New Insights on the Association Between Socioeconomic Status and Weight Loss After Bariatric Surgery: a Systematic Review and Meta-analysis.

The effect of socioeconomic status (SES) on weight loss (WL) after bariatric surgery (BS) remains unclear. This systematic review and meta-analysis aimed to investigate the association between SES and WL at least 12 months after BS. This study included 53 observational studies (retrieved from databases in October 2021 and updated in February 2022) involving adults who underwent any type of BS; SES data and data regarding outcomes of weight loss were also retrieved. Our results revealed that white individuals had a higher percentage of excess WL than blacks (95% confidence interval [CI]: 3.25-10.99, heterogeneity index [I2] = 44.87% and 95% CI: 8.08-13.59, I2 = 0%, respectively; both p < 0.01) after 12 and 24 months of BS. In conclusion, only race/ethnicity was associated with WL after BS.

Grazing Behavior Hinders Weight Loss in Long-Term Post Bariatric Surgery: a Cross-Sectional Study.

BACKGROUND: Grazing behavior is common in patients undergoing bariatric surgery (BS); however, little is known about grazing behavior in operated patients in the long term. We aimed to estimate grazing frequency and its association with weight loss and surgery response in patients who had undergone BS. METHODS: This cross-sectional study included 109 patients who had undergone Roux-en-Y gastric bypass at least 5 years previously. They answered questions about socioeconomic factors, surgical information, and adherence to treatment/follow-up. The Rep(eat) questionnaire was used for grazing assessment. Student's t-test and Pearson's chi-square test were used to evaluate differences between groups. Analysis of covariance and partial correlation were used to investigate grazing behavior, and weight loss outcomes were controlled for the elapsed time since BS, healthcare service type, current psychologist care status, and the presence of a constriction ring. RESULTS: The mean elapsed time since BS was 9.97 ± 2.39 years. Patients with grazing behavior (67%) comprised fewer surgery responders (p = 0.019), had lower total (%TWL, p = 0.005) and excess weight loss (%EWL, p = 0.029), and received less psychological counseling (45.5% vs. 54.5%, p = 0.042). Correlations were found between the presence of grazing and its subtypes and %EWL and %TWL (T = - 0.382, T = - 0.361, p < 0.001; compulsive grazing: T = - 0.358, T = - 0.342, p < 0.001, p = 0.001; non-compulsive grazing: T = - 0.333, T = - 0.311, p = 0.001, p = 0.003). No significant difference between patients with and without grazing behavior was found for previous/current diagnoses of psychological diseases or dietitian counseling. CONCLUSION: Grazing behavior is common in the long-term among patients who have undergone BS and is negatively related to weight loss parameters.

Relative Energy Expenditure Decreases during the First Year after Bariatric Surgery: A Systematic Review and Meta-Analysis.

The effect of bariatric surgery on resting energy expenditure (REE) remains unclear, particularly in terms of the REE/fat-free mass (FFM) ratio. We performed a systematic review with a meta-analysis on Roux-en-Y gastric bypass (RYGB) studies to investigate the effect of bariatric surgery on the REE/FFM ratio 6 and 12 months postoperatively. Five of the 13 records of 6-month data (n = 406) showed a reduction in the REE/FFM ratio without significant summary effects. As regards 12-month data (10 records, n = 713), there was a significant relative REE mean reduction of 1.95 kcal/kg in FFM (CI: -2.82 to -1.09; I2 = 28%; p < 0.00001). These findings suggest that bariatric surgery, specifically RYGB, leads to a decrease in the REE/FFM ratio during the first postoperative year, which may compromise long-term treatment outcomes.

Protease Inhibitors Extracted from Caesalpinia echinata Lam. Affect Kinin Release during Lung Inflammation.

Inflammation is an essential process in many pulmonary diseases in which kinins are generated by protease action on kininogen, a phenomenon that is blocked by protease inhibitors. We evaluated kinin release in an in vivo lung inflammation model in rats, in the presence or absence of CeKI (C. echinata kallikrein inhibitor), a plasma kallikrein, cathepsin G, and proteinase-3 inhibitor, and rCeEI (recombinant C. echinata elastase inhibitor), which inhibits these proteases and also neutrophil elastase. Wistar rats were intravenously treated with buffer (negative control) or inhibitors and, subsequently, lipopolysaccharide was injected into their lungs. Blood, bronchoalveolar lavage fluid (BALF), and lung tissue were collected. In plasma, kinin release was higher in the LPS-treated animals in comparison to CeKI or rCeEI groups. rCeEI-treated animals presented less kinin than CeKI-treated group. Our data suggest that kinins play a pivotal role in lung inflammation and may be generated by different enzymes; however, neutrophil elastase seems to be the most important in the lung tissue context. These results open perspectives for a better understanding of biological process where neutrophil enzymes participate and indicate these plant inhibitors and their recombinant correlates for therapeutic trials involving pulmonary diseases.

Prevalência de anemia ferropriva em obesos em preparo para cirurgia bariátrica / Iron deficiency anemia prevalence in obese in preparation for bariatric surgery

INTRODUÇÃO: Atualmente é crescente o número de realizações de cirurgias bariátricas, tendo sido comprovada como a ferramenta mais eficaz no controle e tratamento da obesidade mórbida. Dentre as complicações nutricionais após a cirurgia, podemos citar a deficiência de ferro e anemia ferropriva que podem ocorrer, especialmente, em cirurgias com disabsorção como o bypass em Y-de-Roux. Alguns pacientes obesos já apresentam essa deficiência mesmo antes de serem submetidos à restrição e disabsorção e devem ser tratados para que o quadro não seja agravado. OBJETIVO: Realizar uma revisão sistemática da literatura científica sobre a prevalência de anemia ferropriva em pacientes obesos candidatos ao bypass gástrico em Y-de-Roux. MÉTODOS: Foi realizado um levantamento bibliográfico de artigos científicos, no período de 2000 a 2015 publicados nas bases de dados em conformidade aos descritores em Ciências da Saúde. RESULTADOS: Foram selecionados 62 artigos, nas línguas inglesa, espanhola e portuguesa. Após serem aplicados os critérios de exclusão, restaram 34 artigos que foram utilizados para elaboração da revisão. Dos 34 (54,8%) artigos utilizados, 12 eram artigos originais, 22 de revisão de literatura. CONSIDERAÇÕES: Poucos estudos foram encontrados relatando a deficiência de ferro em indivíduos com obesidade em situação pré- -operatória. Mais pesquisas são necessárias para determinar os fatores que regulam o estado de ferro em populações obesas, como contribuição para identificação de tal deficiência antes do procedimento cirúrgico para, então, reduzir ou minimizar intercorrências no período pós-operatório

INTRODUCTION: The number of bariatric surgeries is currently increasing and this treatment is been the most effective tool in the control and treatment of morbid obesity. Iron deficiency and iron anemia are common nutritional complications after surgery, especially in malabsorptive surgeries such as bypass Roux-en-Y. Some obese patients have this nutritional deficiency before restriction and malabsorption and it should be treaten not to get worse. OBJECTIVE: To perform a review of scientific literature on the prevalence of iron deficiency and anemia in obese patients candidates to gastric bypass Roux-en-Y. METHODS: A literature review of periodics was conducted in the period from 2000 to 2015 published in the databases according to the descriptors in Health Sciences. RESULTS: From a total of 62 articles in English, Spanish and Portuguese, 34 articles (54.8%) attended all the inclusion criteria. Twelve studies were original and 22 , were review articles. CONSIDERATIONS: Few studies were found reporting iron deficiency in patients with preoperative situation in obesity. More research is needed to determine the factors that regulate the iron status in obese populations, as a contribution to identifying such deficiency before surgery to then reduce or minimize complications in the postoperative period.

Diet micronutrient adequacy of women after 1 year of gastric bypass.

BACKGROUND: The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. AIM: To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. METHODS: This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamin B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. RESULTS: There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. CONCLUSION: The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies.

Desordens no comportamento alimentar antes e após a cirurgia de bypass gástrico em um hospital público / Disorders in eating behavior before and after gastric bypass surgery in a public hospital

A cohort study with 25 patients was carried out in a public hospital unit aiming to identify the prevalence of eating disorders before bariatric surgery; verify their persistence at 6 months postoperatively; and analyze how such disorders influenced the ponderal weight loss in bariatric patients. Through anthropometric comparative analysis and the applica-tion of questionnaires regarding eating behavior, patients were classified as ?presenting? or ?free from? eating disorders before and 6 months after surgery. Significant reduction was observed in the prevalence of nocturnal eating and binge eating among patients at 6 months postoperatively. Lower loss of excess weight was verified among patients classified as ?presenting? eating disorders in the preoperative phase. Patients affected by eating disorders require monitoring by expert staff, which contributes to achieve satisfactory results.

Con el objetivo de determinar la prevalencia de trastornos alimentarios antes de la cirugía bariátrica, de comprobar si éstos persistieron 6 meses después de la intervención y de analizar cómo tales trastornos influyeron en la pérdida de peso de los pacientes bariátricos, se realizó un estudio de cohorte con 25 pacientes en unidad de hospital público, con medición antropométrica y aplicación de un cuestionario relacionado con el comportamiento alimentario, siendo clasificados, los pacientes, como portadores o libres de trastornos alimentarios, antes de la cirugía y 6 meses después. Se encontró una reducción significativa en la prevalencia de comedores compulsivos y nocturnos entre aquellos pacientes evaluados 6 meses después de la intervención. Se evidenció una menor pérdida del exceso de peso entre los pacientes clasificados como portadores de trastornos alimentarios en la fase preoperatoria. Pacientes que sufren de trastornos alimentarios requieren un seguimiento con personal especializado, contribuyendo, así, al logro de resultados satisfactorios.

Objetivando identificar a prevalência de desordens alimentares antes da cirurgia bariátrica, verificar se persistiram aos 6 meses do pós-operatório e analisar como tais desordens influenciaram na perda ponderal de pacientes bariátricos, realizou-se um estudo de coorte com 25 pacientes em unidade pública hospitalar, com aferição antropométrica e aplicação de questionário referente ao comportamento alimentar, sendo classificados como portadores ou livres de desordens alimentares antes e 6 meses após a realização da cirurgia. Foi verificada uma redução significativa na prevalência de comedores compulsivos e comedores noturnos entre os pacientes aos 6 meses do pós-operatório. Foi evidenciada menor perda do excesso de peso entre os pacientes classificados como portadores de desordens alimentares na fase pré-operatória. Pacientes acometidos por desordens alimentares necessitam de acompanhamento com equipe especializada, contribuindo para o alcance de resultados satisfatórios.

Implicações nutricionais da gravidez após cirurgia debypass gástrico: uma revisão da literatura / Nutritional implications of pregnancy after gastric bypass surgery: aliterature review

Introdução: A cirurgia bariátrica destaca-se como a melhor formade tratamento para obesidade mórbida, proporcionando melhora eresolução de comorbidades, além de benefícios sobre a fertilidade.A gestação no pós-operatório pode ser preocupante para a mãe e ofeto, pelo risco de aborto, subnutrição e desenvolvimento de deficiênciasnutricionais.Objetivo: Realizar uma revisão crítica da literatura científica sobreas principais implicações nutricionais para mãe e seu respectivorecém-nascido após a cirurgia de Bypass gástrico em Y-de -Roux.Materiais e métodos: Realizou-se estudo exploratório tipo revisãobibliográfica nas bases de dados SciELO, LILACS, PubMed, Medline,sob os seguintes indexadores: “obesidade”, “gestação”, “cirurgiabariátrica”, “acompanhamento nutricional” e “Bypass”.Resultados: De 57 referências analisadas relativas à gestação apóscirurgia bariátrica, 53 foram selecionadas. Os estudos mostraramque o bypass gástrico exerce influência benéfica sobre a fertilidade,reduz o risco de hipertensão arterial e diabetes gestacional. Asdeficiências nutricionais podem ser prevenidas ou revertidas como adequado manejo nutricional, no entanto, o ganho de peso gestacionalé menor nessa população e há uma tendência maior paracrianças nascidas PIG.Conclusão: A gestação pós-cirurgia bariátrica tem se mostrado segura,tanto para a mãe quanto para o feto, desde que acompanhadaadequadamente. É fundamental que as mulheres que engravidamapós a cirurgia bariátrica sejam acompanhadas por uma equipemultidisciplinar, a fim de prevenir riscos de complicações durantea gestação, tratar precocemente deficiências, proporcionando condiçõesfavoráveis para a mãe e o feto.

Introduction: Bariatric surgery stands out as the best form of treatmentfor morbid obesity, providing improvement and resolutionof comorbidities, and benefits on fertility. The postoperative pregnancycan be worrisome for both mother and fetus at risk of miscarriage,malnutrition and development of nutritional deficiencies.Objective: To conduct a critical review of the scientific literatureon major nutritional implications for mother and their newborn aftersurgery Gastric Bypass Roux-in- Y.Materials and methods : We conducted an exploratory review indatabases SciELO , LILACS , PubMed , Medline, under the followingindexes: “obesity”, “pregnancy” , “bariatric surgery” , “nutritionalcounseling” and “Bypass”.Results: From 57 analyzed references related to pregnancy afterbariatric surgery, 53 were selected. Studies have shown that gastricbypass exerts beneficial influence on fertility, reduces the risk ofhypertension and gestational diabetes. Nutritional deficiencies canbe prevented or reversed with the proper nutritional management,however, the gestational weight gain in this population is lowerand there is a greater tendency for children born SGA.Conclusion: Women who become pregnant after bariatric surgerymust to be is accompanied by a multidisciplinary team in order toprevent risks of complications during pregnancy, early treatmentfailures, providing favorable conditions for mother and fetus.

Determinantes de sucesso após a cirurgia bariátrica:fatores pré-operatórios que influenciam nos resultados pós-operatórios / Determinants of success after bariatric surgery: preoperative factorsinfluencing the postoperative results

Introdução: A obesidade, incluída no grupo de doenças crônicasnão-transmissíveis (DCNT), é definida pelo acúmulo excessivo degordura corporal no organismo. A intervenção cirúrgica é colocadacomo o único método de tratamento mais eficaz dessa patologiae leva em consideração os seguintes critérios para sua indicação:IMC, idade e tempo da doença.As práticas nutricionais no períodopré-operatório têm como foco promover modificações no hábito epadrão alimentar, potencializando as chances de obter resultadospositivos e satisfatórios após a cirurgia. Mais pesquisas ainda sãonecessárias para melhor definir os fatores que devem ser priorizadosno pré-operatório a fim de alcançar os resultados desejados.Objetivo: Determinar os fatores sugeridos na literatura como preditoresno pré-operatório que influenciam o resultado após a cirurgiabariátrica.Métodos: Foi realizada busca de artigos publicados no período de2003 a 2014, utilizando-se palavras-chaves em conformidade aosDescritores em Ciências da Saúde, nos idiomas inglês, português eespanhol. A seleção foi baseada nos títulos, resumos e descritores.Resultados: Foram incluídos 66 estudos sendo 12,1% (n=8) dos artigosforam de revisão, 21,2% (n=14) diretrizes e outros 66,6% (n=44)de artigos originais. Os principais fatores encontrados que podeminfluenciar na obtenção de resultados positivos no pós-operatórioforam a prática de atividades físicas, o comparecimento às consultasnutricionais, o Índice de Massa Corporal pré-operatório, a perdade peso pré-operatória e técnica cirúrgica utilizada e a presença decomorbidades.Considerações finais: apesar de identificados os principais fatorespreditores de sucesso pós-operatório, ainda há muita controvérsianos resultados dos estudos relacionados ao tema. Novos estudosdevem ser conduzidos para que os fatores sejam definitivamenteidentificados a fim de que sejam controlados antes da cirurgia contribuindo

Introduction: Obesity, included in the group of chronic non-communicablediseases (NCDs), is defined by excessive accumulation ofbody fat in the body. Surgical intervention is placed as the only methodto more effectively treat this condition and takes into accountthe following criteria for his nomination: BMI, age and disease duration.Nutritional practices in the preoperative period are focusedon promoting changes in habit and dietary patterns, increasing thechances of obtaining positive and satisfactory results after surgery.More research is needed to better define the factors that should beprioritized preoperatively in order to achieve the desired results.Objective: To determine the factors suggested in the literature aspredictors preoperative influencing the outcome after bariatricsurgery.Methods: A search was conducted for articles published in the period2003-2014, using keywords in accordance to Health SciencesDescriptors in English, Portuguese and Spanish languages . The selectionwas based on the titles, abstracts and keywords.Results: 66 studies were included and 12.1% (n = 8) of the articleswere reviews, 21.2% (n = 14) guidelines and other 66.6% (n = 44)were original articles. The main factors that can influence positivelythe postoperatively outcomes were preoperative physical activity,attendance at nutritional consultations, preoperative bodymass index, weight loss, surgical technique and the presence of comorbidities.Conclusion: Although we identified the main predictors for postoperativesuccess, there is still much controversy on the results ofstudies related to the topic. Further studies should be conductedto definitely identify these factores in order to control then beforesurgery and contribute to postoperative success in the short andlong term

Diet micronutrient adequacy of women after 1 year of gastric bypass / Adequação de micronutrientes da dieta de mulheres após um ano de bypass gástrico

BACKGROUND: The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. AIM: To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. METHODS: This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. RESULTS: There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. CONCLUSION: The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies. .

RACIONAL: O tratamento considerado mais eficiente para o grau severo da obesidade é a cirurgia bariátrica. O bypass gástrico é a técnica cirúrgica mais utilizada no mundo; porém, assim como as outras técnicas, oferece riscos no pós-operatório, incluindo a deficiência de nutrientes. OBJETIVO: Determinar as quantidades de ferro, cálcio, vitamina D e vitamina B12 dietéticas ingeridas por pacientes atendidos em um hospital público após um ano de bypass gástrico, e comparar com as recomendações da Recommended Dietary Allowances. MÉTODOS: Estudo transversal descritivo com amostra composta por 36 mulheres com mais de um ano de bypass gástrico. Foram coletados dados sociodemográficos, antropométricos e alimentares. Estes últimos foram realizados por meio de Questionário de Frequência Alimentar validado. Foi feita comparação da ingestão de ferro, cálcio, vitamina D e vitamina B12 com as Recommended Dietary Allowances, assim como a correlação do tempo de pós-operatório com o consumo desses micronutrientes. RESULTADOS: Houve inadequação no consumo de ferro, cálcio e vitamina D. A ingestão de vitamina B12 mostrou-se adequada. Foi encontrada correlação positiva estatisticamente significativa entre o tempo de operação e o consumo de ferro, vitamina B12 e vitamina D. CONCLUSÃO: A ingestão de ferro, cálcio e vitamina D de mulheres um ano após o bypass gástrico foi inadequada, enfatizando a importância do acompanhamento multiprofissional no pós-operatório para prevenção de carências de nutrientes. .

Adequação de micronutrientes da dieta de pacientessubmetidos à cirurgia bariátrica / Micronutrient adequacy of the diet of patients undergoing bariatricsurgery

Introdução: a obesidade é uma doença crônica caracterizada peloexcesso de tecido adiposo. O tratamento considerado mais eficientepara o grau severo desta patologia é a cirurgia bariátrica. Apesar dosevidentes benefícios da cirurgia, há riscos inerentes a esse tipo detratamento, incluindo a deficiência de nutrientes.Objetivo: realizar uma revisão bibliográfica da literatura científicasobre a adequação na ingestão de cálcio, ferro, vitamina B12 evitamina D na dieta de pacientes submetidos à cirurgia bariátrica.Métodos: foi realizada pesquisa nas bases de dados PubMed, Medline,Lilacs e Scielo utilizando as palavras-chave Cirurgia Bariátrica,Dieta e Micronutrientes. Os critérios de inclusão adotados foram:artigos que abordavam o consumo de ferro, cálcio, vitamina D e/ouvitamina B12 após realização de cirurgia bariátrica, independente datécnica cirúrgica; trabalhos que avaliaram a dieta no pós-operatório;pesquisas que utilizaram apenas adultos na amostra do estudo.Foram excluídos artigos que consideraram o uso de suplementosnutricionais.Resultados e discussão: foram utilizados 11 trabalhos publicadosentre 1991 e 2013. Grande parte dos estudos encontrados apontapara uma inadequação importante da ingestão exclusivamente alimentarde ferro, cálcio e vitamina D. Apenas a vitamina B12 comportou-se de maneira diferenciada, estando adequada na alimentaçãoda amostra na maioria das pesquisas.Conclusão: Apesar da escassez de estudos, diferenças metodológicase difícil comparação entre os estudos analisados, observou-se,em diferentes técnicas cirúrgicas e em períodos pós-operatóriosdistintos, uma inadequação na ingestão de micronutrientes da dieta,especialmente de cálcio, ferro e vitamina D, em pacientes submetidosà cirurgia bariátrica.

Introduction: Obesity is a chronic disease in which occurs the excessof adipose tissue. The method that has been shown to be moreeffective in treating this disease is bariatric surgery. Despite the apparentbenefits of surgery, there are risks inherent to this type oftreatment, including nutrient deficiency.Objective: to review the scientific literature on the adequate intakeof calcium, iron, vitamin B12 and vitamin D of patients undergoingbariatric surgery.Methods: The research was conducted through the databasesPubMed, Medline, Lilacs and SciELO using the keywords BariatricSurgery, Diet and Micronutrients. Inclusion criteria adopted were:articles that addressed the use of iron, calcium, vitamin D and / orvitamin B12 after bariatric surgery, regardless of the surgical technique;studies that assessed the diet postoperatively; studies withadults.Results and discussion: The review found 11 articles publishedfrom 1991 to 2013. Most studies suggest significant inadequacy iniron, calcium and vitamin D intake exclusively through diet. Onlyvitamin B12 had a different result, with adequate intake being foundin the majority of the studies.Conclusion: Despite the lack of studies, the methodological differencesand the difficulty to compare the studies, it was verifiedthat the inadequate intake of micronutrients, especially iron, calciumand vitamin D, is found in distinct surgical and postoperativeperiods of patients undergoing bariatric surgery.

Sleep loss and cytokines levels in an experimental model of psoriasis.

Up to 80% of people develop a cutaneous condition closely connected to their exposure to stressful life events. Psoriasis is a chronic recurrent inflammatory skin disorder with multifactorial etiology, including genetic background, environmental factors, and immune system disturbances with a strong cytokine component. Moreover, psoriasis is variably associated with sleep disturbance and sleep deprivation. This study evaluated the influence of sleep loss in the context of an animal model of psoriasis by measuring cytokine and stress-related hormone levels. Male adult Balb/C mice with or without psoriasis were subjected to 48 h of selective paradoxical sleep deprivation (PSD). Sleep deprivation potentiated the activities of kallikrein-5 and kallikrein-7 in the skin of psoriatic groups. Also, mice with psoriasis had significant increases in specific pro-inflammatory cytokines (IL-1ß, IL-6 and IL-12) and decreases in the anti-inflammatory cytokine (IL-10) after PSD, which were normalized after 48 h of sleep rebound. Linear regression showed that IL-2, IL-6 and IL-12 levels predicted 66% of corticosterone levels, which were selectively increased in psoriasis mice subject to PSD. Kallikrein-5 was also correlated with pro-inflammatory cytokines, explaining 58% of IL-6 and IL-12 variability. These data suggest that sleep deprivation plays an important role in the exacerbation of psoriasis through modulation of the immune system in the epidermal barrier. Thus, sleep loss should be considered a risk factor for the development of psoriasis.

Preoperative nutritional interventions in morbid obesity: impact on body weight, energy intake, and eating quality.

BACKGROUND: Although the benefits of preoperative weight loss and adequacy of dietary patterns in bariatric surgery is well-recognized, the nutritional strategies in the preoperative period have been scarcely investigated. We aimed to evaluate the impact of intensive and standard nutritional interventions on body weight, energy intake, and eating quality. METHODS: This is a retrospective study in which 32 patients undergoing intensive nutritional intervention, with low-calorie diet (10 kcal/kg) and biweekly visits, were pair-matched by age, sex, and body mass index with 32 patients under a standard nutritional intervention, based on a general dietary counseling. Twenty-four-hour food recall was used to assess energy intake and to derive healthy eating index (HEI). The follow-up preoperative period varied from 8 to 16 weeks. RESULTS: Weight loss was observed in 72% of the patients from the intensive intervention group and 75% of the patients from the standard intervention group. According to the mixed model analysis, time effect on weight loss in both groups was significant (P = 0.0002); however, no difference was found between the intervention groups (P = 0.71). The time effect was significant in both groups for energy intake reduction as well (P < 0.0001), but no difference was found between the intervention groups (P = 0.25). Improvement of eating quality was expressed by the nutrient score of the HEI that increased significantly overtime (P = 0.02), also without distinction between the groups (P = 0.61). CONCLUSION: Both intensive and standard nutritional interventions promoted weight loss, energy intake reduction, and improvement of eating quality in morbidly obese patients during preoperative period.

Influência da Cirurgia Bariátrica do DM2 e outras comorbidades: revisão de literatura / Influence of Bariatric Surgery in DM2 and other comorbidities: literature review

Introdução: Muitos estudos apontam uma forte associação entre obesidademórbida e a incidência de doenças crônicas como Diabetes Mellitus tipo 2(DM2), hipertensão arterial sistêmica, esteatose hepática, entre outras. A gastroplastia redutora com derivação intestinal em Y-de Roux (GRDIYR) ou apenas bypass gástrico é, atualmente, considerada a ferramenta mais eficiente na perda ponderal, remissão de comorbidades e manutenção da perda de peso em obesos graves. Objetivo: caracterizar a relação entre a obesidade mórbida e DM2, Doença Hepática Gordurosa não alcoólica (DHGNA) e Síndrome Obstrutiva da Apneia do Sono (SAOS) e investigar, na literatura, a prevalência de melhora ou remissão dessas comorbidades após a GRDIYR.Resultados: a GRDIYR se associa de forma positiva com a melhora ouremissão de comorbidades como o DM2, DHGNA e SAOS em mais da metade dos pacientes dos estudos analisados. Verificou-se, ainda, uma possível associação entre a SAOS e a progressão da DHGNA o que indica a complexidade e forte associação entre a obesidade mórbida e suas comorbidades.

Introduction: Studies show a strong association between morbid obesity and the incidence of chronic diseases such as diabetes type 2(DM2), hypertension, hepatic steatosis, among others. The bariatric surgery with intestinal bypass Roux-Y (GRDIYR) or only gastric bypassis currently considered the most effective tool in weight loss, remissionof comorbiditie sand maintenance of weight loss in severely obese. Objective: Characterize the relationship between morbid obesity and DM2, nonalcoholic fatty liver disease (NAFLD), Obstructive Sleep ApneaSyndrome (OSA) and investigate the prevalence of improvement or remission of these comorbidities after GRDIYR.Results: GRDIYR is positively associated with improvement or remissionof comorbidities such as DM2, NAFLD and OSA in more than half of patients in the studies analyzed. There was also a possible association between OSA and progression of NAFLD which indicates the complexity and the strong association between morbid obesity and its comorbidities.

Desordem no comportamento alimentar e cirurgia bariátrica: relações e implicações / Food and behavior disorders in bariatric surgery: relation and implications

Introdução: a obesidade possui uma etiologia multifatorial e difícil tratamento,principalmente entre os indivíduos acometidos pela obesidadedo tipo III (mórbida). Neste contexto, a cirurgia bariátrica, dadosos resultados satisfatórios alcançados, atua como meio mais eficaz detratamento para esse grupo. Vale ressaltar, porém, que a realização dacirurgia bariátrica não garante a completa resolução de alguns fatoresdesencadeantes da obesidade, tais como desordens no comportamentoalimentar. Pacientes beliscadores, comedores de doces, comedoresnoturnos e/ou acometidos pela compulsão alimentar devem ser monitoradoscom mais rigor a fim de alcançarem o sucesso pós-cirúrgico,especialmente quanto à perda ponderal.Objetivo: descrever desordens alimentares de maior prevalência entrea população obesa. Além disso, identificar na literatura, quais as implicaçõesocasionadas pela presença de tais desordens na fase pré e pós--operatória da cirurgia bariátrica.Métodos: foi realizada uma revisão na literatura, envolvendo artigosrelacionados ao tema proposto indexados nas seguintes bases de dados:Lilacs, Medline, PubMed, Redalyc; e nas bibliotecas virtuais de conteúdocientífico Capes e Scielo, priorizando os publicados dentro dosúltimos dez anos. Sendo a última busca realizada em março de 2012.Resultados e Discussão: entre indivíduos obesos existe maior prevalênciade desordens de cunho alimentar, que contribuem com a manutençãoe agravo da obesidade, gerando ainda influências negativas emassociação à cirurgia bariátrica, aumentando o risco de complicações,prejudicando a perda ponderal e tornando o tratamento mais longo etrabalhoso.Conclusão: candidatos à realização da cirurgia bariátrica, assim como,indivíduos no período pós-operatório devem ser rastreados quanto àpresença de desordens na conduta alimentar para que haja intervençãono momento oportuno; minimizando assim, o risco de complicações epotencializando...

Indroduction: obesity has a multifactorial etiology and difficultto treat, especially among individuals affected by obesity type III (morbid). In this context, bariatric surgery, given the satisfactory results achieved, acts as a more effective treatment of this group.But it is noteworthy that bariatric surgery does not guarantee the full resolution of some triggering factors of obesity, such as eating disorders. Snackers, eating candy, eating at night and / or affected by binge eating should be monitored more rigorously in order toachieve success after surgery, especially regarding weight loss.Objectives: describe eating disorders most prevalent among the obese population. In addition, identify in the literature, the implications arising from the presence of such disorders in the pre-and post-operative bariatric surgery.Methods: we reviewed the literature, involving related articles indexedproposed in the following databases: Lilacs, Medline, PubMed, Redalyc,and the virtual libraries of scientific content and Capes Scielo, prioritizingthose published within the last ten years. Being the last search conducted in March 2012.Results and Discussion: among obese individuals there is a higher prevalence of eating disorders, contributing to the maintenance and aggravation of obesity, generate negative influences in association with bariatric surgery, increasing the risk of complications and damaging weight loss. Making the same treatment, especially long and laborious.Conclusion: candidates for bariatric surgery, as well as individuals in the postoperative period should be screened for the presence of conduct disorders in food so that there is intervention at the appropriate time, aiming to minimize complications and maximize the benefitsbrought about by surgical intervention.

Perda de peso pré-operatória em pacientes submetidos à gastroplastia redutora com derivação gastrointestinal em Y-de-Roux: uma revisão de literatura / Preoperative weight loss in patients undergoing gastric reduction through a Roux-en-Y gastrointestinal bypass: a literature review

Introdução: A cirurgia bariátrica tem sido utilizada como tratamento para os obesos mórbidos e é uma intervenção eficaz e duradoura, sendo a gastroplastia redutora com derivação gastrojejunal em Y-de-Roux (GRYR) a operação mais utilizada no Brasil. A recomendação de perda de peso pré-operatória tem sido estudada, pois parece reduzir comorbidades associadas à obesidade, diminui as complicações associadas à cirurgia, além de melhorar os resultados pós-operatórios.Objetivo: Apresentar os aspectos relacionados à perda ponderal antesda GRYR e sua relação com o sucesso pós-operatório. Métodos: Revisão de literatura, com 40 artigos científicos publicados em revistas indexadas nas bases de dados Pubmed, Lilacs e Bireme, nos idiomas português, inglês e espanhol, sendo selecionadas publicações entre 2001 e 2011.Resultados: A perda de peso pré-operatória é considerada fundamentalpara uma GRYR bem sucedida, com melhora clínica do paciente.Várias vantagens têm sido descritas na literatura, como a diminuição dovolume hepático, redução no tempo da operação, de internação hospitalar,menor risco de complicações, melhor perda ponderal no pós- operatório. O acompanhamento nutricional pré-operatório considera como meta a perda do excesso de peso (PEP), que pode ser alcançada com dietas de baixo e muito baixo valor calórico. Uma PEP pré-operatória entre 5 a 10% tem sido considerada para melhores resultadospós-operatórios. Conclusão: A perda de peso pré-operatória tem importância na preparação de pacientes obesos com indicação de GRYR, no entanto, maisestudos são necessários para o estabelecimento de novos protocolospara o tratamento pré-operatório.

Introduction: Bariatric surgery has been used as treatment for morbid obesity and is an effective and lasting, and the Roux-en-Y gastric bypass(RYGB) the operation most used in Brazil. The recommendation of weight loss pre-operative has been studied, it appears to reduce comorbidities associated with obesity, decreases the complications associated with surgery, and improve the postoperative results. Objective: To describe aspects related to the weight loss before RYGB and its relationship to postoperative success. Methods: Review of literature, using 40 scientific papers published in journals indexed in Pubmed, Lilacs and Bireme, in portuguese, english and spanish, and selected those publications between 2001 and 2011. Results: The preoperative weight loss is considered essential to a successful RYGB with clinical improvement. Several advantages have been described in the literature, such as a decrease in liver volume, reduction in operation time, hospital length of stay, less risk of complications, best postoperative weight loss. The preoperative nutritional monitoring considers the goal of excess weight loss (EWL), which can be achieved with low calorie diets and very low calorie diets. A preoperative EWL of5 to 10% has been considered for better postoperative results. Conclusion: The preoperative weight loss preparation is important in obese patients with RYGB indication, however, further studies are needed for the establishment of new protocols for preoperative treatment.

Chronic infusion of amyloid-ß peptide and sustained attention altered α7 nicotinic receptor density in the rat brain.

It is already known that progressive degeneration of cholinergic neurons in brain areas such as the hippocampus and the cortex leads to memory deficits, as observed in Alzheimer's disease. This work verified the effects of the infusion of amyloid-ß (Aß) peptide associated to an attentional rehearsal on the density of α7 nicotinic cholinergic receptor (nAChR) in the brain of male Wistar rats. Animals received intracerebroventricular infusion of Aß or vehicle (control - C) and their attention was stimulated weekly (Stimulated Aß group: S-Aß and Stimulated Control group: SC) or not (Non- Stimulated Aß group: N-SAß and Non-Stimulated Control group: N-SC), using an active avoidance apparatus. Conditioned avoidance responses (CAR) were registered. Chronic infusion of Aß caused a 37% reduction in CAR for N-SAß. In S-Aß, this reduction was not observed. At the end, brains were extracted and autoradiography for α7 nAChR was conducted using [125I]-α-bungarotoxin. There was an increase in α7 density in hippocampus, cortex and amygdala of SAß animals, together with the memory preservation. In recent findings from our lab using mice infused with Aß and the α7 antagonist methyllycaconitine, and stimulated weekly in the same apparatus, it was observed that memory maintenance was abolished. So, the increase in α7 density in brain areas related to memory might be related to a participation of this receptor in the long-lasting change in synaptic plasticity, which is important to improve and maintain memory consolidation.

Change in central kinin B2 receptor density after exercise training in rats.

Cardiovascular responses elicited by the stimulation of kinin B2 receptors in the IV cerebral ventricle, paratrigeminal nucleus or in the thoracic spinal cord are similar to those observed during an exercise bout. Considering that the kalikrein-kinin system (KKS) could act on the cardiovascular modulation during behavioral responses as physical exercise or stress, this study evaluated the central B2 receptor densities of Wistar (W) and spontaneously hypertensive rats (SHR) after chronic moderate exercise. Animals were exercise-trained for ten weeks on a treadmill. Afterwards, systolic blood pressure decreased in both trained strains. Animals were killed and the medulla and spinal cord extracted for B2 receptor autoradiography. Trained animals were compared to their sedentary controls. Sedentary groups showed specific binding sites for Hoe-140 (fmol/mg of tissue) in laminas 1 and 2 of the spinal cord, nucleus of the solitary tract (NTS), area postrema (AP), spinal trigeminal tract (sp5) and paratrigeminal nucleus (Pa5). In trained W a significant increase (p<0.05) in specific binding was observed in the Pa5 (31.3%) and NTS (28.2%). Trained SHR showed a significant decrease in receptor density in lamina 2 (21.9%) of the thoracic spinal cord and an increase in specific binding in Pa5 (36.1%). We suggest that in the medulla, chronic exercise could hyper stimulate the KKS enhancing their efficiency through the increase of B2 receptor density, involving this receptor in central cardiovascular control during exercise or stress. In the lamina 2, B2 receptor might be involved in the exercise-induced hypotension.

Increases of kinin B1 and B2 receptors binding sites after brain infusion of amyloid-beta 1-40 peptide in rats.

Although numerous inflammation pathways have been implicated in Alzheimer's disease, the involvement of the kallikrein-kinin system is still under investigation. We anatomically localized and quantified the density of kinin B(1) and B(2) receptors binding sites in the rat brain after the infusion of amyloid-beta (Abeta) peptide in the right lateral brain ventricle for 5 weeks. The conditioned avoidance test showed a significant reduction of memory consolidation in rats infused with Abeta (68.6+/-20.9%, P<0.05) when compared to control group (90.8+/-4.1%; infused with vehicle). Autoradiographic studies performed in brain samples of both groups using [(125)I]HPP-[des-Arg(10)]-Hoe-140 (150pM, 90min, 25 degrees C) showed a significant increase in density of B(1) receptor binding sites in the ventral hippocampal commissure (1.23+/-0.07fmol/mg), fimbria (1.31+/-0.05fmol/mg), CA1 and CA3 hippocampal areas (1.05+/-0.03 and 1.24+/-0.02fmol/mg, respectively), habenular nuclei (1.30+/-0.04fmol/mg), optical tract (1.30+/-0.05fmol/mg) and internal capsule (1.26+/-0.05fmol/mg) in Abeta group. For B(2) receptors ([(125)I]HPP-Hoe-140, 200pM, 90min, 25 degrees C), a significant increase in density of binding sites was observed in optical tract (2.04+/-0.08fmol/mg), basal nucleus of Meynert (1.84+/-0.18fmol/mg), lateral septal nucleus - dorsal and intermediary portions (1.66+/-0.29fmol/mg), internal capsule (1.74+/-0.19fmol/mg) and habenular nuclei (1.68+/-0.11fmol/mg). In control group, none of these nuclei showed [(125)I]HPP-Hoe-140 labeling. This significant increase in densities of kinin B(1) and B(2) receptors in animals submitted to Abeta infusion was observed mainly in brain regions related to cognitive behavior, suggesting the involvement of the kallikrein-kinin system in Alzheimer's disease in vivo.