Vitamin D and the Metabolic Phenotype in Weight Loss After Bariatric Surgery: A Longitudinal Study.

PURPOSE: To evaluate the influence of vitamin D (VD) concentrations coupled with metabolic phenotypes preoperatively and 6 months after Roux-en-Y gastric bypass (RYGB) on body variables and weight loss. MATERIALS AND METHODS: A longitudinal, retrospective, analytical study comprising 30 adult individuals assessed preoperatively (T0) and 6 months (T1) after undergoing Roux-en-Y gastric bypass. The participants were distributed preoperatively into metabolically healthy obese (MHO) and metabolically unhealthy obese individuals (MUHO) according to the HOMA-IR classification, as well as the adequacy and inadequacy of vitamin D concentrations in the form of 25(OH)D. All participants were assessed for weight, height, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), visceral adiposity index (VAI), body circularity index (BCI), body adiposity index (BAI), weight loss, and assessment of 25(OH)D and 1,25(OH)2D concentrations using high-performance liquid chromatography with an ultraviolet detector (HPLC-UV). The statistical program used was SPSS version 21. RESULTS: VD adequacy and a healthy phenotype in the preoperative period may play an important role concerning body fat distribution, as the body averages for WHtR (0.020*) and BCI (0.020*) were lower in MHO participants. In comparison, those with VD inadequacy and MUHOs had higher BAI averages (0.000*) in the postoperative period. Furthermore, it is possible that VD inadequacy before and after RYGB, even in the presence of an unhealthy phenotype, may contribute to the increase in VAI values (0.029*) after this surgery. Only those with inadequate VD and MUHOs had higher 25(OH)D concentrations. Besides, this unhealthy phenotype had a greater reduction in BMI in the early postoperative period (p < 0.001). CONCLUSION: This study suggests that VD adequacy and the presence of a healthy phenotype appear to have a positive impact on the reduction of visceral fat in the context of pre- and postoperative obesity. In addition, there was a greater weight reduction in those with VD inadequacy and in MUHO, which suggests that the volumetric dilution effect of VD and catabolism after bariatric surgery is more pronounced in this specific metabolic phenotype.

The Effect of Vitamin D Adequacy on Thyroid Hormones and Inflammatory Markers after Bariatric Surgery.

Vitamin D status affects the clinical and corporal outcomes of postoperative patients who undergo a Roux-en-Y gastric bypass (RYGB). The aim of this study was to evaluate the effect of adequate vitamin D serum concentrations on thyroid hormones, body weight, blood cell count, and inflammation after an RYGB. A prospective observational study was conducted with eighty-eight patients from whom we collected blood samples before and 6 months after surgery to evaluate their levels of 25-hydroxyvitamin D 25(OH)D, thyroid hormones, and their blood cell count. Their body weight, body mass index (BMI), total weight loss, and excess weight loss were also evaluated 6 and 12 months after surgery. After 6 months, 58% of the patients achieved an adequate vitamin D nutritional status. Patients in the adequate group showed a decrease in the concentration of thyroid-stimulating hormone (TSH) (3.01 vs. 2.22 µUI/mL, p = 0.017) with lower concentrations than the inadequate group at 6 months (2.22 vs. 2.84 µUI/mL, p = 0.020). Six months after surgery, the group with vitamin D adequacy showed a significantly lower BMI compared with the inadequate group at 12 months (31.51 vs. 35.04 kg/m2, p = 0.018). An adequate vitamin D nutritional status seems to favor a significant improvement in one's thyroid hormone levels, immune inflammatory profile, and weight loss performance after an RYGB.

Vitamin D Supplementation and Its Relationship with Loss of Visceral Adiposity.

PURPOSE: An inverse relationship between vitamin D (VD) nutritional status and obesity is frequent, and the distribution of body fat is an important aspect to assess the risks of obesity-related metabolic dysfunction. The purpose of the study was to evaluate the relationship between serum VD concentrations and body fat reduction after 12 months of bariatric surgery, using two different vitamin D3 (VD3) supplementation protocols. MATERIAL AND METHODS: A randomized controlled trial consisted of 41 patients divided into G1 (800 IU/day) and G2 (1800 IU/day) according to the VD3 supplementation. At baseline (T0) and follow-up (T1), 25(OH)D, waist circumference (WC), visceral adiposity index (VAI), body adiposity index (BAI), and waist/height ratio (WHtR) were evaluated. RESULTS: In T0, the mean of 25(OH)D was lower in G2 compared to that in G1 (22.6 vs 23.6 ng/mL; p = 0.000). At T1, it had a significant increase in G2 (32.1 vs 29.9 ng/mL; p = 0.000), with 60% sufficiency. A significant negative correlation was observed between VAI, BAI, and WHtR with 25(OH)D in G2 (r = - 0.746, p = 0.024; r = - 0.411, p = 0.036; r = - 0.441, p = 0.032) after surgery. Higher mean changes from baseline of visceral fat loss, represented by VAI, were observed in G2 (176.2 ± 149.0-75.5 ± 55.0, p = 0.000). CONCLUSION: Patients submitted to the 1800 IU/day protocol, 12 months after the surgical procedure, had a higher percentage of sufficient vitamin D levels compared to those submitted to the 800 IU/day protocol. Additionally, higher dose supplementation promoted a significant improvement in VAI.

Adequacy and Vitamin D in the Preoperative Period of Roux-en-Y Gastric Bypass, Bariatric Surgery, Can Protect Metabolic Health in Metabolically Healthy and Unhealthy Individuals.

Evaluating the influence of vitamin D concentrations together with preoperative metabolic phenotypes on remission of chronic noncommunicable diseases (CNCDs) after 6 months of Roux-en-Y gastric bypass (RYGB). Cross-sectional analytical study comprising 30 adult individuals who were assessed preoperatively (T0) and 6 months (T1) after undergoing RYGB. Participants were distributed preoperatively into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) individuals according to HOMA-IR classification and to the adequacy and inadequacy of vitamin D concentrations in the form of 25(OH)D. All participants were assessed for anthropometric characteristics, biochemical variables, and presence of CNCDs. The statistical program used was the SPSS version 21. In face of vitamin D adequacy and regardless of the metabolic phenotype classification in the preoperative period, the means found for HOMA-IR allowed us to define them as metabolically healthy 6 months after RYGB. Only those with vitamin D inadequacy with the MUHO phenotype showed better results regarding the reduction of glucose that accompanied the shift in serum 25(OH)D concentrations from deficient to insufficient. It is possible that preoperative vitamin D adequacy, even in the presence of an unhealthy phenotype, may contribute to the reduction of dyslipidemia and improvement in cholesterol. It is suggested that preoperative vitamin D adequacy in both phenotypes may have a protective effect on metabolic health.

Body Composition, Basal Metabolic Rate and Leptin in Long-Term Weight Regain After Roux-en-Y Gastric Bypass Are Similar to Pre-surgical Obesity.

PURPOSE: The purpose of this study is to evaluate the relationship between body composition, basal metabolic rate (BMR), and serum concentrations of leptin with long-term weight regain after Roux-en-Y gastric bypass (RYGB) and compare it with obesity before surgery. MATERIALS AND METHODS: Prospective longitudinal analytical study. Three groups were formed: individuals 60 months post RYGB, with weight regain (G1) and without it (G2), and individuals with obesity who had not undergone bariatric surgery (G3). Body fat (BF), body fat mass (BFM), visceral fat (VF), fat-free mass (FFM), skeletal muscle mass (SMM), and BMR were assessed by octapolar and multi-frequency electrical bioimpedance. Fasting serum concentrations of leptin were measured. RESULTS: Seventy-two individuals were included, 24 in each group. Higher means of BF, BFM, VF, and leptin levels were observed in G1, when compared to G2 (BF: 47.5 ± 5.6 vs. 32.0 ± 8.0, p < 0.05; FBM: 47.8 ± 11.6 vs. 23.9 ± 7.0, p < 0.05; VF: 156.8 ± 30.2 vs. 96.1 ± 23.8, p < 0.05; leptin: 45,251.2 pg/mL ± 20,071.8 vs. 11,525.7 pg/mL ± 9177.5, p < 0.000). G1 and G2 did not differ in FFM, SMM, and BMR. G1 and G3 were similar according to BF, FFM, BMR, and leptin levels. Body composition, but not leptin, was correlated with %weight regain in G1 (FBM: r = 0.666, p < 0.000; BF: r = 0.428, p = 0.037; VF: r = 0.544, p = 0.006). CONCLUSION: Long-term weight regain after RYGB is similar to pre-surgical obesity in body composition, BMR, and leptin concentrations, indicating relapse of metabolic and hormonal impairments associated with excessive body fat.

Inadequacy of Vitamin D Does Not Interfere with Body Weight Loss in Women of Reproductive Age after Roux-en-Y Gastric Bypass.

Objective: To assess the influence of vitamin D on body weight loss in women who had previously undergone Roux-en-Y gastric bypass (RYGB). Methodology: This is an analytical, longitudinal and retrospective study comprising 40 women of reproductive age who had previously undergone RYGB. To investigate the influence of the serum concentrations of vitamin D on body weight reduction, the variables were analyzed in the pre-operative period (T0), in the first (T1) and in the second postoperative year (T2) and were stratified according to the BMI measured in T1 and T2. In addition, in the pre-operative period, participants were subdivided into groups based on adequacy (G1), deficiency (G2) and insufficiency (G3), according to their serum concentrations of vitamin D. Results: Although weight loss occurred in a substantial way in T1, it continued to decrease in T2 (p = 0.017). The women who reached normal weight within two years of surgery showed the lowest vitamin D concentrations preoperatively when compared to those who were overweight (p = 0.011). Women with preoperative vitamin D deficiency showed increased concentrations in the assessed times (p < 0.001), while the opposite (p = 0.001) occurred in women with adequacy. Conclusion: The study showed that inadequacy of vitamin D does not interfere with weight loss in the two-year-follow-up after RYGB and highlights that vitamin D can present a differentiated response postoperatively, to the detriment of the pre-operative period.

Relationship between vitamin D deficiency and both gestational and postpartum depression.

INTRODUCTION: Introduction: vitamin D deficiency (VDD) has been associated with depressive symptoms in pregnancy and postpartum, which can result in increased adverse outcomes in the maternal-infant segment. A possible explanation in the literature is VDD relationship with genetic and neurological mechanisms. Objective: to evaluate VDD relationship with gestational and postpartum depression. Methods: this review followed the recommendations proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Research was conducted in electronic databases, PubMed and LILACS, including studies of the analytical type (cross-sectional and longitudinal), systematic reviews, meta-analyses, and controlled clinical trials carried out in humans; inclusion and exclusion criteria were applied. Results and conclusions: in this systematic review, eight articles were analyzed comprising 8,583 women from seven different countries. Among the selected articles, six found an association between VDD and gestational and postpartum depression. Considering the data collection, it was possible to conclude that there is a probable relationship between VDD and a higher predisposition to gestational and postpartum depression. Also, we concluded that vitamin D supplementation has proven to be a promising strategy for reducing the risk of depressive symptoms.

INTRODUCCIÓN: Introducción: la deficiencia de vitamina D (VDD) se ha asociado a síntomas depresivos en el embarazo y el posparto, lo que puede resultar en un aumento de los resultados adversos en el segmento materno-infantil. Una posible explicación en la literatura es la relación de la VDD con mecanismos genéticos y neurológicos. Objetivo: evaluar la relación de la VDD con la depresión gestacional y posparto. Métodos: esta revisión siguió las recomendaciones propuestas por los Elementos de Informes Preferidos para revisiones sistemáticas y metaanálisis. La investigación se llevó a cabo en bases de datos electrónicas, PubMed y LILACS, incluyendo estudios de tipo analítico (sección transversal y longitudinal), revisiones sistemáticas, metaanálisis y ensayos clínicos controlados realizados en seres humanos; se aplicaron criterios de inclusión y exclusión. Resultados y conclusiones: en esta revisión sistemática se analizaron ocho artículos que comprenden a 8716 mujeres de siete países diferentes. Entre los artículos seleccionados, seis encontraron asociación entre la VDD y la depresión gestacional y posparto. Teniendo en cuenta la recopilación de datos, fue posible concluir que existe una relación probable entre la VDD y una mayor predisposición a la depresión gestacional y posparto. También llegamos a la conclusión de que la suplementación con vitamina D ha demostrado ser una estrategia prometedora para reducir el riesgo de síntomas depresivos.

Serum concentration of vitamin A and its relationship with body adiposity, oxidative stress, and cardiovascular risk in women with recommended dietary intake of vitamin A.

INTRODUCTION: Background: evidence indicates a role of vitamin A in the regulation of fat mass influencing obesity and cardiovascular diseases. Material and methods: a cross-sectional study in 200 women, paired by age and by the recommended dietary intake of vitamin A. Subjects were divided into four groups according to body mass index (BMI): 80 eutrophic (E), 40 overweight (OW), 40 class I obesity (OI) and 40 class II obesity (OII). Lipid and glycemic profiles were measured and oxidative stress was evaluated through serum concentrations of uric acid, glutathione peroxidase (GSH-Px), and thiobarbituric acid reactive substances (TBARS). Results: the cutoff points for deficiency of serum retinol and ß-carotene levels were < 1.05 µmol/L and 40 µg/dL, respectively. For the recommended dietary intake of vitamin A it was 700 µg/day. Retinol and ß-carotene deficiency was found in the E group at 5 % and 15 %, respectively, reaching 77.5 % and 82.5 % in the OII group. Conclusions: a correlation was observed between serum concentrations of retinol and ß-carotene and glycemic, lipid, and markers of oxidative stress profiles in the groups studied. It was observed that OI and OII subjects who had retinol and ß-carotene deficiency presented a risk that was 16 and 20.7 times greater, respectively, of having a diagnosis with DM2 as compared to E subjects with adequate concentrations of vitamin A. Increased demand of vitamin A may be related to increased BMI, body adiposity, and oxidative stress even when a recommended intake of vitamin A is reached.

INTRODUCCIÓN: Introducción: la evidencia indica un papel de la vitamina A en la regulación de la masa grasa que influye en la obesidad y las enfermedades cardiovasculares. Material y métodos: estudio transversal con 200 mujeres emparejadas por edad y por la ingesta dietética de vitamina A recomendada. Se dividieron en cuatro grupos según el índice de masa corporal (IMC): 80 eutróficas (E), 40 con sobrepeso (OW), 40 con obesidad de clase I (OI) y 40 con obesidad de clase II (OII). Se midieron los perfiles lipídicos y glucémicos y se evaluó el estrés oxidativo a través de las concentraciones séricas de ácido úrico, glutatión-peroxidasa (GSH-Px) y sustancias reactivas del ácido tiobarbitúrico (TBARS). Resultados: los puntos de corte para la deficiencia de las concentraciones séricas de retinol y caroteno fueron de 1,05 µmol/L y 40 g/dL, respectivamente. Para la ingesta dietética recomendada de vitamina A fue de 700 g/día. Se encontró deficiencia de retinol y caroteno en el grupo E, del 5 % y 15 %, respectivamente, alcanzando un 77,5 % y 82,5 % en el grupo OII. Conclusiones: se observó correlación entre las concentraciones séricas de retinol y caroteno y los perfiles glucémico, lipídico y de marcadores de perfiles de estrés oxidativo en los grupos estudiados. Se observó que los sujetos con OI y OII que tenían deficiencia de retinol y caroteno presentaban un riesgo 16 y 20,7 veces mayor, respectivamente, de ser diagnosticados de DM2 en comparación con los E con concentraciones adecuadas de vitamina A. El aumento de la demanda de vitamina A puede estar relacionado con el aumento del IMC, la adiposidad corporal y el estrés oxidativo, incluso cuando se alcanza la ingesta recomendada de vitamina A.

Vertical Sleeve Gastrectomy Has Better Weight Evolution and Serum Concentrations of Vitamin D when Compared with Roux-Y Gastric Bypass.

OBJECTIVE: The objective of this study is to compare the weight evolution and serum concentrations of vitamin D in individuals undergoing Roux-en-Y Gastric Bypass (RYGB) and Sleeve after 1 follow-up year. METHODOLOGY: Descriptive, prospective, and longitudinal study, with 108 individuals divided into 2 groups: RYGB (55 patients) and Sleeve (53), evaluated preoperatively, and at 6 and 12 postoperatively months. Anthropometric data, serum concentrations of 25(OH)D, calcium, and parathyroid hormone were analyzed. RESULTS: The Sleeve group showed greater reductions in excess weight and excess body mass index (BMI) when compared with the RYGB group at both times (p < 0.001). Besides, after 12 months, those who had undergone the Sleeve procedure also had higher percentages of surgical success (84.4% versus 65.0%, p = 0.038). The prevalence of preoperative inadequacy of 25(HO)D in both groups was 78.7%. After 6 months, there was an increase in serum concentrations of 25(HO)D in both groups (p < 0.001), but without significant differences between the groups (p = 0.154). In the comparison between 6 and 12 months, there was only a reduction for the RYGB group (p = 0.001). Also, when comparing both groups, the means of vitamin D in patients undergoing RYGB were also lower after 12 months (p = 0.003). There was a negative correlation between vitamin D and parathyroid hormone (r = - 0.235 p = 0.030). The mean serum concentrations of calcium were adequate at all times. CONCLUSION: Patients undergoing the Sleeve procedure had a better evolution in weight loss and are at a lower risk of vitamin D inadequacy than those undergoing RYGB.

Non-pregnant Women Have a Lower Vitamin D than Pregnant Women After Gastric Bypass.

OBJECTIVE: To compare the nutritional status of vitamin D, calcium, and serum concentrations of parathyroid hormone (PTH) between women undergoing Roux-en-Y gastric bypass (RYGB) who became pregnant and women who did not become pregnant during the same postoperative period, as well as the impact of these changes on maternal and child health. METHODS: This is a longitudinal and retrospective study of women who previously underwent RYGB, paired by age and preoperative body mass index (BMI), divided into two groups: group 1 (G1), comprising 79 women who did not become pregnant, and group 2 (G2), comprising 40 pregnant women assessed in the overall trimesters. Both groups were analyzed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or greater than 1 year (T2), with a 2-year period at the most. Serum concentrations of vitamin D, calcium, parathyroid hormone (PTH), and gestational and neonatal complications were investigated. Statistical analysis was performed by the Statistical Package for the Social Sciences 21.0 (p < 0.05). RESULTS: Despite the additional nutritional demands at pregnancy, women evaluated after 1 year of RYGB had the highest demands of vitamin D when compared with pregnant women in the second trimester(p = 0.04). Women who became pregnant within 1 year of bariatric surgery were more likely to develop a urinary tract infection which, in turn, was associated with vitamin D inadequacy (p = 0.02).In the same period, the concentrations of calcium in the second and third trimesters showed a strong correlation with the number of pregnancies (R = 0.8, p = 0.008, R = 0.8, p = 0.003) and deliveries (R = 0.7, p = 0.013, R = 0.8, p = 0.006) and its nutritional status in the first trimester also showed a strong correlation with the occurrence of small newborns for gestational age/large for gestational age (SGA/LGA) (R = 0.8, p = 0.007). CONCLUSION: Since the highest vitamin D depletions occurred in G1 when compared with G2, the study suggests that a period of time for supplementation and its adjustments in post-bariatric pregnancy may be beneficial. It also encourages further investigation on the number of pregnancies/deliveries during prenatal care, due to vitamin D influence on the nutritional status of calcium, and it points out that changes in concentrations of this vitamin in pregnant women may lead to SGA/LGA newborns' births.

Relationship of Body Composition Measures and Metabolic Basal Rate with Gastrointestinal Hormones in Weight Regain 5 Years After Gastric Bypass.

BACKGROUND: To assess the relationship of body composition measures and basal metabolic rate (BMR) with gastrointestinal hormones in weight regain 5 years after gastric bypass. METHODS: A total of 42 patients were divided into two groups: with and without weight regain 5 years after gastric bypass. Hormone assessments were performed after a fasting period and at 30, 60, and 120 min after the standard meal intake. RESULTS: Patients with no weight regain had significantly lower visceral fat (VF), lower fat body mass (FBM), and lower fat percentage (%F) in relation to the other group. In the group without weight regain, at baseline, glucose-dependent insulinotropic polypeptide (GIP) showed a negative correlation with weight and BMI and a positive correlation with BMR, skeletal muscle mass (SMM), and fat-free mass (FFM). After the standard meal, the following results were found: a negative correlation with %F, a positive correlation of glucagon-like peptide-1 (GLP-1) with FFM, and a positive correlation of GLP-2 and PYY with BMR, SMM, and FFM. In the group with weight regain, at baseline, GIP, PYY, and GLP-1 showed a negative correlation with %F. After the standard meal, PYY and GLP-1 showed a negative correlation with VF, FBM, and %F. On the other hand, GLP-2 negatively correlated with VF and FBM. CONCLUSION: It is possible to conclude that there is a different relationship of concentrations of PYY, GIP, GLP-1, and GLP-2 with body composition and BMR in patients with and without weight regain in the late gastric bypass postoperative period.

Reduction of Serum Concentrations and Synergy between Retinol, ß-Carotene, and Zinc According to Cancer Staging and Different Treatment Modalities Prior to Radiation Therapy in Women with Breast Cancer.

The procedures used for breast cancer treatment are able to increase the level of oxidative stress and cause depletion of antioxidants. OBJECTIVES: To investigate the relationship between serum concentrations of retinol, ß-carotene, and zinc, according to breast cancer staging, considering different treatment modalities prior to radiation therapy and the synergistic action between these micronutrients. METHODS: This is a cross-sectional observational study comprising a cohort of patients with breast cancer which was carried out prior to radiation therapy. Patients were divided into 3 groups: G1 comprised women who had undergone breast-conserving surgery, G2 comprised those who had undergone chemotherapy, and G3 those who had undergone breast-conserving surgery and chemotherapy. Serum concentrations of retinol, ß-carotene, and zinc were quantified. Breast cancer staging was based on the TNM (Tumor, Node, Metastasis) classification of malignant tumors, a type of staging tool for different cancers. RESULTS: A total of 230 patients were assessed. A decrease of the serum concentrations of the micronutrients assessed as the staging level of the disease increased was observed. Surgery alone had a greater negative impact on serum concentrations of retinol. Considering the treatments prior to radiotherapy, patients undergoing surgery alone and chemotherapy associated with surgery had higher percentages of deficiency of ß-carotene and retinol. There was a positive correlation between the concentrations of zinc, retinol, and ß-carotene, showing a synergy between these micronutrients. CONCLUSION: A significant reduction in the serum concentrations of the assessed micronutrients was observed, according to the increase in breast cancer staging. The synergy between the micronutrients must be considered in order to maximize the benefits and minimize the adverse effects of irradiation to normal cells.

Pregnancy after 24 Postoperative Months of Roux-En-Y Gastric Bypass Presents Risk of Pregnancy Complications Similar to Pregnancy within the First Postoperative Year.

BACKGROUND: To assess the influence of the time interval between pregnancy and the Roux-en-Y gastric bypass (RYGB) on maternal-infant complications. METHODS: This is an analytical, longitudinal and retrospective study comprising 42 pregnant women who had previously undergone RYGB, subdivided according to the time interval between pregnancy and bariatric surgery: ≤12 months (G1), >12 and <24 months (G2) and ≥24 months (G3). Anthropometric variables of mothers, newborns and information on pregnancy complications were collected. RESULTS: G1 was the group more likely to develop urinary tract infection, dumping syndrome and inadequacy of birth weight than G2. Pregnancy complications were similar and >80.0% both in the first 12 months and after 24 months of the RYGB and the smallest percentages occurred in the time interval of 12-24 months after it. In addition, the percentage of neonatal complications was the highest in G1 when compared to the other times studied. CONCLUSION: Our findings indicate less predisposition to maternal-infant complications in pregnancies occurring in the time interval of >12 and <24 months and suggest that pregnancy after 24 months can be as harmful as pregnancies occurring before the first 12 postoperative months, since a great catabolism occurs at this time as it has been shown in the literature.

Bone Metabolism in Adolescents and Adults Undergoing Roux-En-Y Gastric Bypass: a Comparative Study.

OBJECTIVE: To compare the bone metabolism of adolescents and adults with obesity before undergoing a Roux-en-Y gastric bypass (RYGB) and 6 and 12 months after the surgery. MATERIALS AND METHODS: Adolescents (G1) and adults (G2) with obesity assessed before (T0), six (T1), and 12 months after (T2) RYGB. Sun exposure, serum concentrations of 25(OH)D, calcium, phosphorous, magnesium, zinc, alkaline phosphatase, parathyroid hormone (PTH), and bone mineral density (BMD) were evaluated. RESULTS: Sixty adolescents and 60 adults were assessed. At T0, there was no significant difference between the groups' serum 25(OH)D levels (G1 21.87 + 7.52 ng/mL, G2 21.73 + 7.60 ng/mL, p = 0.94) or sun exposure (G1 17 ± 2.0 min/day, G2 13.2 ± 5.2 min/day, p = 0.85). G1 had high levels of inadequacy of calcium (66.7%), phosphorous (80.0%), and zinc (18.3%) at T0 and had a significant fall in their 25(OH)D (p < 0.01) and magnesium (p < 0.01) levels from T1 to T2. G2 saw a significant lowering of their serum zinc levels from T0 to T1 and T2 (T1 p < 0.01; T2 p < 0.01). In both groups, there was a significant rise in PTH from T1 to T2 (G1 p = 0.04, G2 p = 0.02) and from T0 to T2 (G1 and G2 p < 0.01). In G2, 40.4% of individuals with osteopenia and osteoporosis presented inadequacy of 25(OH)D. CONCLUSION: RYGB was found to worsen the inadequacy of micronutrients related to bone metabolism and was associated with secondary hyperparathyroidism and low BMD values, especially among the adolescents. The irreversible damaging effects of obesity on bone metabolism can occur in adolescence.

Vitamin A nutritional status in patients with coronary artery disease and its correlation with the severity of the disease.

INTRODUCTION: the purpose of this study was to assess the vitamin A (VA) nutritional status of patients with coronary artery disease (CAD) and its correlation with the severity of the disease, taking into consideration zinc concentration and oxidative stress. METHODS: the patients were preoperative inpatients awaiting myocardial revascularization surgery. The serum concentrations of retinol, ß-carotene, zinc, malondialdehyde (MDA) and C-reactive protein (CRP) were quantified. CAD severity was assessed by cineangiography, observing the parameters of severity, extent and occlusion. An echocardiogram was performed to assess the ejection fraction. RESULTS: ninety individuals were studied (64.5 ± 9.6 years). Zinc did not correlate with retinol (r = -0.009/p = 0.40), ß-carotene (r = -0.06/p = 0.73) or MDA (r = 0.03/p = 0.70), but zinc deficiency was more frequent amongst the patients with high MDA (quartiles 50 and 75). CRP was found to be associated with retinol (x2 = 3.95/p = 0.04). The individuals with retinol deficiency had more severe CAD, and ß-carotene diminished as the extent score rose, although this was not statistically significant (p = 0.12). The degree of severity was associated to extent (x2 = 67.9)/(p < 0.001), occlusion (x2 = 34.5/p < 0.001) and CRP (x2 = 5.9/p = 0.05), while extent was associated with MDA (x2 = 42.1)/(p < 0.001). There was a positive correlation between the ejection fraction and ß-carotene (r = 0.42/p = 0.02). CONCLUSION: findings from this study indicate that chronic inflammation resulting from atherosclerosis is related to disease severity and consequent influence on nutritional status of VA.

Vitamin A supplementation according to zinc status on oxidative stress levels in cardiac surgery patients.

INTRODUCTION: it is widely reported that oxidative stress increases in patients undergoing cardiovascular surgery and causes negative outcomes, such as reduced immunological responses and postoperative complications. In this context, vitamin A and zinc serves an important function in the immunological system because it plays a role in fighting oxidative stress. OBJECTIVES: to evaluate the effect of vitamin A supplementation on oxidative stress levels in cardiac surgery patients based on zinc nutritional status. METHODS: a control group (G1) and a vitamin A intervention group (G2- 5,000 IU of vitamin A daily) were subdivided based on their zinc nutritional status. The patients' serum concentrations of retinol, ß-carotene, zinc and malondialdehyde were assessed before surgery (T0), on the 3rd (T1) and 21st postoperative day (T2). RESULTS: in the individuals with adequate zinc concentrations, the retinol concentrations were significantly higher in G2 than in G1 at T1 and T2. In G2, the ß-carotene concentrations were significantly higher in individuals with adequate zinc concentrations compared to those who had inadequate concentrations at T1 (p = 0.024) and T2 (p = 0.043). After surgery, malondialdehyde levels were significantly higher in individuals who had inadequate zinc concentrations, compared to those who had adequate zinc concentrations. Analyzing the clinical evolution, operative mortality, hospitalization time and length of stay in Intensive Care Unit (ICU) were lower in G2. CONCLUSION: vitamin A has contributed to the reduction of oxidative stress, particularly in patients with adequate zinc concentrations and, this way, may help decrease the risk of postoperative complications.

Maternal Anthropometry and Its Relationship with the Nutritional Status of Vitamin D, Calcium, and Parathyroid Hormone in Pregnant Women After Roux-en-Y Gastric Bypass.

OBJECTIVE: To assess the influence of pre-pregnancy body mass index (BMI), total gestational weight gain (TGWG), and pre-pregnancy surgical success on the nutritional status of vitamin D, calcium, and parathyroid hormone (PTH) in the trimesters of pregnancy of women who previously underwent Roux-en-Y gastric bypass (RYGB). METHODOLOGY: This is an analytical, longitudinal, and retrospective study comprising 42 pregnant women who previously underwent RYGB. Concentrations of vitamin D3, calcium, and PTH were assessed in all trimesters. Anthropometric variables necessary for calculating TGWG, surgical success, and BMI were collected preoperatively and over the trimesters of pregnancy. RESULTS: A total of 97.1% had vitamin D3 inadequacy at some point in pregnancy. Pre-pregnancy BMI, even when classified as overweight, may have exacerbated the serum concentrations of this vitamin in the third trimester (p = 0.011), and it was significantly lower in women with normal weight and/or obesity (p = 0.039). It was evidenced that both pre-pregnancy BMI and TGWG above the recommended optimal weight can be associated with calcium homeostasis, especially early in pregnancy. It was also shown that surgical success in the pre-pregnancy period may have influenced the serum concentrations of vitamin D in the second trimester of pregnancy (p = 0.013). CONCLUSION: This study draws attention to the importance of monitoring the nutritional status of vitamin D3 and calcium in the prenatal period due to its relationship with pre-pregnancy BMI, TGWG, and surgical success.

Comparative study of the nutritional status of vitamin A in pregnant women and in women who became pregnant or did not after Roux-en-Y gastric bypass.

INTRODUCTION: the changes in digestive physiology after Roux-en-Y gastric bypass (RYGB), as well as pregnancy, maximizes the risk of vitamin A deficiency (VAD) and both can result in harm to the mother and child health. OBJECTIVE: to compare the nutritional status of vitamin A among women who became pregnant or did not after RYGB and in pregnant women who did not undergo surgery, and to assess the impact of VAD on the mother and child health. METHODS: this is a cross-sectional study of the analytical type. The women were divided into: group 1 (G1) with 80 pregnant women; group 2 (G2) with 40 pregnant women who had previously undergone RYGB, both in their third trimester of pregnancy; and group 3 (G3) with 77 non-pregnant women who had previously undergone RYGB. Serum concentrations of retinol and ß-carotene, night blindness (NB), gestational and neonatal intercurrences were investigated. The significance level adopted was p < 0.05. RESULTS: RYGB, per se,had a greater impact on the inadequacy of retinol, ß-carotene, and on the increased percentage of NB when compared to non-surgical pregnant women. When surgery was associated with pregnancy, more than 75% of inadequacy of retinol and ß-carotene was noted, as well as a higher percentage of individuals with NB. G2 also showed increased prevalence ratio for developing gestational and neonatal intercurrences, when compared to G1. CONCLUSION: RYGB provides greater negative impact on the nutritional status of vitamin A compared to pregnancy, and surgery associated with pregnancy can create even greater risks.

Serum Antioxidant Associations with Metabolic Characteristics in Metabolically Healthy and Unhealthy Adolescents with Severe Obesity: An Observational Study.

Considering the inadequacy of some antioxidant nutrients in severely obese adolescents, this study aimed to assess the relationship between antioxidant micronutrients status and metabolic syndrome components in metabolically healthy obesity (MHO) and unhealthy obesity (MUO). We performed an observational study in severely obese adolescents (body mass index > 99th percentile) and they were classified into MHO or MUO, according to the criteria adapted for adolescents. Anthropometric, biochemical, and clinical variables were analyzed to characterize the sample of adolescents. The serum antioxidant nutrients assessed were retinol, ß-carotene, Vitamin E, Vitamin C, zinc and selenium. A total of 60 adolescents aged 17.31 ± 1.34 years were enrolled. MHO was identified in 23.3% of adolescents. The MHO group showed lower frequency of non-alcoholic fatty liver disease (14.3% vs. 78.3%, p < 0.001) when compared to MUO. A correlation was found between retinol and ß-carotene concentrations with glycemia (r = -0.372; p = 0.011 and r = -0.314; p = 0.034, respectively) and between Vitamin E with waist circumference (r = -0.306; p = 0.038) in the MUO group. The current study shows that some antioxidant nutrients status, specifically retinol, ß-carotene, and Vitamin E, are negatively associated with metabolic alterations in MUO. Further studies are necessary to determine the existing differences in the serum antioxidant profile of metabolically healthy and unhealthy obese adolescents.

Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group.

OBJECTIVE: The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health. METHODOLOGY: A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or over 1 year (T2), during a maximum of 2 years. Serum concentrations of retinol and ß-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p < 0.05). RESULTS: RYGB reduced the serum levels of retinol and ß-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and ß-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of ß-carotene. CONCLUSION: Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.