Short-term skin reactions associated to sleeve gastrectomy in eight patients.

BACKGROUND: Bariatric procedures have beneficial effects on metabolic disturbances, including dermatological conditions. Short-term skin reactions associated with sleeve gastrectomy are not described in the literature. METHODS: We reviewed our database for patients who underwent bariatric surgery between May and October 2013 who reported a cutaneous rash during the short-term post-surgical period. RESULTS: Of a total of 195 patients, 8 (0.02 %) developed acute skin reactions during the first 3 months. Case 1 was compatible with reticulated papillomatosis. Case 2 was diagnosed as recurrent angioedema. Cases 3, 4, and 7 presented a cutaneous drug reaction to vitamin supplementation. Cases 5, 6, and 8 seemed to be secondary to xerosis and responded to lubrication. CONCLUSION: Acute cutaneous skin reactions after bariatric surgery are unusual. When they do occur, they appear to be benign conditions.

[Micronutrient deficiencies one year after sleeve gastrectomy]. / Déficit de micronutrientes a más de un año postoperatorio de gastrectomía en manga.

INTRODUCTION: Obesity is one of the largest problems in public health worldwide today. For patients with severe obesity and associated comorbidities, surgical treatment is recommended. OBJECTIVE: To analyze the frequency of micronutrient deficiencies and food intake at least 12 months after sleeve gastrectomy (SG). MATERIALS AND METHODS: This is a cross sectional study carried out between October and December 2009 with measure of serum levels of vitamin B12, vitamin D, folate, calcium, ferritin, zinc, parathyroid hormone and bone mineral density on patients underwent SG at least 12 months before the study. A food intake questionnaire was also performed. For the statistical analysis, the Pearson or Spearman tests was used. RESULTS: Forty patients were evaluated with a mean age of 40 ± 10 years and mean time post surgery of 26 ± 6 months. Mean plasma level of 25 OH-vitamin D was 20.9 ± 10.5 ng/ml. Forty-three percent had low levels of vitamin D (< 20 ng/ml), and 68% showed low levels of calcium (< 1,1 mmol/L) without secondary hyperparathyroidism. Anemia was present in 28% and iron deficiency occurred in 38% of these patients. Deficit of folic acid and vitamin B12 were observed in 13% of the patients. Average daily food intake was 1,256 kcal, 54% of total calories as carbohydrates, 26% as fat and 21% as protein. CONCLUSION: Iron, calcium and vitamin D are the most prevalent micronutrient deficiencies after SG. Long-term vitamin and mineral supplementation should be considered on every patient. Additional long-term studies are needed to establish specific supplementation recommendations after SG.

Residual macrovascular risk in 2013: what have we learned?

Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.

Déficit de micronutrientes a más de un año de postoperatorio en gastrectomía en manga / Micronutrient deficiencies one year after sleeve gastrectomy

Introducción: La obesidad es uno de los principales problemas de salud pública a nivel mundial. Para aquellos pacientes con obesidad severa asociada a comorbilidades, se recomienda el tratamiento quirúrgico. Objetivo: Analizar la frecuencia de déficit de micronutrientes e ingesta alimentaria en pacientes sometidos a gastrectomía en manga (GM) en un tiempo post operatorio del al menos 12 meses. Material y métodos: Se realizó un estudio transversal entre los meses de octubre y diciembre de 2009. Se estudió a pacientes que habían sido sometidos a GM al menos 12 atrás y se les midió niveles séricos de vitamina B 12, vitamina D, folato, calcio, ferritina, zinc, paratohormona y densidad mineral ósea. Además se aplicó un cuestionario de ingesta alimentaria. Se utilizó el test de Pearson o Spearman para el análisis estadístico. Resultados: Se evaluó un total de 40 pacientes con una edad promedio de 40 ± 10 años y un tiempo post operatorio de 26 ± 6 meses. El nivel promedio de vitamina D fue de 20.9 ± 10.5 ng/ml. El 43% presentó nivel bajo de vitamina D (< 20 ng/ml), un 68% presentó nivel disminuido de calcio (< 1,1 mmol/L) sin hiperparatoroidismo secundario. Se encontró anemia en un 28% y déficit de hierro en el 38% de la muestra. El déficit de ácido fólico y vitamina B12 se observó en un 13% de los pacientes. El consumo calórico promedio fue de 1.256 kcal/día, de las cuales un 54% correspondió a hidratos de carbono, un 26% a grasa y un 21% a proteínas. Conclusión: El déficit de hierro, calcio y vitamina D son los más prevalentes luego de la GM. La suplementación de vitaminas y minerales debiera ser considerada en todo paciente. Se requiere mayor estudio a largo plazo para establecer las recomendaciones específicas de suplementación luego de la GM (AU)

Introduction: Obesity is one of the largest problems in public health worldwide today. For patients with severe obesity and associated comorbidities, surgical treatment is recommended. Objective: To analyze the frequency of micronutrient deficiencies and food intake at least 12 months after sleeve gastrectomy (SG). Materials and methods: This is a cross sectional study carried out between October and December 2009 with measure of serum levels of vitamin B12, vitamin D, folate, calcium, ferritin, zinc, parathyroid hormone and bone mineral density on patients underwent SG at least 12 months before the study. A food intake questionnaire was also performed. For the statistical analysis, the Pearson or Spearman tests was used. Results: Forty patients were evaluated with a mean age of 40 ± 10 years and mean time post surgery of 26 ± 6 months. Mean plasma level of 25 OH-vitamin D was 20.9 ± 10.5 ng/ml. Forty-three percent had low levels of vitamin D (< 20 ng/ml), and 68% showed low levels of calcium (< 1,1 mmol/L) without secondary hyperparathyroidism. Anemia was present in 28% and iron deficiency occurred in 38% of these patients. Deficit of folic acid and vitamin B12 were observed in 13% of the patients. Average daily food intake was 1,256 kcal, 54% of total calories as carbohydrates, 26% as fat and 21% as protein. Conclusion: Iron, calcium and vitamin D are the most prevalent micronutrient deficiencies after SG. Long-term vitamin and mineral supplementation should be considered on every patient. Additional long-term studies are needed to establish specific supplementation recommendations after SG (AU)

Más allá del sodio: cambios en la dieta y su efecto en hipertensión / Beyond sodium: diet changes and their effect on hypertension

Resumen: La hipertensión arterial (HTA) es un importante factor de riesgo cardiovascular y su prevalencia aumenta con la edad, dado el aumento de la expectativa de vida de nuestra población esta condición constituye una prioridad a nivel de salud pública. Tanto para el tratamiento como para la prevención de la HTA son importantes las medidas no farmacológicas como cambios en el estilo de vida y especialmente la alimentación. Además de la restricción de sodio, existen otras medias dietéticas que han demostrado estar asociadas con un mejor control de la HTA en diversos ensayos clínicos, tales como la reducción del peso corporal, la dieta rica en frutas y verduras, el mayor consumo de potasio y magnesio, la vitamina D, los ácidos grasos ome-ga-3, los flavonoides y la disminución de la ingesta de sacarosa, fructosa, cafeína y alcohol. Dado la gran prevalencia de HTA en nuestro país del orden de un 26,9 por ciento, es importante dar a conocer medidas dietéticas que nos permitirán un mejor control de la presión en pacientes hipertensos y un retraso de la aparición de esta enfermedad en sujetos sanos, además de su incorporación en campañas de educación nutricional poblacional por parte de las autoridades sanitarias.

Hypertension is an important cardiovascular risk factor and its prevalence increases with age. Given the rising life expectancy in Chile, the prevention of hypertension is a priority for public health policies. Non pharmacological therapies, such as life style and diet changes are especially important. In addition to sodium restriction, several clinical studies have shown that other dietary interventions, such as an increased fruit and vegetable content of diet, higher intake of potassium and magnesium, vitamin D, omega-3 fatty acids, flavonoids, decreased intake of sucrose, fructose, caffeine and alcohol, lead to better control of hypertension. Given de high prevalence of hypertension in Chile (26.9 per cent overall) better information about the benefits of diet changes might be very important in order to help prevent and delay the appearance of hypertension. Appropriate public educational policies should be implemented by the sanitary authorities.

Mediterranean diet and red wine protect against oxidative damage in young volunteers.

OBJECTIVE: To assess the effect on oxidative damage of the administration of a Mediterranean diet (MD) compared with an Occidental diet (OD), in young adult volunteers, with or without the concomitant intake of red wine. DESIGN: Forty-two omnivorous male students 20-27 years old were given either diet for 3 months. During the first and third month they received the prepared diets alone but during the second month they also had 240 ml/day of red wine. Blood and urine samples were taken at 0, 30, 60, and 90 days for analyses. A linear mixed effect model was used to compare the effect of both diets and wine, controlling values by baseline measurements. RESULTS: MD increased plasma vitamin C, beta-carotene and total antioxidant reactivity (TAR). OD increased plasma vitamin E. Wine supplementation, analyzed combining both diet groups, raised plasma vitamin C, beta-carotene, uric acid, TAR, plasma and urinary polyphenols and decreased plasma vitamin E. Also wine intake increased concentration of red blood cell (RBC) glutathione while significantly decreasing plasma glutathione. In oxidative damage measurements OD group showed higher concentration of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in DNA from peripheral blood leukocytes and plasma nitrotyrosine, when compared with MD group. Wine intake significantly decreased 8-OHdG and plasma nitrotyrosine in both diets, particularly in OD. CONCLUSION: Volunteers on MD showed better antioxidant defenses and less oxidative damage than those on OD. Moderate wine consumption improved antioxidant defenses in both groups and counteracted the oxidative damage observed with OD.