The Impact of a Nutritional Intervention on Glycemic Control and Cardiovascular Risk Markers in Type 2 Diabetes.

INTRODUCTION: 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. OBJECTIVES: 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). METHODS: 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. STATISTICAL ANALYSIS: 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 Sídák 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 p < 0.05 were adopted. RESULTS: In the intervention group, significant reductions were observed between the first and twelfth month for all parameters (p < 0.05), (except for TC), along with an increase in HDL-C (p = 0.0105). Conversely, in the control group, there was a significant increase in HbA1c, weight, BMI, FBG, and WHR (p < 0.05) between the first and twelfth months. Regarding the comparison between groups, there was a significant difference for all analyzed parameters (p < 0.05) from the first to the twelfth month. In the follow-up, differences were also observed (p < 0.05), except for BMI (p > 0.05). CONCLUSION: 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.

Effects of Mindful Eating in Patients with Obesity and Binge Eating Disorder.

INTRODUCTION: 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. OBJECTIVES: 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. METHOD: 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. STATISTICAL ANALYSIS: 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 p < 0.05 were adopted. RESULTS: 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 p < 0.0001). In contrast, there was a significant increase in the WHOQOL-BREF score and daily water intake (p < 0.0001). CONCLUSIONS: 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 Strategies for the Management of Type 2 Diabetes Mellitus: A Narrative Review.

BACKGROUND: Thinking about greater adherence to dietary planning, it is extremely important to be aware of all nutritional strategies and dietary prescriptions available in the literature, and of which of them is the most efficient for the management of T2DM. METHODS: A search was carried out in 2023 for randomized clinical trials, systematic reviews, meta-analyses, and guidelines in the following databases: Pubmed, Scielo, Web of Science, CrossRef and Google Scholar. In total, 202 articles were collected and analyzed. The period of publications was 1983-2023. RESULTS: There is still no consensus on what the best nutritional strategy or ideal dietary prescription is, and individuality is necessary. In any case, these references suggest that Mediterranean Diet may of greater interest for the management of T2DM, with the following recommended dietary prescription: 40-50% carbohydrates; 15-25% proteins; 25-35% fats (<7% saturated, 10% polyunsaturated, and 10% monounsaturated); at least 14 g of fiber for every 1000 kcal consumed; and <2300 mg sodium. CONCLUSIONS: Individuality is the gold standard for dietary prescriptions, however, the Mediterranean diet with low levels of carbohydrates and fats seems to be the most promising strategy for the management of T2DM.

Linear and non-linear analyses of autonomic modulation in uncontrolled and controlled elderly resistant hypertensives.

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.

Resistant Hypertension On Treatment (ResHypOT): sequential nephron blockade compared to dual blockade of the renin-angiotensin-aldosterone system plus bisoprolol in the treatment of resistant arterial hypertension - study protocol for a randomized controlled trial.

BACKGROUND: Resistant hypertension is characterized when the blood pressure (BP) remains above the recommended goal after taking three antihypertensive drugs with synergistic actions at their maximum recommended tolerated doses, preferably including a diuretic. Identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether acting on the control of intravascular volume or sodium balance, or acting on the effects of the renin-angiotensin-aldosterone system (RAAS) on the kidney. METHODS/DESIGN: This is a randomized, open-label, clinical trial is designed to compare sequential nephron blockade and its contribution to the intravascular volume component with dual blockade of the RAAS plus bisoprolol and the importance of serum renin in maintaining BP levels. The trial has two arms: sequential nephron blockade versus dual blockade of the RAAS (with an angiotensin converting enzyme (ACE) inhibitor plus a beta-blocker) both added-on to a thiazide diuretic, a calcium-channel blocker and an angiotensin receptor-1 blocker (ARB). Sequential nephron blockade consists in a progressive increase in sodium depletion using a thiazide diuretic, an aldosterone-receptor blocker, furosemide and, finally, amiloride. On the other hand, the dual blockade of the RAAS consists of the progressive addition of an ACE inhibitor until the maximum dose and then the administration of a beta-blocker until the maximum dose. The primary outcomes will be reductions in the systolic BP, diastolic BP, mean BP and pulse pressure (PP) after 20 weeks of treatment. The secondary outcomes will evaluate treatment safety and tolerability, biochemical changes, evaluation of renal function and recognition of hypotension (ambulatory BP monitoring (ABPM)). The sample size was calculated assuming an alpha error of 5% to reject the null hypothesis with a statistical power of 80% giving a total of 40 individuals per group. DISCUSSION: In recent years, the cost of resistant hypertension (RH) treatment has increased. Thus, identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether by acting on the control of intravascular volume or sodium balance, or by acting on the effects of the RAAS on the kidney. TRIAL REGISTRATION: Sequential Nephron Blockade vs. Dual Blockade Renin-angiotensin System + Bisoprolol in Resistant Arterial Hypertension (ResHypOT). ClinicalTrials.gov, ID: NCT02832973 . Registered on 14 July 2016. First received: 12 June 2016. Last updated: 18 July 2016.

Impaired flow-mediated dilation response and carotid intima-media thickness in patients with type 1 diabetes mellitus with a mean disease duration of 4 1 years

ABSTRACT Objective This study aimed at assessing the endothelial function in patients with Type 1 diabetes (T1DM) using flow-mediated dilation (FMD) response and carotid artery intima-media thickness (CIMT). Materials and methods This study enrolled 32 T1DM patients (mean disease duration 4.1 years) and 28 age-matched controls (CTL Group). Endothelial function and CIMT were assessed with high-resolution ultrasound using standardized offline measurements. Results FMD was significantly lower in patients in the T1DM Group (8.9 ± 3.2%) compared with those in the CTL Group (13.3 ± 4.3%; P-value < 0.0001). Similarly, CIMT differed significantly between T1DM patients (0.525 ± 0.03 mm) and controls (0.508 ± 0.03 mm; P-value = 0.041). Even though, the values are within the normal range for age. Conclusions Patients with T1DM have impaired endothelial function characterized by reduced FMD when compared to controls. However, vascular remodeling as seen by increases in CIMT was not found in this study.

Controle da pressão central em paciente obeso, após infarto do miocárdio / Control of central pressure in an obese patient, post myocardial infarction

Pacientes hipertensos com evento cardiovascular agudo requerem intervenção adequada com alcance precoce de metas pressóricas pré-definidas, para redução de risco absoluto e residual de desfechos fatais e não fatais. O presente caso clínico trata-se de um paciente obeso, hipertenso que apresentou infarto agudo do miocárdio submetido a cateterismo e angioplastia com sucesso primário. Após alta da Unidade Coronariana, na enfermaria evoluiu com elevação dos valores pressóricos. Foram realizados teste de bioimpedância (para verificar volumetria) e avaliação da pressão central por tonometria de aplanação da artéria radial com Sphygmocor. A conduta a seguir foi orientada pelos resultados dos paramentos hemodinâmicos e realizada a escolha da medicação ideal para o tratamento

Hypertensive patients with an acute cardiovascular event require adequate intervention with early reach of pre-defined blood pressure goals to reduce absolute and residual risk of fatal and nonfatal outcomes. The present case is a hypertensive patient who presented acute myocardial infarction undergoing catheterization and angioplasty with primary success. After discharge from the Coronary Unit, the ward evolved with elevation of blood pressure values. Bioimpedance test (to verify volumetry) and evaluation of the central pressure by tonometry of radial artery aplanation with Sphygmocor were performed. The following conduct was guided by the results of the hemodynamic parameters and the choice of the ideal medication for the treatment was made.

Influence of Apolipoprotein E on the Lipid Profile and Postprandial Triglyceride Levels in Brazilian Postmenopausal Women With Artery Disease.

This study confirms the association of risk factors for coronary artery disease (CAD) and the apoE polymorphisms, specifically related to the APOE*4 allele, with coronary disease in postmenopausal women. Significantly altered values of the lipid profile were found in patients when compared with controls, independent of the presence of the APOE*4 allele. However, the controls showed higher high-density lipoprotein cholesterol (HDL-C) levels and reduced triglyceride (TG) levels, differing significantly from patients. In this case, the study of subgroups, considering the APOE*3/3 and APOE*3/4 genotypes, suggests that the APOE*4 allele is not implicated in the variations of the lipid profile of patients and determined an increase in the production levels of HDL-C and a reduction in TG highly benefiting the control group compared with APOE*3/3 genotype. The metabolic kinetics of TG, although with the same pattern between groups, and the presence of the APOE*4 allele are suggested to be associated with accelerated clearance compared with APOE*3 allele in non-CAD group.

Impaired flow-mediated dilation response and carotid intima-media thickness in patients with type 1 diabetes mellitus with a mean disease duration of 4.1 years.

OBJECTIVE: This study aimed at assessing the endothelial function in patients with Type 1 diabetes (T1DM) using flow-mediated dilation (FMD) response and carotid artery intima-media thickness (CIMT). MATERIALS AND METHODS: This study enrolled 32 T1DM patients (mean disease duration 4.1 years) and 28 age-matched controls (CTL Group). Endothelial function and CIMT were assessed with high-resolution ultrasound using standardized offline measurements. RESULTS: FMD was significantly lower in patients in the T1DM Group (8.9 ± 3.2%) compared with those in the CTL Group (13.3 ± 4.3%; P-value < 0.0001). Similarly, CIMT differed significantly between T1DM patients (0.525 ± 0.03 mm) and controls (0.508 ± 0.03 mm; P-value = 0.041). Even though, the values are within the normal range for age. CONCLUSIONS: Patients with T1DM have impaired endothelial function characterized by reduced FMD when compared to controls. However, vascular remodeling as seen by increases in CIMT was not found in this study.

Disfunção Endotelial e Hipertensão Arterial / Endothelium Dysfunction and Arterial Hypertension

O papel do endotélio vascular na fisiopatologia das doenças cardiovasculares tem sido amplamente difundido. Alguns estudos demonstraram que a alteração da função endotelial constitui um importante mecanismo fisiopatogênico da hipertensão arterial, enquanto outros afirmam que hipertensão arterial provoca alteração da função endotelial. Disfunção endotelial (DE)caracteriza qualquer alteração de atividade normal do endotélio incluindo atividade vasomotora, proliferação celular, adesão/agregação plaquetária, permeabilidade vascular e a interação leucócitos­parede vascular. Contudo, em repouso o leito arterial exibe um estado basal de vasoconstrição (tônus vascular) modulado por mecanismos de controle central (sistema nervoso­simpático), periférico (sistema renina­angiotensina­aldosterona) e um mecanismo local (endotelial), cuja potência é superior às anteriores. DE na hipertensão está relacionada à diminuição da biodisponibilidade de NO por redução da síntese e liberação pela sintase endotelial do óxido nítrico (eNOS) influenciada por fatores genéticos e ambientais como hipóxia, hipofluxo, forças de cisalhamento, redução do substrato L-arginina e seus cofatores, ou inativação do NO resultado da sua ligação com diferentes moléculas como hemoglobina, albumina e, principalmente, sua interação com espécies reativas de oxigênio (estresse oxidativo). DE na hipertensão pode ainda, estar associada à liberação de substâncias vasoconstritoras derivadas do endotélio como tromboxano-A2, prostaglandina-H2, endotelina-1 e angiotensina-II.

The role of the vascular endothelium in the pathophysiology of cardiovascular disease has been widely discussed. Some studies have shown that changes in endothelial function are an important pathophysiological mechanism in hypertension, while others claim that high blood pressure causes changes in the endothelial function. Endothelial dysfunction (ED) includes any change in the normal activity of the endothelium including vasomotor activity, cell proliferation, platelet adhesion/aggregation, vascular permeability and leukocyte­vascular wall interactions. However, at rest, the arterial bed exhibits a baseline vasoconstriction (vascular tone) modulated by central control (sympathetic­nervous system), peripheral (renin­angiotensin­aldosterone system) and local mechanisms (endothelial); the effect of the latter is the greatest. ED in hypertension is related to decreased NO bioavailability due to reduced synthesis and release by endothelial NO synthase (eNOS). This condition is influenced by genetic and environmental factors such as hypoxia, low flow, shear stress, diminished L-arginine substrate and its cofactors or inactivation of NO after binding with molecules such as hemoglobin, albumin, and especially its interaction with reactive oxygen species (oxidative stress). ED in hypertension may also be associated with the release of vasoconstrictor endothelium-derived substances such as thromboxane-A2, prostaglandin-H2, endothelin-1 and angiotensin-II

Lesão folicular: correlação entre achados da punção aspirativa por agulha fina de tireoide e exame anatomopatológico / Follicular lesion: correlation between findings of fine needle aspiration of thyroid and histological study

JUSTIFICATIVA E OBJETIVO: A punção aspirativa por agulha fina é um método de alta acurácia no diagnóstico pré-operatório de nódulos tireoidianos, porém, quando se trata de lesões de padrão folicular, ainda há limitação diagnóstica na distinção entre lesões benignas e malignas. O objetivo deste estudo foi determinar a taxa de malignidade em lesões foliculares de tireoide a partir do exame anatomopatológico de pacientes cirurgicamente tratados em centro médico quaternário. MÉTODOS: Análise observacional retrospectiva dos casos de lesão folicular de tireoide investigados em ambiente ambulatorial pela disciplina de Endocrinologia do Hospital de Base de São José do Rio Preto no período entre 1º de janeiro de 2000 e 31 de dezembro de 2012. RESULTADOS: Dentre o total de 1.150 punções aspirativa por agulha fina realizadas, 841 tiveram diagnóstico citológico de benignidade (73,13%), 117 tiveram diagnóstico de malignidade (10,17%) e 192 tiveram diagnóstico de lesão folicular de significado indeterminado (16,70%). Destes, 144 (75%) foram submetidos à tireoidectomia para diagnóstico anatomopatológico confirmatório, tendo prevalência de malignidade em 36,80%. Houve predomínio do carcinoma papilífero de tireoide (20,83%), seguido do carcinoma folicular de tireoide(15,28%) e apenas um caso de carcinoma medular de tireoide (0,69%). CONCLUSÃO: A taxa de malignidade nas citologias de padrão folicular, após correlação histológica neste serviço, foi superior à estimada na literatura, o que evidencia o valor da punção aspirativa por agulha fina como um exame de screening de nódulos tireoidianos e reforça a importância da confirmação histopatológica, para correto tratamento e seguimento desses pacientes

BACKGROUND AND OBJECTIVE: The fine needle aspiration is a method of high accuracy in preoperative diagnosis of thyroid nodules, but when it comes to follicular lesions there are still limitations in diagnostic distinction between benign and malignant lesions. The aim of this study was to determine the rate of malignancy in thyroid follicular lesions from the pathologic exam of patients surgically treated in a quaternary medical center. METHODS: Retrospective observational analysis of cases of thyroid follicular lesions investigated in an outpatient basis by the Endocrinology Department, at Hospital de Base, in the city of São José do Rio Preto, São Paulo, Brazil, in the period between January 1, 2000 and December 31, 2012. RESULTS: Among a total of 1,150 fine needle aspirations, 841 had benign cytological diagnosis (73.13%), 117 had diagnosis of malignancy (10.17%) and 192 had diagnosis of follicular lesions of undetermined significance (16.70%). Of these, 144 (75%) underwent thyroidectomy for confirmatory histological diagnosis, with prevalence of malignancy in 36.80%. There was a predominance of papillary thyroid carcinoma (20.83%), followed by follicular thyroid carcinoma (15.28%) and only one case of medullary thyroid carcinoma (0.69%). CONCLUSION: The rate of malignancy in follicular cytology after histologic correlation in our service was higher than that estimated in the literature, showing the value of fine needle aspiration as a screening test for thyroid nodules, and reinforcing the importance of histopathological confirmation for correct handling and follow-up of these patients.

O endotélio disfuncionante na hipertensão arterial e no tabagismo / Dysfunctional endothelium in hypertension and smoking

Disfunção endotelial (DE) caracteriza qualquer alteração de atividadenormal do endotélio incluindo atividade vasomotora, proliferaçãocelular, adesão/agregação plaquetária, permeabilidade vascular e a interaçãoleucócitos/parede vascular. Contudo, em repouso o leito arterialexibe um estado basal de vasoconstrição (tônus vascular) modulado pormecanismos de controle centrais (sistema nervoso-simpático), periféricos(sistema renina-angiotensina-aldosterona) e um mecanismo local(endotelial) cuja potência é superior às anteriores. DE na hipertensãoestá relacionada à diminuição da biodisponibilidade de NO por reduçãoda síntese e liberação pela sintase endotelial do óxido nítrico (eNOS)influenciada por fatores genéticos e ambientais como hipóxia, hipofluxo,forças de cisalhamento, redução do substrato L-arginina e seuscofatores, ou inativação do NO resultado da sua ligação com diferentesmoléculas hemoglobina, albumina e, principalmente, sua interação comespécies reativas de oxigênio (estresse oxidativo). DE na hipertensãopode, ainda, estar associada à liberação de substâncias vasoconstritorasderivadas do endotélio como trornboxano-Aç, prostaglândina-Hj,endotelina-l e angotensina-Il. Tabagismo aumenta o risco de eventoscardiovasculares, principalmente quando associado à hipertensão.Nicotina estimula a liberação de catecolarninas e promove lesões noendotélio vascular. Radicais livres e compostos aromáticos diminuema síntese de NO, prejudicando a vasodilatação endotélio-dependente.Tabagismo favorece o crescimento celular por estimulação de fatoresde crescimento do endotélio vascular e inativação do NO por aumentodo estresse oxidativo. Aumento da oxidação das lipoproteínas debaixa densidade (LDL) em fumantes tem efeito sinérgico na adesão emigração de monócitos. Todos esses efeitos deletérios do tabagismono leito vascular também são observados, embora em menor extensão,em tabagistas passivos...

Endothelial dysfunction (ED) characterizes ali changes in the normalactivity ofthe endothelium including vasomotor activity, cell proliferation,platelet adhesion and aggregation, vascular permeability andleukocyte-vascular wall interactions. However, at rest, the arterialbed exhibits a baseline state of vasoconstriction (vascular tone) whichis modulated by central control (sympathetic nervous system) andperipheral mechanisms (Renin angiotensin-aldosterone system) anda local mechanism (endothelial); the latter is the most potent. ED inhypertension is related to decreased bioavailability of nitric oxide(NO) due to its reduced synthesis and release by endothelial nitricoxide synthase (eNOS) regarding genetic and environmental factorssuch as hypoxia, decreased blood flow, shear forces, diminishedL-arginine substrate and its cofactors and NO inactivation as a resultof its binding to different molecules including hemoglobin, albuminand, mainly, its interaction with reactive oxygen species (oxidativestress). ED in hypertension can also be linked to the release of endothelium-derived vasoconstricting substances such as thromboxane-Ai,prostaglandin-H2, endothelin-l and angiotensin-Il. Smoking increasesthe risk of cardiovascular events especially when associated withhypertension. Nicotine stimulates catecholamine release and causesvascular endothelium injury. Free radicais and aromatic compoundsreduce NO synthesis, impairing endothelium-dependent vasodilation.Smoking promotes cell growth by stimulating vascular endotheliumgrowth factors and NO inactivation by increasing oxidative stress.The increased oxidation of low-density lipoproteins ir smokers hasa synergistic effect on monocyte adhesion and migration. All thesedeleterious effects of smoking on the vascular bed are also observed,albeit at a lesser extent, in passive smokers...