Smoking among morbidly obese patients.

BACKGROUND: Smokers usually have a lower Body Mass Index (BMI) when compared to non-smokers. Such a relationship, however, has not been fully studied in obese and morbidly obese patients. The objective of this study was to evaluate the relationship between smoking and BMI among obese and morbidly obese subjects. METHODS: In a case-control study design, 1022 individuals of both genders, 18-65 years of age, were recruited and grouped according to their smoking status (smokers, ex-smokers, and non-smokers) and nutritional state according to BMI (normal weight, overweight, obese, and morbidly obese). RESULTS: No significant differences were detected in the four BMI groups with respect to smoking status. However, there was a trend towards a higher frequency of smokers among the overweight, obese, and morbidly obese subjects compared to normal weight individuals (p = 0.078). In a logistic regression, after adjusting for potential confounders, morbidly obese subjects had an adjusted OR of 2.25 (95% CI, 1.52-3.34; p < 0.001) to be a smoker when compared to normal weight individuals. DISCUSSION: In this sample, while the frequency of smokers diminished in normal weight subjects as the BMI increased, such a trend was reversed in overweight, obese, and morbidly obese patients. In the latter group, the prevalence of smokers was significantly higher compared to the other groups. A patient with morbid obesity had a 2-fold increased risk of becoming a smoker. We speculate that these finding could be a consequence of various overlapping risk behaviors because these patients also are generally less physically active and prefer a less healthy diet, in addition to having a greater alcohol intake in relation to their counterparts. The external validity of these findings must be confirmed.

Need for multivitamin use in the postoperative period of gastric bypass.

BACKGROUND: Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastric bypass (RYGBP) and diet therapy, it is essential in the postoperative period to obtain and maintain an adequate nutritional state, with the aim of preventing malnutrition and seeking a healthy life. It is observed that patients have difficulty in understanding the new food choices that must considered, as they have eating habits that are very divergent from those currently proposed. There is often the need for vitamin and mineral replacement after laboratory tests. METHODS: This study calculated and evaluated the 24-h eating records of 210 patients, collected in the course of nutritional visits in follow-ups of the first, third, sixth, ninth, 12th, 18th, and 24th months postoperative. RESULTS: It was possible to observe an increase in the consumption of nutrients in the course of the study period, but it was not regular and significant for all the nutrients. Also, it is noted that the minimal requirements for vitamin A, vitamin C, calcium, iron and B-complex vitamins (except for cyanocobalamin and riboflavin) were not attained. The nutrients in which satisfactory results were obtained were total proteins of high biological value: cyanocobalamin and riboflavin. CONCLUSION: This study demonstrated the concern for nutrient supplementation in the postoperative period of RYGBP. Thus, the routine use of multivitamins is deemed necessary after the first month postoperatively, with its maintenance preferably for the rest of the patient's life, without abandoning periodic clinical and laboratory follow-up.

Predictors of Excess Weight Loss in Obese Patients After Gastric Bypass: a 60-Month Follow-up.

BACKGROUND: The objective of this study was to analyze the factors associated with change in body mass index (BMI) and with percentage of excess weight loss (%EWL) in patients undergoing Roux-en-Y gastric bypass (RYGB). The following factors were analyzed: sex, age, surgical access (laparotomy vs. laparoscopy), preoperative BMI, waist circumference (WC), type 2 diabetes mellitus (T2DM), high blood pressure, and dyslipidemia. METHODS: Retrospective cohort study using a convenience sample of 2070 patients of both sexes, aged 18 to 65 years, undergoing RYGB between 2000 and 2013. The outcomes of interest were BMI and %EWL at 0, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after RYGB. RESULTS: After 36, 48, and 60 months, approximately 50 % of patients had BMI >30 kg/m(2). As for %EWL, 60-month results were poor for 17 % of patients (%EWL <50 %), good for 40 % of patients (%EWL 50-75 %), very good for 24 % of patients (%EWL from >75-90 %), and excellent for 19 % of patients (%EWL >90 %). The four most significant predictors of BMI change 60 months after RYGB (in descending order of magnitude) were preoperative BMI, preoperative WC, surgical access, and age; and of %EWL, surgical access, preoperative BMI, preoperative WC, and age. CONCLUSIONS: After 60 months of follow-up, the most relevant predictors of weight loss after RYGB were lower preoperative BMI and WC, videolaparoscopy as surgical access, and younger age. Further studies must be carried out to elucidate the impact of these factors on RYGB outcomes.

Smoking is associated with more abdominal fat in morbidly obese patients.

INTRODUCTION: While the association between cigarette smoking and abdominal fat has been well studied in normal and overweight patients, data regarding the influence of tobacco use in patients with morbid obesity remain scarce. The aim of this study is to evaluate body fat distribution in morbidly obese smokers. METHODS: We employed a cross-sectional study and grouped severely obese patients (body mass index [BMI] >40 kg/m2 or >35 kg/m2 with comorbidities) according to their smoking habits (smokers or non-smokers). We next compared the anthropometrical measurements and body composition data (measured by electric bioimpedance) of both groups. We analyzed the effect of smoking on body composition variables using univariate and multiple linear regression (MLR); differences are presented as regression coefficients (b) and their respective 95% confidence intervals. RESULTS: We included 536 morbidly obese individuals, 453 (84.5%) non-smokers and 83 (15.5%) smokers. Male smokers had a higher BMI (b=3.28 kg/m2, p=0.036), larger waist circumference (b=6.07 cm, p=0.041) and higher percentage of body fat (b=2.33%, p=0.050) than non-smokers. These differences remained significant even after controlling for confounding factors. For females, the only significant finding in MLR was a greater muscle mass among smokers (b=1.34kg, p=0.028). No associations were found between tobacco load measured in pack-years and anthropometric measures or body composition. DISCUSSION: Positive associations between smoking and BMI, and waist circumference and percentage of body fat, were found among male morbidly obese patients, but not among females. To the best of our knowledge, this study is the first investigation of these aspects in morbidly obese subjects. We speculate that our findings may indicate that the coexistence of morbid obesity and smoking helps to explain the more serious medical conditions, particularly cardiovascular diseases and neoplasms, seen in these patients.

Prevalence of overweight in children of obese patients: a dietary overview.

BACKGROUND: Evidence indicates that eating habits established during childhood related to food intake persist when the child becomes an adult. Parental obesity is positively associated with the development of obesity in the offspring, who tend to become sick and obese young adults during the reproductive phase and end up looking for bariatric surgery in order to reverse the non-communicable diseases (NCDs) already established. METHODS: This cross-sectional study evaluated 40 children aged 0 to 10 years, whose mothers underwent bariatric surgery at the Center of Morbid Obesity, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL PUCRS). RESULTS: Among these children, 45 % were overweight and 16 had high waist circumference values. The total energy intake and sodium consumption were above the Dietary Reference Intakes (DRIs) for the age group, while dietary fiber and potassium intakes were below DRIs. Obese children had higher percentage of lipid caloric intake (28.3 vs. 25.3 %, p < 0.025), while the non-obese group tended to have an increased consumption of carbohydrate (62.6 vs. 60 %, p < 0.066) when compared to the respective DRIs. The presence of NCDs in children's relatives was 100 %. CONCLUSIONS: There is probably a significantly higher prevalence of obesity among children of morbidly obese parents when compared to the general child population. Since the familial aggregation of NCDs was absolute, these results point to the need for careful evaluation when dealing with children. However, further studies with a larger number of individuals are needed to confirm these results.

Excess weight loss variation in late postoperative period of gastric bypass.

BACKGROUND: In the late postoperative period of gastric bypass surgery, we observe that many patients weight regain. The objective of this study was to determine the excess weight loss variation at 24 and 60 months postoperative. A secondary objective was to evaluate in the period described, the association of weight regain with red meat intolerance, age, gender, and body mass index. METHODS: Historical cohort study includes only patients who had completed a follow-up of up to 60 months postoperative (93 patients). The variation in percent excess weight loss was determined at 24 and 60 months postoperative to assess any association with the variables preoperative body mass index (BMI), gender, age, and red meat intolerance. RESULTS: The excess weight loss varied about -8.7% (95% CI: -12.1 to -5.4). This weight regain showed a significant association with the variable age, where the patients who regained the least weight tended to be younger than those who regained more (p = 0.012). When comparing the intolerance level to red meat with weight regain, we observed that the lower the intolerance the greater the weight loss, although this finding did not reach statistical significance (p = 0.13). CONCLUSIONS: Weight regain did not compromise therapeutic success. Less weight regain was seen in younger patients. Patients with lower intolerance to red meat tended to show less weight regain. Further studies are needed to elucidate the role of protein intake in weight regain in patients submitted to gastric bypass. No association between weight regain and preoperative BMI or gender was observed.

[Smoking and changes in body weight: can physiopathology and genetics explain this association?]. / Tabagismo e variação ponderal: a fisiopatologia e genética podem explicar esta associação?

Tobacco use is the leading preventable cause of death in most countries, including Brazil. Smoking cessation is an important strategy for reducing the morbidity and mortality associated with tobacco-related diseases. An inverse relationship between nicotine use and body weight has been reported, in which body weight tends to be lower among smokers than among nonsmokers. Smoking abstinence results in an increase in body weight for both males and females. On average, sustained quitters gain from 5 to 6 kg, although approximately 10% gain more than 10 kg. Pharmacological treatment for smoking cessation attenuates weight gain. The importance of smoking cessation as a contributing cause of the current obesity epidemic has been little studied. In the USA, the rate of obesity attributable to smoking cessation has been estimated at approximately 6.0 and 3.2% for males and females, respectively. Although the mechanisms are unclear, there is evidence that dopamine and serotonin are appetite suppressants. The administration of nicotine, regardless of the delivery system, acutely raises the levels of these neurotransmitters in the brain, reducing the need for energy intake and consequently suppressing appetite. In addition, nicotine has a direct effect on adipose tissue metabolism, influencing the rate of weight gain following smoking cessation. Leptin, ghrelin and neuropeptide Y are substances that might constitute factors involved in the inverse relationship between nicotine and body mass index, although their roles as determinants or consequences of this relationship have yet to be determined.

Tabagismo e variação ponderal: a fisiopatologia e genética podem explicar esta associação?: [revisão] / Smoking and changes in body weight: can physiopathology and genetics explain this association?: [review]

O tabagismo é a principal causa de morte prevenível na maioria dos países, inclusive no Brasil. Parar de fumar é uma estratégia importante para reduzir a morbidade e mortalidade associada às doenças tabaco-relacionadas. Sabe-se da relação inversa entre uso de nicotina e peso corporal, onde o índice de massa corporal tende a ser menor em fumantes quando comparados aos não fumantes. Além disso, abstinência tabágica resulta em aumento de peso, sendo que ex-fumantes geralmente aumentam de 5 a 6 kg, mas cerca de 10 por cento adquirem mais de 10 kg. O tratamento farmacológico para a cessação do tabagismo pode atenuar este ganho de peso. O aumento de peso na cessação do tabagismo como contributório à epidemia de obesidade é pouco estudado. Nos EUA, calcula-se que a fração do problema atribuível à cessação do tabagismo seja de 6 por cento para homens e 3,2 por cento para mulheres. Os mecanismos não são claros, mas há evidências mostrando que a dopamina e serotonina diminuem a ingestão alimentar. A administração de nicotina por qualquer via eleva agudamente os níveis destes neurotransmissores no cérebro, causando menor necessidade de ingestão energética e diminuindo o apetite. Além disso, a nicotina tem efeito direto no metabolismo do tecido adiposo, influenciando a taxa de ganho ponderal após a cessação do tabagismo. A leptina, grelina e neuropeptídio Y são peptídeos que podem contribuir para esta relação inversa entre nicotina e índice de massa corporal, em um papel ainda não determinado como conseqüente ou causador das variações ponderais.

Tobacco use is the leading preventable cause of death in most countries, including Brazil. Smoking cessation is an important strategy for reducing the morbidity and mortality associated with tobacco-related diseases. An inverse relationship between nicotine use and body weight has been reported, in which body weight tends to be lower among smokers than among nonsmokers. Smoking abstinence results in an increase in body weight for both males and females. On average, sustained quitters gain from 5 to 6 kg, although approximately 10 percent gain more than 10 kg. Pharmacological treatment for smoking cessation attenuates weight gain. The importance of smoking cessation as a contributing cause of the current obesity epidemic has been little studied. In the USA, the rate of obesity attributable to smoking cessation has been estimated at approximately 6.0 and 3.2 percent for males and females, respectively. Although the mechanisms are unclear, there is evidence that dopamine and serotonin are appetite suppressants. The administration of nicotine, regardless of the delivery system, acutely raises the levels of these neurotransmitters in the brain, reducing the need for energy intake and consequently suppressing appetite. In addition, nicotine has a direct effect on adipose tissue metabolism, influencing the rate of weight gain following smoking cessation. Leptin, ghrelin and neuropeptide Y are substances that might constitute factors involved in the inverse relationship between nicotine and body mass index, although their roles as determinants or consequences of this relationship have yet to be determined.