Analysis of the profile of cardiovascular risk in Brazilian schoolchildren: metabolic and behavioral indicators.

OBJECTIVE: There is evidence demonstrating that cardiovascular diseases (CVD) manifesting during adulthood result from an intense interaction among risk factors that may have originated during childhood and adolescence. To compare the prevalence and clustering of cardiovascular risk factors in Brazilian schoolchildren with a 15-year interval between samples. METHODS: A cross-sectional analysis based on the scores for cardiovascular risk factors was used to investigate 1,232 Brazilian schoolchildren of both sexes aged 12 to 18 years. The data of 596 schoolchildren of the 2000 sample were compared to those of 636 schoolchildren of the 2015 sample. RESULTS: The prevalence of physical inactivity and abdominal obesity increased exponentially in both sexes from 2000 to 2015. The score for the clustering of cardiovascular risk factors showed that in 2000 the adolescents were exposed to 1 cardiovascular risk factor (31.7%), while in 2015 the greatest percentage was assigned to the category of 3 or more cardiovascular risk factors (34.9%), p < 0.001. CONCLUSION: The present results demonstrate a high prevalence of exposure to health risk behaviors of the adolescents studied over time. Considering the presence of modifiable risk factors, preventive measures regarding life style are essential.

Analysis of the profile of cardiovascular risk in Brazilian schoolchildren: metabolic and behavioral indicators

ABSTRACT Objective There is evidence demonstrating that cardiovascular diseases (CVD) manifesting during adulthood result from an intense interaction among risk factors that may have originated during childhood and adolescence. To compare the prevalence and clustering of cardiovascular risk factors in Brazilian schoolchildren with a 15-year interval between samples. Subjects and methods A cross-sectional analysis based on the scores for cardiovascular risk factors was used to investigate 1,232 Brazilian schoolchildren of both sexes aged 12 to 18 years. The data of 596 schoolchildren of the 2000 sample were compared to those of 636 schoolchildren of the 2015 sample. Results The prevalence of physical inactivity and abdominal obesity increased exponentially in both sexes from 2000 to 2015. The score for the clustering of cardiovascular risk factors showed that in 2000 the adolescents were exposed to 1 cardiovascular risk factor (31.7%), while in 2015 the greatest percentage was assigned to the category of 3 or more cardiovascular risk factors (34.9%), p < 0.001. Conclusion The present results demonstrate a high prevalence of exposure to health risk behaviors of the adolescents studied over time. Considering the presence of modifiable risk factors, preventive measures regarding life style are essential.

Efeito da acupuntura nos níveis de força de preensão em atletas de jiu-jitsu ­ estudo experimental / Effect of acupuncture on levels of handgrip strength in jiu-jitsu athletes ­ an experimental study

O Jiu-jitsu é um esporte de contato direto com o adversário, que exige dos atletas torções e movimentos musculares rápidos e com grande esforço muscular. Durante a luta de Jiu-Jitsu, o atleta encontra-se em contato com o adversário na maior parte do tempo e, para manter essa posição, necessita de realizar movimentos sucessivos de preensão, o que demonstra a importância de uma função muscular adequada para esse movimento específico. A acupuntura está se expandindo, com uma demanda crescente no ambiente esportivo não só como método de tratamento, mas também como terapia de melhoria no desempenho físico. O objetivo foi avaliar o efeito imediato da acupuntura nos níveis de força de preensão manual em atletas de Jiu-Jitsu. O estudo foi do tipo ensaio clinico-experimental, cego por parte de um dosavaliadores, com avaliação quantitativa. Participaram deste estudo 16 atletas, com idades variando de 18 a 45 anos, de ambos os sexos. Os voluntários foram alocados de forma aleatória em alternância sequencialem um dos dois grupos: Grupo 1: Intervenção (GI n=8) e Grupo 2: Controle (GC n=8). Os acupontos selecionados neste estudo foram IG4 (Hegu) e TA5 (Waiguan). Todos os participantes realizaram o teste de dinamometria antes e após a intervenção. Foram utilizadas agulhas filiformes descartáveis 0,25X30mm. Os resultados mostraram que houve variação na força entre os momentos antes versus pós intervenção, sendo maior no GI de 2,83 (kgf) para a força da preensão na mão direita (p=0,01) e 1,44 (Kgf) para a preensão da mão esquerda (p= 0,25) e o GC apresentou variação de 0,44(kgf) (p=0,79) na preensão da mão direita e 0,31(kgf) (p=0,82) para a preensão da mão esquerda. Conclui-se que o grupo que recebeu agulhamento nos acupontos selecionados apresentou alteração na força (kgf) da preensão de ambas as mãos de forma mais significativa que o grupo que não recebeu acupuntura....(AU)

The Jiu-Jitsu is a sport of direct contact with the opponent, which requires of the athletes twists and muscle movements fast and with great muscular effort. During the Jiu-Jitsu fight, the athlete is in contact with the opponent most of the time and, in order to maintain this position, he needs to perform successive movements of prehension, which demonstrates the importance of a muscular function suitable for this movement. Acupuncture is expanding, with a growing demand in the sports environment not only as a treatment method but also as a therapy for improving physical performance. The objective was to evaluate the immediate effect of acupuncture on handgrip strength levels in Jiu-Jitsu athletes. The study was of the clinical-experimental type, blind by one of the evaluators, with quantitative evaluation. Sixteen athletes, ranging in ages from 18 to 45 years, of both sexes, participated in this study. The volunteers were randomly allocated in sequential alternation in one of two groups: Group 1: Intervention (GI n = 8) and Group 2: Control (GC n = 8). The acupoints selected in this study were IG4 (Hegu) and TA5 (Waiguan). All participants performed the dynamometry test before and after the intervention. Was used 0.25X30mm disposable filiform needles. The results showed that there was a variation in the force between the moments before and after the intervention, superior with a GI of 2.83 (kgf) for the right-hand prehension strength (p = 0.01) and 1.44 (Kgf) for the prehension of the left hand (p = 0.25) and the CG presented a variation of 0.44 (kgf) (p = 0.79) in the right-hand prehension and 0.31 (kgf) (p = 0.82) for the prehension of the left hand. It was concluded that the group that received needlework in the selected acupoints showed a change in the grip strength (kgf) of both hands more significantly than the group that did not receive acupuncture....(AU)

Association of Maternal Roux-en-Y Gastric Bypass with Obstetric Outcomes and Fluid Intelligence in Offspring.

PURPOSE: The purpose of the study is to assess whether Roux-en-Y gastric bypass (RYGB) prior to pregnancy is associated with fluid intelligence in offspring. Additionally, perinatal and obstetric outcomes, and children nutritional status were evaluated. MATERIAL AND METHODS: Singleton births of women who underwent RYGB between 2000 and 2010 (BS) were matched to two control births by maternal age, delivery year, and gender. Control group 1 (CG1) and control group 2 (CG2) included women with a pre-pregnancy body mass index (BMI) < 35 kg/m2 and ≥ 35 kg/m2, respectively, who had never undergone bariatric surgery. RESULTS: Thirty-two children from each group (n = 96) were analyzed, mostly female (59%) and Caucasian (82%), with a mean age of 7 ± 2 years. Their general intelligence scores were similar after adjusting for sociodemographic confounders; family economic class was the strongest predictor (low: ß = - 20.57; p < 0.001; middle: ß = - 9.34; p = 0.019). Gestational diabetes mellitus (OR 0.06; 95% CI 0.03; 0.35) and hypertensive disorders (OR 0.09; 95% CI 0.01; 0.40) were less frequent in BS than CG2. Post-RYGB pregnancies were associated with lower birth weight (P = 0.021) than controls. Child overweight and obesity was higher (OR 4.59; 95% CI 1.55; 13.61; p = 0.006) in CG2 (78%) than CG1 (44%) and similar to BS (65%). CONCLUSIONS: RYGB prior to pregnancy was not associated with fluid intelligence in offspring. Prior RYGB was associated with a lower frequency of gestational diabetes mellitus and hypertensive disorders than in women with a pre-pregnancy BMI ≥ 35 kg/m2, as well as with lower birth weight than both control groups.

Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review.

Restrictive diet implementation in bariatric surgery (BS) preoperative period is common, although its benefits are not well established. This study aimed to assess the effects of very low calorie diets (VLCD) on liver size and weight loss during BS preoperative period. Surgery-related complications were also assessed. A systematic review of the literature was performed. Terms such as "bariatric surgery" and "very low energy diet" were included in the search strategy. Inclusion criteria were adult patients (aged>18 yr); VLCD treatment in BS preoperative period (10 d to 12 wk); and assessment of 1 the following outcomes: weight loss, liver volume reduction, and surgical complications. There were 9 studies included (849 patients including 250 controls, 196 controls without VLCD). Of the studies, 3 were randomized clinical trials and 6 were observational studies. VLCD treatment led to weight loss (-2.8 to -14.8 kg) and to liver size reduction by 5% to 20% of the initial volume. VLCD treatment did not significantly reduce perioperative complications. However, 1 study (n = 273) reported a protective effect 30 days after surgery. This systematic review found VLCD treatment led to significant weight loss and liver volume reduction when applied to patients with obesity in BS preoperative period. The effect of VLCD on surgical risks is not clear. Standardization of dietary characteristics is needed, because weight loss and decrease in liver size were not connected to higher caloric restriction. This is an important matter in clinical practice as to avoid unnecessary prolonged and/or excessive dietary restriction.

Increase in the prevalence of abdominal obesity in Brazilian school children (2000-2015).

INTRODUCTION: The prevalence of overweight and obese children and adolescents is a public health concern. Few studies have critically evaluated this problem in a Brazilian population, despite the growth of community-based programs to combat childhood obesity in this country. OBJECTIVE: To study the anthropometrics of Brazilian adolescents over a fifteen-year period. METHODS: In a cross-sectional analysis, we investigated the anthropometric status of male and female adolescents in Brazil. The anthropometric data and nutritional status of 595 schoolchildren in the year 2000 were compared to 636 schoolchildren in 2015. RESULTS: We found a significant increase in the prevalence of overweight or obese adolescents in 2015 compared to 2000 (23.4% vs. 18.3%, p = .027). A sub-analysis stratified by sex showed that this increase only occurred in females. No statistically significant difference was observed in body mass index between the groups. Waist circumference (73.5 cm vs. 77 cm, p < .001) and the prevalence of abdominal obesity (30% vs. 47.9%, p < .001) were significantly greater in 2015, regardless of sex. CONCLUSION: Overweight or obese children, as well as abdominal obesity were more prevalent in 2015 than in preceding decades. This is a worrying trend as abdominal obesity increases the risk for cardiometabolic morbidity and mortality in adult life.

Emotional and Affective Temperaments in Smoking Candidates for Bariatric Surgery.

INTRODUCTION: The prevalence of smoking habits in severe obesity is higher than in the general population. There is some evidence that smokers have different temperaments compared to non-smokers. The aim of this study is to evaluate the associations between smoking status (smokers, ex-smokers and non-smokers) and temperament characteristics in bariatric surgery candidates. METHODS: We analyzed data on temperament of 420 bariatric surgery candidates, as assessed by the AFECTS scale, in an exploratory cross-sectional survey of bariatric surgery candidates who have been grouped into smokers, ex-smokers and non-smokers. RESULTS: We detected significant statistical differences in temperament related to the smoking status in this population after controlling the current use of psychiatric medication. Smokers had higher anxiety and lower control than non-smokers. Ex-smokers with BMI >50 kg/m(2) presented higher coping and control characteristics than smokers. CONCLUSIONS: Smoking in bariatric surgery candidates was associated with lower control and higher anxious temperament, when controlled by current use of psychiatric medication. Smokers with BMI >50 kg/m(2) presented lower coping and control than ex-smokers. Assessment of temperament in bariatric surgery candidates may help in decisions about smoking cessation treatment and prevention of smoking relapse after surgery.

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.

Implementing laparoscopy in Brazil's National Public Health System: the bariatric surgeons' point of view.

BACKGROUND: Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. AIM: 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. METHODS: A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. RESULTS: From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. CONCLUSION: 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.

Systematic review of economic evaluation of laparotomy versus laparoscopy for patients submitted to Roux-en-Y gastric bypass.

BACKGROUND: Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB). METHODS: A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB. RESULTS: In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost. CONCLUSION: This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs.

Incidence of cancer following bariatric surgery: systematic review and meta-analysis.

Obesity is linked to the development of cancer. Previous studies have suggested that there is a relationship between bariatric surgery and reduced cancer risk. Data sources were from Medline, Embase, and Cochrane Library. From 951 references, 13 studies met the inclusion criteria (54,257 participants). In controlled studies, bariatric surgery was associated with a reduction in the risk of cancer. The cancer incidence density rate was 1.06 cases per 1000 person-years within the surgery groups. In the meta-regression, we found an inverse relationship between the presurgical body mass index and cancer incidence after surgery (beta coefficient -0.2, P < 0.05). Bariatric surgery is associated with reduced cancer risk in morbidly obese people. However, considering the heterogeneity among the studies, conclusions should be drawn with care.

Implementing laparoscopy in Brazil´s National Public Health System: the bariatric surgeons´ point of view / Adesão dos cirurgiões bariátricos à laparoscopia no sistema único de saúde do Brasil

BACKGROUND: Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. AIM: 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. METHODS: A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. RESULTS: From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. CONCLUSION: 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy. .

RACIONAL: Nos últimos anos, apesar do Sistema Único de Saúde Brasileiro - SUS - apresentar avanços relacionados à organização e ampliação das ações voltadas à prevenção e ao tratamento da obesidade, existe demanda reprimida de operações no país. Mesmo com evidências favoráveis à operação por via laparoscópica, o SUS só permite o procedimento por via laparotômica. OBJETIVOS: 1) Estimar se os cirurgiões bariátricos apoiariam eventual incorporação da operação por via laparoscópica no SUS; 2) se haveria incremento no número total de operações caso houvesse esta nova opção de via de acesso; e 3) como seria a redistribuição da oferta de operações pelas duas vias. MÉTODOS: Com o método Delphi, foi construído um painel de especialistas, em que cirurgiões bariátricos responderam um questionário estruturado previamente desenvolvido para esse fim. Foram realizadas duas rodadas, no intuito de melhor consenso. RESULTADOS: Dos 45 cirurgiões que estiveram presentes no evento nacional, 30 (66,7%) participaram do questionário Delphi, o que correspondeu à primeira rodada do estudo. Na segunda, e última rodada, dos 30 respondentes da primeira etapa, 22 (48,9%) cirurgiões responderam. Mediante a possibilidade de incorporação da via laparoscópica no SUS, aproximadamente 95% dos cirurgiões manifestaram interesse em realizá-la. Caso a operação por laparoscopia fosse incorporada no SUS, haveria incremento médio no número de operações na ordem de 25%; nesta nova configuração, a oferta de procedimentos cirúrgicos estaria distribuída da seguinte forma: 62,5% por laparoscopia e 37,5% por laparotomia. CONCLUSÃO: ...

Nutritional profile of patients before and after Roux-en-Y gastric bypass: 3-year follow-up.

BACKGROUND: Bariatric surgery is considered the most effective treatment for obesity class II and III. However, postoperative side effects may occur, such as nutritional deficiencies resulting from reduced gastric capacity and alterations in nutrient absorption along the gastrointestinal tract. METHODS: A total of 170 patients (136 women and 34 men) submitted to Roux-en-Y gastric bypass (RYGB) between 2000 and 2005 were retrospectively assessed. Anthropometric and laboratory data were evaluated and the use of vitamin and mineral supplements, before and 1, 6, 12, 24, and 36 months following surgery, was assessed, as well. RESULTS: Mean excess weight loss at 24 and 36 months was 81.5 ± 19.2 and 78.5 ± 20.8 %, respectively. Anemia was present in 6.5 % of subjects prior to the surgery and increased to 33.5 % at 36 months. The levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and glycemia were reduced, while high-density lipoprotein cholesterol was increased. Albumin and vitamin B12 levels showed no significant differences at the end of the study compared to the preoperative evaluation. Folic acid levels increased significantly during the follow-up. Almost 6 % of the patients had used standard vitamin and mineral supplements in the preoperative period and 72.4, 85.3, 74.7, 77.1, and 72.4 % at 1, 6, 12, 24, and 36 months following RYGB, respectively. CONCLUSIONS: Bariatric surgery is an effective treatment for long-term weight loss. However, nutritional deficiency is one of its side effects and should be properly diagnosed and handled, aimed at improving the patient's quality of life and preventing severe complications.

Changes in bone mineral density in women following 1-year gastric bypass surgery.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is the gold standard surgical treatment for obesity. However, unintended nutritional deficiencies following this surgery are common, including changes in bone metabolism. We assessed changes in bone mineral density (BMD), nutritional compounds, and bone resorption markers before and 1 year following RYGB surgery. METHODS: Our study included 22 female patients with class II/III obesity. A clinical questionnaire, a 24-h recall, blood and urine samples, and dual-energy X-ray absorptiometry were provided. RESULTS: Mean age was 37.2 ± 9.6 years; 86 % were Caucasian and 77.2 % were premenopausal. Mean preoperative body mass index was 44.4 ± 5.0 and 27.5 ± 4.5 kg/m(2) at 1-year follow-up (p < 0.001). 25-OH-vitamin D-levels were similar in both periods [11.7 (9.7-18.0) vs. 15.7 (10.2-2.7) pg/dL, p = 0.327]. Serum N-telopeptide (16.3 ± 3.4 vs. 38.2 ± 7.0 nM BCE, p < 0.001) and parathyroid hormone (45.4 ± 16.7 vs. 62.7 ± 28.9 pg/mL, p = 0.026) increased after RYGB surgery, reflecting bone resorption. BMD decreased after RYGB surgery in the lumbar spine (1.13 ± 0.11 vs. 1.04 ± 0.09 g/cm(2), p = 0.001), femoral neck (1.03 ± 0.15 vs. 0.94 ± 0.16 g/cm(2), p = 0.001), and total femur (1.07 ± 0.11 vs. 0.97 ± 0.15 g/cm(2), p = 0.003). CONCLUSIONS: Decreased BMD in the lumbar spine, femoral neck, and total femur is detectable in women 1 year after RYGB surgery. Calcium malabsorption, caused by vitamin D deficiency and increased bone resorption, is partially responsible for these outcomes and should be targeted in future clinical trials.

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.

Pregnancy after bariatric surgery: 39 pregnancies follow-up in a multidisciplinary team.

BACKGROUND: We investigate the outcomes of pregnancy in women who undergone restrictive-malabsorptive procedure at Centro da Obesidade Mórbida-Hospital São Lucas (COM HSL-PUCRS), Porto Alegre, Brazil. METHODS: All pregnancies started after the bariatric surgery and with estimated due date until June 2008 were eligible for the study. Only the first pregnancy of each patient was included in the data analysis. Data was collected from medical records. RESULTS: Forty seven pregnancies were identified in 41 women. Eight of them were ineligible. There were 30 complete pregnancies and nine miscarriages (23%). Cesarean delivery was performed in 69% of the complete pregnancies. Mature infants occurred in 93.1%. Twelve pregnancies (30.8%) occurred in the first year after surgery. Vitamin B12 was low in 53.4% patients; folic acid in 16.1%, iron in 6.7%, ferritin in 41.7%, calcium in 16.7%, and albumin in 10.3% of the patients. Nineteen women (79.2%) had no complication during the pregnancy and two (8.3%) presented with internal hernia. The average of newborns weight and length on delivery were 3,037 g and 48.07 cm, respectively. Children from pregnancies started in the first year of post operatory had similar outcomes of children from pregnancies started after 1 year of surgery. CONCLUSIONS: Pregnancy after bariatric surgery is safe and has fewer complications than pregnancy in morbidly obese women. However, the recommendation to delay the pregnancy for at least 12-18 months post-operatively should be kept.

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.