Food Intolerance 1 Year After Banded Roux-En-Y Gastric Bypass.

The purpose of this study is to evaluate the food intolerance after banded Roux-en-Y gastric bypass (RYGB), correlating the data of food ingestion. METHODS: This is an observational prospective study, which evaluated the individuals before and 3, 6, and 12 months after banded RYGB. We performed an anthropometric evaluation and an assessment of the habitual food ingestion and applied a food tolerance questionnaire. RESULTS: The study group was comprised of 75 individuals, 89% of them female, with a percentual weight loss of 29.73 ± 6.79%. The observed results were that food intolerance increased over time and 1 year after surgery, only 2.7% reported to ingest any type of food, while the greatest difficulty was related to red meat (80%). Regarding vomits, after surgery, this proportion significantly increased after 3, 6, and 12 months. Preoperatively, the mean protein ingestion was 98 g, which decreased to 50 g after 3 and 6 months and to 51 g after 12 months. As a conclusion, food intolerance significantly increased following banded RYGB, leading to a crescent dissatisfaction regarding food and an increase in the vomits frequency.

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study.

INTRODUCTION: The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). OBJECTIVE: To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. METHOD: This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. RESULTS: BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. CONCLUSION: BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study / Síndrome da apneia obstrutiva do sono em indivíduos portadores de obesidade: um estudo transversal

Summary Introduction: The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). Objective: To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. Method: This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. Results: BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. Conclusion: BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

Resumo Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é uma patologia respiratória, caracterizada por episódios recorrentes de apneia e hipopneia, resultando na cessação ou redução do fluxo aéreo. A obesidade é um dos principais fatores de risco para o desenvolvimento da SAOS. Foram criadas formas de auxiliar o diagnóstico da doença por meio de questionários de fácil aplicação e baixo custo, como o questionário de Berlim (QB). Objetivo: Avaliar a eficácia do QB para rastreamento do risco de desenvolvimento da SAOS em indivíduos portadores de obesidade que participaram do grupo multidisciplinar de preparo pré-operatório para cirurgia bariátrica do Hospital de Clínicas da Universidade Estadual de Campinas (HC-Unicamp). Método: O estudo foi observacional, descritivo e transversal, e avaliou portadores de obesidade que participavam do Programa multidisciplinar de preparo pré-operatório para cirurgia bariátrica do HC-Unicamp foram avaliados por meio do QB. Resultados: O QB foi capaz de detectar que mínimas oscilações no índice de massa corpórea (IMC), na circunferência cervical (Ccv), na circunferência da cintura e na relação cintura/quadril (RCQ) podem alterar o risco de desenvolvimento de SAOS, sendo que quanto maior esses valores, maior o risco de desenvolvimento de SAOS. Conclusão: O QB é uma ferramenta eficaz e fidedigna em demonstrar a prevalência do risco alto para o desenvolvimento da SAOS em indivíduos portadores de obesidade, dado esse que, quando correlacionado com IMC, aumento de idade, medida de cintura, Ccv e RCQ, faz o risco tender a aumentar de forma exponencial.

Aspectos nutricionais e estresse de pilotos de aeronaves de instrução / Nutritional aspects and stress of the flight instructors in civil aviation

Objetivo ­ Avaliar os aspectos nutricionais dos pilotos de aeronaves de instrução civil e seus níveis de estresse desenvolvidos em trabalho e traçar uma possível relação entre essas duas variáveis. Métodos ­ Foi realizado coleta de dados antropométricos (peso e altura). Também foi avaliado a ingestão alimentar a partir da aplicação do recordatório alimentar de três dias e verificação do nível de estresse dos pilotos pelo instrumento de avaliação de estresse de Burnout. A amostra foi composta por 24 pilotos do gênero masculino da região de Jundiaí e Campinas. Resultados ­ Observou-se que 37,5% (n=9) dos voluntários apresentaram-se eutróficos, 50% (n=12) em sobrepeso e 12,5% (n=3) em obesidade grau I. Verificou-se que 75% (n=18) dos pilotos atingiram a necessidade de ingestão calórica recomendada. Todos atingiram a ingestão adequada de proteínas, carboidratos e lipídeos, entretanto, 91% (n=22) apresentaram baixo consumo de vitamina A, C, cálcio, magnésio, folato e fibras e, 87,5% (n=21), apresentaram consumo elevado de sódio. Verificou-se que 33% (n=8) encontram-se na fase inicial de estresse e 66% (n=16) apresentam possibilidade de desenvolver estresse. Conclusão ­ Os pilotos apresentaram baixos níveis de estresse, entretanto o consumo inadequado de nutrientes e os desajustes no peso corporal podem comprometer a saúde e aumentar as chances de desenvolver doenças associadas à nutrição conforme elevação de estresse em trabalho.

Objective ­ To evaluate the nutritional aspects of the pilots of civil aircraft instruction and your stress levels developed in work and outline a possible relationship between these two variables. Methods ­ We conducted anthropometric data (weight and height). Is was also assessed food intake from the application of the three-day food recall, and checked the level of stress in pilots using the Burnout stress assessment tool. The sample consisted of 24 male flight instructors from the Jundiaí and Campinas region. Results ­ It was observed that 37.5% (n=9) of the volunteers had to be eutrophic, 50% (n=12) in overweight and 12.5% (n=3) in obesity degree I. It was that 75% (n=18) of the pilots reached the need for recommended caloric intake, on the other hand showed high intake of cholesterol. All reached the adequate intake of protein, carbohydrates and lipids, however, 91% (n=22) had low intake of vitamin A, C, calcium, magnesium, folate and fiber and 87.5% (n=21) high consumption of sodium. It was found that 33.33% (n=8) lying at the initial stage of stress and 66.66% (n=16) have possibility of developing stress. Conclusions ­ The pilots had low levels of stress, however,inadequate nutrient intake and imbalances in body weight, this can compromise the health and flight safety and also increase the chances of developing diseases associated with nutrition as high stress work.

Micronutrient and physiologic parameters before and 6 months after RYGB.

BACKGROUND: Bariatric surgery is considered an effective method for sustained weight loss, but may cause various nutritional complications. The aim of this study was to evaluate the nutritional status of minerals and vitamins, food consumption, and to monitor physiologic parameters in patients with obesity before and 6 months after Roux-en-Y gastric bypass surgery (RYGB). METHODS: Thirty-six patients who had undergone RYGB were prospectively evaluated before and 6 months after surgery. At each phase their weight, height, body mass index (BMI), Electro Sensor Complex (ES Complex) data, food consumption, and total protein serum levels, albumin, prealbumin, parathyroid hormone (PTH), zinc (Zn), B12 vitamin (VitB12), iron (Fe), ferritin, copper (Cu), ionic calcium (CaI), magnesium (Mg), and folic acid were assessed. RESULTS: The mean weight loss from baseline to 6 months after surgery was 35.34±4.82%. Markers of autonomic nervous system balance (P<.01), stiffness index (P<.01), standard deviation of normal-to-normal R-R intervals (SDNN) (P<.01), and insulin resistance (P<.001) were also improved. With regard to the micronutrients measured, 34 patients demonstrated some kind of deficiency. There was a high percentage of Zn deficiency in both pre- (55.55%) and postoperative (61.11%) patients, and 33.33% of the patients were deficient in prealbumin postoperatively. The protein intake after 6 months of surgery was below the recommended intake (<70 g/d) for 88.88% of the patients. Laboratory analyses demonstrated an average decrease in total protein (P<.05), prealbumin (P = .002), and PTH (P = .008) between pre- and postsurgery, and a decrease in the percentage of deficiencies for Mg (P<.05), CaI (P<.05), and Fe (P = .021). CONCLUSION: Despite improvements in the autonomic nervous system balance, stiffness index markers and insulin resistance, we found a high prevalence of hypozincemia at 6 months post-RYGB. Furthermore, protein supplements were needed to maintain an adequate protein intake up to 6 months postsurgery.

Correlations of HOMA2-IR and HbA1c with algorithms derived from bioimpedance and spectrophotometric devices.

BACKGROUND: Homeostasis model assessment of insulin resistance (HOMA2-IR) and HbA1c, markers of metabolic syndrome and glycemic control, were compared with Electro Sensor (ES) Complex software algorithms. ES complex software integrates data from Electro Sensor Oxi (ESO; spectrophotometry) and Electro Sensor-Body Composition (ES-BC; bioimpedance). METHODS: One hundred forty-eight Brazilian obese candidates for bariatric surgery underwent complete physical examinations, laboratory tests (fasting plasma glucose, fasting plasma insulin, and HbA1c) and ES complex assessments. HOMA2-IR was calculated from fasting plasma glucose and fasting plasma insulin using free software provided by The University of Oxford Diabetes Trial Unit. ES complex-insulin resistance (ESC-IR) and ES complex-blood glucose control (ESC-BCG) were calculated from ESO and ES-BC data using ES complex software. Correlations between HOMA2-IR and ESC-IR and between ESC-BGC and HbA1c were determined. RESULTS: ESC-BGC was correlated with HbA1c (r = 0.85). ESC-BCG values >3 were predictive of HbA1c > 6.5% (φ = 0.94; unweighted κ = 0.9383). ESC-IR was correlated with HOMA2-IR (r = 0.84). Patients with ESC-IR score >2.5 or >3 were more likely to have metabolic syndrome or insulin resistance, respectively, compared with HOMA2-IR value >1.4 and >1.8, respectively. ESC-IR performance was evaluated by receiver operating characteristic curves. The areas under the curve for metabolic syndrome and insulin resistance were 0.9413 and 0.9022, respectively. CONCLUSION: The results of this study in Brazilian subjects with obesity suggest that ES complex algorithms will be useful in large-scale screening studies to predict insulin resistance, metabolic syndrome, and HbA1c >6.5%. Additional studies are needed to confirm these correlations in non-obese subjects and in other ethnic groups.

New approach to beta cell function screening by nitric oxide assessment of obese individuals at the population level.

BACKGROUND: Approximately 27% of Americans today are obese, and this condition increases the prevalence of metabolic syndrome and diabetes. The UK Prospective Diabetes Study suggests that loss of beta cell function can begin at least 10 years before diagnosis, and mean beta cell function is already less than 50% at diagnosis. The aim of this research was to assess the possibility of detecting loss of beta cell function in obese patients by a novel approach involving nitric oxide assessment using a combination of technologies. MATERIALS AND METHODS: One hundred and fifteen obese patients (93 women, 22 men) of mean age 39 (range 17-62) years, who were candidates for bariatric surgery were included in the study, and underwent laboratory tests, including fasting blood glucose, fasting insulin plasma, and examination with the Electro Sensor complex. The Electro Sensor complex offers a new way to assess nitric oxide production using five technologies managed by software, ie, the galvanic skin response, photoelectrical plethysmography, heart rate variability analysis, bioimpedance analysis, and blood pressure oscillometric measurements. The homeostasis model assessment 2% beta cell function (HOMA2% ß) algorithm was calculated from fasting blood glucose and fasting insulin plasma using free software provided by The University of Oxford Diabetes Trial Unit. The Electro Sensor complex percent beta (ESC% ß) algorithm was calculated from the Electro Sensor complex data and statistical neural network. Statistical analysis was performed to correlate ESC% ß and HOMA2% ß using the coefficient of correlation and Spearman's coefficient of rank correlation. Receiver-operating characteristic curves were also constructed to determine the specificity and sensitivity of ESC% ß in detecting a HOMA2% ß value < 100. RESULTS: The coefficient of correlation between ESC% ß and HOMA2% ß was 0.72 (using log values) and the Spearman's coefficient of rank correlation (rho) was 0.799 (P < 0.0001). ESC% ß had a sensitivity of 77.14% and specificity of 78.21% (cutoff ≤ 157, corresponding to 40% after conversion into a 0%-100% scale) to detect a HOMA2% ß value < 100 (P < 0.0001). CONCLUSION: The ESC% ß algorithm has a high predictive correlation with HOMA2% ß, and good specificity and sensitivity to detect a HOMA2% ß value < 100. Therefore, the Electro Sensor complex enabling nitric oxide assessment represents a novel method of screening for beta cell function in the obese population on a large scale. Such a tool, which is easy to administer, noninvasive, and cost-effective, would be of great benefit for widespread screening of beta cell function in obese patients.