Iron absorption and iron status are reduced after Roux-en-Y gastric bypass.

BACKGROUND: Iron deficiency and iron deficiency anemia are common in patients who undergo gastric bypass. The magnitude of change in iron absorption is not well known. OBJECTIVE: The objective was to evaluate the effects of Roux-en-Y gastric bypass (RYGBP) on iron status and iron absorption at different stages after surgery. We hypothesized that iron absorption would be markedly impaired immediately after surgery and would not improve after such a procedure. DESIGN: Anthropometric, body-composition, dietary, hematologic, and iron-absorption measures were determined in 67 severe and morbidly obese women [mean age: 36.9 +/- 9.8 y; weight: 115.1 +/- 15.6 kg, body mass index (BMI: in kg/m(2)); 45.2 +/- 4.7] who underwent RYGBP. The Roux-en-Y loop length was 125-150 cm. Determinations were carried out before and 6, 12, and 18 mo after surgery. Fifty-one individuals completed all 4 evaluations. RESULTS: The hemoglobin concentration decreased significantly throughout the study (repeated-measures analysis of variance). The percentage of anemic subjects changed from 1.5% at the beginning of the study to 38.8% at 18 mo. The proportion of patients with low serum ferritin increased from 7.5% to 37.3%. The prevalence of iron deficiency anemia was 23.9% at the end of the experimental period. Iron absorption from both a standard diet and from a standard dose of ferrous ascorbate decreased significantly after 6 mo of RYGBP to 32.7% and 40.3% of their initial values, respectively. No further significant modifications were noted. CONCLUSION: Iron absorption is markedly reduced after RYGBP with no further modifications, at least until 18 mo after surgery.

[Evolution and quality of the diet of women with severe and morbid obesity undergoing gastric bypass]. / Evolución y calidad de la alimentación de mujeres con obesidad severa y mórbida sometidas a bypass gástrico.

Evolution and quality of the diet of women with severe and morbid obesity undergoing gastric bypass. The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass. In forty-four women with severe and morbid obesity it was assessed their nutrient intakes before and 6, 12, and 18 months after gastric bypass by using three-day food records. Vitamin and mineral intakes from supplements were strictly controlled though personalized records. With the exceptions of calcium and vitamin A, energy and nutrient intakes were significantly decreased at 6, 12, and 18 month after bypass compared to the pre-surgery period. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100% of adequacy from the 6th month after the surgery and thereafter. This situation is reverted when nutrient intakes supplied by supplements are taken into account. Although a "U" shape trend was observed in the nutrient intakes results during the experimental period, in most cases the differences between the observed values at month 12 and 18 were not significant. In conclusion, these patients had important reductions of their energy and nutrient intakes as result of gastric bypass. Routine supplements may correct this situation, nevertheless, the anatomical alterations inherent to this type of surgery may cause that total nutrient intakes reaching adequacy values slightly above 100%, may not necessarily be able to avoid the development of nutritional deficiencies.

Evolución y calidad de la alimentación de mujeres con obesidad severa y mórbida sometidas a bypass gástrico / Evolution and quality of the diet of women with severe and morbid obesity undergoing gastric bypass

El objetivo de este estudio fue evaluar los cambios en la ingesta energía y nutrientes y el grado de suficiencia de la alimentación en pacientes sometidos a bypass gástrico. En 44 mujeres con obesidad severa y mórbida se estudió la alimentación previa y a los 6, 12 y 18 meses después de realizada la intervención quirúrgica mediante encuesta de registro de tres días. El consumo de suplementos de vitaminas y minerales se controló estrictamente mediante el registro individualizado de su consumo. Con la excepción de la ingesta de calcio y vitamina A, el consumo de energía y nutrientes fue significativamente menor a los 6, 12 y 18 meses post cirugía comparado con el período preoperatorio. La ingesta dietética de calcio, hierro, zinc, cobre, ácido fólico, vitamina C y vitamina E estuvo por debajo del 100 por ciento de adecuación a partir del 6º mes post operatorio, situación que se revierte al considerar el consumo de estos nutrientes a partir de los suplementos. Aun cuando se observó una tendencia a una curva en “U” en la ingesta de micronutrientes durante el período experimental, en la mayoría de ellos las diferencias entre los valores obtenidos a los meses 12 y 18 no fue significativa. En conclusión, estos pacientes presentan reducciones importantes de la ingesta dietética de energía y micronutrientes. El consumo rutinario de suplementos podría revertir esta situación, sin embargo, las alteraciones anatómicas inherentes a esta intervención podrían producir que cifras de adecuación ligeramente superiores al 100 por ciento sean, en la práctica, insuficientes para asegurar que no se desarrollen cuadros de deficiencia.

The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass. In fortyfour women with severe and morbid obesity it was assessed their nutrient intakes before and 6, 12, and 18 months after gastric bypass by using three-day food records. Vitamin and mineral intakes from supplements were strictly controlled though personalized records. With the exceptions of calcium and vitamin A, energy and nutrient intakes were significantly decreased at 6, 12, and 18 month after bypass compared to the pre-surgery period. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100 percent of adequacy from the 6th month after the surgery and thereafter. This situation is reverted when nutrient intakes supplied by supplements are taken into account. Although a “U” shape trend was observed in the nutrient intakes results during the experimental period, in most cases the differences between the observed values at month 12 and 18 were not significant. In conclusion, these patients had important reductions of their energy and nutrient intakes as result of gastric bypass. Routine supplements may correct this situation, nevertheless, the anatomical alterations inherent to this type of surgery may cause that total nutrient intakes reaching adequacy values slightly above 100 percent, may not necessarily be able to avoid the development of nutritional deficiencies.

Changes in bone mineral density, body composition and adiponectin levels in morbidly obese patients after bariatric surgery.

BACKGROUND: Gastric bypass surgery (GBP) is increasingly used as a treatment option in morbid obesity. Little is known about the effects of this surgery on bone mineral density (BMD) and the underlying mechanisms. To evaluate changes on BMD after GBP and its relation with changes in body composition and serum adiponectin, a longitudinal study in morbid obese subjects was conducted. METHODS: Forty-two women (BMI 45.0 +/- 4.3 kg/m(2); 37.7 +/- 9.6 years) were studied before surgery and 6 and 12 months after GBP. Percentage of body fat (%BF), fat-free mass (FFM), and BMD were measured by dual-energy X-ray absorptiometry and serum adiponectin levels by RIA. RESULTS: Twelve months after, GBP weight was decreased by 34.4 +/- 6.5% and excess weight loss was 68.2 +/- 12.8%. Significant reduction (p < 0.001) in total BMD (-3.0 +/- 2.1%), spine BMD (-7.4 +/- 6.8%) and hip BMD (-10.5 +/- 5.6%) were observed. Adiponectin concentration increased from 11.4 +/- 0.7 mg/L before surgery to 15.7 +/- 0.7 and 19.8 +/- 1.0 at the sixth and twelfth month after GBP, respectively (p < 0.001). Thirty-seven percent of the variation in total BMD could be explained by baseline weight, initial BMD, BF reduction, and adiponectin at the twelfth month (r (2) = 0.373; p < 0.001). Adiponectin at the twelfth month had a significant and positive correlation with the reduction of BMD, unrelated to baseline and variation in body composition parameters (adjusted correlation coefficient: r = 0.36). CONCLUSION: GBP induces a significant BMD loss related with changes in body composition, although some metabolic mediators, such as adiponectin increase, may have an independent action on BMD which deserves further study.

Persistent anemia after Roux-en-Y gastric bypass.

OBJECTIVE: We report the case of a 42-y-old morbidly obese woman who presented persistent anemia as result of Roux-en-Y gastric bypass. METHODS: The surgical procedure conducted in 1999 consisted of horizontal gastroplasty with truncular vagotomy, Roux-en-Y gastrojejunal anastomosis with an alimentary limb of 60 cm, and cholecystectomy. In 2000 a second surgery (subtotal gastrectomy, i.e., 90%, with a 50-mL gastric pouch) was performed because of failed gastroplasty. Anemia was detected approximately 1 y after the second surgery. This condition worsened significantly after an abdominal lipectomy performed in 2001. Since then, different oral iron compounds were used for treatment, but with unsatisfactory results. The subject was anemic for 4 y. RESULTS: The condition was corrected only after intravenous iron administration. Iron absorptions from 3 mg of iron as ferrous ascorbate and from a standardized diet that also contained 3 mg of iron were 48.4% and 39.9%, respectively. CONCLUSION: Iron absorption tests provided evidence that the reduction of intestinal iron absorption capacity was the most probable cause of the persistent anemia.

[Effect of moderate energy-restricted diets on the nutritional status of selected minerals in obese women]. / Efecto de dietas con restricción moderada de energía sobre el estado nutricional de algunos minerales en mujeres obesas.

The aim of this study was to compare changes of nutrient intakes and nutritional status of selected minerals, during a three-month weightloss program using diets with distinct energy contents. 62 obese women (age 33.2 +/- 8.3 years; BMI 34.6 +/- 3.4 kg/m2) were allocated to two diets, one supplying 1000 kcal/d (Diet 1), and the other 1300 kcal/d (Diet 2). Before and after 3 months, intakes of iron (Fe), zinc (Zn), copper (Cu), and calcium (Ca) were evaluated through self-reported three-day dietary records. Selected laboratory parameters related to the nutritional status of iron, zinc and copper were analyzed: hemoglobin, serum ferritin, zinc-protoporfirin, transferrin saturation, plasma zinc, hair zinc, and plasma copper. Mean weight loss was 10.8% on Diet 1 and 8.5% on Diet 2 (p = 0.29). Intakes of Fe, Zn, Cu and Ca decresed by 50%, 30%, 40%, and 9%, respectively. The change of serum ferritin was significantly greater in the group on Diet 1 (p = 0.04), in > or =10% of weight loss subjects (p = 0.006) and in patients with lower protein intake (p = 0.033). Others parameters studied, although tended consistently to present greater disturbances in subjects receiving the 1000 kcal/d diet, they did not reach statistical significance. The prescription of weight-reducing diets with 1000 y 1300 kcal/d did not produce major effects on the nutritional status of minerals during the first three months of treatment, except by the significant detriment of body iron stores in subjects receiving the 1000 kcal diet, as indicated by the changes of serum ferritin.

[Self perception of nutritional status among adults in Santiago]. / Autopercepción del estado nutricional en adultos de Santiago.

BACKGROUND: The prevalence of obesity is growing in Chile. The personal perception about the own nutritional status is associated to the risk of obesity. AIM: To analyze the personal perception about their nutritional status among adults living in Santiago and to compare it to the objective diagnosis obtained according to Chilean Health Ministry norms. MATERIAL AND METHODS: The body image was explored in 735 people between the ages of 20 and 90. The weight and height were obtained under standard conditions, and the body mass index (BMI) was calculated (kg/m2) and classified according to the criteria of the Health Ministry. The concordance and Kappa index between both criteria in function of age, gender, nutritional status and height were analyzed. The model that best explained the weight subestimation was determined with multivariate logistic regressions. RESULTS: Fifty two percent of subjects classified correctly their nutritional status, 30% subestimated, and 18% overstimated the nutritional status (Kappa 0.27). The multivariate analysis showed greater subestimation in obese (OR 5.8 95% IC 4.2- 7.9), in men (OR 4.5 95% IC 2.7-7.3), people younger than 60 years old (OR 2.0 95% IC 1.3-3.1) and people of small stature (OR 3.1 95% IC 1.9-4.9). CONCLUSIONS: Half of the studied subjects had an inadequate perception of the body image. Educative campaigns are needed to reinforce the concept of adequate weight. This may contribute to promote health and reduce the risk of obesity.

The use of zinc stable isotopes in the study of iron-zinc interactions in Chilean women.

The objective of this study was to compare the fractional zinc absorption (FAZ) and the size of the rapidly exchangeable zinc pool (EZP) after three months of iron supplementation in women consuming ferrous sulfate between meals. Twenty-one non-anemic apparently healthy women received on average 55.1 +/- 18.5 mg elemental iron per day as ferrous sulfate, and five received no supplemental iron. Fractional absorption of zinc was determined before and three days after finishing the third month of iron supplementation by using an extrinsic labeling with zinc stable isotopes and a dual isotope enrichment method in urine. EZP was determined from urine enrichment following intravenous administration of 70Zn. Results of selected zinc-related variables in the iron supplemented women were (before vs. after iron supplementation): FAZ with meal 0.22 vs. 0.24, p = .23; FAZ in fasting state 0.58 vs. 0.69, p = .005; EZP 177 mg vs. 160 mg, p = .058; plasma zinc 90.6 vs. 86.1 micrograms/dl, p = .065. The control group remained unchanged. The capacity to absorb zinc was increased three days after terminating a period of iron supplementation as compared with the pre-iron period. This may be attributable to impairment of zinc status by the iron supplements as evidenced by a trend for lower plasma zinc and EZP.

Riesgos nutricionales en embarazadas adolescentes / Nutritional risk in pregnant adolescent

Con el propósito de evaluar las características nutricionales de embarazadas adolescentes se estudiaron 84 gestantes menores de 18 años de nivel socioeconómico bajo, en comparación a un grupo control de 25 a 30 años. Se estableció la relación peso-talla inicial y final y se realizaron 3 encuestas alimentarias de recordatorio de 24 horas, determinándose la ingesta promedio de energía, proteínas, calcio y hierro y su adecuación a las recomendaciones FAO/OMS 1973. A las 20 semanas de gestación, en una submuestra se efectuó una determinación de hemoglobina, hematocrito, hierro sérico y saturación de trasferrina. En el recién nacido se determinó peso, talla y adecuación del crecimiento intrauterino. En el primer control prenatal las adolescentes presentaron una relación peso-talla significativamente menor (p<0,001), que el grupo control. Al finalizar el embarazo se mantuvieron las diferencias iniciales. La ingesta promedio de energía y calcio fue inferior a las recomendaciones FAO/OMS en ambos grupos. No existieron diferencias en los exámenes hematológicos, estando los valores promedios en los rangos de normalidad. La proporción de bajo peso de nacimiento fue significativamente mayor en el grupo de adolescentes (p<0,05). Esta diferencia se atribuye en parte al estado nutricional y en parte a la variable edad. Se concluye que la embarazada adolescente es un grupo de alto riesgo que requiere de una atención prioritaria que incluya aspectos onbstétricos, nutricionales y psicosociales

Características nutricionales de adolescentes embarazadas controladas en el consultorio de adolescencia / Nutritional characteristics of pregnant adolescents controlled in the adolescent outpatient clinic

Se analizan los datos antropométricos de 78 embarazadas de 12 a 18 años que se controlan en la sección de la Embarazada Adolescente del Departamento de Obstreticia y Ginecología del Hospital Clínico de la Universidade de Chile, con el fin de analizar las características nutricionales de ellas y su relación con el peso de nacimiento de los niños. Se medió peso y talla de las madres en condiciones estandarizadas en el primer y último control prenatal calculándose el índice de peso de acuerdo a las tablas del Ministerio de Salud, clasificándose en enflaquecido (<90%), normales (90-110%) y sobrepeso (>110%). La edad promedio fue de 16 más o menos 1,4 años y la talla 153 más o menos 5.1 cms. Al primer control el 69,2% se catalogó como normal, el 18% con déficit y el 12,8% con sobrepeso, proporción que practicamente se mantuvo al último control. La mayor proporción de malnutrición se observó en el grupo entre 16 y 18 años. El peso promedio de nacimiento (3.225 g.) y su distribución fue superior a lo descripto en adolescentes, y comparable a embarazadas adultas. Al relacionar con el estado nutricional materno se observa que la proporción de bajo peso (<2.500 g.) y peso insuficiente (2.501-3.000 g.), aumenta en las madres con déficit. El incremento promedio semanal (442 g.) supera a lo propiciado por el Ministerio de Salud, pero es inferior a lo recomendado en madres enflaquecidas. El bajo incremento de peso materno se asocia con una clara tendencia al aumento de pesos inadecuados

Actitud de la adolescente embarazada, de su pareja y de su familia frente al embarazo / Attitudes to pregnancy of the pregnant adolescent, of its partner and its family

Se analizan las actitudes frente al embarazo de 300 adolescentes, sus parejas y sus grupos familiares atendidas en un Consultorio Especializado del Departamento de Obstetricia y Ginecología del Hospital Clínico de la Universidad de Chile. Las adolescentes, en su mayoría solteras, inician su embarazo con una actitud de rechazo la que se modifica a positiva en el curso de la gestación. La actitud de la pareja y de la familia es también negativa al comienzo del embarazo, modificándose a positiva en menos proporción que las adolescentes, pese a la necesidad de apoyo que ellas presentan. Se discute el pronóstico a largo plazo de los hijos producto de embarazos no deseados