IS THERE ANY CHANGE IN PHENOTYPIC CHARACTERISTICS COMPARING 5 TO 10 YEARS OF FOLLOW-UP IN OBESE PATIENTS UNDERGOING ROUX-EN-Y GASTRIC BYPASS?

BACKGROUND: : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. AIM: To investigate nutritional status in 10 years follow-up. METHODS: : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. RESULTS: : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. CONCLUSIONS: : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.

Is there any change in phenotypic characteristics comparing 5 to 10 years of follow-up in obese patients undergoing roux-en-y gastric bypass? / Características fenotípicas de pacientes com obesidade submetidos a derivação gástrica em y-de-roux: qual as reais mudanças comparando-se 5 a 10 anos de acompanhamento?

ABSTRACT Background : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. Aim: To investigate nutritional status in 10 years follow-up. Methods : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. Results : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. Conclusions : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.

RESUMO Racional: A cirurgia bariátrica promove importante perda ponderal e melhora das comorbidades associadas; entretanto, deficiências nutricionais e reganho de peso podem ocorrer no pós-operatório médio e tardio. Objetivo: Investigar a evolução do estado nutricional de pacientes após cinco e 10 anos de pós-operatório. Método: Estudo retrospectivo longitudinal, no qual indicadores antropométricos, bioquímicos e a ingestão alimentar foram avaliados no período pré-operatório e após um, dois, três, quatro, cinco e dez anos da operação, por meio de revisão de prontuários. Resultados: Após 10 anos observou-se redução de 29,2% do peso inicial; no entanto, 87,1% dos pacientes tiveram reganho significativo de peso. Além disso, houve aumento da incidência de deficiência de ferro (9,2% para 18,5%), vitamina B12 (4,2% para 11,1%) e magnésio (14,1% para 14,8%). As concentrações de ácido fólico aumentaram e a porcentagem de indivíduos com alterações na glicemia (40,4% a 3,7%), triglicérides (38% a 7,4%), colesterol HDL (31% a 7,4%) e ácido úrico (70,5% a 11,1%) diminuiu. Além disso, houve redução na ingestão alimentar no primeiro ano de pós-operatório. Após 10 anos, houve aumento na ingestão de energia, proteína e lipídios, e redução na de ácido fólico. Conclusões: A derivação gástrica em Y-de-Roux é procedimento eficaz para promover perda de peso e melhorar as comorbidades associadas à obesidade. Entretanto, a comparação entre os períodos pós-operatórios de cinco e 10 anos mostrou que uma porcentagem de pacientes apresenta deficiências de vitaminas e minerais e reganho de peso significativo, evidenciando a necessidade do acompanho nutricional no período pós-operatório.

WEIGHT LOSS AND METABOLIC OUTCOMES 12 MONTHS AFTER ROUX-EN-Y GASTRIC BYPASS IN A POPULATION OF SOUTHEASTERN BRAZIL.

UNLABELLED: BACKGROUNGD: previous outcome research in bariatric surgery has to document positive changes in co-morbidities associated with obesity. OBJECTIVE: the study aimed report a description of the impact of bariatric surgery on weight loss and on the resolution of diseases associated with obesity in patients followed up for 12 months in the public health service of São Paulo/Brazil. METHODS: the study was conducted on the data for 598 selected patients with grade III obesity subjected to Rouxen- Y gastric bypass evaluated postoperatively and 6 and 12 months after surgery. Anthropometric, demographic and biochemical data and personal history were determined at each time point. Serum glucose, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were determined in the biochemical evaluation. Data were analyzed statistically by the Chi-square test, by ANOVA followed by the Bonferroni post-test and by the Student t-test for independent data, significance set at p < 0.05. RESULTS: weight loss of 45.5 ± 13.7kg (33.5%) was observed during the first year after surgery. Serum glucose, total cholesterol and LDL cholesterol were reduced during the first six months after surgery and the values were maintained up to 12 months, whereas weight and triglycerides were reduced throughout the study period. A reduced prevalence of diabetes mellitus and dyslipidemia was observed after surgery (p < 0.001). CONCLUSIONS: Roux-en-Y gastric bypass is an important procedure for weight loss and control of comorbidities such as diabetes and dyslipidemia at least during the first postoperative year.

Introducción: la investigación de los resultados previa en cirugía bariátrica tiene que documentar los cambios positivos en las comorbilidades asociadas a la obesidad. Objetivo: el objetivo del estudio fue informar de una descripción de los efectos de la cirugía bariátrica sobre la pérdida de peso y en la resolución de enfermedades asociadas con la obesidad en pacientes seguidos durante 12 meses en el servicio de salud pública de São Paulo/Brasil. Métodos: el estudio se realizó con los datos de 598 pacientes seleccionados con obesidad grado III sometidos a bypass gástrico en Y de Roux evaluados antes y 6 y 12 meses después de la cirugía. En cada momento se determinaron la antropometría, los datos demográficos y bioquímicos y la historia personal. La glucosa sérica, el colesterol total, el colesterol LDL, el colesterol HDL y los triglicéridos fueron determinados en la evaluación bioquímica. Los datos fueron analizados estadísticamente por el test de Chi-cuadrado, por ANOVA seguido por el post-test de Bonferroni y por la prueba t de Student para datos independientes; significación fijada en p < 0,05. Resultados: se observó pérdida de peso de 45,5 ± 13,7 kg (33,5%) durante el primer año después de la cirugía. Glucosa sérica, colesterol total y colesterol LDL se redujeron durante los primeros seis meses después de la cirugía y los valores se mantuvieron hasta los 12 meses, mientras que el peso y los triglicéridos se redujeron en todo el período de estudio. Se observó una prevalencia reducida de diabetes mellitus y dislipidemia después de la cirugía (p < 0,001). Conclusiones: el bypass gástrico en Y de Roux es un procedimiento importante para la pérdida de peso y el control de las comorbilidades como la diabetes y la dislipidemia, al menos durante el primer año postoperatorio.