Larissa Cohen

Weight loss and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation

Background Obesity is a chronic disease with high growth in population and bariatric surgery is currently considered the most effective treatment for weight reduction; on the other hand, nutritional deficiencies are observed after this procedure. Aim To analyze weight loss progression and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation. Methods Retrospective analysis of 137 patients of both sexes, aged between 18-60 years, using supplemental multivitamins and minerals, were included; personal information, anthropometric and laboratory data in the preoperative, 12, 24, 36 and 48 months postoperatively were collected. Results Postoperatively, in both sexes, occurred weight loss compared to the pre-operative weight gain at 48 months and maintenance of body mass index. There was a decrease in the percentage of excess weight loss at 48 months postoperatively compared to the time of 12, 24 and 36 months in men and decreased at 48 postoperative months compared to the time of 24 months in females. There was a decreased in serum ferritin in both sexes and increased serum iron at 48 months postoperatively in males. There was a decreased in vitamin B12 and folic acid increased serum at 48 postoperative months in females. Conclusions Surgical treatment was effective for reducing weight, body mass index reduction and achievement of success in the late postoperative period along with multivitamin and mineral supplementation on prevention of serious nutritional deficiencies and anemia.

Perda ponderal e presença de anemias carenciais em pacientes submetidos à bypass gástrico em Y-de-roux em uso de suplementação de vitaminas e mine

RACIONAL: A obesidade e doenca cronica com elevado crescimento na populacao. A cirurgia bariatrica e considerada o tratamento mais efetivo para reducao de peso; por outro lado, deficiencias nutricionais sao observadas apos esse procedimento. OBJETIVO: Avaliar a evolucao da perda ponderal e a presenca de anemias carenciais em pacientes submetidos ao bypass gastrico em Y-de-Roux em uso de suplementacao de vitaminas e minerais. METODOS: Analise retrospectiva de 137 pacientes de ambos os sexos, com idade entre 18-60 anos, em uso de suplementacao de polivitaminas e minerais incluindo informacoes pessoais, dados antropometricos e laboratoriais nos periodos pre-operatorio, 12, 24, 36 e 48 meses de pos-operatorio. RESULTADOS: No pos-operatorio, em ambos os sexos, ocorreu perda de peso em relacao ao pre-operatorio, ganho de peso aos 48 meses e manutencao do indice de massa corporal. Houve diminuicao do percentual de perda de excesso de peso aos 48 meses pos-operatorios comparado com os tempos 12, 24 e 36 meses em homens e diminuicao aos 48 meses pos-operatorios em relacao aos 24 meses no sexo feminino. Houve diminuicao da ferritina serica em ambos os sexos e aumento do ferro serico aos 48 meses pos-operatorio no sexo masculino. Houve diminuicao da vitamina B12 e aumento do acido folico sericos aos 48 meses do pos-operatorio no sexo feminino. CONCLUSOES: O tratamento cirurgico mostrou-se eficaz para reducao de peso, reducao do indice de massa corporal e alcance do sucesso no pos-operatorio tardio juntamente com a suplementacao de polivitaminico e minerais na prevencao de deficiencias nutricionais importantes e anemias.

Nutritional profile of patients in a multidisciplinary treatment program for severe obesity and preoperative bariatric surgery

Background Along with the augmentation in obesity rates in recent years, the demand for bariatric surgery has startlingly increased. Nutritional counseling in the preoperative period is very important because it contributes to higher success rate in the post-operative period. Aim To assess the nutritional status of patients in a multidisciplinary program for the treatment of severe obesity and pre-operatively for bariatric surgery, characterizing the consumption of healthy nutrients. Methods A retrospective analysis of 30 patients was conducted. Personal information, anthropometric data and dietary assessment by 24-hour food record were collected. The analysis of energy intake was performed in Dietpro 5.1 Professional® program. The statistical treatment of the caloric intake was performed by an ANOVA test with Bonferronis post hoc and for anthropometric data the paired t test was used. Results From the total, 73% of the patients were women and 27% male, mean age was 48.4+12.9 and 49.8+8.1, respectively. A lower weight in the 5th appointment was observed when compared with the 1st one. There was a reduction in caloric intake in the 2nd, 3rd, 4th and 5th appointments when compared with the 1st. It was observed that in the 5th appointment more than 50% of the patients underwent six meals a day. There was an increase in the consumption of fruit along the appointments and 72.2% of patients consumed 1-2 servings of fruit a day. Vegetables intake was high in all appointments in the pre-operative period and, although low, the whole grain products consumption has increased during the pre-operative period achieving 30% of the study population. Conclusion There was a decrease in body weight, a trend in the decrease of the body mass index and waist circumference and quantitative and qualitative improvement of food consumption.

Perfil nutricional de pacientes em programa multidisciplinar de tratamento da obesidade grave e em pré-operatório de cirurgia bariátrica

RACIONAL: Com o avanco da obesidade nos ultimos anos, a procura pela cirurgia bariatrica tem aumentado de forma alarmante. O aconselhamento nutricional no periodo pre-operatorio e de grande importância, pois contribui para maior taxa de sucesso no pos-operatorio. OBJETIVO: Avaliar o perfil nutricional dos pacientes inseridos em um programa multidisciplinar para o tratamento da obesidade grave e em pre-operatorio de cirurgia bariatrica, caracterizando o consumo de nutrientes saudaveis. METODOS: Foi realizada analise retrospectiva de 30 pacientes sendo coletadas informacoes pessoais, antropometricas e dieteticas por meio de recordatorios de 24 horas. A analise da ingestao energetica foi realizada no programa Dietpro 5.1 Profissional(r). O tratamento estatistico do consumo calorico foi realizado pelo teste ANOVA com post hoc por Bonferroni e para os dados antropometricos foi utilizado o teste t pareado. RESULTADOS: Do total dos pacientes 73% eram mulheres e 27% homens, com idade de 48,4+12,9 e 49,8+8,1, respectivamente. Foi observado menor peso na 5a consulta quando comparado com a 1a. Houve diminuicao no consumo calorico nas 2a, 3a, 4a e 5a consultas quando comparadas com a 1a. Observou-se que na 5a consulta mais de 50% dos pacientes realizavam seis refeicoes ao dia. Houve aumento no consumo de frutas ao longo das consultas chegando a 72,2% dos pacientes que consumiam de uma a duas porcoes de frutas ao dia. A ingestao de verduras e legumes era elevada em todas as consultas no periodo pre-operatorio e o consumo de produtos integrais, apesar de baixo, aumentou ao longo do periodo pre-operatorio, alcancando 30% da populacao ao final do estudo. CONCLUSAO: Houve diminuicao do peso corporal, tendencia na reducao do IMC e circunferencia do abdome e melhora quantitativa e qualitativa do consumo alimentar da populacao estudada.

EFFECTS OF LONG-TERM ROUX-EN-Y GASTRIC BYPASS ON BODY WEIGHT AND CLINICAL METABOLIC COMORBIDITIES IN BARIATRIC SURGERY SERVICE OF A UNIVERSITY HOSPITAL

ABSTRACT Background: Due to the high failure rate observed in the clinical treatment of morbid obesity an increase in bariatric surgery indications, as an alternative for the control of obesity and comorbidities, is noticeable. Aim: To evaluate the performance of type 2 diabetes mellitus, high blood pressure and dyslipidemia in patients submitted to Roux-en-Y gastric bypass in late follow-up. Methods: Retrospective analysis of 59 patients included in the bariatric surgery program. Anthropometric (height and body weight) and laboratory (LDLc, HDLc, VLDLc, triglyceride -TG - and glucose) data were collected on pre- and postoperative stages, through medical records. Results: Among the patients, 86% were female aged 43±11, of whom 52% had attended high school. The average postoperative time was 7±3 years. During the postoperative period, there were decreases of weight and body mass index, respectively (133±06 kg vs 91±04 kg p<0.05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0.05). In comparison to the preoperative stage, lower concentrations of glucose (101.00±26.99 vs 89,11±15.19, p=0.014), total cholesterol rates (179.00±37,95 vs 167.48±28,50, p=0.016), LDLc (104.30±33.12 vs 91.46±24.58, p=0.016), VLDLc (25.40±11,12 vs 15.68±7.40, p<0.01), and TG (143.35±86.35 vs 82.45±37.39, p<0.01) and higher concentrations of HDLc (43.53±8.23 vs 57.90±15.60, p<0.01) were identified in the postoperative stage. 40% of hypertensive patients were still undergoing high blood pressure treatment during the postoperative stage. There was remission of type 2 diabetes mellitus and dyslipidemia on 81% and 94% of the cases, respectively. Conclusion: Roux-en-Y gastric bypass has proven itself to be an effective long term procedure, promoting weight loss, remission of DM2 and dyslipidemia.

EFEITOS NO LONGO PRAZO DA GASTROPLASTIA REDUTORA EM Y-DE-ROUX SOBRE O PESO CORPORAL E COMORBIDADES CLÍNICO METABÓLICAS EM SERVIÇO DE CIRURGIA BARIÁTRICA DE UM HOSPITAL UNIVERSITÁRIO

Racional: Em funcao do alto grau de falencia que se observa no tratamento clinico da obesidade morbida, observa-se um aumento da procura pela cirurgia bariatrica como alternativa para o controle da obesidade e comorbidades. Objetivo: Avaliar a evolucao do diabete melito tipo 2, da hipertensao arterial sistemica e da dislipidemia em pacientes submetidos a gastroplastia redutora em Y-de-Roux no periodo de pos-operatorio tardio. Metodos: Analise retrospectiva de 59 pacientes inseridos em programa de cirurgia bariatrica. Foram coletados dados antropometricos (altura e peso corporal) e laboratoriais (LDLc, HDLc, VLDLc, triglicerideo -TG - e glicose) nos periodos pre e pos-operatorio por meio de prontuarios medicos. Resultados: Entre os pacientes, 86% eram mulheres com idade de 43±11 anos e 52% tinham cursado o ensino medio. O tempo medio de pos-operatorio foi de 7±3 anos. Houve reducao no peso e no indice de massa corporal no pos-operatorio, respectivamente (133±06 kg vs 91±04 kg p<0,05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0,05). Observou-se concentracoes inferiores no pos-operatorio, comparado com o pre-operatorio, da glicose (101,00±26,99 vs 89,11±15,19, p=0,014), colesterol total (179,00±37,95 vs 167,48±28,50, p=0,016), LDLc (104,30±33,12 vs 91,46±24,58, p=0,016), VLDLc (25,40±11,12 vs 15,68±7,40, p<0,01), e TG (143,35±86,35 vs 82,45±37,39, p<0,01) e maiores de HDLc (43,53±8,23 vs 57,90±15,60, p<0,01 ). No pos-operatorio 40% dos pacientes hipertensos ainda estavam em tratamento para hipertensao arterial sistemica. Houve remissao do diabete melito tipo 2 e da dislipidemia em 81% e 94% dos casos, respectivamente. Conclusao: A gastroplastia redutora em Y-de-Roux mostrou ser procedimento eficaz em longo prazo, com resultados persistentes na perda de peso, remissao do DM2 e da dislipidemia.

Effects of long-term reducing gastroplasty roux-y on body weight and clinical metabolic comorbidities in a bariatric surgery service of a university hospital

Background Obesity is a major public health issue in Brazil and in the world, increasing the rate of mortality due to comorbidities like: type-2 diabetes mellitus (DM2), arterial hypertension (AH), dyslipidemias, among others. Conventional obesity treatments show little effect in the long term, leading to an increase in the search for bariatric surgery as an alternative for the control and healing of comorbidities.