The Effect of Vitamin D Adequacy on Thyroid Hormones and Inflammatory Markers after Bariatric Surgery.

Vitamin D status affects the clinical and corporal outcomes of postoperative patients who undergo a Roux-en-Y gastric bypass (RYGB). The aim of this study was to evaluate the effect of adequate vitamin D serum concentrations on thyroid hormones, body weight, blood cell count, and inflammation after an RYGB. A prospective observational study was conducted with eighty-eight patients from whom we collected blood samples before and 6 months after surgery to evaluate their levels of 25-hydroxyvitamin D 25(OH)D, thyroid hormones, and their blood cell count. Their body weight, body mass index (BMI), total weight loss, and excess weight loss were also evaluated 6 and 12 months after surgery. After 6 months, 58% of the patients achieved an adequate vitamin D nutritional status. Patients in the adequate group showed a decrease in the concentration of thyroid-stimulating hormone (TSH) (3.01 vs. 2.22 µUI/mL, p = 0.017) with lower concentrations than the inadequate group at 6 months (2.22 vs. 2.84 µUI/mL, p = 0.020). Six months after surgery, the group with vitamin D adequacy showed a significantly lower BMI compared with the inadequate group at 12 months (31.51 vs. 35.04 kg/m2, p = 0.018). An adequate vitamin D nutritional status seems to favor a significant improvement in one's thyroid hormone levels, immune inflammatory profile, and weight loss performance after an RYGB.

Brazilian guide to nutrition in bariatric and metabolic surgery.

PURPOSE: Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS: A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS: The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION: We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

Impairment of Vitamin D Nutritional Status and Metabolic Profile Are Associated with Worsening of Obesity According to the Edmonton Obesity Staging System.

Obesity is associated with a higher risk of Vitamin D (VD) inadequacy and metabolic diseases. The Edmonton Obesity Staging System (EOSS) is an innovative tool for the evaluation of obesity that goes beyond body weight and considers clinic, functional and menta- health issues. This study aimed to evaluate the nutritional status of VD according to the stages of EOSS and its relationship with the metabolic profile. In the cross-sectional study, we evaluated anthropometric parameters, physical activity, blood pressure, biochemical and metabolic variables, and VD nutritional status. A total of 226 individuals were categorized using EOSS: 1.3%, 22.1%, 62.9%, and 13.7% were in stages 0, 1, 2 and 3, respectively. Regarding the metabolic changes and comorbidities, insulin resistance and hyperuricemia were diagnosed in some individuals in EOSS 1, 2, and 3. EOSS 2 and 3 presented a significant relative-risk for the development of arterial hypertension, metabolic syndrome, and liver disease, compared with EOSS 0. In all stages, there were observed means of 25(OH)D serum concentrations below 30 ng/mL (EOSS 0 24.9 ± 3.3 ng/mL; EOSS 3 15.9 ± 5.4 ng/mL; p = 0.031), and 25(OH)D deficiency was present in all stages. Individuals with obesity classified in more advanced stages of EOSS had lower serum concentrations of 25(OH)D and a worse metabolic profile.

Vitamin D Supplementation and Its Relationship with Loss of Visceral Adiposity.

PURPOSE: An inverse relationship between vitamin D (VD) nutritional status and obesity is frequent, and the distribution of body fat is an important aspect to assess the risks of obesity-related metabolic dysfunction. The purpose of the study was to evaluate the relationship between serum VD concentrations and body fat reduction after 12 months of bariatric surgery, using two different vitamin D3 (VD3) supplementation protocols. MATERIAL AND METHODS: A randomized controlled trial consisted of 41 patients divided into G1 (800 IU/day) and G2 (1800 IU/day) according to the VD3 supplementation. At baseline (T0) and follow-up (T1), 25(OH)D, waist circumference (WC), visceral adiposity index (VAI), body adiposity index (BAI), and waist/height ratio (WHtR) were evaluated. RESULTS: In T0, the mean of 25(OH)D was lower in G2 compared to that in G1 (22.6 vs 23.6 ng/mL; p = 0.000). At T1, it had a significant increase in G2 (32.1 vs 29.9 ng/mL; p = 0.000), with 60% sufficiency. A significant negative correlation was observed between VAI, BAI, and WHtR with 25(OH)D in G2 (r = - 0.746, p = 0.024; r = - 0.411, p = 0.036; r = - 0.441, p = 0.032) after surgery. Higher mean changes from baseline of visceral fat loss, represented by VAI, were observed in G2 (176.2 ± 149.0-75.5 ± 55.0, p = 0.000). CONCLUSION: Patients submitted to the 1800 IU/day protocol, 12 months after the surgical procedure, had a higher percentage of sufficient vitamin D levels compared to those submitted to the 800 IU/day protocol. Additionally, higher dose supplementation promoted a significant improvement in VAI.

Higher cut-off values of non-invasive methods might be needed to detect moderate-to-severe steatosis in morbid obese patients: a pilot study.

To evaluate the diagnostic value of described thresholds of controlled attenuation parameter (CAP) and biomarker scores for liver steatosis and to evaluate new cut-offs to detect moderate-to-severe steatosis (S2-3) in patients with morbid obesity. In this prospective study, 32 patients with morbid obesity with indications for bariatric surgery (15 women and 17 men, mean age = 36 years, median BMI = 40.2 kg/m2) underwent CAP, magnetic resonance spectroscopy (MRS), three biomarker scores (Steato-ELSA, Fatty Liver Index (FLI), and Hepatic Steatosis Index (HSI)), and liver biopsy. Subjects were divided into an exploratory cohort (reliable CAP and liver biopsy) and a confirmatory cohort (reliable CAP and MRS) to evaluate new thresholds for CAP and biomarker scores to detect S2-3. Receiver operator characteristic (ROC) curves analyses were performed and the optimal cut-off points were identified using the maximal Youden index. A total of 22 patients had CAP measure and liver biopsy (exploratory cohort) and 24 patients had CAP measure with MRS (confirmatory cohort). New cut-offs were identified for detection of S2-3 by the non-invasive tests using liver biopsy as the reference standard (exploratory cohort). Considering the new proposed cut-offs for detection of S2-3 for CAP (≥ 314 dB/m), Steato-ELSA (≥ 0.832), FLI (≥ 96), and HSI (≥ 53), for the exploratory and confirmatory cohorts sensitivities were: 71-75%, 86-81%, 85-81%, and 71-69% and specificities were: 94-89%, 75-63%, 63-63%, and 75-88%, respectively. Higher cut-offs for CAP and biomarker scores may be better to diagnose moderate-to-severe steatosis in patients with morbid obesity.

Diagnosis of night blindness through standardized interview and electroretinography / Diagnóstico de la ceguera nocturna mediante entrevista normalizada y electrorretinografía

Objective: To compare the diagnosis of NB through the use of the standardized interview of the World Health Organization/Pan American Health Organization (WHO/PAHO) with electroretinography, and also to evaluate the association of these diagnoses with serum concentrations of retinol in class III obesity individuals. Methods: Adult patients of both genders, in the 20-60 age group, with BMI = 40 kg/m² were studied. NB was diagnosed through electroretinography and the standardized interview validated by the WHO/PAHO. Serum level of retinol was quantified by the HPLC-UV method, and VAD was diagnosed when levels were <1.05 µmol /L, and severity was also evaluated. Statistical analysis was carried out through the Statistical Package for the Social Sciences, version 21.0 (p < 0.05). Results: Mean BMI was 44.9 ? 11.8 kg/m², and a negative correlation was found in serum levels of retinol (p= 0.01). The prevalence of VAD, according to the serum concentrations of retinol, was 14%, and of this percentage 23.3% had NB according to the standardized interview, and 22.0% according to electroretinography. NB diagnosed by both methods showed an association with VAD according to the serum concentrations of retinol. Of these individuals with NB, according to the standardized interview, 6.9% showed severe VAD, 10.3% moderate VAD and 82.8% marginal VAD. Conclusion: The standardized interview for the diagnosis of NB can be a good strategy to evaluate the nutritional status of vitamin A, and it is a simple, non-invasive and low-cost method

Introducción: la deficiencia de vitamina A (DVA) es uno de los mayores problemas de salud pública a escala mundial, y la ceguera nocturna (CN) es el primer cambio funcional causado por la falta de esta vitamina. En este contexto, la electrorretinografía se destaca como el método de diagnóstico de referencia; sin embargo, es un método de coste elevado y su aplicabilidad en la práctica clínica presenta algunas dificultades. Objetivo: comparar el diagnóstico de CN mediante el uso de la entrevista estandarizada de la Organización Mundial de la Salud/Organización Panamericana de la Salud (OMS/OPS) con la electrorretinografía, y también evaluar la asociación de estos diagnósticos con las concentraciones séricas de retinol en las personas con obesidad de clase III. Métodos: se estudiaron pacientes adultos de ambos sexos, en el grupo de 20 a 60 años de edad y con IMC = 40 kg/m². La NB se diagnosticó mediante electrorretinografía y la entrevista estandarizada validada por la OMS/OPS. El nivel sérico de retinol se cuantificó mediante el método HPLC-UV, y el DVA se diagnosticó cuando los niveles eran < 1.05 µmol/l; también se evaluó la gravedad. El análisis estadístico se realizó a través del Paquete Estadístico para las Ciencias Sociales, versión 21.0 (p < 0,05). Resultados: el IMC promedio fue de 44,9 ± 11,8 kg/m² y se encontró una correlación negativa en los niveles séricos de retinol (p = 0,01). La prevalencia de DVA, según las concentraciones séricas de retinol, fue del 14 %; de este porcentaje, el 23,3 % tenían NB de acuerdo con la entrevista estandarizada y el 22,0 % según la electrorretinografía. La NB diagnosticada por ambos métodos mostró asociación con el DVA según las concentraciones séricas de retinol. De estos individuos con NB, según la entrevista estandarizada, el 6,9 % tenían VAD grave, el 10,3 % VAD moderado y el 82,8 % VAD marginal. Conclusión: la entrevista estandarizada para el diagnóstico de NB puede ser una buena estrategia para evaluar el estado nutricional de la vitamina A y es un método simple, no invasivo y de bajo coste

Vitamin D nutritional status and its relationship with metabolic changes in adolescents and adults with severe obesity.

INTRODUCTION: increased vitamin D deficiency occurs together with obesity and the association between these conditions has been observed. OBJECTIVE: to assess the nutritional status of vitamin D and metabolic profile in adolescents and adults with obesity, and the relationship between complications arising from severe class of obesity with vitamin D nutritional status, and to compare the differences between these groups. METHODS: observational comparative study. Population comprises adolescents and adults with severe obesity. Waist circumference (WC) and body mass index (BMI) were measured. Analysis of vitamin D (25(OH)D), lipid profile, C-reactive protein (CRP), blood glucose, fasting insulinemia, insulin sensitivity, blood pressure and diagnoses of nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) were performed. RESULTS: a total of 60 adolescents (G1) and 68 adults (G2) were evaluated. The percentage of vitamin D inadequacy was observed in 90% in G1 and 79.4% in G2. There was a negative and significant correlation of BMI with the values of 25(OH)D in the group of adults (r = -0.244; p = 0.045). Individuals with inadequacy of vitamin D showed higher values of CRP in both groups (p = 0.000). HOMA-IR showed a negative correlation with 25(OH)D in G1 (r = -0.832; p = 0.000) and G2 (r = -0.589; p = 0.000). The inadequacy of this vitamin showed association with high total cholesterol in G1 (p = 0.029) and higher values of LDL-c in G2 (p = 0.003). CONCLUSION: high prevalence of deficiency and insufficiency of vitamin D were observed, associated with metabolic changes both in obese adults and adolescents. It is necessary to develop strategies for the prevention and control of obesity and vitamin D deficiency.

Improvement of anthropometric and biochemical, but not of vitamin A, status in adolescents who undergo Roux-en-Y gastric bypass: a 1-year follow up study.

BACKGROUND: The aim of this study was to describe anthropometric, biochemical, co-morbidity, and vitamin A nutritional status in severely obese adolescents before and 30, 180, and 365 days after Roux-en-Y gastric bypass (RYGB). SETTING: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. METHODS: Sixty-four adolescents (15-19 years old) with a body mass index≥40 kg/m2 were enrolled in a prospective follow-up study. Vitamin A status was evaluated before surgery (T0), and 30 (T30), 180 (T180), and 365 (T365) days after surgery, applying biochemical and functional indicators. Anthropometric measures, lipid profile, glycemia, and basal insulin also were assessed. No patients were lost during follow-up. RESULTS: Before surgery, 26.6% of the sample group experienced vitamin A deficiency (VAD). Serum retinol levels dropped significantly 30 days after surgery and then returned to basal levels. There was a significant increase in the prevalence of ß-carotene deficiency and night blindness throughout the postsurgery period. A significant reduction in blood glucose, insulin resistance, lipid profile, and anthropometric parameters was observed. CONCLUSION: The finding that oral daily supplementation with 5000 IU retinol acetate failed to reverse VAD and night blindness after RYGB is highly significant. We recommend assessment of VAD and night blindness in extremely obese adolescents before and after RYGB. We further recommend monitoring for an additional 180 days (for VAD) and 365 days (for night blindness) after surgery, with particular attention to daily supplementation needs.

Obesity, related diseases and their relationship with vitamin D deficiency in adolescents.

INTRODUCTION: The rise in prevalence of obesity has occurred concomitantly to that of vitamin D deficiency (VDD). The aim of this narrative review was to describe the relationship between obesity and such related diseases as VDD in adolescents, in an effort to warn of the risks of this deficiency during this period of growth and development. METHODS: We searched the electronic databases PubMed, Medline, Scielo, Science Direct and Lilacs for articles from between 2000 and 2015 on the topics obesity and obesity-related diseases and VDD in adolescents. We included articles written in English, Spanish and Portuguese of the analytical variety (transverse and longitudinal), systematic reviews, meta-analysis and controlled clinical trials on humans, and excluded studies that were done on animals, inconclusive or with undefined methodology. RESULTS: We produced an overview of VDD in obesity, in cardiovascular diseases, in diabetes mellitus, in systemic hypertension, and in dyslipidemia. The prevalence of VDD was considered high in obese adolescents and their relationship with the obesity and related diseases was found in adolescents. These findings forewarn of possible clinical repercussions in the health of the adolescents, foremost because of how essential vitamin D is to growth and development, and for its interaction with obesity and obesity-related diseases. CONCLUSION: The worldwide rise in the obesity rate alongside the progressively increasing of vitamin D deficiency in adolescents is alarming. This relationship of VDD with the obesity and related diseases was found in adolescents. Vitamin D supplementation is considered promising measure to take with obese adolescents.

Obesity, related diseases and their relationship with vitamin D deficiency in adolescents / Obesidad, enfermedades relacionadas y su relación con la deficiencia de vitamina D en adolescentes

Introduction: the rise in prevalence of obesity has occurred concomitantly to that of vitamin D deficiency (VDD). The aim of this narrative eview was to describe the relationship between obesity and such related diseases as VDD in adolescents, in an effort to warn of the risks of this defi ciency during this period of growth and development. Methods: We searched the electronic databases PubMed, Medline, Scielo, Science Direct and Lilacs for articles from between 2000 and 2015 on the topics obesity and obesity-related diseases and VDD in adolescents. We included articles written in English, Spanish and Portuguese of the analytical variety (transverse and longitudinal), systematic reviews, meta-analysis and controlled clinical trials on humans, and excluded studies that were done on animals, inconclusive or with undefi ned methodology. Results: We produced an overview of VDD in obesity, in cardiovascular diseases, in type 2 diabetes mellitus, in systemic hypertension, and n dyslipidemia. The prevalence of VDD was considered high in obese adolescents and their relationship with the obesity and related diseases was found in adolescents. These findings forewarn of possible clinical repercussions in the health of the adolescents, foremost because of how essential vitamin D is to growth and development, and for its interaction with obesity and obesity-related diseases. Conclusion: The worldwide rise in the obesity rate alongside the progressively increasing of vitamin D deficiency in adolescents is alarming. This relationship of VDD with the obesity and related diseases was found in adolescents. Vitamin D supplementation is considered promising measure to take with obese adolescents (AU)

Introducción: el aumento de la prevalencia de la obesidad se ha producido de forma concomitante a la deficiencia de vitamina D (DVD). El bjetivo de esta revisión fue describir la relación entre la obesidad y las patologías asociadas a la obesidad y la DVD en adolescentes, en un esfuerzo por advertir los riesgos de esta deficiencia durante este periodo de crecimiento y desarrollo. Métodos: se realizaron búsquedas en las bases de datos electrónicas PubMed, Medline, Scielo, Science Direct y Lilacs para los artículos de entre 2000 y 2015 sobre temas como la obesidad y las patologías asociadas a la obesidad y DVD en adolescentes. Se incluyeron artículos escritos en inglés, español y portugués de la variedad analítica (transversal y longitudinal), revisiones sistemáticas, metaanálisis y ensayos clínicos controlados en seres humanos, y excluyendo los estudios que se realizan en animales, no concluyentes o con metodología indefinida. Resultados: se produjo una visión general de DVD en la obesidad, las enfermedades cardiovasculares, la diabetes mellitus, la hipertensión sistémica y en la dislipidemia. La prevalencia de DVD se considera alta en adolescentes obesos y su relación con las patologías asociadas a la obesidad fueran encontradas en adolescentes. Estos datos advierten sobre posibles repercusiones clínicas en la salud de los adolescentes, sobre todo debido a la forma esencial de vitamina D en el crecimiento y el desarrollo, y por su interacción con la obesidad y las patologías asociadas a la obesidad. Conclusión: el aumento mundial de la tasa de obesidad junto con el aumento progresivo de la defi ciencia de vitamina D en los adolescentes es alarmante. Se encontró una relación en adolescentes entre VDD y obesidad y enfermedades relacionadas. La suplementación de vitamina D se considera una medida promisoria para tratar a los adolescentes obesos (AU)

Association between liver vitamin A reserves and severity of nonalcoholic fatty liver disease in the class III obese following bariatric surgery.

BACKGROUND: Oxidative stress plays a role in nonalcoholic fatty liver disease (NAFLD) pathogenesis and may increase consumption of vitamin A for antioxidant purposes. It is hypothesized that drops in vitamin A concentration induce liver disease progression and increase hepatocellular carcinoma risk. The aim of this study was to assess concentrations of serum and liver retinol in the class III obese and correlate them with the histological diagnosis of NAFLD. METHODS: The sample group was composed of 68 class III obese (body mass index, BMI ≥ 40 kg/m(2)) males and females who underwent bariatric surgery for treating obesity. Concentrations of serum and liver retinol were determined using high-performance liquid chromatography. The cutoff values used to denote inadequate serum and liver retinol stores were <1.05 µmol/L and ≤20 µg/g, respectively. Anthropometric measurements were taken, and NAFLD was diagnosed via histological assessment. RESULTS: All the patients had some degree of NAFLD. Inadequate concentrations of serum and liver retinol were found in 35.9 and 67.9% of them, respectively. A significant association was found between liver retinol concentrations and the histological classification of the disease (p < 0.001). No such association was found for serum retinol. CONCLUSIONS: This study confirms the association between liver retinol and degree of NAFLD, underscoring the need for further research in this area, to identify which patients might benefit from supplementation of vitamin A.

Routine supplementation does not warrant the nutritional status of vitamin d adequate after gastric bypass Roux-en-Y.

UNLABELLED: Bariatric surgery can lead to nutritional deficiencies, including those related to bone loss. The aim of this study was to evaluate serum concentrations of calcium, vitamin D and PTH in obese adults before and six months after gastric bypass surgery in Roux-en-Y (RYGB) and evaluate the doses of calcium and vitamin D supplementation after surgery. METHODS: Retrospective longitudinal study of adult patients of both sexes undergoing RYGB. We obtained data on weight, height, BMI and serum concentrations of 25-hydroxyvitamin D, ionized calcium and PTH. Following surgery, patients received dietary supplementation daily 500 mg calcium carbonate and 400 IU vitamin D. RESULTS: We studied 56 women and 27 men. Preoperative serum concentrations of vitamin D were inadequate in 45% of women and 37% of men, while in the postoperative period 91% of women and 85% of men had deficiency of this vitamin. No change in serum calcium was found before and after surgery. Serum PTH preoperatively remained adequate in 89% of individuals of both sexes. After surgery serum concentrations remained adequate and 89% women and 83% men evaluated. CONCLUSION: Obesity appears to be a risk factor for the development of vitamin D. The results show that supplementation routine postoperative was unable to treat and prevent vitamin D deficiency in obese adults undergoing RYGB.

La cirugía bariátrica puede llevar deficiencias nutrionales, incluyendo aquellas relacionadas a perdida ósea. El objetivo de este estudio fue avaluar las concentraciones séricas de cálcio, vitamina D y PTH en adultos obesos, antes y seis meses pos cirugía de bypass Gástrico en Y-de-Roux (RYGB) y avaluar las dosis de calcio y vitamina D utilizada después da la cirugía. Métodos: Estudio longitudinal retrospectivo con pacientes adultos de ambos sexos que fueron submetidos al RYGB. Fueron obtenidos datos de peso, estatura e IMC y las concentraciones de 25-hidroxivitamina D, calcio iónicos y PTH. Pos cirugía, los pacientes recibieron la suplementación dietética diaria de 500 mg de carbonato de calcio y 400 UI de vitamina D. Resultados: Fueron avaluados 56 mujeres y 27 hombres. El preoperatorio las concentraciones séricas de vitamina D presentaron inadecuadas en 45% de las mujeres y 37% de los hombres, mientras en el periodo posoperatorio 91% de las mujeres y 85% de los hombres presentaron deficiencia de esta vitamina. Ninguna alteración en las concentraciones séricas de calcio fue encontrada antes ni pos la cirugía. Las concentraciones séricas de PTH en el preoperatorio se mantuvieron adecuadas en 89% de los individuos de ambos sexos. Pos la cirugía las concentraciones séricas se mantuvieron adecuadas en 89% y mujeres y 83% de los hombres avaluados. Conclusión: la obesidad puede ser un factor de riesgo para el desarrollo de la deficiencia de vitamina D. Los resultados enseñan que la suplementación fue incapaz de sanar y prevenir la deficiencia de vitamina D en adultos obesos submetidos RYGB.

Routine supplementation does not warrant the nutritional status of vitamin D adequate after gastric bypass Roux-en-Y / Rutina de suplementación no garantiza el estado nutricional de vitamina D adecuado para bypass gástrico en Y-de ROUX

Bariatric surgery can lead to nutritional deficiencies, including those related to bone loss. The aim of this study was to evaluate serum concentrations of calcium, vitamin D and PTH in obese adults before and six months after gastric bypass surgery in Roux-en-Y (RYGB) and evaluate the doses of calcium and vitamin D supplementation after surgery. Methods: Retrospective longitudinal study of adult patients of both sexes undergoing RYGB. We obtained data on weight, height, BMI and serum concentrations of 25-hydroxyvitamin D, ionized calcium and PTH. Following surgery, patients received dietary supplementation daily 500 mg calcium carbonate and 400 IU vitamin D. Results: We studied 56 women and 27 men. Preoperative serum concentrations of vitamin D were inadequate in 45% of women and 37% of men, while in the postoperative period 91% of women and 85% of men had deficiency of this vitamin. No change in serum calcium was found before and after surgery. Serum PTH preoperatively remained adequate in 89% of individuals of both sexes. After surgery serum concentrations remained adequate and 89% women and 83% men evaluated. Conclusion: Obesity appears to be a risk factor for the development of vitamin D. The results show that supplementation routine postoperative was unable to treat and prevent vitamin D deficiency in obese adults undergoing RYGB (AU)

La cirugía bariátrica puede llevar deficiencias nutricionales, incluyendo aquellas relacionadas a perdida ósea. El objetivo de este estudio fue avaluar las concentraciones séricas de cálcio, vitamina D y PTH en adultos obesos, antes y seis meses pos cirugía de bypass Gástrico en Y-de-Roux (RYGB) y avaluar las dosis de calcio y vitamina D utilizada después da la cirugía. Métodos: Estudio longitudinal retrospectivo con pacientes adultos de ambos sexos que fueron submetidos al RYGB. Fueron obtenidos datos de peso, estatura e IMC y las concentraciones de 25-hidroxivitamina D, calcio iónicos y PTH. Pos cirugía, los pacientes recibieron la suplementación dietética diaria de 500 mg de carbonato de calcio y 400 UI de vitamina D.Resultados: Fueron avaluados 56 mujeres y 27 hombres. El preoperatorio las concentraciones séricas de vitamina D presentaron inadecuadas en 45% de las mujeres y 37% de los hombres, mientras en el periodo posoperatorio 91% de las mujeres y 85% de los hombres presentaron deficiencia de esta vitamina. Ninguna alteración en las concentraciones séricas de calcio fue encontrada antes ni pos la cirugía. Las concentraciones séricas de PTH en el preoperatorio se mantuvieron adecuadas en 89% de los individuos de ambos sexos. Pos la cirugía las concentraciones séricas se mantuvieron adecuadas en 89% y mujeres y 83% de los hombres avaluados. Conclusión: la obesidad puede ser un factor de riesgo para el desarrollo de la deficiencia de vitamina D. Los resultados enseñan que la suplementación fue incapaz de sanar y prevenir la deficiencia de vitamina D en adultos obesos submetidos RYGB (AU)

Relação entre o estado nutricional de vitamina a e a regressão da esteatose hepática após gastroplastia em Y- de- Roux para tratamento da obesidade classe III / Relationship of the nutritional status of vitamin a and the regression of hepatic steatosis after Roux-en-Y gastric bypass surgery for treatment of class III obesity

RACIONAL: A vitamina A participa de várias funções primordiais no organismo humano e as suas concentrações séricas podem estar diminuídas nas doenças crônicas não transmissíveis. OBJETIVO: Avaliar a relação entre o estado nutricional da vitamina A, e a regressão da esteatose hepática em indivíduos submetidos à gastroplastia em Y-de-Roux para tratamento da obesidade classe III. MÉTODOS: Foram estudados 30 pacientes obesos classe III, de ambos os sexos, com esteatose hepática, submetidos à gastroplastia em Y-de-Roux. Seis meses após a operação, os pacientes foram submetidos à ultrassonografia abdominal e distribuídos em dois grupos: grupo 1 - pacientes com esteatose detectada na ultrassonografia e grupo 2 - pacientes sem esteatose detectada na ultrassonografia. No pré-operatório e seis meses após a operação foram realizadas análises antropométricas e exames bioquímicos: insulina basal, glicemia, Homeostasis Model Assessment Index (HOMA IR), colesterol, HDL, LDL, triglicerídeos, AST, ALT, Gama-GT, albumina, bilirrubina total, retinol, e beta caroteno. RESULTADOS: A média de perda de peso foi de 35,05 + 10,47 (p<0,01) e a diminuição no Índice de Massa Corporal (IMC) de 11,6 + 4,99 Kg/m² (p<0,01). Após seis meses, todos os exames bioquímicos apresentaram diminuição significativa das concentrações (p<0,05). O grupo 2 (sem esteatose) apresentou no pós-operatório, concentrações significativamente inferiores (p<0,05), nas variáveis: peso, IMC, AST, ALT, gama GT, HOMA IR, insulina basal. As concentrações séricas de albumina apresentaram valores médios aproximados, sem diferença significativa nos dois tempos avaliados. Observaram-se concentrações séricas mais elevadas de retinol e de β-caroteno e redução menor em relação as concentrações do pré-operatório nos pacientes sem esteatose, porém sem diferença estatística. CONCLUSÃO: Adequado estado nutricional de vitamina A pode contribuir na regressão da esteatose hepática em pacientes submetidos à Gastroplastia em Y-de-Roux para tratamento da obesidade classe III.

BACKGROUND: Vitamin A participates in several essentials functions in the human body and their serum concentrations may be decreased in non-transmissible diseases. AIM: To assess the relationship of the nutritional status of Vitamin A through the serum concentrations of retinol and beta carotene, with regression of hepatic steatosis in individuals who undergone Roux-en-Y gastric bypass surgery for treatment of class III obesity. METHODS: Were included 30 individuals, male and female, submitted to Roux-en-Y gastric bypass for treatment of class III obesity, who were diagnosed through an abdominal ultrasonography as presenting hepatic steatosis. From the result of an ultrasonography screened six months after the surgical procedure those subjects were divided into two groups: group 1 - patients with steatosis detected in the ultrasonography (16 subjects) and group 2 - patients without steatosis detected in the ultrasonography (14 subjects). Before and six months after the surgery, were carried out anthropometrical analyses and biochemical exams (basal insulin, glicemy, Homeostasis Model Assessment Index (HOMA IR), cholesterol, HDL, LDL, triglycerides, AST, ALT, Gamma-GT, albumin, total bilirubin, retinol, and beta carotene. RESULTS: The individuals presented an average weight loss of 35.05 + 10.47 (p<0.01) and a decrease in the Body Mass Index (BMI) of 11.6 + 4.99 Kg/m² (p<0.01). After six months, all the biochemical exams presented a significant decrease in their basal concentrations (p<0.05). In the post-operative period the group 2 (without steatosis) presented concentrations significantly lower (p<0.05) in the following variables: weight, BMI, AST, ALT, Gamma-GT, HOMA IR, basal insulin. The albumin serum concentrations presented close average values, with no significant difference in the two periods evaluated. In the assessment of retinol and beta carotene, higher serum concentrations and a small decrease in relation to the concentrations of the pre-operative period in the group without steatosis were observed, however, no statistical difference was found. CONCLUSION: An adequate nutritional status of vitamin A might contribute in the improvement of the hepatic esteatosis after Roux-en-Y gastric bypass for class III obesity treatment.

Association between non-alcoholic fatty liver disease and liver function/injury markers with metabolic syndrome components in class III obese individuals.

OBJECTIVE: To investigate the association between non-alcoholic fatty liver disease (NAFLD) and liver function/injury markers with components of metabolic syndrome (MS) in class III obese individuals. METHODS: The study population consisted of 144 patients with class III obesity (body mass index [BMI] > 40 kg/m²). MS was diagnosed according to the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) criteria, by determining the lipid profile, blood glucose and basal insulin. Liver function/injury markers were also quantified. Insulin resistance (IR) was measured by HOMA-IR and NAFLD diagnosis was established by magnetic resonance imaging (MRI). Statistical calculations were performed by SPSS version 13.0. The association was assessed by the Mann-Whitney and Chi-square tests, with a level of significance set at 5%. RESULTS: There was a significant association between the diagnosis of MS and NAFLD (χ² = 6.84, p = 0.01). As for the diagnostic components of MS, there was a positive and significant association between HDL-C (p = 0.05), waist circumference (p < 0.05) and hypertension (χ² = 4.195, p = 0.041) with NAFLD. HOMA-IR (p < 0.001) also showed a positive association with liver disease. CONCLUSION: A positive and significant association between NAFLD and components of metabolic syndrome in class III obese individuals was observed, suggesting the need and importance of monitoring these components for NAFLD screening.

Associação entre doença hepática gordurosa não alcoólica e marcadores de lesão/função hepática com componentes da síndrome metabólica em indivíduos obesos classe III / Association between non-alcoholic fatty liver disease and liver function/injury markers with metabolic syndrome components in class III obese individuals

OBJETIVO: Investigar a associação entre doença hepática gordurosa não alcoólica (DHGNA) e os marcadores de lesão e função hepática com os componentes da síndrome metabólica (SM) em indivíduos obesos classe III. MÉTODOS: A população estudada foi constituída por 144 pacientes com obesidade classe III (IMC > a 40 kg/m²). A SM foi identificada segundo o critério do NCEP ATP III, por meio da determinação do perfil lipídico, glicemia e insulina basal. Foram quantificados ainda os marcadores de função e lesão hepática. A resistência à insulina (RI) foi verificada pelo índice HOMA-IR e o diagnóstico da DHGNA por ressonância magnética. Os cálculos estatísticos foram realizados pelo programa estatístico SPSS na versão 13.0. A associação foi verificada pelo teste Mann-Whitney e qui-quadrado, com nível de significância de 5%. RESULTADOS: Foi encontrada associação significativa entre o diagnóstico de SM e DHGNA (χ² = 6,84; p = 0,01). Quanto aos componentes diagnósticos para SM, constatou-se associação positiva e significativa entre HDL-c (p = 0,05), circunferência da cintura (p < 0,05) e hipertensão arterial (χ² = 4,195; p = 0,041) com a DHGNA. O índice HOMA-IR (p < 0,001) também apresentou associação positiva com a doença hepática. CONCLUSÃO: Constatouse associação positiva e significativa entre DHGNA e componentes da SM em indivíduos obesos classe III, sugerindo a necessidade e importância do monitoramento desses componentes para rastreamento da DHGNA.

OBJECTIVE: To investigate the association between non-alcoholic fatty liver disease (NAFLD) and liver function/injury markers with components of metabolic syndrome (MS) in class III obese individuals. METHODS: The study population consisted of 144 patients with class III obesity (body mass index [BMI] > 40 kg/m²). MS was diagnosed according to the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) criteria, by determining the lipid profile, blood glucose and basal insulin. Liver function/injury markers were also quantified. Insulin resistance (IR) was measured by HOMA-IR and NAFLD diagnosis was established by magnetic resonance imaging (MRI). Statistical calculations were performed by SPSS version 13.0. The association was assessed by the Mann-Whitney and Chi-square tests, with a level of significance set at 5%. RESULTS: There was a significant association between the diagnosis of MS and NAFLD (χ² = 6.84, p = 0.01). As for the diagnostic components of MS, there was a positive and significant association between HDL-C (p = 0.05), waist circumference (p < 0.05) and hypertension (χ² = 4.195, p = 0.041) with NAFLD. HOMA-IR (p < 0.001) also showed a positive association with liver disease. CONCLUSION: A positive and significant association between NAFLD and components of metabolic syndrome in class III obese individuals was observed, suggesting the need and importance of monitoring these components for NAFLD screening.

Serum levels and liver store of retinol and their association with night blindness in individuals with class III obesity.

BACKGROUND: Studies showed a rise in obesity prevalence in world population and evidences point to a possible association with vitamin A deficiency (VAD). The objective of this study is to assess vitamin A nutritional status through functional [night blindness diagnosis-xerophthalmia (XN)] and biochemical (serum levels and retinol liver store) indicators of class III obesity individuals and its association. METHODS: We studied 114 patients of both genders with BMI ≥40 kg/m2, candidates to bariatric surgery at Clínica Cirúrgica Carlos Saboya in Rio de Janeiro, Brazil. XN was diagnosed through a standardized interview (WHO and MacLaren and Frigg), and serum levels and retinol liver store were quantified by HPLC-UV with <1.05 µmol/L and < 20 mg/g cutoffs for VAD, respectively. RESULTS: XN prevalence was 23.8%, and serum levels and retinol liver store inadequacy were 14.0% and 80%, respectively. The association between VAD and XN presence (p = 0.003) was observed with the biochemical indicator and the gold standard, retinol liver store (p = 0.003 and p = 0.018, respectively). Means were 59.3% (sensitivity), 87.4% (specificity), and 80.8% (accuracy) as regards to the XN role in predicting VAD according to the biochemical indicator. As regards to retinol liver store, XN diagnosis presented 48% of sensitivity and 75% of specificity. VAD highest indexes occurred in patients with highest BMI (rs-0.21, p = 0.02). Distribution of XN prevalence was 59.2% according to serum retinol. CONCLUSIONS: VAD and XN prevalence was high in class III obesity individuals, and the functional indicator for XN diagnosis may be a promising method for diagnosis in this group.

Bariatric surgery: impact on body composition after Roux-en-Y gastric bypass.

BACKGROUND: The aim of this study was to analyze the impact of bariatric surgery on the body composition of patients suffering from class III obesity at different postoperative time intervals. METHODS: The body composition of 114 patients undergoing Roux-en-Y gastric bypass surgery was measured prior to surgery (T0) and then 30 (T30) and 180 (T180) days following surgery. Body composition was evaluated using the following parameters: total body mass, body mass index, excess weight, percentage of excess weight loss, relative body fat (%F), lean body mass (LBM), and fat tissue mass (FTM). To determine these variables, validated formulas and equations proper to obese men and women were employed. RESULTS: A significant reduction in %F (41.5%), LBM (20.3%), FTM (37.9%) was noted at each time interval (p ≤ 0.01). CONCLUSIONS: Bariatric surgery proved to be effective in reducing total body mass and body fat at every time interval. However, dietary measures emphasizing adequate protein intake may be implemented in order to reduce loss of LBM and, coupled with frequent physical activity, may help curtail the impact the surgery has on morphological variables.

Relationship of the nutritional status of vitamin A and the regression of hepatic steatosis after Roux-en-Y gastric bypass surgery for treatment of class III obesity.

BACKGROUND: Vitamin A participates in several essentials functions in the human body and their serum concentrations may be decreased in non-transmissible diseases. AIM: To assess the relationship of the nutritional status of Vitamin A through the serum concentrations of retinol and beta carotene, with regression of hepatic steatosis in individuals who undergone Roux-en-Y gastric bypass surgery for treatment of class III obesity. METHODS: Were included 30 individuals, male and female, submitted to Roux-en-Y gastric bypass for treatment of class III obesity, who were diagnosed through an abdominal ultrasonography as presenting hepatic steatosis. From the result of an ultrasonography screened six months after the surgical procedure those subjects were divided into two groups: group 1 - patients with steatosis detected in the ultrasonography (16 subjects) and group 2 - patients without steatosis detected in the ultrasonography (14 subjects). Before and six months after the surgery, were carried out anthropometrical analyses and biochemical exams (basal insulin, glicemy, Homeostasis Model Assessment Index (HOMA IR), cholesterol, HDL, LDL, triglycerides, AST, ALT, Gamma-GT, albumin, total bilirubin, retinol, and beta carotene. RESULTS: The individuals presented an average weight loss of 35.05 + 10.47 (p<0.01) and a decrease in the Body Mass Index (BMI) of 11.6 + 4.99 Kg/m² (p<0.01). After six months, all the biochemical exams presented a significant decrease in their basal concentrations (p<0.05). In the post-operative period the group 2 (without steatosis) presented concentrations significantly lower (p<0.05) in the following variables: weight, BMI, AST, ALT, Gamma-GT, HOMA IR, basal insulin. The albumin serum concentrations presented close average values, with no significant difference in the two periods evaluated. In the assessment of retinol and beta carotene, higher serum concentrations and a small decrease in relation to the concentrations of the pre-operative period in the group without steatosis were observed, however, no statistical difference was found. CONCLUSION: An adequate nutritional status of vitamin A might contribute in the improvement of the hepatic esteatosis after Roux-en-Y gastric bypass for class III obesity treatment.

Serum retinol and ß-carotene levels and risk factors for cardiovascular disease in morbid obesity.

OBJECTIVE: to evaluate retinol and ß-carotene serum levels and their relationship with risk factors for cardiovascular disease in individuals with morbid obesity, resident in Rio de Janeiro. METHODOLOGY: blood serum concentrations of retinol and ß-carotene of 189 morbidly obese individuals were assessed. The metabolic syndrome was identified according to the criteria of the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). Lipid profile, insulin resistance, basal insulin, glycemia, blood pressure, and anthropometry and their correlation with retinol and ß-carotene serum levels were evaluated. RESULTS: metabolic syndrome diagnosis was observed in 49.0% of the sample. Within this percentage the levels of ß-carotene were significantly lower when body mass index increased. Serum retinol didn't show this behavior. Serum retinol inadequacy in patients with metabolic syndrome (61.3%), according to WHO criterion, was higher (15.8%) than when the whole sample was considered (12.7%). When metabolic syndrome was diagnosed by NCEP criterion, ß-carotene inadequacy was higher (42.8%) when compared to the total sample (37.5%). There was a significant difference between average ß-carotene values of patients with and without metabolic syndrome (p=0.048) according to the classification of the NCEP. Lower values were found in patients with metabolic syndrome. CONCLUSION: considering the vitamin A contribution in antioxidant protection, especially when risk factors for cardiovascular disease are present, it is suggested that great attention be given to morbidly obese. This could aid in prevention and treatment of cardiovascular disease, which affects a significant part of the population.