Micronutrient status in morbidly obese women before bariatric surgery.

BACKGROUND: A high prevalence of micronutrient deficiencies in obese subjects has been reported. Bariatric surgery is the most effective long-term treatment of morbid obesity, but this treatment can result in secondary micronutrient deficiencies. The aim of our work was to describe the micronutrient status in obese women before surgery at a university hospital. METHODS: We analyzed a consecutive series of 115 women who were referred to our unit for evaluation for bariatric surgery. Their weight, height, body mass index, and waist circumference were measured. The basal hemoglobin, albumin, prealbumin, ferritin, copper, zinc, calcium, phosphorus, parathyroid hormone, and vitamin (A, D, E, K, B12, and folic) blood levels were also determined. RESULTS: Deficiencies were found in 6.1% of the subjects for albumin, 21.7% for prealbumin, 2.6% for hemoglobin, and 5.2% for ferritin. In the vitamin analysis, no deficiencies were found in the patients for vitamins A, E, or K, but 71.3% had a moderate deficiency of vitamin D and 26.1% a severe deficiency of vitamin D (<15 ng/mL). In concorndance with the high prevalence of 25-OH vitamin D deficiency, 22.6% of the patients had secondary hyperparathyroidism with intact parathyroid hormone levels >72 pg/mL. Deficiencies were found in 9.5% for vitamin B12, 25.2% for folic acid, 67.8% for copper, and 73.9% for zinc. CONCLUSION: Our study has demonstrated a high prevalence of micronutrient deficiencies in morbidly obese women seeking obesity surgery.

Zinc and copper serum levels of morbidly obese patients before and after biliopancreatic diversion: 4 years of follow-up.

BACKGROUND: Zinc and copper are two essential trace elements. However, few studies have been conducted specifically to investigate these deficiencies in patients who underwent bariatric surgery. The aim of our work was to describe the influence of biliopancreatic diversion (BPD) on serum copper and zinc levels during 4 years. METHODS: We have analyzed a consecutive series of 65 patients who have been followed-up for 4 years after undergoing open BPD. RESULTS: The final (4 years) initial excess weight percent loss was 63.5%. A significant improvement of BMI, weight, waist circumference, and fat mass was detected. The preoperative average zinc (42.2 ± 53.2 µg/dl) and copper (61.3 ± 58.6 µg/dl) levels are under the lower limit of the normal values. These data show a deficient micronutrient status in morbidly obese patients, 73.8% of patients had low basal zinc values and 67.8% low basal copper values. Values of both micronutrients at different times (6 months, 1, 2, 3, and 4 years) were lower than basal value. CONCLUSION: BPD is an effective method of sustainable weight loss. Otherwise, a high prevalence of zinc and copper basal deficiencies in morbidly obese seeking bariatric surgery was detected. These deficiencies of copper and zinc increased during the 4 years of follow-up after BDP.

Influence of lys656asn polymorphism of leptin receptor gene on surgical results of biliopancreatic diversion.

BACKGROUND: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate Lys656Asn polymorphism of leptin receptor gene on outcomes 1 year after biliopancreatic diversion. METHODS: A sample of 41 morbidly obese patients (body mass index (BMI) > 40 kg/m(2)) were operated on. Biochemical and anthropometric evaluation were realized at basal visit and at each visit. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit. RESULTS: Thirty-two patients (78%) had genotype Lys656/Lys656, eight patients (19.5%) Lys656/Asn656 genotype, and one patient (2.4%) Asn656/Asn656 genotype. In the wild-type group, body mass index, weight, glucose, total cholesterol, LDL cholesterol, triacylglycerol, and systolic blood pressure decreased. In the mutant group, the same parameters improved. Initial weight percent loss at 1 year of follow-up was higher in mutant group than in wild-type group (38.9% vs 29.9%; p < 0.05). Total weight loss was higher in mutant group than wild-type group (50.7 vs 37.2 kg; p < 0.05). Basal weight and BMI were higher in mutant group than wild type. CONCLUSION: Weight loss was higher in mutant group (Lys656Asn and Asn656Asn) than wild-type group (Lys656Lys) after bariatric surgery. Carriers of the allelic variant (Asn) had higher basal weight.

Influence of Ala54Thr polymorphism of fatty acid-binding protein-2 on clinical results of biliopancreatic diversion.

OBJECTIVE: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate the fatty acid-binding protein-2 Ala54Thr polymorphism outcomes 1 y after biliopancreatic diversion in morbidly obese patients. METHODS: A sample of 41 morbidly obese patients (body mass index >40 kg/m(2)) were operated upon from December 2004 to December 2006. Weight, fat mass, blood pressure, basal glucose, triacylglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at the basal visit and at each visit. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit. RESULTS: Twenty-three patients (56.1%) had genotype Ala54/Ala54 (wild group) and 18 patients had genotype Ala54/Thr54 (15 patients, 36.5%) or Thr54/Thr54 (3 patients, 7.4%; mutant group). In the wild group, body mass index, weight, fat mass, systolic blood pressure, glucose, total cholesterol, low-density lipoprotein cholesterol, and triacylglycerol concentrations decreased. Diastolic blood pressure remained unchanged. In the mutant group, the same parameters improved, without statistical differences from the wild group. Initial excess weight percent loss at 1 y of follow-up was similar in both genotype groups (61.8% versus 61.9%, NS). CONCLUSION: Polymorphism Ala54Thr of fatty acid-binding protein did not have an effect on weight loss or clinical outcomes after bariatric surgery.

Influence of G308A polymorphism of tumor necrosis factor-alpha gene on inflammatory markers in postsurgical head and neck cancer patients with early enteral nutrition.

OBJECTIVE: Although immune dysfunction in patients with cancer could be multifactorial, the immune system may be modulated by nutritional substrates and genetic background. Our study evaluated the effect of G308A polymorphism of the tumor necrosis factor-alpha (TNF-alpha) gene on inflammatory markers in patients after surgery for head and neck cancer who received early enteral nutrition. METHODS: A population of 60 patients with oral and laryngeal cancer was enrolled. At surgery patients were treated with a hyperproteic enteral diet. Perioperatively and on postoperative day 6 the following parameters were evaluated: serum values of prealbumin, transferrin, total number of lymphocytes, interleukin-6, TNF-alpha, and C-reactive protein. In addition, genotyping of G308A gene polymorphism was assessed. RESULTS: Patients' mean age was 61.1 +/- 14.6 y (four women, 56 men) with a body mass index of 25.4 +/- 5.2 kg/m(2) and a previous weight loss of 0.35 +/- 0.2 kg. Forty patients (37 men, 3 women; 66.6%) had the genotype G308/G308 (wild group) and 20 patients (19 men, 1 woman; 23.4%) had the genotype G308/A308 (mutant group). A significant increase in prealbumin and transferrin levels was detected in both groups. C-reactive protein decreased in both groups (wild group: 105.1 +/- 60 versus 53.8 +/- 62.3 mg/dL, P < 0.05; mutant group: 99.5 +/- 46 versus 43.9 +/- 51.9 mg/dL, P < 0.05). Interleukin-6 decreased in both groups (wild group: 20.1 +/- 22 versus 6.2 +/- 4.1 pg/mL, P < 0.05; mutant group: 22.3 +/- 38 versus 9.2 +/- 7.4 pg/mL, P = NS). Lymphocytes increased in both groups (wild group: 1102 +/- 468 versus 1600 +/- 537 10(3)/mL, P = NS; mutant group: 1441 +/- 739 10(3)/mL versus 1669 +/- 614 10(6)/mL, P = NS). TNF-alpha showed no changes. CONCLUSION: The G308A polymorphism of the TNF-alpha gene did not affect levels of inflammatory markers in patients after surgery for head and neck cancer who were treated with early enteral nutrition.

[Utility of a omega 3 fatty acids oral enhanced formula in biochemical parameters of head and neck cancer patients]. / Influencia de una fórmula enriquecida en ácidos omega 3 y arginina sobre los parámetros bioquímicos en pacientes intervenidos por cáncer de cabeza y cuello.

BACKGROUND AND OBJECTIVE: To investigate the influence of a arginine and omega3 fatty acids enhanced supplement in nutritional variables in postsurgical ambulatory patients with head and neck tumors. PATIENTS AND METHOD: A population of 18 ambulatory postsurgical patients with oral and laryngeal cancer was studied. At hospital discharge, postsurgical head and neck cancer patients were asked to consume two units per day of a specially designed omega3 fatty acid enhanced supplement for a twelve week period. RESULTS: Eighteen patients were enrolled in the study. The mean age was 62.5 (11.4) years (1 females/17 males). Duration of supplementation was 90.5 (22) days. Significant increases of serum protein levels and lymphocites were detected. PCR levels decreased after supplementation (71.96 [21.7] md/dl vs 25.9 [11.1] mg/dl; p < 0.05). No differences were detected in weight and other anthropometric parameters. A positive correlation between omega3/omega6 ratio and kg of fat mass (r = 0.59; p < 0.05) and midarm circumference (r = 0.62; p < 0.05) were detected. When the population was divided in two groups, group I (ratio omega3/omega6 < 0.51) and group II (ratio omega3/omega6 > 0.51), group II showed higher fat mass than group I (17.32 [5.3] kg vs 13.8 [5.1] kg; p < 0.05). CONCLUSIONS: This immuno-enhanced formula could improve serum protein levels and PCR in ambulatory postoperative head and neck cancer patients. An increase in fat mass was detected in patients with a high omega3/omega6 intake of polyunsaturated fatty acids.

Influencia de una fórmula enriquecida en ácidos omega 3 y arginina sobre los parámetros bioquímicos en pacientes intervenidos por cáncer de cabeza y cuello / Utility of a omega 3 fatty accids oral enhanced formula in biochemical parameters of head and neck cancer patients

FUNDAMENTO Y OBJETIVO: Investigar la influencia de una fórmula enteral enriquecida en ácidos grasos omega 3 y arginina en la situación nutricional de 18 pacientes con cáncer de cabeza y cuello. PACIENTES Y MÉTODO: Se administró a los pacientes 2 sobres/día de un preparado enriquecido en ácidos grasos omega 3 y arginina durante 12 semanas. Se realizó una valoración nutricional en el momento basal (tras alta hospitalaria) y a las 12 semanas de tratamiento. RESULTADOS: La edad media (desviación estándar) de los pacientes (una mujer y 17 varones) era de 62,5 (11,4) años. Se detectó una elevación significativa de los valores de albúmina, prealbúmina, transferrina y linfocitos. Los valores séricos de proteína C reactiva disminuyeron de una manera significativa (71,96 [21,7] frente a 25,9 [11,1] mg/dl; p < 0,05). No se detectó ganancia de peso ni variación en otras variables antropométricas. Se detectó una correlación positiva entre la razón omega 3/omega 6 de ingesta de ácidos poliinsaturados y los kilogramos de masa grasa (r = 0,59; p < 0,05), así como la circunferencia muscular del brazo (r = 0,62; p < 0,05). El grupo con una ingesta de omega 3/omega 6 superior a 0,51 mostró mayor masa grasa final que el grupo con menor ingesta (17,32 [5,3] frente a 13,8 [5,1] kg; p < 0,05). CONCLUSIONES: Esta fórmula puede mejorar los valores de proteínas séricas y linfocitos, y disminuir los de proteína C reactiva en pacientes con cáncer de cabeza y cuello. El incremento de masa grasa es superior en los pacientes con una relación favorable en la ingesta de omega 3/omega 6 (AU)

[Isolated dietary counselling program versus supplement and dietary counselling in patients with human immunodeficiency virus infection]. / Consejo nutricional aislado frente a suplemento y consejo nutricionales en pacientes con infección por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: Nutritional intervention is a controversial area. The aim of the study was to compare the influence on nutritional status of nutritional supplementation with a standard polymeric formula as well as nutritional counselling versus isolated nutritional counselling in a group of HIV-infected patients. PATIENTS AND METHOD: There were 70 patients, 66 of whom were fully evaluated for each study end point after application of prospectively determined evaluability criteria. Of these, 35 were randomized to group I (standard formula) and 35 were randomized to unsupplemented group II. Group I patients received standard enteral formula (3 cans/day, 250 ml per can). Patients were submitted to a prospective serial assessment of their nutrition status (anthropometric and biochemical status) and the nutritional intake was determined by means of 24-hours written food records. Determinations were performed at baseline and at 3 months. RESULTS: Treatment with oral supplements in group I resulted in a significant and sustained increase in weight (2.75%; p < 0.05) which was mostly due to fat mass (10.8%; p < 0.05). In contrast, no changes were detected in group II patients. The increase in body weight and tricipital skinfold was significant in group I. Total body water and fat free-mass remained without changes. CD4 counts and viral load remained stable in both groups. CONCLUSIONS: Oral nutritional supplements for a 3-months period resulted in body weight gain in HIV-infected patients, increasing the fat mass. An isolated nutritional counselling did not result in such an increase.

Consejo nutricional aislado frente a suplemento y consejo nutricionales en pacientes con infecciónpor el virus de la inmunodeficiencia humana / Isolated dietary counselling program versus supplement and dietary counselling in patients with human immunodeficiency virus infection

FUNDAMENTO Y OBJETIVO: La intervención nutricional en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) es un aspecto controvertido. El objetivo de nuestro estudio fue comparar la influencia en el estado nutricional de la administración de un suplemento nutricional frente a la educación nutricional sin suplementación. PACIENTES Y MÉTODO: Se aleatorizó a 70 pacientes, 66 fueron totalmente evaluados. De estos pacientes, 35 fueron incluidos en el grupo I (suplementación con fórmula) y 35 en el grupo II (consejo nutricional). Los pacientes del grupo I recibieron tres botes de 250 ml de una fórmula normocalórica y consejo nutricional; el grupo II sólo recibió educación nutricional. A los pacientes se les realizó una evaluación nutricional antropométrica y bioquímica y evaluación inmunológica, así como una encuesta nutricional de 24 h, antes de la aleatorización y a los tres meses de iniciar el tratamiento. RESULTADOS: En los pacientes del grupo I se detectó un aumento significativo del peso (2,75 por ciento; p < 0,05), que fue debido al aumento de masa grasa (10,8 por ciento; p < 0,05); no se detectaron cambios en el grupo II. El agua corporal total y la masa libre de grasa permanecieron sin cambios en ambos grupos. El incremento de peso y masa grasa fue estadísticamente superior en el grupo I que en el II. El recuento de carga viral y de linfocitos CD4 se mantuvo estable en ambos grupos. CONCLUSIONES: La suplementación oral en un período de tres meses en pacientes con infección por el VIH aumenta su peso, debido al aumento de la masa grasa. La educación nutricional aislada no tuvo efectos sobre el peso (AU)

[Clinical evolution of a cohort of patients with Graves-Basedow disease treated with metimazole]. / Evolución clínica de una cohorte de pacientes con enfermedad de Graves-Basedow tratados con metimazol.

BACKGROUND: Prospective studies of Graves-Basedow disease in Spain are scarce. Our objective was to evaluate the clinical and biochemical evolution of a cohort of patients with Graves-Basedow disease. PATIENTS AND METHOD: 202 patients with Graves-Basedow disease diagnosed between January 1997 and June 1999. RESULTS: 5.9% of patients received 131I and 2.5% underwent surgery after treatment with methimazole. A relapse was observed in 23.3% patients. In the survival analysis, significant differences with regard to the rate of relapse were observed according to the goitre degree. CONCLUSIONS: In our study, all patients reached remission with methimazole. There was a high rate of relapse following discontinuation of therapy within the first months. Goitre size at the time of diagnosis was a significant determining factor of relapse.

Evolución clínica de una cohorte de pacientes con enfermedad de Graves-Basedow tratados con metimazol / Clinical evolution of a cohort of patients with Graves-Basedow disease treated with metimazole

FUNDAMENTO: Los estudios de seguimiento en pacientes con enfermedad de GravesBasedow son escasos en España. El objetivo de nuestro trabajo es evaluar la evolución clínica y bioquímica en una cohorte de pacientes con esta enfermedad. PACIENTES Y MÉTODO: Se estudió a un total de 202 pacientes con enfermedad de GravesBasedow diagnosticados entre enero de 1997 y junio de 1999. RESULTADOS: Un 5,9 por ciento de los pacientes requirieron la administración de radioyodo y un 2,5 por ciento fue sometido a cirugía tiroidea para control del hipertiroidismo. Presentó recidiva el 23,3 por ciento de los pacientes. En el análisis de supervivencia sólo se detectaron diferencias en la tasa de recidiva en los pacientes con bocio grado Ib (23 por ciento), II (20 por ciento) y III (25 por ciento) frente a los pacientes con estadio 0 (0 por ciento) y Ia (8,9 por ciento) (p < 0,05). CONCLUSIONES: En esta serie se alcanzó remisión en todos los casos con tratamiento farmacológico, con una alta tasa de recidiva en los primeros meses tras suspender la medicación. El tamaño del bocio en el momento del diagnóstico demostró ser un factor independiente de recidiva. (AU)