Habitual intake of guaran and metabolic morbidities: an epidemiological study of an elderly amazonian population

PHYTOTHERAPY RESEARCHPhytother. Res. (2011)Published online in Wiley Online Library(wileyonlinelibrary.com) DOI: 10.1002/ptr.3437 Habitual Intake of Guaraná and MetabolicMorbidities: An Epidemiological Study of anElderly Amazonian Population Cristina da Costa Krewer,1,2 Euler Esteves Ribeiro,3 Ednéa Aguiar Maia Ribeiro,2Rafael Noal Moresco,4 Maria Izabel de Ugalde Marques da Rocha,1Greice Franciele Feyl dos Santos Montagner,2 Michel Mansur Machado,2 Karin Viegas,1Elorídes Brito1 and Ivana Beatrice Mânica da Cruz1,2,3*1Departamento de Morfologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Brazil2Programa de Pós‐Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de SantaMaria, Brazil3Universidade Aberta da Terceira Idade, Universidade do Estado do Amazonas, Brazil4Departamento de Análises Clinicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Brazil The aim of the present study was to evaluate the associations of metabolic disorders and anthropometric andbiochemical biomarkers of lipid, glucose and oxidative metabolism and the habitual ingestion of guaraná(Paullinia cupana, Mart. Var. sorbilis) by an elderly population residing in the Amazon Riverine region of theMaués municipality (Brazil). A case‐controlled study was performed that included 637 elderly (≥ 60 years of age)patients classified as either those who habitually drank guaraná (GI, n = 421) or those who never drank guaraná(NG, n = 239) based upon their self‐reported intake of guaraná. Indeed, the prevalence of various metabolicdisorders was associated with guaraná ingestion. The prevalence of hypertension, obesity and metabolicsyndrome in the GI group was lower than the prevalence found in the NG group. The NG group exhibited lowersystolic and diastolic blood pressure values. The males in the GI group exhibited a lower waist circumference, onaverage, than the circumference found in the NG group, whereas the females in the GI group had lowercholesterol (total and LDL‐c) levels than the control cohort. Additionally, a significant association was foundbetween lower levels of advanced oxidative protein product (AOPP) and habitual guaraná consumption. Theresults constitute the first epidemiological study to suggest a potentially protective effect of habitual guaranáingestion against metabolic disorders in elderly subjects. Copyright 2011 John Wiley & Sons, Ltd.
Keywords: Paullinia cupana; guaraná; metabolic syndrome; oxidative metabolism; obesity; hypertension 1998; Basile et al., 2005; Jimoh et al., 2007), antimicrobial effects (Da Fonseca et al., 1994; Pinheiro et al., 1987;Yamaguti‐Sasaki et al., 2007) and anticarcinogenic and The plant guaraná (Paullinia cupana, Mart. var.
antitumoral properties (Fukumasu et al., 2006; Leite sorbilis) originates in Brazil, is rich in methylxanthines et al., 2010). Additional studies in animals and human such as caffeine, theobromine and theophylline, and volunteers have demonstrated that guaraná ingestion contains tannins, saponins, catechins, epicatechins, exhibits important biological effects, such as an improve- proanthocyanidols, as well as trace concentrations of ment in cognitive performance (Espinola et al., 1997; many other compounds (Belliardo et al., 1985). A study Kennedy et al., 2004) and an antidepressive effect of the guaraná transcriptome performed by Ângelo et al.
(Campos et al., 2005; Otobone et al., 2007). Similar effects (2008) revealed the presence of important secondary have also been described for green tea consumption compounds in this plant, including transcript sequences (Feng et al., 2010; Niu et al., 2009).
related to flavonoid metabolism. These results suggested The functional properties of guaraná that are that guaraná exhibits similarities to Camelia sinensis potentially the most similar to those of green tea are (green and black tea), a plant that has been shown to those properties related to metabolic disorders. Inves- have several interesting functional properties (Babu tigations have shown that guaraná positively affects lipid metabolism (Lima et al., 2005), enhances weight loss There have been medicinal beverages using extracts of (Boozer et al., 2001; Opala et al., 2006), and increases roasted guaraná seeds available since the pre‐Colombian basal energy expenditure (Bérubé‐Parent et al., 2005).
era (Smith and Atroch, 2007). Previous studies in Therefore, these data suggest that guaraná potentially experimental models as well as in vitro assays have conveys an antiobesity effect. Furthermore, guaraná described several biological effects that guaraná shares exhibits a cardioprotective effect due to opposition to with green tea, such as antioxidant activity (Mattei et al., platelet aggregation (Bydlowski et al., 1988, 1991).
However, in contrast to green tea, in which many epidemiological studies have been performed that * Correspondence to: I. B. M. da Cruz, Av Roraima 1000, Prédio 19, consistently describe effects on metabolic disorders Laboratório de Biogenômica-UFSM, Santa Maria‐RS, Brazil, 97105‐900.
E‐mail: ibmcruz@hotmail.com and components of metabolic syndromes (Imai and Copyright 2011 John Wiley & Sons, Ltd.
Nakachi, 1995; Sasazuki et al., 2000; Iso et al., 2006; previous investigation performed by our research group Kuriyama et al., 2006; Basu et al., 2010, 2011), most that included 1808 elderly subjects (Ribeiro et al., 2010).
studies investigating the effects of guaraná have been The study participants comprised elderly volunteers performed in experimental models or in clinical who could be easily accessed by researchers; about 50% approaches that used guaraná mixed with other of the population lived in far‐flung coastal communities bioactive compounds. In this manner, Boozer et al.
located among the rivers and tributaries of the Amazon (2001) investigated the associations among guaraná, forest. The study age criteria of ≥60 years was based on Mahuang, and obesity, and Bérubé‐Parent et al. (2005) the World Health Organization (WHO, 1998) definition studied the metabolic effects of guaraná, multi‐vitamin of an ‘elderly’ population in a developing country. The supplements and green tea extracts. Other controlled baseline general characteristics of the subjects studied investigations testing the effects of guaraná have been here are described in Table 1. Aside from the higher performed in studies over a short time period and with a number of males in the GI group compared with females, the other socioeconomic and cultural variables The investigation of guaraná consumption is impor- tant, in a manner similar to the investigation of other This study was performed in an elderly population potentially beneficial foods such as green tea, soybeans because elderly people tend to have a stable dietary and red wine, in larger population groups. Therefore, pattern and are less susceptible to changes arising from the objective of our study was to analyse the association the increased global use of nutritional foods compared between guaraná consumption and the prevalence of with young adults. Additionally, epidemiological studies obesity, hypertension, type 2 diabetes and dyslipidemia have demonstrated that the metabolic diseases investi- in an elderly population living in the Riverine region of gated here are most prevalent in elderly adults (Cigolle the Maués municipality in Brazil. Additionally, the study evaluated the effect of habitual guaraná ingestion onanthropometric and biochemical biomarkers of lipid, Region of study and history of guaraná consumption.
The study was performed in Maués because this locationis historically important for guaraná production. Mauésis located in the geographical middle of the Amazonregion; it was founded in 1798 by the Portuguese and became a municipality in 1896. The prominent regionof Maués is located on the right bank of the River Study design, population characteristics, and sample selection. There were a total of 637 elderly (≥60 years of The primary agricultural product of Maués is guaraná age) patients included in the present case‐controlled (Paullinia cupana). Evidence has suggested that the study. The elderly patients were classified into two native Sateré‐Maués people, who live in a native groups based on self‐reported data: those who habitually indigenous reserve localized in Maués, were the first ingested guaraná and those who never ingested guaraná.
to farm guaraná. However, as guaraná consumption At the time of data collection, Maués had 45284 increased rapidly among European colonizers, the inhabitants, of which 2939 (6.4%) were elderly. There- beverage was incorporated into the traditional culture fore, the samples analysed represent 22.4% of the elderly of the mixed population that arose from the interaction population. This sample population was based upon a between the settlers and the indigenous peoples of Table 1. Baseline characteristics of elderly Riverine inhabitants who habitually ingest guaraná (GI) and those who never ingest guaraná(NG), Maués, Amazonas‐Brazil n = amostral sample.
aAgricultural and fishing activities; comparison between categorical variables were performed by Chi‐square statistical test.
Copyright 2011 John Wiley & Sons, Ltd.
HABITUAL INGESTION OF GUARANÁ AND METABOLIC MORBIDITIES Table 2. Maués, Amazonas‐Brazil baseline characteristics guaraná for medical reasons were excluded from thisstudy. The elderly people who reported drinking guaraná noted that they had begun ingesting the drinkat a young age, often as children. Moreover, the subjects who consumed guaraná reportedly ingested this plant at Metabolic disorder diagnosis. Initially, the study eval- uated the associations between guaraná ingestion and the following metabolic disorders: obesity, hypertension, type 2 diabetes, and metabolic syndrome. The subjects were classified into the following groups based on their body mass index (BMI): obese, BMI > 30 kg/m2; overweight, BMI ≥ 25 kg/m2, and <30 kg/m2; control group (non‐overweight), BMI < 25 kg/m2. Hypertension was considered to be present when the subject had a systolic blood pressure (SBP) of >140 mmHg and/or a diastolic blood (DBP) pressure of >90 mmHg, when aBrazilian Governmental Census 2000.
measured on a minimum of two occasions separated by amonth, or when antihypertensive drugs were used.
Subjects with severe hypertension, i.e. SBP ≥ 160 mmHg the Amazon (Smith and Atroch, 2007). This general and/or DBP ≥ 100 mmHg, were also included. Diabetes population is known as the Riverine or Caboclos mellitus (type 2) was considered to be present when two population. The origins of the Caboclos cultural group independent measures demonstrated that the subject can be traced back approximately 300 years. In the had glucose levels above 126 mg/dL or if the subject was Maués region Caboclos are also referred to as using glucose‐lowering drugs. The metabolic syndrome Ribeirinhos or Riverine people (river‐side dwellers).
was diagnosed when the participant met three or more The Riverine people that live in Maués have of the following criteria: (1) high blood pressure: developed several different traditional methods of blood pressure ≥ 130/85 mmHg or under treatment for guaraná production that have been described by Smith hypertension; (2) hypertriglyceridemia: fasting plasma and Atroch (2007); generally, guaraná is produced on triglycerides ≥ 150 mg/dL; (3) low HDL: fasting HDL small and large farms, either as a monocrop or cholesterol < 40 mg/dL in men, <50 mg/dL in women; alongside other crops, and is harvested by hand in the (4) hyperglycemia: fasting glucose level of ≥110 mg/dL dry season. If the entire fruit bunch is ripe, it is either or under treatment for diabetes; (5) central obesity: snipped off with scissors or small pruning shears, or waist circumference >88 or >102 cm in women and men, broken off manually and placed in a basket and carried back to the home. Before roasting the seeds, the red Also elderly patients without metabolic disorders or skin must be removed, and so the fruits are skinned other morbidities (healthy elderly) were identified.
by hand, left to soak in water, or simply stored forseveral days until the skin softens. On small farms in the Biochemical and anthropometric data collection. Bio- Maués watershed the guaraná seeds are roasted on a chemical analyses were performed on blood samples griddle, usually made of clay, that reduces the chance collected from subjects after an overnight (>12 h) fast.
Peripheral blood samples were collected by To prepare the traditional guaraná beverage, the hard venipuncture using Vacutainer® (BD Diagnostics, cylinder containing the seeds is grated with the bony Plymouth, UK) tubes containing heparin and EDTA.
tongue of the pirarucu (Arapaima gigas), one of the The levels of the following blood components were largest fish in the Amazon. The powder is collected assayed: glucose, total cholesterol, HDL‐c, LDL‐c and either on a piece of paper or allowed to fall directly into triglycerides (TG). Total cholesterol, HDL‐c, TG and a calabash gourd containing water. Sugar is then added glucose levels were determined using an enzymatic to the mixture of guaraná powder and water, and the colorimetric method with the following commercial kits: whole concoction is consumed, usually soon after total cholesterol, Cod‐Ana Labtest®; HDL‐c, precipi- waking, while the consumer is still in the fasting state.
tant Labtest®; TG, Gpo‐Ana; Glucose, PAP Labtest®.
The ingestion of guaraná more than once a day does The LDL‐c level was calculated according to the occur, but it appears to depend on an individual's level Friedewald equation: (LDL‐c) = (TG) − (HDL‐c + TG/5) of energy expenditure. Repeated intake of guaraná (Tonks, 1972; Freidewald et al., 1972).
throughout the day may be related to extreme The levels of biomarkers of oxidative metabolism were environmental conditions, such as high temperature analysed; the total polyphenol content was spectro- and humidity, common conditions in the Amazon photometrically determined in plasma by measuring the rainforest region that increase the feeling of fatigue.
absorbance at 750 nm (the Folin‐Ciocalteau method) and We used this information as background in a brief using gallic acid as a standard, as described by Chandra questionnaire about sociocultural, economics, health and De Mejia Gonzalez (2004). The total phenol and lifestyle variables. In the group who reported never concentration of the plasma samples was determined drinking guaraná, the primary motivations were dislike after a procedure of acid extraction/hydrolysis and of the taste and the experience of tachycardia as a protein precipitation with 0.75 M metaphosphoric acid consequence of the high caffeine concentration. Elderly (MPA). For hydrolysis of the conjugated forms of people who had previously been advised not to drink polyphenols, hydrochloric acid was added to the Copyright 2011 John Wiley & Sons, Ltd.
sample, followed by sodium hydroxide in methanol, whether the associations were independent of age, which breaks the polyphenol–lipid links and provides a smoking habits, medicine consumption, previous first extraction of polyphenols. MPA was used in this cardiovascular disease and risk factors. The odds ratio procedure to remove the plasma proteins. The final (OR) and confidence interval at 95% (CI95%) were extraction of polyphenols was performed by adding a calculated for categorical variables associated with 1:1 (v/v) solution of acetone:water. The results were guaraná consumption. All p values were two‐tailed, expressed as the gallic acid equivalent (GAE) in mg/L, and p < 0.05 was considered statistically significant.
and thiol groups were determined as described byEllman (1959). Lipid peroxidation was quantified bymeasuring the formation of thiobarbituric acid reactivesubstances (TBARS) (Ohkawa et al., 1979). Total blood SOD (EC activity was measured spectrophoto-metrically according to Boveris and Cadenas (1997). One The prevalence of metabolic disorders in the GI and unit of activity is defined as the amount of enzyme NG group was analysed, and the results are shown in required to inhibit the rate of epinephrine auto‐oxidation Table 3. The prevalence of metabolic disorders was by 50%. Catalase activity (EC was determined negatively associated with guaraná ingestion. The group according to Aebi (1984). One unit of catalase activity that consumed guaraná showed a lower prevalence of was defined as the activity required to degrade 1 μmol hypertension, obesity and metabolic syndrome than the of hydrogen peroxide in 60 s. Protein carbonyls were NG group. However, the prevalence of type 2 diabetes measured according to a method described previously was identical between the GI and NG groups. Multi- (Morabito et al., 2004). The results were expressed as variate analysis showed that these results were inde- nanomoles of carbonyl groups per mg protein. Advanced pendent of age and sex. For hypertension in the GI oxidized protein products (AOPP) were measured using group, the odds ratio (corrected for sex and age) was a Cobas Mira Plus clinical chemistry analyser and 0.699 (95% CI = 0.500 – 0.960). For obesity the odds ratio using the technique described by Selmeci et al. (2005).
was 0.661 (95% CI = 0.456 – 0.958) and for metabolic Nitric oxide was evaluated indirectly by plasma nitrate syndrome it was 0.856 (95% CI = 0.726 – 1.000). These and nitrite quantification using the Griess method results indicate that there is a protective effect (adapted to Cobas Mira automated analyser by Pereira associated with habitual guaraná ingestion.
Three additional analyses related to health condi- The anthropometric variables investigated included tions among the elderly were performed. As shown in height (measured in meters; without shoes) and weight Table 2 the percent of subjects that had self‐reported (measured in kilograms; with heavy clothing removed daily consumption of medicine was higher in the NG and 1 kg deducted for remaining garments). Body mass group than in the GI group. However, the incidence of index was calculated as weight in kilograms divided by hospitalization over the past year was similar between the square of the height in meters. The waist the two groups. The percent of subjects with no history circumference on standing subjects was measured with of metabolic disorders or other morbidities was 19.9% a soft tape midway between the lowest rib and the iliac (n = 127) and was not significantly different between the crest. Two blood pressure recordings were obtained from the right arm of patients in a sitting position after There were a total of 42 patients in this study who 30 min of rest; measurements were taken in 5 min had self‐reported histories of stroke or myocardial intervals, and the mean values were calculated.
infarction; there was a significantly higher prevalence ofthese seniors in the group who did not drink guaraná Ethics. This study was approved by the Ethical (n = 22, 9%) than in the habitual consumption group Committee of the Universidade do Estado do Amazonas.
(n = 20, 5%) (p = 0.028). These results were independent Since the vast majority of the elderly included in this study were illiterate, oral consent or fingerprint in Term Another important variable in the results described was obtained to indicate their voluntary participation in here is smoking; 12% (n = 76) of the subjects were the study after the researchers read the consent form tothe patients.
Table 3. Comparison of the prevalence of metabolic disordersbetween elderly Riverine inhabitants who habitually ingest Statistical analysis. Statistical analysis was performed guaraná (GI) and those who never ingest guaraná (NG) using the SPSS/PC statistical package, version 17.0(SPSS, Inc., IL). The difference in the prevalence of metabolic diseases between the elderly subjects whohabitually ingested guaraná and the elderly subjects who never consumed guaraná was compared using theChi‐square test. A multivariate analysis was performed using logistic regression (the backward Wald method) to evaluate age, gender, smoking and previous cardio- vascular disease as possible intervening variables.
The biomarker comparison was performed using the Student's t‐test analysis and considered males and females separately due to the potential biological differences between sexes, such as waist circumference.
The variables that presented statistical significance were n = amostral sample. Statistical comparison was performed using tested using multivariate analysis in order to observe Copyright 2011 John Wiley & Sons, Ltd.
HABITUAL INGESTION OF GUARANÁ AND METABOLIC MORBIDITIES smokers, and the frequency of smoking was similar between the GI and NG groups (p = 0.509).
The biochemical and anthropometric variables for the male and female patients were analysed separately This is the first epidemiological study to investigate the due to biological characteristics such as abdominal association between the prevalence of metabolic disease circumference that differ between sexes. This analysis and habitual guaraná ingestion in an elderly Amazon also excluded subjects with a history of type 2 diabetes rainforest population residing in a region of Brazil mellitus, whose self‐reported use of medicine could known for its guaraná production (Maués). In general, influence the variables investigated; the results obtained the results suggest that guaraná consumption, most are shown in Table 4. The males in the GI group likely due to the bioactive compounds present in the exhibited a significantly lower waist circumference, beverage, potentially conveys a protective effect against systolic blood pressure and diastolic blood pressure the metabolic disorders investigated here. The associ- when compared with the males in the NG group and ation between guaraná ingestion and a lower risk or multivariate analysis showed that these factors were obesity, hypertension and metabolic syndrome is significantly associated with guaraná ingestion inde- important because these morbidities are related to pendent of age, smoking habit, diabetes and previous cardiovascular disease risk. Some of the differences in cardiovascular disease. However, the biochemical vari- the biochemical and anthropometric parameters that ables investigated were similar between the two groups, were observed in this study corroborate the possible aside from the AOPP level, that was found to be lower Our findings on the impact of habitual guaraná Females in the GI group exhibited lower systolic and ingestion on the prevalence of metabolic disorders are diastolic blood pressure than the females in the NG in concordance with previous results obtained from group. In contrast to the results obtained in male experimental models and clinical investigations that subjects, waist circumference was found to be similar used guaraná as a supplement. The antiobesity effects of between the two groups. However, habitual ingestion of guaraná have been described by Boozer et al. (2001), guaraná was associated with differences in some Bérubé‐Parent et al. (2005) and Opala et al. (2006).
biochemical parameters. In females, total cholesterol, In addition to finding a lower prevalence of obesity in LDL‐cholesterol and AOPP levels were significantly the elderly subjects who habitually ingested guaraná, an lower in the GI group compared with the NG group.
association was found between the consumption of An additional analysis was performed using a level of guaraná and waist circumference (WC) in men. These 25 μmol/L AOPP between the GI and NG groups as a data potentially have an epidemiological impact as waist cut‐off value in order to delineate the first quartile of circumference is considered to be a measure of the sample population. The frequency of subjects with abdominal obesity correlated with cardiovascular risk, lower AOPP values was significantly reduced in the GI particularly in men. Population studies have described group (n = 117, 38%) compared with the NG group positive associations between this trait and higher (n = 41, 25%) (p = 0.004). The odds ratio for higher mortality, independent of BMI. A recent investigation AOPP values in the NG group (after correction for sex, by Jacobs et al. (2010) examined the association between age, previous cardiovascular diseases and smoking) was WC and mortality among 48500 men and 56343 women OR = 1.709 (95% CI = 1.133–2.578).
aged 50 or more in the Cancer Prevention Study II Table 4. Comparison of biochemical, anthropometric and physiological variables between elderly Riverine inhabitants who habituallyingest guaraná (GI) and those who never ingest guaraná (NG) SD, standard deviation; SBP, systolic blood pressure; DBP, diastolic blood pressure; AOPP, advanced oxidation protein products. Mean comparison between GI and NG groups were performed by statistical Student's t‐test. NS, not significant; ap < 0.05; bp < 0.01 Copyright 2011 John Wiley & Sons, Ltd.
Nutrition Cohort. The authors observed that, after reduction in blood pressure. The authors noticed no adjustment for BMI and other risk factors, very high association between caffeine intake and blood pressure.
WC values were associated with an approximately two‐ It is clear that hypertension, obesity and metabolic fold higher risk of mortality in men and women. Thus, syndrome are common pathophysiological aspects the association between lower waist circumferences and that are directly impacted by nutritional status. Exces- ingestion of guaraná described here appears to be sive energy intake and obesity are major causes of relevant. The catechins, caffeine, and other xanthines hypertension. Obesity is associated with increased present in guaraná likely contribute to these results; activity of the rennin–angiotensin–aldosterone path- however, the exact mechanism of action remains to way and the sympathetic nervous system, as well as with mineralocorticoid activity, insulin resistance, salt‐ As noted previously, guaraná contains some bioactive sensitive hypertension, excess salt intake and reduced compounds that are similar to those found in green tea kidney function (Savica et al., 2010).
(Belliardo et al., 1985; Ângelo et al., 2008) that have been Recently, Namkung et al. (2010) found that tannic acid well studied. Tea polyphenols have been shown to exhibit and the related gallotannins present in green tea and red antioxidative, antithrombogenic, antiinflammatory, wine exhibited an inhibitory effect on Ca2+‐activated hypotensive, hypocholesterolemic, antihypertensive and Cl‐ channels (CACCs). The authors concluded that antiobesogenic effects (Yung et al., 2008).
gallotannins are potent CACCs inhibitors whose bio- An association was also observed between hyperten- logical activity provides a potential molecular basis for sion and metabolic syndrome and guaraná ingestion.
the cardioprotective and antisecretory benefits of red However, the effect of guaraná on hypertension and wine and green tea. Therefore, there is a need for the metabolic syndrome in humans is poorly understood. On performance of complementary studies in order to the other hand, a growing body of evidence indicates that evaluate whether the tannins and catechins present in there is a potential role for green tea, or its ingredient guaraná have similar effects on blood pressure.
bioactive polyphenol epigallocatechin gallate (EGCG), In addition to examining the prevalence of metabolic in significantly ameliorating features of metabolic disorders, we also investigated whether habitual intake syndrome and subsequent risks for type 2 diabetes of guaraná exhibited an impact on components of mellitus and cardiovascular disease. The results from oxidative metabolism. It was decided to investigate this these studies demonstrate the beneficial effects of green as previous evidence has shown that polyphenols (such tea or green tea extracts rich in EGCG on weight as catechins) present in beverages such as green tea management, glucose control and cardiovascular risk and guaraná exhibit antioxidant and antiinflammatory factors (Thielecke and Boschmann, 2009).
properties (Mattei et al., 1998; Basile et al., 2005; Babu Certainly, the most unexpected result reported here, and Liu, 2008). This study describes an important result as guaraná contains a high concentration of caffeine, regarding the association between guaraná ingestion was the association between guaraná intake and the low prevalence of hypertension. The effect of caffeine on blood pressure has been examined for decades, with translational modifications implicated in the pathological variable results that depend on factors such as the development of many age‐related diseases (Zwart et al., population under study. The relationship between foods 2009). Changes in AOPP levels are connected to rich in caffeine and hypertension is based on the poor glycemic control, chronic disease, dyslipidemia extensive use of caffeinated drinks, particularly coffee, and diabetic complications, particularly nephropathy in modern societies. However, epidemiological studies have not found a consistent relationship between A significant association was found between higher dietary caffeine intake and the incidence of hyperten- AOPP levels (≥25 μmol/L) and lack of guaraná sion (Smith et al., 2003). An explanation for the lack of consumption. It is important to note that our choice of such a relationship is that regular caffeine consumption the cut‐off value (≥25 μmol/L) was based on a is thought to lead to complete tolerance of its effects on percentile distribution of AOPP values in our sample blood pressure (Myers and Reeves, 1991).
population and represented the first quartile. However, Therefore, a question that emerges from our results in the study by Selmeci et al. (2005) that established concerning blood pressure and hypertension and gua- reference values for AOPP in a student population aged raná ingestion is whether these results are related to the 18–33 years this cut‐off point lies approximately in the development of tolerance to caffeine or whether the 3rd quartile. We believe that the discrepancy could be association is due to the existence of chemical interac- caused by age because our sample population was tions between that compound with other chemicals composed of elderly volunteers. A previous study present in guaraná, including catechins. Evidence from performed by Pandey et al. (2010) reported that robust longitudinal studies such as the Framingham oxidative alterations in biomarkers of plasma protein Heart Study suggests that there is a significant negative oxidation such as protein carbonyls (PCO), plasma total association between the consumption of caffeinated thiol groups (ThG) and AOPP are age‐dependent; with coffee and cardiovascular events, i.e. lower risk of increased age, PCO and AOPP levels increase and cardiovascular mortality heart valve disease develop- ThG levels decrease. In an additional investigation ment or progression in older Framingham subjects performed by Pandey et al. (2010), healthy control without moderate and severe hypertension (Greenberg subjects with a mean age of 58 ± 7 years exhibited an et al., 2008). A recent study (Chen et al., 2010) examined AOPP concentration of 63.64 ± 25.23 μmol/L, whereas the relationship between sugar‐ sweetened beverages, the mean AOPP level in diabetic patients was signifi- including coffee, and blood pressure in a prospective cantly higher (89.51 ± 36.46 μmol/L). It is of interest to analysis that included 810 subjects. The authors observed point out that the mean AOPP value in our sample that reduction of sugar in such beverages caused a population was lower than that described by Pandey and Copyright 2011 John Wiley & Sons, Ltd.
HABITUAL INGESTION OF GUARANÁ AND METABOLIC MORBIDITIES collaborators regarding the healthy control group. A There is no previous reference to explain the higher greater number of habitual guaraná drinkers exhibited consumption of guaraná by males compared with low levels of AOPP, suggesting a protective effect of females. However, guaraná is traditionally consumed guaraná that is related to protein oxidative damage.
in the region for its antifatigue and aphrodisiac Studies investigating the association between AOPP properties. Therefore, the labor‐intensive fishing and levels and ingestion of phytotherapeutic beverages agricultural work commonly performed by males is such as green tea have also been performed. Nakagawa potentially the culturally associated reason behind the et al. (2002) investigated the potential effects of green higher consumption of guaraná. Thus, in our study we tea extract, a green tea tannin mixture and its compo- opted to maintain this proportion in the case–control nents, on protein damage induced by 2,2′‐azobis(2‐ groups and to evaluate the possible influence of gender amidinopropane) dihydrochloride (a free radical using statistical tools such as multivariate analyses.
generator) and glucose in‐vitro. The authors reported Furthermore, other variables exist that were not that the green tea extract effectively conferred protection investigated in this population, such as physical activity against protein damage and that this protection was and genetic factors, and these variables potentially most likely due to the presence of a tannin compound; influence the results to some extent. However, the results these results suggest that green tea could be useful in described here are intriguing, and are in concordance the control of protein oxidation‐ and glycosylation‐ with previous studies in various experimental models, and moreover are similar to results obtained with other Due to the fact that nitric oxide (NO) participates in such highly active metabolic and regulatory processes as In this context, we believe that, despite the meth- hemostasis, fibrinolysis in platelets, vascular tone odological limitations, the results described in this study modulation and blood pressure homeostasis, plasma suggest that habitual guaraná ingestion contributes nitrite, an indirect measure of NO release, was positively to the prevention of various metabolic evaluated in our sample population. Although the nitrite levels described here are similar to those inother adult populations (Ghasemi et al., 2010), noassociation was found between guaraná ingestion and plasma levels of nitrite or other oxidative biomarkers.
Therefore, although previous studies have described We are grateful to the Maués governmental team for helping us with antioxidant properties of guaraná based on results data collection and especially to Mr Odivaldo Miguel de Oliveira obtained from in vitro assays and other experiments Paiva, Mrs Andréa dos Santos Nascimento, Mrs Shirley Antunes, Mrs (Mattei et al., 1998; Basile et al., 2005; Jimoh et al., 2007) Chrystianne Salles Teixeira, Miss Jenice Coimbra, Mr Deni Dorzani the effect of guaraná on such markers of oxidative and Mr Ildnave Trajano. We are also grateful to the Amazonas ESF‐ metabolism as AOPP levels in humans has, to our SUS and the research team that assisted in data collection, composed knowledge, never before been described.
of Elorídes Brito, Jefferson da Silva Souza, Kennya Motta, ShirleySantos and Karin Viegas and to the UFSM research team that helped It is important to comment on the methodological with the biochemical analyses. This study was supported by Fundação limitations of this study. Because this investigation de Amparo a Pesquisa do Amazonas (FAPEAM) and Conselho used a cross‐sectional design, it is not possible to Nacional de Pesquisa e Desenvolvimento (CNPq) number: 300969/ determine whether the associations found represent 2009‐0 and 471233/2007‐2, Coordenadoria de Aperfeiçoamento de cause‐and‐effect relationships. As we selected the case–control subjects of the population and, as in theprevious investigation in which 1808 subjects wereanalysed, a higher prevalence of guaraná consumptionwas found in males compared with females, thus it was decided to maintain this proportion in the investigationdescribed here.
The authors have declared that there is no conflict of interest.
Aebi H. 1984. Catalase in vitro. Methods Enzymol 105: 121–126.
mixture of epigallocatechin‐3‐gallate and caffeine on 24 h Ângelo PCS, Nunes‐Silva CG, Brígido MM et al. 2008. Guaraná energy expenditure and fat oxidation in men. Br J Nutr 94: (Paullinia cupana var. sorbilis), an anciently consumed stimulant from the Amazon rain forest: the seeded‐fruit Boozer CN, Nasser JA, Heymsfield SB, Wang V, Chen G, Solomon transcriptome. Plant Cell Reports 27: 117–124.
JL. 2001. An herbal supplement containing Ma Huang‐ Babu PV, Liu D. 2008. Green tea catechins and cardiovascular Guaraná for weight loss: a randomized, double‐blind trial. Int health: an update. Curr Med Chem 15: 1840–1850.
J Obes Relat Metab Disord 25: 316–324.
Basile A, Ferrara L, Pezzo MD et al. 2005. Antibacterial and Boveris A, Cadenas E. 1997 Cellular source and steady‐state antioxidant activities of ethanol extract from Paullinia cupana levels of reactive oxygen species. In Oxygen, Gene Expression and Cellular Function, Clerch L, Massaro D (eds). Marcel Basu A, Du M, Sanchez K et al. 2011. Green tea minimally affects biomarkers of inflammation in obese subjects with metabolic Bydlowski SP, D'Amico EA, Chamone DA. 1991. An aqueous extract of guaraná (Paullinia cupana) decreases platelet Basu A, Sanchez K, Leyva MJ et al. 2010. Green tea supplemen- thromboxane synthesis. Braz J Med Biol Res 24: 421–424.
tation affects body weight, lipids, and lipid peroxidation in obese Bydlowski SP, Yunker RL, Subbiah MT. 1988. A novel property of subjects with metabolic syndrome. J Am Coll Nutr 29: 31–40.
an aqueous guaraná extract (Paullinia cupana): inhibition of Belliardo F, Martelli A, Valle MG. 1985. HPLC determination of platelet aggregation in vitro and in vivo. Braz J Med Biol Res caffeine and theophylline in Paullinia cupana Kunth (guaraná) and Cola spp. samples. Z Lebensm Unters Forsch 1180: 398–401.
Cakatay U. 2005. Protein oxidation parameters in type 2 diabetic Bérubé‐Parent S, Pelletier C, Doré J, Tremblay A. 2005. Effects of patients with good and poor glycaemic control. Diab Metab encapsulated green tea and Guaraná extracts containing a Copyright 2011 John Wiley & Sons, Ltd.
Campos AR, Barros AI, Albuquerque FA, M Leal LK, Rao VS.
Morabito F, Cristani M, Saija A et al. 2004. Lipid peroxidation and 2005. Acute effects of guaraná (Paullinia cupana Mart.) on protein oxidation in patients affected by Hodgkin's lymphoma.
mouse behaviour in forced swimming and open field tests.
Myers MG, Reeves RA. 1991. The effect of caffeine on daytime Chandra S, De Mejia Gonzalez E. 2004. Polyphenolic compounds, ambulatory blood pressure. Am J Hypertens 4: 427–431.
antioxidant capacity, and quinone reductase activity of an Nakagawa T, Yokozawa T, Terasawa K, Shu S, Juneja LR. 2002.
aqueous extract of Ardisia compressa in comparison to mate Protective activity of green tea against free radical‐ and (Ilex paraguariensis) and green (Camellia sinensis) teas. J glucose‐mediated protein damage. J Agric Food Chem 50: Chen L, Caballero B, Mitchell DC, Loria C, Lin PH, Champagne Namkung W, Thiagarajah JR, Phuan PW, Verkman AS. 2010.
CM, Elmer PJ, Ard JD, Batch BC, Anderson CA, Appel LJ.
Inhibition of Ca2+‐activated Cl‐ channels by gallotannins as a 2010. Reducing consumption of sugar-sweetened beverages possible molecular basis for health benefits of red wine and is associated with reduced blood pressure: a prospective study among United States adults. Circulation 121(22): Niu K, Hozawa A, Kuriyama S et al. 2009. Green tea consumption is associated with depressive symptoms in the elderly. Am J Cigolle CT, Blaum CS, Halter JB. 2009. Diabetes and cardiovas- cular disease prevention in older adults. Clin Geriatr Med 25: Ohkawa H, Ohishi H, Yagi K. 1979. Assay for lipid peroxide in animal tissues by thiobarbituric acid reaction. Anal Biochem Da Fonseca CA, Leal J, Costa SS, Leitão AC. 1994. Genotoxic and mutagenic effects of guaraná (Paullinia cupana) in prokaryotic Opala T, Rzymski P, Pischel I, Wilczak M, Wozniak J. 2006.
organisms. Mutat Res 321: 165–173.
Efficacy of 12 weeks supplementation of a botanical extract‐ Ellman GL. 1959. Tissue sulphydryl groups. Arch Biochem Biophys based weight loss formula on body weight, body composition and blood chemistry in healthy, overweight subjects – a Espinola EB, Dias RF, Mattei R, Carlini EA. 1997. Pharmacological randomised double‐blind placebo‐controlled clinical trial. Eur J activity of Guaraná (Paullinia cupana Mart.) in laboratory animals. J Ethnopharmacol 55: 223–229.
Otobone FJ, Sanches AC, Nagae R et al. 2007 Effect of lyophilized Feng L, Gwee X, Kua EH, Ng TP. 2010. Cognitive function and extracts from guaraná seeds [Paullinia cupana var. sorbilis tea consumption in community dwelling older Chinese in (Mart.) Ducke] on behavioral profiles in rats. Phytother Res Singapore. J Nutr Health Aging 14: 433–438.
Friedewald WT, Levy RI, Fredrickson DS. 1972. Estimation of the Pandey KB, Mishra N, Rizvi SI. 2010. Protein oxidation biomarkers concentration of low-density lipoprotein cholesterol in plasma, in plasma of type 2 diabetic patients. Clin Biochem 43: without use of the preparative ultracentrifuge. Clin Chem 18: Pereira AC, Olivon VC, De Oliveira AM. 2010. Impaired calcium Fukumasu H, Da Silva TC, Avanzo JL et al. 2006. Chemopreven- influx despite hyper‐reactivity in contralateral carotid follow- tive effects of Paullinia cupana Mart var. sorbilis, the guaraná, ing balloon injury: eNOS involvement. Eur J Pharmacol 642: on mouse hepatocarcinogenesis. Cancer Lett 233: 158–164.
Ghasemi A, Zahediasl S, Azizi F. 2010. Reference values for serum Pinheiro CE, De Oliveira SS, Da Silva SM, Poletto MI, Pinheiro CF.
nitric oxide metabolites in pediatrics. Nitric Oxide 23: 1987. Effect of guaraná and Stévia rebaudiana Bertoni (leaves) extracts, and stevioside, on the fermentation and Greenberg JA, Chow G, Ziegelstein RC. 2008. Caffeinated coffee synthesis of extracellular insoluble polysaccharides of dental consumption, cardiovascular disease, and heart valve disease plaque. Rev Odontol Univ São Paulo 1: 9–13.
in the elderly (from the Framingham Study). Am J Cardiol 102: Ribeiro EE, Ribeiro EAM, Brito E et al. 2010. Health status of Brazilian riverine elderly living in the Amazon Rainforest. Pan Grundy SM. 2005. Metabolic syndrome: therapeutic consider- American J Pub Health. Print go ahead.
ations. Handb Exp Pharmacol 170: 107–133.
Sasazuki S, Kodama H, Yoshimasu K et al. 2000. Relation Imai K, Nakachi K. 1995. Cross sectional study of effects of between green tea consumption and the severity of coronary drinking green tea on cardiovascular and liver diseases. Br atherosclerosis among Japanese men and women. Ann Iso H, Date C, Wakai K, Fukui M, Tamakoshi A; JACC Study Savica V, Bellinghieri G, Kopple JD. 2010. The effect of nutrition Group. 2006. The relationship between green tea and total on blood pressure. Annu Rev Nutr 30: 365–401.
caffeine intake and risk for self‐reported type 2 diabetes Selmeci L, Seres L, Antal M, Lukács J, Regöly‐Mérei A, Acsády G.
among Japanese adults. Ann Intern Med 144: 554–562.
2005. Advanced oxidation protein products (AOPP) for Jacobs EJ, Newton CC, Wang Y et al. 2010. Waist circumference monitoring oxidative stress in critically ill patients: a simple, and all‐cause mortality in a large US cohort. Arch Intern Med fast and inexpensive automated technique. Clin Chem Lab Jimoh FO, Sofidiya MO, Afolayan AJ. 2007. Antioxidant proper- Smith L, Payne JA, Sedeek MH, Granger JP, Khalil RA. 2003.
ties of the methanol extracts from the leaves of Paullinia Endothelin‐induced increases in Ca2+ entry mechanisms of vascular contraction are enhanced during high‐salt diet.
Kennedy DO, Haskell CF, Wesnes KA, Scholey AB. 2004.
Improved cognitive performance in human volunteers follow- Smith N, Atroch AL. 2007. Guaraná's journey from regional tonic to ing administration of guaraná (Paullinia cupana) extract: aphrodisiac and global energy drink. Evid Based Complement comparison and interaction with Panax ginseng. Pharmacol Thielecke F, Boschmann M. 2009. The potential role of green tea Kuriyama S, Shimazu T, Ohmori K et al. 2006. Green tea catechins in the prevention of the metabolic syndrome – a consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. J Am Med Tonks DB. 1972. Quality Control in Clinical Laboratories. Warner‐ Leite RP, Wada RS, Monteiro JC, Predes FS, Dolder H. 2010.
World Health Organization. 1998. Obesity: Preventing and Protective effect of guaraná (Paullinia cupana var. sorbilis) pre‐ Managing the Global Epidemic. Report of a WHO Consultation treatment on cadmium‐induced damages in adult Wistar on Obesity. World Health Organization: Geneva.
testis. Biol Trace Elem Res [Epub ahead of print] Yamaguti‐Sasaki E, Ito LA, Canteli VC et al. 2007. Antioxidant Lima WP, Carnevali LC JR, Eder R, Costa Rosa LF, Bacchi EM, capacity and in vitro prevention of dental plaque formation Seelaender MC. 2005. Lipid metabolism in trained rats: effect by extracts and condensed tannins of Paullinia cupana.
of guaraná (Paullinia cupana Mart.) supplementation. Clin Nutr Yung LM, Leung FP, Wong WT et al. 2008. Tea polyphenols benefit Mattei R, Dias RF, Espínola EB, Carlini EA, Barros SB. 1998. Guaraná vascular function. Inflammopharmacology 16: 230–234.
(Paullinia cupana): toxic behavioral effects in laboratory Zwart SR, Kala G, Smith SM. 2009. Body iron stores and oxidative animals and antioxidants activity in vitro. J Ethnopharmacol damage in humans increased during and after a 10‐ to 12‐day Copyright 2011 John Wiley & Sons, Ltd.

Source: http://www.unati.uea.edu.br/data/noticia/download/3854-1.pdf


KLINGER PHARMACY PRESCRIPTION Captopril 12.5mg SAVINGS PLAN Captopril 25mg Famotidine 20mg Captopril 50mg Famotidine 40mg Levothyroxine 25mcg 90 DAY SUPPLY— $10.00 Captopril 100mg Fluoxetine 10mg caps and tabs Levothyroxine 50mcg Carbamazepine 200mg Fluoxetine 20mg Levothyroxine 75mcg Carvedilol 3.125mg Fluphenazine 1mg Lev

Existing as biocides act_ordinance.docx

This document is a non certified translation and is meant purely as a documentation tool. The information in this document does not constitute legal advice. The only legally binding form of the translated ordinance is the official version, as published in the Federal Law Gazette, in German language. Short title Biocides Act-Ordinance on Existing Active Substances Promulgation Date of

Copyright © 2010-2014 Medical Pdf Finder