Ready-to-Use Multichamber Bags in Home Parenteral Nutrition for Patients with Advanced Cancer: A Single-Center Prospective Study.

Home parenteral nutrition (HPN) is increasingly prescribed for patients with advanced cancer. This therapy improves free-fat mass, quality of life and survival, but it is not free from complications, especially catheter-related bloodstream infections (CRBSIs). The use of commercial multichamber bags in HPN has not been extensively explored in oncologic patients and their association with complications is not well known. In this prospective cohort study, we included 130 patients with advanced cancer and HPN. We compared the effects of individual compounded bags (n = 87) vs. commercial multichamber bags (n = 43) on complications. There were no differences in any complication, including thrombosis (p > 0.05). There were 0.28 episodes of CRBSI per 1000 catheter days in the individual compounded bag group and 0.21 in the multichamber bag group (p > 0.05). A total of 34 patients were weaned off HPN, 22 with individual bags and 12 with multichamber bags (p = 0.749). Regarding survival when on HPN, the group with individual bags showed a median of 98 days (95% CI of 49-147), whereas those with multichamber bags showed a median of 88 days (95% CI of 43-133 (p = 0.913)). In conclusion, commercial multichamber bags for HPN in patients with advanced cancer are non-inferior when compared to individual compounded bags in terms of complications.

Impact of Sarcopenic Obesity on Long-Term Cancer Outcomes and Postoperative Complications After Gastrectomy for Gastric Cancer.

BACKGROUND: The prevalence of sarcopenia in gastric cancer (GC), although varying among the reported studies, is around 60%. In the last few years, it has been recognised that sarcopenia can also occur not only in patients with weight loss and low body weight, but also in patients with normal or increased body mass index. Therefore, the term sarcopenic obesity (SO) is a new definition that further expands the implications of altered body composition. The aim of this study was to assess the impact of SO on the perioperative morbidity and the survival of GC patients undergoing gastrectomy by evaluating body composition on CT images. METHODS: Preoperative CT scans were obtained from all patients with a diagnosis of GC undergoing gastrectomy with curative intent between January 2012 and December 2019. Skeletal muscle mass index (SMMI) and visceral adipose tissue (VAT) cross-sectional area at the level of the transverse processes of the third lumbar vertebra (L3) were measured. Sarcopenia and obesity were defined according to sex-specific cut-off points. RESULTS: After analysing 190 patients, the prevalence of SO was 21.1% (40 patients) and sarcopenia was 14.7% (28 patients). Multivariate analysis showed that corporal composition was an independent factor of overall survival (p = 0.049). Logistic regression was performed to identify risk factors associated with postoperative complications. SO was identified as a risk factor for serious Clavien-Dindo complications > IIIb/IV [OR 2.82 (1.1-7.1); p = 0.028]. CONCLUSION: SO was a risk factor for severe postoperative complications as well as worse long-term oncological after a gastrectomy for GC.

The Beneficial Changes on Inflammatory and Endothelial Biomarkers Induced by Metabolic Surgery Decreases the Carotid Intima-Media Thickness in Men.

Obesity increases cardiovascular risk in men through several mechanisms. Among them, low-grade chronic inflammation and obesity-associated hypogonadism have been described. We aimed to study the effects of metabolic surgery on the carotid-intima media thickness through changes in inflammatory, endothelial biomarkers, and testosterone. We included 60 men; 20 submitted to laparoscopic Roux-en-Y gastric bypass (RYGB), 20 to sleeve gastrectomy (SG), and 20 to lifestyle modification (controls). Several inflammatory and endothelial biomarkers and total testosterone (TT) were measured at baseline and six months after surgery. Free testosterone (FT) was calculated, and carotid intima-media thickness (cIMT) was measured by ultrasonography. Compared to controls, cIMT decreased after surgery concomitantly with CRP, PAI-1, sICAM-1, and IL-18 (p < 0.01) and with an increase in sTWEAK (p = 0.027), with no differences between RYGB and SG. The increase in TT and FT after surgery correlated with the changes in cIMT (p = 0.010 and p = 0.038, respectively), but this association disappeared after multivariate analysis. Linear regression showed that sTWEAK (ß = -0.245, p = 0.039), PAI-1 (ß = 0.346, p = 0.005), and CRP (ß = 0.236, p = 0.049) were associated with the changes in cIMT (R2 = 0.267, F = 6.664, p = 0.001). In conclusion, both RYGB and SG induced improvements in inflammation and endothelial biomarkers that drove a decrease in cIMT compared to men with obesity who submitted to diet and exercise.

Impact of COVID-19 on Short- and Medium-Term Prescription of Enteral Nutrition in the General Population vs. Older People in the Community of Madrid, Spain.

We aimed to analyse the impact of COVID-19 during 2020 and 2021 on the prescription of enteral nutritional support and its expenditure in the Community of Madrid, Spain, compared to pre-pandemic data from 2016 in the general population vs. elderly. We analysed official electronic prescriptions of all public hospitals of the Community of Madrid. The population over 75 years of age have the higher prescription of nutritional supplements (p < 0.001 vs. other age groups), with no differences between the 45−64 age group compared to the 65−74 age group (χ2 = 3.259, p = 0.196). The first wave of COVID-19 or the first time there was a real awareness of the virus in Spain is similar in a way to the first peak of prescription of enteral nutrition in March 2020. The second peak of prescription was observed in the over 75 age group in July 2020, being more pronounced in December 2020 and March−April of the following year (F = 7.863, p = 0.041). The last peaks correspond to summer 2021 and autumn of the same year (p = 0.031­year 2021 vs. 2020, p = 0.011­year 2021 vs. 2019), where a relationship between increased prescription of enteral nutrition and COVID-19 cases is observed. High-protein and high-calorie dietary therapies were the most prescribed in patients with or without diabetes. All of this entailed higher cost for the Community of Madrid. In conclusion, COVID-19 significantly affected the prescription of nutritional support, especially in the population over 75 years of age.

The Role of Adiponectin in the Resolution of Male-Obesity-Associated Secondary Hypogonadism after Metabolic Surgery and Its Impact on Cardiovascular Risk.

Male-obesity-associated secondary hypogonadism (MOSH) is a very prevalent entity that may resolve after marked weight loss. Adiponectin (APN) is an adipokine with anti-inflammatory properties that regulates metabolism. Low-circulating APN is associated with obesity, diabetes, and cardiovascular risk, along with circulating testosterone. We aimed to evaluate APN changes in men with MOSH (low circulating free testosterone (FT) with low or normal gonadotropins) and without it after metabolic surgery. We look for their possible association with cardiovascular risk measured by carotid intima-media thickness (cIMT). We included 60 men (20 submitted to lifestyle modification, 20 to sleeve gastrectomy, and 20 to gastric bypass) evaluated at baseline and 6 months after. The increase in APN at follow-up was reduction in patients with persistent MOSH (n = 10) vs. those without MOSH (n = 30) and MOSH resolution (n = 20), and the former did not achieve a decrease in cIMT. The increase in APN correlated positively with FT (r = 0.320, p = 0.013) and inversely with cIMT (r = -0.283, p = 0.028). FT inversely correlated with cIMT (r = -0.269, p = 0.038). In conclusion, men without MOSH or with MOSH resolution showed a high increase in APN after weight loss with beneficial effects on cIMT. Those without MOSH resolution failed to attain these effects.

Fecal Metabolome and Bacterial Composition in Severe Obesity: Impact of Diet and Bariatric Surgery.

The aim of this study was to monitor the impact of a preoperative low-calorie diet and bariatric surgery on the bacterial gut microbiota composition and functionality in severe obesity and to compare sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). The study also aimed to incorporate big data analysis for the omics results and machine learning by a Lasso-based analysis to detect the potential markers for excess weight loss. Forty patients who underwent bariatric surgery were recruited (14 underwent SG, and 26 underwent RYGB). Each participant contributed 4 fecal samples (baseline, post-diet, 1 month after surgery and 3 months after surgery). The bacterial composition was determined by 16S rDNA massive sequencing using MiSeq (Illumina). Metabolic signatures associated to fecal concentrations of short-chain fatty acids, amino acids, biogenic amines, gamma-aminobutyric acid and ammonium were determined by gas and liquid chromatography. Orange 3 software was employed to correlate the variables, and a Lasso analysis was employed to predict the weight loss at the baseline samples. A correlation between Bacillota (formerly Firmicutes) abundance and excess weight was observed only for the highest body mass indexes. The low-calorie diet had little impact on composition and targeted metabolic activity. RYGB had a deeper impact on bacterial composition and putrefactive metabolism than SG, although the excess weight loss was comparable in the two groups. Significantly higher ammonium concentrations were detected in the feces of the RYGB group. We detected individual signatures of composition and functionality, rather than a gut microbiota characteristic of severe obesity, with opposing tendencies for almost all measured variables in the two surgical approaches. The gut microbiota of the baseline samples was not useful for predicting excess weight loss after the bariatric process.

Impact of muscle mass on the prognosis of liver transplantation for infants with biliary atresia.

Background: Sarcopenia in adult cirrhotic patients is associated with increased morbidity and mortality whereas in children it is still being studied. Anthropometric variables in cirrhotic children are not reliable for assessing muscle mass as they may be altered by ascites, edema, and organomegaly. Measuring the area of the psoas showed good correlation with muscle mass in adults. We aimed to study in cirrhotic infants undergoing liver transplantation the association of the psoas area with liver transplant prognosis as well as with several analytical and anthropometric parameters used to evaluate nutritional status. Methods: Retrospective cohort of 29 infants with cirrhosis due to biliary atresia who underwent abdominal CT scan as a pre-transplant study. We measured the psoas muscle index (PMI) at L4-L5 since it best correlates with muscle mass in pediatric patients. As there are no validated cut-off points to define sarcopenia in children under one year of age, PMI was recorded as a continuous variable and correlated with different prognostic, clinical, and analytical variables. The SPSS 17.0 package was used for statistical analysis and a P < 0.05 was considered significant. Results: 29 infants (10 boys, 19 girls) were studied. 62% were Caucasian and the rest were South American. The mean age at CT scan was 8.5 months (range 3-15 months). There was a negative correlation between PMI and days of admission prior to liver transplant, previous infections, and bone fractures. Among the analytical parameters, cholinesterase, albumin, and prealbumin correlated positively with PMI (P < 0.05). No relationship was observed with anthropometric parameters: weight, height, BMI, brachial perimeter, or bioimpedance. During surgery, patients with lower PMI had a greater need for plasma transfusion, and in the immediate postoperative period, there was a longer stay in intensive care, more days of mechanical ventilation, and more days of hospital admission (P < 0.05). On the contrary, no relationship was found with other complications: bleeding, re-interventions, biliary leaks, rejection, thrombosis, re-transplantation, or infections. Conclusions: The decrease in muscle mass is associated with increased morbidity in infants with biliary atresia undergoing liver transplantation. Muscle mass in these patients cannot be adequately assessed with anthropometric measurements commonly used in the clinic.

Efecto de la COVID-19 en la prescripción dietoterapéutica durante el primer semestre de 2020 en la Comunidad de Madrid / Effect of COVID-19 on dietotherapeutic prescription during the first half of 2020 in the Community of Madrid

Objetivos: el objetivo de este estudio es analizar el impacto de la COVID-19 en el primer semestre del año 2020, con respecto a la prescripción de soportes nutricionales enterales, y su gasto en la Comunidad de Madrid. Material y métodos: estudio descriptivo y comparativo del consumo de productos de nutrición enteral prescritos en recetas oficiales electrónicas durante el primer semestre de los años 2019 y 2020 en los hospitales públicos de la Comunidad de Madrid. Resultados: al analizar la prescripción del número de envases totales durante el periodo estudiado, por meses, se observa un incremento del 8 % en la prescripción durante el mes de marzo, comparado con los meses previos (p < 0,001), seguido de un descenso del 9 % en los meses de abril y mayo (p < 0,001). El comportamiento de la evolución del gasto sigue el mismo patrón, con un incremento en el mes de marzo (p < 0.001) y un descenso en los meses de abril y mayo de similar magnitud (ambos, p < 0,001). Al analizar por grupos de edades, el grupo de edad de más de 75 años fue el grupo con la mayor caída en las prescripciones (33,1 % mayor que entre los menores de 75) en los meses de abril y mayo de 2020 (p < 0,001). Conclusiones: la COVID-19 afectó de forma importante a la prescripción del soporte nutricional, especialmente en el grupo de mayor edad. El seguimiento de la enfermedad nos permitirá profundizar en el papel de la nutrición a corto y largo plazo. (AU)

Objectives: the aim of the study was to analyze the impact of COVID-19 on enteral nutrition prescription in the Community of Madrid during the first semester of 2020. Material and methods: this is a descriptive study of enteral nutrition prescription in the first semester of 2020 and its comparison with the first semester of 2019. We included all the prescriptions in public hospitals of the Community of Madrid as recorded in public electronic databases. Results: there was an 8 % increase in the number of enteral nutrition prescriptions in March 2020 when compared with the previous months (p < 0.001). Then, in April and May 2020 we observed a 9 % decrease in enteral nutrition prescriptions (p < 0.001). Total costs in enteral nutrition showed a similar pattern, with an increase in March 2020 (p < 0.001) and a decrease in April and May 2020 (p < 0.001). When analyzing the data by patient age, those above 75 y.o. showed the highest decrease in enteral nutrition prescriptions (33.1 % higher than for those under 75 y.o.) in April and May 2020 (p < 0.001). Conclusions: the irruption of COVID-19 had a relevant impact on enteral nutrition prescription, especially among the elderly. Follow-up is needed to assess the long-term consequences of this in nutritional therapy. (AU)

[Effect of COVID-19 on dietotherapeutic prescription during the first half of 2020 in the Community of Madrid]. / Efecto de la COVID-19 en la prescripción dietoterapéutica durante el primer semestre de 2020 en la Comunidad de Madrid.

INTRODUCTION: Objectives: the aim of the study was to analyze the impact of COVID-19 on enteral nutrition prescription in the Community of Madrid during the first semester of 2020. Material and Methods: this is a descriptive study of enteral nutrition prescription in the first semester of 2020 and its comparison with the first semester of 2019. We included all the prescriptions in public hospitals of the Community of Madrid as recorded in public electronic databases. Results: there was an 8 % increase in the number of enteral nutrition prescriptions in March 2020 when compared with the previous months (p < 0.001). Then, in April and May 2020 we observed a 9 % decrease in enteral nutrition prescriptions (p < 0.001). Total costs in enteral nutrition showed a similar pattern, with an increase in March 2020 (p < 0.001) and a decrease in April and May 2020 (p < 0.001). When analyzing the data by patient age, those above 75 y.o. showed the highest decrease in enteral nutrition prescriptions (33.1 % higher than for those under 75 y.o.) in April and May 2020 (p < 0.001). Conclusions: the irruption of COVID-19 had a relevant impact on enteral nutrition prescription, especially among the elderly. Follow-up is needed to assess the long-term consequences of this in nutritional therapy.

INTRODUCCIÓN: Objetivos: el objetivo de este estudio es analizar el impacto de la COVID-19 en el primer semestre del año 2020, con respecto a la prescripción de soportes nutricionales enterales, y su gasto en la Comunidad de Madrid. Material y métodos: estudio descriptivo y comparativo del consumo de productos de nutrición enteral prescritos en recetas oficiales electrónicas durante el primer semestre de los años 2019 y 2020 en los hospitales públicos de la Comunidad de Madrid. Resultados: al analizar la prescripción del número de envases totales durante el periodo estudiado, por meses, se observa un incremento del 8 % en la prescripción durante el mes de marzo, comparado con los meses previos (p < 0,001), seguido de un descenso del 9 % en los meses de abril y mayo (p < 0,001). El comportamiento de la evolución del gasto sigue el mismo patrón, con un incremento en el mes de marzo (p < 0.001) y un descenso en los meses de abril y mayo de similar magnitud (ambos, p < 0,001). Al analizar por grupos de edades, el grupo de edad de más de 75 años fue el grupo con la mayor caída en las prescripciones (33,1 % mayor que entre los menores de 75) en los meses de abril y mayo de 2020 (p < 0,001). Conclusiones: la COVID-19 afectó de forma importante a la prescripción del soporte nutricional, especialmente en el grupo de mayor edad. El seguimiento de la enfermedad nos permitirá profundizar en el papel de la nutrición a corto y largo plazo.

Serum zinc and copper in people with COVID-19 and zinc supplementation in parenteral nutrition.

OBJECTIVES: Zinc and copper are important to protect cells from oxidative stress and to enhance immunity. An association between low zinc levels and the severity of acute respiratory distress syndrome has been shown for people with COVID-19. We aimed to study serum zinc and copper concentrations in people with severe COVID-19 and zinc supplementation in parenteral nutrition (PN). METHODS: Thirty-five people with COVID-19 in need of PN were studied in a retrospective design. Serum samples were collected at three time points: at the start of PN, between 3 and 7 d after, and at the end of PN. RESULTS: Participants were on PN for a mean of 14 d, with a mean (± SD) daily supplemental zinc of 14.8 ± 3.7 mg/d. Serum zinc increased during PN administration from 98.8 ± 22.8 to 114.1 ± 23.3 µg/dL (Wilks' λ = 0.751, F = 5.459, P = 0.009). Conversely, serum copper did not vary from baseline (107.9 ± 34.2 µg/dL) to the end of the study (104.5 ± 37.4 µg/dL, Wilks' λ = 0.919, F = 1.453, P = 0.248). Serum zinc within the first week after starting PN and at the end of PN inversely correlated with total hospital stay (r = -0.413, P = 0.014, and r = -0.386, P = 0.022, respectively). Participants in critical condition presented lower serum copper (z = 2.615, P = 0.007). Mortality was not associated with supplemental zinc or with serum zinc or copper concentrations at any time of the study (P > 0.1 for all analyses). CONCLUSIONS: Serum zinc concentrations during PN support were inversely associated with length of hospital stay but not with mortality. Serum copper concentrations were lower in participants in critical condition but not associated with prognosis.

Stress Hyperglycemia and Osteocalcin in COVID-19 Critically Ill Patients on Artificial Nutrition.

We aimed to study the possible association of stress hyperglycemia in COVID-19 critically ill patients with prognosis, artificial nutrition, circulating osteocalcin, and other serum markers of inflammation and compare them with non-COVID-19 patients. Fifty-two critical patients at the intensive care unit (ICU), 26 with COVID-19 and 26 non-COVID-19, were included. Glycemic control, delivery of artificial nutrition, serum osteocalcin, total and ICU stays, and mortality were recorded. Patients with COVID-19 had higher ICU stays, were on artificial nutrition for longer (p = 0.004), and needed more frequently insulin infusion therapy (p = 0.022) to control stress hyperglycemia. The need for insulin infusion therapy was associated with higher energy (p = 0.001) and glucose delivered through artificial nutrition (p = 0.040). Those patients with stress hyperglycemia showed higher ICU stays (23 ± 17 vs. 11 ± 13 days, p = 0.007). Serum osteocalcin was a good marker for hyperglycemia, as it inversely correlated with glycemia at admission in the ICU (r = -0.476, p = 0.001) and at days 2 (r = -0.409, p = 0.007) and 3 (r = -0.351, p = 0.049). In conclusion, hyperglycemia in critically ill COVID-19 patients was associated with longer ICU stays. Low circulating osteocalcin was a good marker for stress hyperglycemia.

Case Report: Extensive Dermatitis Secondary to Severe Malnutrition, Zinc and Vitamin Deficiencies After Malabsorptive Bariatric Surgery.

Bariatric surgery is one of the most effective treatments currently available for obesity and its derived comorbidities. However, complications may occur, especially when malabsorptive surgeries like a biliopancreatic diversion is performed. We present the case of a female patient whose obesity was treated with this technique, and in the 9th year of follow-up developed an extensive dermatitis secondary to zinc deficiency and malnutrition, precipitated by therapeutic non-compliance. A close surveillance of early symptoms and signs of nutritional deficiencies as well as chronic supplementation of vitamins and trace elements is required; this case illustrates the relevance of periodical, lifelong visits to a medical physician with special training and experience in the management of post bariatric surgery patients in order to prevent, diagnosis and early treat related complications.

A body weight loss- and health-promoting gut microbiota is established after bariatric surgery in individuals with severe obesity.

Obesity has reached an epidemic level worldwide, and bariatric surgery (BS) has been proven to be the most efficient therapy to reduce severe obesity-related comorbidities. Given that the gut microbiota plays a causal role in obesity development and that surgery may alter the gut environment, investigating the impact of BS on the microbiota in the context of severe obesity is important. Although, alterations at the level of total gut bacteria, total gene content and total metabolite content have started to be disentangled, a clear deficit exists regarding the analysis of the active fraction of the microbiota, which is the fraction that is most reactive to the BS. Here, active gut microbiota and associated metabolic functions were evaluated using shotgun proteomics and metabolomics in 40 severely obese volunteers. Samples from each volunteer were obtained under basal conditions, after a short high protein and calorie-restricted diet, and 1 and 3 months after BS, including laparoscopic surgery through Roux-en-Y Gastric Bypass or Sleeve Gastrectomy. The results revealed for the first time the most active microbes and metabolic flux distribution pre- and post-surgery and deciphered main differences in the way sugars and short-fatty acids are metabolized, demonstrating that less energy-generating and anaerobic metabolism and detoxification mechanisms are promoted post-surgery. A comparison with non-obese proteome data further signified different ways to metabolize sugars and produce short chain fatty acids and deficiencies in proteins involved in iron transport and metabolism in severely obese individuals compared to lean individuals.

Circulating Zinc and Copper Levels are Associated with Sperm Quality in Obese Men after Metabolic Surgery: A Pilot Study.

(1) Background: Inadequate levels of several trace elements and vitamins may impair spermatogenesis in men. Although weight loss after metabolic surgery normalizes male reproductive hormones, sperm quality seems to not improve. We hypothesized that circulating concentrations of zinc, copper and other trace elements and vitamins might be involved. (2) Methods: We studied 20 men submitted to metabolic surgery at baseline and after two years. Hormone profiles, serum trace elements and vitamins were studied together with sperm analysis. (3) Results: At follow-up, serum testosterone, follicle-stimulating hormone and inhibin B concentrations increased showing a beneficial hormonal response for spermatogenesis. Conversely, serum copper, zinc and ferritin showed a decline after surgery. In total, 33% of men showed zinc deficiency, 27% copper deficiency and 20% iron deficiency, among others. Sperm analysis showed that all revaluated patients had at least one abnormal parameter. Serum zinc concentrations showed a positive correlation with progressive motility (r = 0.577, p = 0.031), and serum ferritin a positive correlation with sperm volume (ρ = 0.535, p = 0.049). Serum copper showed a weak and near significant correlation with motility (r = 0.115, p = 0.051). (4) Conclusions: The lack of improvement in sperm quality in obese men after metabolic surgery may be related to nutrient malabsorption, especially zinc, copper and iron.

Fertility and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome Following Bariatric Surgery.

CONTEXT: Restoration of ovulation is quite common in women with polycystic ovary syndrome (PCOS) after surgically induced weight loss. Whether or not this results in an improvement of PCOS-associated infertility is uncertain. OBJECTIVE: To study fertility and gestational outcomes in women with PCOS after bariatric surgery. DESIGN: Unicenter cohort study. SETTING: Academic hospital. PATIENTS: Two hundred and sixteen premenopausal women were screened for PCOS before bariatric surgery. Women were followed-up after the intervention until mid-2019 regardless of having or not PCOS. INTERVENTIONS: All participants underwent bariatric surgery from 2005 to 2015. MAIN OUTCOME MEASURES: Pregnancy and live birth rates in the PCOS and control groups. RESULTS: In women seeking fertility, pregnancy rates were 95.2% in PCOS and 76.9% in controls (P = 0.096) and live birth rates were 81.0% and 69.2%, respectively (P = 0.403). The time to achieve the first pregnancy after surgery was 34 ±â€…28 months in women with PCOS and 32 ±â€…25 months in controls. Albeit the mean birth weight was lower (P = 0.040) in newborns from women with PCOS (2763 ±â€…618 g) compared with those from controls (3155 ±â€…586 g), the number of newborns with low birth weight was similar in both groups (3 in the PCOS group and 1 in the controls, P = 0.137). Maternal (17.6% in PCOS and 22.2% in controls, P = 0.843) and neonatal (23.5% in PCOS and 14.8% in controls, P = 0.466) complications were rare, showing no differences between groups. CONCLUSIONS: Pregnancy and fertility rates in very obese women with PCOS after bariatric surgery were high, with few maternal and neonatal complications.

Efectos del bypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años / Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years

ANTECEDENTES: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de comorbilidades y una disminución del riesgo cardiovascular. MATERIAL Y MÉTODOS: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante bypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. RESULTADOS: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de comorbilidades al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. CONCLUSIONES: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos

BACKGROUND: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. MATERIAL AND METHODS: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. RESULTS: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. CONCLUSION: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures

[Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years]. / Efectos del baypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años.

INTRODUCTION: Background: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.

INTRODUCCIÓN: Antecedentes: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de la comorbilidad y una disminución del riesgo cardiovascular. Material y métodos: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante baypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. Resultados: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de la comorbilidad al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. Conclusiones: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos.