Predictors of Excess Weight Loss in Obese Patients After Gastric Bypass: a 60-Month Follow-up.

BACKGROUND: The objective of this study was to analyze the factors associated with change in body mass index (BMI) and with percentage of excess weight loss (%EWL) in patients undergoing Roux-en-Y gastric bypass (RYGB). The following factors were analyzed: sex, age, surgical access (laparotomy vs. laparoscopy), preoperative BMI, waist circumference (WC), type 2 diabetes mellitus (T2DM), high blood pressure, and dyslipidemia. METHODS: Retrospective cohort study using a convenience sample of 2070 patients of both sexes, aged 18 to 65 years, undergoing RYGB between 2000 and 2013. The outcomes of interest were BMI and %EWL at 0, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after RYGB. RESULTS: After 36, 48, and 60 months, approximately 50 % of patients had BMI >30 kg/m(2). As for %EWL, 60-month results were poor for 17 % of patients (%EWL <50 %), good for 40 % of patients (%EWL 50-75 %), very good for 24 % of patients (%EWL from >75-90 %), and excellent for 19 % of patients (%EWL >90 %). The four most significant predictors of BMI change 60 months after RYGB (in descending order of magnitude) were preoperative BMI, preoperative WC, surgical access, and age; and of %EWL, surgical access, preoperative BMI, preoperative WC, and age. CONCLUSIONS: After 60 months of follow-up, the most relevant predictors of weight loss after RYGB were lower preoperative BMI and WC, videolaparoscopy as surgical access, and younger age. Further studies must be carried out to elucidate the impact of these factors on RYGB outcomes.

Prevalence of overweight in children of obese patients: a dietary overview.

BACKGROUND: Evidence indicates that eating habits established during childhood related to food intake persist when the child becomes an adult. Parental obesity is positively associated with the development of obesity in the offspring, who tend to become sick and obese young adults during the reproductive phase and end up looking for bariatric surgery in order to reverse the non-communicable diseases (NCDs) already established. METHODS: This cross-sectional study evaluated 40 children aged 0 to 10 years, whose mothers underwent bariatric surgery at the Center of Morbid Obesity, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL PUCRS). RESULTS: Among these children, 45 % were overweight and 16 had high waist circumference values. The total energy intake and sodium consumption were above the Dietary Reference Intakes (DRIs) for the age group, while dietary fiber and potassium intakes were below DRIs. Obese children had higher percentage of lipid caloric intake (28.3 vs. 25.3 %, p < 0.025), while the non-obese group tended to have an increased consumption of carbohydrate (62.6 vs. 60 %, p < 0.066) when compared to the respective DRIs. The presence of NCDs in children's relatives was 100 %. CONCLUSIONS: There is probably a significantly higher prevalence of obesity among children of morbidly obese parents when compared to the general child population. Since the familial aggregation of NCDs was absolute, these results point to the need for careful evaluation when dealing with children. However, further studies with a larger number of individuals are needed to confirm these results.

Excess weight loss variation in late postoperative period of gastric bypass.

BACKGROUND: In the late postoperative period of gastric bypass surgery, we observe that many patients weight regain. The objective of this study was to determine the excess weight loss variation at 24 and 60 months postoperative. A secondary objective was to evaluate in the period described, the association of weight regain with red meat intolerance, age, gender, and body mass index. METHODS: Historical cohort study includes only patients who had completed a follow-up of up to 60 months postoperative (93 patients). The variation in percent excess weight loss was determined at 24 and 60 months postoperative to assess any association with the variables preoperative body mass index (BMI), gender, age, and red meat intolerance. RESULTS: The excess weight loss varied about -8.7% (95% CI: -12.1 to -5.4). This weight regain showed a significant association with the variable age, where the patients who regained the least weight tended to be younger than those who regained more (p = 0.012). When comparing the intolerance level to red meat with weight regain, we observed that the lower the intolerance the greater the weight loss, although this finding did not reach statistical significance (p = 0.13). CONCLUSIONS: Weight regain did not compromise therapeutic success. Less weight regain was seen in younger patients. Patients with lower intolerance to red meat tended to show less weight regain. Further studies are needed to elucidate the role of protein intake in weight regain in patients submitted to gastric bypass. No association between weight regain and preoperative BMI or gender was observed.

Need for multivitamin use in the postoperative period of gastric bypass.

BACKGROUND: Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastric bypass (RYGBP) and diet therapy, it is essential in the postoperative period to obtain and maintain an adequate nutritional state, with the aim of preventing malnutrition and seeking a healthy life. It is observed that patients have difficulty in understanding the new food choices that must considered, as they have eating habits that are very divergent from those currently proposed. There is often the need for vitamin and mineral replacement after laboratory tests. METHODS: This study calculated and evaluated the 24-h eating records of 210 patients, collected in the course of nutritional visits in follow-ups of the first, third, sixth, ninth, 12th, 18th, and 24th months postoperative. RESULTS: It was possible to observe an increase in the consumption of nutrients in the course of the study period, but it was not regular and significant for all the nutrients. Also, it is noted that the minimal requirements for vitamin A, vitamin C, calcium, iron and B-complex vitamins (except for cyanocobalamin and riboflavin) were not attained. The nutrients in which satisfactory results were obtained were total proteins of high biological value: cyanocobalamin and riboflavin. CONCLUSION: This study demonstrated the concern for nutrient supplementation in the postoperative period of RYGBP. Thus, the routine use of multivitamins is deemed necessary after the first month postoperatively, with its maintenance preferably for the rest of the patient's life, without abandoning periodic clinical and laboratory follow-up.