Fatores de risco para recidiva de peso no pós-operatório tardio de cirurgia bariátrica / Risk factors for weight regain in the late postoperative of bariatric surgery

OBJETIVOS: Avaliar os fatores de risco para a recidiva de peso em indivíduos submetidos à cirurgia bariátrica. MÉTODOS: Estudo transversal utilizando-se questionário autoaplicável online. O questionário abordou fatores que poderiam estar associados à recidiva de peso após cirurgia bariátrica. Foram registrados peso, altura, sexo, idade, escolaridade, renda e assiduidade às consultas nutricionais no pré e no pós-operatório. Foram avaliados índice de massa corporal, perda de peso e perda do excesso de peso no pós-operatório imediato e após seis, 12 e 24 meses de pós-operatório, assim como no momento em que o participante respondeu ao questionário. O reganho de peso foi avaliado a partir do menor peso obtido após a cirurgia. O questionário Three Factor Eating Questionnaire-21 foi utilizado para classificar o comportamento alimentar em Alimentação Emocional, Restrição Cognitiva ou Descontrole Alimentar. RESULTADOS: Foram respondidos 46 questionários por indivíduos que realizaram cirurgia bariátrica, com média de idade de 38±8,78 anos e mediana de três anos de pós-operatório. Quarenta e três (93,5%) participantes eram do sexo feminino. As médias de perda do excesso de peso e a perda de peso atual foram de 78,56±16,12% e 35,24±8,19%, respectivamente. A média do índice de massa corporal atual era de 27,35±3,98 kg/m2 . Alimentação Emocional foi encontrada em 18 (39,13%), Restrição Cognitiva em 24 (52,17%) e Alimentação Emocional associada à Restrição Cognitiva em 4 (8,69%) dos entrevistados. A recidiva de peso ocorreu em 18 (39%) dos indivíduos, a partir principalmente dos 12 meses após a cirurgia. Observou-se que a renda familiar mensal superior a 4000 reais e a frequência a consultas com nutricionista inferior a três vezes no pré-operatório estiveram associadas a maior chance de recidiva de peso. CONCLUSÕES: Nessa amostra, a baixa assiduidade às consultas nutricionais no pré-operatório, bem como a renda familiar elevada foram fatores de risco para recidiva de peso no pós-operatório tardio de cirurgia bariátrica.

AIMS: To evaluate risk factors for weight regain in patients undergoing bariatric surgery. Methods: Cross sectional study using self-administered online questionnaire. The questionnaire asked about factors that can be associated with weight regain after bariatric surgery. Weight, height, sex, age, education, income, and nutrition appointment attendance before and after surgery were registered. Body mass index, weight loss, and loss of excess weight in the immediate postoperative period and at 6, 12, and 24 months postoperatively, as well as at the time of completing the questionnaire, were evaluated. Weight regain was evaluated according to the lowest weight achieved since surgery. The Three Factor Eating Questionnaire 21 was used to classify eating behavior into Emotional Eating, Cognitive Dietary Restraint, or Uncontrolled Eating. RESULTS: The questionnaire was answered by 46 individuals who underwent bariatric surgery, with a mean age of 38±8.78 years and a median of three postoperative years. Forty-three (93.5%) patients were female. The mean loss of excess weight and current weight loss were 78.56±16.12% and 35.24±8.19%, respectively. The current body mass index was 27.35±3.98 kg/m2 . Emotional eating was observed in 18 (39.13%), cognitive restraint in 24 (52.17%), and emotional eating associated with cognitive restraint in 4 (8.69%) of the respondents. Eighteen individuals (39%) regained weight, especially after 12 months. A monthly family income greater than 4000 Brazilian Reals and nutrition appointments fewer than three in the preoperative period were associated with a larger probability of weight regain. CONCLUSIONS: In this sample, low nutrition appointment attendance in the preoperative period and a high family income were risk factors for weight regain in the late postoperative period of bariatric surgery.

Nutrition education intervention for women with breast cancer: effect on nutritional factors and oxidative stress.

OBJECTIVES: To assess the effect of a nutrition education intervention on nutritional factors and oxidative stress during treatment of breast cancer. DESIGN: Nonrandomized clinical trial conducted in 2010-2011, including an evaluation at baseline and after 12 months. PARTICIPANTS: Women from Brazil who had breast cancer, divided into an intervention group (IG) (n = 18) and comparison group (n = 75). INTERVENTION: To increase intake of fruits and vegetables and reduce red and processed meats, via telephone and printed materials. MAIN OUTCOME MEASURES: Food intake, anthropometry, and levels of lipid hydroperoxide, carbonyl proteins, reduced glutathione, and ferric reducing antioxidant power. ANALYSES: Chi-square, Mann-Whitney or t tests for baseline data; Wilcoxon or paired t tests for intra-group outcomes, linear regression models, and Bonferroni multiplicity adjustment. RESULTS: The researchers observed an increase in fruit and vegetable intake, reduction in red and processed meat intake, no change in body weight, and an increase in glutathione in the IG over the comparison group. However, after Bonferroni adjustment, only the consumption of fruits and vegetables and fruit was significantly higher in IG. CONCLUSIONS AND IMPLICATIONS: This study presents improved dietary changes after a theory-driven nutrition education intervention. Although the sample size is small, it has proven to be clinically relevant.

Brazilian healthy eating index revised (BHEI-R) of women before and during adjuvant treatment for breast cancer.

INTRODUCTION: Different therapeutic modalities for cancer trigger side effects that affect the selection of food by changing dietary patterns. AIMS: To evaluate changes in the diet quality of women in adjuvant treatment for breast cancer. METHODS: Sociodemographic, clinical and anthropometric data of 78 women were collected. The Brazilian Healthy Eating Index Revised and its components were obtained from food frequency questionnaire applied before and after the treatment. At baseline, participants were classified according to tertiles of diet quality. RESULTS AND DISCUSSION: The score of the Brazilian Healthy Eating Index Revised (BHEI-R) in the lowest tertile was 48.4 to 75.2 points, the second tertile was 75.7 to 81.8 points, and the upper tertile was 82.0 to 95.7 points. During treatment, of the women classified in the first tertile, 62% improved their diet score quality passing to the upper tertiles. Women classified in the second tertile, did not significantly alter the diet quality during the treatment, although 46% went to the third tertile. Patients classified in the third tertile significantly reduced the average score of the Index by 7.3 points during the treatment. Among these women, 38% and 20% decreased their score for the second and first tertiles respectively, where the reduction in the diet quality was due to reducing the score of components Total fruits, Total vegetables, Dark Green and orange vegetables and Legumes, Total grains and Solid fats, Alcohol and Added sugar. CONCLUSION: Dietary changes, which were observed after breast cancer diagnosis, significantly altered the quality of diet among the women participating in the study. Future nutrition interventions are important to aid in food choices during the treatment.

Introducción: Diferentes modalidades terapéuticas para los efectos secundarios de activación de cáncer que afectan a la selección de los alimentos por el cambio de los patrones dietéticos. Objetivo: Evaluar los cambios en la calidad de la dieta de mujeres en tratamiento adyuvante para cáncer de mama. Métodos: se obtuvieron datos sociodemográficos, clínicos y antropométricos de 78 mujeres. El Índice Brasileño de Alimentación Saludable y sus componentes se obtuvieron a partir de cuestionarios de frecuencia alimentar aplicados antes y al final del tratamiento. Los participantes fueron clasificados según terciles de calidad de la dieta con base en las informaciones del inicio del estudio. Resultados: Las puntuaciones del Índice de Calidad de la dieta en el tercil inferior fue 48,4-75,2 puntos, en el segundo tercil fue 75,7-81,8 puntos, y en el tercil superior 82,0-95,7 puntos. Durante el tratamiento, 62 % de las mujeres pertenecientes al primer tercil mejoraron su calidad, pasando para los terciles medio o superior. Las mujeres clasificadas en el segundo tercil no alteraron significativamente la calidad de la dieta durante el tratamiento, a pesar de que 46 % pasó para el tercil superior. Las pacientes pertenecientes al tercer tercil redujeron significativamente la puntuación promedio del Índice en 7,3 puntos durante el tratamiento. Entre estas mujeres, 38% y 20% disminuyeron su puntuación para el segundo y primer tercil, respectivamente. La reducción de la calidad de la dieta fue el resultado de la disminución en la puntuación de los componentes Frutas totales, Verduras totales, Verduras y legumbres de color verde oscuro y naranja, Cereales totales y grasas sólidas, Alcohol y Azúcar añadido. Conclusión: Los cambios observados en la alimentación después del diagnóstico de cáncer de mama alteró significativamente la calidad de la dieta de las mujeres participantes del estudio. Intervenciones nutricionales futuras son importantes para ayudar en la elección de alimentos durante el tratamiento.