The Ganepão conference considers, within its educational proposal, the dissemination of knowledge as a fundamental action. On this space, you can follow relevant nutrition contents based on scientific evidence.
The American Diabetes Association (ADA) has updated the guidelines for hypertension management in diabetes patients. Published in the September issue of Diabetes Care, it is ADA's first updated guidance on the treatment of hypertension since 2003.
The new recommendations provide lifestyle plans to reduce blood pressure (BP), which include suggestions for weight loss, a Dietary Approaches to Stop Hypertension (DASH) style food plan, and increased physical activity. In addition, they point out that the target blood pressure in adult patients with diabetes should be <140/90 mm Hg, once that it reduces cardiovascular events and some microvascular complications.
In patients at high risk of cardiovascular disease, a target lower than 130/80 or 120/80 mm Hg is recommended. However, these goals should be achieved in the least invasive means possible, through lifestyle.
According to the authors, it is necessary for the patient to understand the importance of reducing salt intake, sleeping properly and practicing physical activity. "It will require more time and a nutritionist, but it should be the focus of treatment".
In addition, the report strongly recommends that, in patients with diabetes, blood pressure should be measured at all routine clinical visits. Those with high blood pressure (> 140/90 mm Hg) should have multiple evaluations, on different days, to diagnose hypertension. It should also be encouraged the monitoring of home BP by all hypertensive patients with diabetes, in order to identify the white-coat syndrome.
In addition to lifestyle therapy, treatment for patients with confirmed blood pressure between 140/90 mm Hg and 159/99 mm Hg can be initiated with a single drug. Patients who are at least 20/10 mm Hg above the BP goal should be given single-pill combinations of either renin-angiotensin system [RAS] blockers/calcium-channel blockers or RAS blockers/diuretics. A combination of ACE inhibitors and angiotensin-receptor blockers (ARBs) is not recommended as multidrug therapy to achieve blood-pressure targets.
The authors also emphasize that patients who are pregnant and have preexisting hypertension or mild gestational hypertension (BP <160/105 mm Hg) and no evidence of end-organ damage should not be treated with antihypertensive medications, since there is no benefit that clearly outweighs the potential risks.
Finally, the guideline recommends that individualized treatment must be based on the comorbidities of each patient, and should be part of a shared decision-making process between the clinician and the patient.
de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, et al. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017; 40(9):1273-1284.
Na edição 2018, o Ganepão comemora 40 anos de existência!
Queremos realizar um congresso inesquecível, continuando a trazer conteúdo científico cada vez mais inovador e relevante para a sua vida profissional.
Dessa forma, pedimos que ajude-nos com a sua contribuição, respondendo a seguinte pergunta: Qual tema de curso pré-congresso você gostaria de ver no Ganepão 2018?
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In the Ganepão 60 nutrisegundos of this month, we shared the results of the recently published study in the Nature, which evaluated the prognostic value for mortality of the new ESPEN criteria for malnutrition in 437 elderly people.
Do not miss out!
#ganepao2018 # ganepao60nutrisegundos #malnutrition
By: Giliane Belarmino and Dan L Waitzberg
Jiaojiao Jiang, Xiaoyi Hu, Jing Chen, Haozhong Wang, Lei Zhang, Birong Dong, Ming Yang. Predicting long-term mortality in hospitalized elderly patients using the new ESPEN definition. 2017, Scientific Reports 7: 4067.
Cederholm, T. et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. 2015, Clinical Nutrition. 34: 335–340.
To evaluate the association of long-term gluten ingestion with the development of coronary heart disease, a cohort of 64,714 women and 45,303 men from the Health Professionals Follow-up Study were prospectively studied. They did not have a history of coronary disease, and completed a semi-quantitative food frequency questionnaire of 131 items in 1986, updated every four years until 2010.
During 26 years of follow-up covering 2,273,931 people per year, coronary heart disease developed in 2,431 women and 4,098 men. Fatal myocardial infarction occurred in 2,286 participants (540 women and 1,746 men) and non-fatal myocardial infarction in 4,243 participants (1,891 women and 2,352 men).
Among the individuals eligible for analysis (64,714 women and 45,303 men), the daily average intake of gluten ranged from 2.6 - 7.5 g for women and 3.3 - 10.0 g for men.
Intake of gluten correlated inversely with alcohol intake, smoking, total fat intake and ingestion of unprocessed red meat. Gluten intake was positively correlated with intake of whole and refined grain intake.
Participants who had an average intake of 2.6 to 3.3 g of gluten had a coronary heart disease incidence rate of 352 per 100,000 people, and those with a mean gluten intake of 7.5 to 10g had a lower rate of 277 events per 100,000 people. There was a difference of 75/100.000 fewer cases of coronary heart disease in those who had higher gluten intake.
The authors conclude that long-term dietary intake of gluten was not associated with the risk of coronary heart disease. However, the exclusion of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.
Benjamin Lebwohl, Yin Cao, Geng Zong, Frank B Hu, Peter H R Green, Alfred I Neugut, Eric B Rimm, Laura Sampson, Lauren W Dougherty, Edward Giovannucci, Walter C Willett, Qi Sun, Andrew T Cha. Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ 2017;357:j1892
Carol Ireton-Jones, PhD, RD, Consultant and in private practice specializing in GI nutrition, home parenteral and enteral nutrition, and research, talks about FODMAPS.
Short-chains poorly absorbed carbohydrates can be very important in the management of irritable bowel syndrome.
Check it out!
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A new study that followed more than 2,600 men and women for 16 years found that consuming less sodium wasn't associated with lower blood pressure. The new findings call into question the sodium limits recommended by the current Dietary Guidelines for Americans.
The 2015-2020 Dietary Guidelines for Americans recommends limiting sodium intake to 2300 milligrams a day for healthy people. For the study, the researchers followed 2632 men and women ages 30 to 64 years old who were part of the Framingham Offspring Study. The participants had normal blood pressure at the study's start. However, over the next 16 years, the researchers found that the study participants who consumed less than 2500 milligrams of sodium a day had higher blood pressure than participants who consumed higher amounts of sodium.
The researchers also found that people in the study who had higher intakes of potassium, calcium and magnesium exhibited lower blood pressure over the long term. In Framingham, people with higher combined intakes of sodium (3717 milligrams per day on average) and potassium (3211 milligrams per day on average on average) had the lowest blood pressure.
"This study and others point to the importance of higher potassium intakes, in particular, on blood pressure and probably cardiovascular outcomes as well," said the author. "I hope that this research will help refocus the current Dietary Guidelines for Americans on the importance of increasing intakes of foods rich in potassium, calcium and magnesium for the purpose of maintaining a healthy blood pressure."
The author says that there is likely a subset of people sensitive to salt who would benefit from lowering sodium intake, but more research is needed to develop easier methods to screen for salt sensitivity and to determine appropriate guidelines for intakes of sodium and potassium in this salt-sensitive group of people.
REFERENCE: Experimental Biology 2017. "Low-sodium diet might not lower blood pressure: Findings from large, 16-year study contradict sodium limits in Dietary Guidelines for Americans." ScienceDaily. ScienceDaily, 25 April 2017. .