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1.
Clin Nutr ; 39(12): 3779-3785, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32402684

RESUMO

BACKGROUND: Iron deficiency (ID) is one of the most common postoperative deficiencies that may develop after Roux-en-Y gastric bypass (RYGB). The optimal mode of treatment is uncertain. AIM: To compare the efficacy of oral ferrous fumarate (FF), oral ferrous gluconate (FG), and a single intravenous infusion of ferric carboxymaltose (FCM) in women with ID after RYGB. METHODS: Multicenter randomized controlled trial including 120 women with a serum ferritin <20 µg/l during follow-up after RYGB. They were randomized into three groups: 41 patients were treated with FF 200 mg three times a day (total daily dose: 195 mg elemental iron), 39 received FG 695 mg twice a day (total daily dose: 160 mg elemental iron) for three months, and 39 patients were treated with a single intravenous dose of FCM (1000 mg elemental iron). Serum ferritin levels were measured at six weeks, and three, six and twelve months after the start of supplementation. RESULTS: At three months, persistence of ID was observed in 29.4% and 42.4% of the patients treated with FF and FG, respectively, but in none of those treated with FCM (p < 0.001). Over the next nine months, recurrence of ID was observed in 56.5% of patients treated with FF, in 52.9% treated with FG, and in 27.8% of those treated with FCM. Adverse effects were most common during oral treatment. CONCLUSION: In women developing ID after RYGB, a single dose of intravenous FCM is more effective and better tolerated than the standard treatment with either FF or FG. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE: The study was registered at clinicaltrials.gov under number NCT02271997.


Assuntos
Suplementos Nutricionais , Derivação Gástrica/efeitos adversos , Compostos de Ferro/administração & dosagem , Deficiências de Ferro , Complicações Pós-Operatórias/terapia , Administração Intravenosa , Administração Oral , Adulto , Feminino , Compostos Férricos/administração & dosagem , Ferritinas/sangue , Compostos Ferrosos/administração & dosagem , Humanos , Maltose/administração & dosagem , Maltose/análogos & derivados , Complicações Pós-Operatórias/sangue , Resultado do Tratamento
2.
Obes Surg ; 29(5): 1638-1643, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30725428

RESUMO

INTRODUCTION: Patients with morbid obesity undergoing metabolic surgery are prone to develop vitamin and mineral deficiencies, which may worsen in time. In order to prevent these deficiencies after metabolic surgery, all patients are advised to take daily multivitamin supplementation. The aim of the study was to assess the cost-effectiveness of specially developed multivitamins (WLS Forte®) for metabolic surgery and over-the-counter (standard) multivitamin supplementation (sMVS). METHODS: This cost-effectiveness analysis was preformed alongside an RCT for the Netherlands. Between June 2011 and March 2012, a total of 148 patients were randomized to one tablet daily of either WLS Forte® or sMVS. The patients were followed for 12 months. Data on costs within the health sector and outside the health sector were collected. The primary outcome is financial and logistic advantages, in terms of less patient visits to the outpatient department and the relevant costs to the employer due to absenteeism. RESULTS: In total, 10 (14%) patients in the WLS Forte® group versus 23 (30%) patients in the sMVS group developed a deficiency. The costs for the WLS forte® supplement were €38 versus €23 for sMVS. Additional return visits and associated costs for medical staff were the largest costs, up to 43% in the sMVS group. Total costs for supplementation with sMVS were €243 versus €134 for WLS Forte®. CONCLUSION: Preventing deficiencies with WLS Forte® seem initially more expensive than sMVS. However, treatment with WLS Forte® resulted in less vitamin and mineral deficiencies, which eventually resulted in less overall costs.


Assuntos
Absenteísmo , Assistência Ambulatorial/economia , Deficiência de Vitaminas/prevenção & controle , Derivação Gástrica/efeitos adversos , Vitaminas/economia , Vitaminas/uso terapêutico , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Deficiência de Vitaminas/economia , Deficiência de Vitaminas/etiologia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Adulto Jovem
3.
Obes Surg ; 28(6): 1738-1744, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29327182

RESUMO

INTRODUCTION: Iron deficiency is one of the most common deficiencies that may occur after Roux-en-Y gastric bypass (RYGB). Little is known about the optimal treatment of post-RYGB iron deficiency. AIM: The aim of this study is to evaluate the changes in iron absorption characteristics after RYGB for two oral iron formulations, one presented in tablet form and one as in the form of a solution. METHOD: Iron absorption in 24 obese women was studied before and 1 month after RYGB. Twelve patients were tested with a single dose of 600 mg ferrous fumarate in tablet form (195 mg of elementary iron, group 1), and 12 patients received a single dose of 1390 mg ferrous gluconate as a solution (160 mg of elementary iron, group 2). Serum iron levels were measured before (T0) and every hour after ingestion of the supplement (T1-T9). RESULTS: Before surgery, iron absorption was similar for the two supplements (P = 0.71). However, RYGB was associated with a decrease in fumarate iron absorption (P < 0.001) but did not affect gluconate iron absorption (P = 0.13). Postoperative absorption of fumarate iron was significantly lower than gluconate iron at T1 (P < 0.05), but the overall difference over 9 h did not reach statistical significance (P = 0.53). CONCLUSION: RYGB adversely affects the absorption of ferrous fumarate tablets but not that of solubilized ferrous gluconate. A solubilized supplement is therefore preferred as the supplement of first choice after RYGB.


Assuntos
Derivação Gástrica , Ferro , Suplementos Nutricionais , Feminino , Compostos Ferrosos/administração & dosagem , Compostos Ferrosos/metabolismo , Compostos Ferrosos/uso terapêutico , Derivação Gástrica/efeitos adversos , Derivação Gástrica/estatística & dados numéricos , Humanos , Ferro/sangue , Ferro/metabolismo , Deficiências de Ferro , Obesidade Mórbida/cirurgia
4.
Obes Surg ; 28(1): 234-241, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28861696

RESUMO

BACKGROUND: Vitamin and mineral deficiencies are a major concern after biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS). Evidence-based guidelines how to prevent or how to treat deficiencies in these patients are currently lacking. The aim of the current study is to give an overview of postsurgical deficiencies and how to prevent and treat these deficiencies. METHODS: Retrospective evaluation of a 1-year structured monitoring and treatment schedule for various deficiencies in 34 patients after BPD or BPD/DS. RESULTS: Patients were introduced into the program 12-90 months after surgery. Vitamin B1, B6, B9, and B12 deficiencies could be prevented by mean daily doses of 2.75 mg, 980 µg, 600 µg, and 350 µg, respectively. However, many patients continued to develop deficiencies of vitamin A, D, iron, calcium, and zinc despite major dose adjustments. Current observations suggest that at least total daily doses of 200 mg Fe in premenopausal women and 100 mg in men, 100 mg of Zinc, 3000 mg of calcium, and weekly doses of at least 50,000 IU solubilized vitamin A and vitamin D are needed to prevent the occurrence of major deficiencies. CONCLUSION: Exceptionally high supplementation doses are needed to prevent and treat vitamin and mineral deficiencies in patients after BPD or BPD/DS. Further refinement and simplification of treatment schedules is needed. Focus on improvement of compliance to treatment is recommended.


Assuntos
Desvio Biliopancreático/efeitos adversos , Desnutrição/etiologia , Desnutrição/terapia , Minerais/metabolismo , Obesidade Mórbida/cirurgia , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Deficiência de Vitaminas/etiologia , Deficiência de Vitaminas/metabolismo , Deficiência de Vitaminas/terapia , Desvio Biliopancreático/métodos , Deficiências Nutricionais/etiologia , Deficiências Nutricionais/terapia , Duodeno/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Desnutrição/metabolismo , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Surg Obes Relat Dis ; 12(8): 1548-1553, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27396549

RESUMO

BACKGROUND: After Roux-en-Y gastric bypass, calcium and vitamin D deficiencies are frequently reported. In the presence of adequate vitamin D levels, calcium deficiency is caused by a lower efficacy of the intestinal calcium transport. OBJECTIVE: To investigate whether the use of a simple clinical score quantifying bowel habits (fecal score [FS]) correlates with the degree of secondary hyperparathyroidism that arises to compensate for calcium deficiency postsurgery. SETTING: Large peripheral hospital. METHODS: Seventy-five patients supplemented with calcium and vitamin D were prospectively studied before and 6 and 12 months after Roux-en-Y gastric bypass. FS, calcium (mmol/L), phosphate (mmol/L), magnesium (mmol/L), vitamin D (nmol/L), and parathyroid hormone (PTH; pmol/L) were measured in each patient. RESULTS: Mean body mass index was 44.7±5.4 kg/m2 preoperatively and decreased to 34.3±5.0 kg/m2 at 6 months and 30.8±4.8 kg/m2 at 12 months, corresponding to a total weight loss of 23.2±5.9% and 30.9±8.3% respectively. There were no significant changes in serum calcium levels. Mean PTH levels rose from 3.5 pmol/L at baseline to 4.1 pmol/L at 6 months (P = .01) and to 4.9 pmol/L at 12 months (P<.001). Nine patients (12%) had increased PTH levels at 6 months, and 14 patients (19%) had increased PTH levels at 12 months. A significant positive correlation between FS and PTH at 12 months was found, which persisted after adjusting for vitamin D levels. CONCLUSION: FS is positively correlated with secondary hyperparathyroidism using vitamin D-adjusted PTH levels as a biochemical marker. The present study in humans confirms the relation reported in animal studies. These results emphasize that managing stool habits are important after bariatric surgery.


Assuntos
Diarreia/etiologia , Derivação Gástrica , Hiperparatireoidismo Secundário/etiologia , Cálcio/deficiência , Cálcio/metabolismo , Carbonato de Cálcio/administração & dosagem , Defecação/fisiologia , Suplementos Nutricionais , Feminino , Humanos , Absorção Intestinal/fisiologia , Magnésio/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Hormônio Paratireóideo/metabolismo , Fosfatos/metabolismo , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , Estudos Prospectivos , Vitamina D/administração & dosagem , Vitamina D/análogos & derivados , Vitamina D/metabolismo , Deficiência de Vitamina D/dietoterapia
6.
Surg Obes Relat Dis ; 12(3): 659-667, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26947791

RESUMO

BACKGROUND: Vitamin and mineral deficiencies are common after Roux-en-Y gastric bypass (RYGB) surgery. In particular, inadequate serum concentrations of ferritin and vitamin B12 have been found in 11% and 23% (respectively) of patients using a standard multivitamin supplement (sMVS) 1 year after RYGB. OBJECTIVE: To evaluate the effectiveness and safety of Weight Loss Surgery (WLS) Forte® (a pharmaceutical-grade, optimized multivitamin supplement) compared with an sMVS and a control group (nonuser) 3 years after RYGB. SETTING: General hospital specialized in bariatric surgery. METHODS: A follow-up cohort study of a triple-blind randomized, controlled clinical trial. RESULTS: At baseline 148 patients were enrolled (74 [50%] in the sMVS group and 74 [50%] in the WLS Forte group). After a mean follow-up of 36 months, 11 (7%) patients were lost to follow-up, of whom 2 were secondary to death. At the end of the study, 11 (17%) patients in the WLS Forte and 17 (24%) in the sMVS group stopped using a supplement. In addition, 64 (47%) patients were using WLS Forte and 45 (33%) patients a sMVS. Patient characteristics and follow-up length were comparable between the groups. Significantly more patients were diagnosed with anemia (16% versus 3% [P = .021]), a ferritin deficiency (14% versus 3% [P = .043]), and a zinc deficiency (8% versus 0% [P = .033]) in the sMVS group compared with WLS Forte. Five patients developed a vitamin B12 deficiency while using WLS Forte, versus 15 of sMVS users (P = .001). No adverse events occurred that were related to supplement use. CONCLUSION: At 3 years postoperative of RYGB, an optimized multivitamin supplement (WLS Forte) was more effective in reducing anemia and ferritin, vitamin B12, and zinc deficiencies compared with a standard supplement and control.


Assuntos
Deficiência de Vitaminas/prevenção & controle , Suplementos Nutricionais , Derivação Gástrica/efeitos adversos , Oligoelementos/deficiência , Vitaminas/administração & dosagem , Adulto , Feminino , Ferritinas/deficiência , Seguimentos , Humanos , Masculino , Desnutrição/prevenção & controle , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/prevenção & controle
7.
Surg Obes Relat Dis ; 12(2): 338-44, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26826922

RESUMO

BACKGROUND: Reduced serum vitamin K levels are frequently observed after biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS). The criteria for treatment are not precisely defined. OBJECTIVES: To assess the effects of standardized vitamin K supplementation in patients who develop vitamin K deficiency after BPD or BPD/DS. SETTING: Teaching hospital specializing in bariatric surgery. METHODS: Serum vitamin K levels, clotting times, and vitamin K-dependent coagulation factors were measured after an overnight fast at baseline and then at 4 days and 1, 4, and 52 weeks after the start of vitamin K supplementation in 10 consecutive patients who had developed severe vitamin K deficiency after BPD or BPD/DS. Vitamin K was administered in a dose of 5 mg/d for 1 week, followed by a maintenance dose of 5 mg once a week. RESULTS: At baseline, all patients had serum vitamin K1 levels below the limit of detection, but none reported symptoms of easy bleeding. Minor prolongation of the prothrombin time and minimal decreases of some coagulation factors were observed in a minority of patients. During the first week of vitamin K loading, median serum vitamin K1 levels rose into the high normal range. During maintenance treatment, median vitamin K1 levels settled in the low normal range. CONCLUSION: Vitamin K1 deficiency in patients with BPD or BPD/DS is not commonly associated with bleeding or clinically relevant decreases in coagulation factor activity. We hypothesize that vitamin K2 production in the large intestine is usually sufficient to compensate for vitamin K1 deficiency and to maintain total liver vitamin K stores within the range required for (near) normal coagulation factor production.


Assuntos
Desvio Biliopancreático/efeitos adversos , Gerenciamento Clínico , Duodeno/cirurgia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/terapia , Deficiência de Vitamina K/terapia , Suplementos Nutricionais , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Deficiência de Vitamina K/etiologia
8.
Obes Surg ; 25(9): 1626-32, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25595384

RESUMO

INTRODUCTION: Malabsorptive bariatric procedures, like the biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS), have excellent results in terms of weight loss. However, these malabsorptive techniques are associated with severe malnutrition and vitamin deficiencies. The aim of this study was to evaluate the vitamin and mineral status after BPD and BPD/DS in the long term. METHODS: All patients who underwent BPD or BPD/DS were selected and invited for an additional follow-up (FU) visit, including blood sampling for vitamin and mineral levels. RESULTS: Forty patients completed the blood sampling with a median FU of 42 (range 12-90) months. At that time, all patients used some kind of supplementation. However, 93 % of all patients were diagnosed with a deficiency. There were no significant differences in mean serum level vitamins and minerals between BPD and BPD/DS. Forty-three per cent of the patients were anaemic, and 40 % had an iron deficiency (ID). High deficiency rates for fat-soluble vitamins were present: vitamin A in 28 %, vitamin D in 60 %, vitamin E in 10 % and vitamin K in 60 % of the patients. Hypervitaminosis was found in 43 % of the patients for vitamin B1 and in 50 % for vitamin B6. CONCLUSION: High numbers of vitamin and mineral deficiencies were found after BPD and BPD/DS despite vitamin supplementation. Anaemia, ID and deficiencies for fat-soluble vitamins are frequently diagnosed. Repeated monitoring is necessary to detect deficiencies at an early stage. Taking all of this into consideration, a stringent multivitamin supplementation regimen should be implemented after malabsorptive procedures.


Assuntos
Anemia/etiologia , Deficiência de Vitaminas/etiologia , Desvio Biliopancreático/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Tiamina/sangue , Vitamina B 6/sangue
9.
Medicine (Baltimore) ; 93(25): e169, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25437032

RESUMO

Iron, vitamin B12, and folic acid deficiencies are among the most common deficiencies occurring after laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study evaluates the effectiveness of a specially designed multivitamin supplement (WLS Forte, FitForMe, Rotterdam, the Netherlands) specifically developed for LRYGB patients.A triple-blind, randomized, 12-month study was conducted comparing WLS forte with a standard multivitamin supplement (sMVS) containing approximately 100% of the recommended daily allowance (RDA) for iron, vitamin B12, and folic acid. WLS Forte contains vitamin B12 14000% RDA, iron 500% RDA, and folic acid 300% RDA.In total, 148 patients (74 in each group) underwent a LRYGB procedure. Baseline characteristics were similar for both groups. Per protocol analysis demonstrated that sMVS treatment was associated with a decline in ferritin (-24.4 ±â€Š70.1 µg/L) and vitamin B12 (-45.9 ±â€Š150.3 pmol/L) over 12 months, whereas in WLS Forte patients, ferritin remained stable (+3.2 ±â€Š93.2 µg/L) and vitamin B12 increased significantly (+55.1 ±â€Š144.2 pmol/L). The number of patients developing ferritin or vitamin B12 deficiency was significantly lower with WLS Forte compared with sMVS (P < 0.05). Iron deficiency (ID) was reduced by 88% after WLS Forte compared with sMVS. Adverse events related to supplement use did not occur.An optimized multivitamin supplement is safe and reduces the development of iron and vitamin B12 deficiencies after LRYGB.


Assuntos
Deficiência de Vitaminas/prevenção & controle , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Derivação Gástrica , Ferro/administração & dosagem , Vitamina B 12/administração & dosagem , Deficiência de Ácido Fólico/prevenção & controle , Testes Hematológicos , Humanos , Países Baixos , Deficiência de Vitamina B 12/prevenção & controle , Deficiência de Vitamina D/epidemiologia
10.
Obes Surg ; 21(2): 207-11, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21088925

RESUMO

BACKGROUND: Recently, the laparoscopic sleeve gastrectomy (LSG) has become popular as a single-stage procedure for the treatment of morbid obesity and its co-morbidities. However, the incidence of micronutrient deficiencies after LSG have hardly been researched. METHODS: From January 2005 to October 2008, 60 patients underwent LSG. All patients were instructed to take daily vitamin supplements. Patients were tested for micronutrient deficiencies 6 and 12 months after surgery. RESULTS: Anemia was diagnosed in 14 (26%) patients. Iron, folic acid, and vitamin B12 deficiency was found in 23 (43%), eight (15%), and five (9%) patients, respectively. Vitamin D and albumin deficiency was diagnosed in 21 (39%) and eight (15%) patients. Hypervitaminosis A, B1, and B6 were diagnosed in 26 (48%), 17 (31%), and 13 (30%) patients, respectively. CONCLUSIONS: Due to inadequate intake and uptake of micronutrients, patients who underwent LSG are at serious risk for developing micronutrient deficiencies. Moreover, some vitamins seem to increase to chronic elevated levels with possible complications in the long-term. Multivitamins and calcium tablets should be regarded only as a minimum and supplements especially for iron, vitamin B12, vitamin D, and calcium should be added to this regimen based on regular blood testing.


Assuntos
Gastrectomia/efeitos adversos , Gastrectomia/métodos , Micronutrientes/deficiência , Obesidade Mórbida/cirurgia , Redução de Peso , Adolescente , Adulto , Idoso , Deficiências Nutricionais/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
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