WEIGHT REGAIN AND THE METABOLIC PROFILE OF WOMEN IN THE POSTOPERATIVE PERIOD OF BARIATRIC SURGERY: A MULTIVARIATE ANALYSIS.

BACKGROUND: Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients' biochemical profile. AIMS: To assess the metabolic impact of weight regain on preoperative comorbidities and on patients' biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery. METHODS: A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed. RESULTS: The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained. CONCLUSIONS: The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients' metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed.

Weight regain and the metabolic profile of women in the postoperative period of bariatric surgery: a multivariate analysis / Reganho de peso e perfil metabólico de mulheres no pós-operatório de cirurgia bariátrica: análise multiariada

ABSTRACT BACKGROUND: Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients' biochemical profile. AIMS: To assess the metabolic impact of weight regain on preoperative comorbidities and on patients' biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery. METHODS: A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed. RESULTS: The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained. CONCLUSIONS: The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients' metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed.

RESUMO RACIONAL: Reganho de peso no pós-operatório de cirurgia bariátrica está diretamente relacionado à recidiva das comorbidades pré-operatórias e a um impacto negativo no perfil bioquímico desses pacientes. OBJETIVOS: avaliar o impacto metabólico do reganho de peso nas comorbidades pré-operatórias e no perfil bioquímico desses pacientes, a fim de mostrar o impacto das complicações nos desfechos metabólicos finais da cirurgia bariátrica. MÉTODOS: Estudo retrospectivo que analisou 75 mulheres no pós-operatório tardio de cirurgia bariátrica que apresentaram reganho patológico de peso (=20% do máximo de peso perdido). Foram coletados dados referentes às medidas dos perfis glicêmico, lipídico e inflamatório em três momentos distintos de avaliação: no pré-operatório, no nadir de peso (menor peso) e após o reganho ponderal. Foi realizada uma análise multivariada. RESULTADOS: A idade média foi 46.39±12.09 anos. IMC médio pré-operatório foi 40.10±4.11 kg/m2. Houve um aumento de 3,36 pontos no IMC médio entre o nadir e após reganho: de 26.30±3.9 Kg/m2 para 29.66±4.66 Kg/m2. O tempo médio para atingir o nadir foi de 18±7.6 meses, com uma %PEP de 91.08±11.8%. O tempo médio para o reganho patológico foi de 48 meses, e a média de reganho foi 8.85±5.65 kg. Houve correlação significativa entre o reganho patológico e os níveis de insulina (r=0.351; p<0.011), peptídeo C (r=0.303; p<0.011), proteína C reativa (r=0.402; p<0.001) e vitamina D (r=-0.435; p<0.001), sendo os dois últimos os mais influenciados pela porcentagem de reganho de peso. CONCLUSÕES: O reganho de peso patológico no pós-operatório de cirurgia bariátrica resulta em prejuízos ao perfil metabólico e inflamatório dos pacientes. No entanto, os benefícios bioquímicos perduram em relação aos níveis pré-operatórios dos parâmetros analisados

Hiperglicemia, evolução clínica e estado nutricional de pacientes criticamente enfermos / Hyperglycemia, clinical evolution and nutritional condition of critically ill patients

Introdução: O paciente criticamente enfermo frequentemente apresenta hipercatabolismo, caracterizado pela elevação do gasto energético e episódios de hiperglicemia. O estado hiperglicêmico está associado a fatores clínicos e nutricionais e quando mantido por um longo período, aumenta o risco de mortalidade. Objetivos: Avaliar a hiperglicemia e os parâmetros clínicos e nutricionais de pacientes em terapia nutricional enteral, internados em uma Unidade de Terapia Intensiva de um hospital Escola do Recife. Métodos: Estudo transversal realizado com pacientes internados na Unidade de Terapia Intensiva em suporte enteral por um período mínimo de 48 horas. Dados clínicos: motivo e tempo de internamento, diabetes pré-existente, uso de insulina e de drogas vasoativas, média da glicemia capilar diária, início da terapia nutricional, necessidade de ventilação mecânica, indicadores de mortalidade e desfecho clínico. Dados antropométricos: índice de massa corporal, circunferência do braço e da panturrilha. A análise estatística foi realizada pelo programa Statistical Package for Social Sciences versão 13.0. Resultados: Foram avaliados 40 pacientes, com idade média de 57,3 ± 17,87 anos. A circunferência do braço foi o parâmetro de diagnóstico nutricional com maior percentual de desnutrição (57,5%). Foi observada associação significativa da hiperglicemia com idade (p=0,049), diabetes pré-existente (p= 0,017), uso de insulina (p < 0,001), dias de ventilação mecânica (p=0,015) e Sepsis Related Organ Failure Assessment do desfecho (p=0,011). A mortalidade esteve presente em 15% da amostra. Conclusão: O monitoramento e o controle glicêmico em Unidade de Terapia Intensiva é de grande relevância, pois pode reduzir as complicações clínicas que levariam a uma menor taxa de mortalidade. A utilização de um protocolo de controle glicêmico seria uma ferramenta de grande valor nessa condição

Introduction: The critically ill patient frequently presents hypercatabolism, characterized by elevated energy expenditure and episodes of hyperglycemia. The hyperglycemic state is associated with clinical and nutritional factors and when maintained over a long period increases the risk of mortality. Objective: To evaluate hyperglycemia and the clinical and nutritional parameters of patients in enteral nutritional therapy, interned at an Intensive Therapy Unit in Recife School hospital. Methods: Transversal study conducted with in-patients at an Intensive Therapy Unit in enteral support for a minimum period of 48 hours. Clinical data: reason and time of internment, preexisting diabetes, insulin and vasoactive drugs usage, daily capillary glycemy average, start period of nutritional therapy, need for mechanical ventilation, mortality indicators and clinical outcome. Anthropometric data: body mass index, arm and calf circumference. The statistical analysis was taken by Statistical Package for Social Sciences programme version 13.0. Results: 40 evaluated patients, with an average age of 57,3 ± 17,87. Arm circumference was the nutritional diagnostic parameter with the highest percentage of malnutrition (57.5%). It has been observed significant relation between hyperglycemia and age (p=0,049), preexisting diabetes (p= 0,017), insulin usage (p < 0,001), days of mechanical ventilation (p=0,015) and Sepsis Related Organ Failure Assessment outcome (p=0,011). Mortality was present in 15% of the sample. Conclusion: Monitoring and glycemic control at the Intensive Therapy Unit is of great relevance, for it can reduce clinical complications that would lead to a minor mortality rate. The usage of glycemic control protocol would be an invaluable tool in this condition

No disponible

Avaliação subjetiva global e métodos funcionais no diagnóstico nutricional de pacientes com hepatopatia crônica / Subjective global assessment and functional methods for the nutritional diagnosis of patients with chronic liver disease

Introdução: As comorbidades atreladas ao dano hepático surgem tardiamente, estando a desnutrição presente entre 10 e 100% dos pacientes, sendo o estado nutricional reconhecido como fator prognóstico. Objetivo: Avaliar a concordância entre avaliação subjetiva global e métodos funcionais na avaliação nutricional de pacientes com doença hepática crônica. Métodos: Estudo transversal realizado nas enfermarias de clínica médica, gastroenterologia e cirurgia geral/transplante hepático do Hospital Universitário Oswaldo Cruz, Recife - Pernambuco, de abril à setembro/2015, com adultos e idosos de ambos os sexos, hospitalizados. Realizada a avaliação subjetiva global e, para avaliação funcional, a força de preensão palmar e espessura do músculo adutor do polegar. Realizados os testes Exato de Fisher, Anova e Tukey. Resultados: 101 indivíduos avaliados. 51,5% mulheres; Idade média de 59,2 ± 11 anos, com predomínio de idosos (52,5%). A etiologia por esquistossomose foi maioria (47,5%). A força de preensão palmar e espessura do músculo adutor do polegar apresentaram média de 18,54 ± 9,31 kg/F e 15,66 ± 4,08mm, respectivamente, inferiores à referência para sadios e hepatopatas em acompanhamento ambulatorial; Distúrbios gastrointestinais ocorreram em 92% e ascite em 85%. Detectada maior prevalência de desnutrição pela avaliação subjetiva global, seguida da força de preensão palmar e espessura do músculo adutor do polegar (95%, 89,1% e 13,9%, respectivamente). Observados baixos níveis de concordância entre os três métodos. Conclusão: O diagnóstico nutricional foi discrepante entre os métodos. A avaliação subjetiva global foi superior à força de preensão palmar e espessura do músculo adutor do polegar na detecção de desnutrição. Portanto, a avaliação subjetiva global é um instrumento que pode ser utilizado a nível hospitalar para avaliação do estado nutricional de hepatopatas crónicos (AU)

Introduction: Comorbidities emerge late in individuals with liver damage and malnutrition is found in 10 to 100% of such patients. Objective: The aim of the present study was to determine the level of agreement between a subjective global assessment and functional methods for the nutritional evaluation of patients with chronic liver disease. Methods: A cross-sectional study was conducted at the Oswaldo Cruz University Hospital in the city of Recife, Brazil, between April and September 2015 involving hospitalized male and female adults and elderly individuals with chronic liver disease. The subjective global assessment was compared to functional methods (grip strength and thumb adductor thickness) using Fisher's exact test, ANOVA and Tukey's test. Results: One hundred one individuals were analyzed (51.5% female; mean age: 59.2 ± 11 years; 52.5% elderly). The most common etiology was schistosomiasis (47.5%). Mean grip strength and thumb adductor thickness were 18.54 ± 9.31 kg/F and 15.66 ± 4.08 mm, respectively, which were lower than reference values for healthy individuals and patients with liver disease in outpatient follow up. Gastrointestinal disorders were found in 92% and ascites was found in 85%. The prevalence of malnutrition was 95%, 89.1% and 13.9% based on the subjective global assessment, grip strength and thumb adductor thickness, respectively. Low levels of agreement were found among the three methods. Conclusion: Divergences were found among the methods employed for a nutritional evaluation. The detection of malnutrition was higher when using the subjective global assessment rather than grip strength and thumb adductor thickness. Thus, the subjective global assessment can be used in the hospital setting for the evaluation of nutritional status in patients with chronic liver disease (AU)

Adductor pollicis muscle as predictor of malnutrition in surgical patients.

BACKGROUND: In the compromised nutritional status, there is excessive skeletal muscle loss and decreased inflammatory response, contributing to increased morbidity and mortality and length of stay. AIM: To estimate the prevalence of malnutrition by measuring adductor pollicis muscle using cutoffs for surgical patients suggested in the literature. METHODS: Cross-sectional study with 151 patients scheduled for elective surgical procedure. Nutritional assessment was performed by classical anthropometric measurements: arm circumference, triceps skinfold thickness, arm muscle circumference, corrected arm muscle area, BMI and percentage of weight loss and the extent of the adductor pollicis muscle in both hands. RESULTS: The prevalence of malnutrition in patients was high. A significant association between nutritional diagnosis according to the measures of adductor pollicis muscle and arm circumference, BMI and triceps skinfold thickness but there was no association with arm muscular circumference, arm muscular area or percentage of weight loss. CONCLUSION: The adductor pollicis muscle has proved to be a good method to diagnose muscle depletion and malnutrition in surgical patients.

Adductor pollicis muscle as predictor of malnutrition in surgical patients / Musculo adutor do polegar como preditor de desnutricao em pacientes cirurgicos

Background - In the compromised nutritional status, there is excessive skeletal muscle loss and decreased inflammatory response, contributing to increased morbidity and mortality and length of stay. Aim: To estimate the prevalence of malnutrition by measuring adductor pollicis muscle using cutoffs for surgical patients suggested in the literature. Methods: Cross-sectional study with 151 patients scheduled for elective surgical procedure. Nutritional assessment was performed by classical anthropometric measurements: arm circumference, triceps skinfold thickness, arm muscle circumference, corrected arm muscle area, BMI and percentage of weight loss and the extent of the adductor pollicis muscle in both hands. Results: The prevalence of malnutrition in patients was high. A significant association between nutritional diagnosis according to the measures of adductor pollicis muscle and arm circumference, BMI and triceps skinfold thickness but there was no association with arm muscular circumference, arm muscular area or percentage of weight loss. Conclusion: The adductor pollicis muscle has proved to be a good method to diagnose muscle depletion and malnutrition in surgical patients. .

Racional: No estado nutricional comprometido, há excessiva perda muscular esquelética e diminuição da resposta inflamatória, contribuindo para o aumento da morbimortalidade e do tempo de internamento. Objetivo : Estimar a prevalência de desnutrição pela medida do músculo adutor do polegar utilizando pontos de corte para pacientes cirúrgicos sugeridos na literatura. Métodos : Estudo de corte transversal com 151 pacientes candidatos a procedimento cirúrgico de caráter eletivo. Realizou-se avaliação nutricional através das medidas antropométricas clássicas: circunferência do braço, dobra cutânea tricipital, circunferência muscular do braço, área muscular do braço corrigida, IMC e percentual de perda ponderal e pela medida do músculo adutor do polegar em ambas as mãos. Resultados : A prevalência da desnutrição nos pacientes avaliados foi elevada. Houve associação significativa entre o diagnóstico nutricional, segundo o músculo adutor do polegar, e as medidas da circunferência do braço, prega cutânea tricipital e IMC. No entanto, não se associou à circunferência muscular do braço, área muscular do braço corrigida ou ao percentual de perda de peso. Conclusão : O músculo adutor do polegar mostrou ser bom método para diagnosticar a depleção muscular e a desnutrição nos pacientes cirúrgicos. .

Nutritional status and life quality in patients undergoing bariatric surgery / Estado nutricional e qualidade de vida em pacientes submetidos à cirurgia bariátrica

BACKGROUND: The obesity has achieved an alarming increase in recent years, which led this disease to global epidemic condition. AIM: To evaluate the nutritional status as well as the quality of life of obese patients undergoing bariatric surgery. METHODS: A transversal study was conducted with obese adults of both genders who underwent bariatric surgery by Fobi-Capella technique for at least 30 days. It was evaluated: age, gender, marital status, occupation, weight before surgery, current weight, height, preoperative and current BMI, weight loss and loss of excess weight percentages, presence of clinical manifestations and food intolerances. RESULTS: The sample consisted of 70 patients, being 81.4% female, 37.1% aged 30 to 39 years, 58.6% were married, 41.4% have undergone the bariatric surgery in the last 12 months. It was observed a reduction in BMI from 37.2 kg/m2 (one to three months) to 28.9 kg/m2 (>12 months) and consequent increase in weight loss and loss of excess weight percentages. The most frequent clinical manifestation was alopecia (62.9%). The most reported food intolerance was on the red meat (24%). According to the Baros questionnaire, 50% of patients were classified as having good quality of life. CONCLUSION: The operation of Fobi-Capella proved to be effective in promoting gradual and lasting weight loss. Quality of life was considered good in most patients, indicating that the operation had a positive impact on their lives. .

RACIONAL: A obesidade obteve aumento assustador nos últimos anos, levando essa doença à condição de epidemia global. OBJETIVO: Avaliar o estado nutricional, bem como a qualidade de vida de pacientes obesos submetidos à cirurgia bariátrica. MÉTODO: Estudo transversal realizado em obesos adultos de ambos os sexos que se submeteram à cirurgia bariátrica por técnica de Fobi-Capella há pelo menos 30 dias. Foram avaliados: idade, sexo, estado civil, profissão, peso anterior à operação, peso atual, altura, índice de massa corpórea pré-operatório e atual, porcentagem de perda ponderal e porcentagem de perda do excesso de peso, manifestações clínicas e presença de intolerâncias alimentares. RESULTADOS: A amostra foi constituída de 70 pacientes, sendo 81,4% do sexo feminino, 37,1% na faixa etária entre 30 a 39 anos, 58,6% casados, 41,4% com >12 meses de cirurgia bariátrica. Observou-se redução do índice de massa corpórea de 37,2 kg/m2 (um a três meses) para 28,9 kg/m2 (>12 meses) e consequente aumento da porcentagem de perda ponderal e da perda do excesso de peso. A manifestação clínica mais frequente foi alopecia (62,9%). A intolerância alimentar mais relatada foi em relação à carne vermelha (24%). De acordo com o questionário Baros, 50% dos pacientes foram classificados como tendo boa qualidade de vida. CONCLUSÃO: A operação de Fobi-Capella mostrou-se efetiva em promover perda ponderal gradual. A qualidade de vida foi considerada boa na maior parte dos pacientes, indicando que a operação tem impacto positivo na vida desses pacientes. .

Eating habits, nutritional status and quality of life of patients in latepostoperative gastric bypass Roux-Y / Hábitos alimenticios, estatus nutricional y calidad de vida en pacientes en el postoperatorio de cirugía bariátrica a fobi-capela

OBJECTIVE: To characterize the food habits, nutritional status and quality of life of patients in the postoperative period of bariatric surgery to Fobi-Capella. METHODS: Analytical cross-sectional study was conducted with 66 patients underwent bariatric surgery and monitoring by the staff of the Hospital Universitario Oswaldo Cruz (HUOC), in northeast Brazil. A questionnaire was applied in witch was covered sociodemographic characteristics, and demographic information related to eating habits, and also evaluated the quality of life by the method BAROS. RESULTS: The tolerance to food, the category "hardly eaten" were reported food such as meat, chicken, rice, raw salad and corn meal and that "not eaten" were corn meal, followed by sweets, meat and chicken. There was a reduction of total body weight and BMI and, consequently, the increase in PEP% over time. Regarding quality of life, it can be observed which is classified as "good" for most patients in both groups of 6-18 months and ≥ 18 months. CONCLUSIONS: Our results demonstrate that bariatric surgery showed satisfactory effects in this population, however the need for continuous nutritional education work, especially in groups of more than 18 months postoperatively (AU)

Objetivo: Caracterizar los hábitos alimenticios, el estado nutricional y la calidad de vida de pacientes en el periodo posoperatorio de la cirugía bariátrica de Fobi-Capella. Métodos: Se realizó un estudio analítico transversal en 66 pacientes sometidos a cirugía bariátrica y monitorizados por el personal del Hospital Universitario Oswaldo Cruz (HUOC), en el noreste de Brasil. Se aplicó un cuestionario que contemplaba características sociodemográficas e información demográfica relativa a los hábitos alimenticios, y también se evaluaba la calidad de vida por el método BAROS. Resultados: En la tolerancia a los alimentos, en la categoría de «difícil de comer» se notificaron alimentos tales como carne, pollo, arroz, ensalada cruda y maíz y en la «no ingeridos» estaban maíz, seguido de caramelos, carne y pollo. Hubo una reducción del peso corporal total y del IMC y, en consecuencia, un aumento del PEP% con el tiempo. Con respecto a la calidad de vida, se pudo observar que la mayor parte de los pacientes la clasificaron como «buena» en ambos grupos de 6-18 meses y de > 18 meses. Conclusiones: Nuestro resultados demuestran que la cirugía bariátrica produjo unos efectos satisfactorios en esta población; sin embargo, existe la necesidad de una educación nutricional continuada, especialmente en el grupo de más de 18 meses tras la cirugía (AU)

[Clinical-nutritional evaluation of obese patients submitted to Roux-en-Y gastric bypass]. / Avaliação clínico-nutricional de obesos submetidos ao bypass gástrico em Y de Roux.

Bariatric surgery (BS) is considered the only effective method to treat refractory obesity. This study evaluated the clinical-nutritional behavior of obese patients submitted to Roux-en-Y gastric bypass. This cross-sectional and analytical study evaluated weight, Body Mass Index (BMI), weight loss percentage (% WLP), excess weight loss (%EWL) and clinical manifestations. Results were evaluated considering a significance level of 5%. The sample was composed of 37 obese patients, mainly females (n = 26), median age of 40 years. Progressive and significant reduction of weight (128.2 +/- 21.5 vs. 104.4 +/- 18.2 kg), BMI (49.3 +/- 7.7 vs. 40.4 +/- 6.8 kg/m2) and consequent increase in the %WLP (18.6 +/- 3.9%) and %EWL (39.4 +/- 10.6%) were observed over 90 days of follow-up (P < 0.001). Significant increase in the number of patients presenting alopecia (10 vs. 18) and diminished events of dumping syndrome (9 vs 8) and xerostomia (21 vs. 11) were evidenced between 30 and 90 postoperative days. There was also significant reduction in the levels of fasting glucose (100.9 +/- 32.0 vs 83.0 +/- 12.3 mg/dL), total cholesterol (208.1 +/- 38.5 vs. 173.3 +/- 48.2 mg/dL), triglycerides (150.9 +/- 7.7 vs. 102.2 +/- 27.3 mg/dL), hemoglobin (13.3 +/- 1.4 vs. 12.6 +/- 1.0 g/dL) and hematocrit (41.1 +/- 3.8 vs. 39.2 +/- 3.3%) at 90 postoperative day compared to the preoperative period (P < 0.005). We conclude that BS is an effective treatment for weight loss and improved lipid and glycemic profiles. However, the frequency of alopecia and significant reduction in the hemoglobin and hematocrit levels at 90 posotperative day deserves attention.

Anemia, disfunção renal e desnutrição associadas à insuficiência cardíaca em pacientes valvopatas / Anemia, renal dysfunction and malnutrition associated with heart failure in patients with valvulopathy

FUNDAMENTO: A doença valvar pode cursar com insuficiência cardíaca (IC), anemia e disfunção renal (DR), aumentando o risco nutricional e piorando o prognóstico dos pacientes. OBJETIVO: Avaliar a prevalência de anemia e DR em pacientes portadores de valvopatias com ou sem IC, bem como estabelecer correlação com o estado nutricional. MÉTODOS: Foram avaliados 104 pacientes internados na enfermaria de valvopatias do PROCAPE/UPE, no período de ago-out/2008. Os dados foram obtidos das fichas de acompanhamento nutricional e dos prontuários. As variáveis coletadas foram: sexo, idade, estado nutricional segundo o índice de massa corpórea (IMC), presença de IC, anemia, DR. Considerou-se como anemia valores de hemoglobina < 13 g/dl nos homens e < 12 g/dl nas mulheres. A DR foi estabelecida de acordo com a taxa de filtração glomerular (TGF), sendo calculada pela fórmula proposta por Cockcroft e Gault. RESULTADOS: A prevalência de anemia e DR em pacientes com IC foi de 71,1 por cento e de 68,8 por cento, e nos pacientes sem IC foi de 48,1 por cento e de 60,0 por cento, respectivamente, com diferença estatisticamente significativa para anemia (p = 0,022). Dos pacientes, 48,1 por cento estavam eutróficos, 26,9 por cento com excesso de peso e 25,0 por cento com algum grau de desnutrição. Os pacientes com IC apresentaram uma frequência maior de baixo peso (p = 0,020). O estado nutricional não apresentou associação com anemia (p = 0,117), mas apresentou associação com DR, sendo a função renal diminuída mais frequente nos pacientes com baixo peso (p = 0,000). CONCLUSÃO: Houve significância estatística quando comparamos as prevalências de desnutrição, anemia e DR entre pacientes com e sem IC.

BACKGROUND: Valvular disease can course with heart failure (HF), anemia and renal dysfunction (RD), increasing the nutritional risk and worsening patient prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RD in patients with valvulopathy with or without HF, as well as establish a correlation with the nutritional status. METHODS: A total of 104 patients admitted at the Clinic of Valvulopathy of PROCAPE/UPE, during the period of Aug-Oct/2008. The data were obtained from the nutritional and medical follow-up files. The collected variables were: sex, age, nutritional status according to the body mass index (BMI), presence of HF, anemia and RD. Anemia was considered when hemoglobin values were < 13 g/dl in men and < 12 g/dl in women. RD was established according to the glomerular filtration rate (GFR) and it was calculated through the formula proposed by Cockcroft and Gault. RESULTS: The prevalence of anemia and RD was 71.1 percent and 68.8 percent, and 48.1 percent and 60.0 percent, in patients with and without HF, respectively, with a statistically significant difference for anemia (p = 0.022). Of the patients, 48.1 percent were eutrophic, 26.9 percent had excess weight and 25.0 percent presented some degree of malnutrition. The patients with HF presented a higher frequency of low weight (p = 0.020). The nutritional status was not associated with anemia (p = 0.117), but it was associated with RD, with renal function being decreased more often in patients with low weight (p = 0.000). CONCLUSION: When the prevalence of malnutrition, anemia and RD was compared between patients with and without HF, it showed statistical significance.

Anemia, renal dysfunction and malnutrition associated with heart failure in patients with valvulopathy.

BACKGROUND: Valvular disease can course with heart failure (HF), anemia and renal dysfunction (RD), increasing the nutritional risk and worsening patient prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RD in patients with valvulopathy with or without HF, as well as establish a correlation with the nutritional status. METHODS: A total of 104 patients admitted at the Clinic of Valvulopathy of PROCAPE/UPE, during the period of Aug-Oct/2008. The data were obtained from the nutritional and medical follow-up files. The collected variables were: sex, age, nutritional status according to the body mass index (BMI), presence of HF, anemia and RD. Anemia was considered when hemoglobin values were < 13 g/dl in men and < 12 g/dl in women. RD was established according to the glomerular filtration rate (GFR) and it was calculated through the formula proposed by Cockcroft and Gault. RESULTS: The prevalence of anemia and RD was 71.1% and 68.8%, and 48.1% and 60.0%, in patients with and without HF, respectively, with a statistically significant difference for anemia (p = 0.022). Of the patients, 48.1% were eutrophic, 26.9% had excess weight and 25.0% presented some degree of malnutrition. The patients with HF presented a higher frequency of low weight (p = 0.020). The nutritional status was not associated with anemia (p = 0.117), but it was associated with RD, with renal function being decreased more often in patients with low weight (p = 0.000). CONCLUSION: When the prevalence of malnutrition, anemia and RD was compared between patients with and without HF, it showed statistical significance.

Consumo alimentar de obesos em períodos pré e pós-operatórios de cirurgia bariátrica / Food consumption in obese patients before and after bariatric surgery

A cirúrgia bariátrica é atualmente considerada o mais efetivo tratamento para a redução do peso e manutenção dessa perda em pacientes com obesidade grave, porém pode acarretar risco de deficiências nutricionais específicas que devem ser identificadas e tratadas. O objetivo deste estudo foi avaliar o consumo alimentar de obesos morbidos submetidos à cirúrgia bariátrica de Fobi-capella, através de recordatório alimentar de 24 horas, em períodos pré e pós-operatórios no HC/UFPE. A amostra foi constituida de 48 pacientes, sendo 36 do sexo feminino, com 29 na faixa etária entre 20 a 44 anos e IMC pré-operatório de 50,4±7,9m2. A dieta na fase pré-operatória apresentou-se hipercalórica, hiperprotéica e hiperlipídica, quando comparada com a RDA/1989, além de insuficiente aporte de micronutrientes. Por outro lado, no perído pós-operatório, observou-se uma redução drástica no consumo calórico, de macronutrientes e micronutrientes, principalmente no período < 6 meses com aumento progressivo, ao longo dos períodos. Em conclusão, o consumo desequilibrado de macro e micronutrientes, nos períodos pré e pós-operatórios, evidenciou potenciais riscos nutricionais. O acompanhamento nutricional deve ser prioritário para correção precoce dos hábitos alimentares, possibilitando uma perda de peso efetiva sem morbimortalidade