Violeta Moizé

Obese Patients Have Inadequate Protein Intake Related to Protein Intolerance Up to 1 Year Following Roux-en-Y Gastric Bypass

Background: Inadequate protein intake is a concern following Roux-en-Y gastric bypass (RYGBP). The small gastric pouch and bypass restrict energy intake and may lead to insufficient protein intake and absorption, and excess loss of lean tissue. Methods:We evaluated protein intake in 93 (77 F,16 M) morbidly obese individuals (BMI = 52.0±12.9 [SD]) who underwent RYGBP at our medical center. Participants completed 24-hr food recalls and received nutritional counseling at 3, 6, and 12 months following surgery. Results: Daily energy intake (kcal/day) increased from 849±329 (SD) at 3 months to 1,101±400 at 12 months (P=.009). Protein intake also increased (g/day) from 45.6±14.2 at 3 months to 58.5±17.1 at 12 months (P=.04), and as a percentage of goal protein intake from 55.1%±23.0 at 3 months to 73.5%±38.0 at 12 months (P=.02). Although energy and protein intake increased significantly over the 12-month period, protein intake at 12 months remained significantly lower (P=.01) than the daily recommended guidelines (1.5 g/kg IBW) for a low-energy restrictive diet. Energy intake did not differ in those who reported food intolerances at 3 months (P=.77) or 6 months (P=.65), but was lower in them at 12 months (trend, P=.06). Also at 12 months, protein intake (P=.02) and percentage of protein intake goal (P=.04) were significantly lower in those with protein intolerance. Conclusions: These results suggest that postoperative patients consume insufficient amounts of protein, possibly mediated by protein intolerance. Protein supplementation following RYGBP deserves further consideration.

Long-Term Dietary Intake and Nutritional Deficiencies following Sleeve Gastrectomy or Roux-En-Y Gastric Bypass in a Mediterranean Population

BACKGROUND Data on long-term dietary changes and nutritional deficiencies after sleeve gastrectomy (SG) in grade 3 obese patients are scarce. OBJECTIVE To prospectively compare dietary changes and nutritional deficiencies in grade 3 obese patients 5 years after SG and Roux-en-y gastric bypass (GBP). PARTICIPANTS/SETTING Three hundred and fifty-five patients who had SG (n=61) or GBP (n=294) (May 2001-December 2006) at a Spanish university hospital. DESIGN Longitudinal, prospective, observational study. PRIMARY OUTCOMES/STATISTICAL ANALYSES: Changes in energy, macronutrient, and micronutrient intake, and weight loss were analyzed using mixed models for repeated measurements. RESULTS At the 5-year follow-up visit, the percentage of excess weight loss (P=0.420) and daily energy intake (P=0.826), as well as the proportion of energy from carbohydrates (P=0.303), protein (P=0.600), and fat (P=0.541) did not differ between surgical groups. Energy intake (P=0.004), baseline weight (P<0.001), and time period (P<0.001), but not the proportion of different macronutrients or the type of surgery, independently predicted the percentage excess weight loss over time. After SG or GBP, the mean daily dietary intake of calcium, magnesium, phosphorus, and iron was less than the current recommendations. Despite universal supplementation, the prevalence of nutritional deficiencies was comparable after SG or GBP, with 25-hydroxyvitamin D being the most commonly observed deficiency (SG, 93.3% to 100%; GBP, 90.9% to 85.7%, P=not significant). In an adjusted multivariate regression model, energy intake and lipid intake independently predicted plasma 25(OH)-vitamin D levels. CONCLUSIONS Data show that SG and GBP are associated with similar long-term weight loss with no differences in terms of dietary intake. Furthermore, data demonstrate that both types of surgeries carry comparable nutritional consequences.

Transcultural adaptation of the Night Eating Questionnaire (NEQ) for its use in the Spanish population.

BACKGROUND Establishing valid and reliable methods of assessing night eating symptoms is an important goal to maximize identification and treatment of the night eating syndrome (NES). The 14-item Night Eating Questionnaire (NEQ) is the only published and validated assessment instrument but is not yet adapted to Spanish. METHODS We examined the factor structure, internal consistency and validity of the NEQ in Spanish. The study had 4 phases: a) translation from English to Spanish; b) back-translation from Spanish to English, c) administration of translated version to a Spanish sample, and d) a re-test in 36 participants two weeks later. Reliability, stability, and scale structure were evaluated by Cronbachs α, test-re-test, and factor analysis, respectively. Divergent validity was assessed by correlation with the Spanish versions of the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI-II). RESULTS Two-hundred forty-four individuals (181 f; BMI 34.3±10 kg/m(2); age 40.5±15 y) completed the questionnaire. The mean NEQ score was 12.5±7. The Cronbachs α coefficient for the total score was 0.79, the intraclass correlation was 0.85, and the factor analysis yielded a similar four factor solution as the original scale. Correlation for the test-re-test total score was 0.86. Total NEQ score was significantly correlated with the BDI-II (r=0.48 p<0.001), but this correlation was not significant during the test-re-test (r=0.28, p=0.10) or with STAI at either time point (0.05, p=0.40; r=0.07, p=0.69, respectively). CONCLUSIONS The Spanish version of the NEQ demonstrated adequate internal consistency for the majority of domains and excellent reproducibility. There was divergent validity with anxiety and a relationship between night eating and depression. These results suggest that the Spanish-version of the NEQ is an instrument that is valid for use in clinical research.

Inflammation and iron status in bariatric surgery candidates

BACKGROUND Iron homeostasis is disturbed by the systemic inflammation commonly encountered in morbid obesity. However, inflammatory markers have seldom been considered in studies investigating the prevalence of iron deficiency (ID) in bariatric surgery (BS) candidates. The objective of this study was to evaluate the prevalence of ID and anemia with ID in BS candidates, accounting for inflammatory status as measured using high sensitivity C-reactive protein (hs-CRP), and to further characterize indices of iron status in BS candidates with systemic inflammation. PATIENTS AND METHODS On the basis of ferritin, hemoglobin, and hs-CRP levels, iron status was categorized in 803 (85%) of 947 consecutive BS candidates. Ferritin<12 ng/mL in females and<15 ng/mL in males irrespective of hs-CRP level was classified as absolute-ID, whereas ferritin between those thresholds and 100 ng/mL was categorized as functional-ID (FID) if hs-CRP>3 mg/L. Anemia was defined as hemoglobin<12 or<13 g/dL in females and males, respectively. Additional iron and hematological indices were assessed in patients with FID. RESULTS Prevalence of absolute- and functional-ID was 8.7 and 52.5%, respectively. Anemia was found in 11.2% of the cohort, 80% of which were associated with ID. Among patients with FID, transferrin saturation (T-Sat)<20% was common (70.0%) and associated with larger impairment of hematological indices. CONCLUSION The data show that when hs-CRP as inflammatory marker and ferritin as iron index are considered, impaired iron status could be identified in approximately two thirds of BS candidates. Furthermore, T-Sat<20%, especially along with ferritin<30 ng/mL, appear to be practical cut-offs to identify patients with FID with larger iron status impairment.

Nystagmus: An Uncommon Neurological Manifestation of Thiamine Deficiency as a Serious Complication of Sleeve Gastrectomy

Wernicke encephalopathy--a debilitating acute or subacute neurological disorder-is caused by a deficiency in thiamine (vitamin B(1)). It is characterized by a classical clinical triad of symptoms: ocular impairment, cerebellar dysfunction, and confusion. Although bariatric surgery can certainly improve the overall health of an obese individual, it can also make him or her more susceptible to serious nutrition deficiencies. Following surgery, inadequate caloric intake, rapid and excessive weight loss, food intolerance, lack of adherence to nutrition supplementation, and/or the onset of prolonged vomiting can lead to severe nutrition deficiencies. It is generally believed that the more malabsorptive the surgery proves, the more likely is it that such a deficiency will occur. The case presented here shows that after sleeve gastrectomy (SG), a patient may also develop dangerous nutrition deficits that can negatively affect his or her life. In this particular case, a patient presented with a severe vitamin B(1) deficiency following SG for morbid obesity. Although patients may exhibit pathophysiologies similar to Wernicke encephalopathy after this surgery, only 2 cases of severe vitamin B(1) deficiency following sleeve gastrectomy have been reported. The grave consequences of thiamine deficiency observed in this patient underscore the importance of supplementation after SG.

Weight loss in the healthy elderly might be a non-cognitive sign of preclinical Alzheimer’s disease

Weight loss has been proposed as a sign of pre-clinical Alzheimer Disease (AD). To test this hypothesis, we have evaluated the association between longitudinal changes in weight trajectories, cognitive performance, AD biomarker profiles and brain structure in 363 healthy controls from the Alzheimer´s Disease Neuroimaging Initiative (mean follow-up 50.5±30.5 months). Subjects were classified according to body weight trajectory into a weight loss group (WLG; relative weight loss ≥ 5%) and a non-weight loss group (non-WLG; relative weight loss < 5%). Linear mixed effects models were used to estimate the effect of body weight changes on ADAS-Cognitive score across time. Baseline CSF tau/AΔ42 ratio and AV45 PET uptake were compared between WLG and non-WLG by analysis of covariance. Atrophy maps were compared between groups at baseline and longitudinally at a 2-year follow-up using Freesurfer. WLG showed increased baseline levels of cerebrospinal fluid tau/AΔ42 ratio, increased PET amyloid uptake and diminished cortical thickness at baseline. WLG also showed faster cognitive decline and faster longitudinal atrophy. Our data support weight loss as a non-cognitive manifestation of pre-clinical AD.

Genetic background influences weight-loss trajectories on the mid-term after bariatric surgery

Bariatric surgery (BS) is a highly effective therapy for morbid obesity, yet with a wide inter-individual variability on weight-loss responses. To determine genetic influence on weight loss after BS we compared the within-pairs difference in maximum percentage excess weight loss (%EWL) and the within-pairs %EWL differences over a mean follow-up of 53.6 ± 36.4 months between 47 pairs of first-degree relatives and 47 genetically unrelated control pairs. Within-pairs maximum %EWL difference was similar between first-degree related pairs and control pairs (p = 0.100). Within-pairs %EWL difference increased through follow-up (p < 0.001). However, effect of time was different depending on genetic background (ptime*group = 0.001). Increased variability in mid-term weight response was present in unrelated pairs but not in first-degree pairs (p < 0.001 and p = 0.535, respectively). To assess shared environment influence, 16 married couples were identified and 16 unrelated and non-cohabiting matched pairs were also analyzed. In these analysis within-pairs difference in %EWL also increase over time (p = 0.025) but no group by time effect was observed (ptime×group = 0.177). In conclusion first-degree related participants showed closer weight trajectories after BS time than genetically unrelated subjects. Genetic background might partially explain the variability in mid-term weight-loss after BS.

Se cumplen los objetivos proteicos tras la cirugía bariátrica

Resumen Introduccion El objetivo proteico (OP) tras la cirugia bariatrica es motivo de debate. La amplitud de las recomendaciones (60–80 g de proteinas/dia o 0,8-1,5 g de proteinas/kg de peso ideal [PI]/dia) ilustra la falta de consenso. Objetivo Evaluar la consecucion de dos OP distintos (60 g de proteinas/dia y 1,2 g de proteinas/kg de PI/dia) tras la cirugia de la obesidad y el efecto de los suplementos proteicos (SP) en la consecucion de dichos OP. Material y metodo Se estudio a 101 individuos (el 75% mujeres; edad, 43,2 ± 1 anos; IMC, 47,7 ± 0,7) antes de la cirugia, y a los 4, 8 y 12 meses se evaluo el consumo proteico (CP) y la adherencia al SP recomendado (registro dietetico de 3 dias). Resultados El CP prequirurgico fue de 97,9 ± 3,5 g de proteinas/dia y a los meses 4, 8 y 12 fue de 56,9 ± 1,9, 67,2 ± 1,8 y 71,3 ± 2,3 g de proteinas/dia. No se alcanzo el OP1 (60 g) en el 5, el 45, el 35 y el 37% respectivamente. El OP2 (1,2 g de proteinas/kg de PI/dia) no se alcanzo en el 32, el 87, el 75 y el 68% respectivamente. La adherencia al SP fue del 63,4, el 50,5 y el 33,7% a los 4, 8 y 12 meses tras la cirugia y su seguimiento se asocio a la consecucion de los OP en cada momento de forma significativa (p Conclusiones Hay dificultades para lograr los objetivos proteicos propuestos tras la cirugia de la obesidad. La suplementacion proteica ayuda a alcanzar los objetivos proteicos despues de la cirugia bariatrica.

Pica secundaria al déficit de hierro después de un año del bypass gástrico: a propósito de un caso

Resumen La pica es un trastorno alimentario caracterizado por una ingesta compulsiva de sustancias inapropiadas para el consumo, tales como tierra, tiza, yeso, papel, hielo y otras sustancias no nutritivas. La pagofagia (ingesta de hielo) y la geofagia (ingesta de compuestos del suelo) son las formas de pica mas comunes, que con frecuencia se han asociado con casos de deficit de hierro y anemia ferropenica. En el presente articulo se describe el caso de una mujer sometida a bypass gastrico (BPG) con anemia ferropenica que manifiesta un deseo incontrolable de comer hielo (pagofagia) y el impulso de oler y comer tierra humeda secundarios al deficit de hierro. Como consecuencia de la ingesta de hielo de la paciente ha sufrido lesiones en las piezas dentarias. Tras el correcto manejo de la anemia (hierro intravenoso), se resuelven los trastornos alimentarios de la paciente. Este caso clinico ilustra la importancia del reconocimiento temprano de pica en este tipo de pacientes para prevenir las lesiones dentales.