Binge eating disorder (BED) is a psychiatric illness related to a high frequency of episodes of binge eating, loss of control, body image dissatisfaction, and suffering caused by overeating. It is ...estimated that 30% of patients with BED are affected by obesity. "Mindful eating" (ME) is a promising new eating technique that can improve self-control and good food choices, helping to increase awareness about the triggers of binge eating episodes and intuitive eating training.
To analyze the impact of ME on episodes of binge eating, body image dissatisfaction, quality of life, eating habits, and anthropometric data weight, Body Mass Index (BMI), and waist circumference in patients with obesity and BED.
This quantitative, prospective, longitudinal, and experimental study recruited 82 patients diagnosed with obesity and BED. The intervention was divided into eight individual weekly meetings, guided by ME sessions, nutritional educational dynamics, cooking workshops, food sensory analyses, and applications of questionnaires Body Shape Questionnaire (BSQ); Binge Eating Scale (BES); Quality of Life Scale (WHOQOL-BREF). There was no dietary prescription for calories, carbohydrates, proteins, fats, and fiber. Patients were only encouraged to consume fewer ultra-processed foods and more natural and minimally processed foods. The meetings occurred from October to November 2023.
To carry out inferential statistics, the Shapiro-Wilk test was used to verify the normality of variable distribution. All variables were identified as non-normal distribution and were compared between the first and the eighth week using a two-tailed Wilcoxon test. Non-Gaussian data were represented by median ± interquartile range (IQR). Additionally, α < 0.05 and
< 0.05 were adopted.
Significant reductions were found from the first to the eighth week for weight, BMI, waist circumference, episodes of binge eating, BSQ scale score, BES score, and total energy value (all
< 0.0001). In contrast, there was a significant increase in the WHOQOL-BREF score and daily water intake (
< 0.0001).
ME improved anthropometric data, episodes of binge eating, body image dissatisfaction, eating habits, and quality of life in participants with obesity and BED in the short-term. However, an extension of the project will be necessary to analyze the impact of the intervention in the long-term.
Nutritional management plays a crucial role in treating patients with type 2 diabetes (T2D), working to prevent and control the progression of chronic non-communicable diseases.
To evaluate the ...effects of individualized nutritional interventions on weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), fasting blood glucose (FBG), hemoglobin A1c (HbA1c), total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), triglycerides (TGs), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR)} over 12 months and subsequently at follow-up (15 months).
This longitudinal experimental study (without randomization and blinding) enrolled 84 sedentary participants with T2D (both sexes, aged 18-80 years). They were divided into a control group of 40 participants who received only medical consultations, and an intervention group of 44 participants who received the same medical care along with a nutritional assessment. Consultations occurred quarterly from August 2020 to November 2022 (first-twelfth month), with six to nine patients per session. Subsequently, a follow-up was conducted from December 2022 to November 2023, during which the intervention group had only medical care (during the 12th-15th months). Personalized dietary planning was inspired by the Mediterranean/DASH diets adapted to Brazilian foods and socioeconomic cultures.
Normal variables were compared between groups for each time point and also within each group across different time points using a two-way ANOVA (repeated measures for intragroup) followed by the Šídák post hoc test. Non-normal variables were compared between groups for each time point using Kruskal-Wallis followed by the Dunn post hoc test, and within each group across different time points using Friedman followed by the Dunn post hoc test. Data with a Gaussian distribution were presented as mean ± standard deviation (SD), and data with a non-Gaussian distribution were presented as median ± interquartile range (IQR). For all cases, α < 0.05 and
< 0.05 were adopted.
In the intervention group, significant reductions were observed between the first and twelfth month for all parameters (
< 0.05), (except for TC), along with an increase in HDL-C (
= 0.0105). Conversely, in the control group, there was a significant increase in HbA1c, weight, BMI, FBG, and WHR (
< 0.05) between the first and twelfth months. Regarding the comparison between groups, there was a significant difference for all analyzed parameters (
< 0.05) from the first to the twelfth month. In the follow-up, differences were also observed (
< 0.05), except for BMI (
> 0.05).
The individualized nutritional intervention improved eating habits, anthropometric, biochemical, and cardiovascular markers in T2D over 12 months, with sustained results during follow-up. The dietary plan inspired by the Mediterranean and DASH diets demonstrated good adaptation to the Brazilian food culture and the patients' socioeconomic contexts. Consistent monitoring and personalized nutritional management are essential for optimizing long-term outcomes. However, more clinical trials are necessary in order to optimize the level of evidence for longitudinal interventions.
Cardiac innervation by the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS) modulates the heart rate (HR) (chronotropic activity) and the contraction of the cardiac ...muscle (inotropic activity). The peripheral vasculature is controlled only by the SNS, which is responsible for peripheral vascular resistance. This also mediates the baroreceptor reflex (BR), which in turn mediates blood pressure (BP). Hypertension (HTN) and the autonomic nervous system (ANS) are closely related, such that derangements can lead to vasomotor impairments and several comorbidities, including obesity, hypertension, resistant hypertension, and chronic kidney disease. Autonomic dysfunction is also associated with functional and structural changes in target organs (heart, brain, kidneys, and blood vessels), increasing cardiovascular risk. Heart rate variability (HRV) is a method of assessing cardiac autonomic modulation. This tool has been used for clinical evaluation and to address the effect of therapeutic interventions. The present review aims (a) to approach the heart rate (HR) as a CV risk factor in hypertensive patients; (b) to analyze the heart rate variability (HRV) as a "tool" to estimate the individual risk stratum for Pre-HTN (P-HTN), Controlled-HTN (C-HTN), Resistant and Refractory HTN (R-HTN and Rf-HTN, respectively), and hypertensive patients with chronic renal disease (HTN+CKD).
Objective: The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe ...reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment. Design and method: This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug uptitration. Participants were evaluated during five visits at 28-day intervals. Results: The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001). Central systolic blood pressure had a greater reduction in the SNB group pre x post-intervention (128.8± 22.1 x 117.4± 17.9) (p = 0.03). Conclusions: In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction and a greater reduction in Central systolic blood pressure.
Resistant hypertension (RHT) is associated with worse outcomes among patients, and sympathetic overactivity is a challenge in treating this clinical condition. Here, we evaluated the autonomic ...modulation (by linear and non-linear analyses), central blood pressure, and pulse wave velocity in controlled and uncontrolled RHT patients, as well as those in use of beta-blockers. We observed that uncontrolled RHT patients display, in addition to an increase in peripheral blood pressure, presented higher central blood pressure values concerning controlled RHT. Furthermore, despite the use of beta-blockers, both patients in the RHT + beta-blockers and uncontrolled RHT groups had negative changes in autonomic balance as compared with controlled RHT. These results reinforce the importance of autonomic nervous system interventions in managing arterial hypertension.
Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern.
The primary aim was to compare sequential nephron blockade (SNB) versus dual ...renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment.
This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals.
The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001).
In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.
Objective: Resistant hypertensive patients have a high prevalence of target organ damage. Increased central systolic blood pressure (cSBP) is more relevant than the peripheral one in these patients, ...because heart, brain and kidneys are directly exposed to high cSBP levels. Moreover, it is directly related to left ventricular hypertrophy, left atrial size, ischemic heart disease, brain injury, and kidney dysfunction. Currently, assessing cSBP and Augmentation Index (Aix) can be helpful to stratify cardiovascular risk and there is evidence that an improvement on cSBP leads to reduction of cardiovascular events and guides the antihypertensive treatment with drugs that more effective on cSBP reduction.An open prospective study was conducted, to identify markers associated with high cSBP values in resistant hypertensive patients on antihypertensive treatment. Design and method: Seventy-two hypertensive patients were recruited in the Hypertension Outpatient Clinic of FAMERP (44 women/ 28 men). Clinical characteristics and biochemical data collected are shown in the Table 1. The central systolic arterial pressure (cSBP) and the augmentation index (AIx) were measured using Tonometry HEM 9000-A validated OMRON equipment (JAPAN). Results: Multiple regression (cSBP) showed positive correlation between cSBP and brachial SBP (p = 0,0243) and microalbuminuria (p = 0,0325) and negative correlation with 24-h urinary sodium (p = 0,0277). Table2 and Figures. Conclusions: In Resistant hypertensive patientes the microalbuminuria can be useful as a marker to Increased central systolic blood pressure (cSBP)
Objective: Resistant hypertension (RHTN) is a clinical entity, difficult to manage. To identify the contribution of the volume as well as the renin activity from the maintenance of blood pressure ...levels could individualize the treatment. Objectives : To demonstrate the efficacy of therapy of sequential nephron blocking (SNB) in relation to the double blockade of the renin-angiotensin system associated with beta-blockers (DBRAS) in patients with RHTN with > 85%-adherence rate after 20 weeks of treatment. Design and method: A prospective study was conducted, open, randomized, parallel comparison between two regimens for RHT: SNB versus DBRAS. SNB consists in a progressive increase of sodium depletion with thiazide, followed by a blockade of mineralocorticoid receptor, followed by progressive doses of loop diuretics and finally blocking sodium channels. DBRAS consists in reinforcing the effect of angiotensin receptor blocker (ARB) with an angiotensin converting enzyme inhibitors (ACEI), followed by betablockers to decrease the renin secretion. Seventy-two patients were randomized (35 to SNB 13 M/22F and 37 to RASDB 14 M/23F) coming from the tertiary outpatient clinic (HB-FAMERP). We used the criteria of the Brazilian VII Guidelines for Hypertension and V Guidelines for ABPM and HBPM. The BP was monitored with the SpaceLabs 90207. Results: Baseline clinical characteristics and laboratory parameters of the 72 RHTM randomized to SNB (n = 35) or DBRAS (n = 37) were similar across both study groups. At the end of the study, a significant reduction of the office pressure was observed (SBP and DBP) in both post-intervention groups (SNB group: initial SBP: 174.5 ± 21.08; final SBP: 127.0 ± 14.74; Initial DBP: 105.3 ± 15.5, final DBP: 78.11 ± 9.28 (p < 0.0001), RAASDB group: initial SBP: 178.4 ± 21.08, final SBP: 134.4 ± 23.25, initial DBP: 102.7 ± 11.07, final DBP: 77.33 ± 13.75 (p < 0.0001). No discontinuation due drug-related adverse events in both study groups. Conclusions: SNB and DBRAS associated with the beta-blocker in RHTN patients with full adherence to the treatment showed excellent therapeutic efficacy. However, the SNB group disclosed a greater absolute reduction of central blood pressure values.
Objective: The different classes of drugs routinely used in anti-hypertensive therapy promote different effects on markers of arterial stiffness and, consequently, on the central blood pressure. ...Arterial stiffness is the main determinant for the increase of the central blood pressure and considered an important predictor for myocardial infarction, stroke and congestive heart failure. Objective: The objective of this study was to compare the effect on the systolic central blood pressure and arterial stiffness in resistant hypertensive patients submitted to sequential nephron blockade (SNB) against double blockade of the renin-angiotensin-aldosterone system (DBRAS) plus Bisoprolol. Design and method: Fifty-five resistant hypertensive patients were recruited in the Hypertension Outpatient Clinic of FAMERP, twenty-nine in the SNB group (18F/11 M) and twenty-six in the DBRAS group (22F/4 M). Central systolic blood pressure (cSBP), incrementing index (AI) and AI75 were measured with Omron HEM9000-A. (Japan). Results: The main result showed significant reduction of the central systolic blood pressure in patients submitted to sequential blockade nephron treatment when compared with the double blockade of the renin-angiotensin system plus Bisoprolol group (128.8 ± 22.1 vs. 117.4 ± 17.9 mmHg - P = 0.03). Figure 1 Conclusions: The sequential nephron blockade group, when compared with the double blockade of the renin-angiotensin-aldosterone system plus Bisoprolol, promotes significant higher reduction of the central systolic blood pressure in resistant hypertensive patients.
IntroductionHypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern. ObjectivesThe primary aim was to compare sequential nephron ...blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment. Material and MethodsThis trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals. ResultsThe mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001). ConclusionIn patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.
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