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1.
Nutrients ; 16(4)2024 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-38398839

RESUMEN

BACKGROUND: Plant-based dietary patterns are a source of different amounts and proportions of fatty acids (FAs) from those in traditional diets. Information about the full FAs profile provided by plant-based diets is widely lacking. The aim of this study was to present the exact serum profiles of FAs among people on a plant-based diet compared with omnivorous subjects. METHODS: FAs compositions and inflammation statuses (based on serum C-reactive protein (CRP) levels) were studied in serum samples obtained from 102 female volunteers (divided into four groups: vegans, vegetarians, pescatarians, and omnivores). The quality of the volunteers' diets was assessed based on seven-day dietary records. RESULTS: Both vegans and vegetarians had lower total n-3 PUFAs, EPA, and DHA serum levels than omnivores. Decreased levels of these FAs presumably did not cause inflammation in vegetarians and vegans, as vegetarians had similar serum levels of CRP compared to omnivores, and vegans had even lower levels. CONCLUSION: The analysis of serum FAs and CRP levels in vegetarians and vegans suggests that factors other than diet alone influence inflammation and overall health status. Further research on long-term plant-based diet users is needed to better understand this issue, and supplementation with EPA and DHA is worth considering in vegans and vegetarians.


Asunto(s)
Dieta Vegetariana , Ácidos Grasos , Humanos , Femenino , Dieta , Vegetarianos , Dieta Vegana , Estado de Salud , Inflamación
2.
Obes Surg ; 34(1): 77-85, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37964164

RESUMEN

INTRODUCTION: One anastomosis gastric bypass (OAGB) is one option of a revisional procedure for failed sleeve gastrectomy. Moreover, it can be used as a primary bariatric procedure, and is an effective surgery resulting in significant weight loss and the resolution or improvement of obesity-associated medical problems, accompanied by low perioperative complications. However, as with any therapy, OAGB has its limitations, including micronutrient deficiency or malnutrition. In our study, we compared the fatty acid (FA) profile in serum of patients after both primary OAGB (pOAGB) and revisional OAGB (rOAGB) to identify potential postsurgical FA alterations. METHODS: This is a retrospective study on patients with obesity who underwent OAGB procedures (pOAGB n=68; rOAGB n=17), conducted from 2016 to 2018. In blood, we analyzed a series of biochemical parameters, and in the serum, the FA profile was determined using gas chromatography-mass spectrometry. RESULTS: The percentage of excess BMI loss (% EBMIL) after pOAGB was 73.5 ± 2.47% in comparison to 45.9 ± 4.15% in the rOAGB group (p<0.001). In contrast to the lack of effect of rOAGB on most polyunsaturated FAs, in the pOAGB group, there was a decrease in eicosapentaenoic acid, and eicosatetraenoic and docosahexaenoic acid levels (p<0.001). We also found a decrease in very long-chain FAs (VLCFAs) and an increase in branched-chain FAs (BCFAs) after both types of OAGB procedure. CONCLUSIONS: Both OAGB procedures improved the profile of most FAs, leading to a decrease in VLCFAs, which are considered harmful, and an improvement in BCFAs, which are considered to be beneficial. There is a need to further investigate the possibility of n-3 polyunsaturated FA supplementation after pOAGB, due to the large decrease in these FAs after pOAGB.


Asunto(s)
Derivación Gástrica , Obesidad Mórbida , Humanos , Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Ácidos Grasos , Obesidad/cirugía , Gastrectomía/métodos
3.
Biosci Rep ; 43(10)2023 10 31.
Artículo en Inglés | MEDLINE | ID: mdl-37850622

RESUMEN

Fatty acids (FAs) are known to play an important role in human metabolism; however, still little is known about the functions of certain FA classes present in blood at relatively low concentrations. Examples of such compounds include branched-chain fatty acids (BCFAs). Recently, lowered BCFAs blood concentration was noticed in obese patients. An inverse correlation was found between serum concentrations of BCFAs and triglyceride levels, as well as C-reactive protein (CRP) concentration. Obesity is the most frequently observed component of metabolic syndrome and both disorders are accompanied by the dysregulation of FAs metabolism. However, not all of them are well understood. Our study is the first attempt at presenting the opposite effects of an iso-BCFA (14-methylpentadecanoic acid, 14-MPA) and an anteiso-BCFA (12-methyltetradecanoic acid, 12-MTA) on selected genes related to fatty acid synthesis and inflammation: FASN, SREBP1, CRP, and IL-6 in the HepG2 cell line. We observed lowered expression of FASN, SREBP1, CRP, and IL-6 in cells treated with 14-MPA in comparison with control cells. In contrast, supplementation with 12-MTA caused opposite effects: increased mRNA levels of FASN, CRP, and IL-6. 12-MTA did not influence SREBP1 expression. The results of our preliminary study may suggest potential benefits of the supplementation of iso-BCFAs in obese patients, for inflammation and hypertriglyceridemia prevention.


Asunto(s)
Proteína C-Reactiva , Interleucina-6 , Humanos , Proteína C-Reactiva/genética , Interleucina-6/genética , Ácidos Grasos/metabolismo , Obesidad/genética , Ácido Graso Sintasas/genética , Hepatocitos/metabolismo , Inflamación
4.
Obes Surg ; 33(4): 1228-1236, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36829082

RESUMEN

INTRODUCTION: Obesity is associated with disturbed gut microbiota homeostasis that translates into altered intestinal and blood metabolite profiles. The long-chain fatty acid (LCFA) may be absorbed in the intestine, but until now, their composition in intestinal contents of patients with obesity has not been studied. The aim of the present study was to verify whether obesity is related to any changes in fecal LCFA content and whether intestinal LCFA content may be associated with the health status of patients with obesity. METHODS: The fatty acid composition has been studied in stool samples obtained from 26 patients with morbid obesity and 25 lean subjects by gas chromatography-mass spectrometry. The dietary habits were assessed using the Food Frequency Questionnaire (FFQ-6). RESULTS: Our results show for the first time that lean subjects and patients with obesity differ in their stool LCFA profiles. The levels of most n-3 polyunsaturated fatty acids (PUFAs) and n-6 PUFAs were significantly higher in fecal samples from people with obesity than in those from lean controls. CONCLUSIONS: Based on the current knowledge, we have defined three hypotheses that may explain proving the cause-and-effect relationships observed differences in fecal LCFA profiles between patients with obesity and lean subjects. They may be related to alterations in fat digestion and/or LCFA absorption and diet. However, proving the cause-and-effect relationships requires further research.


Asunto(s)
Ácidos Grasos Omega-3 , Obesidad Mórbida , Humanos , Contenido Digestivo , Obesidad Mórbida/cirugía , Ácidos Grasos Insaturados , Ácidos Grasos/metabolismo
5.
Nutrients ; 14(11)2022 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-35684110

RESUMEN

Recently, we have demonstrated a decreased level of iso-branched-chain fatty acids (iso-BCFAs) in patients with excessive weight. However, it is still unclear whether BCFAs may influence lipid metabolism and inflammation in lipogenic tissues. To verify this, human visceral adipocytes were cultured with three different concentrations of selected iso-BCFA (14-methylpentadecanoic acid) and anteiso-BCFA (12-methyltetradecanoic acid), and then the expression of genes associated with lipid metabolism (FASN-fatty acid synthase; SREBP1-sterol regulatory element-binding protein 1; SCD1-stearoyl-CoA desaturase; ELOVL4-fatty acid elongase 4; ELOVL6-fatty acid elongase 6; FADS2-fatty acid desaturase 2; FADS1-fatty acid desaturase 1) and inflammation (COX-2-cyclooxygenase 2; ALOX-15-lipoxygenase 15; IL-6-interleukin 6) were determined. This study demonstrates for the first time that incubation with iso-BCFA decreases the expression of adipocyte genes that are associated with lipid metabolism (except FASN) and inflammation. These findings suggest that changes in the iso-BCFA profile in obese patients may contribute to adipose inflammation and dyslipidemia. Further studies should evaluate whether iso-BCFA supplementation in obese patients would be beneficial.


Asunto(s)
Ácidos Grasos , Estearoil-CoA Desaturasa , Adipocitos/metabolismo , Elongasas de Ácidos Grasos/genética , Ácidos Grasos/metabolismo , Humanos , Inflamación/genética , Obesidad/genética , Estearoil-CoA Desaturasa/genética
6.
Obes Surg ; 31(10): 4264-4271, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34255274

RESUMEN

PURPOSE: Obesity is associated with alterations in serum fatty acid profiles. One-anastomosis gastric bypass is a type of bariatric surgery used in the treatment of morbid obesity. The aim of this study was to establish if, between 6 and 9 months after this procedure, the fatty acid composition in the serum of patients normalizes to values similar to the healthy, lean population. MATERIALS/METHODS: The study included 46 patients that underwent surgical treatment for obesity with one-anastomosis gastric bypass. The serum fatty acid composition was determined using gas chromatography-mass spectrometry. Principal component analysis was conducted to detect the differences between fatty acid profiles in patients pre- and post-surgery, and in 29 control nonobese subjects. RESULTS: Patients with morbid obesity were characterized by lowered levels of beneficial odd- and branched-chain fatty acids and polyunsaturated fatty acids. While the odd- and branched-chain fatty acid amounts normalized 6-9 months after bariatric treatment, the polyunsaturated fatty acid levels did not. Moreover, the total fatty acid profiles of patients pre- and post-bariatric surgery were still markedly different than those of lean, healthy controls. CONCLUSION: Following one-anastomosis gastric bypass, there are some beneficial changes in serum fatty acids in treated patients, possibly due to weight loss and dietary regimen changes. However, they may be insufficient to restore the proper levels of other fatty acids, which may need to be additionally supplemented.


Asunto(s)
Cirugía Bariátrica , Derivación Gástrica , Obesidad Mórbida , Ácidos Grasos , Humanos , Obesidad Mórbida/cirugía , Pérdida de Peso
7.
Nutrients ; 13(3)2021 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-33671115

RESUMEN

Patients with end-stage kidney disease, treated with renal transplantation, are at increased risk of cardio-vascular disease (CVD) and cardio-vascular mortality. They are also characterized by an atherogenic dyslipidemia. Alterations of the fatty acids (FA) profile contribute to increased cardio-vascular risk in the general population. In the current study, we test the hypothesis that kidney transplantation is associated with ab-normalities in FA profile. The FA profile was analyzed by gas chromatography-mass spectrometry in 198 renal transplant recipients, and 48 control subjects. The most profound differences between renal transplant patients and controls were related to the content of branched chain FA, monounsaturated FA, and n-6 polyunsaturated FA, respectively. The FA profile significantly separated the patients from the controls in the principal component analysis (PCA). The abnormalities of FA profile showed a tendency for normalization in long-term kidney recipients, as compared to patients with recent transplants. The n-3 PUFA content demonstrated a strong inverse association with the presence of inflammation. Most profound alterations of the FA profile were observed in patients with impaired graft function (glomerular filtration rate < 45 mL/min). The study demonstrated significant disorders of the FA profile in kidney transplant recipients, which might contribute to cardio-vascular risk in this vulnerable patient population.


Asunto(s)
Ácidos Grasos/sangre , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Receptores de Trasplantes , Adulto , Anciano , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , HDL-Colesterol/sangre , Dislipidemias/sangre , Ácidos Grasos Monoinsaturados/sangre , Ácidos Grasos Omega-3/sangre , Ácidos Grasos Omega-6/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertrigliceridemia/sangre , Inflamación/sangre , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad
8.
Transplant Proc ; 52(8): 2324-2330, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32334793

RESUMEN

BACKGROUND: Disturbances in polyunsaturated fatty acids (PUFA) could predispose renal transplant (RTx) patients to cardiovascular risk. The purpose of this study was to evaluate serum content of ω-3 and ω-6 PUFA in RTx subjects, in comparison to nontransplanted chronic kidney disease (CKD) patients in predialysis stages and to healthy controls. In the second part of the study, PUFA were analyzed in subcutaneous adipose tissue of CKD subjects at the time of kidney transplantation. METHODS: The first part of the study was conducted in a cohort (n = 134) of 3 groups: patients after renal transplantation (RTx group, n = 24), patients with CKD in stages 2-5, not on dialysis (CKD-ND group, n = 67), and controls without CKD (control group, n = 43). The fatty acids (FA) assessed by gas chromatography-mass spectrometry (GC-MS) were alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), linoleic acid (LA), and arachidonic acid (AA). Diet was assessed by food frequency questionnaire FFQ-6. In the second part of the study, the same FA were evaluated in samples of adipose tissue taken during the kidney transplantation procedure and compared with FA of controls from the adipose tissue collected during hernia surgeries. RESULTS: The first part of the study showed that RTx patients presented significantly lower serum content of all the examined PUFA, in comparison to the CKD-ND group and controls. For instance, EPA in RTx equaled 0.65 ± 0.32%, in CKD-ND 0.82 ± 0.43%, and in controls 1.06 ± 0.68% (P = .005). No significant correlations were found between serum PUFA and diet in RTx patients. The second part of the study revealed no significant difference in the adipose tissue PUFA between CKD patients at the time of kidney transplantation and controls. CONCLUSIONS: RTx patients present with low serum content of potentially beneficial PUFA. This finding does not seem to be solely due to an altered diet. Observed disorders might result from immunosuppressive drugs or other, yet undetermined, causes.


Asunto(s)
Dieta/efectos adversos , Ácidos Grasos Insaturados/sangre , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/etiología , Insuficiencia Renal Crónica/sangre , Tejido Adiposo/química , Adulto , Estudios de Cohortes , Encuestas sobre Dietas , Ácidos Docosahexaenoicos/sangre , Ácido Eicosapentaenoico/sangre , Ácidos Grasos Omega-3/sangre , Ácidos Grasos Omega-6/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Insuficiencia Renal Crónica/cirugía
9.
Sci Rep ; 10(1): 1954, 2020 02 06.
Artículo en Inglés | MEDLINE | ID: mdl-32029824

RESUMEN

Although a growing body of evidence suggests that colorectal cancer (CRC) is associated with alterations of fatty acid (FA) profiles in serum and tumor tissues, available data about polyunsaturated fatty acid (PUFA) content in CRC patients are inconclusive. Our study showed that CRC tissues contained more PUFAs than normal large intestinal mucosa. However, serum levels of PUFAs in CRC patients were lower than in healthy controls. To explain the mechanism of PUFA alterations in CRC, we measured FA uptake by the colon cancer cells and normal colon cells. The levels of PUFAs in colon cancer cell culture medium decreased significantly with incubation time, while no changes were observed in the medium in which normal colon cells were incubated. Our findings suggest that the alterations in tumor and serum PUFA profiles result from preferential uptake of these FAs by cancer cells; indeed, PUFAs are essential for formation of cell membrane phospholipids during rapid proliferation of cancer cells. This observation puts into question potential benefits of PUFA supplementation in CRC patients.


Asunto(s)
Neoplasias Colorrectales/metabolismo , Ácidos Grasos Insaturados/metabolismo , Anciano , Línea Celular Tumoral , Membrana Celular/metabolismo , Proliferación Celular/fisiología , Colon/metabolismo , Femenino , Células HT29 , Humanos , Mucosa Intestinal/metabolismo , Masculino , Fosfolípidos/metabolismo
10.
Nutrients ; 12(1)2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31936610

RESUMEN

One-anastomosis gastric bypass is a promising type of bariatric surgery, but it may lead to a deficiency in important nutrients, such as fatty acids. The short-term effects of one-anastomosis gastric bypass on serum fatty acids have not been studied thus far. Therefore, the aim of this study was to determine the effect of one-anastomosis gastric bypass on serum fatty acid composition two weeks after surgery. This study included 38 patients who underwent one-anastomosis gastric bypass as surgical treatment for morbid obesity. Serum fatty acid composition was analyzed before and two weeks after surgery using gas chromatography-mass spectrometry. We observed a decrease in essential polyunsaturated fatty acids (p < 0.001 for linolenic acid and p < 0.001 for linoleic acid) and odd-chain fatty acids (p = 0.004) in the serum of obese patients shortly after a one-anastomosis gastric bypass. Considering the benefits of the aforementioned fatty acids for human health, the implementation of a fatty-acid-rich diet or the use of supplementation may be recommended for patients immediately after one-anastomosis gastric bypass.


Asunto(s)
Ácidos Grasos Esenciales/sangre , Derivación Gástrica/métodos , Obesidad/cirugía , Adulto , Glucemia/análisis , Índice de Masa Corporal , Estudios de Cohortes , Ácidos Grasos Esenciales/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/metabolismo
11.
Molecules ; 24(17)2019 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-31450672

RESUMEN

Morus alba L. (white mulberry) has been commonly used as a functional food and for medicinal purposes. Hence, the aim of the study was to compare the phenolic profile of white mulberry commercial samples in relation to their antioxidant potential and acetylcholinesterase (AChE) inhibitory activity. It is of interest to determine whether herbal products originating from different commercial sources differ in their phenolic profiles. For this purpose, a simple and rapid high-performance liquid chromatography (HPLC) method was used for the separation and determination of ten major phenolic compounds. Total phenolic (TPC), total flavonoid (TFC), and total phenolic acid contents (TPAC), as well as l(+)-ascorbic acid (ASA) contents, were determined. The antioxidant potential was assessed by DPPH (2,2-diphenyl-1-picrylhydrazyl radical) scavenging activity and ferric-reducing/antioxidant power (FRAP) assay, while the AChE inhibitory activity was determined by the Ellman assay for water extracts. The study revealed that excluding two herbal products containing fruits and a sample containing leaves of white mulberry, yerba mate and lemon, the remaining samples were generally consistent in terms of phenolic composition as well as antioxidant potential and AChE inhibitory activity. This reflects the health-promoting properties of the samples under study. Moreover, the results showed that the water extracts of white mulberry were richer in phenolic compounds and presented higher antioxidant activity than the hydromethanolic extracts. However, the water extracts showed low inhibitory activity against AChE. Moreover, the correlation analysis indicated a high positive relationship between phenolic composition and antioxidant activity in extracts of white mulberry. Overall, the obtained results may be useful in the evaluation of new dietary supplements and food products. The water extracts of white mulberry could be used for antioxidant purposes, while the hydromethanolic extracts could be incorporated in antioxidant formulations.


Asunto(s)
Morus/química , Fenoles/química , Fenoles/farmacología , Extractos Vegetales/química , Extractos Vegetales/farmacología , Antioxidantes/química , Antioxidantes/farmacología , Ácido Ascórbico/química , Cromatografía Líquida de Alta Presión , Flavonoides , Hidroxibenzoatos , Fitoquímicos/química , Fitoquímicos/farmacología
12.
Front Physiol ; 10: 602, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31156468

RESUMEN

Exercise and supplementation with conjugated linoleic acid (CLA) are used to reduce body weight and to improve health. Applied together, they may exert a synergistic effect. However, the effects of exercise and CLA supplementation on liver metabolism are poorly understood. The aim of this study was to examine the influence of exercise and CLA supplementation on fatty acids (FA) composition in mouse liver. We analyzed 44 of known FAs of this organ by gas chromatography-mass spectrometry. Our results demonstrated that exercise contributed to a decrease in odd-chain FA and an increase in n-6 polyunsaturated FA contents. In turn, CLA stimulated an increase in branched-chain FAs and n-3 polyunsaturated FAs. Exercise combined with CLA supplementation caused a substantial increase in branched-chain FA content and a slight increase in n-6 polyunsaturated FAs. The elevated liver content of branched-chain FAs after the exercise combined with CLA supplementation, as well as the increase in n-3 polyunsaturated FAs after CLA may be favorable since both these FA groups were previously shown to produce health benefits. However, the expression pattern of enzymes involved in fatty acid synthesis did not match the changes in FA composition. Thus, the mechanism of exercise- and CLA-induced changes in liver FA profile is yet to be established. Also, the consequences of CLA- and/or exercise-induced changes in the composition of liver FAs need to be elucidated.

13.
Ren Fail ; 39(1): 406-412, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28260396

RESUMEN

Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular mortality. Lipid disorders, a constant feature of CKD, might contribute to this state. The aim of this study was to evaluate n-3 polyunsaturated fatty acids (PUFA) composition in CKD patients treated with dialysis, in comparison to the general population and to assess possible associations between the n-3 PUFA profile and anthropometric variables. Thirty-three prevalent dialysis patients were studied and compared with an age- and sex-adjusted control group of 22 patients. Fatty acid composition in serum was analyzed by gas chromatography with a mass spectrometer detector (GC-MS) and anthropometric measures were assessed by bioimpedance spectroscopy. The fatty acid profile of dialyzed patients was characterized by a significantly lower percentage content of n-3 PUFA. For α-linolenic acid (ALA), it was 0.21 ± 0.09% in dialysis patients versus 0.33 ± 0.11% in the control group (p < .001). For eicosapentanoic acid (EPA), 0.59 ± 0.23% versus 1.15 ± 0.87% (p < .001), and for docosahexaenoic acid (DHA) 1.11 ± 0.50% versus 1.75 ± 0.87% (p < .001), respectively. The amount of n-3 PUFA decreased with time on dialysis and it correlated positively with body fat mass. For DHA, this correlation was r = .48 (p < .01) and for EPA r = .40 (p < .05). Patients with CKD have a relatively low content of n-3 PUFA which may contribute to their high cardiovascular risk. Patients with a higher content of body fat are characterized by a favorable fatty acid composition.


Asunto(s)
Tejido Adiposo , Composición Corporal , Enfermedades Cardiovasculares/metabolismo , Ácidos Grasos Omega-3/sangre , Diálisis Renal , Enfermedades Cardiovasculares/epidemiología , Ácidos Docosahexaenoicos/sangre , Ácido Eicosapentaenoico/sangre , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Persona de Mediana Edad , Obesidad/metabolismo , Pronóstico , Insuficiencia Renal Crónica/terapia , Factores de Riesgo , Ácido alfa-Linolénico/sangre
14.
Obes Surg ; 21(10): 1634-9, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21618064

RESUMEN

Bariatric surgery significantly reduces the risk of cardiovascular diseases but has no effects on hyperhomocysteinemia, the risk factor for atherogenesis. We hypothesize that the decrease in serum betaine (involved in homocysteine metabolism) concentrations, after bariatric surgery, impairs conversion of homocysteine to methionine, leading to hyperhomocysteinemia. If this is true, it may be desirable to supply patients after bariatric surgery with betaine. Serum betaine and homocysteine concentrations were measured by liquid chromatography/mass spectrometry, in 16 obese patients, before and 6 months after bariatric surgery. Ten healthy individuals with normal body mass index served as controls. Serum betaine concentrations decreased to the values lower than in controls after bariatric surgery, whereas serum homocysteine concentrations remained elevated. In patients supplemented with B(12) and folate, no effect of bariatric surgery on serum concentrations of vitamins involved in homocysteine metabolism was observed. These results suggest that betaine deficit could be responsible for maintenance of hyperhomocysteinemia after bariatric surgery. We postulate that supplementation with betaine could be of therapeutic value for the treatment of hyperhomocysteinemia after bariatric surgery.


Asunto(s)
Cirugía Bariátrica , Betaína/sangre , Obesidad/sangre , Adulto , Femenino , Homocisteína/sangre , Homocisteína/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Obesidad/cirugía
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