[Bariatric surgery: how and why to supplement]

Body weight management in overweight and obese breast cancer survivors

BACKGROUND

Studies suggest that overweight and obese breast cancer survivors are at increased risk of cancer recurrence and have higher all-cause mortality. Obesity has an impact on breast cancer survivor's quality of life (QOL) and increases the risk of longer-term morbidities such as type 2 diabetes mellitus and cardiovascular disease. Many cancer guidelines recommend survivors maintain a healthy weight but there is a lack of evidence regarding which weight loss method to recommend.

OBJECTIVES

To assess the effects of different body weight loss approaches in breast cancer survivors who are overweight or obese (body mass index (BMI) ≥ 25 kg/m2).

SEARCH METHODS

We carried out a search in the Cochrane Breast Cancer Group's (CBCG's) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6), MEDLINE (2012 to June 2019), Embase (2015 to June 2019), the World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov on 17 June 2019. We also searched Mainland Chinese academic literature databases (CNKI), VIP, Wan Fang Data and SinoMed on 25 June 2019. We screened references in relevant manuscripts.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials evaluating body weight management for overweight and obese breast cancer survivors (BMI ≥ 25 kg/m2). The aim of the intervention had to be weight loss.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed data extraction and assessed risk of bias for the included studies, and applied the quality of the evidence using the GRADE approach. Dichotomous outcomes were analysed as proportions using the risk ratio (RR) as the measure of effect. Continuous data were analysed as means with the measure of effect being expressed as the mean differences (MDs) between treatment groups in change from baseline values with 95% confidence intervals (CIs), when all studies reported exactly the same outcomes on the same scale. If similar outcomes were reported on different scales the standardised mean difference (SMD) was used as the measure of effect. Quality of life data and relevant biomarkers were extracted where available.

MAIN RESULTS

We included a total of 20 studies (containing 23 intervention-comparisons) and analysed 2028 randomised women. Participants in the experimental groups received weight loss interventions using the core element of dietary changes, either in isolation or in combination with other core elements such as 'diet and exercise', 'diet and psychosocial support' or 'diet, exercise and psychosocial support'. Participants in the controls groups either received usual care, written materials or placebo, or wait-list controls. The duration of interventions ranged from 0.5 months to 24 months. The duration of follow-up ranged from three months to 36 months. There were no time-to-event data available for overall survival, breast cancer recurrence and disease-free survival. There was a relatively small amount of data available for breast cancer recurrence (281 participants from 4 intervention-comparisons with 14 recurrence events; RR 1.95, 95% CI 0.68 to 5.60; low-quality evidence) and the analysis was likely underpowered. Overall, we found low-quality evidence that weight loss interventions for overweight and obese breast cancer survivors resulted in a reduction in body weight (MD: -2.25 kg, 95% CI: -3.19 to -1.3 kg; 21 intervention-comparisons; 1751 women), body mass index (BMI) (MD: -1.08 kg/m2, 95% CI: -1.61 to -0.56 kg/m2; 17 intervention-comparisons; 1353 women), and waist circumference (MD:-1.73 cm, 95% CI: -3.17 to -0.29 cm; 13 intervention-comparisons; 1193 women), and improved overall quality of life (SMD: 0.74; 95% CI: 0.20 to 1.29; 10 intervention-comparisons; 867 women). No increase was seen in adverse events for women in the intervention groups compared to controls (RR 0.94, 95% CI: 0.76 to 1.17; 4 intervention-comparisons; 394 women; high-quality evidence). Subgroup analyses revealed that decreases in body weight, BMI and waist circumference were present in women regardless of their ethnicity and menopausal status. Multimodal weight loss interventions (which referred to 'diet, exercise and psychosocial support') appeared to result in greater reductions in body weight (MD: -2.88 kg, 95% CI: -3.98 to -1.77 kg; 13 intervention-comparisons; 1526 participants), BMI (MD: -1.44 kg/m2, 95% CI: -2.16 to -0.72 kg/m2; 11 studies; 1187 participants) and waist circumference (MD:-1.66 cm, 95% CI: -3.49 to -0.16 cm; 8 intervention-comparisons; 1021 participants) compared to dietary change alone, however the evidence was low quality.

AUTHORS' CONCLUSIONS

Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias regarding blinding of participants and assessors. Further research is required to determine the optimal weight loss intervention and assess the impact of weight loss on survival outcomes. Long-term follow-up in weight loss intervention studies is required to determine if weight changes are sustained beyond the intervention periods.

Phase angle and non-alcoholic fatty liver disease before and after bariatric surgery

BACKGROUND

Obesity is a global health problem that is continuing to increase in the young population. In Brazil, the frequency of obesity in 2018 was 19.8%. Several comorbidities are directly associated with obesity, such as non-alcoholic fatty liver disease (NAFLD), which is considered the most common liver disorder in Western countries and affects up to 46% of adults. Bariatric surgery is effective in treating obesity and can improve NAFLD; however, the effect of bariatric surgery on body composition, phase angle (PA), and improving NAFLD needs to be further studied.

AIM

To analyze the PA in the postoperative period of bariatric surgery and to correlate it with changes in body composition and liver disease.

METHODS

This study is a retrospective cohort study of the analysis of the medical records of patients undergoing bariatric surgery in a reference center of a teaching hospital in Porto Alegre over a 2-year period. Patients older than 18 years whose record contained all information relevant to the study were included. The data analyzed were body composition and PA through electrical bioimpedance and NAFLD through liver biopsy in the pre- and postoperative period. The level of significance adopted for the statistical analyses was 5%.

RESULTS

We evaluated 379 patients with preoperative data. Regarding PA, 169 patients were analyzed, and 33 patients had liver biopsy pre- and postoperatively with NAFLD information. In total, 79.4% were female, with a mean age of 39.1 ± 10.6 years. The average body mass index (BMI) was 45.9 ± 7.5 kg/m². The PA showed a mean of 5.8 ± 0.62° in the preoperative period and a significant reduction in the postoperative period. A postoperative reduction in body composition data (skeletal muscle mass, fat percentage, fat mass, body cell mass, BMI and visceral fat area) was shown as well. Regarding liver disease, all patients presented a reduction in the degrees and stages of liver disease in the postoperative period, and some had no degree of liver disease at all.

CONCLUSION

PA decreased after bariatric surgery, with a direct correlation with weight loss and changes in body composition. The decrease in PA was not correlated with the improvement in NAFLD.

Vertical Sleeve Gastrectomy Has Better Weight Evolution and Serum Concentrations of Vitamin D when Compared with Roux-Y Gastric Bypass

OBJECTIVE

The objective of this study is to compare the weight evolution and serum concentrations of vitamin D in individuals undergoing Roux-en-Y Gastric Bypass (RYGB) and Sleeve after 1 follow-up year.

METHODOLOGY

Descriptive, prospective, and longitudinal study, with 108 individuals divided into 2 groups: RYGB (55 patients) and Sleeve (53), evaluated preoperatively, and at 6 and 12 postoperatively months. Anthropometric data, serum concentrations of 25(OH)D, calcium, and parathyroid hormone were analyzed.

RESULTS

The Sleeve group showed greater reductions in excess weight and excess body mass index (BMI) when compared with the RYGB group at both times (p < 0.001). Besides, after 12 months, those who had undergone the Sleeve procedure also had higher percentages of surgical success (84.4% versus 65.0%, p = 0.038). The prevalence of preoperative inadequacy of 25(HO)D in both groups was 78.7%. After 6 months, there was an increase in serum concentrations of 25(HO)D in both groups (p < 0.001), but without significant differences between the groups (p = 0.154). In the comparison between 6 and 12 months, there was only a reduction for the RYGB group (p = 0.001). Also, when comparing both groups, the means of vitamin D in patients undergoing RYGB were also lower after 12 months (p = 0.003). There was a negative correlation between vitamin D and parathyroid hormone (r = - 0.235 p = 0.030). The mean serum concentrations of calcium were adequate at all times.

CONCLUSION

Patients undergoing the Sleeve procedure had a better evolution in weight loss and are at a lower risk of vitamin D inadequacy than those undergoing RYGB.

The Effect of Bariatric Surgery on Peripheral Polyneuropathy: a Systematic Review and Meta-analysis

Neurological complications such as peripheral neuropathies are the most common complications among patients with morbid obesity following bariatric surgery. Reduction in nutrient intake especially thiamin may develop polyneuropathy, while neuropathic symptoms improved in patients with diabetes independent of glycemic control after bariatric surgery. The aim of the present review is to investigate the effect of bariatric surgery on peripheral neuropathy. Electronic literature search was done via scientific search engines. After the removal of duplicates and selection of articles of interest, 4 studies were included. A random effects model was applied in this meta-analysis. Considering the pooled analysis, bariatric surgery was significantly associated with Neuropathy Symptoms Score (NSS) (ES = - 3.393, 95% CI (- 4.507, - 2.278), and P value < 0.0001). Reduction in NSS for patients with type 2 diabetes and BMI < 35 kg/m² who were insulin-dependent was more than patients with morbid obesity without diabetes. Furthermore, neuropathy disability score (NDS) significantly decreased in patients having bariatric surgery (ES = - 0.626, 95% CI (- 1.120, - 0.132), and P value < 0.013). The NDS significantly decreased in patients with type 2 diabetes and BMI < 35 kg/m² treated with insulin as well as patients with morbid obesity and type 2 diabetes. In subgroup of patients with follow-up of more than 6 months after surgery, a significant reduction in NDS was detected while this reduction was not significant in patients with a follow-up of 6 months or less. Bariatric surgery had a positive effect on peripheral neuropathy, though many studies showed neuropathy as one of the complications of bariatric surgery.

Food consumption and its association with nutritional status, physical activity and sociodemographic factors of bariatric surgery candidates

OBJECTIVE

to evaluate the association of food consumption with nutritional status, physical activity and sociodemographic factors in the bariatric surgery period preoperative.

METHODS

we conducted a cross-sectional study from 2018 to 2019, with patients admitted for bariatric surgery at the Oswaldo Cruz University Hospital, Federal University of Pernambuco. We collected data sociodemographic and nutritional data such as body mass index (BMI), waist circumference, highest weight and pre-surgical weight. We evaluated food consumption with the food frequency questionnaire based on the food pyramid adapted for bariatric patients and physical activity.

RESULTS

the study involved 60 patients, 78.3% were female, mean age was 38.8±9.6 years, 53.3% were married, and 70% had more than 12 years of education. As for physical activity, 31.7% were sedentary. Regarding nutritional status, the mean BMI was 47.3±6.96kg/m2. Preoperative weight, highest weight reached before surgery and waist circumference were higher in males (p<0.05). There was an association between physical activity and food intake, and sedentary individuals consumed more carbohydrates (p=0.041). On the other hand, sociodemographic data and nutritional status were not associated with food consumption.

CONCLUSION

the level of physical activity showed significant association only with carbohydrate consumption.

Baseline Pro-inflammatory Diet Is Inversely Associated with Change in Weight and Body Fat 6 Months Following-up to Bariatric Surgery

OBJECTIVE

To evaluate whether the baseline Dietary Inflammatory Index (DII®) was associated with weight loss and body composition change after bariatric surgery.

METHODOLOGY

This longitudinal study included 132 women with obesity (BMI ≥ 35 kg/m², 43.0 ± 9.7 years), followed up for 6 months after bariatric surgery. The DII® was calculated from dietary data collected using 24-h dietary recall interviews. Anthropometric variables, socio demographic variables, health-related habits, history of disease, as well as gastrointestinal symptoms, both in the preoperative period (baseline) and 6 months after bariatric surgery were collected from the patients' medical records.

RESULTS

Individuals with a more pro-inflammatory diet (DII > 0.35 median value) preoperatively experienced smaller weight loss (- 22.7% vs. - 25.3%, p = 0.02) and fat mass loss (- 31.9 vs. - 36.2%, p = 0.026), with no difference in lean mass (p = 0.14). In a linear regression model, the baseline DII score was negatively associated with percentage change in weight and fat mass and positively associated with weight and fat mass in the sixth month after surgery. In addition, a pro-inflammatory baseline DII score was correlated with a lower intake of fruit (r = - 0.26, p = 0.006), vegetables (r = - 0.47, p = 0.001), and legumes (r = - 0.21, p = 0.003) in the postoperative period.

CONCLUSION

In this longitudinal study, a pro-inflammatory diet at baseline was associated with smaller reductions in weight and body fat and poorer dietary quality (reduced consumption of fruits, vegetables, and legumes) 6 months after bariatric surgery.

Repercussões da cirurgia bariátrica na qualidade de vida, no perfil bioquímico e na pressão arterial de pacientes com obesidade mórbida

RESUMO A indicação da cirurgia bariátrica (CB) para perda de peso e redução de comorbidades associadas à obesidade é crescente. O objetivo do presente estudo foi analisar as repercussões da CB na qualidade de vida (QV), no perfil bioquímico e na pressão arterial (PA) de indivíduos obesos mórbidos em três momentos distintos: um mês antes, três meses depois e seis meses após a CB. Participaram da pesquisa 42 indivíduos com obesidade mórbida do programa de CB de um hospital da cidade de Juiz de Fora - MG, os quais foram aleatoriamente divididos em grupo intervenção (GI, n=21) e grupo controle (GC, n=21). O GI sofreu intervenção cirúrgica e o GC foi orientado a manter os afazeres diários usuais durante todo período do estudo, além de receberem acompanhamento nutricional. Foram avaliados a QV, o perfil bioquímico e a PA através do instrumento SF-36, do exame laboratorial de sangue obtido no prontuário dos pacientes e do esfigmomanômetro e estetoscópio, respectivamente. Os resultados demonstraram redução nas variáveis bioquímicas High-density lipoproteins (HDL), Low-density lipoproteins (LDL), Very Low-Density Lipoprotein (VLDL), colesterol, triglicerídeos, hemoglobina glicada, glicose, pressão arterial sistólica e pressão arterial diastólica no GI, após 6 meses de cirurgia. Houve melhora significativa nas variáveis relacionadas à QV, exceto nos aspectos emocionais. Conclui-se que a CB pode repercutir positivamente na maioria dos domínios da QV, na melhora do perfil bioquímico e na PA de pacientes obesos mórbidos após 3 e 6 meses de CB.

Long-term repercussions of Roux-en-Y gastric bypass in a low-income population: assessment ten years after surgery

OBJECTIVE

to evaluate the weight, nutritional and quality of life of low-income patients after ten years of Roux-en-Y gastric bypass (RYGB).

METHODS

we conducted a longitudinal, retrospective and descriptive study evaluating the excess weight loss, weight regain, arterial hypertension, type 2 diabetes mellitus, anemia and hypoalbuminemia in 42 patients of social classes D and E submitted to RYGB. We assessed quality of life through the Bariatric Analysis and Reporting Outcome System (BAROS).

RESULTS

of the 42 patients, 68.3% defined themselves as doing non-regular physical activity, and only 44.4% and 11.9% had regular medical and nutritional follow-up, respectively. We found a mean excess weight loss of 75.6%±12 (CI=71.9-79.4), and in only one patient there was insufficient weight loss. The mean weight loss was 22.3%±16.2 (CI=17.2-27.3) with 64.04% of the sample presenting regain greater than 15% of the minimum weight; 52.3% of the sample presented anemia after ten years of surgery and 47.6%, iron deficiency. We found hypoalbuminemia in 16.6% of the sample. There was remission of hypertension in 66%, and of type 2 diabetes mellitus, in 50%. BAROS showed an improvement in the quality of life of 85.8% of the patients.

CONCLUSION

in a population with different socioeconomic limitations, RYGB maintained satisfactory results regarding weight loss, but inefficient follow-up may compromise the final result, especially with regard to nutritional deficiencies.

Nutritional Status of Bariatric Surgery Candidates

Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76%) and Vitamin B₁₂ (16%). Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV) 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B₆ (24%) was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery.

Obesity, bariatric surgery and oxidative stress

Introduction:

Obesity refers to the accumulation of fatty tissues and it favors the occurrence of oxidative stress. Alternatives that can contribute to body weight reduction have been investigated in order to reduce the production of reactive oxygen species responsible for tissue damage. The aim of the current study was to assess whether the oxidant and antioxidant markers of obese women before and after bariatric surgery were able to reduce oxidative damage.

Method:

We have assessed 16 morbidly obese women five days before and 180 days after the surgery. The control group comprised 16 non-obese women. Levels of thiobarbituric acid-reactive substances, carbonylated proteins, reduced glutathione and ascorbic acid were assessed in the patients' plasma.

Results:

Levels of lipid peroxidation and protein carbonylation in the pre-surgical obese women were higher than those of the controls and post-surgical obese women. Levels of reduced glutathione in the pre-surgical obese women were high compared to the controls, and declined after surgery. Levels of ascorbic acid fell in the pre--surgical obese women compared to the control and post-surgical obese women.

Conclusion:

Body weight influences the production of reactive oxygen species. Bariatric surgery, combined with weight loss and vitamin supplementation, reduces cellular oxidation, thus reducing tissue damage.

NUTRITIONAL ASPECTS AND THE USE OF NUTRITIONAL SUPPLEMENTS BY WOMEN WHO UNDERWENT GASTRIC BYPASS

Background

Bariatric surgery is deemed one of the most effective procedures for the treatment of obesity and it aims at the reduction and maintenance of weight loss in long term, as the control of the related comorbidities.

Aim

Quantify the occurrence of alterations of the gastrointestinal tract, suggestive signs of nutritional deficiencies and the use of supplements in a group of women undergoing bariatric surgery.

Methods

The sample consisted of women aged 20-65 years submitted to Roux-en-Y gastric bypass with monitoring equal to or higher than 24 months. For the qualitative analysis, the Feeding Frequency Questionnaire was used.

Results

In the postoperative period, alopecia was the most reported (79.3%), followed by changes in the texture of the nails, both considered predictive of nutritional deficiencies. Changes in the gastrointestinal tract were described in 86.2%, and episodes of dumping were reported in 65.5%. Qualitative analysis has shown reduced daily consumption of sources of animal and plant proteins.

Conclusion

After bariatric surgery can occur flatulence, vomiting and dumping syndrome as the most frequent representative symptoms of digestive functional disorders. Alopecia and nail changes are the most important signs of nutritional deficiency. The use of dietary supplements in the postoperative period is scarce and sporadic.

Comparison Between Different Intramuscular Vitamin B12 Supplementation Regimes: a Retrospective Matched Cohort Study

BACKGROUND

The incidence of vitamin B₁₂ deficiency after bariatric surgery can range from 26 to 70 %. There is no consensus on optimal vitamin B₁₂ supplementation in postbariatric patients. The objective of this study was to compare three different regimes.

METHODS

In this retrospective matched cohort study, we included 63 patients with methylmalonic acid (MMA) levels ≥300 nmol/L. Group A (n = 21) received 6 intramuscular (im) vitamin B₁₂ injections including a loading dose, group B (n = 21) received 3 im vitamin B₁₂ injections without loading dose and group C (n = 21) received no im vitamin B₁₂ injections.

RESULTS

The total post-bariatric patient population consisted of 14 males (22.2 %) and 49 women (77.8 %) with a mean current body mass index of 30.6 ± 8.0 kg/m². There was no significant difference in vitamin B₁₂ and MMA levels between 3 groups at baseline. There was a significant difference in follow-up vitamin B₁₂ levels of group A compared to group B (p = 0.02) and group A compared to group C (p = 0.03). In the follow-up results, there is also a significant decrease in MMA levels of group A compared to group B (p = 0.02), group A compared to group C (p < 0.001), and group B compared to group C (p < 0.01).

CONCLUSIONS

In this study, a shorter injection regime is probably not sufficient to treat a vitamin B₁₂ deficiency. An injection regime with 6 injections recovered all vitamin B₁₂ deficiencies biochemically. MMA levels cannot recover spontaneously over time without additional im injection regime.

Diet micronutrient adequacy of women after 1 year of gastric bypass

Background

The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency.

Aim

To determine the amounts of dietary iron, calcium, vitamin D and vitamin B₁₂ ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances.

Methods

This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B₁₂ was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery.

Results

There was inadequate consumption of iron, calcium and vitamin D. The vitamin B₁₂ intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B₁₂ and vitamin D.

Conclusion

The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies.

Food quality in the late postoperative period of bariatric surgery: an evaluation using the bariatric food pyramid

Bariatric surgery is an effective intervention in the treatment of obesity, but lifestyle and diet should be monitored after this procedure to ensure success. The Bariatric Food Pyramid was created basing on long-term nutritional care that proposes a standard of healthy living and eating habits considering gastric capacity and specific nutritional needs. The purpose of the current study is to evaluate the life habits and diet quality of patients who have undergone bariatric surgery (who have been recovering for at least 6 months) based on the specific food pyramid. Retrospective data analysis was performed using medical records of patients who had been followed for at least 6 months after bariatric surgery. The following data were collected from patient records: age, gender, education level (years), BMI (preoperative and postoperative), percentage of excess weight loss (EWL) relative to the time of surgery, frequency of physical activity, use of nutritional supplements, usual dietary intake history, and fluid intake. Results were analyzed using descriptive statistics. We evaluated 172 patient records. In this study, there was a low prevalence of physical activity, use of vitamin-mineral supplements, and water intake. There also was low consumption of protein, fruit, vegetables, and vegetable oils. In addition, intake of carbohydrates, sugars, and fats were higher than the recommendations established by the pyramid. The results indicate that patients who have undergone bariatric surgery have an inadequate diet according to food evaluation with the specific pyramid. In the long term, this may lead to weight gain and vitamin and mineral deficiencies.

Study of the clinical and histopathological repercussions of the "omental band" in dogs' stomach

PURPOSE

To evaluate the efficacy of the "omental band" as a bariatric surgical technique.

METHODS

A sample of 35 dogs was studied. The Test Group was composed by 20 dogs. Of these, six were observed by 10 days, six were observed by 20 days and eight were observed by 30 days of post-operatory. The Control Group was composed by 15 dogs. Of these, five were observed by 10 days, five were observed by 20 days and five were observed by 30 days of post-operatory. The weight loose was the variable utilized to the evaluation of the efficacy of the surgical technique described in this study, once all of the dogs were weighted in precision balance before the surgical act and at the end of the post-operatory observation period.

RESULTS

At the end of the study it was observed that the weight loose of the dogs submitted to the "omental band's" surgical technique was meaningfully higher in comparison with the dogs of the Control Group at the end of the post-operatory observation period.

CONCLUSION

The surgical technique of the "omental band" showed effective in dogs, once has proposed a meaningfully weight loose.

Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively?

BACKGROUND

Nutritional deficiencies are common among morbidly obese patients. Data are scarce for patients who have undergone laparoscopic sleeve gastrectomy (LSG).

OBJECTIVES

The aim of the study is to clarify the prevalence of deficiencies and to identify risk factors for postoperative deficiencies.

SETTINGS

Hebrew University, Israel.

METHODS

Preoperative and 1-year postoperative data were collected. We included anthropometric parameters, obesity-related co-morbidities, and laboratory findings.

RESULTS

There were 192 candidates. Seventy-seven of them completed follow-ups at 12 months. Before surgery, 15% had anemia. Deficiencies of iron, folate, and B12 were 47%, 32%, and 13%, respectively. Women were more deficient in iron (56% women, 26% men, P<.001). Before surgery, low levels of vitamin D and elevated parathyroid hormone (PTH) were 99% and 41%, respectively. One year postsurgery, the deficiencies of hemoglobin and vitamin B12 worsened (20% and 17%, P<.001, P = .048, respectively). One year postsurgery, deficiencies of iron, folate, vitamin D, and PTH improved (28%, 21%, 94%, and 10%, respectively). Deficiencies of hemoglobin, folate, and B12 before surgery were predictors for deficiencies 1 year after surgery (P = .006 OR = .090; P = .012 OR = .069; P = .062 OR = .165, respectively).

CONCLUSIONS

LSG had a modest effect on nutritional deficiencies in our patients at 1-year postsurgery. Focusing on the preoperative nutritional status and tailoring a specific supplemental program for each individual should prevent postoperative deficiencies.

Weight loss in the first month post-gastroplasty following diet progression with introduction of solid food three weeks after surgery

Background

Bariatric surgery is an effective tool in treating severe obesity. It provides significant weight loss in morbidly obese people accompanied by improvement in comorbidities and quality of life.

Aim

To investigate the weight loss outcomes in the first month after bariatric surgery after introduction of solids three weeks postoperatively.

Methods

Thirty-two charts of patients who underwent bariatric surgery were analyzed at a private nutritional clinic in São Sebastião do Paraíso, MG, Brazil; 93,75% of the subjects underwent Roux-en-Y gastric bypass, and 6,25% vertical gastrectomy. The subjects were 16 to 60 years. A body mass index of 30 to 69 Kg/m² was obtained. Patients were instructed to eat small amounts several times a day, eat slowly, chew foods thoroughly, substitute sugar for sweetener, stop drinking gassy beverages, set the utensils down in between meals, drink only in between meals, avoid processed condiments and fried and greasy foods.

Results

In the first month after surgery, the mean weight loss was 9,7% and the percentage of excess weight loss was 23,9%. It was found that there was significant statistical difference in relation to initial and final weight (p=0,00; p<0,05).

Conclusion

This protocol provides more freedom of choice in health care once one does not have to go on food intake modifications for more than three weeks; more nutritional guidelines is followed and prospective weight loss is presented.

Iron deficiency after Roux-en-Y gastric bypass: insufficient iron absorption from oral iron supplements

BACKGROUND

Roux-en-Y gastric bypass (RYGB) may reduce the absorption of iron, but the extent to which this absorption is impeded is largely unknown. First, we determined the prevalence of iron deficiency following RYGB and explored the risk factors for its development. Second, we examined to what extent oral iron supplements are absorbed after RYGB.

METHODS

Monocentric retrospective study in 164 patients (123 females, 41 males; mean age 43 years) who underwent RYGB between January 2006 and November 2010 was done. Pre- and postoperative data on gender, age, BMI, serum levels of iron, ferritin, hemoglobin, vitamin B12, 25-hydroxy vitamin D, and use of proton pump inhibitors and H2 antagonists were collected. Generalized linear mixed models were used for the analysis of the data. In 23 patients who developed iron deficiency after surgery, an oral challenge test with 100 mg FeSO4 · 7H2O was performed.

RESULTS

Following RYGB, 52 (42.3 %) female patients and 9 male (22.0 %) patients developed iron deficiency (serum ferritin concentration ≤ 20 μg/L). The prevalence of iron deficiency was significantly higher in females than males (p = 0.0170). Young age (p = 0.0120), poor preoperative iron status (p = 0.0004), vitamin B12 deficiency (p = 0.0009), and increasing time after surgery (p < 0.0001) were also associated with iron deficiency. In the oral iron challenge test, only one patient out of 23 showed sufficient iron absorption.

CONCLUSIONS

Iron deficiency is extremely frequent after RYGB and is linked with different risk factors. Iron supplementation seems essential, but the effect of oral tablets may be limited as absorption of oral iron supplements is insufficient post-RYGB.

Pharmacotherapy prevention and management of nutritional deficiencies post Roux-en-Y gastric bypass

Roux-en-Y gastric bypass is the most commonly performed bariatric procedure. It is associated with nutritional deficiencies due to gastric reduction, intestinal bypass, reduced caloric intake, avoidance of nutrient-rich foods, noncompliance with supplementation and poor food tolerability. Although there are multiple publications on this topic, there is a lack of consistent guidance for the healthcare practitioner caring for the bariatric patient. This article will encompass literature reviewing the pharmacotherapy approach to prevention and management of nutritional deficiencies since the American Society of Metabolic and Bariatric Surgery guidelines were published in 2008.

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(r) program. The statistical treatment of the caloric intake was performed by an ANOVA test with Bonferroni's 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.

Hydrosoluble vitamins

The hydrosoluble vitamins are a group of organic substances that are required by humans in small amounts to prevent disorders of metabolism. Significant progress has been made in our understanding of the biochemical, physiologic and nutritional aspects of the water-soluble vitamins. Deficiency of these particular vitamins, most commonly due to inadequate nutrition, can result in disorders of the nervous system. Many of these disorders have been successfully prevented in developed countries; however, they are still common in developing countries. Of the hydrosoluble vitamins, the nervous system depends the most on vitamins B and C (ascorbic acid) for proper functioning. The B group vitamins include thiamin (vitamin B1), riboflavin (vitamin B2), niacin or niacinamide (vitamin B3), pantothenic acid (vitamin B5), pyridoxine or pyridoxal (vitamin B6) and cobalamin (vitamin B12). Clinical findings depend upon the deficiency of the underlying vitamin; generally, deficiency symptoms are seen from a combination rather than an isolated vitamin deficiency. True hereditary metabolic disorders and serious deficiency-associated diseases are rare and in general limited to particular geographic regions and high-risk groups. Their recognition is truly important as that determines the appropriate therapeutic management. The general availability of vitamins to practically everyone and several national health programs have saved many lives and prevented complications. However, there has been some apprehension for several decades about how harmless generous dosages of these vitamins are. Overt overdosages can cause vitamin toxicity affecting various body systems including the nervous system. Systemically, vitamin toxicity is associated with nonspecific symptoms, such as nausea, vomiting, diarrhea, and skin rash which are common with any acute or chronic vitamin overdose. At a national level, recommended daily allowances for vitamins become policy statements. Nutrition policy has far reaching implications in the food industry, in agriculture, and in food provision programs. Overall, water-soluble vitamins are complex molecular structures and even today, many areas of vitamin biochemistry still need to be explored. Many readers might be of the opinion that the classic forms of nutritional deficiency diseases have faded into the background of interesting history. This has caused their diverse symptoms to be neglected by most modern physicians since vitamin enrichment of many foods automatically erases them from their consideration in differential diagnosis. Vitamin B12 and folic acid deficiencies are discussed in other chapters.

Influence of nutritional variables and obesity on health and metabolism

Obesity is a recurring theme in current scientific literature. This can easily be explained by its exponential increase in all layers of society. The popularity of this subject has also given rise to associated questions, which have achieved greater prominence in health-related publications. In order to assess what has been studied in the field of obesity and nutrition, an overview of all articles published on these subjects in some of the main Brazilian scientific journals over the past two years was performed. Among the subthemes selected for this study, those related to childhood obesity attracted attention due to their greater frequency. These were subdivided into: prevalence, intrauterine and breastfeeding influences that may lead to the development of this condition, impact on quality of life, cardiovascular system and metabolism, and possible prevention strategies. Furthermore, issues related to obesity in adults were explored, such as risk factors and new strategies for prevention, with special attention given to the many studies evaluating different aspects of bariatric surgery. Finally, the subject of malnutrition and the impact of the deficiency of specific micronutrients such as selenium, vitamin D, and vitamin B12 were assessed. Based on the results, it was possible to assess the actual importance of obesity and nutrition in health maintenance, and also the several lines of research regarding these issues. Thus, it is essential to create new methods, which must be quick and efficient, to update health professionals involved in the treatment of obesity.