VITAMIN D LEVELS AND LIPID PROFILE IN PATIENTS UNDERGOING BARIATRIC SURGERY.

BACKGROUND: Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences. AIMS: To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery. METHODS: Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery. RESULTS: A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery. CONCLUSIONS: It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.

Vitamin d levels and lipid profile in patients undergoing bariatric surgery / Níveis de vitamina d e perfil lipídico em pacientes submetidos à cirurgia bariátrica

ABSTRACT BACKGROUND: Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences. AIMS: To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery. METHODS: Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery. RESULTS: A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery. CONCLUSIONS: It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.

RESUMO RACIONAL: Deficiências vitamínicas, minerais e metabólicas ocorrem no pós-operatório de cirurgia bariátrica, a curto e longo prazo, sendo intercorrências preocupantes. OBJETIVOS: Avaliar a associação dos níveis séricos de vitamina D com o perfil lipídico, em pacientes obesos submetidos à cirurgia bariátrica. MÉTODOS: Série de casos de pacientes atendidos de 2010 até 2018, em hospital privado de média e alta complexidade, submetidos à cirurgia bariátrica pelas técnicas da gastrectomia vertical e derivação gástrica em Y de Roux, acompanhados pelo mesmo cirurgião. Foram coletados dados sociodemográficos, clínicos, dados laboratoriais e antropométricos no pré-operatório, 6 meses, 12 meses e 24 meses após cirurgia. RESULTADOS: Foram acompanhados 156 indivíduos, maioria sexo feminino (75,6%), comorbidades mais frequentes foram esteatose hepática (76,3%) e hipertensão (48,27). Em relação aos níveis de vitamina D pré-operatórios, apenas 18,9% da população apresentaram níveis satisfatórios (=30 ng/mL). Observou-se redução do peso e melhora do perfil lipídico pós-cirúrgico. Sobre as correlações entre o perfil lipídico e concentração de vitamina D foram observadas correlações significativas apenas na amostra que passou pela técnica cirúrgica derivação gástrica em Y de Roux: correlação negativa entre o colesterol total e vitamina D após 2 anos de cirurgia; correlação positiva entre triglicerídeo e vitamina D 1 ano pós-operatório; e correlação negativa entre HDL e vitamina D 2 anos pós-operatório. CONCLUSÕES: é essencial acompanhar os níveis de vitamina D e perfil lipídico no pré e pós-operatório de forma rotineira a fim de evitar danos relacionados a deficiência dessa vitamina.

Ingestão dietética e nível de atividade física como preditoresde mudanças no peso e no índice de massa corporal de universitários / Ingesta dietética y nivel de actividad física como predictores de cambios en el peso y en el índice de masa corporal de universitarios / Dietary intake and level of physical activity as predictors of changes in weight and body mass index among college student

OBJETIVO: O objetivo do presente trabalho foi investigar aingestão dietética e o nível de atividade física como preditores de mudanças no peso e no índice de massa corporal (IMC) de estudantes de uma universidade pública do Nordeste do Brasil. MÉTODOS: Tratou-se de uma coorte, onde 138 estudantes foram avaliados ao início do curso e após 1 ano de vida acadêmica. Foram coletados o peso corporal e a altura, dados sobre o nível de atividade física e sobre o consumo alimentar. O modelo conceitual também considerou variáveis sociodemográficas, comportamentais, de composição corporal e distribuição de gordura corporal. RESULTADOS: A amostra foi 76,1% do sexo feminino, com média de idade de 19,7 ± 3,3 anos no baseline. Ao final do seguimento, 50,7% dos universitários ganharam mais de 0,5Kg de peso, dentre esses, a média de ganho de peso foi 2,87 ± 2,01kg. Nos estudantes que no baseline apresentavam consumo ≤ a uma vez por semana de salada crua e ≤ a uma vez ao dia de frutas e legumes cozidos, a chance de ganho em peso foi de 3,06; 2,57 e 2,49 respectivamente. Houve uma correlação negativa entre a variação anual no peso e a variação no consumo de frutas, salada crua e legumes cozidos. Por outro lado, houve uma correlação positiva com o consumo de embutidos, salgados e doces. Comportamento similar foi observado com a variação no índice de massa corporal (IMC). CONCLUSÃO: Não foi identificado influência da prática de atividade física sobre o ganho de peso. No entanto, o padrão alimentar no baseline e o praticado durante o ano de ingresso na universidade exerceu influência sobre o peso e o IMC dos universitários

OBJETIVO: El objetivo del presente estudio fue investigar la ingesta dietética y el nivel de actividad física como predictores de cambios en el peso y el índice de masa corporal (IMC) de estudiantes de una universidad pública en el noreste de Brasil. MÉTODOS: Se trató de una cohorte, donde se evaluó a 138 estudiantes al inicio del curso y luego de 1 año de vida académica. Se recogieron el peso y la altura corporal, los datos sobre el nivel de actividad física y el consumo de alimentos. El modelo conceptual también consideró variables sociodemográficas, conductuales, de composición corporal y distribución de la grasa corporal. RESULTADOS: La muestra fue 76,1% de mujeres, con una edad media de 19,7 ± 3,3 años al inicio del estudio. Al final del seguimiento, el 50,7% de los estudiantes universitarios ganó más de 0,5 kg de peso, entre ellos, la ganancia de peso promedio fue de 2,87 ± 2,01 kg. En los estudiantes que tenían un consumo inicial ≤ una vez a la semana de ensalada cruda y ≤ una vez al día de frutas y verduras cocidas, la probabilidad de aumento de peso fue de 3,06; 2,57 y 2,49 respectivamente. Hubo una correlación negativa entre la variación anual en peso y la variación en el consumo de frutas, ensalada cruda y verduras cocidas. Por otro lado, hubo una correlación positiva con el consumo de embutidos, snacks y dulces. Se observó un comportamiento similar con la variación en el índice de masa corporal (IMC). CONCLUSIÓN: No se identificó la influencia de la actividad física en el aumento de peso. Sin embargo, el patrón dietético en la línea de base y el practicado durante el año de ingreso a la universidad influyó en el peso y el IMC de los estudiantes

OBJECTIVE: The objective of the present study was to investigate dietary intake and the level of physical activity as predictors of changes in weight and body mass index (BMI) of students at a public university in Northeast Brazil. METHODS: This was a cohort, where 138 students were assessed at the beginning of the course and after 1 year of academic life. Body weight and height, data on the level of physical activity and food consumption were collected. The conceptual model also considered sociodemographic, behavioral, body composition and body fat distribution variables. RESULTS: The sample was 76.1% female, with a mean age of 19.7 ± 3.3 years at baseline. At the end of the follow-up, 50.7% of university students gained more than 0.5 kg of weight, among them, the average weight gain was 2.87 ± 2.01 kg. In students who had a baseline consumption ≤ once a week of raw salad and ≤ once a day of cooked fruits and vegetables, the chance of weight gain was 3.06; 2.57 and 2.49 respectively. There was a negative correlation between the annual variation in weight and the variation in the consumption of fruits, raw salad and cooked vegetables. On the other hand, there was a positive correlation with the consumption of sausages, snacks and sweets. Similar behavior was observed with the variation inbody mass index (BMI). CONCLUSION: The influence of physical activity on weight gain was not identified. However, the dietary pattern in the baseline and that practiced during the year of entry into the university influenced the weight and BMI of the students

Predictive factors of hospitalization in an intensive care unit in patients with COVID-19: A case-control study / Factores predictivos de ingreso a unidad de cuidados intensivos en pacientes con COVID-19: un estudio de casos y controles

OBJECTIVE: The aim of the present study was to evaluate potential predictive factors for the aggravation of COVID-19 in patients hospitalized at a reference hospital in northeastern Brazil. METHODS: A non-paired case-control study was conducted with 235 patients hospitalized at a reference hospital in northeastern Brazil between March and April 2020.The case group was composed of individuals who required hospitalization in the ICU. The control group was composed of patients hospitalized due to COVID-19 who did not meet the criteria established in the institutional protocol for classification as "severe case of the disease" and therefore did not require intensive care. RESULTS: The case group was composed of 84 patients with a median age of 45 years (P25-P75: 36-59); 63.1% weremen; 56.0% were less than 60 years of age; 76.2% had excess weight; 14.3% had a previous heart disease; 46.4% had hypertension; 11.9% had lung disease; and 67.1% took continuous-use medications. The median stay of severe cases in the ICU was positively correlated with weight and BMI only among female patients less than 60 years of age. CONCLUSION: The logistic regression analysis revealed that age older than 60 years and a compromised cardiovascular system were independent predictive factors for the severity of COVID-19

OBJECTIVE: The aim of the present study was to evaluate potential predictive factors for the aggravation of COVID-19 in patients hospitalized at a reference hospital in northeastern Brazil. METHODS: A non-paired case-control study was conducted with 235 patients hospitalized at a reference hospital in northeastern Brazil between March and April 2020. The case group was composed of individuals who required hospitalization in the ICU. The control group was composed of patients hospitalized due to COVID-19 who did not meet the criteria established in the institutional protocol for classification as "severe case of the disease" and therefore did not require intensive care. RESULTS: The case group was composed of 84 patients with a median age of 45 years (P25-P75: 36-59); 63.1% were men; 56.0% were less than 60 years of age; 76.2% had excess weight; 14.3% had a previous heart disease; 46.4% had hypertension; 11.9% had lung disease; and 67.1% took continuous-use medications. The median stay of severe cases in the ICU was positively correlated with weight and BMI only among female patients less than 60 years of age. CONCLUSION: The logistic regression analysis revealed that age older than 60 years and a compromised cardiovascular system were independent predictive factors for the severity of COVID-19

Estudo randomizado de intervenção com dieta hiperproteica vs dieta de alto teor de carboidrato em idosas com excesso de peso submetidas a treino de força / Randomized intervention study with high protein vs. high carbohydrate diet in overweight older women undergoing strength training

INTRODUÇÃO: Estudos sugerem que dietas hipocalóricas ricas em proteínas podem ser mais eficazes na perda de peso e de gordura corporal do que dietas hipocalóricas com quantidades normais de proteínas. OBJETIVO: Avaliar o impacto de intervenções dietéticas isocalóricas com modificações nas quantidades de proteínas e carboidratos sobre o peso e a composição corporal de idosas. MÉTODOS: 25 mulheres idosas com excesso de peso (índice de massa corporal > 25Kg/m2) foram submetidas a treino de força e dietas com redução de 300Kcal, modificações nas quantidades de proteínas (1,8g/Kg/dia X 1,0g/Kg/dia) e carboidratos (2,0g/Kg/dia X 3,0g/Kg/dia) e quantidades similares de lipídios e fibras durante oito semanas. RESULTADOS: O grupo carboidrato apresentou uma perda ponderal clinicamente significativa comparado ao grupo controle (-2,5±2,3 X -0,4 ±2,1 p = 0,086). Quanto à perda de gordura corporal, os grupos carboidrato e proteína apresentaram valores superiores ao dobro do grupo controle, com diferencial clínico importante, principalmente entre os grupos controle e carboidrato (714±1701 X -2061±2297). DISCUSSÃO: Apesar de alguns estudos relatarem os efeitos benéficos de uma dieta rica em proteína no emagrecimento, como saciedade e maior efeito termogênico induzido pela dieta, no presente estudo, a restrição calórica foi mais importante do que a manipulação na quantidade dos macronutrientes. CONCLUSÃO: A dieta hipocalórica com padrões diferentes de ingestão de proteínas parece não ser superior à simples restrição calórica na perda de peso e mudança de composição corporal

INTRODUCTION: Studies suggest that low protein calorie diets may be more effective in losing weight and body fat than low calorie diets with normal amounts of protein. OBJECTIVE: To evaluate the impact of isocaloric dietary interventions with changes in the amounts of proteins and carbohydrates on the weight and body composition of elderly women. mass index> 25 kg / m2) were submitted to strength training and diets with a reduction of 300 kg, changes in the amounts of proteins (1.8 g / kg / day X 1.0 g / Kg / day) and carbohydrates (2.0g / kg / day X 3.0g / kg / day) and similar amounts of lipids and fibers for eight weeks. RESULTS: The carbohydrate group had a clinically significant weight loss compared to the control group (-2.5 ± 2.3 X -0.4 ± 2.1 p = 0.086). As for the loss of body fat, the carbohydrate and protein groups showed values higher than twice the control group, with an important clinical differential, especially between the control and carbohydrate groups (714 ± 1701 X -2061 ± 2297). DISCUSSION: Although some studies report the beneficial effects of a protein-rich diet on weight loss, such as satiety and a greater thermogenic effect induced by the diet, in the present study, caloric restriction was more important than manipulation in the amount of macronutrients. CONCLUSION: The low-calorie diet with different patterns of protein intake does not seem to be superior to the simple caloric restriction in weight loss and changes in body composition

No disponible

Precisão do IMC em diagnosticar o excesso de gordura corporal avaliada pela bioimpedância elétrica em universitários / Accuracy of the BMI in diagnosing the excess body fat evaluated by electrical bioimpedance in university students

Introdução: Considerando-se que o excesso de gordura corporal está relacionado ao aumento da morbimortalidade, principalmente em adultos, para a sua avaliação são necessários métodos precisos e confiáveis, de baixo custo e grande aplicabilidade em estudos populacionais e na prática clínica. Objetivo: Determinar a precisão do Índice de Massa Corporal (IMC) em diagnosticar o excesso de gordura corporal avaliada pela BIA em uma população de adultos jovens. Métodos: Foi realizado estudo de delineamento transversal, sendo a amostra composta por 326 indivíduos (mediana de 21 anos), estudantes da Universidade Federal de Pernambuco. Os pontos de corte do IMC adotados foram os preconizados pela Organização Mundial de Saúde (OMS). A gordura corporal foi avaliada pela bioimpedância elétrica (BIA) e para indicar níveis acima da média, foram utilizados os valores de 16% para homens e 24% para mulheres. Resultados: 27,3% dos 66 homens e 26,8% das 220 mulheres classificados como eutróficos, segundo o IMC, apresentaram percentual de gordura corporal acima da média, e apenas três mulheres e dois homens com IMC≥25Kg/m2 apresentaram massa corporal gorda abaixo dos níveis normais. Nas análises das curvas ROC, observou-se que o valor de IMC com melhor equilíbrio entre a sensibilidade e a especificidade foi de 22Kg/m2 e 23Kg/m2 em mulheres e homens, respectivamente. Conclusão: A área sob a curva ROC foi menor no sexo feminino, indicando uma menor probabilidade dos valores do IMC em produzir um diagnóstico correto em mulheres do que em homens

Introduction: Considering that excess body fat is related to the increase of morbimortality, especially in adults, accurate and reliable methods, low cost and great applicability in population studies and in clinical practice. Goals: To determine the Body Mass Index (BMI) accuracy to diagnose the excess body fat measured by BIA in a population of young adults. Methods: A cross-sectional study was conducted being the sample consisted of 326 individuals with a median of 21 years-students from the Federal University of Pernambuco. The cutoff points of body mass index (BMI) adopted were those recommended by the World Health Organization (WHO). Body fat was measured by bioelectrical impedance analysis (BIA) and to indicate levels above the average were those higher than 16% for men and 24% for women. Results: 27.3% of 66 men and 26.8% of 220 women classified as normal, according to BMI, showed body fat percentage above the average, and only three women and two men with BMI ≥ 25Kg/m2 had body fat below normal levels. In the analysis of ROC curves was observed that the BMI value with the best balance between sensitivity and specificity was 22Kg/m2 and 23Kg/m2 in women and men, respectively. Conclusion: The area under the ROC curve was lower in females, indicating a lower probability of BMI values to produce a correct diagnosis in women than in men

No disponible

Sensibilidade da creatinina sérica como marcador da função renal em pacientes coronariopatas / Sensitivity of serum creatinine as a maker of renal function in patients with coronary artery disease

JUSTIFICATIVA E OBJETIVOS: Na prática clínica a avaliação da função renal costuma ser realizada através da dosagem da creatinina. No entanto, este constitui um parâmetro relativamente tardio para detecção da lesão renal. O objetivo deste estudo foi avaliar a sensibilidade da creatinina sérica como marcador da função renal em pacientes coronariopatas, e identificar os fatores associados à hipercreatinemia e à redução da taxa de filtração glomerular (TFG).MÉTODO: Estudo transversal com 969 pacientes de ambos os sexos e idade ≥ 20 anos com diagnóstico de coronariopatia (firmado pelo cateterismo cardíaco ou cintilografia do miocárdio), internados em enfermaria de hospital universitário cardiológico. Avaliaram-se dados demográficos, clínicos, bioquímicos e antropométricos. A TFG foi estimada pela equação proposta por Cockcroft Gault, sendo considerada disfunção renal quando TFG < 60 mL/min/1,73m2. RESULTADOS: A mediana de idade foi 61 anos, com predomínio do sexo masculino (60,9%) e de pacientes com excesso de peso (47,7%). A prevalência de hipercreatinemia foi 19,6%e de TFG < 60 mL/min/1,73m2 foi 30,9%. A sensibilidade da creatinina na detecção do comprometimento renal foi 54,2%, sendo menor nas mulheres e nos idosos, e a especificidade foi 95,8%. Um paciente com creatinina normal apresentou probabilidade de 17,6% de ter TFG diminuída. Maior acurácia da creatinina na avaliação da função renal foi observada nos adultos e no sexo masculino. Foi identificada associação da TFG diminuída com a idade > 60 anos (p < 0,001), diabetes (p =0,003), hipertensão arterial (p = 0,004) e com o baixo peso (p < 0,001).(...)

BACKGROUND AND OBJECTIVES: In clinical practice, assessment of renal function is usually performed by creatinine dosage. However, this is a relatively late parameter for detection of renal injury. The aim of this study was to assess the sensitivity of serum creatinine as a maker of renal function in patients with coronary artery disease and identify the factors associated with hipercreatinemy and reduced glomerular filtration rate (GFR). METHOD: Cross-sectional study with 969 patients of both sexes and aged ≥ 20 years with a diagnosis of coronary arterydisease (signed by cardiac catheterization or myocardial scintigraphy), admitted to a cardiology university hospital's ward. Demographic, clinical, biochemical and anthropometric data were evaluated. The glomerular filtration rate (GFR) was estimated by the equation proposed by Cockcroft Gault with renal dysfunction considered when GFR < 60 mL/min/1.73m2. RESULTS: The median age was 61 years with male predominance (60.9%) and overweight (47.7%). The hipercreatinemy was found in 19.6% of patients and GFR < 60 mL/min/1,73m²in 30.9%. The creatinine sensitivity was 54.2% in the rena limpairment detection and 95.8% specificity. Less sensitivity was observed in women and elderly. One patient with normal creatinine showed 17.6% probability to have impaired GFR.Greater creatinine accuracy was observed in adults and males. GFR association was decreased with age > 60 years (p < 0.001), diabetes (p = 0.003), hypertension (p = 0.004) and low weight(p < 0.001). CONCLUSION: Serum creatinine dosage as marker of renal function in patients with coronary artery disease, especially inthe elderly and women, had low sensitivity compared to the GFR estimated by the Cockcroft Gault equation. Diabetic, hypertensive, elderly and low weight patients who had higher prevalence of renal dysfunction should have their FG rate monitored routinely.

[Nutritional influences in psoriasis].

Psoriasis is an inherited inflammatory skin disease mediated by T-cells and influenced by environmental factors. High intake of omega-3, fasting, low-calorie and vegetarian diets show beneficial effects. Some patients presenting IgA/IgG antigliadin antibodies and who are gluten-sensitive improve after a gluten-free diet. Calcitriol is used in topical treatment. The use of alcohol may exacerbate the disease. In this report, diet factors are analyzed and their benefits in psoriasis are described.

Influências nutricionais na psoríase / Nutritional influences in psoriasis

A psoríase é uma doença inflamatória de pele, mediada por células T, hereditária, que sofre influência ambiental. Ingestão elevada de ômega-3, jejum, dietas hipocalóricas e vegetarianas mostram efeitos benéficos. Alguns pacientes que apresentam anticorpos antigliadina IgA/IgG, com sensibilidade ao glúten, melhoram após a retirada deste. O calcitriol é usado no tratamento tópico. Ingestão de álcool pode exacerbar a doença. Neste trabalho, analisam-se fatores dietéticos e descrevem-se seus benefícios na psoríase.

Psoriasis is an inherited inflammatory skin disease mediated by T-cells and influenced by environmental factors. High intake of omega-3, fasting, low-calorie and vegetarian diets show beneficial effects. Some patients presenting IgA/IgG antigliadin antibodies and who are gluten-sensitive improve after a gluten-free diet. Calcitriol is used in topical treatment. The use of alcohol may exacerbate the disease. In this report, diet factorsare analyzed and their benefits in psoriasis are described.