Evaluation of Resting Energy Expenditure in Subjects with Severe Obesity and Its Evolution After Bariatric Surgery.

PURPOSE: One major determinant of weight loss is resting energy expenditure (REE). However, data regarding REE is scarce in patients with severe obesity (SO)-BMI>50kg/m2. Most studies used equation in order to estimate REE and not indirect calorimetry (IC) (gold standard). Additionally, there is no reliable data on the impact of bariatric surgery (BS) on REE. OBJECTIVES: (a) To evaluate the REE in patients with SO; (b) to compare REE measured by IC (mREE) to that calculated by Mifflin St-Jeor equation (eREE); (c) to evaluate the impact of BS on REE and the relationship with evolution post-BS. MATERIAL AND METHODS: Single-center observational study including consecutive patients with SO between January 2010 and December 2015, candidates for BS. mREE was determined at baseline, and 1 and 12 months post-BS by IC, using a Vmax metabolic monitor. RESULTS: Thirty-nine patients were included: mean age 46.5±11.77 years, 64.1%women. Preoperative mREE was 2320.38±750.81 kcal/day. One month post-BS, the mREE significantly decreased (1537.6 ± 117.46 kcal/day, p = 0.023) and remained unchanged at 12 months (1526.00 ± 123.35 kcal/day; p =0.682). Reduction in mREE after the BS was a predictor of reaching successful weight loss (nadir) and weight regain (5 years follow-up) (AUCROC of 0.841 (95%CI [0.655-0.909], p=0.032) and AUCROC of 0.855 (95% CI [0.639-0.901]), p= 0.027, respectively). eREE was not valid to identify these changes. CONCLUSION: In patients with SO, a significant reduction of mREE occurs 1 month post-BS, unchanged at 12 months, representing the major conditioning of successful weight loss and maintenance post-BS.

Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group.

Intestinal failure (IF) is the consequence of a reduction of gut function below the minimum necessary for the absorption of nutrients from the gastrointestinal tract. Types I and II comprise acute intestinal failure (AIF). Although its prevalence is relatively low, type II AIF is serious and requires specialist multidisciplinary care, often for prolonged periods before its resolution. The key aspects are: sepsis control, fluid and electrolyte resuscitation, optimization of nutritional status, wound care, appropriate surgery and active rehabilitation. The ESPEN Acute Intestinal Failure Special Interest Group (AIF SIG) has devised this position paper to provide a state-of-the-art overview of the management of type II AIF and to point out areas for future research.

ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults.

BACKGROUND & AIMS: Intestinal failure (IF) is not included in the list of PubMed Mesh terms, as failure is the term describing a state of non functioning of other organs, and as such is not well recognized. No scientific society has yet devised a formal definition and classification of IF. The European Society for Clinical Nutrition and Metabolism guideline committee endorsed its "home artificial nutrition and chronic IF" and "acute IF" special interest groups to write recommendations on these issues. METHODS: After a Medline Search, in December 2013, for "intestinal failure" and "review"[Publication Type], the project was developed using the Delphi round methodology. The final consensus was reached on March 2014, after 5 Delphi rounds and two live meetings. RESULTS: The recommendations comprise the definition of IF, a functional and a pathophysiological classification for both acute and chronic IF and a clinical classification of chronic IF. IF was defined as "the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth". CONCLUSIONS: This formal definition and classification of IF, will facilitate communication and cooperation among professionals in clinical practice, organization and management, and research.