1
|
Phan A, Hage M, Zaharia R, Vigan M, Coursault S, Wilson S, Gabali E, Foussier L, Vychnevskaia K, Raffin-Sanson ML, Bretault M. Nutritional Status of Vegetarian Patients Before and After Bariatric Surgery: a Monocentric Retrospective Observational Case-Control Study. Obes Surg 2023; 33:1356-1365. [PMID: 36991254 DOI: 10.1007/s11695-023-06538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
The obesity pandemic is associated with an increasing number of bariatric surgeries which allow improvement in obesity-related comorbidities and life expectancy but potentially induce nutritional deficiencies. Vegetarianism becomes more and more popular and exposes as well to vitamin and micronutrient deficiencies. Only one study has explored the impact of vegetarianism on the preoperative nutritional status of eligible patients for bariatric surgery, but none in postoperative care. MATERIALS AND METHODS We conducted a retrospective case-control study in our cohort of bariatric patients, matching 5 omnivores for each vegetarian. We compared their biological profile regarding vitamin and micronutrient blood levels before and 3, 6, 12, and 30 months after surgery. RESULTS We included 7 vegetarians including 4 lacto-ovo-vegetarians (57%), 2 lacto-vegetarians (29%), and one lacto-ovo-pesco-vegetarian (14%). Three years after surgery with equivalent daily standard vitamin supplementation, the two groups showed a similar biological profile including blood levels of ferritin (p = 0.6), vitamin B1 (p = 0.1), and B12 (p = 0.7), while the total median weight loss at 3 years was comparable (39.1% [27.0-46.6] in vegetarians vs 35.7% [10.5-46.5] in omnivores, p = 0.8). We observed no significant difference between vegetarians and omnivores before surgery regarding comorbidities and nutritional status. CONCLUSION It seems that, after bariatric surgery, vegetarian patients taking a standard vitamin supplementation do not show an increased risk of nutritional deficiencies compared to omnivores. However, a larger study with a longer follow-up is needed to confirm these data, including an evaluation of different types of vegetarianism such as veganism.
Collapse
Affiliation(s)
- Aurélie Phan
- Department of Nutrition, European Georges Pompidou Hospital, APHP, Paris, France
| | - Mirella Hage
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Ramona Zaharia
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Marie Vigan
- Clinical Research Unit, AP-HP, Paris-Saclay, Hôpital Ambroise Pare, Boulogne-Billancourt, France
| | - Séverine Coursault
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Sandy Wilson
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Elodie Gabali
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Loic Foussier
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Karina Vychnevskaia
- Department of Surgery and Oncology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Marion Bretault
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France.
| |
Collapse
|
2
|
Bretault M, Zaharia R, Vigan M, Vychnevskaia K, Raffin-Sanson ML, Crenn P, Hage M. Complications Requiring Intensive Nutritional Care After Bariatric Surgery Result in More Long-Term Weight Loss but Has No Impact on Nutritional Deficiencies and Depression-Anxiety Scores. Obes Surg 2021; 31:4767-4775. [PMID: 34491508 DOI: 10.1007/s11695-021-05623-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Bariatric surgery is associated with significant weight loss and improvement in comorbid conditions but in rare cases can expose to complications requiring intensive nutritional care (INC). INC in this context is poorly described and no data are available concerning long-term impact. MATERIALS AND METHODS We retrospectively reviewed charts of bariatric patients who were hospitalized in our institution between 2013 and 2018. We identified patients with a postoperative complication requiring INC and we described their nutritional management (INC group). These patients were compared with controls matched to age, gender, preoperative BMI, and type of surgery selected from our database (control group). The primary endpoint was the percentage of total weight loss (%TWL) at 2.5 years. Secondary endpoints were improvement of co-morbidities, vitamin deficiencies, and depression/anxiety scores. RESULTS The INC group consisted of 18 patients among which 77.8% had sleeve gastrectomy (SG). Half of these patients underwent revisional surgery. The most common complication was fistula formation (66.7%). Patients in the INC group, compared to the control group, showed a significantly higher %TWL at 2.5 years (33.6% vs 26.1%, P = 0.03). There was no significant difference in either reduction of preoperative comorbidities or depression/anxiety scores between the two groups. The number of patients with more than three nutritional deficiencies was similar in both groups. Thiamine deficiency was only observed in the INC group. CONCLUSION Complications requiring INC after bariatric surgery occur mainly after revisional surgery and may increase long-term %TWL but have no impact on nutritional deficiencies or symptoms of anxiety/depression.
Collapse
Affiliation(s)
- Marion Bretault
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, University Paris-Saclay, 92100, Boulogne-Billancourt, France.
| | - Ramona Zaharia
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Marie Vigan
- Clinical Research Unit, AP-HP, Paris-Saclay, Hôpital Ambroise Pare, Boulogne-Billancourt, France
| | - Karina Vychnevskaia
- Department of Surgery and Oncology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Pascal Crenn
- Department of Gastro-enterology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Mirella Hage
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| |
Collapse
|
3
|
Abdellaoui Y, Magkou D, Bakopoulou S, Zaharia R, Raffin-Sanson ML, Cazabat L. Coexistence of Autoimmune Hyper- and Hypothyroidism in a Kindred with Reduced Sensitivity to Thyroid Hormone. Eur Thyroid J 2020; 9:263-268. [PMID: 33088795 PMCID: PMC7548835 DOI: 10.1159/000506424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Resistance to thyroid hormone beta (RTHβ) is a rare disease with an autosomal dominant transmission. Diagnosis may be challenging especially in patients with hyper- or hypothyroidism. CASE PRESENTATION A 31-year-old male patient with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine and free triiodothyronine, along with high thyroid receptor antibodies was diagnosed with Graves' disease. Benzylthiouracil was started. One month later, reduced sensitivity to thyroid hormones was suspected because of persistently high thyroid hormone levels contrasting with high TSH level. Molecular analysis highlighted a 10c.1357C>T p.P453S mutation in the thyroid hormone receptor beta gene (THRB). RTHβ was diagnosed. Several relatives also had RTHβ (the mother, the young son, and 2 out of 3 siblings). Autoimmune hypothyroidism was present in the mother, whereas 2 out of 3 siblings had asymptomatic autoimmunity. DISCUSSION/CONCLUSION Both Graves' disease and autoimmune hypothyroidism were described in patients with RTHβ. We show here for the first time that autoimmune hypo- and hyperthyroidism may coexist in kindred with RTHβ. Seven previously published cases of Graves' disease and RTHβ were retrieved and analyzed. Treatments and thyroid hormone level targets are discussed as well as the possible link between RTHβ and autoimmune thyroid diseases.
Collapse
Affiliation(s)
| | - Dimitra Magkou
- Department of Endocrinology and Nutrition, Ambroise Paré Universitary Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, France
| | - Sofia Bakopoulou
- Department of Endocrinology and Nutrition, Ambroise Paré Universitary Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, France
| | - Ramona Zaharia
- Department of Endocrinology and Nutrition, Ambroise Paré Universitary Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology and Nutrition, Ambroise Paré Universitary Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, France
- EA 4340, Université Versailles Saint Quentin en Yvelines, UFR Simone Veil Santé, Montigny le Bretonneux, France
- *Marie-Laure Raffin-Sanson, Endocrinology and Nutrition, Université Versailles Saint Quentin en Yvelines, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, FR–92100 Boulogne (France),
| | - Laure Cazabat
- Department of Endocrinology and Nutrition, Ambroise Paré Universitary Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, France
- EA 4340, Université Versailles Saint Quentin en Yvelines, UFR Simone Veil Santé, Montigny le Bretonneux, France
| |
Collapse
|
4
|
Bretault M, Carette C, Zaharia R, Vychnevskaia K, Bouillot JL, Czernichow S, Raffin-Sanson ML. Liraglutide 3mg as a weight-loss strategy after failed bariatric surgery in a patient with hypothalamic obesity following craniopharyngioma. Diabetes Metab 2019; 46:514-515. [PMID: 31362076 DOI: 10.1016/j.diabet.2019.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/05/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- M Bretault
- Department of Endocrinology-Nutrition, Ambroise-Paré Hospital, AP-HP, 9, avenue Charles de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - C Carette
- Department of Nutrition, Georges-Pompidou Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - R Zaharia
- Department of Endocrinology-Nutrition, Ambroise-Paré Hospital, AP-HP, 9, avenue Charles de-Gaulle, 92100 Boulogne-Billancourt, France
| | - K Vychnevskaia
- Department of Visceral and Metabolic Surgery, Ambroise-Paré Hospital, AP-HP, 9, avenue Charles de-Gaulle, 92100 Boulogne-Billancourt, France
| | - J-L Bouillot
- Department of Visceral and Metabolic Surgery, Ambroise-Paré Hospital, AP-HP, 9, avenue Charles de-Gaulle, 92100 Boulogne-Billancourt, France
| | - S Czernichow
- Department of Nutrition, Georges-Pompidou Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - M-L Raffin-Sanson
- Department of Endocrinology-Nutrition, Ambroise-Paré Hospital, AP-HP, 9, avenue Charles de-Gaulle, 92100 Boulogne-Billancourt, France
| |
Collapse
|
5
|
Raffin-Sanson ML, Abiven G, Ritzel K, de Corbière P, Cazabat L, Zaharia R, Groussin L, Libe R, Bertherat J, Fassnacht M, Bertagna X. [Adrenocortical carcinoma and pregnancy]. Ann Endocrinol (Paris) 2016; 77:139-47. [PMID: 27172868 DOI: 10.1016/j.ando.2016.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
Adrenocortical carcinoma is a rare cancer with a poor but heterogeneous prognosis. These tumours are more frequently encountered in women, sometimes very young and may be diagnosed in women in their child bearing years or already pregnant. Several clinical data have indicated that the secretion and or proliferation of adrenocortical tumors may be affected by the hormonal context of pregnancy. In this review, we will examine the link between ACC and pregnancy in two main aspects. We will first consider the situation of a pregnant woman with a clinical suspicion of adrenocortical carcinoma: which diagnostic procedures will be useful and safe for the foetus? What are the therapeutic options? What is the prognosis if the diagnosis is confirmed? In a second part, we will examine the possible risk of mothering a child in a patient previously treated for an ACC. The data shown here were obtained from studies carried out in a tertiary reference medical centre in Paris (Hôpital Cochin) and from the European Network for the Study of Adrenal Tumor (ENS@T) database of adrenocortical carcinoma.
Collapse
Affiliation(s)
- Marie-Laure Raffin-Sanson
- Service d'endocrinologie-nutrition, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France; Inserm U1173, université Versailles-Saint-Quentin, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France.
| | - Gwenaelle Abiven
- Department of Endocrinology, Cochin University Hospital, AP-HP, French Adrenal Cancer Network COMETE-Cancer, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; UMR 8104, institut Cochin, Paris, France
| | - Katrin Ritzel
- Medizinische Klinik IV, Klinikum der Universität München, Munich, Allemagne
| | - Pauline de Corbière
- Service d'endocrinologie-nutrition, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France; Inserm U1173, université Versailles-Saint-Quentin, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - Laure Cazabat
- Service d'endocrinologie-nutrition, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France; Inserm U1173, université Versailles-Saint-Quentin, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - Ramona Zaharia
- Service d'endocrinologie-nutrition, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France; Inserm U1173, université Versailles-Saint-Quentin, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - Lionel Groussin
- Department of Endocrinology, Cochin University Hospital, AP-HP, French Adrenal Cancer Network COMETE-Cancer, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; UMR 8104, institut Cochin, Paris, France
| | - Rossella Libe
- Department of Endocrinology, Cochin University Hospital, AP-HP, French Adrenal Cancer Network COMETE-Cancer, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; UMR 8104, institut Cochin, Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Cochin University Hospital, AP-HP, French Adrenal Cancer Network COMETE-Cancer, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; UMR 8104, institut Cochin, Paris, France
| | - Martin Fassnacht
- Medizinische Klinik IV, Klinikum der Universität München, Munich, Allemagne
| | - Xavier Bertagna
- Department of Endocrinology, Cochin University Hospital, AP-HP, French Adrenal Cancer Network COMETE-Cancer, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; UMR 8104, institut Cochin, Paris, France
| |
Collapse
|
6
|
Marin I, Doran H, Zaharia R, Lupu L, Panazan T, Brezean I. Peristomal necrotizing fasciitis - peculiar evolution of a patient with metachronous colonic tumors. Chirurgia (Bucur) 2014; 109:693-696. [PMID: 25375061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
UNLABELLED We hereby present a case report of a patient with an unusual neoplasic and surgical history. M.V. is a 54-year-old patient who had been operated, two years ago, for intestinal obstruction caused by a sigmoid tumor; a segmental rectal and sigmoid resection (Hartmann's procedure) was then performed. Two other surgical procedures were attempted during the last two years, in another surgical department: a colo-rectal anastomosis and a repair of the parastomal hernia, both failed due to postoperative adhesions syndrome. The patient was hospitalized for peristomal gangrene with necrotizing fasciitis. Emergency action was taken to resolve the parietal gangrene. The postoperative local evolution of the wound was favourable and allowed a skin graft for parietal restoration. An intestinal obstruction occurred 2 months later, caused by an extended metachronous tumor of the splenic flexure. The patient underwent other surgeries including the completion of the left hemicolectomy, total gastrectomy, caudal splenopancreatectomy and left adrenalectomy. The patient has a favourable postoperative evolution after 1 year. CONCLUSION We noticed a very severe evolution of the peristomal gangrene and the rapid growth towards intestinal obstruction of the metachronous colonic tumor.
Collapse
|
7
|
Marin I, Doran H, Catrina E, Degeratu D, Predescu G, Zaharia R, Pătraşcu T. [The gastric plasmacytoma--a case report]. Chirurgia (Bucur) 2009; 104:213-217. [PMID: 19499666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The gastric plasmacytoma represents a rarely encountered, so that, the diagnosis criteria, the medical attitude and the evolution of this disease are less coded. It is known the fact that this tumours, extramedullary plasmacytomas with gastric localization, develop in soft submucous tissue, therefore it's very difficult or even impossible preoperative diagnosis through an upper endoscopy including biopsy. We present the case of a 54 years old patient, with no significant pathological personal record, that was admitted in our Clinic for having melenic dark stools which have repeated within a 6 months period prior to this hospitalisation. Repeated gastric mucosal samples taken in another medical unit shown normal aspects, contrary to all imaging testing (e.g. ultrasonography, upper endoscopy and barium swallow) which revealed a tumor mass of considerable extent at the level of the gastric corpus. First-line therapy was gastric resection followed by radiotherapy, because it is well known that the tumour is highly radiosensitive. The patient's postoperative course was satisfactory, showing no signs or recurrence 6 months after surgery at upper endoscopy and CT-scan.
Collapse
Affiliation(s)
- I Marin
- Clinica de chirurgie "Prof. I. Juvara", Spitalul Clinic "Dr. I. Cantacuzino", Bucuresţi.
| | | | | | | | | | | | | |
Collapse
|