RESUMEN
BACKGROUND: Despite multiple beneficial effects of weight loss after laparoscopic Roux-en-Y gastric bypass (LRYGB), the influence on bone mineral density (BMD) remains largely unknown. Our objective was to evaluate the changes in BMD and serum/urine bone markers after LRYGB. METHODS: Thirty-four women undergoing LRYGB were prospectively enrolled and underwent bone densitometry and serum/urine analysis preoperatively and 1 year postoperative. Changes≥.025 g/cm(2) in hip, femoral neck, and spine BMD and decreases>2% in total BMD were considered significant. Statistical analysis included paired t tests and McNemar's test. RESULTS: Mean age was 44.6 years. Body mass index at the preoperative and 1-year postoperative intervals were 46.7 and 29.6 kg/m(2), respectively. Mean hip, femoral neck, and spine (L1-L4) BMD was 1.191 versus 1.087 g/cm(2) (P< .001), 1.105 versus 1.032 g/cm(2) (P< .001), and 1.323 versus 1.277 g/cm(2) (P< .001) at the preoperative and 1 year postoperative intervals, respectively. Mean total BMD decreased from 1.328 preoperatively to 1.251 g/cm(2) at 1 year postoperative (P<.001). The decreases in BMD were 5.8%, 6.5%, 3.5%, and 8.8% for hip, femoral neck, spine (L1-L4) and total BMD from preoperative to 1 year postoperative. The proportion of patients with low vitamin D levels decreased from 55% preoperatively to 21% at 1 year postoperative (P = .004). Elevated osteocalcin and bone alkaline phosphatase was observed in 4% and 63% (P<.001), and 14% and 41% (P = .011) of patients preoperatively and at 1 year postoperative, respectively. CONCLUSION: BMD and bone markers changed significantly after LRYGB. Current recommendations for supplementation in post-LRYGB women may need to be reevaluated.
Asunto(s)
Densidad Ósea/fisiología , Resorción Ósea/diagnóstico , Derivación Gástrica/métodos , Osteocalcina/sangre , Vitamina D/sangre , Adulto , Factores de Edad , Biomarcadores/sangre , Índice de Masa Corporal , Resorción Ósea/tratamiento farmacológico , Resorción Ósea/etiología , Estudios de Cohortes , Suplementos Dietéticos , Femenino , Estudios de Seguimiento , Derivación Gástrica/efectos adversos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Persona de Mediana Edad , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/cirugía , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Medición de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: To determine the prevalence of ascorbic acid deficiency in the surgical population, whether the body mass index (BMI) has an effect on ascorbic acid concentrations; and whether an association exists between ascorbic acid deficiency and adverse surgical outcomes. METHODS: Preoperative plasma ascorbic acid concentrations were prospectively assessed in 20-60-year-old patients undergoing elective abdominal surgery. Ascorbic acid deficiency was defined as any concentration < or =0.3 mg/dL and depletion as any concentration >0.3-0.59 mg/dL. RESULTS: Of the 266 patients evaluated, 167 had a BMI > or =35 kg/m(2). A greater BMI was associated with lower mean ascorbic acid concentrations (P = .021). Of the 266 patients, 96 (36%) had abnormally low ascorbic acid concentrations, with 57 (21%) depleted and 39 (15%) deficient. The factors associated with decreased mean ascorbic acid concentrations included younger age (P = .004) and limited vegetable and fruit intake (P = .026). Ascorbic acid supplementation was associated with lower depletion and deficiency rates (P = .001). CONCLUSION: Ascorbic acid depletion and deficiency occur within the surgical population. The contributing factors included younger age, limited intake of fruits and vegetables, lack of vitamin supplementation, and greater BMI. Low concentrations of ascorbic acid did not affect the surgical outcome.