OBJECTIVE: To determine the relationship between enteral nutrition discontinuation and outcome in general critically ill patients. MATERIALS AND METHODS: All patients admitted to a mixed intensive care unit in a tertiary care hospital from May-August 2009 were screened for an indication for enteral nutrition. Patients were followed up until leaving the intensive care unit or a maximum of 28 days. The gastrointestinal failure score was calculated daily by adding values of 0 if the enteral nutrition received was identical to the nutrition prescribed, 1 if the enteral nutrition received was at least 75% of that prescribed, 2 if the enteral nutrition received was between 50-75% of that prescribed, 3 if the enteral nutrition received was between 50-25% of that prescribed, and 4 if the enteral nutrition received was less than 25% of that prescribed. RESULTS: The mean, worst, and categorical gastrointestinal failure scores were associated with lower survival in these patients. Age, categorical gastrointestinal failure score, type of admission, need for mechanical ventilation, sequential organ failure assessment, and Acute Physiologic and Chronic Health Evaluation II scores were selected for analysis with binary regression. In both models, the categorical gastrointestinal failure score was related to mortality. CONCLUSION: The determination of the difference between prescribed and received enteral nutrition seemed to be a useful prognostic marker and is feasible to be incorporated into a gastrointestinal failure score.

OBJETIVO: Avaliar os efeitos da suplementação do ácido graxo poliinsaturado ômega-3 (n3) sobre a sinalização da insulina e via próinflamatória no tecido hepático de camundongos. MÉTODOS: Camundongos Swiss foram divididos em seis grupos que receberam, por gavagem esofágica, diferentes doses de óleo de peixe contendo ômega-3 (1mg, 5mg, 10mg e 50mg). O grupo-controle recebeu água. Para determinar os efeitos do ômega-3 dependentes de dose e tempo, a glicemia de jejum foi avaliada nos dias 0 (sem suplementação), 14 e 21 (após suplementação). Como o grupo n-3-21dias (21 dias de suplementação) apresentou menor nível de glicemia, esse intervalo de tempo foi selecionado para as análises moleculares. Após jejum de 8 horas, amostras do tecido hepático foram obtidas do grupo-controle, e n-3-21dias e análises das vias de sinalização da insulina e próinflamatória foram realizadas por western blot. RESULTADOS: Os resultados mostraram que a dose de 10mg induziu maior redução na glicemia no 14° e no 21° dias quando comparada às demais doses. Dessa forma, essa foi a dose utilizada nos experimentos de análises moleculares e foi a que diminuiu de forma significativa a fosforilação da c-Jun n-terminal quinase e quinase e níveis proteicos do fator de transcrição Kappa B. Em paralelo, foi observado aumento na fosforilação do receptor da insulina, substrato do receptor de insulina 1 e proteína quinase B. CONCLUSÃO: O presente estudo sugere que o ômega-3 induza melhora na via de sinalização da insulina no fígado de camundongos, pelo menos em parte, por reduzir inflamação. Esses resultados podem explicar menores níveis de glicose de jejum.

OBJECTIVE: The aim of the present study was to assess the effects of omega-3 polyunsaturated fatty acid supplementation on insulin signaling and the proinflammatory pathway in the liver tissue of mice. METHODS: Swiss mice were divided into six groups given different dosages of fish oil containing ômega-3 (1mg, 5mg, 10mg and 50mg) by gavage. The control group was given water. Fasting plasma glucose was measured on days 0 (no supplementation), 14 and 21 (after supplementation) to determine the dosage and timedependent effects of omega-3. Because the group n-3-21days (21 days of ômega-3 supplementation) demonstrated lower blood glucose, this time interval was selected for molecular analysis. After an 8hour fast, liver tissue samples were taken from the control and n-3-21days groups, and western blot analyses were performed to assess insulin signaling and the proinflammatory pathway. RESULTS: The results showed that the dosage of 10mg leads to greater reduction in blood glucose at 14 and 21 days when compared with other dosages. Thus, this dosage was selected for molecular analysis. This dosage significantly decreased phosphorylation of cJun nterminal protein kinase and IkB kinase and protein levels of nuclear factor Kappalightchainenhancer of activated B cells. In parallel, increased insulin pathway signaling was observed, as confirmed by increases in insulin receptors, insulin receptor substrate 1 and protein kinase B phosphorylation. CONCLUSION: The present study suggests that omega-3 fatty acids improve insulin signaling by reducing inflammation. These results may be one of the explanations for low fasting glucose.