all groups.

Keywords: Diabetes, Osteoporosis, Fracture, Nutritional Status

Alfieri Simone, MS a,b

a Department of clinical nutrition, Biomedical Campus, Rome, Italyb Department of diabetology, Gemelli Hospital, Rome, Italy

Received: 3th October 2016.

UDK: 616.379-008.64:616.71-007.234613.2-056.24:616.379-008.64

INTRODuCTION

Since Albright first proposed the concept of “diabetic osteopenia”, many studies have investigated the levels of bone mineral density (BMD) and the risk of osteoporosis in type 1 and type 2 diabetes [1]. Diabetes mellitus and low-trauma fractures are the major causes of morbidity and premature mortality worldwide. Although several observational studies have been investigated the association between diabetes and risk of fractures, the role of diabetes as a potential risk factor for osteoporosis and low- trauma fractures remains unsettled [1].

The risk of osteoporotic fractures is increased in patients with both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Although BMD is decreased in T1DM, BMD in T2DM is often normal or even slightly elevated compared to an age-matched control population. However, in both

T1DM and T2DM, bone turnover is decreased and the bone material properties and microstructure of bone are altered. This is reflect- ed in a decrease in serum markers of bone formation, such as osteocalcin [2]. However, the pathophysiological mechanisms underlying bone fragility in diabetes mellitus are complex, and include hyperglycemia, oxidative stress and the accumulation of advanced glycation end products that compromise collagen properties, increase marrow adiposity, release inflammatory factors and adipokines from visceral fat, and potentially alter the function of osteocytes. Additional factors including treatment-induced hypoglycemia, different antidiabetic medications with a direct effect on bone and mineral metabolism (such as thiazolidinediones), as well as an increased predisposition to falls, all contribute to the increased fracture risk in patients with diabetes [2].

In particular, T1DM does appear to be a significant risk factor for osteoporosis (OP). Many


of the nutrients and food components we consume as part of a Westernized diet can potentially have a positive or negative impact on bone health. They may influence bone by various mechanisms, including alteration of bone structure, the rate of bone metabolism, the endocrine and/or paracrine system, and homeostasis of calcium and possibly of other bone-active mineral elements. These dietary factors range from inorganic minerals (e.g., calcium, magnesium, phosphorus, sodium, potassium, and various trace elements) and vitamins (vitamins A, D, E, K, C, and certain B vitamins), to macronutrients, such as protein and fatty acids. Protein has been identified as being both detrimental and beneficial to bone health, depending on a variety of factors, including the level of proteins in the diet, the protein source, calcium intake, weight loss, and the acid/base balance of the diet. Currently, we recommend that patients with both types of diabetes must be monitored more carefully than persons without diabetes, and should be encouraged to consume a diet rich in both calcium (at least 1200 mg/day) and vitamin D (400-600 IU/day). Adequate calcium intake is critical to achieving optimal peak bone mass and modifies the rate of bone loss associated with aging. There is a considerable body of evidence that vitamin D deficiency is an important contributor to osteoporosis through less efficient intestinal absorption of calcium, increased bone loss, muscle weakness, and a weakened bone microstructure. Increasing vitamin D intake can significantly reduce risk of bone fracture in older people.

It appears that intensive insulin therapy and a stable body weight in patients with type 1 diabetes is important to prevent bone loss [3].

The aim of this study was to evaluate the relationship between nutritional status, dairy calcium intake, serum levels of vitamin D, glycemic control, the onset of osteoporosis and/or bone fractures predisposition in diabetic patients. In addition, the differences between diabetic and non diabetic patients regards to anthropometric and physiologic parameters in relation to the onset of fractures were evaluated.

MATERIAL AND METHODS

Between November 2014 and July 2015, a total of 1151 patients were enrolled. According to the National Health and Nutrition Examination Survey, in all subjects, anthropometric parameters (age, BMI, waist and wrist circumference), cardio-metabolic parameters (basal metabolism, diastolic and systolic pressure, total cholesterol, HDL, LDL, triglycerides, serum levels of vitamin D) and parameters related to glycemic control (fasting glucose and HbA1c) were first evaluated. Then, parameters related to nutritional status, like energy intake and nutrients intake, were determined throughout a validated food frequency questionnaire.

BMD (as T-score) at the lumbar spine (LS-BMD), at femoral neck (FN-BMD) and at total femur (Ftot- BMD) were also measured with Dual energy X Ray Absorptiometry. The risk factors involved in the etiology of osteoporosis and the prevalence of bone fracture between the different groups were determined throughout two different quality of life questionnaires: the QUALEFFO-41

was used for patients with vertebral fractures [4], and the IOF Wrist Fracture Questionnaire was used for patients with wrist fractures [5]. For what concerning statistical analyses, the characteristics of all participants were compared to identify the main differences related to the anthropometric and physiological parameters between the different groups surveyed. Subsequently, the characteristics of type 1 diabetes mellitus (TIDM) and type 2 diabetes mellitus (TIIDM) patients were compared to identify the differences between the two groups and, after this, they wer e compared with non-diabetic patients (NDP). The IBM SPSS statistical software has been used, using model Analysis of Variance (ANOVA), which allows the analysis of variance of the various parameters in relation to the observed variables. In the case in which the variable considered is linked in a statistically significant manner to the variable of interest, this will be expressed by a p-value (probability of obtaining a result equal to or more extreme than the one observed, suppository true the null hypothesis, that is, the hypothesis you want to check in the test) equal to or less than 0.05.

RESuLTS

In the period between November 2013 and July 2014, a total of 1151 patients were enrolled in this study. Among them, 350 (30%) were men and 801 (70%) women. The patients were divided into three groups according to their pathology. The first group consists of 400 patients with T1DM of which 19 (5%) with osteoporosis (age 42,39±13.66 yo; BMI 23,88±3,28), the second group consists of 401 patients with T2DM of which 64 (16%) with osteoporosis (age 62.01±13.21 yo; BMI 30,25±8,83) and the third group consists of

350 non-diabetic patients with osteoporosis (NDP) (age 64.59 ± 10.45 years; BMI 25,64±4,17). It was observed that the age of patients with T1DM was significantly lower compared to both patients with T2DM (p = 0.0001) and non-diabetic patients (p = 0.02). As expected, both BMI (p = 0.0001) and waist circumference (p = 0.0001) were higher in T2DM patients than the other two groups.

Regard to the cardio-metabolic parameters, patients with T2DM showed higher value of systolic blood pressure, total cholesterol (202.8 ± 38.63 vs. 175.17 ± 23, 79; p = 0.0001), LDL cholesterol (151.69 ± 37.05 vs 129.26 ± 24.54; p = 0.001) and triglycerides (117.38 ± 38.17 vs 72.71 ± 21,62; p = 0.0001), but lower level of HDL (27,63 ± 31,37 ± 5.6 vs 7.5; p = 0.0001) than patients with T1DM. The serum levels of vitamin D were higher in non-diabetic patients compared to both T1DM (21.18 ± 9.75 vs 16.38 ± 2.74 ng/mL) and T2DM patients (21.18 ± 9.75 vs. 15.04 ± 9.35 ng/mL). However, all patients showed an inverse correlation between serum levels of vitamin D and their age. All groups presented low level of this vitamin (vitamin D<30 ng/ml).

Regard to the nutritional status, the comparison between T1DM patients and T2DM patients showed a significant difference between all parameters, except for daily calcium intake. For what concerning this parameter, examination of the data showed that diabetic subjects had higher daily calcium intake than non-diabetics (DMI vs OP: 634.84 ± 159.97


mg / day vs 592.21 ± 130.72 mg / day ; p = 0.0001) (DMII vs OP: 649.43 ± 189.86 mg / day vs 592.21 ± 130.72 mg / day; p = 0.003) (Fig. 1). Further, a significant correlation between daily calcium intake, BMI (p = 0.001) and waist circumference (p = 0.011) was observed in patients with T1DM. About daily caloric intake, as expected, it was higher in patients with T2DM, who consume a lot of animal protein (p = 0.0001), than other groups.

Regards to the analysis of the bone mineral density, patients with T1DM had a femoral neck (T-score: -2.373 ± 0.68 vs -1.91 ± 0.72; p = 0.016) and total hip BMD (T-score: -2.368 ± 0.79 vs -1.60 ± 0.96; p = 0.003) lower than patients with T2DM, and they have lower column BMD compared to non-diabetic patients (T- score: -2.26 ± 0.79 vs. -2.91 ± 0.86). Instead patients with T2DM had lumbar spine, femoral neck and total hip BMD higher than non-diabetic with osteoporosis patients (p = 0.0001, p = 0.004; p = 0.007). Patients with T1DM showed different cardio-metabolic parameters and a significant correlation between BMD analyzed in various locations and the basal metabolism of the diabetic. In the T2DM patients a correlation between BMD at lumbar spine and basal metabolism with vitamin D was observed. Instead in non-diabetic group a significant correlation between femoral neck BMD and vitamin D level emerged. Further analyzing the values related to the glycemic control (fasting blood glucose T2DM: 182.67 ± 74.59 vs T1DM: 136.64 ± 56.60 vs OP: 92.29 ± 20.87 mg / dL) (glycated hemoglobin T2DM : 8.12 ± 2.31 vs T1DM: 7.15 ± 0.77; p = 0.0001) in both diabetes patient groups, it seems that these parameters did not affect BMD. In addiction, no significant correlations emerged between BMD and the factors related to the glycemic control (fasting blood glucose and glycated hemoglobin). It seems that there was no significant correlation between BMD and parameters related to the nutritional status in patients with T1DM, whilst BMD of the total femur is significantly correlated to the percentage of animal protein and sodium intake in patients with T2DM. Furthermore, no significant correlation between BMD and daily calcium intake emerged.

Regard to the fractures, 93 patients with only osteoporosis (26,60%); 19 patients with both T1DM

and osteoporosis (4.75%) and 44 patients with T2DM and osteoporosis (11%) had at least one fracture (Fig. 2). Fractures analysis showed that respectively 1% T1DM patients, 3.2% of T2DM and 14.8% of NDP had vertebral fractures; 22.7%, 9.2% and 14% had non-vertebral fractures and 23.2%, 10.2% and 26.9% had total fractures in the three different groups. Furthermore, a logistic regression for different fractures was performed as reported in table 1. Patients with T1DM showed an increased risk of fractures with an OR of 1.81 (95% CI 1.24 to 2.66) compared to controls. Instead, patients with T2DM showed an odds ratio (OR) of 0.62 (95% confidence interval (CI)= 0.39 to 0.98) and a reduced risk of 38% related to the non-vertebral fractures compared to controls.

DISCuSSION

Several studies have shown that there is a correlation between bone and glucose metabolism in patients with diabetes who may reflect an increased risk of fractures, nevertheless the mechanisms involved are not yet fully known. Diabetes can affect bone metabolism via different mechanisms, many of which can have contradictory effects. In this context, the aim of this study was to evaluate the relationship between nutritional status, dairy calcium intake, serum levels of vitamin D, glycemic control, the onset of osteoporosis and/or bone fractures predisposition in diabetic patients. In addition, the differences between diabetic and non diabetic patients regards to anthropometric and physiologic parameters in relation to the onset of fractures wer e evaluated.

The serum levels of vitamin D observed were significantly higher in non-diabetic patients compared to patients with both types of diabetes. However, all groups of patients had low levels of vitamin D (vitamin D <30NG / ml). In addition, both groups of diabetic patients analyzed had lower values of vitamin D compared to patients with osteoporosis and it seems to be inversely correlated to age. To reduce the risk of fractures in diabetic patients is necessary to ensure an adequate intake of vitamin D; its deficit can increase the risk of

Fig. 1 Daily calcium intake in all groupsDM1= type 1 diabetes DM2= type 2 diabetes OP= osteoporosis

Fig. 2 Percentage of patients with almost one fracture in the dif-ferent groupsDM1= type 1 diabetes DM2= type 2 diabetes OP= osteoporosis


fractures. The recommended quantity of vitamin D in adults and elderly should be about 30µg/day, since it reduces the risk of falls and fractures by 20 and 23%. The main source of vitamin D for humans is the light exposure throughout endogenous synthesis. The mechanisms involved in vitamin D deficiency in obese subjects are not fully known; it has been hypothesized that the reduced exposure to sunlight and low intake in the diet can contribute to this deficiency. Moreover, it is likely that the excessive surface fat present in the obese, act as a depot, limiting the circulating levels of vitamin D. In addition, a deficiency of vitamin D could play a role in the development of insulin resistance and, consequently, in type II diabetes mellitus. Some studies report that patients with low levels of vitamin D have lower insulin sensitivity than those with normal levels. Although the role of vitamin D in the onset of diabetes mellitus is not entirely known, several studies have shown that an adequate daily intake of vitamin D could reduce the risk of developing diabetes through stimulation of insulin synthesis at the level of beta cells of the pancreas, stimulating the expression of insulin receptors or regulating calcium homeostasis, which is essential for intracellular signals mediated by insulin.

Furthermore, calcium intake was significantly higher in patients with diabetes compared to non-diabetic and was positively correlated to BMI, glycated hemoglobin and waist circumference. The adequate calcium intake is fundamental to reduce the risk of osteoporosis and the onset of the fractures in patients with diabetes. The daily recommended levels of calcium intake are 1000mg/day for healthy adults and 1200mg/day for elderly people, because, with age, the absorption of calcium in the intestine decreases.

The most important factor related to the calcium intake regards its bioavailability, the fraction of dietary calcium that is potentially absorbable and the incorporation of the absorbed calcium into bone.

Various dietary factors can affect calcium bioavailability. Some food components act synergistically to pro- mote calcium absorption. They include: vitamin D, lactose and casein phosphopeptides present in milk [6]. Instead, other food components, such as phytates, oxalates, polyphenols (such as the tannic and caffeic acid), fatty acids and dietary fiber, may limit the bioavailability of this microelement. For this reason, some plant foods, although they are good

sources of calcium, in terms of absolute content, they do not provide coverage of the recommended requirements.

Regards to the BMD observed, the results of this study confirmed that patients with diabetes type I had low levels of BMD at all sites compared to diabetes type II patients. The risk of fractures in type I diabetes is due primarily, to a reduction in BMD that results from an absolute deficiency of insulin and IGF-1 and which results in low values of peak bone mass. In patients with T2DM, obesity and insulin resistance leads to increased bone formation. Regards to the nutritional status, the BMD of the total femur of patients with T2DM appears to be related to both the percentage of animal protein and the sodium intake; whilst in no group ther e was a correlation between BMD and daily calcium intake. Nevertheless, patients with T2DM showed a BMD of the spine, total femur and femoral neck higher than non-diabetic patients.

In addition, an inadequate glycemic control for both groups of diabetic patients, despite their dietary and drug treatment, was observed but it did not reveal any correlation between BMD and the fundamental factors related to glycemic control (fasting blood glucose and glycated hemoglobin).

Finally, the greater bone loss observed in diabetic patients leads to an increased risk of spontaneous pathological fractures. In the present study, the prevalence of fractures appears to be greater in non-diabetic patients compared to those with diabetes, probably due to the small number of the sample. Moreover, patients with T2DM had a reduced risk of 38% compared to patients with T1DM regards to the non-vertebral fractures. Starting from these results, it is reasonable to carry out a broader screening for diabetes patients in the future. The ineffectiveness of BMD in assessing fractures risk in patients with T2DM leads to problems to perform risk assessment and to initiate therapy for the prevention of fractures in clinical practice. Although there are several candidates (osteocalcin, AGEs and insulin) for this purpose, yet it is unclear whether they can effectively be used in clinical practice.

CONCLuSIONS

The lack of effective treatments for degenerative diseases such as osteoporosis places increased emphasis on a preventative approach, including

frattw· OR IC

T1DM

FX non vert. 1,80 1,24 2,67

Fx vert. 0,058 0,02 0,14

Fx tot. 0,83 0,59 1,15

T2DM

FX non vert. 0,62 0,39 0,98

Fx vert. 0,19 0,99 0,35

Fx tot. 0,31 0,21 0,46

OR= odds ratio, IC = confidence interval

Table 1. Analysis offractme risk in patients with T1DM and T2DM compared with controls


dietary strategies. The therapeutic considerations in diabetic patients with osteoporosis may be considered simple recommendation of “good clinical practice” evidence based and they should include: maintaining a good control of glycaemia, minimizing hypoglycemic episode, preventing diabetes complication, especially renal pathology, evaluating and prevent falls, supplementing calcium and vitamin D, practicing physical activity to minimize the risk of falls, using anti-osteoporotic treatment like alendronate.

In conclusion, to achieve a good glycemic control throughout proper nutrition and an adequate level of physical activity in patients with diabetes appears to be the best way to prevent and treat this disease.

ACKNOWLEDGEMENTS

The author gratefully acknowledge the diabetology department of Gemelli, Rome, Italy and the endocrinology department of Biomedical Campus, Rome, Italy.

Conflicts of interest

The author declare that they have no competing interests.

REFERENCES

1. Janghorbani et al, Systematic Review of Type 1 and Type 2 Diabetes Mellitus and Risk of Fracture Am. J. Epidemiol. (2007) 166 (5): 495-505

2. Napoli N et al., Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol. 2016 Sep 23.

3. Campos Pastor et al., Intensive insulin therapy and bone mineral density in type 1 diabetes mellitus: a prospective study. Osteoporos Int. 2000;11(5):455-9.

4. Tadic I et al., Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population. Health Qual Life Outcomes. 2012 Jun 18;10:74

5. Lips P et al., Validation of the IOF quality of life questionnaire for patients with wrist fracture. Osteoporosis Int. 2010 Jan;21(1):61-70

6. Caroli A et al. Invited review: Dairy intake and bone health: A viewpoint from the state of the art. J Dair Sci2011;94(11):

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 42-46, 2016. Luketina – Šunjka Marina: Efekti primene redukcione niskoproteinske ishrane kod pacijenata sa dijabetesom complicate tip I i hipertenzijom42

Efekti primene redukcione niskoproteinske ishrane kod pacijenata sa dijabetesom complicate tip I i hipertenzijom

Kratak sadržajUvod Početak bubrežnih bolesti često bude neprepoznat, a

i neretko koegzistira uz druge hronične bolesti (na pr. dijabetes i kardiovaskularne bolesti, KVB). U literaturi je malo objavljenih slučaja kojima je primenom dijete odložena dijaliza kod dijabetesa complicate tip I. Cilj rada je praćenje efekata primene redukcione niskoproteinske (RNP) dijete koja bi kod hroničnih bolesnika sa oštećenom funkcijom bubrega dovela do promene praćenih parametara, kao posledice dijabetesa i hipertenzije. Prikaz bolesnika Prikazana su dva slučaja sa hroničnim zdravstvenim problemima, jedan ima dijabetes melitus tipa 1, a drugi ima hipertenziju, oba sa komplikacijama na bubrezima, što se vidi, povećanjem uree i kreatinina, kojima je uspešno primenjena RNP dijeta. Kod prvog slučaja, korekcijom vrednosti uree i kreatinina je odložena dijaliza, a kod drugog su trajno rešene komplikacije. U radu je dat i kratak pregled objavljenih radova na temu primene redukcione niskoproteinske dijete. Novo u radu je to, što je prilikom izbora namirnica, uspešno korišćen novi metodološki pristup testiranja, elektropunkturna dijagnostika po Voll-u (EPD). Nakon eliminacije namirnica sa visokim sadržajem proteina izvršeno je testiranje EPD čime se dobio usko individualni izbor namirnica za svakog pacijenta ponaosob. Prilikom izbora namirnica, akcenat je stavljan, na one sa visokim procentom hranljivih sastojaka, kao antioksidanasa, flavonoida, vitamina, minerala, nezasićenih masnih kiselina, posebno tipa omega3. Zaključak Prikaz ova dva slučaja praktično obezbedjuju jedan od dokaza da je primena ovakvog načina ishrane ne samo sprečila nastanak novih bolesti, nego pomogla u sanaciji postojećih. Zbog toga se preporučuje ozbiljan multidisciplinaran pristup, prilikom lečenja ovakvih pacijenata, koji bi se još mogao proveriti kroz studiju na većem broju uzoraka. Radom na kvalitetu života hroničnih pacijenata, primenom RNP dijete može se znatno uštedeti u troškovima lečenja.

Ključne reči: redukciona dijeta, niskoproteinska dijeta, kreatinin, urea elektropunkturna dijagnostika po Voll-u, antioksidansi

Luketina – Šunjka MarinaSavetovalište za ishranu, doo 4lifebiodesign Beograd, Beograd, Resavska br.11, Srbija

Primljeno: 06.10.2016.

Kontakt adresa:[email protected] 333 0 126 Marina Luketina ŠunjkaĐačkog bataljona 7а 11500 Obrenovac

UDK: 613.2-056.24:616.379-008.64

Uvod

Dijabetes je jedno od najčešćih hroničnih nezaraznih oboljenja i predstavlja veliki javno-zdravstveni problem. Svetska zdravstvena organizacija (SZO) i Medjunarodna federacija za dijabetes (IDF) procenjuju da će se do 2030. godine broj obolelih povećati na 438 sa 347 miliona ljudi koliko je bilo 2012. godine [1]. Vrlo često, uz dijabetes, hipertenziju i KVB koegzistiraju hronične bubrežne bolesti (chronic kidney disease – CKD) tako da sam početak CKD često bude neprepoznat [2]. Medju faktorima rizika, za učestalost i razvoj hroničnih bubrežnih bolesti CKD, važnu ulogu ima ishrana. Upotreba zaštitnih hranljivih sastojaka, ishranom, kao što su nezasićene omega 3 masne kiseline, biljna vlakna, vitaminski antioksidansi (A, C i E), flavonski antioskidanti kao resferatrol, antocijani, kurkumin [3], od posebnog značaja su minerali kalcijum, magnezijum, koji zajedno sa pomenutim, povoljno utiču na funkciju bubrega i smanjuju rizik od CKD. To su pokazali obrasci Mediteranske ishrane i Dietary Approaches to Stop Hypertension (DASH)

[4]. Najnovija istraživanja iz 2016. godine, koja su sprovedena kroz Tehran Lipid and Glucose Study [5] su takodje pokazali značaj principa i mehanizama redukcione niskoproteinske dijete [6]. Na osnovu meta analize koju su uradili Pan i saradnici iz 2008. godine, pregledanjem 8 randomizovanih kontrolisanih kliničkih studija, shvaćeno je da je RNP dijeta od velikog značaja za smanjenje razvoja CKD [7]. U ovom radu će biti prikazani slučajevi na kojima je vrlo uspešno primenjena RNP dijeta.

METOD

Tokom višegodišnjeg rada i velikog broja pacijenata čiji broj dostiže blizu 3000, pregledanjem njihove medicinske dokumentacije izdvojena su dva slučaja. Prvi, zbog toga, što je reč o pacijentu sa teškom hroničnom bolešću, sa nizom komplikacija, kome je primenom RNP dijete uspešno sprečen razvoj istih. A drugi, je bio značajan zbog toga, što je primena RNP dijete omogućila trajnu sanaciju komplikacija.

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 42-46, 2016. Luketina – Šunjka Marina: Efekti primene redukcione niskoproteinske ishrane kod pacijenata sa dijabetesom complicate tip I i hipertenzijom 43

Prikaz slučaja: Prvi slučaj, pedesetdvogodišnji pacijent iz Lazarevca, hospitalizovan 31.12.2015. godine, sa dijagnozom dijabetes melitus complicate tip I, sa kreatininom 485 i ureom 11,9 (referentne vrednosti: kreatinin 45 – 124, urea 3,3 – 7,5). Pripreman je bio za dijalizu. Bolnicu napušta 08.01.2016. na svoju inicijativu sa kreatininom 548 i ureom 22. Po rečima svoje majke, dijabetes melitus dobija, u svojoj drugoj godini nakon antibiotske terapije Sigmamicinom. Prva intervencija se desava 1983.godine na desnom oku usled retinopatije. Do insulta dolazi 1999. godine. Od tada ne čuje na levo uvo. Polineuropatija je ustanovljena 2000. godine. Druga intervencija na desnom oku usled retinopatije se dešava 2006. godine. U trenutku dolaska u naš centar 08.01.2016. godine koristio je 4 insulinske doze, prve tri 10 + 10 + 8 IJ Actrapid HM 100, a noćna, četvrta doza je bila 14 IJ Insulatard. Nakon prijema pacijenta, primenjen je nov metodološki pristup, izvršeno je testiranje namirnica EPD po Voll-u. Testiranje je vršeno na 6 kontrolnih akupunkturnih tačaka na ruci, aparatom za EPD po Voll-u, (proizvedenog u Kijevu, proizvodjač Olvia Nova) [8]. Prilikom testiranja korišćeni su uzorci namirnica koji su za to godišnje doba bili dostupni. Za pravilno testiranje, pored potrebnih uzoraka namirnica, lekovitog bilja i suplemenata, korišćena je i rezonantna kutija u koju su smeštani jedan po jedan uzorak, za vreme testiranja. Prvo je vršeno ispitivanje i beleženje, kožne provodljivosti, šest kontrolnih akupunkturnih tačaka bez delovanja bilo koje testirane supstance. Nakon toga su u rezonantnu kutiju, koja je preko kabla povezana za sondu koja se nalazi u ruci pacijenta, ubacivani jedan po jedan uzorak. Za svaki od uzoraka je ponovo vršeno ispitivanje i beleženje vrednosti kožne provodljivosti. Potom su dobijene vrednosti uporedjivane. Ukoliko su novonastale vrednosti (sa supstancom) odstupale od normalnih (bez supstance) supstanca se ne prihvata, a ako ne odstupa od norme onda se prihvata [8]. Po obavljenom testiranju zaključili smo koje namirnice odgovaraju iz grupe žitarica, mleka i mlečnih proizvoda, mesa, povrća, voća, masti i ulja. Na istom principu, je testirano lekovito bilje i suplementi. Potom je izvršen još jedan nivo eliminacije namirnica, po količini proteina. Tako da su se zbog loše funkcije bubrega iz ishrane eliminisali svi proizvodi životinjskog porekla, meso i mesne preradjevine, riba, mleko i mlečni proizvodi, prvi mesec su eliminisane čak i mahunarke, biljke visokog izvora proteina kao soja, pasulj, grašak, bob, naut i kikiriki. Takodje su eliminisani svi veštački začini (kocke za supu, supe iz kesice, začin C, vegeta) industrijski proizvodi zbog prisustva u njima poboljšivača ukusa, aditiva, konzervanasa i sl. Jelo je začinjavano morskom solju i prirodnim začinima. Eliminisani su bojeni i gazirani sokovi, a korišćeni sveži cedjeni sokovi od testiranog povrća i voća. Testa sa kvascem, su takodje eliminisana, zbog toga što kvasac ima visok sadržaj purina 880mg na 100g, pivski čak 1810

mg, a kod takvih pacijenata maksimalna dozvoljena količina 100 do 150mg na 100g [9]. Umesto kvasca je korišćena soda bikarbona. Na kraju je uradjen jelovnik koji na dnevnom nivou nije sadržavao više od 0.3-0.4 g/kg proteina [10] . Prilikom testiranja suplemenata koji su priključeni dijeti, test je prošlo riblje ulje i magnezijum, a od namirnica sa visokim procentom antioksidanasa, djumbir i kurkuma. Riblje ulje, sa prisutnim omega3 masnim kiselinama i kurkumin iz kurkume imaju potencijal da ograniče upalu [11]. Stoga mogu da daju značajan doprinos kvalitetu života obolelih od CKD jer, stepen hroničnog oboljenja bubrega (CKD), je u direktnoj sprezi sa rastom nivoa upale [12, 13]. Djumbir koji je prošao EPD test i primenjen u RNP dijeti, takodje ima potencijal za smanjenje upale, sniženjem C reaktivnog proteina kod pacijenata sa Dijabetesom tipa 2 [14]. Omega3 masne kiseline i navedeni antioksidansi u niskoproteinskim redukcionim dijetama, ukupno deluju na smanjenje mehanizama ishemijskih oštećenja: ekscitotoksičnost, oksidativni stress i upalu [15]. Ekscitotoksičnost može dovesti do povrede, a i do potpunog gubitka neurona. Dolazi do nakupljanja aminokiselina u nervnom tkivu, intracelularno kalcijuma i natrijuma, što aktivira enzime proteinkinaze i endonukleaze što se smatra uzrokom povrede [16]. Oštećenje oksidativnim stresom, uzrokovano je slobodnim radikalima, uključujući superoksidni anjon, azotni oksid i hidroksilni radikal, nastalim u mitohondrijama, koji dovode do ćelijske apoptoze ili upalnih procesa [17]. Uz RNP dijetu, organizam se i podmladjuje, jer aktivira autofage koji recikliraju oštećene proteine i organelle iz ćelija [18]. Od lekovitog bilja test su prošli rastavić (Equisetum arvense), kopriva (Urtica dioica), troskot (Polygonum aviculare), kantarion (Hipericum perforatum), koji su činili jednu mešavinu čajeva, koja nosi naziv u jelovniku (tabela br. 3) čaj za bubrege i žalfija (Salviae officinalis), kantarion (Hipericum perforatum) , matičnjak (Melissae folium) i nana (Menthae piperitae), koji su činili drugu mešavinu čajeva, a u jelovniku su nosili naziv čaj miks žalfija (tabela br.3). Mešavine su spremane po specifičnom receptu doktora Rudolfa Brojsa [19].

REzuLTATI

Po primeni dijete laboratorijskim testovima, je kontrolisana količina uree i kreatinina u krvi. Završni testovi 07.05.2016.godine, su dali sledeće vrednosti, urea je sa vrednosti od 22 spala na 8,4 a kreatinin sa 548 na 382. Merenja po datumima su data u tabeli broj 1. Tokom čitavog perida dolazilo je do kolebanja nivoa šećera, zbog čega je konsultovan endokrinolog. Često je dolazilo do pada šećera, tako da je u jednom trenutku (11.03.2016.) došlo do hipoglikemijske kome, zbog čega su insulinske doze korigovane. Zamenjen je noćni insulin uveden je Lantus, na kraju su insulinske doze spuštene na 8+8+8 IJ Actrapid HM

pokazatelji 08.01’16. 23.01’16. 10.02’16. 09.03’16. 19.03’16. 06.04’16. 13.04'16. 30.04'16. 07.05'16.

urea 22 9.7 10,4 8,6 10,5 8,9 8,1 9 8,4

kreatinin 548 395 414 419 435 310 373 395 382

Tabela br.1. Analize vrednosti uree i kreatinina po datumima


100 i 8 IJ Lantus.Pacijent je, već nakon desetak dana, od primene

RNP dijete, počeo bolje da se oseća. Otok sa nogu koji je bio jako izražen, postepeno je krenuo da opada. Nakon dve sedmice bol koji je osećao u predelu kukova, nogu i duž kičme potpuno je iščezao. Koža je postala svetlija, a beonjače oka koje su bile zamućene su se izbistrile. Psihičko stanje se izmenilo, postao je mnogo vedriji i raspoloženiji. Pacijentu je uspešno odložen odlazak na dijalizu, smanjenjem obima komplikacija, što se i vidi po vrednostima koje su zabeležene u tabeli br.1.

Drugi slučaj je, pukovnik u penziji koji se u svojoj sedamdesetoj godini javio u naš centar, pre sedam godina, 06.10.2009. godine, sa sledećim simptomima: česte vrtoglavice, povremen nesnosni bol u predelu desne slepoočnice, otežana pokretljivosti desne ruke u ramenom pojasu, sa učestalim trnjenjem leve ruke i leve noge sa izrazitim osećajem hladnoće, sa vidnim otokom u predelu jetre, uz dugogodišnju hipertenziju, koja je bez lekova bila 200/110/90 a, uz terapiju 140/90/80. Prisutni su bili strahovi, uznemirenost i nesanica. Pokazatelji, koji su skretali pažnju na pojavu bubrežnih bolesti, kreatinin i urea, su se od februara 2008. godine, do dolaska u savetovalište oktobra 2009. godine, kretali iznad gornje grnice. Nakon primene tromesečne RNP dijete, vrednosti ispitivanih pokazatelja, koje su izlazile izvan norme su vraćene u istu. Vrednosti pokazatelja su vidljive u tabeli br. 2. Prilikom izbora namirnica takodje je upotrebljen test po Voll-u (EPD). Kod ovog pacijenta je dozvoljen unos ribe, kao i pilećeg belog

mesa (testiranog), dva do tri puta nedeljno, a unos proteina se kretao od 0,4 do 0,6g/kg na dnevnom nivou [10]. Unos proteina je bio nešto viši nego kod pacijenta sa dijabetesom. Od lekovitog bilja u ovom slučaju, test su prošli žalfija (Salvia officinallis), kantarion (Hypericum perforatum), matičnjak (Mellisa officinalis) i nana (Mentha piperita). Prilikom testiranja suplemenata test je prošlo riblje ulje, a od namirnica sa zaštitnim hranljivim sastojcima, takodje, izmedju ostalog, djumbir (Zingiber officinale) i ginko (Ginkgo biloba) [10].

REzuLTATI

Pacijent je nakon mesec dana regulisao pritisak, raspoloženje mu se vidno popravilo čak je počeo sa vožnjom bicikla, po 25 kilometara i dnevno šetao po 5 km. Otok sa jetre je potpuno iščezao. Mir i spokojstvo koje je osećao vratio mu je veru u život. Trnjenje ruku i nogu je prestalo i povukle su se vrtoglavice. Analize koje su ponovljene nakon godinu i po dana, pokazale su da je pacijent promenio navike u ishrani i zadržao normalne vrednosti, što se vidi u tabeli br 2.

zAKLJuČAK

1. Na osnovu prethodno publikovanjh radova i dostupne literature na temu korekcije ishrane i pripreme RLP dijetetskih lista, za hronično obolele sa hipertenzijom, CKD predlaže se vrlo

pokazatelji Referentne vrednosti 18.02.2008. 02.02.2009.

06.10.2009.Pacijent dolazi u savetovalište 4life biodesign

18.01.2010.Nakon primene

RLP dijete25.11.2011.

kreatinin 45 - 124 140 128 130 110 107

urea 3,3 – 7,5 9,8 9,3 9,4 5,9 7,5

mokraćna kis. 200 - 420 429 456 425 400 414

holesterol 3,6 - 6,5 5,8 7,4 7,3 6,3 6,1

trigliceridi 0,84 – 2,26 6,3 7,2 4,3 3,3 2,42

doručak užina ručak užina večera

Pre doručka Pre užine Pre ručka Pre užine Pre večere

1/3 čaja za bubrege ½ čaja miks žalfija 1/3 čaja za bubrege ½ čaja miks žalfija 1/3 čaja za bubrege

Doručak užina: za blender: Ručak užina: za blender: Večera

heljdina kaša sa seckanom kruškom, jabukom sa semenkama suncokreta i bundeve

200 ml soka od pomorandze, 20ml soka od limuna, 1 čen belog luka, 1cm korena djumbira, 150ml vode, jedna supena kašika maslinovog ulja cedjenog na hladno

Punjene paprike kuvanim ječmom, celerom i šargarepom sa belim lukom i vlašcem, sa malo morske soli. Papriku ne kuvati.

- Potaž od povrća hleb od kukuruza sa ječmom

Dva lista blitve jabuka, banana, mleveni susam supena kašika, mlevenog lana supena kašika, sa 5 badema, 5 lešnika, u soku od pomorandže sa kafenom kašičicom kurkume

Kratko grilovano povrće, tikvice, šargarepa, paprike, crni luk.

Salata krastavac sa belim lukom, peršunom i maslinovim uljem

Posle večere:Supena kašika ribljeg ulja i Mg 375mg

Tabela br 2. Analize vrednosti pokazatelja po datumima

Tabela br. 3. Primer izgleda jednog dana RNP dijete

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 42-46, 2016. Luketina – Šunjka Marina: Efekti primene redukcione niskoproteinske ishrane kod pacijenata sa dijabetesom complicate tip I i hipertenzijom 45

ozbiljan multidisciplinaran pristup. 2. Korišćenjem EPD po Voll dobija se usko indi-

vidualni izbor namirnica, poštujući specifičnost pacijenta.

3. Na taj način, uz angažovanje nutricionista u tim kliničara došlo bi do dobrog zbrinjavanja hroničnih bolesnika a izbegle bi se komplikaci-je. Jer se na taj način primenom RNP dijete dobijaju dobri efekti kod hroničnih bolesnika.

4. Imajući u vidu to da hipertenzija i dijabe-tes mogu biti praćene komplikacijama veza-nih za CKD, koje mogu dovesti i do dijalize, sprečavanjem istih imamo dvostruku korist, pored poboljšanja zdravstvenog stanja, imamo koristan finansijski efekat.

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19. Rudolf Breus Krebs, leukemia und andere scheinbar unheilbare Krankeiten mit naturli-chen mitteln heilbar , u prevodu Miodraga Marinkovića, VIII izdanje, Beograd 1997:52-53


The effects inclusion of Reducing Low Protein diet in patients with Diabetes complicate type 1 and hipertension

Summary: Introduction: Given the fact, that it is very hard to diagnose early stages of kidney diseases, one could also add that those diseases usually coexist with other chronic disorders (e.g. diabetes and CVD diseases). Available literature doesn’t showcase too many studies indicating the effect of Reduction Low Protein RLP diet in delay of dialysis with complicate type 1.The aim of this case report is to monitoring the effects and inclusion of Reducing Low Protein RLP diet and timely management of potentially serious complications with above mentioned type of patients Low Protein RLP diet in delay of dialysis with complicate type 1. Case report: Two different patients with chronic health disorders have been observed; one of them was diagnosed with diabetes type 1 and the other one with hypertension, both however having complications resulting in kidney diseases and increased level of urea and creatinin. The RPL diet was successfully included in their therapy. Results showed that the first patient, after decreasing the values of urea and creatinin have delayed a dialysis and the other patient solved long term the hypertension issue. This report also indicates a brief overview of related, already published studies and theoretical facts. The innovation in this report, among all previously published documents is the use of new, methodological testing system, the electro-punctual diagnostic by dr Voll (EPD). After EPD testing, all food items that contained high saturation of protein have been reduced, and food items containing saturation with antioxidants, flavonoids, vitamins, minerals, unsaturated fat acids such as omega 3 have been selected. Conclusion: By show casing these two examples one could conclude without a doubt that the inclusion of this particular diet could not only prevent diseases from happening, but also aid in treating already existing diseases. Therefore, a serious multidisciplinary approach is required that would allow research on a greater number of patients. The RLP diet inclusion would increase the quality of life of patients with chronic diseases, as well as it would have a decreasing effect on the therapy costs. Key words: reduction diets, low protein diet, creatinin, urea, electro-punctual diagnostic by dr Voll.

Luketina – Šunjka Marina Savetovalište za ishranu, doo 4lifebiodesign Beograd,

Beograd, Resavska br.11, Srbija

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 47-52, 2016. Jelena Golijan, Aleksandar Ž. Kostić: Značaj polifenola iz žitarica u ljudskoj ishrani 47

značaj polifenola iz žitarica u ljudskoj ishraniKratak sadržaj: Polifenolna jedinjenja čine najzastupljeniju

grupu antioksidanasa u hrani, biljnim vrstama, kao i proizvodima koji se dobijaju njihovom preradom. U ljudskom organizmu, kao posledica prevelike količine oksidanasa, koji dovode do oksidativnog stresa, nastaju brojna oštećenja makromolekula, što za krajnju posledicu ima pojavu brojnih degenarativnih oboljenja. Polifenolna jedinjenja, usled svoje specifične građe i mehanizma dejstva, vrše modulaciju efekata oksidanasa, te na taj način umanjuju oksidativna oštećenja ovih makromolekula. U zrnu žitarica, većina fenola se nalazi u vezanoj formi. Zdravstvene koristi od konzumiranja žitarica i njihovih proizvoda (usled njihovog jedinstvenog fitohemijskog sastava), dokazana su mnogobrojnim medicinskim istraživanjima. Unos žitarica u svakodnevnoj ishrani prevencija je protiv nastanka brojnih hroničnih bolesti, kao što su karcinom, srčana oboljenja, dijabetes i dr.Osim toga, pokazalo se da imaju protivupalno i antialergijsko dejstvo. Među žitaricama, najveću antioksidativnu aktivnost poseduje kukuruz, a zatim pšenica i ovas. Brojne studije su dokazale da kukuruz crvenog, ljubičastog i plavog pigmenta poseduje antimutagenu aktivnost, a takođe vrši i inhibiciju kolorektalnih karcinogenaza. Polifenoli belog kukuruza-ferulinska i ρ-kumarinska kiselina sa njihovim derivatima ispoljavaju naročito jako antioksidativno i antikancerogeno dejstvo. S obzirom na to da je najveća ukupna količina polifenola skoncentrisana u spoljašnjim slojevima zrna žitarica, za optimalno zdravlje preporučuje se unos njihovih celih zrna, u odnosu na prerađena.

Keywords: polifenolna jedinjenja, antioksidansi, žitarice, bolesti.

Jelena Golijan1, Aleksandar Ž. Kostić1

1Poljoprivredni fakultet, univerzitet uBeogradu, Nemanjina 6, 11080 zemun

Primljeno: 17.11. 2016.

Kontakt adresa:Jelena Golijan, Poljoprivredni fakultet, Univerzitet u Beogradu, Nemanjina 6, 11080 Zemun, SrbijaTel.: 063 1501988E-mail: [email protected]

UDK: 613.26:633.1633.1:547.56

Uvod

Ishrana igra ključnu ulogu u prevenciji hroničnih bolesti kao što su, između ostalog dijabetes, srčana oboljenja, rak, Alchajmerova bolest i dr. Unos povrća, voća i žitarica povezan je sa smanjenim rizikom od hroničnih bolesti, usled prisutnih fitohemikalija koje se ,,bore” protiv oksidativnog stresa u ćelijama, održavajući ravnotežu između oksidanasa i antioksidanasa. Neravnoteža izazvana prekomernim prisustvom oksidanasa dovodi do oksidativnog stresa, što potom dovodi do oštećenja velikih biomolekula poput DNK, lipida i proteina, a sve to rezultuje pojavom degenerativnih oboljenja. Antioksidansi, poput polifenola, smanjuju oksidativna oštećenja biomolekula modulacijom efekata reaktivnih oksidanasa. Dosadašnjim istraživanjima su dokazane izuzetne prednosti i značaj konzumiranja žitarica pri svakodnevnoj ishrani, u prevenciji hroničnih bolesti, poput raka i srčanih oboljenja. Ipak, u poređenju sa proučavanjem konzumiranja voća i povrća, posvećeno je malo pažnje žitaricama, iako su one radi postizanja optimalnog zdravlja, neophodne u ljudskoj ishrani [1].

Polifenoli nalaze veliku zastupljenost u biljnom svetu. To su sekundarni metaboliti, koji su kao bioaktivni biljni produkti uključeni u različite procese otpornosti na patogene, kao i zaštite od štetnog UV zračenja [2, 3]. Predstavljaju heterogenu grupu jedinjenja, čiji su molekuli sastavljeni od dve ili više OH grupa (vezanih za aromatični prsten), te usled njihovog prisustva mogu stupati u reakcije sa slobodnim radikalima i na taj način ublažiti njihov negativan uticaj [4]. U hrani, biljkama i njihovim

proizvodima, polifenoli čine najzastupljeniju grupu antioksidanasa, gde glavnu ulogu antioksidativne aktivnosti igra njihov redoks potencijal, te deluju kao donori vodonikovih atoma [5, 6]. Dokazano je antikancerogeno, antialergijsko i protivupalno dejstvo mnogih polifenolnih komponenti, a takođe i namirnica u čijem se sastavu nalaze [7].

Determinacija polifenolnih komponenti

Prema broju fenolnih prstenova i strukturnoj vezi između dva prstena, polifenoli se mogu klasifikovati u različite grupe, te se prema strukturnim karakteristikama razvrstavaju na flavonoide, fenolne kiseline, lignane i stilbene [2, 3, 8]. U biljkama, polifenoli mogu delovati na različite načine-kao signalni molekuli, zatim u zaštiti od štetnog UV zračenja, ispoljavaju antibiotsko delovanje (zaštita od infekcija prouzrokovanih raznim mikroorganizmima), vrše hormonsku regulaciju rasta biljaka, privlače oprašivače, učestvuju u pigmentaciji biljaka, dok prisutni u namirnicama doprinose njihovoj boji, ukusu, mirisu, gorčini i oksidativnoj stabilnosti [9]. Prema Rice-Evans et al. [10] jedinjenja iz grupe flavonoida ispoljavaju najjače antioksidativno dejstvo, veće čak i od vitamina E i C. Antioksidativna aktivnost polifenola ispoljava se u njihovoj sposobnosti uklanjanja reaktivnih kiseoničnih i azotnih vrsta, kao i inhibiciji enzima koji povećavaju oksidativni stres (indukcija antioksidativnih enzima). Takođe, dokazana je i njihova sposobnost vezivanja proteina i ugljenih hidrata hidroksidnim grupama.

Determinacija koncentracije ukupnih polifenola pripada analitičkim metodama koje se uobičajeno

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 47-52, 2016. Jelena Golijan, Aleksandar Ž. Kostić: Značaj polifenola iz žitarica u ljudskoj ishrani48

sprovode, naročito u agro i prehrambenoj industriji, jer su podaci o njihovom ukupom sadržaju neophodni u analizi antioksidativnog kapaciteta namirnica, nakon koga se pristupa merenju indeksa ukupnih antioksidanasa [11]. Fenolne komponente, usled svoje različitosti u namirnicama, mere se grupno-kao indeks ukupnih polifenola, što ima za krajnji rezultat prosek analitičkih odgovora fenolnih komponenti iz ispitivanog uzorka. Najbitnija faza u procesu izolacije polifenola je ekstrakcija. Mujica i saradnici [12] sugerišu da je rastvorljivost polifenola osobina koja direktno zavisi od polarnosti rastvarača, interakcije sa drugim komponentama, kao i od stepena polimerizacije. Prema Stalikas-u [13] efikasnost ekstrakcije ovih jedinjenja pokazuje zavisnost od pH vrednosti, temperature, selektivnosti rastvarača, kao i od prirode samog materijala iz koga se vrši ekstrakcija. Pri ekstrakciji polifenola iz uzoraka biljnog porekla, najčešće se kao rastvarači koriste etil-acetat, etanol, aceton i metanol, dok se pri ekstrakciji iz semena koriste vodeni rastvori metanola, etanola i acetona. U istraživanju uticaja rastvarača na sadržaj polifenola i antioksidativni kapacitet ekstrakata iz semena različitih biljaka, Franco i saradnici [14] su došli do rezultata da je etanol najpogodnije ekstrakciono sredstvo, jer omogućava najefikasniju ekstrakciju (izraženo inhibicijom DPPH radikala).

Pri određivanju koncentracije ukupnih polifenola, najviše su korišćene spektrofotometrijske metode,

pri kojima se uglavnom merila apsorbancija ispitivanog uzorka na 280 nm. S obzirom na to da postoji više različitih spektrofotometrijskih metoda (nedostatak je što spektri analita mogu varirati), najpouzdanija se pokazala metoda po Folin-Ciocalteu (FC), u kojoj pri blago baznim uslovima reakcijom FC reagensa (smeša fosfovolframove i fosfomolibdenske kiseline) i polifenola dolazi do stvaranja kompleksa plave boje, koji se može odrediti spektrofotometrijski u opsegu od 725-750 nm [11].

značaj polifenola u žitaricama za ljudsko zdravlje

Dosadašnjim istraživanjima dokazana je delotvornost polifenola u prevenciji mnogih bolesti, među kojima su neurodegenerativne bolesti, rak, osteoporoza, bolesti kardiovaskularnog sistema, dijabetes i dr. [15, 16, 17]. Medicinska ispitivanja su dokazala da je konzumiranje žitarica i njihovih proizvoda povezano sa smanjenim rizikom od hroničnih bolesti. Zdravstvene koristi od žitarica baziraju se na njihovom jedinstvenom fitohemijskom sastavu. Adom i Liu [18] su pri ispitivanju antioksidativne aktivnosti i polifenolnog sastava zrna žitarica dokazali da se većina fenola nalazi u vezanoj ili slobodnoj formi-uz strukture ćelijskog zida. Dosadašnji naučni podaci ukazuju na činjenicu da se većina fenola u zrnu nalazi u vezanoj

FENOLNE KISELINE OSOBINE/DEJSTVO REFERENCE

Ferulinska kis. Antifungalno dejstvo protiv Sclerotium rolfsii Sarma and Singh, (2003)

Ferulinska kis. i njeni dimeri Katalizacija peroksidaza; Alelopatski efekti

Fray, (1986);Harborne,( 1991)

Hinoni i tanini Insekticidno dejstvo Harborne, (1991)

Galna kis.Polifenol i galna kis.

Antibakterijsko dejstvoAntikonvulzivna aktivnost

Binutu and Cordall, (2000);DeLima et al., (1998)

Hlorogena kis. Primarni i sekundarni antioksidant; Lugasi et al., (1999);

Hlorogena kis. Antioksidant za belančevine niske gustine Donovan et al., (1998)

Hlorogena kis., kvercetin i kampferol Moćni antioksidanti Terauchi et al., (1997)

Metil estar hlorogene kis. Inhibitor enzima HIV proteaze koji je neophodan za virusnu proliferaciju Matsuse et al., (1997)

Flavonoidi i hlorogena kis. Antioksidanti Jung et al., (1999)

Epikatehin i 4’-kafeoilhininska kiselina

Otpornost na “kraste” Venturia inaequalis Metraux et al., (1990)

Biljni polifenoli (Tanini) Biološki antioksidanti Hagerman et al., (1998)

Flavanoli Antimutageni Abbas et al., (1997)

Galna kis. i hidrohinon Antitirozinazna aktivnost Matsuo et al., (1997)

Galna i salicilna kis. Važna uloga u interakciji insekt-biljka Ananthakrishan, (1997)

Protokatehinska kis. Otpornost na izazivače bolesti luka; Fungicidna aktivnost

Link et al., (1929);Harborne, (1991)

Luteolin, hlorogena kis., difeorilhininska kiselina Antiinflamatorna svojstva Abeysekera et al.,(1999)

Hidroksicimetna kis. Alelopatski efekti Harborne, (1991)

Izvor: Pandey i sar., 2013

Tabela 1. Fenolne kiseline i njihova biološka aktivnost


formi, pri čemu udeo slobodnih fenola u odnosu na ukupne u različitim fenotipovima iznosi 18-23%, što je u skladu sa ranije potvrđenim izveštajima da je 80% ukupnih fenola u kukuruzu prisutno u vidu vezane forme [18, 19, 20].

Oksidativno oštećenje biomolekula u telu povezano je sa određenim uslovima bolesti. Žitarice u svom sastavu sadrže širok niz fitohemikalija, za koje je dokazano da pozitivno deluju na ljudsko zdravlje kroz različite mehanizme, uključujući antioksidativna svojstva i posredovanje hormonima (Tab. 1) [21]. Studije su dokazale da konzumiranje celog zrna žitarica ima zaštitnu ulogu preko smanjenog rizika od kolorektalnog karcinoma, raka dojke, koronarne bolesti srca i dijabetesa, a čak je prema istraživanju smanjen i ukupan mortalitet [22]. Pošto se većina polifenola u zrnu, poput fenolnih kiselina, nalazi u spoljašnjim slojevima zrna, konzumiranje celih zrna žitarica, u odnosu na rafinirana zrna, preporučuje se za optimalno zdravlje. Mnoge studije su dokazale da unos antioksidanasa, kao što su polifenoli, tokoferoli, karotenodidi i flavonoidi, imaju ulogu u zaštiti od kardiovaskularnih oboljenja [1, 14, 15, 16, 17, 22, 23]. Međutim, često pitanje koje javnost nameće naučnicima i nutricionistima je koja količina antioksidanasa i polifenola bi se trebala unositi hranom svakog dana. Ukratko rečeno, i dalje nema indikativnih dokaza koji bi ukazali koje su to najniže količine polifenola koje bi se unosile ishranom svakodnevno, radi održavanja optimalnog zdravstvenog stanja. Jedan od primera koji nam daje najnovije informacije o ukupnom unosu polifenola, odnosi se na istraživanje francuske populacije [23]. Učesnici istraživanja (4942 učesnika, srednjih godina) unosili su putem hrane 337 vrsta polifenola, dok je najmanje polovina populacije hranom unosila 258 polifenola. Merenjem, autori su utvrdili da se 98 vrsta polifenola unosi na nivoima od preko 1mg/dnevno, dok srednji ukupan unos iznosi 1193 mg/dnevno, a maksimalan unos je 1,8 g na dan (najčešće iz bezalkoholnih pića-uglavnom kafe, voća, a zatim i žitarica). Prema procenama, samo 5-10% ukupnih polifenola koji se unesu, apsorbuju se u tankom crevu. Preostalih 90-95%, zajedno sa dekonjugovanim polifenolima se izlučuju u žuči, do debelog creva, gde se metabolišu crevnom mikroflorom pre nego što se resorbuju ili eliminišu iz organizma, što znači da mikroflora menja početnu hemijsku strukturu polifenola koji dospevaju u ćeliju. Prisutna mikroflora debelog creva razlaže vezane forme fermentacijom i na taj način obezbeđuje specifično mesto njihove apsorpcije [24, 25].

Ukupan sadržaj fenola predstavljen je

udelom slobodnih i rastvorljivih konjugovanih fenola, pri čemu konjugovani fenoli mogu da se oksiduju i doprinesu ukupnom sadržaju fenola i antioksidativnoj aktivnosti [5]. Adom i Liu [18], pri ispitivanju sadržaja polifenola u zrnima nekoliko vrsta žitarica (Tab.2), došli su do rezultata da se u zrnu kukuruza nalazi najveći ukupni sadržaj fenola (15.55 ± 0.60 µmol galne kiseline/g zrna), zatim u pšenici (7.99 ± 0.39 µmol galne kiseline/g zrna), ovsu (6.53 ± 0.19 µmol galne kiseline/g zrna), a najmanje u pirinču (5.56 ± 0.17 µmol galne kiseline/g zrna). Najveći udeo fenola u zrnu nalazi se u vezanoj formi (85% u kukuruzu, 75% u ovsu i pšenici, a 62% u pirinču), što je u skladu sa potvrđenim analizama od strane Lopez-Martinez-a i saradnika [26]. Prema rezultatima ispitivanja Adom and Liu [18], ferulinska kiselina je bila dominantno fenolno jedinjenje u testiranim žitaricama.

Takođe, kukuruz poseduje najveću antioksidativnu aktivnost, a zatim pšenica i ovas [19, 20]. Različiti fenotipovi kukuruza ispoljavaju različit stepen antioksidativne aktivnosti. Nekoliko studija su dokazale da u kukuruzu postoji niz bioaktivnih komponenata sa antioksidantnim i antikancerogenim dejstvom, kao što su polifenoli belog kukuruza-ferulinska i ρ-kumarinska kiselina sa njihovim derivatima (Tab. 3) [21]. Utvrđeno je da kukuruz crvenog, ljubičastog i plavog pigmenta inhibira kolorektalne karcinogenaze, poseduje antimutagenu aktivnost, kao i sposobnost uklanjanja slobodnih radikala, što je povezano ne samo sa sadržajem polifenola, već i njihovom udruženom aktivnošću sa antocijanima [26]. Pri ispitivanju antioksidativne aktivnosti, ukupnog sadržaja polifenola i antocijana 18 fenotipova Meksičkog kukuruza, Lopez-Martinez i saradnici [26] su došli do zaključka da se ukupan sadržaj fenolnih komponenti kretao u vrednosti od 215.8 do 3400.1 mg galne kiseline/100 g zrna, pri čemu se većina fenola nalazila u vezanoj formi (85 %), dok su glavne slobodne fenolne komponente bili antocijani. Takođe, autori su dokazali da veću antioksidativnu aktivnost poseduju vezane forme, u odnosu na slobodne. Malenčić i sar. [27] u Srbiji su ispitivali 17 različitih genotipova Triticum spp. i tom prilikom došli do rezultata da je dominantna kiselina bila trans-cimetna, dok je kvercetin bio najdominantniji flavonoid (Tab. 4).

zAKLJuČAK

Antioksidativna aktivnost predstavlja aktivnost od fundamentalnog značaja za ljudski život. Antimutagenost, antikancerogenost, borba protiv starenja, čine samo neke od aktivnosti koje su u

Tabela 2. Procentualni udeo slobodnih i vezanih frakcija ukupnih fenola, flavonoida i ukupna antioksidativna aktivnost u celom zrnu žitarica

Biljna vrstaSadržaj fenola (%) Sadržaj favonoida (%) ukupna antioksidativna

aktivnost (%)

slobodni vezani slobodni vezani slobodni vezani

Kukuruz 15 85 9 91 13 87

Pšenica 25 75 7 93 10 90

ovas 25 75 39 61 42 58

Pirinač 38 62 35 65 29 71


korelaciji sa antioksidativnim jedinjenjima, kao što su polifenoli. Unos celog zrna žitarica ne samo da smanjuje rizik od brojnih bolesti poput dijabetesa, bolesti srca, kolorektalnog karcinoma, raka dojke, Alchajmera i dr., već prema brojnim istraživanjima učestvuje i u smanjenju smrtnosti ljudske populacije. Uprkos mnogobrojnim istraživanjima mehanizma aktivnosti polifenola u ljudskom organizmu i dobrobiti koje nastaju njihovim unosom namirnicama, i dalje

su neophodne studije intracelularnog metabolizma i biokoncentrovanja polifenolnih metabolita u određenim organima. Rezultati dosadašnjih naučnih istraživanja čine doprinos selekciji genotipova žitarica sa povećanim sadržajem polifenola, kao izvora funkcionalne hrane, kao i izazov oplemenjivačima da stvaraju forme i genotipove sa visokim sadržajem polifenolnih jedinjenja, s obzirom na njihovu visoku biološku aktivnost i neophodnost u ljudskom organizmu.

Tabela 3. Fenolne kiseline u različitim vrstama kukuruza

Tabela 4. Sadržaj slobodnih monomernih jedinjenja polifenola u celom zrnu pšenice i njenih divljih srodnika ( ± SEM , izražen kroz µg g-1 celog suvog zrna, nd-nije detektovano)

Različiti oblici kuku-ruza u ishrani

Fenolne kiseline (µg/ml suve materije)

Taninska kis.

Galna kis.

Vanilinska kis.

O-ku-marinska

kis.

Kofeinska kis.

Ferulin-ska kis.

Cimetnakis.

Salicilnakis.

“Baby cob” (mladi klip za turšiju) 4.58 - 121.40 - 11.27 - 0.11 0.69

“Baby cob” (mladi klip za turšiju) 4.58 - 121.40 - 11.27 - 0.11 0.69

Sirovo seme - 4.6 - - 3.2 0.99 - 0.57

Kuvano seme - 1.3 - - 0.99 0.33 - 0.003

Pečeno seme - 0.20 1.30 0.003 - - - -

Prženo seme - 5.37 2.17 - 2.99 - 0.01 -

Zrelo zrno 2.21 0.37 1.59 1.01 5.41 1.40 0.02 0.19

Kukuruzne kokice 2.57 - - 0.59 0.60 - 0.01 0.92

Kukuruzne pahuljice 8.57 18.9 - 4.53 40.32 - 0.26 0.96

Kukuruzno brašno - 1.99 0.19 0.44 0.54 0.40 0.05 13.04

Klipni list - 10.99 - 0.66 6.0 1.87 0.04 0.0003

Kukuruzna svila 1.77 - - 0.97 4.32 0.50 0.006 0.47

Izvor: Pandey i sar., 2013

Genotip Galna kis. trans-cimetna kis

o-kumarinskakis.

p-kumarinskakis

Kvercetin

Pobeda (T.aestivum)Simonida (T.aestivum)NS 40S (T.aestivum)Nirvana (T.spelta)T. zhuhovkyT. macha1T. macha2T. dicoccoides1T. dicoccoides2T. turgidum var. nigrobarbatumT. araraticumT. durum var. caerulescensT. polonicum var. levissimumT. dicoccum var.farum JaT. dicoccum var.inerne DT. dicoccum Sherik var. ligTriticum L. var. Vulga I

nd2.05±0.022.23±0.022.77±0.012.82±0.003.40±0.052.57±0.013.52±0.012.94±0.012.67±0.01

3.03±0.042.29±0.063.54±0.04

nd3.07±0.04

nd3.39±0.03

1.27±0.001.59±0.000.64±0.003.5±0.053.82±0.015.09±0.032.86±0.016.36±0.014.13±0.020.32±0.02

3.18±0.030.64±0.00

nd

1.59±0.004.77±0.01

nd1.53±0.01

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1.23±0.001.49±0.00

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0.59±0.010.44±0.01

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0.79±0.00ndndnd

nd0.91±0.01

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0.72±0.00nd

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4.0±0.05ndndndndndndnd

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2.87±0.011.44±0.020.70±0.02

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Izvor: Malenčić i sar, 2016.


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of polyphenols 1, 2. Free Radical Biology and Medicine, 2002, 32 (4): 314-318.

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24. Monagas, M., Urpi-Sarda, M., Sánchez-Patán, F., Llorach, R., Garrido, I., Gómez-Cordovés, C., ... & Bartolomé, B. Insights into the metabolism and microbial biotransformation of dietary flavan-3-ols and the bioactivity of their metabolites. Food & function, 2010, 1 (3): 233-253.

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26. Lopez-Martinez, L. X., Oliart-Ros, R. M., Valerio-Alfaro, G., Lee, C. H., Parkin, K. L., Garcia, H. S. Antioxidant activity, phenolic compounds and anthocyanins content of eighteen strains of Mexican maize. LWT-Food Science and Technology, 2009, 42 (6): 1187-1192.

27. Malenčić, Đ., Kiprovski, B., Bursić, V., Vuković, G., Hristov, N., Kondić-Šipka, A. Whole grain phenolics and antioxidant activity of Triticum cultivars and wild accessions, J. Serb. Chem. Soc. 2016, 81 (5): 499–508.


Polyphenolic from grains – importance for human nutrition

Summary: Polyphenol compounds make the most present group of antioxidants in food, plant species, as well as products obtained by processing them. Damaging of important biomacromolecules in human body occurs under the oxidative stress conditions which can lead to developing of many degenerative diseases. Polyphenol compounds, due to their specific structure and mode of action, perform the modulation effects of oxidants, and thus reduce oxidative damage to these macromolecules. The majority of phenolics in the cereal’s grains are bounded with some carbohydrates or proteins. The health benefits of consuming grains and their products (due to their unique phytochemicals composition), are proven in numerous medical studies. Grains intake in the daily diet is a prevention against the occurrence of many chronic diseases, such as cancer, heart disease, diabetes, and others. Also, this type of food shows anti-inflammatory and anti-allergic effect. Among the grains, maize possesses the greatest antioxidant activity (especially colored hybrids), wheat and oats. Numerous studies have shown that red, purple and blue maize pigment possesses antimutagenic activity, and also performs the inhibition of colorectal carcinogenesis. Polyphenols from white maize-ferulic and ρ-coumaric acids with their derivatives exhibit particularly strong antioxidant and anticancer effect. Considering that the most part of total amount of the polyphenols are concentrated in the outer layers of cereal grains, it is preferred to consume whole grains compared to refined cereal’s grains. Key words: polyphenolic compounds, antioxidants, cereals, diseases.

Jelena Golijan 1, Аleksandar Ž. Kostć 1

1 Faculty of Agriculture-University of Belgrade, Nemanjina 6, 11080 Zemun-Belgrade

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 52-56, 2016. Despotovic M Milena et al.: The impact of nutrition on the health of the elderly 53

The impact of nutrition on the health of the elderly

ABSTRACT Introduction: Elders have higher health risks due to changes

connected with general abilities and everyday functioning as a result of biological ageing. Researchers have shown that 4 out of 5 elderly people suffer from some kind of chronic illness, and the needs of this population are mainly connected to the supply of adequate medical and social support. Adequate nutrition is an important protection factor, characteristic for the general health of the elderly population, in cases such as chronic cardiovascular diseases, cognitive problems, etc. Both obesity and malnutrition are important health problems amongst elders. The aim: The aim of this article is to analyze the importance of effects related to the nutritional needs amongst the elderly and to provide guidance for further researches. Materials and methods: The article is written based on recent scientific literature review, and uses descriptive methods and scientific documents analysis. Nutrition and health of elderly: Persons above the age of 65, suffer higher risk of health problems due to nutritional factors associated with illnesses commonly related to ageing, such as co morbidity in correlation with psychological health. Luger and others found connections between malnutrition, social participation and Qol amongst elders. Despite that, they couldn’t prove if malnutrition is cause or consequence. New studies have shown nutrition has important influence on skeletomuscular pain, liver diseases, fractures, cardiovascular diseases, diabetes, cognitive problems and colorectal cancer. Conclusion: Based on present knowledge, we can conclude that adequate nutritional supply can work as an important protective factor to benefit the general health status of the elders. It is necessary to develop national health strategies, educate population, while national Social and Health policies needs to recognize the nutritional needs of elderly people to ensure they are able to get the right amount of healthy foods required for securing their well being. New research should focus on different dietary styles and gender differences in health status connected to dietary intake.

Keywords: nutrition, elders, health

Despotovic M Milena 1,Despotovic Mile 2,Ilic Biljana 2,Stanojevic Cedomirka 2,Stanojevic Vojislav 3,Urosevic Jadranka 2

1 Faculty of Medical Sciences, univesity of Kragujevac 2 Medical College, Cuprija3 General Practice Health Center zajecar, Serbia

Received: 3rd October 2016.

Corresponding author:MirelaNedelescu, National Institute of Public Health, Dr. Leonte Street, no. 1-3, Bucharest, Romania. E-mail: [email protected]

UDK: 613.2-053.9

INTRODuCTION

Elderly population often faces increased health risks that arise due to the changes related to their abilities and daily functioning, caused by biological ageing of the body. Some studies have shown that four out of five elderly people suffer from a chronic disease and, most commonly, the needs of the older population are related to medical and social support [1]. According to the World Health Organization, there are about 605 million of elderly people in the world, of which about 400 million live in poor countries. It is believed that by 2025, the number of elderly people in poor countries will exceed 840 million. Based on data available from the World Health Organization, the percentage of elderly people in the global population increases from year to year, which especially contributes to the importance of developing specific strategies for improving the health of the elderly, with an emphasis on prevention of diseases characteristic of this age [2]. Nutrition and nutritional status have

very important role in maintaining good health, functioning independence and body resistance. Diseases such as anemia, malnutrition, obesity, constipation, etc., are related to dietary habits and nutrition. Recommended type of diet can decrease the risk of nutrition related diseases, but on the other hand, unhealthy dietary habits can be the reason of chronic diseases that can lead to rapid and pathological ageing [3]. The research conducted by Giuli et al. in Italy, was aimed to determine the correlation of the quality of life, health related, in obese, overweight, and normal weight adult patients in Italy. The results showed lower levels of life satisfaction and poorer health in obese and those whom were overweight, compared to normal weight patients [4,5].

One of the major problems is that the bad nutritional habits of elderly often remain unrecognized and unidentified on time. It happens often that older people are being sent to counseling or advised to make changes to their regular diet only when they see a doctor because

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 52-56, 2016. Despotovic M Milena et al.: The impact of nutrition on the health of the elderly54

of the newly created health issue. Unfortunately, most of the professionals and responsible institutions do not identify the problem of inadequate nutrition of old people during the routine examinations.

Particular attention should be paid to the promotion of a healthy diet for the elderly in poor countries, taking into account that many of the essential ingredients are unavailable to them. As examples of good preventive health care policies, these are often the countries of Northern Europe, especially Finland [6]. However, poor countries are often devastated by a number of issues that directly affect the health profile of the population. Due to the lack of resources, as well as educators, most countries are reluctant to initiate this process.

THE AIM

The aim of this paper is to discuss the impact of nutrition on the health status of the elderly, taking into account the existing literature, and on the basis of the analysis of existing knowledge provide recommendations for further research in this field.

MATERIALS AND METHODS

The paper gives an overview of the existing scientific literature and uses techniques of descriptive method and analysis of documentation.

NuTRITION AND HEALTH OF ELDERLy people

Nutrition causes musculoskeletal pain, liver disease, fractures, as well as cardiovascular diseases, diabetes, cognitive abilities, oral health, but also to the prognosis of the outcome of colorectal cancer. Malnutrition and weight loss have serious consequences for the health of the elderly. The use of nutritional supplements can provide functional benefits in this population. Inadequate calorie intake is a factor which is consistently associated with weight loss and the use of supplements in nutrition can increase the weight of elderly people with acute and chronic illnesses. These supplements do not improve functionality and do not affect mortality in the general population of aged people but show good results in those who are weak or malnourished [7].

It was found that people older than 65 are exposed to greater nutritional risks due to greater exposure of comorbid diseases due to psychological factors caused by ageing [8]. The study by Luger and others showed that there is a significant correlation between malnutrition, lower quality of life and social participation. However, this research has not established the exact direction of causes and effects. A significant correlation was found between nutritional status and quality of life for elderly people in collective flats (community apartments) in Vienna, especially for the domains “autonomy” and

“participation in society”. However, it remains unclear whether the nutritional status is a cause or a consequence, or it is the intermediation of the potential third factor that has influenced the result [9].

Effects of nutrition among poor elderly people with hip fractures have rarely been investigated. Secondary analysis of data from randomized trial with 24 months follow-up conducted in Taiwan, tries to answer this question. The original study was conducted in a large medical center in northern Taiwan, with about 3000 beds. Only the respondents who had “poor nutrition” on the discharge from the hospital were considered, including those at risk of malnutrition. Data were collected relying on nutritional status and physical functions, including range of motion, muscular strength, balance and functional independence, and were analyzed using the approach of generalized estimation of equations. Besides, the main characteristics of patients were discussed: demographic characteristics, type of surgery, comorbidity, length of hospitalization, cognitive functions and depression. The results have shown that patients with poor nutrition who got comprehensive care have 1.67 greater chances to improve their nutritional status compared to those who received an interdisciplinary and usual care [10].

Osteoporosis is a health problem that has multiple effects on the lives of elderly people, especially in the context of injuries and fractures. Injuries caused by osteoporosis result in new inabilities and are the reason of taking patients in hospitals, nursing homes and long-term care facilities. Besides, the treatment of these injuries costs billions of dollars on a national level. Healthy choices and lifestyle including the therapy on the basis of vitamins and minerals, a stable environment; diet full of calcium, vitamin D and proteins; support and resistance exercises, as well as the promotion of prevention programs contribute reducing the number of injuries caused by osteoporosis [11]. Special attention is paid to the impact of nutrition in the treatment of osteoporosis and the effects of nutrition on the prevention of injuries.

The effects of vitamin D in the diet of elderly were further investigated in order to define its protective character in preserving bone density and preventing injuries and fractures. The effects of vitamin D doses larger than recommended on the density and quality of bone are not known sufficiently. Existing studies examined how a bone responds to the standard dose of vitamin D, but the results are often contradictory and unclear. In addition, the effects of higher doses on the density and quality of the bone have not been examined. Postmenopausal women undergo changes in the body weight and changes in hormonal status expose them to a particular risk of losing bone mass, so that they can benefit from taking vitamin D above the recommended value. One-year, randomized, double-blind controlled study examined the influence of vitamin D in healthy obese older women on the density and quality of bone in fifty eight elderly women surveyed. The decline in the thickness of the cortical width of the tibia was prevented by


the treatment of higher doses of vitamin D, but there were no other significant changes caused by the treatment over a period of one year [12].

Reduced capacity and limited functioning greatly complicate the life of elderly, so that eating habits of this population must be such as to respond to the needs of the body. It is necessary to ensure a good correlation of all necessary nutrients. It is especially important that older people bring plenty of fluids in the body to prevent dehydration of the body. The loss of water or dehydration of the body in the elderly is associated with increased mortality and disability. The aim of the research conducted in the UK is to assess the incidence of dehydration in elderly people who live in this country as well as the long-term care and related cognitive, functional and health characteristics. It was found that dehydration was present in 20% of 188 patients, average age 86 years. Linear and logistic regression analyses have shown that the kidney, cognitive and diabetes status are consistently correlated with the risk of dehydration, while the diuretics on the basis of potassium, gender, number of recent healthcare contacts, and urinary incontinence are sometimes associated with the dehydration. The thirst had no impact on the results. The conclusion was that dehydration is often present in older people living in the UK and that it is necessary to further investigate the relationship between cognitive and kidney functions and hydration of the body [13].

Musculoskeletal pain is defined as the presence of pain in the last six months, which has not disappeared for at least 30 consecutive days. Nutrition habits have been associated with the chronic musculoskeletal pain. Individuals classified into a category of medium or high nutritional risk had significantly higher chances (~ 90%) of musculoskeletal pain compared to those who were in the low risk category [14].

Evident is the impact of dietary habits on the occurrence of liver disease in the elderly. Excessive weight, defined by a body mass index and percentage of body fat, has been associated with the condition of fatty liver in the elderly [15].

The study conducted on the island of Menorca has shown that five percent of older participants were malnourished, while 60% of people were overweight or obese. The prevalence of obesity was 66.8% in male and 85.1% in female population. Same study has found that BMI correlates with parameters such as hypertension, hypercholesterolemia, heart insufficiency and other cardiovascular diseases[16].

Poor dietary habits often lead to the development of hypertension in the elderly. Excessive consumption of coffee, low levels of potassium and magnesium, as well as high levels of sodium, are just some of the problems related to inadequate nutrition. Numerous studies have shown that coffee raises blood pressure by 5-15 mmHg and maintain it at that level for the next two hours. [17]

Some studies have proven the correlation between diet and cognitive abilities in the elderly. It is evident that there is a relationship between

metabolic syndrome and cognitive abilities and functions in the elderly [18]. Alzheimer’s disease is mainly characterized by the accumulation and aggregation of amyloid-b (Ab) peptides in the brain parenchyma and cerebral microvasculature. Unfortunately, the exact causes of the disease are still unclear. However, the dysfunctional blood-brain barrier and activation of inflammatory pathways are involved in the AD pathogenesis. The influence of a diet rich in fats on the development of Alzheimer’s disease was examined using animal model. The results have shown that such a diet accelerates the cognitive reduction in this disease [19].

The impact of nutrition on oral health of the elderly is well known. The aim of a Spanish study was to determine the relationship between oral health of life quality in relation with oral health and risk of malnutrition in the elderly. This study shows that poor eating habits were 3.43 times more frequent in patients with poorer oral health. The correlation was determined between nutrition and inadequate dietary habits and lower quality of life related to oral health [20].

Finally, it should be noted that proper nutrition can have an effect on the prevention of malignant diseases in the elderly. A study by Kaneko, Sasaki et al, demonstrated that malnutrition was put into a significant relationship with the outcomes of colorectal cancer. The survey included the elderly ill people. It was evident that malnutrition correlates with lower survival rate [21]. It is believed that about 80% of malignant diseases can be influenced through the modification of risk factors. Inadequate nutrition is one of the most important risk factors, thus, it is necessary to point out that the promotion of proper nutrition has extraordinary public health significance [22].

Previous studies have determined a positive impact of the optimal nutrition on health status of the elderly. Meals should contain a sufficient amount of dietary fiber, then, iron, folic acid, calcium and vitamin D. At the same time, the amount of water must ensure the proper functioning of the body and prevent dehydration while intake of salt should be reduced [23].

Many conditions characteristic of old age, such as chronic non-infectious diseases or cognitive problems can be inhibited or prevented by proper nutrition, and the future of treating these diseases lies in the proper eating habits.

CONCLuSION

Based on current data, we can make a conclusion that nutrition habits function as a protective factor when it comes to the health status of the elderly. In order to meet the health needs of this population, it is essential to develop new national strategies, educate population and, through health and social policies, ensure the elderly access to the healthy and nutritious foods. Future studies should focus on the impact of different nutrition styles, and an additional explanation of different impacts of nutrition on the health of different genders or segments of the elderly population. At the same time, it is necessary to work on education and training

HRANA I ISHRANA (BEOGRAD), VOL. 57. No. 2., 52-56, 2016. Despotovic M Milena et al.: The impact of nutrition on the health of the elderly56

of population, especially people older than 65. There is a need for harmonization of international trends and national health systems in order to provide better health of the elderly, prolongation of life expectancy and the promotion of active aging.

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7. Gammack JK, Sanford AM. Caloric supplements for the elderly. Curr Opin Clin Nutr Metab Care. 2015 Jan;18(1):32-6.

8. Wells J, Dumbrell A. Nutrition and Aging: Assessment and Treatment of Compromised Nutritional Status in Frail Elderly Patients.Clin Interv Aging. 2006 Mar; 1(1): 67–79.

9. Luger E, Haider S, Kapan A, Schindler K, Lackinger C, Dorner TE. Association between Nutritional Status and Quality of Life in (Pre)frail Community-dwelling Older Persons. J Frailty Aging. 2016;5(3):141-8.

10. Liu HY, Tseng MY, Li HJ, et all. Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status. J Am Med Dir Assoc. 2014 Jun;15(6):416-22.

11. Parsons LC. Osteoporosis: incidence, prevention, and treatment of the silent killer. Nurs Clin North Am. 2005 Mar;40(1):119-33.

12. Pop LC, Sukumar D, Schneider SH, et all. Three doses of vitamin D, bone mineral density, and geometry in older women during modest weight control in a 1-year randomized controlled trial. Osteoporos Int. 2016 Aug 17. Epub ahead of print

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is Associated with Chronic Musculoskeletal Pain in Community-dwelling Older Persons: The PAINEL Study. J Nutr Gerontol Geriatr. 2016;35(1):43-51.

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16. Ferra A, Bibiloni Mdel M, Zapata ME, at all. Body mass index, life-style, and healthy status in free living elderly people in Menorca Island. J Nutr Health Aging. 2012 Apr;16(4):298-305.

17. Despotovic M. Social support as a factor of health and quality of life of elderly people with hypertension. Ph.D.Thesis. Kragujevac: University of Kragujevac, Faculty od medical sciences; 2014.

18. Raffaitin C, Féart C, Le Goff M, et all. Metabolic syndrome and cognitive decline in French elders: the Three-City Study. Neurology. 2011 Feb 8;76(6):518-25.

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22. Stanojevic C, Stanojevic V, Despotovic M, Despotovic M, Vukosavljevic-Sebez I. Problems in the implementation of the national programme of organiyed screening of malignant diseases. Med Cas (Krag) / Med J (Krag) 2015; 49(4): 122-129.

23. Nutrition of elderly. Institute of public Health of Vojvodina. Available at: http://www.izjzv.org.rs/uploads/8baa2c98c0028a954c57b5ef71d6e3d4/ishrana_starih_osoba.pdf


uticaj ishrane na zdravlje starih

Kratak sadržaj: Uvod: Starije osobe se često suočavaju sa povećanim zdravstvenim rizicima koji nastaju usled promena vezanih za sposobnosti i svakodnevno funkcionisanje, prouzrokovanih biološkim starenjem organizma. Neka istraživanja su pokazala da četvoro od petoro starih ljudi boluje od nekog hroničnog oboljenja i da su najčešće potrebe starog stanovništva vezane za medicinsku i socijalnu potporu. Pravilna ishrana se smatra protektivnim faktorom kod brojnih stanja karakterističnih za starije životno doba, uključujući hronična kardiovaskularna oboljenja, ali i kognitivne probleme. I gojaznost i neuhranjenost predstavljaju probleme vezane za nepravilnu ishranu starih. Cilj rada: Cilj ovog rada je da uvidom u postojeću literaturu razmotriti uticaj ishrane na zdravstveni status starijih osoba i na osnovu analize postojećih saznanja da predloge za naredna istraživanja na ovom polju. Materijal i metode: Rad daje pregled postojeće naučne literature i koristi tehnike desktiptivne metode i analize dokumentacije. Ishrana i zdravlje starih: Utvrđeno je da su osobe starije od 65 godina izložene većim nutritivnim rizicima usled većoj izloženosti komorbidnih bolesti nastalih delovanjem psiholoških faktora izazvanih starenjem. Istraživanje Lugera i saradnika pokazalo je da postoji značajna veza između neuhranjenosti, niže ocene kvaliteta života i socijalne participacije. Ipak, ovo istaživanje nije ustanovilo tačan smer uzroka i posledica. Novije studije pokazale su da ishrana utiče na pojavu skeletomuskularnog bola, bolesti jetre, prelome, kao i kardiovaskularne bolesti, dijabetes, kognitivne sposobnosti, kao i na prognozu ishoda kolorektalnog kancera. Zaključak: Na osnovu postojećih podataka, može se zaključiti da način ishrane deluje kao protektivni faktor kada je u pitanju zdravstveni status starijih osoba. U cilju zadovoljenja zdravstvenih potreba ove populacije, neophodno je razviti nove nacionalne strategije, edukovati stanovništvo, a zdravstvenom i socijalnom politikom obezbediti starima pristup zdravim i hranljivim namirnicama. Buduća istraživanja treba da se fokusiraju na uticaj različitih stilova ishrane i dodatno objašnjenje različitog uticaja ishrane na zdravlje starih različitih polova.

Ključne reči: ishrana, stari, zdravlje.

Despotovic M Milena 1,Despotovic Mile 2,Ilic Biljana 2,Stanojevic Cedomirka 2,Stanojevic Vojislav 3,Urosevic Jadranka 2

1 Faculty of Medical Sciences,Univesity of Kragujevac

2 Medical College, Cuprija3 General Practice Health Center Zajecar,

Serbia

58

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Evropski kongres o ishrani,Madrid Reus (Tarragona), Španija,

20-21. maj 2013. godine

http://www.nutritionalconference.com/europe/

9th International Congress on Nutrition & Health Berlin, Germany

February 20-21, 2017

[email protected]

Nutrition and Food Science Osaka

http://www.nutritionalconference.com/

11th European Nutrition and Dietetics Conference

Madrid, Spain

June 29- July 01, 2017

[email protected]

13th International Congress on Advances In Natural Medicines, Nutraceuticals & Neurocognition

Rome, Italy

July 27-28, 2017

[email protected]

14th International Conference onClinical Nutrition

Rome, Italy

July 27-29, 2017

[email protected]

15th International Conference on Sports Nutrition and Supplements

San Antonio, uSA

Sep 13-14 , 2017

[email protected]

16th World Congress on Nutrition and Food Chemistry

zurich, Switzerland

September 18-20, 2017

[email protected]

6th International Conference and Exhibition on Probiotics, Functional and Baby Foods

Orlando, uK

October 02-03, 2017

[email protected]

Nutrition Congress 2017, Spain

Food Microbiology 2017, Spain

Food Technology-2017, France

Food Safety 2017, Italy

UPUTSTVO AUTORIMASaradnici se mole da detaljno i pažljivo pročitaju

predložena uputstva za pripremu radova pre predaje rukopisa za štampanje. Izuzetno je važno da sarad-nici/autori pripreme radove prema ustanovljenim principima jer je to izuzetno značajno za klasifikaciju naučnih časopisa.

“Hrana i ishrana” je časopis Društva za ishranu Srbije osnovanog 1956. godine, u kome se objavlju-ju radovi članova Društva za ishranu Srbije i članova društava drugih srodnih struka. Objavljuju se origi-nalni radovi, saopštenja, pregledni radovi, izveštaji sa kongresa i stručnih sastanaka, stručne vesti, prilozi, prikazi knjiga, pisma uredništvu i dopisi “U spomen”. Uz rukopis članka treba priložiti potvrdu s potpisima svih autora da članak nije objavljen, kao i da nije u toku razmatranje za objavljivanje. Prispeli članak Uređivački odbor upućuje recenzentima radi stručne recenzije (2 recenzenta). Ako recenzenti predlože izmene ili dopune, kopija recenzije, bez imena recenzenata, dostavlja se autoru radi njegove konačne odluke. Radovi se ne honorišu. Rukopisi se ne vraćaju.

Rukopis, u dva primerka slati poštom preporučeno na adresu: Uredništvo “Hrane i ishrane”, Savska 9/II, 11000 Beograd. Neophodno je da se celokup-ni materijal (rad) pošalje i elektronskom poštom glavnom uredniku na e-mail: petrica @eunet.rs .

Opšta pravilaRukopis članka i svi prilozi treba da budu jasni i

napisani na engleskom ili srpskom jeziku, a za iz-radu rada koristiti isključivo tekst-procesor Microsoft Word. Rukopis treba da je pripremljen na formatu A4. Sve margine treba da budu 2,5 cm. Stranice je potrebno numerisati. Koristiti tip slova (font) Times New Roman, veličine 12. Radove treba kucati pro-redom 1,5.

U rukopisu članka obeležiti mesta za slike, sh-eme, grafikone, tabele i ne ostavljati prazan prostor u tekstu. Literaturni podaci u tekstu se označavaju arapskih brojevima u zagradama redosledom kojim se pojavljuju u tekstu, na primer [1,2].

Skraćenice upotrebljavati samo izuzetno, i to u slučajevima kada se navode veoma duga imena hemijskih supstancija ili veoma poznate skraćenice (npr., DNK) ali je preporučljivo dati objašnjenje.

Merne jedinice: dužina, visina, težina i zapremina označavaju se u metričkim jedinicama (metar - m; kilogram - kg; litar -l) ili podjedinice. Temperatura se izražava u stepenima Celzijusa (°C), koncentracije u molima; uređaji se označavaju trgovačkim nazivima, a naziv i mesto proizvođača su u zagradama. Svi re-zultati kliničkih i biohemijskih istraživanja izražavaju se u jedinicama međunarodnog sistema mera - SI.

Autorstvo. Svi autori treba da budu odgovorni za autorstvo. Svaki autor treba da aktivno učestvuje u pisanju članka da bi bio odgovoran za rad u celosti. Autorstvo se bazira samo na višeslojnom spoju kon-cepcije rada, dobijenih rezultata/analize kao i inter-pretacije dobijenih rezultata. Konačna verzija nakon stručne obrade priprema se za štampu.

Sastav/struktura rukopisaRukopisi treba da sadrže sledeća poglavlja:

naslov, autore, ustanove, kratak sadržaj na srpskom jeziku sa ključnim rečima, uvod, eksperimentalni deo (materijal, metode), rezultate, diskusiju, zah-valnica, literaturu i kratak sadržaj (Abstract) na en-gleskom jeziku takođe sa ključnim rečima. Pregled-ni članak sadrži sledeća poglavlja: uvod, pregled slučaja, zaključak i literaturu. Pregledni članak mora

INSTRUCTIONS TO AUTHORSContributors are strongly encouraged to read the

instructions carefully before preparing the manuscript for submission and to check the manuscript for com-pliance with the terms before submitting it for publica-tion. It is essential for the authors to prepare the man-uscripts according to the established specifications.

Food and Nutrition is the Journal of the Serbian Nu-trition Society founded in 1956. Articles

supplied by the members of the Serbian Nutrition Society are published, as well as articles by members of other associations in the field of Public Health Nutri-tion (PHN) and related fields. The Journal publishes original articles, communications, case reports, review articles, congress and scientific meeting reports, pro-fessional news, book reviews, obituaries, as well as comments and letters to the Editorial Board in relation to the published papers.

The manuscript should be accompanied by signed confirmation of all contributors that the paper has not been previously published and not submitted for pub-lication elsewhere.

The papers are forwarded to the expert evaluation and an anonymous copy of the evaluation containing suggested changes is mailed to the authors for their final consent.

The authors are not rewarded and the manuscripts are not returned.

The manuscripts should be forwarded to the follow-ing address: Uredništvo “Hrane i ishrane” Savska 9/II 11000 Beograd, Serbia in duplicate. All papers also have to be submitted to the Editor-in- Chief as an elec-tronic version: petrica @eunet.rs

General demands on manuscriptsManuscripts should be written in clear concise Ser-

bian or English language, using MS WinWord program in short and clear sentences. Manuscripts should be on A4 format, all margins 2.5 cm, pages numbered. Recommended font is Tames New Roman 12. Papers should be typed 1,5 spaced. The author(s) should in-dicate in the text where figures and tables fit in. All references should be numbered in sequence as they appear in the text and indicated with Arabic numbers in parentheses - example [1, 2].

Abbreviations should be avoided, only to be used if appropriate, for very long names of chemical com-pounds, or as well-known abbreviations (such as DNA).

Units of measure: Length, height, weight and vol-ume should be expressed in metric units (meter - m, kilogram - kg, and liter -l) or their sub-units. Tempera-ture should be given in Celsius degrees (°C). Concen-trations are given in moles, proprietary names of instru-ments with factory name and place of manufacture in parenthesis. All results of clinical and biochemical mea-surements should be expressed in the metric system according to the International System of Units – SI.

Authorship All individuals listed as authors should be qualified

for authorship. Every author should have participated sufficiently in writing the article in order to take re-sponsibility for the whole article and results presented in the text. Authorship is based only on crucial contri-bution to the article conception, obtaining of results or analysis and interpretation of results, and final revision of the manuscript being prepared for publication.

Structure of the manuscriptsThe manuscript has to be arranged as follows: The

title, Authors, Institutions, Abstract, Introduction, Ex-perimental part, Results, Discussion, Acknowledge-

ments, and References. Review articles include Introduction, correspond-

ing section heading, Conclusions and References. The review article may be published only by authors who may cite at least four auto-citations (references in which they are either authors or co-authors).

Title page The title should be short, clear and with-out abbreviations, typed on the separate sheet. Names and family names of authors should be written under the title, as well as full names of their institutions indi-cated by corresponding Arabic numbers if there is more than one institution. The address of corresponding au-thor, with the telephone, fax number and e-mail ad-dress should be added at the bottom of this page.

Abstract.Original articles, communications, case reports, review articles and book reviews; the abstract not exceeding 200 - 300 words should be typed on a separate sheet of paper. (Srp. Arh) The abstract should not contain any references.

Key words. Key words - four to eight, relevant for rapid identification should be typed below the ab-stract in English. In original articles the abstract should have the following structure: introduction, objective, method, results and conclusion. In case reports the abstract should consist of the following: introduction, case outline and conclusion.

Introduction should be clear, concise, pointing to the essence of the problem and with the purpose of the study. References related to the problem should be cited.

The Experimental part should include description of materials (subjects) and methods used. If methods are widely known and described in the literature, only reference(s) should be cited. New or modified meth-odologies should be fully described. Methods used for parameters calculation and statistical analyses should be indicated. All abbreviations have to be explained in the manuscript when used for the first time.

Results should be clear and precise, with corre-sponding statistical analysis.

Discussion encompasses interpretation of the re-sults and their comparison to the references data. The last two parts can be given together as Results and Discussion.

At the end of this part conclusions obtained from the research should be reported.

All section headings should be in capital letters us-ing bold lettering.

Original articles shall have the following section headings: Introduction, Objective, Method, Results, Discussion, Conclusion and References

Case reports should consist of introduction, case outline, discussion, references.

Length of the manuscriptsThe entire text of the manuscript: title page, ab-

stract, the whole text, list of references and captions to figures and tables should have maximum 5 000 words for original articles, 2 000 words for communications and review articles, 1 500 words for case reports and up to 1 000words in the section ‘’other’’.

The total number of figures and tables should not exceed the half of the number of typed pages of the manuscript.

Tables, figures (graphs, charts, pho-tographs, and illustrations)

Tables are typed on a separate sheet of paper 1,5 spaced, including title, subtitle, headings of lines and columns. They must be identified by Arabic number in order or appearance with a shot description of the title, abbreviation should be explained. Photographs should be explained. Photographs should be black and white and good sharpness. First author’s name, title of

da sadrži u literaturi navedena najmanje 4 autocitata autora.

Sva poglavlja se pišu velikim slovima koristeći oznaku ”bold”.

Naslov rada. Na posebnoj stranici navesti naslov članka, bez skraćenica, velikim slovima, a ispod naslo-va navesti imena autora indeksirana brojkama koje od-govaraju onima pod kojima se nalaze nazivi i adrese ustanova u kojima autori rade. Pri dnu ove stranice otkucati ime i prezime autora odgovornog za dalji kon-takt, punu adresu, broj telefona, faksa ili e-mail adresu.

Kratak sadržaj. Uz originalni rad, saopštenje ili pregled iz literature treba priložiti na posebnoj strani-ci kratak sadržaj, koji sadrži naslov rada, prezimena, inicijale imena autora, nazive ustanova i mesta (iz kojih su autori), zatim sadržaj članaka u ne više od 200 do 300 reči. Za naslove kratkog sadržaja koriste se oznake italic i bold, a za tekst sadržaja samo italic.

Kratak sadržaj ne treba da sadrži literaturne po-datke. U njemu se navode, bez opisivanja, bitne činjenice, kratak prikaz problema i osnovni zaključak. U originalnom članku kratak sadržaj treba da sadrži sledeća poglavlja: uvod, cilj, metod rada i zaključak. U saopštenju/pregledu kratak sadržaj sadrži sledeća po-glavlja: uvod, pregled slučaja i zaključak.

Radovi na engleskom jeziku moraju da sadrže Kratak sadržaj i Ključne reči na srpskom, sa svim nave-denim elementima.

Ključne reči. Na kraju apstrakta/kratkog sadržaja dodaju se ključne reči ne više od 8, koje su bitne za brzu identifikaciju i klasifikaciju sadržaja članka.

Uvod rada se piše jasno, sažeto, uz navođenje suštine materije i radova koji su u vezi sa problema-tikom, kao i ciljem istraživanja.

Eksperimentalni deo opisuje materijale i metode, bez posebnih detalja ako su već opisani u literaturi (navesti literaturni podatak), a detaljno opisati ako je metodologija nova ili modifikovana. Potrebno je navesti metode izračunavanja parametara i statističke analize re-zultata. Ukoliko se upotrebljavaju skraćenice, pri prvom navođenju u tekstu treba napisati i njihov pun naziv.

Rezultate prikazati jasno i pregledno, sa odgovarajućom statističkom obradom.

Diskusija obuhvata interpretaciju dobijenih rezul-tata i njihovo upoređenje sa literaturnim podacima. Re-zultati i diskusija mogu se objediniti.

Zaključak se daje na kraju teksta jasno i koncizno kao rezultat istraživanja u vidu opšteg zaključka ili više pojedinačnih označenih numerički (arapskim brojevima).

Originalni članci sadrže sledeća poglavlja: uvod, cilj rada, metod, rezultate, diskusiju, zaključak i literaturu.

Kratak sadržaj (Abstract) na engleskom jeziku tre-ba da bude otkucan na posebnoj stranici i treba da sadrži sve elemente kao i kratak sadržaj na srpskom jeziku.

Obim rukopisaCeo tekst rukopisa: naslovna strana, kratak sadržaj,

uvod, eksperimentalni deo (materijal, metode), rezul-tati, diskusija, zahvalnost, literatura uključujući leg-ende (tabele, fotografije, grafikone, sheme itd.) mogu imati 5.000 reči za originalne članke; za saopštenja i pregledne radove 2.000 reči; za stručne izveštaje 1.500 reči a za ostale preglede 1.000 reči.

Broj tabela, slika, shema, crteža, grafikona (zajed-no) može biti najviše do polovine broja kucanih stranica rukopisa.

Tabele, slike, crteži, sheme, grafikoniSvaka tabela se kuca na posebnoj stranici prore-

dom 1,5, uključujući naslov, zaglavlje kolone i retka. Tabele se označavaju arapskim brojevima po redosledu navođenja u tekstu. Naslov tabele prikazuje sadržaj ta-bele. Upotrebu skraćenica u tabeli obavezno objasniti

u legendi tabele. Fotografije moraju biti isključivo crno-bele, oštrih kontura. Tekst (opis) slike kuca se na posebnom listu hartije. Crteže (sheme i grafikone) priložiti na posebnom listu (sa precizno unetim vrednostima na apscisi i ordinati).

Zahvalnica se kuca na kraju teksta a sadrži podatke ili izraze zahvalnosti autora na pomoći: naučnoj, stručnoj, tehničkoj ili finansijskoj.

LiteraturaLiteratura se kuca na posebnim stranicama jed-

nostrukim proredom, a dvostrukim između poje-dinih referenci, s rednim arapskim brojevima prema redosledu navođenja u tekstu.

Broj referenci u literaturi ne prelazi 30, osim za pregled iz literature gde je prihvatljivo i do 50 jedi-nica. Reference se navode po ugledu na Vancouver sistem, koji se zasniva na principima

National Library of Medicine i Index Medicus (Srp Arh Celok Lek). Citiranje literature uz poštovanje određenih standarda izuzetno je značajno za klasifi-kaciju naučnih časopisa.

Za članke u časopisu:1.Josselson J, Kyser BA, Weir MR, Sadler JH.

Hepatitis B surface antigenemia in a chronic hemo-dialysis program: lack of influence on morbidity and mortality. Am J Kidney Dis 1987; 9(6):456-61.

(U zagradama je naveden broj sveske, a ispred je broj volumena). Navode se imena najviše šest au-tora; ako ih je više, iza šestog se dodaje: i sar.

Knjige: 2.Weinstein L, Swartz MN. Pathologic properties

of invading microorganisms. Philadelphia: Saun-ders; 1974; 457-72.

Poglavlja u knjigama:3.Clayton D, Gill C. Covariate measurement er-

rors in nutritional epidemiology: effects and rem-edies. In: Margetts BM, Nelson M, eds. Design Con-cepts in Nutritional Epidemiology. Oxford: Oxford University Press, second edition 1997: 87-106.

Za članke sa kongresa ili sastanaka:4.Marković P, Živković L. Uticaj zračenja na po-

javu recidiva. Zbornik radova “II kongres lekara”, Vrnjačka Banja 1975;315-6.

Stručna izdanja:5.Medical Assessment of Nutritional Status.

WHO. Tech Rep Ser 1993:298.

Javni/državni izveštaji (zakoni, pravilnici, direktive, izjave):

6.Pravilnik o normativu društvene ishrane dece u ustanovama za decu. Službeni glasnik RS, Beograd 1994;50:1643-9.

Citat internet stranice:7.Complementary/Integrative Medicine [Internet].

Houston: University of Texas, M. D. Anderson Cancer Center; c2007 [cited 2007 Feb 21]. Available from: http://www.mdanderson.org/departments/CIMER/.

Citat internet stranice sa autorima:8.Hooper JF. Psychiatry & the Law: Forensic Psy-

chiatric Resource Page [Internet]. Tuscaloosa (AL): University of Alabama, Department of Psychiatry and Neurology; 1999 Jan 1 [updated 2006 Jul 8; cited 2007 Feb 23]. Available from: http://bama.ua.edu/~jhooper/.

the manuscript, number of the illustration and arrow indicating the top of the figure are given on the back with lead pencil. The legends are given on separate sheet. Drawings (schematic drawing and graphs) are supplied on separate sheets with lead precise identifi-cation of abscissa and ordinate.

Acknowledgements (sources of funding, conflict of interest declaration, and authorship responsibilities): this should be included at the end of the text.

ReferencesReferences should be supplied on a separate sheet,

single spaced, with double space between each refer-ence, Arabic numbers indicating the sequence of ap-pearance.

The number of references should not exceed 30, except in literature reviews with maximum 50 is ac-ceptable. References are cited according to the so-called Vancouver style, based on formats being used by the National Library of Medicine and Index Medicus. (Srp Arh Celok Lek)

In citation of references the defined standards should be strictly followed because it is the essential factor of indexing and classification of scientific journals.

The following rules should be applied:Journals:1.Josselson J, Kyser BA, Weir MR, Sadler JH. Hepa-

titis B surface antigenemia in a chronic hemodialysis program: lack of influence on morbidity and mortality. Am J Kidney Dis 1987; 9(6):456-61. (The number of the volume is given in parentheses, the preceding num-ber indicating the issue). Only up to six names of the authors are quoted, if more than six “et al “ is added.

Books and contributions to books:2.Weinstein L, Swartz MN. Pathologic properties

of invading microorganisms. Philadelphia: Saunders, 1974; 457-72.

Book chapter:3.Clayton D, Gill C. Covariate measurement errors

in nutritional epidemiology: effects and remedies. In: Margetts BM, Nelson M, eds. Design Concepts in Nutri-tional Epidemiology. Oxford: Oxford University Press, second edition 1997: 87-106.

Congress articles:4.Marković P, Živković L. Uticaj zračenja na pojavu

recidiva. Zbornik radova “II kongres lekara”, Vrnjačka Banja 1975; 315-6.

Other: 5.Medical Assessment of Nutritional Status. WHO.

Tech. Rep. Ser. 1993:298.

Legislation:6.Pravilnik o normativu društvene ishrane dece u

ustanovama za decu. Službeni glasnik RS, Beograd 1994; 50: 1643-9.

Standard citation of links:7.Complementary/Integrative Medicine [Internet].

Houston: University of Texas, M. D. Anderson Cancer Center; c2007 [cited 2007 Feb 21]. Available from: http://www.mdanderson.org/departments/CIMER/.

Links with author(s):8.Hooper JF. Psychiatry & the Law: Forensic Psy-

chiatric Resource Page [Internet]. Tuscaloosa (AL): University of Alabama, Department of Psychiatry and Neurology; 1999 Jan 1 [updated 2006 Jul 8; cited 2007 Feb 23]. Available from: http://bama.ua.edu/~jhooper/.

Documents

ČASOPIS DRUŠTVA ZA ISHRANU SRBIJE ... - hrana-ishrana.orghrana-ishrana.org/wp-content/uploads/2017/10/HRANA-I-ISHRANA-57-2.pdf · „Hrana i ishrana“ je naučno-stručna pub-likacija