Physical and mental health outcomes of an integrated cognitive behavioural and weight management therapy for people with an eating disorder characterized by binge eating and a high body mass index : a randomized controlled trial

Background: Bulimia nervosa (BN) and binge eating disorder (BED) are eating disorders (EDs) characterized by recurrent binge eating. They are associated with medical complications, impaired adaptive function and often a high BMI, for which a multidisciplinary treatment approach may be needed. This study explored the efficacy of a novel intervention integrating Cognitive Behavioural Therapy- Enhanced (CBT-E) and weight management for people with recurrent binge eating episodes and high BMI with respect to physical, psychopathological and quality of life outcomes. Methods: Ninety-eight adults diagnosed with BN, BED, or Other Specified/Unspecified Feeding or Eating Disorder (OSFED/UFED) and BMI ≥ 27 to <40 kg/m2 were randomized to a multidisciplinary approach, the Healthy APproach to weIght management and Food in Eating Disorders (HAPIFED) or to CBT-E. Metabolic parameters, health-related quality of life, general psychological and ED symptoms and ED diagnostic status outcomes are reported. Data were analyzed with mixed effects models adopting multiple imputed datasets where data were missing. Results: Both HAPIFED and CBT-E showed statistical significance for the time effect, with reduction in stress (p < 0.001), improvement in mental health-related quality of life (p = 0.032), reduction in binge eating severity (p < 0.001), and also in global ED symptoms scores (p < 0.001), with the significant changes found at end of treatment and sustained at 12-month follow-up. However, no statistical significance was found for differences between the interventions in any of the outcomes measured. Despite a high BMI, most participants (> 75%) had blood test results for glucose, insulin, triglycerides and cholesterol within the normal range, and 52% were within the normal range for the physical component of quality of life at baseline with no change during the trial period. Conclusion: Integrating weight and ED management resulted in comparable outcomes to ED therapy alone. Although adding weight management to an ED intervention had no adverse effects on psychological outcomes, it also had no beneficial effect on metabolic outcomes. Therefore, more intense weight management strategies may be required where indicated to improve metabolic outcomes. Safety will need to be concurrently investigated. Trial registration: US National Institutes of Health clinical trial registration number NCT02464345, date of registration 08/06/2015. Changes to the present paper from the published protocol paper (Trials 18:578, 2015) and as reported in the Trial registration (clinicaltrials.gov) are reported in Supplementary File 1

Uso de ácidos graxos omega-3 na prática clínica e sua influência na resposta inflamatória em pacientes com neoplasia colorretal e indicação cirúrgica: uma revisão integrativa

Inflammation is a physiological response triggered by injury, whether infectious or not. In recent decades, this process has become a hallmark of cancer since it is a critical component for tumor progression and metastasis. Omega-3 fatty acids has been shown to be a potent anti- inflammatory agent and its application in clinical practice mainly in colorectal cancer has shown relevants results. This study aimed to conduct an integrative review on the use of omega- 3 in patients with colorectal neoplasia undergoing surgical treatment. The related articles on the topic were organized chronologically, thus showing the evolution of knowledge and its application in clinical practice. The results of clinical trials were analyzed using omega-3 in the perioperative period, with special attention to the type of composition, dose offered, route of administration, period and time of use and the impact on the modulation of the inflammatory process of patients being treated. The results after this analysis can help decision making for the better management of these patients, in addition to providing new strategies for the development of future research regarding the proof and improvement of the effectiveness of omega-3 in the perioperative inflammatory control of patients with colorectal neoplasia.A inflamação é uma resposta fisiológica desencadeada a partir de uma injúria, seja de natureza infecciosa ou não. Nas últimas décadas, esse processo tornou-se característica marcante do câncer, uma vez que é um componente crítico para a progressão do tumor e sua metastatização. Os ácidos graxos ômega-3 tem se mostrado como um potente agente anti-inflamatório e a sua aplicação na prática clínica principalmente em câncer colorretal tem mostrado resultados relevantes. O presente trabalho teve por objetivo realizar uma revisão integrativa sobre o uso de ômega-3 em pacientes com neoplasia colorretal em tratamento cirúrgico. Os artigos relacionados sobre o tema foram organizados de maneira cronológica evidenciando assim a evolução do conhecimento e a sua aplicação na prática clínica. Foram analisados os resultados dos ensaios clínicos utilizando-se ômega-3 no perioperatório, com especial atenção sobre tipo de composição, dose ofertada, via de administração, período e tempo de uso e o impacto na modulação do processo inflamatório dos pacientes em tratamento. Os resultados após essa análise podem auxiliar a tomada de decisão para o melhor manejo desses pacientes, além de propiciar novas estratégias para o desenvolvimento de futuras pesquisas no que tange a comprovação e melhoria da eficácia do ômega-3 no controle inflamatório perioperatório de pacientes com neoplasia colorretal.Dados abertos - Sucupira - Teses e dissertações (2020

Homeostasis - An Integrated Vision

The human body is composed of several systems and organs, consisting of millions of cells that need relatively stable conditions to function and contribute to the survival of the body as a whole. The maintenance of stable conditions for the cells against the variations of the external environment is an essential function of the body and is called homeostasis. As a consequence of the loss of homeostasis, a disease is manifested. This book aims to provide the reader with an up-to-date view of the self-regulatory mechanisms that are activated to achieve homeostasis, the pathways that are altered during the disease process, and how medicine can intervene to restore balance in critical patients