Supplementation Adherence and Outcomes Among Pregnant Women After Bariatric Surgery.

PURPOSE: Most patients undergoing bariatric surgery (BS) are fertile women whose postoperative (post-op) hormonal balance and weight loss increases fertility, frequently leading to pregnancy. This study aims to analyze supplementation adherence of pregnant women after BS and perinatal outcomes. MATERIALS AND METHODS: This retrospective study analyzed records from women after BS who consulted nutritionists at least twice during pregnancy. Each patient received nutritional guidance about vitamin and mineral supplementation and protein intake. Demographic data, body mass index (BMI), percentage of weight loss (%WL) at conception, maximum post-op BMI and %WL, post-op time at conception, supplementation adherence, biochemical data, possible gestational complications, and infant's birth weight were collected. RESULTS: Data was obtained from 23 women (mean age 33 ± 4 years). On average, patients became pregnant 43 months after surgery. The mean preoperative BMI was 40.2 kg/m2, the maximum post-op %WL was 36.6%, and the mean %WL at conception was 32.0%. No gestational intercurrence was related to biochemical data. Supplementation adherence was 34.7% for one multivitamin and 34.7% for two multivitamins; 43.5% for iron, 43.5% for omega 3, 39.1% for folic acid, 17.4% for B complex, and 60.8% for calcium. Mean infant birth weight was 3.0 kg, and it was not associated with maximum %WL, % WL at conception, and time since BS at conception. CONCLUSION: Our data indicate satisfactory adherence to post-op micronutrient supplementation and few gestational complications following BS. Moreover, child's birth weight was not associated with maximum %WL, %WL at conception, or time since BS.

Diet-induced thermogenesis in postoperatve Roux-en-Y gastric bypass patients with weight regain.

BACKGROUND: Bariatric surgery has been shown to be an effective treatment for obesity. Changes in energy expenditure, especially through diet-induced thermogenesis (DIT), have been identified as one of the mechanisms to explain this success. However, not all patients are able to maintain healthy postoperative weight loss. Therefore, a question arises: In the weight regain after bariatric surgery, are these changes in energy metabolism still active? OBJECTIVE: To investigate if weight regain after Roux-en-Y gastric bypass (RYGB) surgery is associated with a lower diet-induced thermogenesis in the late postoperative period. SETTING: A cross-sectional study with the participants chosen from among the patients from a private practice. METHODS: This was a cross-sectional study where 3 groups of female patients were evaluated: (1) 20 patients with a RYGB postoperative time period of at least 2 years, who kept a healthy weight after surgery (loss of at least 50% of excess weight; Healthy group); (2) 19 patients with clinically severe obesity (BMI>40 kg/m(2), without co-morbidities and>35 kg/m(2), with co-morbidities; Pre group); (3) 18 patients who experienced weight regain after RYGB (Regain group). The 3 groups were submitted to indirect calorimetry to measure resting metabolic rate (RMR), respiratory quotient (RQ), and DIT. Immediately after the RMR measurement, a mixed meal of regular consistency was offered. Ten minutes after the food intake began, energy expenditure measurements were initiated continuing throughout the following 3 postprandial hours. Body composition was evaluated using multifrequency bioelectrical impedance. In subgroups of the studied population, glucose and insulin levels were measured at baseline and at 30, 60, 90, 120, and 180 minutes after feeding. The mean area under the curve (AUC) between the 3 groups and measurements at baseline were compared using the analysis of variance (ANOVA). RESULTS: The Healthy group had the highest weight adjusted RMR value compared with both the Pre and Regain group (23.03±3.02 kcal/kg; 16.18±2.94 kcal/kg; 17.11±3.28 kcal/kg, respectively; P<.0001). The Regain and Pre groups showed no difference for this variable. The weight-adjusted DIT (AUC 0-180 min) was about 42% and 34% higher in the Healthy group compared with the Pre and Regain groups, respectively (P<.0001). Lean body mass (kg) showed a positive correlation with the AUC of weight-adjusted DIT in the 3 groups. Multiple regression revealed that lean body mass was the only variable related to weight adjusted DIT, independent of group and other selected variables. CONCLUSION: Weight-adjusted DIT in the Regain group was smaller compared with the Healthy group, and with no difference compared with the Pre group. The lean body mass seems to have a positive association with diet-induced thermogenesis.

Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial.

BACKGROUND: Preoperative bariatric patients can follow very low calorie diets (VLCD), reducing surgical risks. However, possible advantages of a liquid diet over one of normal consistency are controversial. This study investigated the effect of a liquid VLCD compared with one of normal consistency considering visceral fat (VF) loss and metabolic profile in preoperative clinically severe obese patients. METHODS: This was a randomized, open-labeled, controlled clinical trial. Patients were divided into 2 groups: liquid diet and normal diet. Data were collected at baseline and 7 and 14 days after intervention. Information gathered was analyzed for loss of weight and VF, biochemical data, anthropometric data, and energy intake. RESULTS: Fifty-seven patients consumed the liquid diet and 47 consumed the normal consistency diet. The liquid diet group lost significantly more weight (P<.0290) and VF (P<.0410) than the normal diet group. An inverse correlation occurred between VF loss and surgical time among the liquid diet group (r2=-.1302, P=.001). Additionally, there was a positive correlation between the percentage of excess weight loss and ketonuria (P=.0070). No between-group difference occurred regarding calorie intake. CONCLUSION: Patients that consumed a liquid diet presented a positive effect on reducing VF and greater weight loss than the normal diet group. Both VLCDs presented benefits offering a protective effect during the preoperative stage.

Comparison of weight loss, food consumption and frequency of vomiting among Roux-en-Y gastric bypass patients with or without constriction ring.

BACKGROUND: After Roux-en-Y gastric bypass to avoid rapid gastric emptying, dumping syndrome and regained weight due to possible dilation of the gastric pouch, was proposed to place a ring around the gastric pouch. AIM: To compare weight loss, consumption of macronutrients and the frequency of vomiting among patients who underwent Roux-en-Y gastric bypass with and without the placement of a constriction ring around the pouch. METHOD: A retrospective study, in which an analysis of medical records was carried out, collecting data of two groups of patients: those who underwent the operation with the placement of a constriction ring (Ring Group) and those who underwent without the placement of a ring (No-Ring Group). The food intake data were analyzed using three 24-hour recalls collected randomly in postoperative nutritional accompaniment. Data on the percentage of excess weight loss and the occurrence of vomiting were collected using the weight corresponding to the most recent report at the time of data collection. RESULTS: Medical records of 60 patients were analyzed: 30 from the Ring Group (women: 80%) and 30 from the No-Ring Group (women: 87%). The average time since the Ring Group underwent the operation was 88 ± 17.50 months, and for the No-Ring Group 51 ± 15.3 months. The percentage of excess weight loss did not differ between the groups. The consumption of protein (g), protein/kg of weight, %protein and fiber (g) were higher in the No-Ring Group. The consumption of lipids (g) was statistically higher in the Ring Group. The percentage of patients who never reported any occurrence was statistically higher in the No-Ring Group (80%vs.46%). The percentage who frequently reported the occurrence was statistically higher in the Ring Group (25%vs.0%). CONCLUSION: The placement of a ring seems to have no advantages in weight loss, favoring a lower intake of protein and fiber and a higher incidence of vomiting, factors that have definite influence in the health of the bariatric patient.

Diet-induced thermogenesis and respiratory quotient after Roux-en-Y gastric bypass surgery: a prospective study.

BACKGROUND: Studies in humans and other animals have shown that Roux-en-Y gastric bypass (RYGB) leads to increased energy expenditure (EE). We analyzed several components of EE, such as the respiratory quotient (RQ), resting metabolic rate (RMR), and diet-induced thermogenesis (DIT) among patients before and after RYGB. METHODS: In this prospective clinical study, RMR, DIT, and RQ were measured by indirect calorimetry (IC) in the same patients before and 12 months after RYGB (the preoperative and postoperative time points, respectively). Postprandial RQ and DIT were measured after patients consumed a standard ~270 kcal meal (62% carbohydrates, 12% proteins, and 26% lipids). RESULTS: The population studied consisted of 13 patients (mean age 40.8 ± 6.7 years, 85% female).At the postoperative (postop) time point, patients showed higher weight-adjusted RMR compared with the preoperative (preop) time point (P<.01). The absolute and weight-adjusted metabolic rates 20 minutes after the meal were increased postoperatively (P<.0001) but not preoperatively (P = 0.2962) (DIT); this increase in RQ was significantly higher in the postop than in the preop time point. CONCLUSION: The observed patients showed increased EE, DIT, and RQ after RYGB surgery. These data may serve as important physiologic factors contributing to the loss and maintenance of weight after RYGB.

Comparison of weight loss, food consumption and frequency of vomiting among Roux-en-Y gastric bypass patients with or without constriction ring / Comparação da perda de peso, consumo alimentar e frequência de vômitos entre pacientes do bypass gástrico em Y-de-Roux com e sem colocação de anel de contenção

BACKGROUND: After Roux-en-Y gastric bypass to avoid rapid gastric emptying, dumping syndrome and regained weight due to possible dilation of the gastric pouch, was proposed to place a ring around the gastric pouch. AIM: To compare weight loss, consumption of macronutrients and the frequency of vomiting among patients who underwent Roux-en-Y gastric bypass with and without the placement of a constriction ring around the pouch. METHOD: A retrospective study, in which an analysis of medical records was carried out, collecting data of two groups of patients: those who underwent the operation with the placement of a constriction ring (Ring Group) and those who underwent without the placement of a ring (No-Ring Group). The food intake data were analyzed using three 24-hour recalls collected randomly in postoperative nutritional accompaniment. Data on the percentage of excess weight loss and the occurrence of vomiting were collected using the weight corresponding to the most recent report at the time of data collection. RESULTS: Medical records of 60 patients were analyzed: 30 from the Ring Group (women: 80%) and 30 from the No-Ring Group (women: 87%). The average time since the Ring Group underwent the operation was 88±17.50 months, and for the No-Ring Group 51±15.3 months. The percentage of excess weight loss did not differ between the groups. The consumption of protein (g), protein/kg of weight, %protein and fiber (g) were higher in the No-Ring Group. The consumption of lipids (g) was statistically higher in the Ring Group. The percentage of patients who never reported any occurrence was statistically higher in the No-Ring Group (80%vs.46%). The percentage who frequently reported the occurrence was statistically higher in the Ring Group (25%vs.0%). CONCLUSION: The placement of a ring seems to have no advantages in weight loss, favoring a lower intake of protein and fiber and a higher incidence of vomiting, factors ...

RACIONAL: Após bypass gástrico em Y-de-Roux e a fim de evitar o rápido esvaziamento gástrico, amenizar a síndrome de dumping e evitar o reganho de peso devido à possível dilatação da anastomose gastrojejunal, foi idealizada a colocação de um anel ao redor do reservatório gástrico. OBJETIVO: Comparar a perda de peso, o consumo de macronutrientes e a frequência de vômitos entre pacientes que realizaram o bypass gástrico em Y-de-Roux com e sem a colocação do anel de contenção. MÉTODOS: Estudo retrospectivo na análise de prontuários para a coleta dos dados de dois grupos de pacientes: os que realizaram o bypass gástrico em Y-de-Roux com a colocação do anel de contenção ao redor da bolsa gástrica (grupo com anel) e sem a colocação do anel (grupo sem anel). Os dados de consumo alimentar foram analisados através de três recordatórios de 24 horas coletados aleatoriamente nos atendimentos nutricionais do pós-operatório. Os dados quanto à porcentagem de perda do excesso de peso e ocorrência de vômitos foram coletados utilizando o peso e o relato mais recente em relação ao período da coleta. RESULTADOS: Analisaram-se prontuários de 60 pacientes: 30 do grupo com anel e 30 do grupo sem anel. A média do tempo de operado do grupo com anel foi de 88±17,5 meses, e do grupo sem anel 51±15,3 meses. A porcentagem de perda do excesso de peso não diferiu entre os grupos. O consumo de proteína (g), proteína/kg de peso, %proteína e fibras (g) foi estatisticamente superior no grupo sem anel. O consumo de lipídios (g) foi estatisticamente superior no grupo com anel. A porcentagem de pacientes que nunca relataram a ocorrência foi estatisticamente superior no grupo sem anel (80%vs46%). A porcentagem ...

Validation of ultrasound examination for assessment of the abdominal visceral fat in clinically serious obese patient.

BACKGROUND: Computerized tomography is the gold-standard for measurement of abdominal visceral fat. However, it is costly and involves submitting patients to ionizing radiation. AIM: To validate the use of ultrasonography in assessing abdominal visceral fat among clinically serious obese patients of both genders. METHODS: The sample included adult patients with clinically serious obesity with body mass index of 40 kg/m2 or from 35 kg/m(2) to 40 kg/m2 with co-morbidities. Abdominal visceral fat thickness was measured using ultrasound and tomography. Two ultrasonographic exams were conducted to assess the interobserver reproducibility among a patient subsample. Validation was done by comparing these results with the tomographic findings. RESULTS: The study included 13 patients (61.54% female) with an average BMI of 38.82 kg/m2. In terms of validation, the result obtained from applying the Pearson correlation coefficient was equal to 0.94 (p = 0.0005), showing a strong positive correlation between the two measurements. As for the results for reproducibility, the interobserver was equal to 0.822, with a confidence interval of 95% (-0.076 to 0.980), revealing good interobserver agreement. The average difference between the two ultrasound interobserver examination was equal to 0.10 ± 1.51 (p=0.8898) and so not significant. Interobserver bias was also not significant. CONCLUSION: The validation of ultrasonographic examination to replace tomographic method in assessing abdominal visceral fat among clinically serious obese patients was effective. The ultrasound measurement is independent of the examiner.

Validação da ultrassonografia para a avaliação da gordura abdominal visceral em obesos clinicamente graves / Validation of ultrasound examination for assessment of the abdominal visceral fat in clinically serious obese patient

RACIONAL: A tomografia computadorizada é o padrão-ouro para a medida da gordura abdominal visceral. No entanto é dispendiosa e envolve submeter os doentes à radiação ionizante. OBJETIVO: Validar o método ultrassonográfico para avaliação da gordura abdominal visceral em obesos clinicamente graves de ambos os sexos. MÉTODOS: A amostra incluiu adultos com obesidade clinicamente grave que apresentavam índice de massa corporal de 40kg/m² ou entre 35kg/m² e 40kg/m² com comorbidades associadas. Os exames realizados para medição da espessura da gordura visceral foram: ultrassonografia e de tomografia computadorizada. Foram realizados dois exames para avaliação da reprodutibilidade interobservador em uma subamostra de pacientes. O estudo ultrassonográfico foi validado comparando-o aos resultados do exame tomográfico. RESULTADOS: Participaram do estudo 13 pacientes, sendo 61,54% mulheres com IMC médio de 38,82kg/m². A validação foi feita pelo coeficiente de correlação de Pearson resultando ser igual a 0,94 (p = 0,0005). Evidenciou-se correlação positiva e forte entre as duas medidas. Quanto aos resultados da reprodutibilidade, o coeficiente de correlação intraclasse interobservador foi igual a 0,822 com intervalo de confiança de 95% (-0,076 a 0,980), o que revela boa concordância interobservador. A diferença média entre os dois observadores na ultrassonografia foi igual a 0,10 ± 1,51 (p = 0,8898), não significativa e sem viés significativo interobservador. CONCLUSÃO: Foi efetiva a validação do exame ultrassonográfico como substituição ao tomográfico para avaliar a gordura abdominal visceral entre obesos clinicamente graves. A medida ultrassonográfica independe do examinador.

BACKGROUND: Computerized tomography is the gold-standard for measurement of abdominal visceral fat. However, it is costly and involves submitting patients to ionizing radiation. AIM: To validate the use of ultrasonography in assessing abdominal visceral fat among clinically serious obese patients of both genders. METHODS: The sample included adult patients with clinically serious obesity with body mass index of 40kg/m2 or from 35kg/m2 to 40kg/m2 with co-morbidities. Abdominal visceral fat thickness was measured using ultrasound and tomography. Two ultrasonographic exams were conducted to assess the interobserver reproducibility among a patient subsample. Validation was done by comparing these results with the tomographic findings. RESULTS: The study included 13 patients (61.54% female) with an average BMI of 38.82 kg/m2. In terms of validation, the result obtained from applying the Pearson correlation coefficient was equal to 0.94 (p = 0.0005), showing a strong positive correlation between the two measurements. As for the results for reproducibility, the interobserver was equal to 0.822, with a confidence interval of 95% (-0.076 to 0.980), revealing good interobserver agreement. The average difference between the two ultrasound interobserver examination was equal to 0.10 ± 1.51 (p=0.8898) and so not significant. Interobserver bias was also not significant. CONCLUSION: The validation of ultrasonographic examination to replace tomographic method in assessing abdominal visceral fat among clinically serious obese patients was effective. The ultrasound measurement is independent of the examiner.

Diet-induced thermogenesis and respiratory quotient after Roux-en-Y gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is an effective tool for long-term weight loss. Mechanisms underlying the effectiveness of such surgery might result not only from the anatomic changes due to the procedure, but also from favorable changes in energy metabolism. Our objective was to evaluate the respiratory quotient (RQ), resting metabolic rate (RMR), and diet-induced thermogenesis (DIT) among clinically severe obese patients (control group) and patients who had undergone RYGB ≥ 1 year previously. The setting was Gastrocirurgia de Brasilia (Brasilia, Brazil). METHODS: The present study was cross-sectional and involved 35 clinically severe obese patients (body mass index ≥ 40 kg/m(2) or body mass index ≥ 35 kg/m(2) with co-morbidities) as the control group and 34 RYGB patients who had undergone the procedure ≥ 12 months previously (RYGB group). The anthropometric data (height and weight) were determined for both groups, and the RMR and RQ were measured using indirect calorimetry after a 12-hour fast. Patients then received a standard meal, and DIT was determined. The RMR and DIT were also adjusted per kilogram of body weight (BW), i.e BW-adjusted RMR and BW-adjusted DI. RESULTS: The BW-adjusted RMR and RQ did not differ between the 2 groups in the fasting period. However, the DIT of the RYGB group, whether absolute or BW-adjusted, was >200% that of the control group (P <.0001). The BW-adjusted DIT of the RYGB group correlated significantly with the percentage of excess weight loss (P = .0097). The postprandial RQ value among the RYGB group was also significantly (P <.0001) greater than that of the control group, suggesting an increased use of carbohydrates. CONCLUSION: Postprandial changes in energy expenditure and fuel use might contribute, in part, to the effectiveness of weight loss as a result of the RYGB procedure.

Energy expenditure before and after Roux-en-Y gastric bypass.

BACKGROUND: Weight loss may decrease the energy expenditure (EE) because of changes in body composition (BC). The reduction in EE may contribute, in part, to weight regain. Experimental studies in animals indicate that Roux-en-Y Gastric Bypass (RYGB) increases the resting metabolic rate (RMR) when adjusted for body weight (BW). Thus, the aim of this study was to assess the clinical effects of RYGB on EE in patients who have undergone RYGB. METHODS: The study was prospective and included 46 RYGB patients whose RMR was assessed prior to and at least 6 months post-surgery by indirect calorimetry. BW and BC were measured at these same time points using bioelectric impedance. RMR was adjusted for changes in BW, i.e., kilocalories per kilogram. Statistical tests were used to analyze the results. RESULTS: The BW-adjusted RMR (kilocalories per kilogram) increased post-RYGB by 17.66 % (p < 0.0001). RMR adjusted for BW was negatively correlated to the total percentage of body fat preoperatively (r = -0.30729, p = 0.0378) and postoperatively (r = -0.46731, p = 0.0011) and was positively correlated to the fat-free mass percentage (%FFM) both preoperatively and postoperatively. Furthermore, BW-adjusted RMR and %FFM were positively correlated to percent excess weight loss (r = 0.55398, p < 0.0001 and r = 0.31677, p = 0.0283, respectively). CONCLUSIONS: Weight loss following RYGB is associated with an increase in BW-adjusted RMR and with %FFM. An increase in energy expenditure post-RYGB may be responsible, in part, for successful long-term weight loss of the RYGB procedure.

Metabolic profile of clinically severe obese patients.

BACKGROUND: Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition. METHODS: We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables. RESULTS: Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p < 0.0001). A positive correlation between fat-free mass and a negative correlation between body fat percentage and BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC. CONCLUSIONS: The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

Dietary protein intake and bariatric surgery patients: a review.

Bariatric surgery, a highly successful treatment for obesity, requires adherence to special dietary recommendations to insure the achievement of weight loss goals and weight maintenance. Postoperative consumption of protein is linked to satiety induction, nutritional status, and weight loss. Hence, we conducted an extensive literature review to identify studies focused on the following: protein and nutritional status; recommendations for dietary protein intake; the effects of protein-rich diets; and associations between dietary protein intake and satiety, weight loss, and body composition. We found that there have been few studies on protein intake recommendations for bariatric patients. Dietary protein ingestion among this population tends to be inadequate, potentially leading to a loss of lean body mass, reduced metabolic rates, and physiological damage. Conversely, a protein-rich diet can lead to increased satiety, enhanced weight loss, and improved body composition. The quality and composition of protein sources are also very important, particularly with respect to the quantity of leucine, which helps to maintain muscle mass, and thus is particularly important for this patient group. Randomized studies among bariatric surgery patient populations are necessary to establish the exact quantity of protein that should be prescribed to maintain their nutritional status.

Correlation of respiratory muscle strength with anthropometric variables of normal-weight and obese women.

OBJECTIVE: To correlate anthropometric data and respiratory muscle strength (RMS) of normal-weight and obese women. METHODS: The sample consisted of 103 sedentary women, divided into two groups: 57 obese and 46 normal-weight women. Waist circumference (WC) and hip circumference (HC) were measured to calculate the waist-to-hip ratio (WHR), and maximal respiratory pressures (Pmax) were determined using an analog vacuum manometer to ± 300 cm H2O. Body composition was measured using tetrapolar bioelectrical impedance analysis. Descriptive statistics was used for data analysis, in addition to the Student t test for independent samples, Pearson correlation, and stepwise multiple linear regression analysis. Significance level was set at p ≤ 0.05. RESULTS: The analysis showed significant differences in Pmax of normal-weight women (PImax = -73.04±16.55 cm H2O and PEmax = 79.67±18.89 cm H2O) and obese women (PImax = -85.00±21.69 cm H2O and PEmax = 103.86±20.35 cm H2O). Anthropometric and manometric variables showed no significant correlation in both groups. When analyzing the influence of bioelectrical impedance on RMS, a positive correlation was observed between lean body mass and PImax. CONCLUSION: Bioelectrical impedance and obesity showed a direct correlation with RMS. WC and WHR had no influence on RMS of obese women; however, a relevance to risk factors for associated diseases was observed. We believe that these results are due to an adjustment to excess body weight over the years.

Nutritional management of weight regain after bariatric surgery.

BACKGROUND: The aim of this study was to propose dietetic guidelines for the nutritional management of weight regain in Roux-en-Y gastric bypass (RYGB) patients. METHODS: Thirty patients more than 2 years after RYGB surgery were followed up once every 15 days for at least 3 months. We collected from the medical records weight before surgery, excess weight, minimum weight reached 2 years after surgery, and percent of body fat before the operation. Current weight and bioelectrical impedance analysis were assessed at every appointment. The prescribed diet had a low glycemic load with 45% of carbohydrates, 35% of protein (80 g for women and 100 g for men) and 20% of fat, three servings of dairy products, and a supplement of soluble fibers (15 g/day). RESULTS: The patients had a previous average weight regain of 8 kg (+/-19). Forty percent of the sample had an excess weight loss (EWL) of less than 50%. After the intervention, 86% of the patients lost weight. The mean weight lost was 1.8 kg in the first month, 1.2 kg in the second month, and 1.3 kg in the third. Half of the sample with unsuccessful weight loss achieved an EWL of at least 50%. The failure rate of the group dropped from 40% to 20%. The percentage of body fat declined from 36.2% to 34% (p < 0.001). CONCLUSION: Despite the short period of time, we observed that the nutritional counseling reduced the weight of patients with previous weight regain. There was also a reduction in body fat, which improves the perspective of weight maintenance in the future.

Correlação da força muscular respiratória com variáveis antropométricas de mulheres eutróficas e obesas / Correlation of respiratory muscle strength with anthropometric variables of eutrophic and obese women

OBJETIVO: Correlacionar dados antropométricos e de FMR de mulheres eutróficas e obesas. MÉTODOS: A amostra foi formada por 103 mulheres sedentárias, dividas em dois grupos: 57 obesas e 46 eutróficas. Foram realizadas medidas da circunferência da cintura (CC) e do quadril (CQ) para cálculo da relação cintura/quadril (RC/Q) e coletados as Pressões Respiratórias Máximas (PRM) pela manovacuometria com aparelho analógico de ± 300cmH2O. Para a mensuração da composição corporal, utilizou-se a Bioimpedância Tetrapolar, análise descritiva com o teste T de Student para amostras independentes, correlação de Pearson e regressão linear múltipla com método stepwise. O nível de significância adotado foi p < 0,05. RESULTADOS: A análise demonstrou diferença significativa nas PRM de eutróficas (Pimáx = -73,04±16,55 cm H2O e Pemáx = 79,67±18,89 cm H2O) e de obesas (Pimáx = -85,00±21,69 cm H2O e Pemáx=103,86±20,35 cm H2O). As variáveis da antropometria e da manovacuometria não apresentaram correlação significante nos grupos. Ao analisar a influência da bioimpedância sobre a FMR, observou-se uma correlação positiva da quantidade de massa magra com a Pimáx. CONCLUSÃO: As variavéis da bioimpedância e a obesidade apresentaram uma relação direta com a FMR. As variáveis CC e RC/Q não influenciaram na FMR nas obesas, porém há uma relevância com os fatores de risco para doenças associadas. Acreditamos que esses resultados se devam a uma adaptação ao excesso de peso ao longo dos anos.

OBJECTIVE: To correlate anthropometrical data and RMS of eutrophic and obese women. METHODS: The study group comprised 103 sedentary women, divided into two groups: 57 obese and 46 eutrophic. For measurement of body composition, the Tetrapolar Bioimpedance was used. Measurements of waist and hip circumference were performed to calculate the waist/hip (W/H) ratio, and maximum respiratory pressures (MRP) were collected by analog manovacumeter with ± 300cm H2O. For data evaluation descriptive analysis and the Student's t Test for independent samples were used, as well as the Pearson correlation and multiple linear regression with stepwise method. The level of significance used was p < 0.05. RESULTS: Analysis showed a significant difference in MRPs of eutrophic (MIP = -73.04 ± 16.55cmH2O and MEP = 79.67 ± 18.89cmH2O) and obese (MIP = -85.00 ± 21.69cmH2O and MEP = 103.86 ± 20.35cmH2O). The anthropometry and manovacumetry variables showed no significant correlation in the groups. A positive correlation of the lean mass with the MIP was noted, when analising the bioimpedance influence on the RMS. CONCLUSION: The bioimpedance variables and obesity showed a direct relation with the RMS. The W/H ratio and WC variables had no influence on the obese RMS, however a relevance to the risk factors for associated diseases was found. We believe that these results are due to an adjustment to the excess weight over the years.

Relation between carbohydrate intake and weight loss after bariatric surgery.

BACKGROUND: Weight loss and long-term weight maintenance in bariatric surgery patients are related to maintaining satiety. It can be related to glycemic load (GL) and carbohydrate (g CHO) intake. The aim of this study was to investigate the effect of g CHO and GL and in weight loss on patients who had undergone bariatric surgery. METHOD: The following measurements/calculations were conducted as follows: current body weight (kg), current BMI, percentage of excess weight loss (PEWL), average monthly weight loss (AMWL), energy intake (kcal per day), and GL calculation. Correlations were found among the studied variables. A multiple linear regression analysis of diet variables executed with GL and weight loss. RESULTS: The population presented 66% of EWL. The average of total energy intake (TEI) was 1220+/-480, and the calculated GL resulted in an average of 73.2. Negative correlations were found between AMWL and TEI (p=0.04), and between AMWL and GL (p=0.009); furthermore, a negative correlation was found between carbohydrate intake in grams and AMWL (p=0.003). A positive correlation (p=0.017) was found between GL and TEI. Weight loss and GL were also correlated. Among the intake variables, GL and g CHO consumed are held accountable for 62 percent of AMWL. The multiple linear regression analysis showed that GL and carbohydrate grams (g CHO) account for 62% of AMWL. CONCLUSION: The glycemic load and grams of carbohydrate are intake factors that can be useful tools in weight loss and long-term weight maintenance on patients who have undergone Roux-en-Y Gastric Bypass (RYGB).

Obesos mórbidos tratados com gastroplastia redutora com Bypass gástrico em Y de Roux: análise de 160 pacientes / Obese patients treated with the gastric reduction through a Roux-en-Y gastric Bypass: analysis of 160 patients

Objetivo: Descrever o resultado do tratamento cirúrgico da obesidade mórbida e analisar sua morbimortalidade operatória. Pacientes e métodos: Cento e sessenta pacientes portadores de obesidade mórbida foram submetidos à gastroplastia redutora com bypass gástrico em Y de Roux com anel de contenção (operação de Fobi-Capella), no período de abril de 2000 a novembro de 2002. Foram analisados: indicação cirúrgica, comorbidades, complicações pós-operatórias e resultados tardios. Resultados: Nesta série, 76 por cento dos pacientes eram do sexo feminino. A média de idade foi 36,0 mais ou menos 10,9 anos. O índice de massa corporal (IMC) médio foi 45,8 mais ou menos 6,0 Kg/m quadrado. A maioria dos pacientes (93 por cento) teve uma ou mais comorbidades (49 por cento foram portadores de hipertensão, 33,8 por cento de esteatose hepática à ultra-sonografia abdominal, 28,7 por cento foram dislipidêmicos e 6,9 por cento portadores de diabetes melito tipo 2). O tempo cirúrgico médio da operação foi 192 mais ou menos 42 minutos (ou de 150 min a 420 min). O tempo médio de internação hospitalar no pós-operatório foi 3,5 mais ou menos 1,6 dias. A porcentagem da perda do excesso de peso foi 22,7 mais ou menos 7,5 por cento no primeiro mês de acompanhamento pós-operatório, 47,2 mais ou menos 12,6 por cento no terceiro mês, 61,2 mais ou menos 14,4 por cento no sexto mês e 81,1 mais ou menos 11,4 por cento no décimo segundo mês. Não houve óbitos. Conclusão: Nesta série de casos, a operação de Fobi-Capella mostrou ser procedimento seguro e efetivo para promover perda de peso e sua manutenção em longo prazo.

Tumores do cólon, reto e ânus / Colon, rectum and anus tumors

No período de outubro de 1973 a março de 1989, 120 pacientes portadores de câncer de ânus, reto e cólon, diagnosticados no HDA-INAMPS-DF, apresentavam-se em 14% na 3ª década de vida e 46.7% dos tumores do reto localizavam-se em seu terço inferior, explicando o grande número de cirúrgias amputadoras, assim como uma alta incidência em paciente jovens. O diagnóstico foi realizado em 57.3% pela simples inspeçäo, toque e retos sigmoidoscopia, subindo para 92.8% apenas em relaçäo aos tumores do reto e ânus. Oitenta e cinco foram submetidos a tratamento cirúrgico considerando radical e 35 a paliativo. A mortalidade operatória imediata foi de 9%. Os óbitos tardios do restante ocorreram em 20% e o abandono logo após a alta ou recidiva em 34%. Vivos sob controle sem recidiva, com recidiva tratada cirurgicamente ou näo tratada existem 45.8% 1 sendo que apenas 16.5 com mais de 05 anos de controle. Se levarmos em conta apenas o grupo dos 85 submetidos à cirurgia radical a sobrevida de 05 anos é de 21%. As recidivas pélvicas, perineais ou de anastomose ocorreram em 11.5% e, se acrescidas das hepáticas, pulmonares e carcinomatose, sobem para 27%