RESUMEN
OBJECTIVES: Vitamin B12 (B12) deficiency after Roux-en-Y gastric bypass (RYGB) is highly prevalent and may contribute to postoperative complications. Decreased production of intrinsic factor owing to gastric fundus removal is thought to have a major role, but other components of B12 metabolism may also be affected. We evaluated changes in the expression levels of multiple B12 pathway-encoding genes in gastrointestinal (GI) tissues to evaluate the potential roles in contributing to post-RYGB B12 deficiency. METHODS: During double-balloon enteroscopy, serial GI biopsies were collected from 20 obese women (age, 46.9±6.2 years; body mass index, 46.5±5.3 kg/m2) with adult-onset type 2 diabetes (fasting plasma glucose ≥126 mg/dl; hemoglobin A1c≥6.5%) before and, at the same site, 3 months after RYGB. Gene expression levels were assessed by the Affymetrix Human GeneChip 1.0 ST microarray. Findings were validated by real-time quantitative PCR (RT-qPCR). RESULTS: Gene expression levels with significant changes (P≤0.05) included: transcobalamin I (TCN1) in remnant (-1.914-fold) and excluded (-1.985-fold) gastric regions; gastric intrinsic factor (GIF) in duodenum (-0.725-fold); and cubilin (CUBN) in duodenum (+0.982-fold), jejunum (+1.311-fold), and ileum (+0.685-fold). Validation by RT-qPCR confirmed (P≤0.05) observed changes for TCN1 in the remnant gastric region (-0.132-fold) and CUBN in jejunum (+2.833-fold). CONCLUSIONS: RYGB affects multiple pathway-encoding genes that may be associated with postoperative B12 deficiency. Decreased TCN1 levels seem to be the main contributing factor. Increased CUBN levels suggest an adaptive genetic reprogramming of intestinal tissue aiming to compensate for impaired intestinal B12 delivery.
RESUMEN
Objetivo: Descrever particularidades relativas à nutrição em pacientespediátricos com queimaduras e a adesão à prescrição dietética no primeiro centro especializado do Pará. Método: Foram inclusos pacientes de zero a dez anos, internados no Centro de Tratamento de Queimados do Hospital Metropolitano de Urgência e Emergência do Estado do Pará. Os procedimentos de avaliação antropométrica, diagnóstico nutricional, estimativa das necessidades nutricionais, valor nutritivo das dietas oferecidas, adesão às dietas hospitalares, uso e indicação de suporte nutricional e tratamento estatístico foram cumpridos. Resultados: Um total de 49 pacientes foram estudados. As queimaduras observadas chegaram a comprometer até 53% da superfície corporal. Eutrofia esteve presente em mais de 50% da amostra. O estado nutricional foi inversamente proporcional ao tempo de internação hospitalar (p=0,0001). A dieta hospitalar atendeu às necessidadesde 97,95% dos pacientes em relação a calorias e 100% a proteínas, de acordo com a fórmula preditiva de necessidades nutricionais. Cerca de 88% das necessidades de suplementos foram cumpridas. Anorexia foi detectada em 71,43% da amostra, sendo observada em 100% dos pacientes com superfície corporal queimada acima de 21% (p<0,005). Conclusão: A manutenção do estado nutricional se mostrou importante para a recuperação do estado clínico. Apesar de a dieta hospitalar e o uso de suplementos atenderem às necessidades nutricionais da maioria dos pacientes, a anorexia limitou as possibilidades da terapia nutricional oral, comprovando a necessidade de estimular o uso de sondas e nutrição enteral neste centro de queimados.
Objective: To describe particularities related to nutrition in pediatric patients with burns and the adherence to dietary prescription in the first specialized center in the Para. Methods: We included patients from zero to ten years, admitted to the Burn Treatment Center ofMetropolitan Hospital of Urgency and Emergency State of Para. Methods:Procedures anthropometric, nutritional diagnosis, estimation of nutrient requirements, nutritional value of diets offered, adherence to hospital diets, requirements and use of nutritional supplements and statistical analysis were completed. Results: A total of 49 patients were studied. The total body surface area stricken represents 53%.Normal weight was present in more than 50% of the sample. Nutritional status was inversely proportional to the length of hospital stay (p<0.0001). The hospital diet attended the requirements of 97.95% of patients in terms of calories and protein to 100% according to the formula predictive of nutritional needs. About 88% of supplements needs are met. Anorexia was detected in 71.43% of the sample, being observed in 100% of patients with total body surface area over 21% (p <0.005). Conclusion: The maintenance of nutritional status was important for the recovery of clinical table. Although thehospital diet and use supplements meet the nutritional needs of most patients, anorexia has limited the possibilities of oral nutritional therapy, confirming the need to encourage the use of enteral nutrition in the place of study.