Adherence to Nutritional Supplementation Determines Postoperative Vitamin D Status, but Not Levels of Bone Resorption Marker, in Sleeve-Gastrectomy Patients.

BACKGROUND: Taking advantage of isomeric form of vitamin E in the supplement, adherence to supplement could be evaluated by changes in circulating α- and γ-tocopherol concentrations. Accordingly, effects of supplementation on postoperative nutrition and bone metabolism were studied in terms of adherence. METHODS: Thirty-eight SG patients were all prescribed a postoperative nutritional supplement containing a low dose of vitamin D (600 IU) and calcium (200 mg). Blood samples were collected prior to (M0) and 6 months after (M6) surgery and concentrations of nutrients and C-terminal telopeptide of type I collage (CTX), a marker of bone resorption, were measured. Adherence and non-adherence were stratified according to change (△, M6-M0) in serum α-tocopherol concentrations (> 0 vs. ≤ 0, respectively). RESULTS: When M0 and M6 were compared, there were significant increases in serum concentrations of 25(OH)D, α-tocopherol and selenium, whereas there were reductions in parathyroid hormone, ferritin, and γ-tocopherol. At M6, the prevalence of vitamin D insufficiency (25(OH)D < 30 ng/mL) and high CTX were 72 and 26%, respectively. When comparison was made between adherence and non-adherence, only △25(OH)D concentrations, but no other nutrients nor postoperative CTX differed. Multiple linear regression demonstrated that postoperative vitamin D status was independently associated with its preoperative concentrations (ß = 0.85, p < 0.001) and adherence (ß = 0.52, p < 0.05). CONCLUSION: SG patients' adherence to supplementation, even with a low dose of vitamin D and calcium, determined vitamin D status but not bone resorption marker concentrations, at least within 6 months after surgery.

Nutritional Status of Obese Taiwanese Before Bariatric-Metabolic Surgery and Their Serum 25-Hydroxyvitamin D Concentrations for Maximal Suppression of Parathyroid Hormone.

BACKGROUND: This is the first report from Taiwan using laboratory tests to assess nutritional status of patients with obesity before bariatric-metabolic surgery. Moreover, the 25(OH)D threshold for maximal suppression of parathyroid hormone (PTH) was evaluated to offer a reference value for preoperative nutritional care. METHODS: Inclusion criteria were Taiwanese, 18-65 years old, and with BMI ≥ 27.5 kg/m2 awaiting bariatric-metabolic surgery. Anthropometric data and blood samples were collected before surgery. Serum concentrations of protein; vitamins B1, B12, folate, A, D, and E; calcium; iron; zinc; copper; selenium; PTH; and erythrocyte glutathione reductase activity coefficient (vitamin B2 status) were measured. RESULTS: For 52 participants with a mean BMI 37.6 ± 6.4 kg/m2, vitamin D deficiency (25(OH)D < 20 ng/mL) and insufficiency (20 < 25(OH)D < 30 ng/mL) were at 73 and 22% prevalence, respectively. Secondary hyperparathyroidism (PTH â‰§ 65 pg/mL) was 24% and hypocalcemia was 50% (ionized Ca < 4.5 mg/dL). Deficiency of other nutrients was sporadic (< 10%) or nil. When participants were stratified according to 25(OH)D concentrations (< 10, 10-15, 15-20, and ≥ 20 ng/mL), PTH increased at 25(OH)D < 10 ng/mL (ß = 48.34, p = 0.001) after adjusting for age, gender, and BMI. CONCLUSION: For patients with obesity before bariatric-metabolic surgery, vitamin D/calcium deficiency was the only nutritional issue that needs to be addressed in Taiwan. However, a lower cutoff point of 25(OH)D, i.e., 10 ng/mL, for vitamin D deficiency may be considered for patients before surgery. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03915158.

Development of a quantitative assessment system for correlation analysis of footprint parameters to postural control in children.

It is known that neurological impairments impact postural stability, but few studies have observed the biomechanical influence of foot structure on balance. The aim of this study was to develop an integrated device for investigating the relationship between static balance and the foot structure, derived from a footprint image, under clinical tests of sensory interactions. Quantitative analysis of the footprint image acquired during balanced standing was developed as an indirect measure of the longitudinal arch, an important structural component of the foot. A data pool was collected from 64 children, 32 children from each of two age groups (4-5 years old versus 8-10 years old). Six common footprint parameters derived from the footprint angle or contact area were used to investigate the relationship between footprint parameters and postural stability. Postural balance ability was evaluated by analyzing sway area in posturography under visual or somatosensory confliction conditions. The footprint parameters, derived from the footprint image, inter-correlated well with each other (p < 0.01). The relationships between footprint parameters and sway area were correlated only for younger children under visually deprived (eye close) and cutaneous unreliable (standing on compliant foam) conditions. This implies that the correlations between footprint parameters and sway area are very subtle which can only be observed in unreliable visual and somatosensory conditions of younger children. In addition, younger children with a lower arch height would have a smaller sway area and better posture control which might result from more cutaneous somatosensation or a flexible biomechanical structure in low arch feet during conditioned static standing.

Image analysis system for acquiring three-dimensional contour of foot arch during balanced standing.

Compared to the X-ray approach, footprint analysis is a non-radiation and more viable method for clinical assessment of the medial longitudinal arch of the foot. In this study, we have designed an optical footprint acquisition system that consists of a digital camera and two pieces of glass, each with four load cells under each corner. When the subject stands on the transparent force plates, the digital camera is triggered, photographing the soles of the feet at the moment when both feet bear approximately at the same weight. A blue gel is placed between the foot and the force plate to enhance the contrast between sole and background. Based on the relationship between the brightness of the image and the thickness of the gel, the three-dimensional (3D) structure of the arch can be reconstructed which can provide more representative information than a conventional footprint image, with its low resolution and easy smearing.

Development of a virtual reality environment for somatosensory and perceptual stimulation in the balance assessment of children.

In this study, we developed a balance assessment system in which the visual stimulus was generated by a virtual reality (VR) technique and somatosensation was obtained from a movable platform. By standing on the movable platform, the center of pressure (COP) was measured to express the subject's postural control in response to varied visual stimuli. From the COP data, a singular value decomposition technique was used to derive the sway area and direction, represented in a polar form. Our system demonstrated the feasibility of using a VR environment in postural control trials and provided more realistic somatosensory and visual inputs.

The use of the Gaussian curve fitting method for scintigraphic measurements of the swallowing process in healthy subjects: implications for evaluation of dysphagia.

OBJECTIVE: To present the results of scintigraphic evaluation, using the Gaussian curve fitting method, via 3 parameters of oropharyngeal swallow: (1) pharyngeal transit time, (2) premature pharyngeal entry, and (3) postswallow pharyngeal stasis while ingesting liquid. DESIGN: A descriptive study. SETTING: A rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Eighteen healthy subjects. INTERVENTION: All 18 subjects received scintigraphic swallow examination to evaluate dynamic swallow process of 5 mL of liquid. MAIN OUTCOME MEASURES: The Gaussian curve fitting method was used to calculate the pharyngeal transit time, premature pharyngeal entry, and postswallow pharyngeal stasis. RESULTS: The mean pharyngeal transit time was .71 seconds. The maximal percentage of premature pharyngeal entry was 3%. The maximal percentage of postswallow pharyngeal stasis was 9%. CONCLUSIONS: The Gaussian curve fitting can be used as an objective and time-saving method to calculate the parameters in scintigraphic swallowing examination. Our results approximate other researchers' reports.