Maria Goretti Pessoa de Araújo Burgos

CLINICAL AND NUTRITIONAL ASPECTS IN OBESE WOMEN DURING THE FIRST YEAR AFTER ROUX-EN-Y GASTRIC BYPASS

Background: Clinic care for morbid obesity is not very effective. Bariatric surgery is being considered the best way of intervention for this kind of obesity. Aim : Evaluate the clinical and nutritional evolution during the first year of obese women submitted to Roux-en-Y gastric bypass. Method : Retrospective series non-concurrent with 61 women. The variables were weight, BMI, weight loss percentage, loss of excessive weight percentage, waist circumference, hip circumference, lipid profile, daily use of supplements, practice of physical exercise, occurrence of sickness, nausea, constipation, diarrhea, asthenia, alopecia, dry skin, cramps and brittle nails. Results : They presented significant weight and IMC reduction as well as improvement in their lipid profile, in all consultations. After one year they presented 36,6% loss of the initial weight and 75% loss of excessive weight. The waist circumference also presented a considerable reduction on all the moments, decreasing from 122,1±13,4 cm to 94,1±10,6 cm. Regarding the intercurrences, the most frequent were alopecia, asthenia, dry skin and cramps. Conclusion : The Roux-en-Y gastric bypass was effective in promoting and maintenance weight loss during the period of the first postoperative year.

Complicações gastrointestinais e adequação calórico-protéica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva

OBJETIVO: Avaliar a prevalencia de complicacoes gastrointestinais e a adequacao calorico-proteica de pacientes criticos em uso de terapia de nutricao enteral. METODOS: Estudo retrospectivo realizado na unidade de terapia intensiva do Hospital das Clinicas da Universidade Federal de Pernambuco, onde foram coletados, mediante analise das fichas de acompanhamento nutricional, as complicacoes gastrointestinais mais frequentes durante o periodo de internamento do paciente, bem como a necessidade e a oferta calorico-proteica. Considerou-se como ofertado, o volume e o tipo de formula efetivamente recebido pelo paciente no ultimo dia de internamento hospitalar. Foi utilizado o programa SPSS, versao 13 para analise estatistica. RESULTADOS: A amostra foi composta de 77 pacientes com idade 54,7 ± 18,1 anos e predominância do sexo feminino (54,5%). A dieta ofertada foi adequada e todos os pacientes apresentaram algum tipo de complicacao gastrointestinal, sendo o retorno gastrico o mais prevalente (39%), seguido da constipacao com 36,4%. CONCLUSAO: Apesar da elevada prevalencia de complicacoes gastrointestinais, nao foi observada uma inadequacao na oferta calorica-proteica. As condutas multidisciplinares frente a resolucao dessas complicacoes necessitam ser padronizadas para que solucoes precoces possam ser tomadas.

Impacto dos nutrientes na saúde óssea: novas tendências

Nutrition is an important factor in bone mass development/maintenance and in osteoporosis prevention. This disease is characterized by decreased skeletal mass and increased susceptibility to fractures. The greatest determinant of this condition is the peak bone mass (PBM). Hence, alterations over time indicate the importance of maintaining adequate nutrition during the development of this peak. In adult age, individuals who reached a high PBM will have a low risk of developing bone metabolic diseases when aging. Nutrients exert intense and wide-ranging effects on skeletal structures. Some of them have been consistently related with bone health, such as calcium, phosphorus and vitamin D. However, it has been suggested that other nutrients are essential for normal bone metabolism: proteins, lipids, potassium, vitamins K and A, and sodium chloride. The influence of interactions between these nutritional factors, environment, lifestyle, and heredity will help understand the complex development of osteoporosis and subsequent fractures. In addition, energy deficits can lead to reduced bone mass, in view of endocrine-metabolic disorders caused by food deprivation. This review aims at clarifying the impact of nutrients and of calories intake on the bones during different stages in life, describing possible interactions among nutrients and how these could affect bone and mineral homeostasis.

Qual é a importância clínica e nutricional da síndrome de realimentação

INTRODUCTION Feedback syndrome is characterized clinically by neurological alterations, respiratory symptoms, arrhythmias and heart failure few days after refeeding. It happens due to severe electrolyte changes, such as hypophosphatemia, hypomagnesemia and hypokalemia associated with metabolic abnormalities that may occur as a result of nutritional support (oral, enteral or parenteral) in severely malnourished patients. OBJECTIVE To evaluate its causes and the preventive dietary measures aiming to reduce the morbimortality. METHODS Was conducted literature review in SciELO, LILACS, Medline / PUBMED, Cochrane Library and government websites in Portuguese, English and Spanish. The survey was about the last 15 years, selecting the headings: refeeding syndrome, malnutrition, hypophosphatemia, hypokalemia, hypomagnesemia. CONCLUSION The monitoring of metabolic parameters and electrolyte levels before starting nutritional support and periodically during feeding should be based on protocols and the duration of therapy. Patients at high risk and other metabolic complications should be followed closely, and depletion of minerals and electrolytes should be replaced before starting the diet. A multidisciplinary team of nutrition therapy can guide and educate other health professionals in prevention, diagnosis and treatment of the syndrome.INTRODUCTION: Feedback syndrome is characterized clinically by neurological alterations, respiratory symptoms, arrhythmias and heart failure few days after refeeding. It happens due to severe electrolyte changes, such as hypophosphatemia, hypomagnesemia and hypokalemia associated with metabolic abnormalities that may occur as a result of nutritional support (oral, enteral or parenteral) in severely malnourished patients. OBJETIVE: To evaluate its causes and the preventive dietary measures aiming to reduce the morbimortality. METHODS: Was conducted literature review in SciELO, LILACS, Medline / Pubmed, Cochrane Library and government websites in Portuguese, English and Spanish. The survey was about the last 15 years, selecting the headings: refeeding syndrome, malnutrition, hypophosphatemia, hypokalemia, hypomagnesemia. CONCLUSION: The monitoring of metabolic parameters and electrolyte levels before starting nutritional support and periodically during feeding should be based on protocols and the duration of therapy. Patients at high risk and other metabolic complications should be followed closely, and depletion of minerals and electrolytes should be replaced before starting the diet. A multidisciplinary team of nutrition therapy can guide and educate other health professionals in prevention, diagnosis and treatment of the syndrome.

Influências nutricionais na psoríase

Psoriasis is an inherited inflammatory skin disease mediated by T-cells and influenced by environmental factors. High intake of omega-3, fasting, low-calorie and vegetarian diets show beneficial effects. Some patients presenting IgA/IgG antigliadin antibodies and who are gluten-sensitive improve after a gluten-free diet. Calcitriol is used in topical treatment. The use of alcohol may exacerbate the disease. In this report, diet factors are analyzed and their benefits in psoriasis are described.

Efeitos de bebidas alcóolicas em mães lactantes e suas repercussões na prole

Foi feita uma revisao de estudos sobre os efeitos ocasionados pelo consumo de bebidas alcoolicas por lactantes, analisando os multiplos disturbios metabolicos, nutricionais e psicologicos evidenciados no organismo materno e dos recem-nascidos. E enfatizada a necessidade de orientacoes clinico-nutricionais nos servicos de pre-natal e puericultura acerca dos riscos da ingestao de bebidas alcoolicas em qualquer quantidade, por maes no periodo de gestacao e aleitamento.

Avaliação do estado nutricional de pacientes internados em um hospital universitário

O objetivo deste trabalho foi avaliar o estado nutricional de pacientes internados no Hospital das Clinicas da Universidade Federal de Pernambuco, na faixa etaria de 15 a 89 anos. A amostra escolhida ao acaso, foi composta por 154 individuos de ambos os sexos (74 homens e 80 mulheres). Durante o estudo foram coletados os dados antropometricos, os habitos alimentares e as causas do internamento. As analises mostraram uma grande instabilidade nutricional, com elevadas prevalencias tanto de baixo peso como de excesso de peso. Com relacao aos habitos alimentares foi observada pobreza e monotonia nos cardapios. Dos pacientes entrevistados, a maioria mencionou apenas seis tipos de alimentos comuns como sendo seus favoritos (arroz e feijao, carne bovina, galinha, macarrao e pao). Por outro lado, esse estudo tambem deixou claro a alta frequencia de tabus alimentares, o que pode limitar o consumo de varios nutrientes. Em termos de admissoes as clinicas medica e cirurgica, a proporcao para ambos o grupos foi muito similar.

Use of alcohol before and after bariatric surgery

OBJECTIVE to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS Patients were interviewed at Surgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil) from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C). RESULTS One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years), with a predominance of the female gender (83.2%), non-Caucasian race (55%), married individuals or in a stable union (65.5%), with a high school education (40.3%)and active in the job market (37%). Weight and body mass index (BMI) were 128.77+25.28 Kg and 49.09+9.26 Kg/m2,respectively in the preoperative period (class II obesity) and 87.19+19.16 Kg and 33.04+6.21 Kg/m2, respectively in the postoperative period (class I obesity) (p<0.001). Hypertension was the most frequent disease in the pre (66.6%) and postoperative (36.5%) periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337). CONCLUSION The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.

Effect of oral nutritional support on hospitalized patients with AIDS

INTRODUCTION The emergence of more effective therapies for the treatment of Acquired Immunodeficiency Syndrome (AIDS) has reduced the rates of illness, mortality and malnutrition among infected patients. However, reduced food intake, nutrient malabsorption and metabolic alterations induced by fever and infection are seen in cases of hospital malnutrition. OBJECTIVES The aim of the present study was to assess the impact of oral nutritional support (ONS) on hospitalized patients with AIDS. METHODS The following variables were analyzed: weight, body mass index (BMI), triceps skinfold (TSF), arm circumference (AC), arm muscle circumference (AMC), albumin, hemoglobin, hematocrit and total serum lymphocytes. RESULTS Significant improvements were found in weight, BMI, TSF, AC, albumin and lymphocytes after 19.27 ± 7.45 days of ONS, whereas no significant improvements were found in AMC, hemoglobin or hematocrit. CONCLUSION Dietary intervention with nutritional counseling and the use of supplements led to an improvement in the nutritional status of malnourished individuals with AIDS, but with an increase in adipose tissue and no impact on lean muscle mass or anemia.

SERUM VITAMIN B12, IRON AND FOLIC ACID DEFICIENCIES IN OBESE INDIVIDUALS SUBMITTED TO DIFFERENT BARIATRIC TECHNIQUES

ABSTRACT Background: Different surgical techniques to combat obesity combine malabsorption with restrictive procedures and can lead to metabolic problems, such as micronutrient deficiencies. Aim: Assess vitamin B12, iron and folic acid deficiencies associated with the lifestyle of obese individuals having been submitted to different bariatric techniques. Methods: A retrospective analysis was performed using the electronic charts of patients submitted to bariatric surgery involving adjustable gastric banding and Roux-en-Y gastric bypass at the São João Hospital Center in the city of Porto, Portugal, between 2005 and 2010. The following data were collected: surgical technique, sex, age, marital status, serum concentrations of vitamin B12, iron and folic acid and postoperative lifestyle. A 5% significance level was used for the statistical analysis (p<0.05). Results: Among 286 individuals evaluated, females accounted for 90.9% of the overall sample (both techniques). Gastric banding was performed more (68.9%), but greater nutrient deficiencies were found following gastric bypass. Iron was the most prevalent deficiency (21.3%), followed by vitamin B12 (16.9%) and folic acid (4.5%). Mild to moderate alcohol intake, adherence to the diet and the use of multivitamins reduced the frequency, but did not avoid micronutrient deficiency. Conclusion: Vitamin B12, iron and folic acid deficiencies were found in the first and second year following the two bariatric techniques analyzed and were more frequent among individuals submitted to gastric bypass.