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1.
Arq Gastroenterol ; 59(4): 513-521, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36515347

RESUMO

BACKGROUND: Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. OBJECTIVE: To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. METHODS: This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. RESULTS: A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. CONCLUSION: Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.


Assuntos
Cirurgia Bariátrica , Doenças Ósseas Metabólicas , Diabetes Mellitus Tipo 2 , Derivação Gástrica , Obesidade Mórbida , Masculino , Feminino , Humanos , Idoso , Obesidade Mórbida/cirurgia , Densidade Óssea , Estudos Prospectivos , Derivação Gástrica/métodos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Redução de Peso , Índice de Massa Corporal , Hormônio Paratireóideo , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/cirurgia
2.
Ther Adv Gastrointest Endosc ; 15: 26317745221105087, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388729

RESUMO

Morbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery. Plain Language Summary: Management of biliary stones in bariatric surgery The complications related to biliary stones may impose complexity on their management. Knowing the main prophylactic and therapeutic intervention options is essential for clinicians to properly manage the biliary stones in patient candidates or submitted to bariatric surgery. This study reviewed the main tools clinicians can handle to properly manage candidates for bariatric surgery or patients submitted to bariatric surgery.

3.
Arq Gastroenterol ; 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36383883

RESUMO

BACKGROUND: Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. OBJECTIVE: To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. METHODS: This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. RESULTS: A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. CONCLUSION: Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.

4.
Obes Surg ; 32(12): 4082-4088, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36261630

RESUMO

The demand for revisional bariatric surgery after sleeve gastrectomy (SG) has increased, but the ideal procedure remains unclear. A systematic review and meta-analysis were performed to compare the outcomes of weight loss and safety of one-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) as revisional procedures for failed SG. Four retrospective comparative studies were included, comprising 499 individuals. Patients submitted to OAGB had a more significant total weight loss (TWL) (MD = - 5.89%; 95% CI - 6.80 to - 4.97) after revisional surgery. Overall early complication rate was similar between procedures (RD = 0.04; 95% CI: - 0.05 to 0.12). Limited and heterogeneous data prevent meaningful conclusions, but the present analysis suggests that OAGB has a better TWL after revisional surgery.


Assuntos
Derivação Gástrica , Obesidade Mórbida , Humanos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Reoperação/métodos , Gastrectomia/métodos , Redução de Peso , Resultado do Tratamento
5.
Arq Gastroenterol ; 59(3): 370-374, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36102434

RESUMO

BACKGROUND: Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population. METHODS: Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery. RESULTS: Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group. CONCLUSION: Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Idoso , Gastrectomia/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Redução de Peso
6.
Arq. gastroenterol ; 59(3): 370-374, July-Sept. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1403489

RESUMO

ABSTRACT Background: Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population. Methods: Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery. Results: Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group. Conclusion: Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.


RESUMO Contexto: A cirurgia bariátrica ainda é controversa em pacientes idosos com obesidade grave. A maioria das publicações tem foco em segurança e desfechos clínicos precoces. A tolerância alimentar e o risco nutricional pós-operatório são desconhecidos para essa população. Métodos: Trinta e seis pacientes idosos com obesidade grave foram recrutados para um estudo clínico randomizado de setembro de 2017 a maio de 2019 comparando gastrectomia vertical com Bypass Gástrico em Y-de-Roux (BGYR). A tolerância alimentar foi avaliada pelo questionário de qualidade alimentar e dados sobre perda de peso, composição corporal e risco nutricional foram coletados entre 6 e 24 meses após a cirurgia. Resultados: Comparando os pacientes de gastrectomia vertical com BGYR, estes tiveram maior perda de peso total (22% vs 31%, P=0,01) e perda do excesso de peso (53% vs 68%, P=0,01). A tolerância alimentar para oito grupos foi similar entre grupos 14 vs 15 pontos, P=0,270), bem como o escore de Suter (23 vs 25, P=0,238). A ingestão diária de proteínas foi abaixo do recomendado para ambos os grupos (40 vs 51 g/d, P=0,105). O risco nutricional, avaliado através do ângulo de fase padronizado (-1,48 vs -1,99, P=0,027), foi pior para o grupo do BGYR. Conclusão: A tolerância alimentar e adequação do consumo alimentar foi similar entre os grupos. Pacientes submetidos a BGYR tiveram maior risco nutricional.

7.
Arq Bras Cir Dig ; 34(4): e1626, 2022.
Artigo em Português, Inglês | MEDLINE | ID: mdl-35107488

RESUMO

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients. The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population. METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery. RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m2 (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%. CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.


OBJETIVOS: A doença hepática gordurosa não-alcoólica já é considerada um problema de saúde pública, principalmente em pacientes com obesidade severa. O objetivo do presente estudo foi investigar os diferentes escores de bioquímiosa disponíveis e determinar qual deles poderia servir melhor como uma ferramenta de avaliação da NAFLD em uma população de obesos. MÉTODOS: Este é um estudo transversal de pacientes obesos. Todos os pacientes foram avaliados com parâmetros laboratoriais séricos 1 semana antes da biópsia e todos os pacientes foram submetidos a biópsia hepática intra-operatória, durante a cirurgia bariátrica. RESULTADOS: Cento e quarenta e três pacientes obesos foram incluídos. Apenas APRI (0,65; IC 95%: 0,55 a 0,8) e HOMA-IR (0,7; IC 95%: 0,58 a 0,82) mostraram capacidade significativa de predição de esteatose grave. HSI, NALFDS, ALS / AST e FIB-4 não foram capazes de prever corretamente esteatose grave na biópsia hepática. APRI mostrou alta especificidade (82%) e baixa sensibilidade (54%). Em contraste, o HOMA-IR apresentou alta sensibilidade (84%) e baixa especificidade (48%). CONCLUSÃO: O NALFDS, FIB-4, AST / ALT e HSI não têm utilidade para avaliação de esteatose grave em pacientes com obesidade severa. Diabetes e avaliação bioquímica relacionada à resistência à insulina, como o HOMA-IR, podem ser empregados como boas ferramentas de rastreamento para esteatose grave em tais pacientes. O escore APRI é a ferramenta diagnóstica bioquímica mais específica para esteatose em pacientes com obesidade severa e pode ser empregado, por equipes médicas, para auxiliar na indicação de cirurgia bariátrica ou metabólica.


Assuntos
Cirurgia Bariátrica , Resistência à Insulina , Hepatopatia Gordurosa não Alcoólica , Estudos Transversais , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade
10.
Obes Surg ; 31(6): 2359-2363, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33683573

RESUMO

PURPOSE: Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes. OBJECTIVES: This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older. METHODS: Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions. RESULTS: The median age (67 × 67 years; p=0.67) and initial body mass index (BMI) (46.3 × 51.3 kg/m2; p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 × 47.6 kg/m2; p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 × 68%; p=0.04; 24.9 × 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (-1.1 × -0.5%; p<0.01) as well as LDL control (-27.5 × +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality. CONCLUSION: Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Idoso , Gastrectomia , Humanos , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Redução de Peso
11.
ABCD arq. bras. cir. dig ; 34(4): e1626, 2021. tab, graf
Artigo em Inglês, Português | LILACS | ID: biblio-1360002

RESUMO

RESUMO - RACIONAL: A doença hepática gordurosa não-alcoólica já é considerada um problema de saúde pública, principalmente em pacientes com obesidade severa. OBJETIVOS: O objetivo do presente estudo foi investigar os diferentes escores de bioquímiosa disponíveis e determinar qual deles poderia servir melhor como uma ferramenta de avaliação da NAFLD em uma população de obesos. MÉTODOS: Este é um estudo transversal de pacientes obesos. Todos os pacientes foram avaliados com parâmetros laboratoriais séricos 1 semana antes da biópsia e todos os pacientes foram submetidos a biópsia hepática intra-operatória, durante a cirurgia bariátrica. RESULTADOS: Cento e quarenta e três pacientes obesos foram incluídos. Apenas APRI (0,65; IC 95%: 0,55 a 0,8) e HOMA-IR (0,7; IC 95%: 0,58 a 0,82) mostraram capacidade significativa de predição de esteatose grave. HSI, NALFDS, ALS / AST e FIB-4 não foram capazes de prever corretamente esteatose grave na biópsia hepática. APRI mostrou alta especificidade (82%) e baixa sensibilidade (54%). Em contraste, o HOMA-IR apresentou alta sensibilidade (84%) e baixa especificidade (48%). CONCLUSÃO: O NALFDS, FIB-4, AST / ALT e HSI não têm utilidade para avaliação de esteatose grave em pacientes com obesidade severa. Diabetes e avaliação bioquímica relacionada à resistência à insulina, como o HOMA-IR, podem ser empregados como boas ferramentas de rastreamento para esteatose grave em tais pacientes. O escore APRI é a ferramenta diagnóstica bioquímica mais específica para esteatose em pacientes com obesidade severa e pode ser empregado, por equipes médicas, para auxiliar na indicação de cirurgia bariátrica ou metabólica.


ABSTRACT - INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients. OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population. METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery. RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m2 (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%. CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.


Assuntos
Humanos , Resistência à Insulina , Cirurgia Bariátrica , Hepatopatia Gordurosa não Alcoólica/complicações , Estudos Transversais , Obesidade
12.
Surg Obes Relat Dis ; 16(10): 1436-1440, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32753300

RESUMO

BACKGROUND: The aging population along with the obesity epidemic has increased the number of older patients undergoing bariatric surgery. Nevertheless, there is still conflicting data regarding surgical safety in this population. OBJECTIVES: The aim of this study was to compare the surgical morbidity of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for older patients. SETTING: University hospital, São Paulo, Brazil. METHODS: We performed a prospective randomized clinical trial from September 2017 to May 2019. Obese patients aged ≥65 years were randomized to LSG or LRYGB. Data collection included demographic information, body mass index (BMI), and co-morbidities. We assessed readmission, postoperative complications, and mortality. Complications were scored according to Clavien-Dindo classification. RESULTS: A total of 36 patients, with a BMI between 35.5 and 52.8 kg/m2 were randomized to either LSG (18 patients) or LRYGB (18 patients). The overall complication rate was similar between LSG and LRYGB (3 versus 7, P = .13). Severe complication was more prevalent in LRYGB patients but had no statistically significant difference (0 versus 3, P = .07). Each group had 1 readmission and there was no mortality in 90-day follow-up. CONCLUSIONS: Morbidity and mortality rates of bariatric surgery are low in elderly obese patients. Despite not statistically significant, LSG had a lower rate of severe complications compared with LRYGB in this population setting.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Idoso , Brasil , Gastrectomia/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Redução de Peso
13.
Clinics (Sao Paulo) ; 75: e1588, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294671

RESUMO

OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.


Assuntos
Cirurgia Bariátrica , Prescrições de Medicamentos/estatística & dados numéricos , Derivação Gástrica/métodos , Laparoscopia , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Brasil , Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dislipidemias/complicações , Dislipidemias/tratamento farmacológico , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Obesidade Mórbida/complicações , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Resultado do Tratamento , Redução de Peso
14.
Surg Obes Relat Dis ; 16(1): 40-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31796297

RESUMO

BACKGROUND: Limited access to publicly funded, insurance-covered, and self-paid obesity surgery is a reality worldwide. Waiting lists for procedures are usually based on chronologic criteria and body mass index (BMI)-defined obesity categorization. Obesity classification systems assess overall health and have been proposed as an alternative. OBJECTIVE: To investigate the correlation between BMI-based classification and the Edmonton Obesity Staging System (EOSS) to support current evidence that the assessment of the clinical severity of obesity could be a helpful tool to maximize access to surgery. SETTING: University hospital, Brazil. METHODS: Retrospective analysis of all 2011 to 2014 adult patients who underwent obesity surgery under the public health system. Data on sex, age, presurgical BMI, and co-morbidities were extracted from hospital records. Spearman correlation coefficients were used to assess the strength and direction of the relationship between BMI classification and EOSS. RESULTS: Of 565 patients, 79% were female, mean age 44.1 ± 10.9 years and mean BMI 46.9 ± 6.2 kg/m2. The most common EOSS stage was 2 (86.5%), followed by stages 3 (8.5%) and 1 (4.9%). There was no correlation between the severity of obesity measured by BMI and EOSS (ρ = -.030, P = .475). Older patients had higher Edmonton scores (ρ = .308, P < .001). No difference was observed regarding sex. CONCLUSIONS: No correlation was found between EOSS and BMI and between these and sex. Age correlated with both obesity indicators. EOSS was reproducible in Brazilian surgical patients and may be an important tool from a health services perspective contributing to the more efficient use of limited resources for obesity surgery.


Assuntos
Cirurgia Bariátrica , Acesso aos Serviços de Saúde , Obesidade/classificação , Obesidade/cirurgia , Adulto , Índice de Massa Corporal , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , Índice de Gravidade de Doença , Listas de Espera
15.
Clinics ; 75: e1588, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1101089

RESUMO

OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.


Assuntos
Humanos , Feminino , Adulto , Prescrições de Medicamentos/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Derivação Gástrica/métodos , Laparoscopia , Cirurgia Bariátrica , Obesidade Mórbida/complicações , Brasil , Redução de Peso , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Índice de Massa Corporal , Estudos Retrospectivos , Resultado do Tratamento , Avaliação de Resultados em Cuidados de Saúde , Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dislipidemias/complicações , Dislipidemias/tratamento farmacológico , Hipertensão/complicações , Hipertensão/tratamento farmacológico
16.
Clinics (Sao Paulo) ; 74: e1198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31664418

RESUMO

OBJECTIVES: The gut microbiota is associated with obesity and weight loss after bariatric surgery and has been related to its changing pattern. Exactly how the bacterial population affects weight loss and the results of surgery remain controversial. This study aimed to evaluate the intestinal microbiota of superobese patients before and after gastric bypass surgery (RYGB). METHOD: DNA fragments for the microbiota obtained from stool samples collected from nine superobese patients before and after bariatric surgery were sequenced using Ion Torrent. RESULTS: We observed that with a mean follow-up of 15 months, patients achieved 55.9% excess weight loss (EWL). A significant population reduction in the Proteobacteria phylum (11 to 2%, p=0.0025) was observed after surgery, while no difference was seen in Firmicutes and Bacteroidetes. Further analyses performed with two specific individuals with divergent clinical outcomes showed a change in the pattern between them, with a significant increase in Firmicutes and a decrease in Bacteroidetes in the patient with less weight loss (%EWL 50.79 vs. 61.85). CONCLUSIONS: RYGB affects the microbiota of superobese patients, with a significant reduction in Proteobacteria in patients with different weight loss, showing that different bacteria may contribute to the process.


Assuntos
Cirurgia Bariátrica , Microbioma Gastrointestinal , Obesidade Mórbida/microbiologia , Obesidade Mórbida/cirurgia , Redução de Peso , Adolescente , Adulto , Fezes/microbiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/análise , Adulto Jovem
17.
Arq Gastroenterol ; 56(1): 55-60, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31141066

RESUMO

BACKGROUND: Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures. OBJECTIVE: The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED. METHODS: A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach. RESULTS: A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED. CONCLUSION: Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.


Assuntos
Cirurgia Bariátrica , Transtorno da Compulsão Alimentar/diagnóstico , Obesidade Mórbida/cirurgia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Obesidade Mórbida/psicologia , Estudos Observacionais como Assunto , Prevalência
18.
Arq. gastroenterol ; 56(1): 55-60, Jan.-Mar. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1001323

RESUMO

ABSTRACT BACKGROUND: Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures. OBJECTIVE: The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED. METHODS: A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach. RESULTS: A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED. CONCLUSION: Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.


RESUMO CONTEXTO: Os transtornos alimentares entre os candidatos à cirurgia bariátrica são comuns e estão associados a resultados cirúrgicos adversos, incluindo recuperação de peso e baixa qualidade de vida. No entanto, sua avaliação é difícil pela grande variedade e uso inconsistente de métodos de avaliação padronizados. OBJETIVO: O objetivo desta revisão foi sintetizar o conhecimento atual sobre a prevalência do transtorno de compulsão alimentar (TCA) em pacientes pré-cirúrgicos e fazer uma avaliação crítica dos instrumentos de avaliação para TCA. MÉTODOS: A busca foi realizada nas bases de dados PubMed, Scopus e Web of Science de janeiro de 1994 a março de 2017. Os dados foram extraídos, tabulados e resumidos usando uma abordagem narrativa. RESULTADOS: Um total de 21 estudos observacionais foram revisados para extração e análise de dados. A prevalência de TCA nas populações bariátricas variou de 2% a 53%. Variações consideráveis nas características dos pacientes e nas medidas de avaliação do TCA foram evidentes entre os estudos. Além disso, várias fragilidades metodológicas na maioria dos estudos foram reconhecidas. Estudos utilizaram 10 diferentes instrumentos psicométricos para avaliar a TCA. Entrevistas clínicas foram utilizadas em 12 estudos, embora seja a ferramenta preferencial para diagnosticar o TCA. CONCLUSÃO: A heterogeneidade dos estudos foi responsável pela variabilidade dos resultados nos diferentes centros e falhas metodológicas, como tamanho insuficiente da amostra e viés de seleção, prejudicaram a estimativa da magnitude do TCA em cenários cirúrgicos. Para fins de comparabilidade e generalização dos achados em estudos futuros, os pesquisadores devem recrutar amostras representativas de candidatos à cirurgia bariátrica e fazer a aplicação sistemática de instrumentos padronizados para a avaliação do TCA.


Assuntos
Humanos , Masculino , Feminino , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica , Transtorno da Compulsão Alimentar/diagnóstico , Obesidade Mórbida/psicologia , Prevalência , Manual Diagnóstico e Estatístico de Transtornos Mentais , Estudos Observacionais como Assunto
19.
Clinics ; 74: e1198, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039552

RESUMO

OBJECTIVES: The gut microbiota is associated with obesity and weight loss after bariatric surgery and has been related to its changing pattern. Exactly how the bacterial population affects weight loss and the results of surgery remain controversial. This study aimed to evaluate the intestinal microbiota of superobese patients before and after gastric bypass surgery (RYGB). METHOD: DNA fragments for the microbiota obtained from stool samples collected from nine superobese patients before and after bariatric surgery were sequenced using Ion Torrent. RESULTS: We observed that with a mean follow-up of 15 months, patients achieved 55.9% excess weight loss (EWL). A significant population reduction in the Proteobacteria phylum (11 to 2%, p=0.0025) was observed after surgery, while no difference was seen in Firmicutes and Bacteroidetes. Further analyses performed with two specific individuals with divergent clinical outcomes showed a change in the pattern between them, with a significant increase in Firmicutes and a decrease in Bacteroidetes in the patient with less weight loss (%EWL 50.79 vs. 61.85). CONCLUSIONS: RYGB affects the microbiota of superobese patients, with a significant reduction in Proteobacteria in patients with different weight loss, showing that different bacteria may contribute to the process.


Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Obesidade Mórbida/cirurgia , Obesidade Mórbida/microbiologia , Redução de Peso , Cirurgia Bariátrica , Microbioma Gastrointestinal , RNA Ribossômico 16S/análise , Seguimentos , Estudos Longitudinais , Fezes/microbiologia
20.
Obes Surg ; 28(4): 1047-1054, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29058237

RESUMO

PURPOSE: The purpose of this study is to correlate the left ventricular hypertrophy (LVH) patterns according to severe obesity and arterial hypertension (AHT) grades. METHODS: A cross-sectional prospective study was conducted in 379 patients with severe obesity. Obesity was classified according to the BMI in the following: morbidly obese (MO; 40 < BMI < 50 kg/m2) and super obese (SO; BMI > 50 kg/m2). The AHT was classified into classes 1 and 2 according to American Heart Association. The presence of LVH and the pattern of cardiac remodeling were determined by transthoracic echocardiography. RESULTS: LVH was present in 58.6% of patients. Obesity and AHT had additive effects in LVH prevalence. LVH was found in 32.9 and 46.7% of MO with AHT grades 1 and 2, respectively. LVH was diagnosed in 39.1% in SO with AHT grade 1 and in 50% of AHT grade 2. Patients with AHT presented a significantly higher risk of developing LVH (OR 1.97; p = 0.003). Hypertension grade was also a determinant variable in the development of LVH. Patients with AHT 2 had 4.31-fold greater risk (p < 0.001) when compared to normotensive patients. BMI was only considered an independent risk factor for LVH in patients with BMI greater than 47.17 kg/m2 (OR 1.62; p = 0.023). CONCLUSION: AHT is a stronger predictive factor of LVH than obesity grade.


Assuntos
Ecocardiografia , Coração/diagnóstico por imagem , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/complicações , Obesidade Mórbida/complicações , Pressão Sanguínea/fisiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Obesidade Mórbida/diagnóstico por imagem , Estudos Prospectivos , Fatores de Risco
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