Impacto de dois programas de educação nutricional sobre o risco cardiovascular em pacientes hipertensos e com excesso de peso Impact of two nutritional education programs on cardiovascular risk in overweight hypertensive patients

OBJETIVO:Comparar os efeitos de dois protocolos de um programa de intervenção nutricional sob o risco cardiovascular em pacientes hipertensos e com excesso de peso em uso de medicamentos usual. Os pacientes foram acompanhados no Ambulatório de Hipertensão e Metabologia Cardiovascular, Universidade Federal de São Paulo. MÉTODOS:A população do estudo foi constituída por 63 pacientes hipertensos e com excesso de peso &#91;índice de massa corporal >27 e <39kg/m²&#93;, com a média de idade de M=55,7, DP=6,1 anos; 12 homens e 51 mulheres, divididos em dois grupos de acordo com a freqüência das visitas, a cada cinco semanas (G35 n=25) ou a cada duas semanas (G14 n=38), durante 20 semanas. Os dois grupos foram submetidos a um programa de intervenção nutricional que englobou atendimentos em grupos, nos quais foram abordados conceitos de alimentação saudável. No início e no término do período do estudo, todos os pacientes foram submetidos a medidas de pressão arterial, avaliação antropométrica e avaliação laboratorial para cálculo do Risco Coronariano de Framingham. RESULTADOS:Ao término do estudo, foi observada redução no índice de massa corporal, na circunferência da cintura (M=102,9, DP=9,7cm vs M=101,8, DP=7,6cm NS), na pressão arterial sistólica (M=139,7, DP=12,4mmHg vs M=134,8, DP=8,2mmHg NS), no colesterol total sérico (M=192,9, DP=35,7mg/dL vs M=195,2, DP=37,8mg/dL NS), no consumo energético referido (M=1759,5, DP=385,8Kcal vs M=1858,7, DP=452,8kcak NS) e no RCF (M=11,1, DP=6,1 vs M=9,4, DP=3,5 NS). CONCLUSÃO:A intervenção nutricional educativa de curto prazo, se mostrou eficaz para redução do risco cardiovascular em pacientes hipertensos e com excesso de peso. Em relação a freqüência das visitas, pôde-se verificar que a visita mensal já produz resultados positivos no sentido de modificar os hábitos alimentares e reduzir o risco cardiovascular.<br>OBJECTIVE:To evaluate and compare the effects of two study protocols with a program of educational nutrition intervention on CARDIOVACULAR risk in overweight hypertensive patients maintained on their usual medication. Patients were followed at Hypertension and Metabology Division of Federal University of São Paulo. METHODS: Sixty tree overweight &#91;body mass index >27 e <39kg/m²&#93; hypertensive patients, age M=55,7 (Standard deviation - SD=6,1) years old, 12 men and 51 women, were divided into two groups according to visit intervals, either every five weeks (G35 n=25) or every two weeks (G14 n=38), during twenty weeks. The two groups were submitted to an educational program aiming to improve the quality of their diet and to promote changes in their alimentary habits. Before and at the end of the study period, all patients were submitted to blood pressure determinations, to anthopometric measurements and to laboratorial evaluation for the calculation of Framingham coronary risk. RESULTS:At the end of the study significant and similar changes in body mass index, waist circumference (102,9, SD=9,7 vs 101,8, SD=7,6 NS), systolic blood pressure (139,7, SD=12,4 vs 134,8, SD=8,2 NS), total cholesterol (192,9, SD=35,7 vs 195,2, SD=37,8 NS), energy intake (1759,5, SD=385,8 vs 1858,7, SD=452,8 NS) and Framingham coronary risk (11,1, SD=6,1 vs 9,4, SD=3,5 NS) we observed in G14 and G35 groups respectively. CONCLUSION: A short program of nutritional intervention was shown to be useful to reduce coronary risk in overweight hypertensive patients despite a very small change in body weight. A higher frequency of visits did not achieve better results, with a monthly visit being enough for positive changes although with a higher rate of drop outs

Impacto do exercício físico isolado e combinado com dieta sobre os níveis séricos de HDL, LDL, colesterol total e triglicerídeos Impact of isolated and combined with diet physical exercise on the HDL, LDL, total cholesterol and triglycerides plasma levels

Adequados hábitos alimentares e a prática de exercícios físicos exercem efeito benéfico sobre as dislipidemias. Se associados, podem ainda otimizar as mudanças do perfil lipoprotéico plasmático, sendo, além disso, intervenções de custo moderado quando comparados com tratamentos medicamentosos e dependentes de alta tecnologia. Este estudo tem por objetivo avaliar o impacto do exercício físico isolado e combinado com dieta sobre o perfil lipídico em indivíduos com sobrepeso/obesos. O presente trabalho é do tipo retrospectivo analítico observacional. Nele foi analisada a evolução do perfil lipídico e do peso, por período entre três e seis meses, de 30 indivíduos, divididos em dois grupos: grupo exercício (prática de exercício físico) e grupo dieta (prática de exercício físico associada à intervenção nutricional). Foram encontradas reduções estatisticamente significativas no CT (-14,4mg/dl; P = 0,022) e no LDL-c (-20,9mg/dl; P = 0,013) para os componentes do grupo exercício. Tal redução também ocorreu em relação à razão CT/HDL-c (-0,9; P = 0,005) para os componentes do grupo dieta. Foi observada elevação dos níveis de HDL-c, apenas no grupo dieta (+4,2 mg/dl). Nesse mesmo grupo verificou-se diminuição no CT (-8mg/dl) e no LDL-c (-9,8mg/dl), bem como redução de peso (-2,6kg), no entanto, tais resultados não foram estatisticamente significativos. Quanto aos níveis de TG, não foi verificada evolução positiva em ambos os grupos. Concluiu-se que o efeito isolado do exercício físico foi mais evidente em relação às variáveis CT e LDL-c. Os TG não sofreram modificações positivas com a prática exclusiva de exercícios físicos ou com sua associação à dieta. Para as variáveis HDL-c e peso, a combinação da dieta com o exercício físico apresentou maiores benefícios.<br>Adequate eating habits and physical exercise have a beneficial effect on dislipidemies. When associated, they might even optimize changes to the plasmatic lipoproteic profile, apart of which they are moderate-cost interventions if compared to drug-based and high-tech depending treatments. The present study aims at assessing the impact of physical exercise as isolated and combined with a diet on the lipidic profile of overweight/obese individuals. Tn observational analytical retrospective study has looked into the evolution of the lipidic profile and weight over a period of 3 to 6 months of 30 individuals divided in two groups: the exercise group (physical exercise practice) and the diet group (physical exercise associated with a nutritional intervention). Significant statistical reductions were found in the CT (-14.4 mg/dl; P=0,022) and in the LDL-c (-20.9 mg/dl; P = 0,013) for the components in the exercise group. Such reduction has also occurred regarding the CT/HDL-c (-0,9; P = 0,005) ratio for the components of the diet group. The increase in the HDL-c levels was observed only in the diet group (+4.2 mg/dl). In this same group a decrease in the CT (-8 mg/dl) and in the LDL-c (-9,8 mg/dl) was observed as well as a weight reduction (-2.6 Kg), however, such results have not been statistically significant. Regarding the TG levels, there was no evidence for a positive evolution in either group. As a conclusion, the isolated effect of physical exercise was more evident concerning the variables CT and LDL-c. The TG did not undergo positive modifications upon the exclusive practice of physical exercise or with their association with the diet. As for variables HDL-c and weight, the combination of diet and physical exercise has proven to bring enhanced benefits

Purinergic receptors in the endocrine and exocrine pancreas

The pancreas is a complex gland performing both endocrine and exocrine functions. In recent years there has been increasing evidence that both endocrine and exocrine cells possess purinergic receptors, which influence processes such as insulin secretion and epithelial ion transport. Most commonly, these processes have been viewed separately. In β cells, stimulation of P2Y1 receptors amplifies secretion of insulin in the presence of glucose. Nucleotides released from secretory granules could also contribute to autocrine/paracrine regulation in pancreatic islets. In addition to P2Y1 receptors, there is also evidence for other P2 and adenosine receptors in β cells (P2Y2, P2Y4, P2Y6, P2X subtypes and A1 receptors) and in glucagon-secreting α cells (P2X7, A2 receptors). In the exocrine pancreas, acini release ATP and ATP-hydrolysing and ATP-generating enzymes. P2 receptors are prominent in pancreatic ducts, and several studies indicate that P2Y2, P2Y4, P2Y11, P2X4 and P2X7 receptors could regulate secretion, primarily by affecting Cl− and K+ channels and intracellular Ca2+ signalling. In order to understand the physiology of the whole organ, it is necessary to consider the full complement of purinergic receptors on different cells as well as the structural and functional relation between various cells within the whole organ. In addition to the possible physiological function of purinergic receptors, this review analyses whether the receptors could be potential therapeutic targets for drug design aimed at treatment of pancreatic diseases